Citation Nr: 20022426 Decision Date: 03/31/20 Archive Date: 03/31/20 DOCKET NO. 15-04 398 DATE: March 31, 2020 REMANDED Entitlement to service connection for a neurological disability of the bilateral upper extremities, to include carpal tunnel syndrome, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1966 to October 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), which denied the Veteran service connection for bilateral carpal tunnel syndrome. In August 2018, the Board remanded the Veteran’s claim to the Agency of Original Jurisdiction (AOJ) for further action consistent with the Board’s remand directives. Specifically, the Board remanded to afford the Veteran a VA examination as to secondary service connection regarding the Veteran’s bilateral carpal tunnel syndrome. The claim is back before the Board for further appellate proceedings. By way of history, the Board notes that the entitlement of service connection for bilateral carpal tunnel syndrome was initiated on a claim for peripheral neuropathy of the bilateral upper extremities as due to the Veteran’s service-connected diabetes. See June 2014 VA form 21-526EZ. Upon a December 2014 VA examination, an examiner found that the Veteran did not have peripheral neuropathy of any kind in any extremity. The examiner explained that the Veteran’s reports were more consistent with a possible hand disability affecting the ulnar nerve. See December 2014 VA examination report. In October 2015, the Veteran was diagnosed with a hand neuropathy, specifically carpal tunnel syndrome. See January 2016 VA treatment records. The October 2015 physician mentioned that it was “difficult to say” whether the Veteran’s carpal tunnel syndrome was due to his diabetes and expressed no further opinion; this was the basis of the August 2018 Board remand. Id. After the Board’s remand, a VA examiner opined that the Veteran’s carpal tunnel syndrome was not due to his diabetes mellitus. See April 2019 VA examination report. The record does not reflect that a medical professional has opined whether the Veteran’s carpal tunnel syndrome is causally related to his active duty service. An October 1966 treatment entry shows the Veteran was treated for tendonitis in his hand. See service treatment record. There is insufficient competent evidence of record to determine whether the Veteran’s tendonitis in service is related to his current bilateral carpal tunnel syndrome. Thus, a remand is necessary for an opinion as to direct service connection. The matter is REMANDED for the following action: 1. Obtain any outstanding VA and/or private treatment records relevant to treatment the Veteran received for his bilateral carpal tunnel syndrome. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified, and the record clearly documented. 2. After the above development is completed, obtain an opinion from an appropriately qualified clinician to determine the nature and etiology of the Veteran’s bilateral carpal tunnel syndrome. The evidentiary record, including a copy of this remand, must be made available and reviewed by the clinician. The opinion should include a notation that this record review took place. It is up to the discretion of the reviewing clinician as to whether a new examination is necessary to provide an adequate opinion. After the record review, and examination if deemed necessary, the reviewing clinician is asked to respond to the following inquiries: A. Is it at least as likely as not that the Veteran’s bilateral carpal tunnel syndrome was incurred in, or is otherwise related to, his time on active service, to include treatment for tendonitis therein? B. Is it at least as likely as not that the Veteran’s bilateral carpal tunnel syndrome was (a.) caused or (b.) aggravated by his service-connected diabetes? In rendering this opinion, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran’s reports, he or she must provide an explanation for such rejection. The reviewing clinician is not to improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. After the above has been completed to the extent possible, readjudicate the claims. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Strickland 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.