Citation Nr: 20026098 Decision Date: 04/15/20 Archive Date: 04/15/20 DOCKET NO. 15-07 064 DATE: April 15, 2020 ORDER Entitlement to service connection for a left ulnar neuropathy is granted. REMANDED Entitlement to service connection for a right-hand disability is remanded. Entitlement to service connection for a left-hand disability, other than ulnar neuropathy is remanded. FINDING OF FACT The Veteran’s left ulnar neuropathy is at least as likely as not related to his service-connected cervical spine disability. CONCLUSION OF LAW The criteria for service connection for left ulnar neuropathy are met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from October 1981 to October 2007. In June 2018, the Board remanded the appeal for additional evidentiary development. Entitlement to service connection for a left ulnar neuropathy. The Veteran claims that he is entitled to service connection for left hand pain. Service connection may be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra. The Board concludes that the Veteran’s left ulnar neuropathy is at least as likely as not related to his service-connected cervical spine disability. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310. First, an October 2019 VA examination diagnosed the Veteran with left ulnar neuropathy. Second, the Veteran is service connected for cervical spine degenerative disc disease (DDD). Thirds, there is competent, credible evidence that the Veteran’s current left ulnar neuropathy is secondary to service-connected cervical spine disability. Specifically, An October 2019 VA examination reflects a diagnosis for left little finger neuropathy, ulnar nerve. He stated that this diagnosis had a clear and specific etiology which was cervical disc syndrome. He indicated that this was a cervical radiculopathy affecting the ulnar nerve. The Board notes that this is a different radiculopathy than his separately service-connected left upper extremity radiculopathy associated with the radial nerve. The Board has reviewed the remaining medical and lay evidence and finds that none of it contradicts the October 2019 examiner’s opinion or provides an alternative etiology for the Veteran’s left ulnar neuropathy. In light of the positive VA opinion and lack of contradictory evidence, the Board finds that the evidence is, at minimum, in equipoise regarding whether the Veteran’s current left ulnar neuropathy is related to his service-connected cervical spine disability. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. The benefit of the doubt will be conferred in the Veteran’s favor, and the service-connection claim for left ulnar neuropathy is granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Accordingly, service connection for left ulnar neuropathy is granted. REASONS FOR REMAND 1. Entitlement to service connection for a right-hand disability is remanded. 2. Entitlement to service connection for a left-hand disability, other than ulnar neuropathy is remanded. A remand by the Board imposes upon the Secretary of VA a concomitant duty to ensure compliance with the terms of the remand. Where remand orders of the Board are not complied with, the Board errs in failing to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). A June 2018 Board remanded these for a VA examination and opinion on the nature and etiology of the Veteran’s bilateral hand pain, and whether it is at least as likely as not related to an in-service injury, event, or disease. A November 2018 VA hand/finger examination, pursuant to Board remand, reflects that the Veteran does not have a current diagnosis associated with the right or left hand. See C&P at 3 (November 2018). A November 2018 peripheral nerves examination reflects a diagnosis of bilateral carpal tunnel syndrome (CTS). In December 2018, the physician assistant who conducted those examinations provided identical medical opinions as to each hand as follows: After reviewing medical records and physical exam, the hand condition is not joint related but neurological. The left carpal tunnel syndrome is less likely than not occurred during service due to the fact that there is no medical records to indicate service relations. After reviewing medical records and physical exam, the hand condition is not joint related but neurological. The right carpal tunnel syndrome is less likely than not occurred during service due to the fact that there is no medical records to indicate service relations. An October 2019 VA hand/finger examination reflects examination of the hand and that the Veteran denied any problems with the right hand. The diagnosis was left little finger neuropathy, ulnar nerve. After careful review of the evidentiary development, the Board finds that there is not substantial compliance with the Board’s prior remand directives insofar as (1) is the Veteran’s bilateral hand pain due to diagnosed bilateral CTS, and (2) whether CTS is linked to service-connected cervical spine disability. Dyment v. West, 13 Vet. App. 141 (1999). Further, the December 2018 medical opinion is inadequate as it relied solely on the absence of other medical records to indicate a link to service, and does not discuss the Veteran’s service treatment records (STRs), clinical picture, service-connected cervical spine disorder, or other relevant evidence to support his negative conclusion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The Board observes that September 2006 STRs note left hand weakness and numbness and tingling in the medial side of the left arm. A medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record. See Stefl v. Nicholson, 21 Vet. App. 102, 124-25. Also, “[A] medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two.” Nieves-Rodriguez, supra. Therefore, to ensure substantial compliance with the prior remand directives, remand is necessary. See Stegall, supra. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from an appropriately qualified physician to address the nature and etiology of the Veteran’s bilateral hand symptoms and his diagnosed bilateral CTS and any other identified hand disorders (other than left ulnar neuropathy). The Veteran may be recalled for examination if deemed necessary for the medical opinion. The medical opinion should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge, etc., relied upon in reaching the conclusion(s). (a.) Opine on whether it is at least as likely as not that Veteran’s symptoms of right-hand and/or left-hand pain are attributable to CTS and, if not, identify the underlying disorder to account for his symptoms of hand pain to the extent possible. (b.) Opine on whether it is at least as likely as not left and/or right CTS, or any other identified left- or right-hand disorders, is related to an in-service injury, event, or disease. The examiner should specifically address the service treatment records showing September 2006 left hand/arm complaints and November 2006 right upper extremity EMG, as well as the Veteran’s complaints of continuous symptoms since service. (c.) Address whether the Veteran’s hand pain has a known pathology or is at least as likely not due to an undiagnosed illness. 2. Ensure that the VA medical opinion obtained includes a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. (CONTINUED ON NEXT PAGE) 3. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Moore, 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.