Citation Nr: 21063592 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 16-44 949 DATE: October 14, 2021 REMANDED Entitlement to service connection for a right-hand disability, to include ulnar neuropathy and carpal tunnel syndrome (CTS), is remanded. Entitlement to service connection for a left-hand disability, to include ulnar neuropathy and CTS, is remanded. Entitlement to service connection for Hypertension (HTN), to include as secondary to a lumbar spine disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1970 to December 1973. The Veteran testified at a hearing before the undersigned Veterans Law Judge in January 2020. A transcript of that proceeding is part of the claims file. A March 2021 Board of Veterans' Appeals (Board) decision remanded these matters for an addendum opinion regarding the Veteran's HTN and bilateral hand disabilities. 1. Entitlement to service connection for a right-hand disability, to include ulnar neuropathy, CTS, is remanded. 2. Entitlement to service connection for a left-hand disability, to include ulnar neuropathy, CTS, is remanded. Pursuant to the Board's remand directives, a VA addendum opinion was provided and associated with the record in July 2021. In providing a negative nexus opinion, the VA examiner stated that although the Veteran reported complaints of numbness and tingling in the hands since service, and had served as a combat engineer, there were no significant medical records available for his review concerning a hand condition. It is unclear to the Board whether this means that there was no evidence in the medical record, whether the medical records were unavailable for review, or are missing. Further, the examiner appears to disregard the Veteran's lay statements regarding repetitive hand movements performed as a combat engineer. The rationale is unclear, speculative, and does not include information based in medical knowledge. As such, an addendum opinion is necessary. 3. Entitlement to service connection for HTN, to include as secondary to a low back disability, is remanded. The Veteran contends that this HTN is related to service, to include as secondary to his service-connected low back disability. The examiner was asked to discuss whether medications used in the management of his low back disability aggravated his HTN. The examiner noted that aggravation of his heart condition beyond the natural progression would be evidenced by advanced changes in the Veteran's heart. The examiner then noted that the Veteran's heart condition was evidenced by left ventricular hypertrophy, See May 2021 VA examiner opinion at pg. 3. When VA undertakes to provide a VA examination or obtain a VA opinion it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). The examiner also did not address the medications used in the treatment of his low back disability. For this reason, the matter must be remanded for an addendum examination that addresses whether the medications used to manage the Veteran's low back condition aggravated his HTN. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding the nature and etiology of the Veteran's right-and left-hand conditions, to include ulnar neuropathy and CTS. The entire claims file, including a complete copy of this remand, should be made available and reviewed by the clinician. a) The clinician must opine whether it is at least as likely as not (50 percent or greater probability) that the right and left-hand conditions are related to an in-service injury, event, or disease, including paresthesias, pain and other hand complaints the Veteran reported experiencing during active service. In that regard, the clinician must note that a lack of contemporaneous medical evidence may not be the sole reason for providing a negative opinion and will necessitate a further opinion. 2. Obtain an addendum opinion regarding the Veteran's HTN. The examiner is asked to opine on the following: a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's HTN was caused by his service-connected back disability? b.) If the Veteran's HTN was not caused by his service-connected back disability, is it at least as likely as not that the HTN has been aggravated (worsened beyond normal progression) by his back disability, to include medications used to treat his back disability? c.) If the physician finds that the Veteran's HTN has been aggravated by his service-connected back disability, the examiner should attempt to quantify the degree of aggravation beyond the baseline level of HTN. The examiner is asked to address the Veteran's contentions that the medications he uses to treat his back disability has caused or aggravated his HTN. H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. McKenzie, 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.