Citation Nr: 21072222 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 15-41 356 DATE: December 2, 2021 REMANDED Entitlement to service connection for left wrist arthritis, to include rheumatoid arthritis, is remanded. Entitlement to service connection for right wrist arthritis, to include rheumatoid arthritis, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1968 to September 1970. This matter comes before the Board of Veterans' Appeals (Board) from a July 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board videoconference hearing in December 2018 before a Veterans Law Judge who is no longer with the Board. A transcript of this hearing is of record. The Veteran was notified that he is entitled to another hearing and did not elect to have another hearing. See 38 U.S.C. § 7107(c). Accordingly, the Board will proceed without further delay. 1. Entitlement to service connection for left wrist arthritis, to include rheumatoid arthritis, is remanded. 2. Entitlement to service connection for right wrist arthritis, to include rheumatoid arthritis, is remanded. Although the Board regrets additional delay, remand is necessary to obtain an adequate opinion regarding the Veteran's claim for service connection for bilateral wrist arthritis. VA examination opinions were most recently obtained in July 2021. The examiner stated that there is no current diagnosis of the right wrist, and in regard to either wrist, there is no indication that the Veteran had any continuous treatment on an ongoing basis from active duty to present, there is no evidence that the Veteran sought medical attention for a condition within a year after separation, and there is no additional evidence to support chronicity and continuity. Additionally, the examiner stated that it is acknowledged that mental health conditions can affect physical conditions. Pathophysiological, the claimed conditions are separate and distinct. First, the Board finds that the evidence demonstrates that the Veteran suffers from bilateral wrist osteoarthritis and he also has a diagnosis of rheumatoid arthritis in the left wrist. See Capri Records October 2019. Additionally, in regard to the right wrist, pain that causes functional impairment can be considered a disability. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Next, the examiner continued to provide an opinion based on lack on in-service treatment and did not adequately consider the Veteran's lay statements. The Board finds that the Veteran's lay statements are competent and credible. The Veteran has additionally submitted medical records that demonstrate treatment for his wrist going back at least to the 1990s. An April 2020 examiner stated that arthritis will worsen over time and can be due to repetitive use. The Veteran has consistently reported using his wrists to brace himself during falls in service and that he had to carry 40-pound radios. The examiners did not address whether this repetitive use could have caused his arthritis. Additionally, the 2021 examiner stated that mental health conditions can affect physical conditions but concluded without a rationale that the Veteran's wrist condition is not related to his mental health condition. The examiner failed to provide an adequate rational for this conclusion or adequately address the medical treatise the Veteran submitted regarding the relationship between mental health and rheumatoid arthritis. The examiner also failed to address whether the Veteran's mental health condition caused or aggravated his wrist condition. The Veteran also claims that his right wrist condition is secondary to his left wrist condition due to overuse. An opinion should address this contention as well. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all outstanding treatment records relevant to treatment for his wrists. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the Veteran of the unavailability of the records. 2. After records development is completed, the claims file should be sent to an appropriate examiner to offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that: (a.) the current wrist arthritis and/or right wrist pain had its onset during service or is otherwise related to an in-service injury, event, or disease, to include due to overuse from bracing falls and carrying 40-pound radios. (b.) any current disability of the wrists is at least as likely as not (a) caused by, or (b) aggravated by (worsened beyond natural progression) service-connected mental health condition; (c.) and whether the Veteran's right wrist condition was caused by or aggravated by his left wrist disability. In offering the opinion, the examiner is asked to consider that the Veteran is competent to report his accounts in service and that lack of treatment in service is not an adequate reason for a negative opinion. The examiner must also consider the medical literature that the Veteran submitted regarding the relationship between mental health and rheumatoid arthritis. The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. L. BARSTOW Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Hofmeister 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.