Citation Nr: 21070479 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 16-61 270 DATE: November 24, 2021 REMANDED Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a bilateral upper extremity disability, to include carpal tunnel syndrome and neuropathy, is remanded. REASONS FOR REMAND The Veteran had active service from September 1982 to December 1982 and from May 1997 to January 1998. The Veteran also had Army National Guard service from March 1981 to January 2001. He appealed a March 2016 rating decision by the Agency of Original Jurisdiction (AOJ). A Board hearing was held in October 2020. A transcript is of record. The Veteran's appeals were remanded in December 2020 and June 2021. Unfortunately, another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The June 2021 remand directed the AOJ to obtain an opinion as to whether the Veteran's service-connected lumbar spine disability caused or aggravated his claimed cervical spine disability. The Board specifically directed the AOJ to obtain an opinion from a clinician who had not previously reviewed the claims file. The AOJ obtained an opinion in September 2021. The opinion was prepared by the author of the February 2021 and April 2021 opinions, which the Board previously determined were insufficient as to secondary service connection. The clinician's rationale addressed direct service connection and relied on facts regarding the Veteran's service. Although the AOJ sought an addendum opinion, the additional opinion was wholly conclusory on aggravation, and restated facts regarding the Veteran's service rather than addressing the relationship between his claimed cervical spine disability and his service-connected lumbar disability. With respect to the Veteran's neurological claims, the clinician opined that his diagnosed bilateral carpal tunnel syndrome was not caused or aggravated by the cervical spine disability. The clinician reasoned that carpal tunnel syndrome was caused by pressure on the median nerve, and that a cervical x-ray did not mention cervical nerve compression. The clinician restated the same rationale for the aggravation opinion. It is unclear which cervical x-ray image the clinician referred to, as the clinician did not provide a date of those results. However, MRI results from October 2011, February 2016, and November 2017 have shown that the Veteran had neural foramen narrowing at C6-7. As the clinician did not address this relevant evidence, a new opinion regarding the Veteran's neurological claim is required. Based on these deficiencies, there has not been substantial compliance with the Board's prior remand instructions and an additional remand is necessary. The matters are REMANDED for the following actions: 1. Refer the claims file to an appropriately qualified clinician who has not previously reviewed this appeal for preparation of a medical opinion. The entire claims file, including a copy of this remand, must be made available to the clinician, and the clinician should confirm that such records were reviewed. No additional examination of the Veteran is necessary unless the reviewing clinician determines otherwise. The reviewing clinician is asked to respond to the following queries: (a.) Is it at least as likely as not that the Veteran's cervical spine disability was caused by his service-connected lumbar spine disability? (b.) Is it at least as likely as not that the Veteran's cervical spine disability was aggravated by his service-connected lumbar spine disability? (c.) at least as likely as not that the Veteran's bilateral upper extremity disability, to include carpal tunnel syndrome and / or neuropathy, was caused by his cervical spine disability? (d.) at least as likely as not that the Veteran's bilateral upper extremity disability, to include carpal tunnel syndrome and / or neuropathy, was aggravated by his cervical spine disability? The reviewing clinician's attention is directed to the results of the October 2011, February 2016, and November 2017 MRIs showing narrowing of neural foramen. For the purposes of this opinion, the reviewing clinician is to apply the proper aggravation standard, which is that any degree of worsening of a condition by a service-connected condition is sufficient to establish aggravation. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 2. After the above has been completed, readjudicate the claims. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Pelican, Luke H. 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.