Citation Nr: 21066979 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 17-64 945 DATE: November 3, 2021 REMANDED Entitlement to service connection for bilateral carpal tunnel syndrome is remanded. Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a lumbar spine disability is remanded. Entitlement to service connection for a bilateral ankle disability is remanded. Entitlement to service connection for right leg sciatica is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1972 to June 1976 and from August 1983 to June 1987. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2021, the Veteran appeared at a Board of Veterans' Appeals (Board) hearing via virtual videoconference before the undersigned. A transcript of that hearing is of record. 1. Service connection for bilateral carpal tunnel syndrome is remanded. During his July 2021 Board hearing, the Veteran stated that his bilateral hand and wrist pain began during active service. He worked as a mechanic during both periods of active service and was required to perform repetitive hand movements with manual tools. His hand pain began during active service and had continued since. He did not report his hand pain, nor did he seek treatment. VA treatment records note that the Veteran was diagnosed with bilateral carpal tunnel syndrome in December 2002 and hand joint pain in August 2020. The Board notes pain that results in functional impairment may be considered a disability for VA purposes. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The Board cannot make a fully-informed decision on the issue of service connection for bilateral carpal tunnel syndrome because no VA examiner has provided an opinion on the etiology of the Veteran's reported hand and wrist pain. 2. Service connection for a cervical spine disability is remanded. 3. Service connection for a lumbar spine disability is remanded. The Veteran contends that his neck and back disabilities are due to active service. During his July 2021 Board hearing, the Veteran stated that his neck and back pain began during active service while performing mechanic duties. He noticed that his neck and back hurt after climbing around vehicles as he had to twist into awkward positions and perform repetitive motions. Also, he was required to wear a heavy toolbelt while lifting objects, bending, and squatting, which caused back pain. VA treatment records show that the Veteran was diagnosed with cervical spondylosis in April 2001 and neck/back pain in November 2010. The Board notes pain that results in functional impairment may be considered a disability for VA purposes. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The Board cannot make a fully-informed decision on the issue of service connection for a cervical spine disability or service connection for a lumbar spine disability because no VA examiner has provided opinions on the etiology of the Veteran's reported neck and back conditions. 4. Service connection for a bilateral ankle disability is remanded. The Veteran contends that his bilateral ankle pain is proximately due to, or aggravated beyond the natural progression, by his service-connected bilateral calf strains. Also, he asserts that his bilateral ankle disability is directly related to active service. During his July 2021 Board hearing, the Veteran stated that he believed his bilateral ankle instability was due to his service-connected bilateral calf strains. Also, he noted that he fell during active service when he stepped in a pothole. The pain was so great that he "almost passed out." He reported that his ankles have been unstable since falling and that he had to wear his boots to provide stability for his feet. He has been prescribed ankle braces. In August 1987, the Veteran reported joint pain when running. Also, he reported bilateral bruised heels with distal pain due to direct trauma. The Board also notes pain that results in functional impairment may be considered a disability for VA purposes. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The Board cannot make a fully-informed decision on the issue of bilateral ankle disabilities because no VA examiner has opined whether it is secondary to, or aggravated beyond their natural progression, by his service-connected bilateral calf strains, or due to in-service complaints of bilateral heel trauma/pain. 5. Service connection for right leg sciatica is remanded. The Veteran contends that his right leg sciatica is proximately due to, or aggravated beyond the natural progression, by his service-connected bilateral calf strains. During his July 2021 Board hearing, the Veteran stated that he believed his right leg and foot tingling was associated with his back pain since active service. Also, he noted right leg spasms/cramping since August 1975. However, service treatment records note that the Veteran had left lower leg soreness in August 1975. The Board cannot make a fully-informed decision on the issue of right lower extremity sciatica because no VA examiner has opined whether it is secondary to, or aggravated beyond their natural progression, by his back disability, or due to in-service complaints of leg cramps. