Citation Nr: 21073955 Decision Date: 12/13/21 Archive Date: 12/13/21 DOCKET NO. 20-19 794 DATE: December 13, 2021 ORDER New and material evidence having been submitted, reopening of the claim of entitlement to service connection for a left shoulder disability is granted. New and material evidence having been submitted, reopening of the claim of entitlement to service connection for a right hand disability, to include carpal tunnel syndrome (CTS), is granted. Entitlement to service connection for a left shoulder disability is denied. REMANDED Entitlement to service connection for a right hand disability, to include CTS, is remanded. Entitlement to a rating in excess of 20 percent for left CTS is remanded. Entitlement to a rating in excess of 10 percent for residuals of a left wrist fracture with post-traumatic arthritis, is remanded. FINDINGS OF FACT 1. The evidence associated with the claims file since the July 2017 decision is not cumulative or redundant and raises a reasonable possibility of substantiating the claim for service connection for a left shoulder disability. 2. The evidence associated with the claims file since the July 2010 decision is not cumulative or redundant and raises a reasonable possibility of substantiating the claim for service connection for a right hand disability, to include CTS. 3. The Veteran's left shoulder disability is not related to a disease or injury incurred in or aggravated by active duty for training (ACDUTRA) or an injury incurred in or aggravated by inactive duty for training (INACDUTRA). CONCLUSIONS OF LAW 1. The criteria for reopening a previously denied claim of service connection for a left shoulder disability are met. 38 U.S.C. § 5108 (2018); 38 C.F.R. § 3.156 (2020). 2. The criteria for reopening a previously denied claim of service connection for a right hand disability, to include CTS, are met. 38 U.S.C. § 5108 (2018); 38 C.F.R. § 3.156 (2020). 3. The criteria for service connection for a left shoulder disability are not met. 38 U.S.C. §§ 101, 1110, 1131, 5107 (2018); 38 C.F.R. § 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Army Reserve from September 1976 to November 2006, including a period of ACDUTRA from September 1976 to December 1976. This case comes before the Board of Veterans' Appeals (Board) on appeal from an August 2018 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). Claim to Reopen Left Shoulder In a final July 2017 rating decision, the RO denied the Veteran's claim for service connection for a left shoulder disability. The RO noted that left shoulder bursitis was reported once in 1988, but that the condition was not chronic or continuing and that there was no evidence that the disability began or was caused by active service. The Board finds that new and material evidence has been received to reopen the claim for service connection for a left shoulder disability. VA treatment records received since the July 2017 rating decision show treatment for a chronic left shoulder disability. Specifically, a July 2018 treatment record noted left shoulder degenerative joint disease, impingement, tendonitis, and bursitis. The Board finds this evidence both new and material. Therefore, the claim is reopened. Claim to Reopen Right Hand In a December 2007 rating decision, the RO denied the Veteran's claim for service connection for a right hand disability. Although evidence of record at the time showed a diagnosis of right-sided CTS, the RO found that there was no evidence that the disability was incurred in or aggravated by active service. In a final July 2010 rating decision, the RO denied the Veteran's request to reopen the claim, finding that new and material evidence had not been submitted. The Board finds that new and material evidence has been received to reopen the claim for service connection for a right had disability, to include CTS. In June 2017, the Veteran was afforded a VA examination in connection with her claim for a right arm/wrist disability. The examination report noted a diagnosis of right wrist strain with tendinopathy/tendonitis, but also noted that the Veteran had bilateral CTS symptoms involving numbness of the fingers. The examiner opined that the Veteran's service-connected left wrist disability resulted in the need for her to compensate with her right wrist, which led to the diagnosis of right wrist strain with tendinopathy/tendonitis. Accordingly, in a July 2017 rating decision, the RO granted service connection for right wrist strain with tendinopathy/tendonitis as secondary to the Veteran's service-connected left wrist disability. The Board notes that the June 2017 VA examiner did not address the Veteran's right CTS in his opinion; however, the rationale for the opinion raises a reasonable possibility that the Veteran's right CTS might be caused or aggravated by her service-connected left wrist disability. The Board finds this evidence both new and material. Therefore, the claim is reopened. Service Connection Left Shoulder Service connection may be granted for disability resulting from disease or injury incurred in or aggravated while performing ACDUTRA or for an injury incurred or aggravated by inactive duty for training (INACDUTRA). 38 U.S.C. §§ 101(24), 106, 1110, 1131. ACDUTRA means full-time duty in the Armed Forces performed by Reserves for training and full-time duty as members of the Army National Guard or Air National Guard of any State. 38 U.S.C. § 101(22)(a), (c). INACDUTRA means duty other than full-time duty prescribed for Reserves or the National Guard of any state. 38 U.S.C. § 101(23); 38 C.F.R. § 3.6(d). Initially, the Board notes that the Veteran's service treatment records during ACDUTRA from September 1976 to December 1976 are unremarkable for any complaints, treatment, or diagnoses related to the left shoulder. At her December 1976 separation examination, her upper extremities were normal. During a period of ACDUTRA in April 1986, the Veteran fell while running during a physical training test. She was taken to the emergency room and treated for lacerations of the right hand and a left wrist fracture. She underwent a closed reduction and application of external fixator to the left wrist. It was determined that the injury was incurred in the line of duty and the Veteran is service connected for disabilities related to the left wrist injury. There is no indication that she sustained any injury to the left shoulder during the fall. During an April 2002 Army Reserve retention examination, the Veteran reported that she had bursitis in her left shoulder in 1988 and had intermittent sharp pains with swelling in the left neck and arm. She stated that she had to keep it covered with a heating pad and that she received nonsteroid anti-inflammatories (NSAIDs) from her physician. In July 2002, it was noted that she was qualified for service. Her summary of defects and diagnoses included left shoulder bursitis and it was recommended that she have an orthopedic evaluation for the left shoulder. During a November 2003 retention examination, it was also noted that she had bursitis of the left shoulder. An April 2007 private treatment record noted that the Veteran complained of left shoulder pain, which she stated developed over the past several months. Examination of the left shoulder showed evidence of tendonitis with a