Citation Nr: 18149963 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 16-20 058 DATE: November 14, 2018 REMANDED Entitlement to restoration of a 30 percent rating for residuals of a right ganglion cyst status post carpal boss surgery, is remanded. Entitlement to a restoration of a 10 percent rating for a scar associated with right ganglion cyst status post carpal boss surgery, is remanded. Entitlement to a rating in excess of 10 percent for residuals of a right ganglion cyst status post carpal boss surgery, is remanded. Entitlement to a compensable rating for a scar associated with right ganglion cyst status post carpal boss surgery, is remanded. REASONS FOR REMAND The Veteran had active air service from December 1998 to December 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2014 decision issued by the Department of Veteran Affairs (VA) Regional Office (RO) in Boise, Idaho. In this case, a ganglion cyst of the Veteran’s right hand was noted prior to his separation from service in December 2004. Private treatment records indicate that the mass was surgically excised in December 2011. In January 2012, he underwent a revision surgery for a hypertrophic scar mass. It was noted that there was no vascular or neurologic compromise. In April 2012, he stated that his condition was markedly improved and he was pleased with his outcome. He reported that he was back to work full time and that his pain was scant. In July 2012, the RO granted service connection for a postoperative ganglion cyst and assigned a 30 percent rating for moderate neuritis of the median nerve. The rating was based on a July 2012 VA examination, which showed decreased grip strength, decreased pinch strength, and decreased sensation in the right hand and fingers. The examiner noted that the Veteran had sensory loss of the interosseous branch nerve of the right index and long finger. Special tests, including Phalen’s sign and Tinel’s sign, for median nerve evaluation were not conducted. The examiner indicated that the median nerve was affected and that there was moderate incomplete paralysis. In July 2012, the RO also granted service connection for a scar associated with the Veteran’s postoperative cyst and assigned a 10 percent rating based on the July 2012 VA examiner’s finding that the scar was painful. In July 2013, the Veteran filed a claim for increased rating for his postoperative ganglion cyst and the associated scar. In May 2014, the RO reduced the rating for the postoperative ganglion cyst to 10 percent. The reduction was based on a May 2014 VA examiner’s opinion that the Veteran’s service-connected disability was more accurately reflected by limitation of motion of the wrist. The RO also reduced the rating for the scar to noncompensable based on the May 2014 VA examiner’s finding that a painful or unstable scar was not present. In February 2016, a VA examination for peripheral nerves was conducted. The Veteran had decreased grip strength and decreased pinch strength in the right hand. Sensation in the right hand and fingers was normal. Tinel’s sign was positive. The examiner indicated that the Veteran had moderate incomplete paralysis of the median nerve. The examiner opined, however, that the findings were most consistent with carpal tunnel syndrome. The examiner noted the July 2012 VA examiner’s finding of “sensory loss interosseous branch nerve of the right index and long finger” and stated that those findings were consistent with an operative injury to the radial nerve, which runs on the dorsum of the wrist at or very close to the operative site. The examiner noted that the median nerve is on the palmar side, which is on the opposite side of the wrist from the operative site. The examiner opined that the medial nerve condition was less likely than not incurred in or caused by the ganglion cyst surgery. In this case, the evidence is unclear as to whether the Veteran’s right hand disability underwent improvement so as to warrant a reduction from 30 to 10 percent. Therefore, the Board finds that a remand is necessary for an additional VA examination. Regarding the postoperative scar of the right hand, the July 2012 VA examiner indicated that the scar was painful. The February 2016 VA examiner indicated that the scar was present, but that it was not painful or unstable. The Veteran maintains that he has pain associated with the scar. Because it is unclear whether the scar improved, the Board finds that a remand is necessary for an additional VA examination. The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Then, schedule the Veteran for an appropriate VA examination(s) to determine the current level of severity of all impairment resulting from his postsurgical ganglion cyst. A VA examination for peripheral nerves must be conducted by a VA examiner who has not previously examined the Veteran, a neurologist, if possible. All indicated tests should be performed and all findings should be reported in detail. The examiner should clarify whether the Veteran has any neurologic impairment associated with his service-connected postoperative ganglion cyst. In doing so, the examiner should address the July 2012 and February 2016 VA examinations for peripheral nerves. If the Veteran does not have any neurologic impairment associated with his service-connected postoperative ganglion cyst, the VA examiner should clarify whether the disability has improved since the July 2012 VA examination or whether the July 2012 VA examiner’s conclusion that the Veteran’s neurological impairment was related to his ganglion cyst surgery was in error. 3. Then, schedule the Veteran for an appropriate VA examination to determine the current level of severity of all impairment resulting from any scar associated with his postoperative ganglion cyst. The VA examination should be conducted by a VA examiner who has not previously examined the Veteran, if possible. All indicated tests should be performed and all findings should be reported in detail. The examiner should clarify whether the Veteran’s postoperative scar is painful. 4. Confirm that the VA examination reports and all opinions provided comport with this remand and undertake any other development found to be warranted. 5. Then, readjudicate the issues on appeal. If a decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Mishalanie, Counsel