Citation Nr: 20034476 Decision Date: 05/18/20 Archive Date: 05/18/20 DOCKET NO. 14-22 820 DATE: May 18, 2020 REMANDED Entitlement to service connection for neuropathy of the left upper extremity (claimed as left hand neuropathy), to include as secondary to service-connected left shoulder disability is remanded. Entitlement to service connection for neuropathy of the right upper extremity (claimed as right hand neuropathy), to include as secondary to service-connected right shoulder disability is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active duty service from July 1986 to April 1995. This appeal comes before the Board of Veterans’ Appeals (Board) from September and November 2011 rating decisions of a Department of Veterans Affairs Regional Office (RO). The appeal was last before the Board in April 2018. The appeal has been returned for further appellate review. 1. Entitlement to service connection for neuropathy of the left and right upper extremities is remanded. Here, the Veteran was afforded VA examination with respect to these claims in June 2019. The examiner opined that the Veteran’s carpal tunnel syndrome (CTS) of the bilateral wrist was less likely than not incurred in or caused by service. The examiner reasoned that there was no military medical record of a diagnosis of CTS or peripheral neuropathy. The examiner acknowledged that service treatment records (STRs) mentioned complaints of bilateral numbness in both arms at an orthopedic consult in 1995 but indicated the neurovascular examination was normal. Additionally, the examiner noted there were no specific entries for bilateral upper extremity numbness and tingling or CTS in STRs. The examiner also concluded that without better documentation he could not render a positive association between the Veteran’s shoulder instability and his upper extremity paresthesia. The Board finds this opinion is inadequate for adjudication purposes. Review of the June 2019 examination report and medical opinion reveals the examiner may not have had or reviewed the Veteran’s STRs in its entirety. The examiner listed the evidence utilized to make his decision and only the Veteran’s reports of shoulder injury and the 1995 consult were noted. Review of STRs reveal several instances where the Veteran injured his hands while playing football and note a history of arthritic pain in the bilateral hands. None of this evidence was taken into consideration at the time the medical opinion was rendered. Additionally, this medical evidence would presumably aid the examiner in determining if the Veteran’s bilateral upper extremity disabilities are caused or aggravated by his service-connected disabilities. Based on the foregoing, the Board finds an additional opinion is required to determine the nature and etiology of the Veteran’s disabilities of the bilateral upper extremities. 2. Entitlement to a TDIU is remanded. In the April 2018 decision, the Board remanded the claim for additional development. If the benefit sought on appeal remained denied, the Veteran and his representative were to be furnished a supplemental statement of the case (SSOC) and afforded opportunity to respond before the appeal was returned to the Board. A review of the record shows the requested development was conducted and additional VA examinations were added to the record, however, a SSOC was not issued. Accordingly, remand is required for issuance of a SSOC. Stegall v. West, 11 Vet. App. 268 (1998); 38 C.F.R. § 19.9 (c). The matters are REMANDED for the following action: 1. Obtain an addendum opinion by an appropriate clinician to determine the nature and etiology of any bilateral CTS syndrome. An examination of the Veteran is not required unless deemed necessary by the medical professional selected to offer the opinion. The examiner must opine whether the Veteran’s bilateral CTS syndrome is at least as likely as not related to an in-service injury, event, or disease, including the Veteran’s reports of injury and pain to his wrist and hands during service. In addition, the examiner must opine whether the Veteran’s bilateral CTS syndrome is at least as likely as not (1) proximately due to service-connected disability, or (2) aggravated beyond its natural progression by service-connected disability. (Continued on the next page)   A complete rationale for any opinion rendered must be provided. If you cannot provide the requested opinions without resorting to speculation, please expressly indicate this and state why that is so. 2. Readjudicate the appeal. If any benefit sought on appeal remains denied, the agency of original jurisdiction (AOJ) should issue an SSOC. After the Veteran is given an opportunity to respond, the case should be returned to the Board. C. TRUEBA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. McDuffie, 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.