Citation Nr: 21004354 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 15-01 570 DATE: January 26, 2021 REMANDED The following issues are remanded for further development: (1) entitlement to service connection for arthritis of multiple joints; (2) entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD); (3) entitlement to service connection for an elbow disability; (4) entitlement to service connection for a bilateral shoulder disability; (5) entitlement to service connection for a bilateral wrist disability, to include carpal tunnel syndrome (CTS); and (6) entitlement to service connection for a right hand disability. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1959 to September 1961. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a June 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky. Jurisdiction of the Veteran’s claims file currently resides with the Indianapolis, Indiana RO. In September 2013, the Veteran testified at a hearing at a VA RO before a Decision Review Officer (DRO). A transcript of the hearing is of record. The Veteran was scheduled to present testimony at a hearing before a Veterans Law Judge in November 2016. However, the Veteran did not report to the hearing. As the record does not contain an explanation regarding his absence or a request to reschedule the hearing, the Board deems the Veteran’s request for a Board hearing to be withdrawn. See 38 C.F.R. § 20.704(d). In July 2017, the Board remanded the case for additional development. The case has returned to the Board for appellate review. VA Examinations Although the Board regrets the additional delay, it finds that remand is warranted once again as the Agency of Original Jurisdiction (AOJ) did not substantially comply with the July 2017 remand directives, contrary to the Court of Appeals for Veterans Claims’ holding in Stegall v. West, 11 Vet. App. 268 (1998). Specifically, in July 2017, the Board directed the AOJ to provide the Veteran with VA examinations with respect to the issues of service connection for arthritis of multiple joints, an acquired psychiatric disorder, an elbow disability, a bilateral shoulder disability, a bilateral wrist disability, and a right hand disability. Following the Board’s remand, a document labeled “Exam Request” was associated with the claims file in September 2019. This document indicated that the Veteran resided at an address in South Carolina and pertained to scheduling him VA examinations with a private medical contractor. Thereafter, several other documents labeled “Exam Request” were added to the claims file in October 2019. These documents note that the Veteran did not appear for scheduled VA examinations regarding arthritis of multiple joints, the wrists, the shoulders, the elbow, and the right hand. However, it is unclear from the record whether the Veteran received actual notice of these examinations. Indeed, there is no correspondence in the claims file notifying the Veteran that a private medical facility would be contacting him to schedule for VA examinations regarding arthritis of multiple joints, the wrists, the shoulders, the elbow, and the right hand. Additionally, documentation of subsequent communications informing him of the scheduled time and place of the examinations are not located in the claims file. Relatedly, another document labeled “Exam Request” was associated with the Veteran’s claims file in May 2020. This document was generated in connection with scheduling the Veteran a VA psychiatric examination with a different private medical contractor. This document listed the Veteran as residing in South Carolina. Unlike the other examinations, correspondence was sent to the Veteran later in May 2020 notifying him that a private medical facility would be contacting him to schedule a VA examination. This correspondence was sent to the Veteran at his South Carolina address. Subsequent to this May 2020 correspondence, VA received a completed VA Form 21-2680 for the Veteran which listed an address in New Jersey as the current address. Like the issues of arthritis, the wrists, the shoulders, the elbow, and the right hand, subsequent communications informing the Veteran of the scheduled time and place of the VA psychiatric examination are not documented in the claims file. In October 2020, a document labeled “Exam Scheduling Request Modification” indicated that the Veteran did not appear for this examination. This document noted a current address in New Jersey for the Veteran. Due to this lack of documentation of notification—and the change of the Veteran’s address from South Carolina to New Jersey at some point in the period following the July 2017 remand—the Board finds that good cause has been demonstrated such that the Veteran should be afforded an additional opportunity to be afforded VA examinations. See 38 C.F.R. § 3.655(a). Accordingly, the Board remands all of the issues identified on the title page for the scheduling of VA examinations. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination with an appropriate clinician to determine the nature and etiology of any acquired psychiatric disorder. The examiner should review the Veteran’s entire claims file and any relevant studies, tests, and evaluations deemed necessary should be performed. Thereafter, the examiner should address the following: (a.) Please identify any current psychiatric disorder by diagnosis. For VA purposes, “current” means occurring at any time during the pendency of the Veteran’s claim—i.e., from August 2011. (b.) If a diagnosis of PTSD is warranted pursuant to part (a), specify the claimed in-service stressor(s) upon which that diagnosis is based. (c.) For each disorder identified in part (a), please state whether it is at least as likely as not (50 percent probability or more) that the disorder had its onset in, was caused by, or is otherwise related to service. In providing a response to part (c), please address and consider: • December 2014 VA treatment records diagnosing the Veteran with adjustment disorder and anxiety disorder; • The Veteran’s testimony during the September 2013 DRO hearing; • A July 2012 VA treatment record wherein the Veteran’s screen for PTSD was positive and the Veteran discussed feeling uncomfortable and unsafe while in service; and • The Veteran’s October 2011 statements describing in-service stressors. In offering any opinion, the examiner should consider medical and lay evidence dated both prior to and since the filing of the claim. For any opinion rendered, the examiner should provide a complete rationale. If the examiner cannot provide the requested opinion(s) without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. 