Citation Nr: 18154737 Decision Date: 11/30/18 Archive Date: 11/30/18 DOCKET NO. 16-58 724 DATE: November 30, 2018 REMANDED Entitlement to service connection for spinal stenosis (also claimed as a neck condition) is remanded. Entitlement to service connection for residuals of a carpal tunnel surgery (also claimed as elbow and wrist damage to include neuropathy) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1986 to September 2006. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2015 rating decision. At the outset, the Board observes the Veteran’s concerns, as he noted on his November 2016 VA Form 9, that a nurse practitioner conducted his examination and provided medical opinions. However, the Court has held a nurse practitioner has the medical education and training to provide medical diagnoses and medical opinions. See Cox v. Nicholson, 20 Vet. App. 563 (2007) (holding that a nurse practitioner’s medical education and training allows him or her to provide competent medical diagnoses, statements, or opinions). 1. Entitlement to service connection for spinal stenosis (also claimed as neck condition) is remanded. The Veteran received a VA examination and opinion in March 2016. The examiner determined the Veteran’s spinal stenosis was less likely as not proximately due to or the result of degenerative arthritis of the lumbar spine. The examiner noted that medical literature indicated cervical spine stenosis “is usually caused by age-related changes of the spinal column” and “is most often due to degenerative changes of the cervical spine as the result of general wear and tear.” The Board does not find this opinion sufficient for service connection purposes. On his November 2016 VA Form 9, the Veteran stated he believes his neck condition is due to wear and tear caused by the nature of his job and/or the result of a low back surgery, which he believes affected his gait and posture. For example, he stated that, while in service, he had to crawl in tight spaces and constantly bent his neck while doing so. Indeed, the examiner did not comment on why any trauma or repeated use during the Veteran’s 20-year military career would not have caused the wear and tear that would have led to the degenerative changes seen today. Furthermore, there is no detailed medical history regarding the onset of symptoms, which the Veteran is certainly permitted to provide. Accordingly, a new examination and opinion are needed – preferably from an examiner different than the one who provided the March 2016 opinion. 2. Entitlement to service connection for carpal tunnel surgery (also claimed as elbow and wrist damage to include neuropathy) is remanded. The Veteran received a VA examination and opinion in March 2016. The examiner determined the Veteran’s carpal tunnel surgery was less likely as not proximately due to or the result of degenerative arthritis of the lumbar spine. The examiner noted that carpal tunnel syndrome is caused by compression of the median nerve as it travels through the carpal tunnel, and a review of the current medical evidence did not indicate a causal relationship of the Veteran’s carpal tunnel surgery and degenerative arthritis of the lumbar spine. A new opinion is needed because the examiner did not address direct service connection. For example, on his November 2016 VA Form 9, the Veteran stated he believes his duties during his active service caused damage to his elbow and wrist because he often had to crawl on his hands, elbows, and knees to do his job while on active duty. Furthermore, there is no detailed medical history regarding the onset of symptoms, which the Veteran is competent to provide. Accordingly, a new examination and opinion are needed – preferably from an examiner different than the one who provided the March 2016 opinion. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records and any outstanding private medical records identified by the Veteran as pertinent to his claim. 2. Obtain an examination and opinion for the Veteran’s neck disability. The claims file and a copy of this Remand must be made available to and reviewed by the examiner in conjunction with the opinion. In providing the opinion, the examiner should acknowledge the Veteran’s statement that he believes his neck condition is due to wear and tear caused by his job during active service and/or having had low back surgery, which he believes affected his posture. The examiner should elicit from the Veteran a complete history of his neck symptomatology, including any in-service symptomatology and treatment; as well as his complete post-service history of neck symptoms and treatment. (a.) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) any current neck disability had its clinical onset during active service or is related to any in service disease, event, or injury to include the nature of the Veteran’s job during his active service. (b.) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) any current neck disability was caused by any service-connected disability, to include by any altered posture associated with any disability. (c.) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) any current neck disability was aggravated (i.e., worsened) by any service-connected disability, to include by any altered posture associated with any disability. The examiner must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. 3. Obtain an examination and opinion for the Veteran’s wrist disability. The claims file and a copy of this Remand must be made available to and reviewed by the examiner in conjunction with the opinion. In providing the opinion, the examiner should consider the Veteran’s statement that he believes the nature of his job during his active service caused his wrist disability. The examiner should elicit from the Veteran a complete history of his wrist symptomatology, including any in-service symptomatology and treatment; as well as his complete post-service history of wrist symptoms and treatment. (a.) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) any current wrist disability had its clinical onset during active service or is related to any in service disease, event, or injury to include the nature of the Veteran’s job during his active service. (b.) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) any current wrist disability was caused by any service-connected disability. (c.) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) any current wrist disability was aggravated (i.e., worsened) by any service-connected disability. (Continued on the next page)   The examiner must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. M. TENNER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Denton, Buck