Citation Nr: 18156438 Decision Date: 12/11/18 Archive Date: 12/10/18 DOCKET NO. 15-18 496 DATE: December 11, 2018 ORDER Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for bilateral carpal tunnel syndrome is granted. REMANDED Entitlement to service connection for bilateral carpal tunnel syndrome is remanded. Entitlement to a rating in excess of 20 percent for left lower extremity radiculopathy is remanded. Entitlement to a rating in excess of 20 percent for right lower extremity radiculopathy is remanded. FINDINGS OF FACT 1. A March 2010 rating decision denied the Veteran’s claims for entitlement to service connection for bilateral carpal tunnel syndrome. The Veteran did not perfect an appeal of that decision or submit new and material evidence within one year; it is final. 2. The evidence added to the record since the March 2010 rating decision is not cumulative of the evidence previously considered, contributes to a more complete picture of the Veteran’s claims for entitlement to service connection for bilateral carpal tunnel syndrome and creates a reasonable possibility of an allowance of the claim. CONCLUSION OF LAW 1. The March 2010 rating decision denied the claim for service connection for bilateral carpal tunnel syndrome is final. 38 U.S.C. §§ 5103, 7105 (West 2014); 38 C.F.R. §§ 3.104, 3.156 (b) 20.302, 20.1103 (2017). 2. New and material evidence has been received to reopen the claim of entitlement to service connection for bilateral carpal tunnel syndrome. 38 U.S.C. § 5108 (West 2014); 38 C.F.R. § 3.156 (a) (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION 1. Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for bilateral carpal tunnel syndrome. The Veteran seeks to reopen a claim of entitlement to service connection for his bilateral carpal tunnel syndrome. The claim was previously denied in a March 2010 rating decision because there was no evidence of a wrist disability during the Veteran’s active service and no nexus to service. The question before the Board is whether new and material evidence has been submitted to reopen the claim. Since the March 2010 rating decision, the Veteran has submitted statements indicating his carpal tunnel syndrome is etiologically related to his active service. In addition, the Veteran’s physician submitted a July 2013 statement and attached a June 1996 service treatment record (STR) indicating the Veteran had a right fifth metacarpal fracture, which was initially thought to be carpal tunnel syndrome. Thus implying that the Veteran contends his bilateral carpal tunnel syndrome is secondary to his service-connected residuals of right metacarpal syndrome, which was present during his active service. The Board finds this evidence is “new” in that it had not been previously submitted. Moreover, the evidence is “material” because it relates to an unestablished fact necessary to substantiate the Veteran’s claim, whether the Veteran had in-service symptoms. The evidence is neither cumulative nor redundant of the evidence of record at the time of the March 2010 rating decision and raises a reasonable possibility of substantiating the claim. 38 U.S.C. § 5108; 38 C.F.R. § 3.156; Shade v. Shinseki, 24 Vet. App. 110 (2010). De novo consideration of the claim is addressed in the remand below. REASONS FOR REMAND 1. Entitlement to service connection for bilateral carpal tunnel syndrome is remanded. The Veteran contends that his current bilateral carpal tunnel is etiologically related to his active service to include his in-service right metacarpal fracture. To date neither a VA examination nor nexus opinion has been obtained in connection with the Veteran’s claim. The Board cannot make a fully-informed decision without a VA examination and opinion which addresses whether the Veteran’s carpal tunnel syndrome is etiologically related to his active service to include his service-connected residuals of right metacarpal fracture. 2. Entitlement to a rating in excess of 20 percent for left lower extremity radiculopathy is remanded. 3. Entitlement to a rating in excess of 20 percent for right lower extremity radiculopathy is remanded. The Veteran is seeking ratings in excess of 20 percent for his service-connected left and right lower extremity radiculopathy respectively. During the period on appeal the Veteran has not been provided with a VA examination specific to peripheral nerve conditions. The Veteran was provided with July 2014 VA examination in connection with his service-connected back disability, however, this examination indicated he did not have radiculopathy in either lower extremity. However, this is contradicted by the Veteran’s current VA treatment records which indicate he does have current bilateral lower extremity radiculopathy. See March 2017 VA treatment record. As such, a new VA examination which adequately addresses the severity of the Veteran’s bilateral lower extremity radiculopathy must be obtained on remand. Moreover, the Veteran continues to receive treatment at a VA medical center. As such, any and all outstanding VA treatment records must be obtained on remand. The matters are REMANDED for the following action: 1. Attempt to obtain and associate with the claims file any and all outstanding VA treatment records. 2. After completion of the above, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his bilateral carpal tunnel syndrome. The examiner must address the following: a. Whether it is at least as likely as not (50 percent or higher degree of probability) that the Veteran’s bilateral carpal tunnel syndrome is related to his active service. b. Whether it is at least as likely as not (50 percent or higher degree of probability) that the Veteran’s bilateral carpal tunnel syndrome was caused by his service-connected residuals of right metacarpal fracture? c. Whether it is at least as likely as not (50 percent or higher degree of probability) that the Veteran’s service-connected residuals of right metacarpal fracture aggravated the Veteran’s bilateral carpal tunnel syndrome? The examiner is informed that aggravation here is defined as any increase in disability. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected bilateral lower extremity radiculopathy. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the Veteran’s bilateral lower extremity radiculopathy alone and discuss the effect of it on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Biggins, Associate Counsel