2. Schedule the Veteran for a VA examination with an appropriate clinician to determine the nature and etiology of any elbow disabilities. The examiner should review the Veteran’s entire claims file and any relevant studies, tests, and evaluations deemed necessary should be performed. Thereafter, the examiner should address the following: (a.) Please identify any current elbow disabilities by diagnosis. For VA purposes, “current” means occurring at any time during the pendency of the Veteran’s claim—i.e., from August 2011. (b.) For each disability identified in part (a), please state whether it is at least as likely as not (50 percent probability or more) that the disability had its onset in, was caused by, or is otherwise related to service. In providing a response to part (b), please address: • A December 2014 VA treatment record stating that the Veteran had a history of olecranon bursitis; • An August 2014 VA treatment record wherein x-ray results indicated arthritis of the elbow; • The Veteran’s testimony during the September 2013 DRO hearing; and • A March 2006 VA treatment record wherein imaging results indicated right elbow osteoarthritic changes. In offering any opinion, the examiner should consider medical and lay evidence dated both prior to and since the filing of the claim. For any opinion rendered, the examiner should provide a complete rationale. If the examiner cannot provide the requested opinion(s) without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. 3. Schedule the Veteran for a VA examination with an appropriate clinician to determine the nature and etiology of any shoulder disabilities. The examiner should review the Veteran’s entire claims file and any relevant studies, tests, and evaluations deemed necessary should be performed. Thereafter, the examiner should address the following: (a.) Please identify any current shoulder disabilities by diagnosis. For VA purposes, “current” means occurring at any time during the pendency of the Veteran’s claim—i.e., from August 2011. (b.) For each disability identified in part (a), please state whether it is at least as likely as not (50 percent probability or more) that the disability had its onset in, was caused by, or is otherwise related to service. In providing a response to part (b), address: • A November 2014 VA treatment record wherein imaging revealed degenerative joint disease of the left shoulder; • A June 2014 VA treatment record wherein x-ray results indicated arthritis of both shoulders; • The Veteran’s testimony during the September 2013 DRO hearing; and • A March 2003 VA treatment record assessing the Veteran with several conditions of the right shoulder, including subacromial impingement, acromioclavicular degenerative changes, and a full thickness rotator cuff tear. In offering any opinion, the examiner should consider medical and lay evidence dated both prior to and since the filing of the claim. For any opinion rendered, the examiner should provide a complete rationale. If the examiner cannot provide the requested opinion(s) without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. 4. Schedule the Veteran for a VA examination with an appropriate clinician to determine the nature and etiology of any right hand disability. The examiner should review the Veteran’s entire claims file and any relevant studies, tests, and evaluations deemed necessary should be performed. Thereafter, the examiner should address the following: (a.) Please identify any current right hand disabilities by diagnosis. For VA purposes, “current” means occurring at any time during the pendency of the Veteran’s claim—i.e., from August 2011. (b.) For each disability identified in part (a), please state whether it is at least as likely as not (50 percent probability or more) that the disability had its onset in, was caused by, or is otherwise related to service. In providing a response to part (b), please address: • A September 2014 VA treatment record wherein the Veteran complained of numbness in his right hand and the clinician noted severe atrophy of the right thenar eminence; • A July 2014 VA treatment record wherein the Veteran was diagnosed with carpal tunnel syndrome of the right hand; and • The Veteran’s testimony during the September 2013 DRO hearing. In offering any opinion, the examiner should consider medical and lay evidence dated both prior to and since the filing of the claim. For any opinion rendered, the examiner should provide a complete rationale. If the examiner cannot provide the requested opinion(s) without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. 5. Schedule the Veteran for a VA examination with an appropriate clinician to determine the nature and etiology of any wrist disability. The examiner should review the Veteran’s entire claims file and any relevant studies, tests, and evaluations deemed necessary should be performed. Thereafter, the examiner should address the following: (a.) Please identify any current wrist disabilities by diagnosis. For VA purposes, “current” means occurring at any time during the pendency of the Veteran’s claim—i.e., from August 2011. (b.) For each disability identified in part (a), please state whether it is at least as likely as not (50 percent probability or more) that the disability had its onset in, was caused by, or is otherwise related to service. In providing a response to part (b), please address: • A November 2014 VA treatment record noting a history of severe right wrist degenerative joint disease; • An August 2014 VA treatment record wherein x-ray results indicated arthritis of the right wrist; • The Veteran’s testimony during the September 2013 DRO hearing; • A December 2009 VA treatment record noting that the Veteran had been wearing bilateral carpal tunnel braces for his wrists at night; • An August 2006 VA treatment record noting osteoarthritic changes of the left wrist; and • A September 1961 STR wherein the Veteran complained of pain in his left wrist. In offering any opinion, the examiner should consider medical and lay evidence dated both prior to and since the filing of the claim. For any opinion rendered, the examiner should provide a complete rationale. If the examiner cannot provide the requested opinion(s) without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. 6. Schedule the Veteran for a VA examination with an appropriate clinician regarding the Veteran’s claim for service connection for arthritis of multiple joints—to include the knees, left hand, feet, and ankles. The examiner should review the Veteran’s entire claims file and any relevant studies, tests, and evaluations deemed necessary should be performed. Thereafter, the examiner should address the following: (a.) Please state whether the Veteran currently has arthritis in any joints other than the elbows, wrists, shoulders, right hand—to include the knees, left hand, feet, and ankles. For VA purposes, “current” means occurring at any time during the pendency of the Veteran’s claim—i.e., from August 2011. (b.) For each area identified in part (a), please state whether it is at least as likely as not (50 percent probability or more) that the disability had its onset in, was caused by, or is otherwise related to service. In providing a response to part (b), please directly address whether the symptoms associated with the identified joint are attributable to gouty arthritis. In offering any opinion, the examiner should consider medical and lay evidence dated both prior to and since the filing of the claim. For any opinion rendered, the examiner should provide a complete rationale. If the examiner cannot provide the requested opinion(s) without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. (Signature on Next Page) S.C. KREMBS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N.S. Pettine, 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.