Citation Nr: 21072536 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 14-04 655 DATE: December 3, 2021 REMANDED Entitlement to service connection for gout is remanded. Entitlement to service connection for bilateral carpal tunnel syndrome is remanded. Entitlement to a total disability rating based upon individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1968 until June 1970. He testified before the undersigned in May 2017; a transcript of the hearing is associated with the record. This appeal was most recently remanded in July 2021. Unfortunately, there has not been substantial compliance with the Board's prior remand directives and another remand is now required. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Gout 2. Bilateral carpal tunnel syndrome The claims must be remanded again because the August 2021 VA opinions are inadequate. The rationale for the negative opinions was based, in large part, on the absence of treatment records and medical evidence. The examiner stated that the Veteran's testimony as the onset of gout symptoms during service was considered but there was no evidence to support his claim. The examiner also did not opine on the Veteran's report that he was diagnosed with gout by a private doctor two to five years after service. The negative opinion on carpel tunnel syndrome also relied on an absence of medical evidence and a diagnosis of carpel tunnel after more than 45 years from service. The examiner stated carpel tunnel syndrome is caused by repetitive activity over a long period of time but did not explain why the use of firearms during service was not a likely cause. The Veteran's military occupation specialty (MOS) was infantry and presumed to have been exposed to frequent use of firearms during his two years of service. 3. TDIU The TDIU claim is remanded as inextricably intertwined with the service connection claims being remanded. See Harris v. Derwinski, 1 Vet. App. 183 (1990). The matters are REMANDED for the following action: 1. Forward the copies of all pertinent records to an appropriate VA examiner other than the August 2021 examiner to obtain a medical opinion on the likely etiology of the Veteran's gout and carpel tunnel syndrome claim. If the examiner determines that an opinion cannot be provided without an examination, one should be scheduled. The examiner is asked to answer the following questions: (a) Is it at least as likely as not (50 percent probability) that any currently diagnosed gout was incurred in or is otherwise related to service? The opinion provider must consider and discuss the Veteran's lay contention that his gout symptoms began as pain in his knee and elbow shortly before discharge from service and that he was first diagnosed by a private physician two to five years following service (b) Is it at least as likely as not (50 percent probability) that any currently diagnosed carpel tunnel syndrome was incurred in or is otherwise related to service, to include discharge of firearms? The opinion provider must consider and discuss the Veteran's lay contention that he experienced pain in his wrists during service and that the pain was due to the repetitive use of firearms as an infantryman. The examiner must provide reasons for each opinion given. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to TDIU. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Jarman, 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.