Citation Nr: 20076949 Decision Date: 12/03/20 Archive Date: 12/03/20 DOCKET NO. 15-18 760 DATE: December 3, 2020 REMANDED Entitlement to service connection for right carpal tunnel syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1997 to March 2001. This matter again comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Guaynabo, Commonwealth of Puerto Rico. The Board previously remanded this matter in July 2018 and August 2020. As a preliminary matter, the Board notes that the Veteran’s other issue of entitlement to service connection for right lower extremity radiculopathy was granted in an October 2020 rating decision. Accordingly, the only issue on appeal before the Board is entitlement to service connection for right carpal tunnel syndrome. Entitlement to service connection for right carpal tunnel syndrome is remanded. Unfortunately, another remanded is warranted in this case. The Board sincerely regrets the additional delay; however, further evidentiary development is necessary before the Veteran’s claim of entitlement to service connection for right carpal tunnel syndrome can be adjudicated on the merits. Pursuant to the Board’s August 2020 remand, an addendum opinion was obtained regarding the etiology of the Veteran’s right carpal tunnel syndrome. However, the Board finds that this opinion is inadequate. The September 2020 examiner noted review of the claims file, including a March 2019 opinion, which the Board previously determined was also inadequate. See August 2020 Board Decision. The examiner did not address the Veteran’s October 1999 service treatment records reflecting an injury to his wrist. Furthermore, the examiner stated that the Veteran’s service-connected lumbar condition and/or lumbar radiculopathy did not cause or aggravate his right carpal tunnel syndrome; however, the examiner did not provide a rationale as to his negative causation opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Moreover, the Board notes that in its August 2020 decision, service connection was granted for a cervical spine disability. Consequently, the question rises as to whether the Veteran’s right carpal tunnel syndrome is at least as likely as not etiologically linked to his service-connected cervical spine condition. Regarding this matter, the Board notes that there is a November 2020 opinion answering in the negative; however, this opinion is also inadequate, as the examiner did not opine as to aggravation or provide an adequate rationale as to his opinion on causation. See El-Amin v. Shinseki, 26 Vet. App. 136 (2012); Nieves-Rodriguez, 22 Vet. App. at 301. Thus, on remand, the Board requests an addendum opinion as to the nature and etiology of the Veteran’s right carpal tunnel syndrome. The matters are REMANDED for the following action: 1. Return the claims file to the clinician who authored the September 2020 opinion regarding the nature and etiology of the Veteran’s right carpal tunnel syndrome for an addendum opinion. If this clinician is not available, forward the claims file to another clinician with the appropriate expertise. If the clinician determines that a new examination (or telehealth interview, etc., if an in-person examination is not feasible) would be beneficial, one is to be provided. The clinician should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s right carpal tunnel syndrome manifested during, or is the result of, his active service. The clinician should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s right carpal tunnel syndrome was either (i) caused or (ii) aggravated by his service-connected disabilities, including, but not limited to, small left paracentral L4-L5 herniated nucleolus pulposus; left lower extremity radiculopathy; right lower extremity radiculopathy; right lateral epicondylitis; and/or cervical condition. NOTE: With respect to the question concerning aggravation, the clinician is advised that aggravation under 38 C.F.R. § 3.310(b) does not require “permanent worsening” of the nonservice-connected condition. If aggravation is found, the clinician should attempt to identify the baseline level of disability prior to such aggravation. In formulating his or her opinion, the clinician should consider and address the competent medical and lay evidence of record, including, but not limited to: (a) The Veteran’s service treatment records, including an October 1999 record reflecting that the Veteran had right elbow and lower arm pain for approximately two and one-half weeks and that the Veteran exhibited pain in wrist extension; (b) The Veteran’s post-service VA medical records; (c) The Veteran’s post-service private medical records, including: (i) A July 2013 record from LF Rehab Institute Inc. concluding that the Veteran had median sensory-motor carpal tunnel syndrome; (ii) A July 2013 record from LF Rehab Institute, Inc., diagnosing the Veteran with distal latency prolongation right median carpal tunnel syndrome; and (iii) An October 2013 sonogram reflecting that the cross-sectional area of the median nerve at the proximal carpal tunnel is consistent with swelling from carpal tunnel syndrome; and (d) The Veteran’s competent lay statements regarding the onset and continuity of his symptomatology. If the clinician determines that the Veteran’s right carpal tunnel syndrome is less likely than not due to service and/or is less likely than not caused and/or aggravated by his service-connected disabilities, the clinician should discuss what other factor(s) caused the disorder. In other words, the clinician should note the most likely etiology of the Veteran’s right carpal tunnel syndrome. The clinician must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Seserman 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.