Citation Nr: 21070704 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 18-20 197 DATE: November 24, 2021 REMANDED Entitlement to an initial rating in excess of 10 percent disabling for right wrist strain (claimed as right arm condition) is remanded. Entitlement to service connection for degenerative changes, lumbar spine (claimed as lower back condition), to include as secondary to service-connected right wrist strain, is remanded. Entitlement to service connection for right shoulder condition, to include as secondary to service-connected right wrist strain, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from September 1968 to June 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The September 2013 rating decision denied the Veteran's claims of service connection for a traumatic brain injury, low back condition, acquired psychiatric condition, and right shoulder condition. The rating decision also denied the Veteran's claim for entitlement to individual unemployability and granted service connection for a right wrist strain with an evaluation of 10 percent effective May 2, 2012. The Veteran specifically declined to appeal all of the claims to the Board in his substantive appeal. See April 2018 VA Form 9 ("I am only appealing these issues: evaluation of right wrist strain, service connection for acquired degenerative changes lumbar spine, [and] service connection for right shoulder condition.") Thus, the claims for entitlement to service connection for traumatic brain injury, acquired psychiatric condition, and entitlement to TDIU will not be addressed in this decision. 1. Entitlement to evaluation of right wrist strain (claimed as right arm condition) currently evaluated as 10 percent disabling is remanded. The Veteran contends that his right wrist strain is more disabling than 10 percent. In July 2013, the Veteran attended a VA examination for his wrist condition. See July 2013 VA Examination. The examiner noted that the Veteran was diagnosed with right wrist strain in 1967. In April 2021, the Veteran testified that on an average day, his pain level is between a 5 and 6 on a scale where 10 is the highest pain. See April 2021 Hearing Transcript. He noted that if he does any lifting or activities such as gardening, he has to periodically take breaks. Additionally, he shared that humidity causes less wrist mobility. The most recent VA examination in connection with the Veteran's service-connected wrist condition was conducted more than 7 years ago. At his Board hearing, the Veteran contends that his wrist condition symptoms have worsened since his last examination and there is no recent VA examination of record, the Board finds that a new VA examination is appropriate to assess the current severity of the Veteran's wrist condition. See Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (VA has a duty to provide the Veteran with a thorough and contemporaneous medical examination) and Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (an examination too remote for rating purposes cannot be considered "contemporaneous"). 2. Entitlement to service connection for degenerative changes, lumbar spine (claimed as lower back condition), to include as secondary to service-connected right wrist strain, is remanded. 3. Entitlement to service connection for right shoulder condition, to include as secondary to service-connected right wrist strain, is remanded. The Board notes that the VA's duty to provide a VA examination is triggered in this case. Notably, at his Board hearing the Veteran contended that his lumbar spine and right shoulder conditions are secondary to his service-connected wrist condition. In determining whether VA's duty to assist requires a VA medical examination or medical opinion, four factors are for consideration: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d) (2012); 38 C.F.R. § 3.159(c)(4) (2017); see McLendon v. Nicholson, 20 Vet. App. 79 (2006). The evidence of record includes complaints of right shoulder pain and spasms and indicates that the Veteran has a current degenerative change in the lumbar spine, which may be connected to his fall from a deck in active duty training. The Veteran contends that he fell approximately 10 feet from one deck to another, with his arms crossed across his chest. See April 2021 Hearing Transcript. The Veteran indicated that his fall caused or aggravated his current right shoulder and lumbar spine conditions. Review of the service treatment records (STRs) corroborate treatment of the Veteran for his fall. See November 1967 Service Treatment Records. As such, a VA examination and opinion, to include secondary service connection, is necessary. The matters are REMANDED for the following action: 1. In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. 2. Obtain updated VA and/or private treatment records. If such records are unavailable, the Veteran's claim file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 3. Schedule the Veteran for a VA medical examination to determine the current severity of his service-connected right wrist condition. The electronic claims file must be reviewed in conjunction with the examination. All necessary testing should be conducted. In particular, the examination must include tests of all applicable ranges of motion in active motion, passive motion, weight-bearing, and non- weight-bearing in both wrists. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. In addition, if the examination is not conducted during a flare-up, the examiner must attempt to ascertain information, such as frequency, duration, characteristics, severity, and functional loss, regarding any flare-ups by alternative means. The examiner must provide an estimate of additional functional loss in terms of range of motion based on the Veteran's statements, available medical records, and other relevant sources. The examiner must also provide an assessment of the Veteran's functional limitations due to his right wrist condition as it may relate to his ability to function in a work setting and to perform work tasks. However, the examiner should refrain from commenting on the Veteran's employability. A complete rationale for all medical opinions is required. The examiner 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). If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). The examiner should provide a complete rationale explaining the medical reasons for all opinions provided. If an opinion cannot be provided without resorting to mere speculation, the examiner should fully explain why he or she cannot provide the requested opinion and identify what additional evidence (if any) would make it possible to provide a more definitive opinion. 4. Schedule the Veteran for a VA examination with a medical professional with appropriate expertise to determine the nature and etiology of the Veteran's residuals for low back condition. The examiner should review the Veteran's claims file. Based on a review of the record and an examination, the examiner must address the following: (a.) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's low back condition is related to his active service or is caused by or aggravated by military service. (b.) Is it at least as likely as not (i.e., probability of 50 percent or higher) that low back condition is proximately due to or the result of the Veteran's service-connected disabilities and/or the medications taken for the Veteran's service connected disabilities? (c.) If the answer to (b) is negative, is it at least as likely as not that low back condition is aggravated (i.e., permanently or temporarily worsened) by the Veteran's service-connected disabilities? (d.) If aggravation is found, the examiner should address the following medical issues: 1) the baseline manifestations of the disorder found prior to aggravation; and 2) the increased manifestations which, in the examiner's opinion, are proximately due to the service-connected disorder. In all opinions rendered, the examiner is advised that the Veteran is competent to report his symptoms and treatment history related to low back condition from in-service to the present. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 5. Schedule the Veteran for a VA examination with a medical professional with appropriate expertise to determine the nature and etiology of the Veteran's residuals for right shoulder condition. The examiner should review the Veteran's claims file. Based on a review of the record and an examination, the examiner must address the following: (a.) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's right shoulder condition is related to his active service or is caused by or aggravated by military service. (b.) Is it at least as likely as not (i.e., probability of 50 percent or higher) that right shoulder condition is proximately due to or the result of the Veteran's service-connected disabilities and/or the medications taken for the Veteran's service connected disabilities? (c.) If the answer to (b) is negative, is it at least as likely as not that right shoulder condition is aggravated (i.e., permanently or temporarily worsened) by the Veteran's service-connected disabilities? (d.) If aggravation is found, the examiner should address the following medical issues: 1) the baseline manifestations of the disorder found prior to aggravation; and 2) the increased manifestations which, in the examiner's opinion, are proximately due to the service-connected disorder. In all opinions rendered, the examiner is advised that the Veteran is competent to report his symptoms and treatment history related to right shoulder condition from in-service to the present. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Schmidt 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.