Citation Nr: 21066923 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 16-13 389 DATE: November 2, 2021 ORDER Entitlement to service connection for right arm disability (other than radiculopathy and apart from the hand/wrist) is denied. REMANDED Entitlement to service connection for right hand/wrist disability is remanded. Entitlement to service connection for left hand/wrist disability is remanded. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has had a right arm disability (other than radiculopathy and apart from the hand/wrist) or any related disability at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for entitlement to service connection for right arm disability (other than radiculopathy and apart from the hand/wrist) are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had service from June 1975 to June 1979. He died in February 2020. The appellant is the Veteran's surviving spouse and has been substituted in his appeal pending at the time of his death. This matter is before the Board of Veterans' Appeals (Board) on appeal of an August 2015 decision of a Department of Veterans Affairs (VA) Regional Office (RO). In March 2019, the Veteran testified before the undersigned Veterans Law Judge. A hearing transcript is associated with the record. In April 2021, the Board remanded the appeal for further development. During remand status, a July 2021 rating decision granted service connection for neck disability was granted in a July 2021 rating decision. As this is a full grant of the benefit sought as to this matter, there remains no controversy for the Board to consider. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (noting that a grant of service connection extinguishes appeals before the Board). At that time, the July 2021 rating decision also granted service connection for bilateral upper extremity radiculopathy associated with service-connected cervical spine disability. Thereafter, the RO issued a July 2021 Supplemental Statement of the Case addressing the claims for service connection for right arm condition and bilateral hand/wrist disability. Entitlement to service connection for right arm disability (other than radiculopathy and that involving the hand/wrist). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). To the extent that the Veteran sought service connection for right arm disability, the Board observes that he was granted service connection for right arm radiculopathy during the pendency of this appeal. However, as to right arm disability other than radiculopathy, the question for the Board is whether there was disability present at any time during the pendency of the claim or recent to the filing of the claim. The Board concludes that the Veteran has not had a right arm disability (other than radiculopathy and apart from the hand/wrist) and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Here, neither the lay nor the medical evidence reflects that the Veteran had a disability other than radiculopathy of the right upper extremity (and apart from the hand/wrist, which is addressed in the below remand) during the pendency of the claim or recent to the filing of the claim. Accordingly, this claim is denied. There is no doubt to resolve. 38 U.S.C. § 5107(b). REASONS FOR REMAND 1. Entitlement to service connection for right hand/wrist disability 2. Entitlement to service connection for left hand/wrist disability Issues 1-3: The Veteran contended that he sustained injuries to his hands/wrist/right arm when thrown from a dump truck that flipped in 1977 while he was in service. He stated that, at the time, Corpsman used a small brush to clean out the abrasions from his face, arms, and wrists. He denied getting any follow up care. See NOD (August 2015) and Hearing Transcript (March 2019). A July 2015 VA hand and finger examination report reflects a diagnosis of Dupuytren's disease of the hands. A July 2015 VA medical opinion reflects that the Veteran's Dupuytren's disease, of the bilateral hands, was less likely than not related to service. No rationale was provided. A January 2017 VA wrist examination reports reflects a diagnosis for left wrist arthritis. By history, he developed symptoms while in the service after he landed on hands and wrist in November 1978 while jumping out of a truck. It was noted that the Veteran was diagnose with tenosynovitis. The clinician opined that less likely than not (less than 50% probability) incurred in or caused by the condition was less likely than not related to the claimed in-service injury. The rationale was that, while the Veteran's service treatment records (STRs) indicate "a one-time injury to the left wrist in 1978, there is no further evidence in the STR's to indicate that a chronic condition developed. Nor is there evidence in post-service medical records to indicate continuity of symptoms. Thus there is a lack of a nexus between the symptoms in the service and the current condition. A June 2019 Veteran submitted Disability Benefits Questionnaire reflects diagnoses for right wrist sprain and right de Quervain's syndrome; and that testing was positive for bilateral de Quervain's tenosynovitis. By history, the Veteran had been "riding in a dump truck when it flipped forcing the veteran to jump out of it when he landed on his wrists." The clinician opined that his "right wrist pain was initially caused by his military service due to MVA while on active duty. Veteran presents with new condition of wrist pain and special tests indicating De Quervain's Tenosynovitis on examination today." An April 2021 Board decision remanded the issues because the 2015 and 2017 VA medical opinions of record lacked a complete rationale for the conclusions reached and the 2020 VAMO failed to address all diagnoses pertaining to the hands and wrists or explain why it rejected a diagnosis. See BVA Decision (April 2021). Pursuant to Board remand, a June 2021 VA medical opinion was obtained in these matters. It provided that the Veteran's bilateral wrist and hand conditions to include de Quervain's syndrome, chronic right wrist sprain, bilateral tendonitis and arthritis of the wrists, and Dupuytren's contracture, were less likely than not related to service, to include injury to hands when the Veteran jumped out of a truck in service. The rationale was twofold: (1) there was normal clinical evaluation on service separation in May 1979; and (2) the lack of complaints until 2015, more than 35 years later. The Board finds the June 2021 VA medical opinion (VAMO) is are inadequate for adjudicative purposes as it lacks a complete rationale. In this regard, while it contains a clear conclusion and supporting data, it does not provide a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22Vet. App.295, 301 (2008). In other words, the opinion does not explain why the normal clinical evaluation on service separation coupled with the lack of complaints for many years or decades after the initial injury supports the conclusion that the conditions involving the hands/wrist are not etiologically related to the in-service injury. Given the above, remand is required. See Barr v. Nicholson, 21Vet. App.303, 312 (2007) (When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). Further, a remand by the Board imposes upon the Secretary of VA a concomitant duty to ensure compliance with the terms of the remand. Where remand orders of the Board are not complied with, the Board errs in failing to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). Accordingly, the matters are REMANDED for the following action: 1. Obtain an addendum opinion from the June 2021 physician, or another an appropriate clinician if unavailable, to address the Veteran's claimed bilateral hand/wrist disability. The entire claims file along with a copy of this REMAND should be reviewed. The opinion should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). (a.) If the opinion is returned to the same clinician, then he should explain why the normal clinical evaluation on service separation coupled with the lack of complaints for many years or decades after the initial injury supports his June 2021 negative conclusion that the conditions involving the hands/wrist are less likely than not etiologically related to the in-service injury. A complete rationale is required for all conclusions. (b.) If a new opinion is obtained, then for each diagnosed disorder (to include right side de Quervain's syndrome, chronic right wrist sprain, tendonitis and arthritis of the wrists, and Dupuytren's contracture), opine on whether it is at least as likely as not due in-service injury or disease, and specifically to landing on his hands and wrists when jumping out of a truck during an accident in service. A complete rationale is required. 2. Ensure that the VA medical opinion obtained include a complete rationale for the conclusion reached. The medical opinions must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Edwards 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.