Citation Nr: 18146027 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 16-15 109A DATE: October 30, 2018 REMANDED Entitlement to service connection for a right-hand disorder, to include Dequervain’s Tenosynovitis (claimed as bilateral hand joint pain) is remanded. Entitlement to service connection for a cervical spine disability, to include muscle spasms and degenerative disc disease (DDD) is remanded. Entitlement to service connection for an eye disorder is remanded. Entitlement to a compensable rating for extension of the right hip arthralgia, sacroiliitis is remanded. Entitlement to a rating in excess of 10 percent for flexion of the right hip arthralgia, sacroiliitis is remanded. Entitlement to a rating in excess of 10 percent for flexion of the left hip arthralgia, sacroiliitis is remanded. Entitlement to a compensable rating for extension of the right hip arthralgia, sacroiliitis is remanded. REASONS FOR REMAND The Veteran served on active duty from September 2009 to March 2010, and from March 2012 to February 2013. 1. Entitlement to service connection for a right-hand disorder, to include Dequervain's Tenosynovitis (claimed as bilateral hand joint pain) is remanded. The Veteran contends that she is entitled to service connection for a right-hand disorder, to include Dequervain’s Tenosynovitis (claimed as bilateral hand joint pain), which was incurred in service. She was recently granted service connection for a left-hand disorder, to include Dequervain’s Tenosynovitis. The Veteran was afforded VA examination in June 2014. The examiner diagnosed her with bilateral Dequervain’s Tenosynovitis. The Veteran reported that while she was in Honduras, she developed bilateral thumb pain with hyperextension of the thumbs. This limited her dressing and combing abilities, and she used hot water and rest to treat the thumbs. The examiner indicated that pain, weakness, fatigability or incoordination could significantly limit functional ability during flare-ups, or when the joint was used repeatedly over a period of time; and noted that all musculoskeletal disorders present in an individual could potentially cause functional limitations during repetitive use over a period of time, and limit functional ability during a flare up. The June 2014 VA examiner did not provide an opinion or clear conclusion with supporting data. As such, the June 2014 VA examination is inadequate with respect to the Veteran’s right-hand condition. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (stating that a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two); see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (stating that a medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions). Given the deficiencies described above, the Board finds that this issue must be returned for a new VA opinion. 2. Entitlement to service connection for a cervical spine disability, to include muscle spasms and DDD is remanded. The Veteran contends that she is entitled to service connection for a cervical spine disability that is related to service, or in the alternative, is secondary to her service-connected lumbar spine disability. The Veteran was afforded VA examination in June 2014. She was diagnosed with cervical muscle spasms and DDD. She reported that she had neck ‘sounds’ with headaches and tension at her shoulder muscles. She noted that she started to have neck pain after a fall during basic training. The June 2014 VA cervical spine examiner also did not provide an opinion or clear conclusion with the examination. As such, the Veteran was afforded additional VA examination in January 2017. The January 2017 VA examiner diagnosed the Veteran with cervical muscle spasms/DDD, and noted that it was less likely as not due to, or the result of propulsion, imbalance and weight bearing caused by the Veteran’s service-connected lumbar strain. The examiner reasoned that the Veteran’s cervical condition has an unrelated anatomical location and etiology to the lumbar strain. Degenerative changes, including disc herniation, are usually age-related conditions and are local at each anatomical area independent from each other, cervical versus lumbar. As the June 2014 examiner did not provide an opinion on direct service connection, and the January 2017 VA secondary opinion did not address aggravation, both VA examinations are inadequate, and the issue of service connection for a cervical spine disability must be remanded for a new VA opinion on direct and secondary service connection. Additionally, the Veteran stated in an April 2016 Form 9 that her cervical disorder manifested while in service, as she complained about her cervical disorder each time she wore her military helmet and it caused neck pain and discomfort. As the Board notes that these complaints are not in the records, all outstanding medical records should be obtained while on remand. 