Citation Nr: 18150748 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 14-23 017 DATE: November 15, 2018 ORDER Entitlement to service connection for left upper extremity carpal tunnel syndrome (“left CTS”) is granted. REMANDED Entitlement to service connection for right shoulder condition is remanded. FINDING OF FACT Resolving all reasonable doubt, the Veteran’s left CTS was chronic in service. CONCLUSION OF LAW The criteria for entitlement to service connection for left carpal tunnel syndrome have been met. 38 U.S.C. §§ 1110, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1983 to March 2011. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. Entitlement to service connection for left upper extremity carpal tunnel syndrome Generally, to prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303(a). Certain “chronic diseases” may be presumed to have been incurred in service if they manifest to a compensable degree within one year of separation from service. For a showing of chronic disease in service, there is a required combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time; however, if the evidence of the record is insufficient to establish a disease was chronic in service, and/or manifested within the specified time period, then there must be a continuity of disease symptoms shown after discharge in order to warrant service connection. 38 C.F.R. §3.303(b). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence that there were characteristic manifestations of the disease to the required degree during that time. 38 C.F.R. §§ 3.307, 3.309(a). Carpal tunnel syndrome, an organic disease of the nervous system, is considered to be a “chronic disease” under 38 C.F.R. § 3.309(a). The Veteran contends that his current left CTS was caused by his military service; however, he did not specify any specific in-service occurrent that he believed caused his disability. The Board notes that the Veteran’s service treatment records (STRs) are silent for complaints, treatments, or diagnosis of carpal tunnel syndrome, and the STRs do not mention any wrist conditions during service. The first objective medical evidence of record for carpal tunnel syndrome is not shown until February 2012, where the Veteran was diagnosed with bilateral CTS. See Wrist Conditions DBQ, February 2012. This manifestation of his carpal tunnel disease was diagnosed less than a year after the Veteran’s separation from service in March 2011. Even so, in a March 2013 Peripheral Nerve Condition DBQ, the Veteran reported that he was first diagnosed with CTS on a nerve conduction test while in-service, however, the examiner noted that there was no record of the test or diagnosis. To corroborate the Veteran’s assertion, he submitted a September 2013 letter from a medic, M.P., who was stationed with the Veteran from 2003-2008. M.P. states that the Veteran endured significant pain and mobility issues with both of his wrists, and he eventually was diagnosed with CTS in both wrists and issued braces by the Battalion flight surgeon. See Letter from M.P., September 2013. Additionally, the Veteran submitted a letter from the Battalion flight surgeon, N.P., the medical director of the U.S. Army Health Clinic and the Veteran’s treating physician during service. In that letter, N.P. stated that she oversaw the Veteran’s medical care while on deployment and post-deployment; and that she can verify that he was treated and sought medical attention for his CTS while in service, even though those records are unavailable. N.P. further stated that the Veteran used splints for his CTS, and experienced persistent bilateral wrist pain on redeployment. See Letters from N.P., September 2013 and April 2015. Regarding the statements, the Board finds them to be competent and credible; and these statements reflect that the Veteran’s chronic disease of carpal tunnel syndrome manifested in service, and showed to be continuous for a long period of time in service. Therefore, resolving all reasonable doubt in favor of the Veteran, the Board finds that the Veteran’s current left CTS was incurred in service. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.307, 3.309(a). REASONS FOR REMAND Entitlement to service connection for right shoulder condition is remanded. With respect to the Veteran’s claim on appeal, the Board notes that, to date, the Veteran has not been provided with a VA examination addressing the nature and etiology of his service connection claim for his right shoulder condition. Pursuant to VA’s duty to assist regarding a claim for disability compensation, the VA must afford a veteran a medical examination and/or obtain a medical opinion when, after review of the record, the VA finds it necessary to adjudicate the claim. 38 C.F.R. § 3.159(c)(4). In service connection claims, such as the case here, VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to adjudicate the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006). The Board acknowledges the Veteran has a current right shoulder disability, based on the assessment of competent and credible VA treatment records. See 38 U.S.C. § 5103A(d)(2)(A); see also Charles v. Principi, 16 Vet. App. 370, 374 (2002). The record also suggests a possible relationship between this current disability and the Veteran’s active service. In an April 2012 VA treatment record, it was noted that the Veteran has right shoulder pain from an injury occurring in 1997 from a parachute landing. Additionally, the Veteran’s Battalion surgeon, who treated the Veteran from 2004-2007, stated that the Veteran had experienced persistent shoulder pain throughout his deployments in service; as well as, a statement from a medic, who was stationed with the Veteran from 2003-2008, noting the Veteran suffered from extreme pain in his right shoulder. See Letter from N.P., September 2013; Letter from M.P., September 2013. Given the “low threshold” standard for determining when a VA examination is necessary, the Board finds that the requirements have been met. Consequently, the Board finds that a remand for such examination is necessary. McLendon, 20 Vet. App. 79, 81 (2006). The matters are REMANDED for the following action: 1. Request the Veteran to identify all medical providers (VA and private) from whom he has received treatment for his right shoulder disability, and obtain any outstanding records and associate them with the Veteran’s claims file. 2. After associating all newly acquired records with the claims file, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s right shoulder disability. The claims file, including a copy of this remand, must be made available to the examiner in conjunction with the examination, and the examiner should note review of the record in the examination report. 3. The examiner is requested to furnish an opinion as to whether it is at least as likely as not (50 percent or higher probability) that the Veteran’s right shoulder disability had its onset during any period of active military duty, or is otherwise etiologically related to service. 4. Any opinion should include a detailed rationale. The examiner should consider the entire claims file, and discuss the Veteran’s lay statements regarding the nature and onset of symptoms. The examiner is advised that the Veteran is competent to report symptoms, and that his reports must be considered in formulating the requested opinion. 5. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resorting to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. See Jones v. Shinseki, 23 Vet. App. 382 (2010). M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Hodges, Associate Counsel