Citation Nr: 21073942 Decision Date: 12/13/21 Archive Date: 12/13/21 DOCKET NO. 14-30 088 DATE: December 13, 2021 REMANDED Entitlement to service connection for a right-hand disability, to include carpal tunnel syndrome, to include as secondary to service-connected neck disability, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU), prior to November 29, 2012, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1975 to October 1978 and from December 1990 to March 1991. The matters come before the Board of Veterans' Appeals (Board) on appeal from an October 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2018 and May 2021, the Board remanded the matters for further development. The Board notes that an April 2020 rating decision granted entitlement to TDIU, effective November 29, 2012. The Veteran filed a VA Form 10182 in August 2020, seeking an earlier effective date for the award of TDIU, which is pending in the Appeals Modernization Act (AMA) system. An appeal for TDIU can exist in both legacy and AMA systems, depending on the specific circumstances of the appeal. Here, the Board notes that the claim for entitlement to TDIU was raised in part and parcel with the legacy appeal for an initial increased rating for service-connected neck and back disabilities, which was denied in the May 2021 Board decision, as well as inextricably intertwined with the claim for service connection for right-hand disability. Accordingly, the claim for TDIU prior to November 29, 2012, will be addressed by the Board under the legacy system herein. The Board notes that a decision under the AMA system will be issued at a later date. Entitlement to service connection for right-hand disability is remanded. The Veteran contends that his right-hand disability is due to an August 1987 in-service electric shock injury. See August 25, 1987, Report of Investigation, Line of Duty and Misconduct Status. Alternatively, he contends that his right-hand disability is secondary to his service-connected neck disability. A February 2011 VA treatment record noted that the Veteran reported neck pain, right peri-scapular pain, and some distally radiating pain and paresthesias to the entire right hand. The Veteran's May 2011 VA treatment records note reports of "tingling" in the right hand and upper extremity. A May 2011 VA nerve conduction study revealed mild right carpal tunnel syndrome. No electrodiagnostic evidence for cervical radiculopathy or ulnar neuropathy was found. During a September 2012 VA central nervous system and neuromuscular disease examination, the Veteran reported having occasional, intermittent right lateral wrist pain and weakness. The examiner noted that a 2011 EMG revealed mild right carpal tunnel syndrome. The examiner did not provide a medical opinion regarding the Veteran's reported right-hand disability because the Veteran denied any chronic right-hand condition and his hand appeared normal upon examination. A May 2013 VA hand and finger conditions examination report concluded that the Veteran did not have a hand or finger condition. The Veteran reported having right hand and wrist pain, which the examiner indicated has been diagnosed as right carpal tunnel syndrome by EMG. The examiner opined that it was less likely than not that the Veteran's right-hand condition was secondary to electrocution in service and/or his service-connected disabilities as there was no diagnosed right-hand condition. The Veteran's private treatment records reveal that a March 2013 EMG showed no evidence of carpal tunnel syndrome, cervical radiculopathy (except for neuropathy motor units left C8T1 muscles), or peripheral polyneuropathy. An October 2019 VA hand and finger conditions examination noted a diagnosis of right-hand degenerative arthritis. Examination of the right hand revealed normal strength, range of motion, and sensation. The examiner noted that the Veteran did not describe any functional limitation related to his right hand despite his reports of pain and stiffness. The Veteran was afforded another VA hand and fingers examination in September 2021, in which he was diagnosed with right hand degenerative arthritis. The examiner noted that the Veteran exhibited signs of right-sided carpal tunnel syndrome. The examiner opined that the Veteran's right-hand degenerative arthritis was less likely than not related to service or secondary to a service-connected disability. No opinion was provided regarding the Veteran's right carpal tunnel syndrome. The Board finds that remand is warranted to obtain another VA examination and medical opinion regarding the nature and etiology of the Veteran's right-hand disability as there is no adequate medical opinion on which to adjudicate the matter. Here, the evidence of record indicates that the Veteran's reported right-hand symptoms are referrable to right carpal tunnel syndrome, which he has been diagnosed with during the appellate period. To date, no VA examination and medical opinion discussing the Veteran's carpal tunnel syndrome has been obtained. Entitlement to TDIU prior to November 29, 2012, is remanded. As the outcome of the claim for service connection for a right-hand disability may have a direct impact on the issue of entitlement to TDIU prior to November 29, 2012, the claim for TDIU is inextricably intertwined with the claim for service connection and consideration of the claim for TDIU must be deferred. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) The matters are REMANDED for the following action: 1. With any necessary identification of sources by the Veteran, request all VA treatment records not already associated with the claims file from the Veteran's VA treatment facilities, and all private treatment records from the Veteran not already associated with the claims file. 2. Thereafter, schedule the Veteran for an examination by an appropriate examiner to determine the nature and etiology of any right-hand disability. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. Following a review of the claims file, the examiner is asked to address the following: a) Identify any diagnosed right-hand disability, to include carpal tunnel syndrome, during the appeal period. b) Opine as to whether it is at least as likely as not (a 50 percent or greater probability) that any diagnosed right-hand disability is etiologically related to service, to include the August 1987 electric shock injury? Please explain why or why not. c) Opine as to whether it is at least as likely as not (a 50 percent or greater probability) that any diagnosed right-hand disability was caused by his service-connected neck disability? Please explain why or why not. d) Opine as to whether it is at least as likely as not (a 50 percent or greater probability) that any diagnosed right- hand disability was aggravated by his service-connected neck disability? Please explain why or why not. If the examiner finds that the disability was aggravated by the service-connected disability, the examiner must identify the baseline level of the disability that existed before aggravation by the service-connected disability occurred. A complete rationale must be provided for all opinions expressed. If the examiner is unable to provide an opinion without resort to speculation, an explanation as to why this is so should be provided and any additional evidence that would be necessary before an opinion could be rendered should be identified. 3. 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 prior to November 29, 2012. If the benefit sought is not granted to the Veteran's satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. Jenna Brant Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Robinson, 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.