3. Entitlement to service connection for an eye disorder is remanded. The Veteran maintains that she has a current eye condition as a result of her active duty service. Service treatment records (STRs) from April 2012 notes that the Veteran had dry eye syndrome from a chemical burn; and a January 2013 record indicated that she suffered from eye pain and dry eye syndrome. The Veteran was afforded VA examination in April 2014. She was diagnosed with blepharitis and associated dry eye, as well as small pterygium in both eyes and pinguecula. The examiner stated that there was no mention of blepharitis, pinguecula or pterygium in STRs, and all three issues are not caused by pepper spray. The examiner concluded that the Veteran’s dry eye was secondary to blepharitis. The Veteran was afforded additional VA examination in January 2017. She was diagnosed with blepharitis, nasal pterygium and temporal pinguecula. The examiner noted that after being exposed to pepper spray in training, the Veteran had an examination several days later and presented with conjunctiva with no abnormalities, no hyperemia, no purulent or watery discharge. Her cornea was normal and she had no ulcerations. An April 2012 follow-up note indicated that she received medication and her condition resolved; eye pain resolved; no further evidence found of ocular complaints. There were no notes of optometry or ophthalmology evaluation found. The examiner indicated that the condition resolved without residual, and the condition was less likely than not incurred in or caused by the claimed in-service event or injury. The examiner reasoned that the bilateral blepharitis found in this examination was not the result of chemical injury. Blepharitis presents with inflammation, resulting in crusty scales along the eye lashes, which is common in the adult population and often coexists with dry eye disease. The condition is most commonly associated with staphylococcal infection and rosacea. The examiner stated that the Veteran’s dry eye symptoms can be explained due to blepharitis. She presented with bilateral small incipient stationary pterygia, and there was no mention of blepharitis or pterygia in the STRs. Blepharitis and bilateral pterygium are not the result of pepper spray exposure. Pterygium is a fibrovascular degeneration of the conjunctiva that can invade the cornea; and these changes are usually associated with ultraviolet light damage due to sun exposure, which is very common in the tropics. The January 2017 VA examiner indicated that after the Veteran’s April 2012 pepper spray exposure incident, her condition resolved and there was no evidence of residuals. However, the Board notes that there is a January 2013 record indicating that the Veteran suffered from eye pain and dry eye syndrome almost 10 months after the pepper spray incident. As such, a new VA opinion is needed that reflects an accurate depiction of all the facts and whether the Veteran’s current eye condition began in service. 4. Entitlement to a compensable rating for extension of the right hip arthralgia, sacroiliitis; entitlement to a rating in excess of 10 percent for flexion of the right hip arthralgia, sacroiliitis; entitlement to a rating in excess of 10 percent for flexion of the left hip arthralgia, sacroiliitis; and entitlement to a compensable rating for extension of the left hip arthralgia, sacroiliitis are remanded. The Veteran is service connected for extension of the right hip arthralgia, sacroiliitis, rated as noncompensable; flexion of the right hip arthralgia, sacroiliitis, rated as 10 percent disabling; flexion of the left hip arthralgia, sacroiliitis, rated as 10 percent disabling; and extension of the left hip arthralgia, sacroiliitis, rated as noncompensable. She seeks higher ratings. In the September 2018 Appellant Brief provided by her representative, she presented that the current severity of her right and left hip disabilities warrant increased evaluations. Having reviewed the record evidence, the Board finds that additional development is necessary before the underlying claim can be adjudicated on the merits. The Veteran last underwent VA examination in January 2017. The Veteran indicated that her disabilities are worse, as she contends that she is now in physical therapy, pool therapy, acupuncture therapy, and has a TENS unit. As this suggests a worsening of her hip symptomatology, a remand for a new VA examination is warranted. See Snuffer v. Gober, 10 Vet. App. 400 (1997). The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records since the Veteran’s separation from both periods of active service and associate them with the claims file. 2. After obtaining all missing treatment records, schedule the Veteran for VA examinations with appropriate examiners. The claims file should be made available to, and reviewed by each examiner. Following a review of the claims file, the examiners should offer the following opinions: Right Hand Is it at least as likely as not (50 percent or greater probability) that the Veteran’s current right-hand condition, to include Dequervain’s Tenosynovitis, began in service, or is otherwise the result of a disease or injury in service? The rationale for any opinion offered should be provided. Cervical Spine Is it at least as likely as not (50 percent or greater probability) that the Veteran’s current cervical spine disability, to include cervical spasms and DDD, began in service, or is otherwise the result of a disease or injury in service, to include the Veteran’s complaints of neck pain when wearing her helmet in service? Notwithstanding the above, is it at least as likely as not (50 percent or greater probability) that the Veteran’s current cervical spine condition was caused or aggravated beyond its natural progression by her service-connected lumbar spine disability? The opinion must address both causation and aggravation, as these are two separate inquiries. The rationale for any opinion offered should be provided. Eye Condition Is it at least as likely as not (50 percent or greater probability) that the Veteran’s current eye condition began in service, or is otherwise the result of a disease or injury in service, to include exposure to pepper spray in April 2012, which resulted in eye pain and dry eye syndrome in January 2013? The rationale for any opinion offered should be provided. Hips Schedule the Veteran for a new VA hip examination to determine the nature, severity and extent of her bilateral hip condition. 3. Readjudicate the appeal. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD I. Warren, Associate Counsel