Citation Nr: 21064835 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 17-03 871 DATE: October 21, 2021 ORDER Entitlement to service connection for a right upper extremity carpal tunnel syndrome (CTS) is granted. REMANDED Entitlement to service connection for a left upper extremity neurological disability, claimed as carpal tunnel is remanded. FINDING OF FACT The Veteran's right upper extremity carpal tunnel syndrome was aggravated by his service-connected lumbar spine disability. CONCLUSION OF LAW Right upper extremity carpal tunnel syndrome is proximately due to or the result of a service-connected disability. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION Duty to Assist As explained below, the Board has determined that the evidence currently of record is sufficient to grant entitlement to service connection for right arm CTS. Therefore, no further development is required under 38 U.S.C. §§ 5103, 5103A or 38 C.F.R. § 3.159. Burden of Proof Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Legal Criteria Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d). Additionally, any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. 38 C.F.R. § 3.310 (b). Factual Background and Analysis The Veteran seeks service connection for right upper extremity CTS, which he contends was caused by a malfunctioning morphine pump used to treat his service-connected lumbar spine disability. Recently, the Veteran underwent a VA examination where he was again diagnosed with bilateral upper extremity carpal tunnel syndrome. The central issue that must be resolved at this time is whether the Veteran's current disability was caused or aggravated by his service-connected lumbar spine disability. Following the most recent VA examination the examiner noted the Veteran's CTS began prior to the time when his morphine pump malfunctioned, and therefore, he concluded the CTS could not have been actually caused by the malfunctioning morphine pump. However, the examiner did find the Veteran's CTS symptoms had resolved prior to the pump malfunction, but then returned after the pump malfunction. The examiner explained that when the pump entered the dura matter the Veteran experienced documented nerve damage. As such, the examiner concluded the Veteran's right CTS was at least as likely as not aggravated by his service-connected lumbar spine disability. Based on the foregoing, the Board finds service-connection for the Veteran's right upper extremity CTS is warranted. REASONS FOR REMAND As noted above, the Veteran was diagnosed with bilateral CTS following his recent August 2021 VA examination. Following that examination, the examiner found the Veteran's left upper extremity CTS was less likely than not caused or aggravated by his service-connected lumbar spine disability. In support of this conclusion, the examiner explained that a malfunctioning morphine pump would only be expected to affect one side, and as such, his left upper extremity CTS was less likely than not aggravated by his service-connected lumbar spine disability. The examiner did not explain how or why he came to this conclusion. To be considered adequate, a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Based on this insufficiency, the Board finds a remand is necessary in order to obtain an addendum medical opinion from the August 2021 VA examiner. Accordingly, this case is REMANDED for the following actions: Obtain an addendum medical opinion from the physician that conducted the Veteran's August 2021 VA peripheral nerves examination, if available, and if unavailable from an examiner with sufficient expertise to comment on the etiology of the Veteran's left upper extremity carpal tunnel syndrome. All pertinent evidence of record should be made available to and reviewed by the examiner. A new examination should only be conducted if deemed necessary by the examiner. Following a review of the relevant records and lay statements, the examiner should state whether the Veteran's left extremity carpal tunnel syndrome at least as likely as not (a 50 percent probability or greater) was worsened to any degree by his service-connected lumbar spine disability. In this regard, the examiner is asked to fully explain how and why he came to the conclusion that a malfunctioning morphine pump would only affect one extremity in this case. The examiner is asked to specifically consider and expressly discuss the Veteran's competent lay statements concerning the severity and manifestations of his left upper extremity CTS. The examiner is also asked to specifically consider and expressly discuss the June 2019 statement provided by the Veteran's treating physician, which indicates the Veteran has experienced several side effects associated with his malfunctioning morphine pump. The examiner must provide a complete rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Fraser, 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.