Citation Nr: 18146781 Decision Date: 11/01/18 Archive Date: 11/01/18 DOCKET NO. 10-47 317 DATE: November 1, 2018 REMANDED Entitlement to an initial rating in excess of 30 percent from December 1, 2009, for carpal tunnel release, right, associated with impairment right elbow (major) is remanded. REASONS FOR REMAND The Veteran served on active duty in the Marine Corps from September 1974 to September 1978. In January 2017, the Board granted, in part, the Veteran’s claim for entitlement to an initial evaluation in excess of 10 percent for carpal tunnel release, right, granting an initial rating of 30 percent from December 1, 2009. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In an April 2018 Order, the Court granted the VA General Counsel’s and Appellant’s Joint Motion for Partial Remand, vacating part of the Board’s decision relative to the claim for carpal tunnel release, right, and remanding it to the Board. Entitlement to an initial rating in excess of 30 percent from December 1, 2009, for carpal tunnel release, right, associated with impairment right elbow (major) is remanded. The Court remanded this matter to the Board to address the Veteran’s tremors and determine whether the Veteran’s right wrist disability warrants a separate rating for arthritis. The Board finds that a remand is necessary for further development. During a June 2009 orthopedic consultation, the Veteran was diagnosed with right carpal tunnel syndrome and right wrist degenerative joint disease. On VA examination in March 2010, diagnoses included loss of motion, right wrist, secondary to osteoarthritis, and right wrist osteoarthritis. The examiner noted that the bilateral wrists were asymmetrical in appearance due to surgery and arthritis. In light of the Veteran’s diagnosis of right wrist arthritis, a VA examination is necessary to determine whether the Veteran’s arthritis is related to his service-connected right wrist disability and to assess the degree of limitation of motion attributable to the Veteran’s right wrist disability. The matter is REMANDED for the following action: 1. Obtain all outstanding VA medical records and private medical records, and associate them with the claims file. Any attempts to obtain these records and responses received thereafter should be associated with the Veteran’s claims file. 2. Schedule the Veteran for a VA examination with an appropriate clinician to determine the current nature and severity of his service-connected right wrist disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. As to the Veteran’s right wrist arthritis, the examiner is asked to determine: a) whether it is at least as likely as not related to an in-service injury, event, or disease. b) whether it at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. c) whether it is at least as likely as not (1) proximately due to any service-connected disability, or (2) aggravated beyond its natural progression by any service-connected disability. The examiner should specifically opine whether the Veteran’s right wrist osteoarthritis is related to his service-connected carpal tunnel release, right, associated with impairment right elbow (major). The examiner should perform range of motion testing and test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner should also address the severity (i.e., favorable or unfavorable) and location of any ankylosis. All symptoms and manifestations of the right arm disability must be noted in the report, including the level of functioning of muscle group VII in the right upper extremity such as flexion of wrist and fingers, as well as the level of functioning in the muscles arising from internal condyle of humerus, to include flexors of the carpus and long flexors of fingers and thumb; pronator. The report should also note the level of functioning of muscle group VIII in the right upper extremity, such as extension of wrist, fingers, and thumb and abduction of thumb as well as the level of functioning in the muscles arising mainly from external condyle of humerus, to include extensors of carpus, fingers, and thumb; supinator. The severity of all symptoms and impairment must be described in detail. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the right wrist disability alone and discuss the effect of the right wrist disability on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner does not have the knowledge or training. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Freeman, Associate Counsel