Citation Nr: 18159329 Decision Date: 12/19/18 Archive Date: 12/18/18 DOCKET NO. 13-18 541A DATE: December 19, 2018 REMANDED Entitlement to service connection for a right hand disability, to include carpal tunnel syndrome, is remanded. Entitlement to service connection for a left hand disability, to include carpal tunnel syndrome, is remanded. REASONS FOR REMAND The Veteran had active military service from April to August 1994 and from June 1995 to September 2000, including in Southwest Asia from March to July 1999. He appealed to the Board of Veterans’ Appeals (Board/BVA) from a June 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In December 2014, in support of his claims, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge (VLJ) of the Board. A transcript of the hearing has been associated with the claims file, so is of record. This case was previously before the Board in August 2015, when the Board remanded these right and left hand disability claims for additional development. The Board’s August 2015 decision additionally (1) granted a petition to reopen a claim for service connection for a right foot disability, (2) denied claims of entitlement to service connection for left and right hip disorders, (3) denied claims of entitlement to increased disability ratings for left and right knee disabilities, and (4) remanded claims of entitlement to service connection for disabilities of the right foot, right shoulder, and left shoulder. During the processing of the Board’s remand, a May 2016 RO rating decision granted the claims of entitlement to service connection for the claimed right and left shoulder disabilities as well as for the claimed right foot disability. As explained by that RO rating decision, the grants were considered complete grants of those claims on appeal. Those issues are thus resolved and no longer in appellate status for Board consideration. The only issues remaining on appeal before the Board at this time are the claims of entitlement to service connection for disabilities of the right hand and the left hand. These issues were previously characterized in the August 2015 Board decision and remand as “Entitlement to service connection for arthritis” of the right and left hands. However, the Board discussed in the August 2015 remand discussion that “the claims file does not reveal a diagnosis of arthritis” for the hands, and the Board directed additional development of medical evidence to clarify the diagnostic nature of the Veteran’s claimed disabilities. During the processing of the August 2015 remand directives, as discussed below, a May 2016 VA examination report with medical opinion indicated that the Veteran’s symptom complaints are attributable to carpal tunnel syndrome. The Board consequently has recharacterized the issues to reflect the updated diagnostic indication of the nature of the Veteran’s claimed disabilities on appeal in this case. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009). The Board also observes that the claims-file now includes an October 2017 VA Form 21-0958 submitted by the Veteran to initiate a separate appeal on the issues of entitlement to increased ratings for the right and left knee disabilities and the issue of entitlement to service connection for a cervical spine disability. Those claims were denied by the RO in a May 2017 rating decision. The Board is aware of the Court’s holding in Manlincon v. West, 12 Vet. App. 238 (1999), but the Board finds that it is not necessary to take jurisdiction over these additional issues to remand them for issuance of a statement of the case (SOC) at this time. VA’s Veterans Appeals Control and Locator System (VACOLS) indicates that the Agency of Original Jurisdiction (AOJ) has acknowledged the October 2017 notice of disagreement (NOD) and is preparing to issue an SOC in response, as required. A remand of these issues to instruct the RO to process the NOD, when such processing has already begun, would serve no useful purpose. In this situation, formal strict adherence to the holding in Manlincon is not reasonably necessary as the purpose of that holding has already been satisfied in this case (as the RO has begun action to prepare an SOC). See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991). 1. Entitlement to service connection for a right hand disability, to include carpal tunnel syndrome, is remanded. 2. Entitlement to service connection for a left hand disability, to include carpal tunnel syndrome, is remanded. The Veteran has claimed entitlement to service connection for disabilities of the right and left hands. The Board’s prior August 2015 remand explained the need for a Persian Gulf War protocol examination to determine the nature and etiology of the Veteran’s complaints of hand pain. During the processing of the August 2015 remand, the Veteran underwent a pertinent VA examination in April 2016. The report of the examination includes the medical opinion that the Veteran’s pertinent complaints, including his hand complaints, “have specific etiologies and diagnoses.” The report does not specifically identify a diagnosis associated with the hand symptoms. In May 2016, a further VA medical examination of the Veteran’s hands was conducted, and the report of this examination specifies that the Veteran’s “complaint of subjective weakness and decreased sensation, along with positive exam findings of Tinnel sign and positive compression test suggest diagnosis of bilateral carpal tunnel syndrome.” The report did not include an opinion concerning the etiology of the referenced carpal tunnel syndrome. The May 2016 supplemental statement of the case denied the Veteran’s claims of entitlement to service connection for disabilities of the hands on the basis that “evidence of record does not show that you have an undiagnosed illness affecting the hands,” and “there is no evidence linking the currently diagnosed carpal tunnel syndrome to your military service....” However, the Board finds it significant that the May 2016 RO rating decision granted service connection for disabilities of the right and left shoulders on the basis of accepting the findings and opinion presented in an April 2016 VA examination report that attributed the shoulder disabilities to the nature of the Veteran’s particular duties during service involving repetitive strain to his upper extremities. The pertinent April 2016 VA examination report was accepted as supporting an award of service connection for the shoulder disabilities in that it presented the examiner’s opinion that the shoulder disability “likely started in service related to repetitive motion activities,” citing that the Veteran’s “job was to manage and teach the artillery cannon firing …. [H]e fired an average of 80 rounds a day, each round weighed 70 lbs.” The Board briefly notes that the Veteran’s service personnel records reasonably corroborate the described nature of his military duties. The VA examiner cited the Veteran’s “repetitive lifting” as a likely cause of disability. Significantly, the Board takes judicial notice of the fact that carpal tunnel syndrome is a disability commonly associated with repetitive stress injury featuring the upper extremities (including as regularly documented in publicly available medical treatise information). The Board finds that the evidence and VA determinations of record raise the question of whether the Veteran’s noted carpal tunnel syndrome of the right and left wrists / hands may be causally linked to the recognized in-service repetitive-motion injuries featuring his upper extremities. The Board cannot make a fully-informed decision on this matter because no VA examiner has opined as to whether the Veteran’s carpal tunnel syndrome of the right and left hands / wrists is causally linked to his military service. The Board finds that a remand for a medical opinion on this matter is necessary to allow for adequtely informed appellate review of the claims.   The matters are REMANDED for the following action: 1. Associate with the claims file all outstanding pertinent treatment records, including any additional VA treatment records (such as those that may have been created since the last such update of the claims file). Additionally, ask the Veteran to complete a VA Form 21-4142 for any new outstanding records from private providers of pertinent medical treatment of his hands/wrists that he may wish VA to assist him in obtaining for the record. (Continued on the next page)   2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s carpal tunnel syndrome of the right and left wrists/hands is at least as likely as not (a 50 percent or greater probability) causally/etiologically related to his military service. In particular, the examining clinician should specifically discuss, as necessary, whether the Veteran’s carpal tunnel syndrome is etiologically linked to the in-service repetitive motion and lifting injuries that have previously been established as a cause of the Veteran’s shoulder disabilities in the April 2016 VA examination of his shoulders. KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Barone, Counsel