Citation Nr: 21070569 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 15-27 832 DATE: November 24, 2021 REMANDED Entitlement to service connection for left carpal tunnel syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty from December 2003 to March 2005 and from August 2008 to October 2009, with a period of active duty for training from March 2003 to July 2003 and additional service in the National Guard. This matter is on appeal from a July 2015 decision of a Department of Veterans Affairs (VA) Regional Office (RO). In September 2018, a hearing was held before the undersigned. A transcript of the hearing is in the record. The case was previously before the Board in March 2019 and January 2021 when it was remanded for further development. Entitlement to service connection for left carpal tunnel syndrome is remanded. The Veteran contends that he is entitled to service connection for left carpal tunnel syndrome. However, upon review of the record, the Board finds that further development is necessary to ensure substantial compliance with the prior remand directives. In February 2021, VA obtained a medical opinion in which the clinician opined that it is less likely than not that the Veteran's condition is related to an in-service condition. The clinician noted that "the left wrist ... had no complaints until 2015 and had normal exams in the meantime and had no predisposing injury." As noted in the prior remand, the Veteran provided lay statements that he has experienced numbness and tingling from the wrist down to the fingertips since service. While it is true that the Veteran's reports of such symptoms are not contemporaneously documented in the file, lay evidence does not lack credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). Further, the examiner was requested to consider the Veteran's lay reports as competent and credible, but the rationale does not reflect such consideration as the examiner did not discuss these lay reports. Stegall v. West, 11 Vet. App. 268, 271 (1998). Additionally, regarding secondary service connection the clinician opined that there was no medical evidence that left carpal tunnel syndrome was aggravated by right carpal tunnel syndrome as records did not support left carpal tunnel syndrome until 2015. The clinician indicated that it was "not unusual for an individual to develop [carpal tunnel syndrome] in one wrist only to develop it in the other wrist years later." This opinion does not substantially comply with the Board's remand directives as it does not address whether the Veteran's right carpal tunnel syndrome caused his left carpal tunnel syndrome and only addresses aggravation. Moreover, the opinion appears to indicate some correlation between the onset of carpal tunnel in the left arm, as it states that it is not uncommon for a person to develop carpal tunnel in one wrist and then the other wrist years later; however, that rationale is provided with a less likely than not opinion. Given this inconsistency and the lack of opinion on causation, the Board finds another opinion is needed on the matter of secondary service connection. The record also reflects the Veteran receives VA treatment; thus, updated VA treatment records should be associated with the claims file. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from May 2020 to the present. 2. After completing the development requested in item 1, return the claims file to the February 2021 VA examiner, or another appropriate clinician if that examiner is not available, for review and an addendum medical opinion. The reviewing clinician should be requested to provide opinions (based on a review of the record) to answer the following: a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's left carpal tunnel syndrome was incurred in service or is otherwise related to an in-service injury, disease, or event? The rationale must reflect consideration of the Veteran's lay reports of numbness and tingling from the left wrist down to the fingertips since service to be both competent and credible. b) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's left carpal tunnel syndrome is caused by his service-connected right carpal tunnel syndrome? c) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's left carpal tunnel syndrome is aggravated (i.e., any increase in the severity of the condition beyond its natural progression) by his service-connected right carpal tunnel syndrome? A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. H. White, Associate 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.