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to ascertain the nature and etiology of the Veteran's bilateral carpal tunnel syndrome and hand joint pain. All necessary tests should be conducted. The AOJ should ensure that the examiner has access to the Veteran's claims file, including a copy of this remand. For each diagnosed hand/wrist disability, the examiner should then provide an opinion as to whether it is at least as likely as not that the disability is etiologically related to an in-service injury, event, or disease, including the Veteran's reported in-service bilateral hand/wrist pain due to repetitive hand movements while performing mechanic duties. In rendering the opinions, the examiner should consider the statements of the Veteran regarding the symptoms of his bilateral hand/wrist pain to be competent. The examiner should provide a complete rationale for all opinions expressed and conclusions reached. If it is not possible to provide an opinion without speculation, the examiner must 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), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 2. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to ascertain the nature and etiology of the Veteran's cervical spine and lumbar spine disabilities. All necessary tests should be conducted. The AOJ should ensure that the examiner has access to the Veteran's claims file, including a copy of this remand. Based on a review of the record the examiner should address the following: (a.) Identify all cervical spine and lumbar spine diagnoses as shown in the record. (b.) As to each currently diagnosed disorder of the lumbar and cervical spine, indicate whether it is at least as likely as not that the condition (1) began during active service; (2) is related to any in-service event or injury, to include repetitive neck and back movements in awkward positions, squatting, bending and lifting, as well as wearing a heavy toolbelt; or (3), for arthritis only, manifested within one year of active duty service. The examiner should address the Veteran's competent statements and testimony that he has had continuous back pain and neck pain since active service, as well as provide a complete rationale for all opinions expressed and conclusions reached. If it is not possible to provide the requested opinion without speculation, the examiner must 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), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 3. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the etiology of the Veteran's bilateral ankle disabilities. The record should be made available to the examiner for review. Any indicated tests should be accomplished. Based on a review of the record and any examination findings, the examiner should confirm a diagnosis of any right or left ankle disabilities which may account for the Veteran's reported symptoms. Following a review of the Veteran's record, the examiner should address the following: (a.) identify all underlying disability manifested by left and right ankle pain and/or instability; if there is no actual diagnosable disability, indicate whether there is evidence of left and right ankle pain that results in functional impairment of earning capacity; (b.) address whether it is at least as likely as not (50 percent or greater likelihood) that any current disability manifested by bilateral ankle pain (including in the absence of an actual diagnosed underlying disability) is proximately due to, or aggravated beyond the natural progress of the disease by, the service-connected bilateral calf strains. (c.) Lastly, the examiner should then provide an opinion as to whether it is at least as likely as not that the disability is etiologically related to an in-service injury, event, or disease, including the Veteran's reported in-service bilateral ankle pain due to falling during physical training. In rendering the opinions, the examiner should consider the statements of the Veteran regarding the symptoms of his left ankle disability and right ankle disability to be competent. The examiner should provide a complete rationale for all opinions expressed and conclusions reached. If it is not possible to provide an opinion without speculation, the examiner must 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), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 4. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the etiology of the Veteran's right lower extremity disability. The record should be made available to the examiner for review. Any indicated tests should be accomplished. Based on a review of the record and any examination findings, the examiner should confirm a diagnosis of any right lower extremity disability which may account for the Veteran's reported symptoms. Following a review of the Veteran's record, the examiner should address the following: (a.) identify all underlying disability manifested by right lower extremity tingling; if there is no actual diagnosable disability, indicate whether there is evidence of right lower extremity pain that results in functional impairment of earning capacity; (b.) address whether it is at least as likely as not (50 percent or greater likelihood) that any current right lower extremity disability is proximately due to, or aggravated beyond the natural progress of the disease by, the Veteran's back disability. (c.) Lastly, the examiner should then provide an opinion as to whether it is at least as likely as not that the disability is etiologically related to an in-service injury, event, or disease, including the Veteran's reported in-service right lower extremity tingling, camps, and spasms. The examiner should provide a complete rationale for all opinions expressed and conclusions reached. If it is not possible to provide an opinion without speculation, the examiner must 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), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). S. L. Kennedy Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Costello, 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.