Citation Nr: 21063614 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 07-07 977 DATE: October 14, 2021 REMANDED Entitlement to service connection for a right wrist disability, including as secondary to service-connected somatic symptom disorder and residuals of a traumatic brain injury (TBI), is remanded. REASONS FOR REMAND The Veteran had active duty service from July 1962 to July 1966. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2005 administrative decision issued by a Department of Veterans Affairs (VA) Regional Office (RO), which continued the previous denial of service connection for right wrist nerve damage. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in August 2011. A copy of the transcript has been reviewed and associated with the claims file. In an October 2013 decision, the Board denied service connection for residuals of a traumatic brain injury (TBI), to include wrist nerve damage. The Veteran appealed to the US Court of Appeals for Veterans Claims (CAVC). In a March 2015 memorandum decision, CAVC vacated the October 2013 Board decision and remanded the issue. This matter was last before the Board in May 2020, at which time it was remanded for additional evidentiary development. While in remand status, in an August 2021 rating decision, the RO granted service connection for gastroesophageal reflux disease (GERD). Thus, this issue is no longer in appellate status. Entitlement to service connection for a right wrist disability, including as secondary to service-connected somatic symptom disorder and residuals of a traumatic brain injury (TBI), is remanded. Throughout the rating period on appeal, the Veteran has been assessed with right superficial radial neuropathy and right-hand tremors. He asserts that his right wrist disability was incurred in service and/or secondary to his service-connected somatic symptom disorder and residuals of a traumatic brain injury (TBI). The Veteran's service-treatment records reveal complaints of pain in his right wrist in October 1962. The Veteran testified at the hearing and submitted a statement in May 2010 indicating that he was involved in a bicycle accident in the summer of 1966. Moreover, he indicated that due to his position as a corpsman in the infirmary, he was able to receive informal and undocumented treatment during service. Given the procedural background and complexity of this matter, the Board requested a medical opinion by a neurologist. Pursuant to the Board's remand instructions, a medical opinion was provided by a neurologist in December 2020. The examiner concluded that it was unlikely that his mild essential tremor was a residual of his remote 1966 mild traumatic brain injury (TBI) given that there were no claims of right wrist issues or tremors during his service. After a review of the evidence, the Board finds that an addendum medical opinion is needed from the December 2020 neurologist. In this regard, the Veteran's service-treatment records document complaints of right wrist pain. Moreover, the examiner failed to provide an opinion with regard to his diagnosis of superficial radial neuropathy. Lastly, the examiner failed to provide an opinion as to whether his right wrist disability was caused or aggravated by his service-connected somatic disorder. The Board acknowledges the additional medical opinions following the Board's May 2020 remand in June 2020, August 2020, and August 2021. However, these opinions were rendered by non-neurologists and did not adhere to the Board's May 2020 remand instructions. Accordingly, the Board finds that an addendum medical opinion by a neurologist is warranted on remand. The matter is REMANDED for the following actions: 1. Obtain and associate with the claims file the Veteran's updated VA treatment records from October 2020 to the present. 2. After completion of #1, forward the claims file to the December 2020 neurologist for an addendum medical opinion. If the December 2020 neurologist is unavailable, forward to a neurologist for an addendum medical opinion. An examination is not necessary unless deemed so by the examiner. The claims file, including a copy of this remand, must be reviewed by the examiner and such review should be noted in the examination report. The examiner should identify and discuss all right wrist disabilities identified during the pendency of this claim, including superficial radial nerve neuropathy and essential tremors, and respond to the following: A. Is it at least as likely as not (probability of at least 50 percent) that the Veteran's right wrist disability, including superficial radial nerve neuropathy and/or essential tremors, was caused by his service-connected somatic disorder and residuals of a TBI? B. Is it at least as likely as not (probability of at least 50 percent) that the Veteran's right wrist disability, including superficial radial nerve neuropathy and/or essential tremors, was aggravated (any incremental increase in disability) by his service-connected somatic disorder and residuals of a TBI? If aggravation is found, is there medical evidence created prior to aggravation or between the aggravation and current level of disability that shows a baseline of the right wrist disability prior to aggravation? C. If the Veteran's right wrist disability is not caused and/or aggravated by his service-connected somatic disorder and residuals of a TBI, is it at least as likely as not (probability of at least 50 percent) that his right wrist disability, including superficial radial nerve neuropathy and/or essential tremors, had its onset in and/or is otherwise etiologically related to his period of active service, including the TBI and bike accident? The examiner should provide a comprehensive rationale for each opinion provided. Specifically, the examiner should discuss and consider the Veteran's in-service right wrist complaints and testimony that due to his position as a corpsman in the infirmary he was able to receive informal and undocumented treatment during service. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports are to be considered in formulating any opinion. If any opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner does not have the knowledge or training. As appropriate, the AOJ should conduct additional development or supplement the record. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Merrick 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.