Citation Nr: 19123761 Decision Date: 04/01/19 Archive Date: 03/29/19 DOCKET NO. 17-46 681 DATE: April 1, 2019 REMANDED The claim of entitlement to service connection for tenosynovitis of the left wrist, to include as secondary to a service-connected left wrist fracture, is remanded. REASONS FOR REMAND The Veteran had honorable active duty service with the United States Army from May 1974 to May 1977. 1. The claim of entitlement to service connection for tenosynovitis of the left wrist, to include as secondary to a service-connected left wrist fracture is remanded. The Board cannot make a fully informed decision regarding the Veteran’s claim of entitlement to service connection for tenosynovitis of the left wrist as the medical opinion of record is inadequate. The Veteran’s service treatment records reflect an initial fracture of the left wrist in August 1975 with subsequent treatment. After removing the cast, the Veteran reinjured the wrist around July 1976 and reported ongoing pain in the thumb with pain on motion. His February 1977 separation examination notes a history of broken bones but does not provide further explanation. The Veteran underwent a VA examination in December 2016 to assess the nature and severity of his claimed wrist condition. He was diagnosed with an in-service left wrist fracture, as well as De Quervain’s tenosynovitis. The Veteran reported persistent and worsening soreness and loss of grip after the in-service fracture. The examiner concluded that it was less likely than not that the Veteran’s De Quervain’s tenosynovitis was proximately related to his in-service wrist fracture. His rationale was that “[t]his fracture is not associated with his current exam finding of a left DeQuervain’s tenosynovitis.” No additional explanation was provided. Unfortunately, absent any rationale for the examiner’s conclusion, the examination is inadequate for adjudicative purposes. The examiner does not address favorable medical evidence from the Veteran’s service treatment records reporting residual pain in his left thumb after the injury purportedly healed, which may be related to the development of tenosynovitis. The examiner also failed to provide any rationale as to why the Veteran’s initial fracture could not have led to tenosynovitis, including the potential development of scar tissue that could impinge on the tendon. A conclusory statement is insufficient for adjudication, and thus the Board cannot afford any probative value to this examination report. On remand, a new examination must be ordered, and a thorough medical opinion must be obtained regarding the etiology of the Veteran’s De Quervain’s tenosynovitis. The matter is REMANDED for the following action: 1. Obtain any relevant, outstanding VA treatment records that are not already associated with the claims file. If no records are available, the claims folder must indicate this fact and the Veteran should be notified in accordance with 38 C.F.R. § 3.159 (e). All attempts to contact the Veteran should be documented in the record. 2. Once the aforementioned development is complete, schedule the Veteran for a VA examination with a new examiner, if possible, to determine the etiology of his tenosynovitis. A complete copy of the claims file must be provided to the examiner, including a copy of this remand. The examiner should take a thorough history of observable symptomatology associated with the Veteran’s tenosynovitis. After a detailed review of the claims file, the examiner should opine as to the following: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s tenosynovitis had its onset during active duty service, is related to an incident of service, or began within one year after discharge from active service? (b.) If not, is it at least as likely as not (50 percent or greater probability) that the Veteran’s tenosynovitis was caused by or aggravated by his service-connected left wrist fracture? The examination report should specifically state that a review of the record was conducted. The examiner should provide a complete rationale for all opinions provided. If an opinion cannot be provided without to resorting to mere speculation, the examiner should identify all medical and lay evidence considered in this conclusion, fully explain why this is the case and identify what additional evidence (if any) would allow for a more definitive opinion. 3. Following completion of the foregoing, the AOJ should review the record and readjudicate the claim on appeal. If it remains denied, the AOJ should issue an appropriate supplemental SOC, afford the Veteran and his representative an opportunity to respond, and return the case to the Board. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD H. Fisher, Associate Counsel