Citation Nr: 18151489 Decision Date: 11/20/18 Archive Date: 11/19/18 DOCKET NO. 13-12 989 DATE: November 20, 2018 REMANDED Entitlement to service connection for a bilateral hand/wrist disorder, to include bilateral carpel tunnel syndrome and/or bilateral residuals of a cold injury, is remanded. Entitlement to service connection for a sinus disorder, to include allergic rhinitis and chronic sinusitis, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1984 to January 1990. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board has recharacterized the bilateral hand/wrist claims on appeal as above in order to more accurately reflect the breadth of those claims on appeal. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). As a final initial matter, the issues on appeal originally included entitlement to a total disability rating based on unemployability (TDIU). Before the appeal was certified to the Board, however, in a September 2018 rating decision, the RO granted TDIU effective May 30, 2014. The record currently available to the Board contains no indication that the Veteran has initiated an appeal with any downstream element of this claim. Thus, this issue is not in appellate status. Regarding the bilateral hand/wrist claims, the Veteran has asserted that he has had issues with sensation, cramping, and grip strength in his hands for many years, and that he has residuals of a bilateral cold injury related to military service. His service treatment records contain a diagnosis of cubital tunnel syndrome while he was on active service; however, there is no evidence in the record of a cold related injury to the hands. Additionally, the evidence of record indicates the Veteran has been diagnosed with bilateral carpal tunnel syndrome during the appeal period. Finally, he is also currently service connected for neuritis in his left upper extremity and paresthesias in his left ring and little finger. As of this decision, no VA examination or medical opinion has been obtained with respect to the Veteran’s bilateral hands/wrists that addresses whether his current bilateral carpel tunnel syndrome is a separate and distinct neurological disorder from his service-connected neuritis of the left upper extremity, and in any event whether the Veteran’s carpel tunnel syndrome or any other bilateral hand/wrist disorder is related to military service or to a service-connected disability. A remand is therefore necessary in order for such to be accomplished. See 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Regarding the sinusitis claim, the Veteran’s service treatment records from April 1988 and August 1988 indicate that, while in service, he was diagnosed with chronic maxillary sinusitis. He currently receives treatment for allergic rhinitis and he has complained of sinus infections at his VA treatment appointments. The Veteran has additionally contended his sinus disorder is due to a root canal in service. As of this decision, no VA examination or medical opinion has been afforded to the Veteran regarding whether any current sinus disorder is related to service; a remand is necessary in order for such to be accomplished. See Id. On remand, the Board also finds that any outstanding VA treatment records should also be obtained. See 38 U.S.C. § 5103A(b), (c); 38 C.F.R. § 3.159(b); see also Sullivan v. McDonald, 815 F.3d 786 (Fed. Cir. 2016) (where the Veteran “sufficiently identifies” other VA medical records that he or she desires to be obtained, VA must also seek those records even if they do not appear potentially relevant based upon the available information); Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Obtain any and all VA treatment records not already associated with the claims file from the Houston VA Medical Center, or any other VA medical facility that may have treated the Veteran and associate those documents with the claims file. 2. Ensure that the Veteran is scheduled for a VA examination with an appropriate examiner in order to determine whether any current bilateral hand/wrist disorders, including bilateral carpel tunnel syndrome, are related to military service or a service-connected disability. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. Following review of the claims file and examination of the Veteran, the examiner should identify all bilateral hand/wrist disorders currently found, to include bilateral carpel tunnel syndrome and/or any residuals of a cold injury. Respecting the Veteran’s left upper extremity, the examiner should specifically address whether the Veteran’s neurological manifestations, including the noted left carpel tunnel syndrome, is a separate and distinct disorder from the Veteran’s service-connected paresthesias and neuritis of the left upper extremity. For each separate and distinct bilateral hand/wrist disorder found, to include bilateral carpel tunnel syndrome, the examiner should opine whether each disorder at least as likely as not (50 percent or greater probability) began in or is otherwise related to military service, include the noted treatment for cubital tunnel syndrome and/or any cold exposure therein. Next, for any bilateral hand/wrist disorders found that are not directly found to be related to service, the examiner should also opine whether any bilateral hand/wrist disorders at least as likely as not were (a) caused by; or, (b) aggravated (i.e., chronically worsened) by the Veteran’s service-connected disabilities, particularly his bilateral shoulder, cervical spine, and paresthesias and neuritis of the left upper extremity disabilities. The examiner is reminded that he or she must address both prongs (a) and (b) above. In addressing the above, the examiner should also discuss the Veteran’s lay statements regarding onset of symptoms and any continuity of symptomatology since onset and/or since discharge from service. The examiner should also consider any other pertinent evidence of record, as appropriate. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. 3. Ensure that the Veteran is scheduled for a VA examination with an appropriate examiner in order to determine whether any current sinus disorders, including rhinitis or sinusitis, are related to military service. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. Following review of the claims file and examination of the Veteran, the examiner should identify all sinus disorders currently found, to include allergic rhinitis and/or chronic sinusitis. Then, the examiner should opine whether each disorder at least as likely as not (50 percent or greater probability) began in or is otherwise related to military service, include the treatment for sinusitis during service or for any root canal performed during service. In addressing the above, the examiner should also discuss the Veteran’s lay statements regarding onset of symptoms and any continuity of symptomatology since onset and/or since discharge from service. The examiner should also consider any other pertinent evidence of record, as appropriate. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Kleponis, Associate Counsel