positive impingement sign, tenderness along the anterolateral border of the acromion, and some mild crepitus. An X-ray showed early acromioclavicular (AC) joint arthritis. The report of a May 2018 VA examination noted a diagnosis of left shoulder degenerative arthritis. The report of May 2018 magnetic resonance imaging (MRI) of the left shoulder noted the following impression: tendinopathy of the supraspinatus tendon; tendinopathy/sprain of the subscapularis tendon with contusion of the humeral head at the insertion of the subscapularis; tendinopathy/contusion of the proximal portion of the tendon of the long head of the biceps; tenosynovitis of the biceps tendon; remote injury to anterior inferior glenoid labrum; degenerative change of the AC joint; glenohumeral joint effusion; and subacromial/subdeltoid bursitis. A July 2018 VA record noted left shoulder degenerative joint disease, impingement, tendinitis, and bursitis. The Board notes that the Veteran was provided with a VA examination in May 2018, but that a medical opinion relating to the left shoulder was not obtained. VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies; and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability; but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. See 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79 (2006). When VA undertakes to provide VA examinations or obtain VA opinions, it must ensure that the examinations or opinions are adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In this case, however, the evidence does not indicate that the Veteran's left shoulder disability may be associated with her service. See McLendon, 20 Vet. App. at 83; see also Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010). The Veteran has not alleged nor does the evidence show that she sustained a left shoulder injury during a period of ACDUTRA or INACDUTRA, or that a left shoulder disease manifested during a period of ACDUTRA. There is also no evidence of any aggravation of a left shoulder disability during a period of ACDUTRA or INACDUTRA. Accordingly, the Board finds that a VA medical opinion is not warranted. Furthermore, although left shoulder arthritis was diagnosed in April 2007, several months after the Veteran separated from the Army Reserve, the presumption of service connection for a chronic disease does not apply where a claim of entitlement is based on a period of ACDUTRA or INACDUTRA. See Smith v. Shinseki, 24 Vet. App. 40, 46-47 (2010). The Board has also considered the lay evidence of record. The Veteran is competent to describe what she has personally observed or experienced; however, she has not provided any statements specifically addressing why she believes her left shoulder disability is related to service. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for a left shoulder disability is not warranted. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND The Board finds that additional development is necessary before the remaining claims on appeal are decided. Service Connection Right Hand/CTS As noted above, a June 2017 VA examiner opined that the Veteran's service-connected left wrist disability led to her right wrist strain with tendinopathy/tendonitis and service connection has been granted for that disability. See 38 C.F.R. § 3.310. The examiner, however, did not address the Veteran's right CTS with symptoms involving numbness in the fingers. Therefore, the Board finds that a remand is necessary for an additional VA examination and medical opinion. Increased Rating Claims Left Wrist CTS and Arthritis The Veteran was most recently afforded VA examinations to assess the severity of her service-connected left wrist disability and CTS in June 2018. On her April 2020 substantive appeal (VA Form 9), she reported that her lifestyle and the severity of her disabilities had changed tremendously in the past nine months. She stated that she now required assistance to do routine chores around the house and that getting dressed had become more difficult. Given her reports of worsening symptomatology, the Board finds that a remand is necessary for additional VA examinations. Additionally, the Board finds that any current treatment records should be identified and associated with the claims file. The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Then, schedule the Veteran for a VA examination by an examiner with appropriate expertise to determine the nature and etiology of any right hand disability/CTS that may be present. The claims file must be made available to, and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or better) that any currently present right hand disability/CTS (excluding right wrist strain with tendinopathy/tendonitis, which is already service connected) was caused or aggravated by any of the Veteran's service-connected disabilities (or combination thereof). A rationale for all opinions expressed must be provided. 3. Then, schedule the Veteran for an appropriate VA examination to determine the current level of severity of all impairment resulting from her service-connected left CTS. The claims file must be made available to and reviewed by the examiner. All indicated tests should be performed and all findings should be reported in detail. The examiner should provide all information required for rating purposes and describe the effects of the service-connected disability on the Veteran's ordinary activity. 4. Then, schedule the Veteran for appropriate VA examination to determine the current level of severity of all impairment resulting from her service-connected residuals of a left wrist fracture, to include arthritis. All indicated tests should be performed and all findings should be reported in detail. The examiner should provide all information required for rating purposes, to specifically include a full description of the functional impact of the service-connected disability on the Veteran's ordinary activity. The examiner most report relevant findings, to include range of motion in active motion, passive motion, weight bearing, and non-weight bearing. 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. The examiner must report whether there is a lack of normal endurance or functional loss due to pain and pain on use, including that experienced during flare ups; whether there is weakened movement, excess fatigability, incoordination; and the effects of the service-connected disability on the Veteran's ordinary activity. The examiner should also ask the Veteran to identify the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment resulting from flare-ups. The examiner should identify the extent of the Veteran's functional loss during flare-ups and offer range of motion estimates based on that information. If the examiner cannot provide any of the requested findings without resorting to speculation, the examiner must state why that is so and provide a detailed rationale as to the reason why the requested findings could not be provided. 5. Confirm that the VA examination reports and all opinions provided comport with this remand and undertake any other development found to be warranted. 6. Then, readjudicate the issues remaining on appeal. If a decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Mishalanie, 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.