Citation Nr: 20052708 Decision Date: 08/07/20 Archive Date: 08/07/20 DOCKET NO. 13-25 822 DATE: August 7, 2020 REMANDED Entitlement to service connection for left wrist carpal tunnel syndrome is remanded. REASONS FOR REMAND The Veteran had active service from July 1998 to October 1998. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2012 rating decision of a Regional Office (RO) for Department of Veterans Affairs (VA). In May 2017, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing has been associated with the claims file. This case has previously been remanded by the Board in March 2018 and April 2020. The Board notes that the Veteran has requested a hearing relating to other issues on appeal and will be addressed by a separate decision following a hearing. 1. Entitlement to service connection for left wrist carpal tunnel syndrome is remanded. Although the Board sincerely regrets the additional delay, a remand is necessary to ensure there is a complete record upon which to decide the Veteran’s claim so that he is afforded every possible consideration. The VA opinion obtained in May 2020 is inadequate as it did not substantially comply with the prior Board remand directives. The May 2020 examiner offered an opinion that it was less likely than not that the Veteran’s left carpal tunnel syndrome (CTS) was caused by service or by a service-connected disability and as a rationale indicated that the Veteran’s February 12, 2018 EMG/NCV test from Baylor Scott & White indicated that the Veteran did not have CTS in either wrist. The Board notes that the Veteran was diagnosed with CTS in May 2011 and that these results were based upon an EMG/nerve conduction testing and has been repeatedly diagnosed with CTS throughout the period on appeal. Additionally, the Board notes that March 2018 medical records from Baylor Scott & White, following the EMG/NCV test relied upon by the May 2020 VA examiner, indicate that his treating physician followed up with the Veteran regarding the results of this study and they would follow up with a carpal tunnel injection if his hand paresthesias did not improve. The Board finds that a further opinion is necessary as the May 2020 opinion did not address the May 2011 diagnosis of CTS based upon EMG/nerve conduction studies. The Board notes a claimant may be granted service connection even though the disability resolves prior to the Secretary’s adjudication of the claim. McLain v. Nicholson, 21 Vet. App. 319, 321 (2007). As this opinion did not address the prior diagnoses of carpal tunnel syndrome present during the period on appeal the Board finds an addendum opinion is necessary. The matters are REMANDED for the following action: 1. Obtain additional VA treatment records from March 18, 2020 and associate them with the Veteran’s claims file. The Veteran should also be afforded an opportunity to identify and submit any outstanding private treatment related to his left wrist carpal tunnel syndrome. 2. Following the above development, schedule the Veteran’s for an examination regarding his left carpal tunnel syndrome. The need for an in-person examination is left to the discretion of the examiner. The Veteran’s record, to include a copy of this remand, should be made available to and be reviewed by the examiner. The examiner should identify all diagnoses during the period on appeal relating to nerve conditions of the Veteran’s left wrist (June 2011 to present). If the examiner finds any prior diagnosis was made in error or is no longer present, specifically carpal tunnel syndrome, the examiner should support such findings with evidence of record. The examiner should address the following with regard to any condition identified: (a) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s left wrist carpal tunnel syndrome or other nerve condition of the wrist had its onset in service or is otherwise related to his military service? The examiner must consider (1) the May 2011EMG/nerve conduction study and diagnosis by Dr. Steven Gulevich of left carpal tunnel syndrome (2) the May 2012 private treatment record diagnosing the Veteran with carpal tunnel syndrome and noting that the Veteran’s problems are from his left shoulder and are attributable to the injury he had while he was in the Army in 1998; (3) the March 2015 VA treatment record noting wrist pain and history of injury to the wrist; and (4) the December 2017 private treatment note documenting that the Veteran reported he also hurt his hand at the same time that he dislocated his shoulder in service in 1998 and has experienced persistent pain and intermittent numbness since. The examiner must address the Veteran’s reports that he injured his wrist in service and continued experiencing pain since service. (b) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s left wrist carpal tunnel syndrome or other nerve condition of the wrist identified is (1) proximately due to OR (2) aggravated by his service-connected left shoulder (non-dominant) dislocation with subsequent recurrent dislocations, degenerative joint disease, grade IV anterior instability and Hill-Sachs lesion status post arthroscopy with anterior labral reconstruction and placement of four anchors? (c) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s left wrist carpal tunnel syndrome or other nerve condition of the wrist identified is (1) proximately due to OR (2) aggravated by his service-connected left elbow ulnar neuropathy? (d) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s left wrist carpal tunnel syndrome or other nerve condition identified of the wrist is (1) proximately due to OR (2) aggravated by his service-connected left upper extremity cubital tunnel syndrome? The examiner is advised that he/she must provide a rationale for both causation AND aggravation. Additionally, if aggravation is found, the examiner should quantify the degree of aggravation, if possible. State whether there was an increase in disability regardless of permanence, but medically ascertainable. Any increase in disability should be described in terms of diagnosis, severity, and duration. In so doing, the examiner should consider that the June 2012 VA peripheral nerves examination indicates the Veteran did not use any assistive devices while the November 2018 VA peripheral nerves examination reflects the Veteran used a left wrist brace. A clearly stated rationale should be provided for all opinions and must not be based solely on the lack of any evidence of a diagnosis in the Veteran’s service treatment records or immediately thereafter. In this regard, a discussion of the relevant facts and medical principles involved would be of considerable assistance to the Board. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board John M. Middleton 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.