Citation Nr: 20034597 Decision Date: 05/18/20 Archive Date: 05/18/20 DOCKET NO. 16-23 836 DATE: May 18, 2020 REMANDED Entitlement to service connection for left elbow fracture, status post open reduction internal fixation (ORIF) is remanded. Entitlement to service connection for left ulnar neuropathy associated with left elbow fracture is remanded. REASONS FOR REMAND The Veteran had active service from June 1969 to October 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In his May 2016 substantive appeal, the Veteran requested a hearing before a Veterans Law Judge. A hearing was scheduled for May 2019, but the Veteran failed to appear. As good cause has not been shown, the Veteran’s request for a hearing is deemed withdrawn. 38 C.F.R. § 20.704 (d).   1. Entitlement to service connection for left elbow fracture, status post ORIF is remanded. 2. Entitlement to service connection for left ulnar neuropathy associated with left elbow fracture is remanded. The Veteran seeks service connection for residuals of a left elbow fracture and left ulnar neuropathy associated with left elbow fracture. He asserts that his preexisting left elbow injury was aggravated during his active duty service. Service treatment records include a June 1969 entrance examination report that shows the Veteran’s upper extremities appeared normal on physical examination. A PULHES profile of “1” was assigned for the upper extremities. See Odiorne v. Principi, 3 Vet. App. 456, 457 (1992) (PULHES is the six categories into which a physical profile is divided; the P stands for the upper extremities). Clinical records dated in September 1969 show the Veteran was initially seen for a complaint of left elbow pain on September 5, 1969. A left elbow loose body and ulnar nerve transplant prior to service were suspected and he found to meet existed prior to service (EPTS) discharge requirements. There was no mention of an in-service injury during this visit or in the subsequent treatment records; however, the Veteran reported that he previously had fractured his left elbow four years prior while playing basketball. When seen again on September 9, 1969; there was an immediate suspension of all training and he was placed on a permanent profile. A Narrative Summary dated September 12, 1969 shows the Veteran was in his 11th week of advanced individual clerical training (AIT). A Medical Board Proceedings report dated September 17, 1969, shows the Veteran had been in training a total of 84 days. He was given a diagnosis of loose body, left elbow; tardy ulnar paresis, left. The clinicians determined this condition was not incurred in the line of duty, but rather had existed prior to entrance (EPTE) and was not aggravated during the Veteran’s 11 weeks of AIT. The Veteran was discharged from service due to his left elbow condition. The separation examination reflects a PULHES profile of “3” was assigned for the upper extremities. The Veteran underwent a VA examination in January 2015 in connection with this claim for service connection. The Veteran reported that he had fractured his elbow at 15 years of age but felt a snap during basic training and was told to continue training. He reports that he sought treatment after basic training and was then given light duty until discharge. The examiner diagnosed the current conditions as left elbow fracture/dislocation and left ulnar neuropathy. The examiner opined that she was unable to resolve the matter of causal nexus without resort to speculation due to a lack of/conflicting information. Although the examiner explained why she was unable to answer the causal nexus question, the opinion and rationale suggests that the examiner did not consider the correct evidentiary standard that pertains to this case- as the question was not properly posed in the examination request. Hence, an addendum opinion is needed. The matters are REMANDED for the following action: 1. Ask the Veteran to provide any medical records in his possession that pertain to his left elbow injury and treatment that occurred prior to service and/or provide authorization for VA to obtain such records. 2. Obtain an addendum opinion from an appropriate clinician regarding the etiology of the Veteran’s current left elbow disabilities- diagnosed as left elbow fracture/dislocation residual and left ulnar neuropathy. a) The examiner must provide an opinion as to whether these two conditions clearly and unmistakably (undebatable) preexisted the Veteran’s service. If the examiner finds they did clearly and unmistakably preexist service, the examiner must then opine whether they were clearly and unmistakably not aggravated by service. b) If the examiner finds that these conditions either did not clearly and unmistakably preexist service, or were not clearly and unmistakably aggravated by service, then the examiner must opine whether they are at least as likely as not related to an in-service injury, event, or disease. The examiner should review the claims file, and this Remand, and provide a fully explained rationale for the opinions offered. The examiner is advised that the service treatment records show no evidence of an acute arm/elbow injury in service. The records also reflect that the Veteran was placed on a permanent profile shortly after he complained of left elbow pain on September 5, 1969 during AIT clerical. His records show he completed basic combat training. An additional summary of the pertinent facts is provided in the Remand text. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Lauritzen, 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.