Citation Nr: 18149622 Decision Date: 11/14/18 Archive Date: 11/13/18 DOCKET NO. 14-11 102 DATE: November 14, 2018 REMANDED Entitlement to service connection for bilateral pinguecula is remanded. Entitlement to service connection for a disability of the larynx, to include residuals of a ruptured larynx is remanded. Entitlement to service connection for carpal tunnel syndrome of the right arm is remanded. Entitlement to service connection for carpal tunnel syndrome of the left arm is remanded. REASONS FOR REMAND The Veteran had active duty military service from January 1993 to May 1995. The Board notes that the majority of the Veteran’s medical records from her time in service are not included in the record and were ruled to be unavailable in December 2006. See 12/29/2006 VA Memo. In light of the passage of time since the last attempts to obtain the Veteran’s service treatment records, another attempt should be made to locate any potentially relevant records. Additionally, in light of the current unavailability of the Veteran’s service treatment records, the Board has a heightened duty to assist her in the development of her claim, to include providing a VA examination. See O’Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). Under 38 C.F.R. § 3.159(c)(4), a VA examination or opinion is necessary if the evidence of record: (A) contains competent evidence that the Veteran has a current disability, or persistent or recurrent symptoms of disability; and (B) establishes that the Veteran suffered an event, injury or disease in service; (C) indicates that the claimed disability or symptoms may be associated with the established event, injury, or disease in service or with another service- connected disability, but (D) does not contain sufficient medical evidence for the Secretary to make a decision on the claim. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Entitlement to service connection for bilateral pinguecula. The Veteran seeks service connection for bilateral pinguecula in her eyes, which she has stated she was first treated for in service while aboard a ship returning from Saudi Arabia. The record shows that the Veteran has been treated for pinguecula on at least two occasions since service separation. This evidence is sufficient to trigger the low threshold for a VA examination. Entitlement to service connection for a disability of the larynx, to include residuals of a ruptured larynx. The Veteran also seeks service connection for a disability of the larynx, asserting that she suffered a ruptured larynx in basic training and still has residuals issues as a result. The record shows that the Veteran has been treated on several occasions since service separation for throat pain and similar symptoms. This is also sufficient to trigger the low threshold for a VA examination.   Entitlement to service connection for carpal tunnel syndrome of the right arm. Entitlement to service connection for carpal tunnel syndrome of the left arm. The Veteran seeks service connection for bilateral carpal tunnel syndrome, which she asserts is the result of her duties in service as a mechanic. The record shows that the Veteran was first treated for carpal tunnel syndrome of the right wrist within several months of her separation from service. Carpal tunnel syndrome in the left wrist was noted in 2000. Again, this evidence is sufficient to necessitate a VA examination. The matters are REMANDED for the following actions: 1. Make another attempt to obtain the Veteran’s complete service treatment records, to include any evidence of a ruptured larynx in basic training, pinguecula aboard ship, and treatment for wrist and/or hand pain. If, after all due diligence, it is determined that any of the records are unavailable or further efforts to obtain them would be futile, the Veteran and her representative should be so advised in accordance with the provisions of 38 C.F.R. § 3.159(e). 2. After completing #1, schedule the Veteran for an examination(s) by an appropriate clinician(s) to determine the nature and etiology of any of the following disabilities: bilateral pinguecula and/or residuals thereof, residuals of a ruptured larynx, and carpal tunnel syndrome in either wrist. The examiner is to provide an opinion whether it is at least as likely as not (probability 50 percent or greater) that any pinguecula in either eye which has been present since the date of the Veteran’s claim was related to or otherwise the result of her service, to include any diagnosis of pinguecula in service, and/or any exposure during service. The examiner is to provide an opinion whether it is at least as likely as not (probability 50 percent or greater) that the Veteran has any current throat, larynx, or pharynx disability, to include scarring and/or recurrent infections, which would be the result of a ruptured larynx sustained in basic training. The examiner is to provide an opinion whether it is at least as likely as not (probability 50 percent or greater) that the Veteran’s carpal tunnel syndrome in either her right or left wrist were incurred in or had their onset in service, to include as a result of her duties as a mechanic. The examiner should address the significance, if any, of the manifestation of right carpal tunnel syndrome in late 1995 and early 1996, and whether that is an indication that the disability had its onset in service. The examiner is advised that the Veteran is considered competent to report on her experiences in service and her symptoms during service and after service. The examiner should not discount the Veteran’s reports based solely on a lack of documentation, particularly in light of the paucity of service treatment records. (Continued on the next page)   The examiner is to provide a comprehensive rationale for all opinions provided. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Cheryl E. Handy, Counsel