Citation Nr: 18150807 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 16-33 435 DATE: November 15, 2018 REMANDED The claim for service connection for a right hand disability is remanded. The claim for service connection for a left hand disability is remanded. REASONS FOR REMAND The Veteran had active duty service from June 1983 to September 1983, and from December 2007 to December 2008. 1. The claim for service connection for a bilateral hand disability is remanded. The Veteran asserts that he has a bilateral hand disability due to a 2008 in-service motor vehicle accident, or, in the alternative, as caused or aggravated by service-connected disability. See 38 C.F.R. §§ 3.303, 3.310. The Veteran’s service treatment records show that in October 2008, after a motor vehicle accident, he sought treatment for neck pain, pain radiating in his left arm, numbness in his wrist and fingers, and a weak grip. He subsequently received additional treatment for symptoms that included pain radiating into his hand. See e.g., reports dated in December 2008 and March 2009. In September 2009, he underwent surgical procedures that included a left shoulder arthroscopy, and acromioplasty, and anterior capsular release. The Veteran asserted in his substantive appeal in July 2016 that during the 2008 vehicle accident in Afghanistan, he braced himself for the impact with both hands on the dashboard with an estimated impact speed of approximately 30 miles per hour. He believes that his hands, wrists elbows and shoulders acted as “shock absorbers.” The veteran states that the right hand began with similar symptoms with a later onset and he contends the only mechanism of injury he has encountered was the vehicle accident in Afghanistan. The Veteran submitted a copy of a “Chronological Record of Medical Care,” dated October 24, 2008, while he was on deployment in Afghanistan. This record entry states the motor vehicle accident occurred three days prior. The entry states, “Getting worse and worse each day. Pain radiated into L arm, associated numbness down tricep, skips forearm, then into the wrist and fingers, whole hand front and back.” The Veteran submitted a copy of his Demobilization (DEMOB) examination from Afghanistan dated December 1, 2008. This records notes, “Occasionally has pain that radiates down into hand.” The Veteran attended a follow-up examination December 15, 2008. The record again details a motor vehicle accident as mechanism of injury. Among the complaints listed are left post neck pain with radiculopathy through left post shoulder and down the left triceps associated with tingling of all fingers on left hand and weakness of grip strength and left biceps began the next day. In August 2010, the RO granted service connection for a left shoulder disability. Following separation from service, in October 2015, he underwent surgery for carpal tunnel syndrome of the right upper extremity. In December 2015, he underwent left arthroscopic rotator cuff repair and arthroscopic subacromial decompression, revision. In January 2018, he underwent a left rotator cuff repair and labral debridement. The postoperative diagnosis was left rotator cuff repair. A September 2015 VA peripheral nerves disability benefits questionnaire (DBQ) notes severe median neuropathy at the right wrist, and moderate median neuropathy at the left wrist. The diagnosis was bilateral carpal tunnel syndrome. The examiner opined that the Veteran’s conditions are less likely as not due to, or the result of, his service-connected left shoulder disability. The examiner stated that carpal tunnel syndrome is caused by compression of the median nerve at the wrist, and that there is no evidence that bilateral carpal tunnel syndrome is related to his left shoulder condition. In June 2016, the RO granted service connection for cervical intervertebral disc syndrome, and left upper extremity radiculopathy. The September 2015 VA examiner’s opinion does not discuss the possibility of direct service connection, or aggravation of a hand disability by the Veteran’s service-connected disabilities. In this regard, following the September 2015 opinion, service connection was granted for cervical intervertebral disc syndrome, and left upper extremity radiculopathy. The etiological effects, if any, of these disabilities was not discussed by the September 2015 VA examiner. Under the circumstances, a remand is required to obtain supplemental VA etiological opinions. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matters are REMANDED for the following action: 1. Return the file to the examiner who authored the September 2015 VA peripheral nerves DBQ, or if he is not available, to another examiner. If any of the requested opinion(s) cannot be provided without a physical examination, one should be scheduled. The examiner should be notified that service connection is currently in effect for: intervertebral disc syndrome, left upper extremity radiculopathy, and left shoulder impingement syndrome. After review of the record, the examiner should provide the following opinions: a) Is it at least as likely as not (i.e., a likelihood of 50 percent or greater) that the Veteran has a disability of either wrist or hand that is due to his service, to include the motor vehicle accident therein? Why or why not? b) Is it at least as likely as not (i.e., a likelihood of 50 percent or greater) that the Veteran has a disability of either wrist or hand that was caused by any of his service-connected disabilities? Why or why not? c) Is it at least as likely as not (i.e., a likelihood of 50 percent or greater) that the Veteran has a disability of either wrist or hand that was aggravated (made worse) by any of his service-connected disabilities? Why or why not? If aggravation due to a service-connected disability is found, the examiner should identify the baseline level of severity of the nonservice-connected disease or injury by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T.S.E., Counsel