Citation Nr: 20041826 Decision Date: 06/18/20 Archive Date: 06/18/20 DOCKET NO. 10-41 461 DATE: June 18, 2020 REMANDED Entitlement to service connection for a right wrist disability, to include residuals of a fractured right wrist is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1992 to July 1998 and from May 2001 to June 2007. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2013 rating decision. In October 2019, the Veteran testified before the undersigned Acting Veterans Law Judge (AVLJ) at a video-conference hearing. A transcript of that hearing is of record. This matter was previously remanded by the Board in September 2016 to schedule a video-conference hearing for the Veteran. As a hearing was held in October 2019, the Board finds that there was substantial compliance with the September 2016 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with its remand instructions, and imposes upon VA a concomitant duty to insure compliance with the terms of the remand); see also D’Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only substantial rather than strict compliance with the Board’s remand directives is required under Stegall). Entitlement to service connection for a right wrist disability, to include residuals of a fractured right wrist is remanded. The Veteran was afforded a VA Wrist Disability Benefits Questionnaire in November 2013 to evaluate the nature and etiology of his claimed right wrist disability. For the reasons discussed below, the Board finds that the November 2013 VA medical opinion is inadequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); D’Aries, 22 Vet. at 104 (holding that an examination must be based on consideration of the claimant’s medical history and must describe the disability in sufficient detail so that the Board’s evaluation of the disability will be a fully informed one). The November 2013 VA examination report demonstrates that the Veteran was diagnosed with a right wrist fracture in 1992. The medical history section indicates that the Veteran has constant pain and weakness in the right wrist. The examination report further provides that radiographic findings from November 2013 show an unremarkable wrist as there was no evidence of acute fracture or dislocation, the joint spaces are preserved, there is no aggressive bone destruction, and there are unremarkable soft tissues. The examination report also notes that the Veteran had a ganglion cyst removed from his right wrist in November 2007 and that he currently has increased sensitivity of the scar area. The corresponding December 2013 VA medical opinion states that given the nature of the Veteran’s normal wrist films, the documented bilateral complaints, and the development of his symptoms years after his resolved wrist fracture, his current right hand symptoms are less likely as not due to his resolved 1992 right radius fracture. In support, the medical opinion provides that the Veteran is status post non-displaced fracture of his right distal radius in June 1992 and that the current radiographic films of his wrist in 2013 do not show evidence of posttraumatic arthritis. Also, the medical opinion notes that a review of the records shows that the onset of pain in the Veteran’s right wrist with numbness and tingling occurred years after his active service and that it is worsened with repetitive action. An orthopedic note in 2010 reported bilateral hand pains aggravated by activities, particularly with repetitive movements according to the medical opinion. The Board finds the December 2013 VA medical opinion is inadequate, as the medical opinion fails to discuss a May 1993 service treatment record that showed the Veteran complained of right wrist pain and was assessed with tendonitis. The medical opinion also does not address whether the Veteran’s current right wrist disability is related to his service-connected painful scarring, right elbow and right wrist and/or ganglion cyst, right wrist, status post excision. Additionally, since the November 2013 VA examination and December 2013 VA medical opinion, new evidence concerning the Veteran’s right wrist disability has been added to his claims folder. In particular, a May 2014 VA Primary Care Outpatient Note demonstrates that the Veteran has right hand/wrist tendinosis. A May 2014 VA Occupational Therapy Consultation provides that the Veteran had a ganglion cyst removed and has had numbness and tingling since that time. As such, the Veteran must be afforded a new VA examination to determine the nature and etiology of his right wrist disability. The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records for the period from August 2016 to the present. 2. After the above development is completed, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any right wrist disability. The examiner must: (a.) Identify all current right wrist disabilities found to be present. (b.) Opine whether any identified right wrist disability is at least as likely as not (50 percent or greater probability) related to an in-service injury, event, or disease. (c.) Opine whether any identified right wrist disability is at least as likely as not (50 percent or greater probability) proximately due to service-connected painful scarring, right elbow and right wrist and/or ganglion cyst, right wrist, status post excision. (d.) Opine whether any identified right wrist disability is at least as likely as not (50 percent or greater probability) aggravated beyond its natural progression by service-connected painful scarring, right elbow and right wrist and/or ganglion cyst, right wrist, status post excision. In providing these medical opinions, the examiner should review and address:  The June 1992 service treatment record that showed the Veteran had a right distal radius fracture, and the July 1992 orthopedic follow-up.  The May 1993 service treatment record that showed the Veteran complained of right wrist pain and was assessed with tendonitis.  The May 2014 VA Primary Care Outpatient Note that demonstrates that the Veteran has right hand/wrist tendinosis.  The May 2014 VA Occupational Therapy Consultation that provides that the Veteran had a ganglion cyst removed and has had numbness and tingling since that time. All examination findings, along with the complete rationale for all opinions expressed, must be set forth in the examination report. A. J. Spector Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Sean Mussey, 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.