Citation Nr: 18149051 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 17-62 246A DATE: November 8, 2018 REMANDED Entitlement to an evaluation in excess of 20 percent for right carpal and cubital tunnel syndrome with peripheral neuropathy is remanded. REASONS FOR REMAND The Veteran had active service from December 1989 to September 1996 and from June 2000 to September 2013. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. In a rating decision dated in March 2017, the RO continued the Veteran’s 20 percent rating for his right carpal and cubital tunnel syndrome with peripheral neuropathy. In a May 2017 notice of disagreement, the Veteran requested a 40 percent rating. The Veteran’s disability is rated under Diagnostic Code 8513. See 38 C.F.R. § 4.124a. The Veteran received a VA examination in February 2017. He reported a history of a decrease in grip strength, his hands falling asleep, pain, numbness, and tingling sensation within his right hand. The Veteran’s treatments were noted to include physical and occupational therapy and the use of a wrist brace. It was also noted the Veteran had an arthroscopic release surgery on both wrists in 2014. The examiner stated that previous imaging studies and electromyography (EMG) of the Veteran’s hands had been completed, but the results were not available. The examiner did not perform imaging or EMG studies to assess the severity of the Veteran’s disability. A pre-printed portion of the examination report noted that for purposes of the examination, EMG studies are usually rarely required to diagnose specific peripheral nerve conditions in the appropriate clinical setting; if EMG studies are in the record and reflect the Veteran’s current conditions, repeat studies are not indicated. The examiner noted that the Veteran reported that he had had an upper extremity EMG done in 2013 with abnormal results, but the results were not available for review. The examiner also indicated that the basis of the report was an in-person examination of the Veteran and that no records were reviewed in connection with the examination. The Veteran later submitted an examination report of nerve conduction and EMG studies dated February 2013, and the examiner characterized the Veteran’s disability as being moderately severe. As noted, however, the Veteran reportedly did undergo arthroscopic release surgery on both wrists in 2014, and it is unclear as to whether the 2017 examination results represent some improvement in the Veteran’s right arm condition from 2013. Further, the 2017 VA examiner did not review the 2013 examination report findings and apparently, any other relevant records, and thus, did not have a complete record to review prior to the examination. Accordingly, given that the available medical evidence dated before his VA examination shows some inconsistency with the February 2017 VA examination findings, and the fact that it appears that the VA examiner did not have a complete record before him including available imaging or EMG studies that are clearly available for reference, the Veteran should be given a new examination. The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records and private medical records identified by the Veteran as pertinent to his claims. If the RO cannot locate such records, it must specifically document the attempts that were made to locate them and explain in writing why further attempts to locate or obtain any records would be futile. The RO must then: (a.) Notify the claimant of the specific records that it is unable to obtain; (b.) Explain the efforts VA has made to obtain that evidence; and (c.) Describe any further action it will take with respect to the claim. A request should include attempts to obtain treatment records associated with physical and occupational therapy, surgical procedures, and any additional previous imaging or EMG studies that are not currently of record. 2. Upon completion of the foregoing, schedule the Veteran for an appropriate VA examination to assess the nature and current level of severity of his service-connected right arm disability (right carpal and cubital tunnel with peripheral neuropathy of the upper extremity syndrome). The Veteran’s claims file, including a copy of this REMAND, must be made available to and reviewed by the examiner in conjunction with the examination. The examiner must note in the examination report that the evidence in the claims file has been reviewed. The appropriate Disability Benefits Questionnaire (or equivalent) should be filled out. The examiner should perform all necessary tests and studies (including x-rays, EMG, and nerve conductions testing) or explain why such testing is not necessary to assess the Veteran’s service-connected right arm disability. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Denton, Buck