Citation Nr: 20058076
Decision Date: 09/02/20	Archive Date: 09/02/20

DOCKET NO. 18-29 913
DATE: September 2, 2020

REMANDED

Entitlement to service connection for left hand carpal tunnel syndrome is remanded.

REASONS FOR REMAND

The Veteran had active duty service in the United States Army from September 1965 to June 1967.  He has confirmed boots-on-ground service in the Republic of Vietnam from May 1966 to June 1967.  Exposure to herbicides has been conceded.

Entitlement to service connection for left hand carpal tunnel syndrome is remanded.

The Board previously remanded the Veteran’s claim in November 2018 to obtain additional VA medical opinion.  The Veteran afforded a VA examination and such opinion was obtained in December 2019.  The examiner found that the Veteran had a diagnosis of left carpal tunnel syndrome and opined: 

In review of his MOS, it is also less likely than not that this is a service related injury.  It is also noted that in the latest Institute of Medicine report on Agent Orange, carpel tunnel syndrome is not a consideration.

This examination report is incomplete as the examiner did not provide any rationale for the opinions rendered.  Specifically, the Veteran’s MOS was a supply handler.  On VA examination in October 2015, he also reported being a fuel specialist.  These job duties include dispensing bulk fuels and water from storage and distribution facilities, performing petroleum and water accounting duties, connecting hoses and valves and operating pumps to load products into tanker trucks, airplanes, ships and railroad cars, repairing pipeline systems, and storing and moving fuel products, among other things.  The examiner did not address why these in-service job duties could not at least as likely as not have caused the Veteran’s left hand carpal tunnel.  Further, the examiner alluded to the fact that the IOM does not address carpal tunnel syndrome.  However, although carpal tunnel is not among the listed diseases and conditions that may be presumptively service-connected based on exposure to herbicide agents, that does not preclude the claim for service connection to be established on a direct basis.  Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

Therefore, remand is warranted for additional VA medical opinion.

The matters are REMANDED for the following action:

Obtain a VA addendum opinion from an appropriate clinician addressing the etiology of the Veteran’s left hand carpal tunnel.  The examiner must review the entire claims file.  After such review, the examiner is asked to opine:

Whether the Veteran’s left hand carpal tunnel was at least as likely as not caused by or related to service, to include the Veteran’s conceded herbicide exposure.

The examiner is to take as conclusive fact that the Veteran is presumed exposed to herbicides as a result of his military service in the Republic of Vietnam.  Further, the examiner is asked to address his in-service duties that may have caused the CTS.  

The examiner is reminded he/she may not rely solely on the mere lack of contemporaneous evidence of such during service and/or that carpel tunnel syndrome is not on the presumptive disease list for herbicide exposure as a basis for denial.  

A complete rationale for any medical opinion rendered must be provided.

 

 

H.M. WALKER

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board	Martha R. Luboch, 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.