Citation Nr: 19192587 Decision Date: 12/10/19 Archive Date: 12/10/19 DOCKET NO. 17-30 760 DATE: December 10, 2019 REMANDED Entitlement to service connection for a left elbow disorder, to include as secondary to a service-connected left shoulder disability, is remanded. Entitlement to service connection for a left wrist disorder, to include as secondary to a service-connected left shoulder disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from May 1983 to May 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. Upon review, the Board finds that further development is needed prior to adjudication of the claims. The Veteran was afforded a VA examination in June 2015 in connection with his claims for service connection for a left elbow disorder and left wrist disorder. The VA examiner diagnosed him with left cubital tunnel syndrome/ulnar neuropathy status decompression with anterior transposition and with left carpal tunnel syndrome status post release. The VA examiner opined that the Veteran’s left elbow and wrist disorders are less likely than not proximately due to or the result of his service-connected left shoulder disability, but are likely aggravated by it. She indicated that the Veteran's elbow condition is due to a separate diagnosis of ulnar nerve neuropathy and that carpal tunnel syndrome is due to nerve entrapment at the wrist. However, the VA examiner did not provide any rationale for her opinions other than listing evidence in the file, and it is also unclear as to whether the diagnosis of left cubital tunnel syndrome/ulnar neuropathy status decompression with anterior transposition is separate from the Veteran’s service-connected left upper extremity radiculopathy. Moreover, the June 2015 VA examiner did not address whether the Veteran has left elbow and wrist disorders that are directly related to his military service. In an April 2019 statement, the Veteran reported that he injured his left elbow and wrist when he fell through a ceiling in August 1984. The service treatment records document a fall and indicate that the Veteran sustained a soft tissue injury, an abrasion, and minimal swelling to his left elbow. Additionally, in an August 2015 statement and a June 2017 VA Form 9, the Veteran claimed that his left elbow and left wrist disorders are the result of his repetitive use of power tools during his military service. Moreover, the VA examiner did not address the January 1997 and April 1997 service treatment records showing that the Veteran had a cyst on his left wrist, pain radiating down his left arm, and occasional numbness and tingling in his hand. For these reasons, the Board finds that an additional VA medical opinion is needed to determine the nature and etiology of any left elbow and left wrist disorders that may be present. The matters are REMANDED for the following action: 1. The agency of original jurisdiction (AOJ) should request that the Veteran provide the names and addresses of any and all healthcare providers who have provided treatment for his left elbow and left wrist. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also secure any outstanding VA treatment records. 2. After completing the foregoing development, the AOJ should refer the Veteran’s claims file to the June 2015 VA examiner or, if that examiner is unavailable, to another suitably qualified VA examiner, for an additional medical opinion as to the nature and etiology of any left elbow disorder or left wrist disorder that may be present. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and lay statements. It should be noted that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should identify any current left elbow and left wrist disorders other than his service-connected left upper extremity radiculopathy. He or she should address whether his cubital tunnel syndrome/ulnar neuropathy status decompression with anterior transposition is a separate diagnosis from his left upper extremity radiculopathy. For each diagnosis identified, the examiner should opine as to whether it is at least as likely as not that the disorder that manifested in service or that is otherwise causally or etiologically related to his military service, to include any injury or symptomatology therein. Specifically, the Veteran has claimed that he injured his left elbow and left wrist after falling through a ceiling in August 1984. The Veteran has also claimed that his left elbow and left wrist disorders are the result of repetitive use of power tools during his military service. The Veteran’s service treatment records show that he fell through a ceiling in August 1984 and sustained a soft tissue injury, an abrasion, and minimal swelling to his left elbow. Service treatment records dated in January 1997 and April 1997 also indicate that the Veteran had a cyst on his left wrist, pain radiating down his left arm, and occasional numbness and tingling in his hand. The examiner should further state whether it is at least as likely as not that any left elbow disorder or left wrist disorder are either caused by or aggravated by the Veteran’s service-connected left shoulder disability. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history,” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner of review. 3. After completing these actions, the AOJ should conduct any other development as may be indicated. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. J. Williams, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.