Citation Nr: 21075735 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 18-46 264 DATE: December 21, 2021 REMANDED Entitlement to a temporary total disability rating based on convalescence following a left wrist surgery is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1992 to December 1996. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a May 2017 Agency of Original Jurisdiction (AOJ) rating decision issued by the Department of Veterans Affairs (VA). A Board hearing was held in August 2021. A transcript is of record. The Veteran is service connected for a healed left wrist fracture that was incurred in active service. The Veteran initiated a claim for a temporary total rating based on convalescence following a left wrist surgery to repair scapholunate, lunotriquetral, and triangular fibrocartilage complex (TFCC) ligament tears. At issue is whether the October 2016 surgery requiring at least one month of convalescence and/or resulted in severe postoperative residuals is related to his service-connected left wrist fracture. 38 C.F.R. § 4.30. The Veteran testified that he relied on statements from his physicians that the ligament damage to his wrist that necessitated surgery was service-related and not due to his work as a firefighter. See August 201 Board Hearing Tr. at 4-5. He reported left wrist pain ever since his in-service fracture with no other wrist injuries since service; he stated that his work as a firefighter did not increase left wrist pain beyond what was present since service and that he believed intermittent increased pain during athletic activities was an aggravation of the service injury. See August 2021 Board Hearing Tr. at 3-4, 9-10. The Veteran is competent to testify to facts he personally observed, including recall of what he personally felt, saw, smelled, heard, or tasted. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board finds the testimony credible and notes that it is supported by other evidence of record. See, e.g., May 2016 VA treatment record (reporting a history of volar-ulnar wrist pain during activities involving dorsiflexion since the in-service wrist injury); July 2016 VA treatment record (reporting that an MRI was ordered in response to ulnar-side left wrist pain with activities involving wrist hyperextension and revealed a chronic TFCC tear). The Board finds remand is warranted to obtain a VA medical opinion that addresses all relevant evidence of record. The September 2016 VA examiner found the Veteran's TFCC tear was unrelated to the service-connected wrist condition because the left wrist fracture affected the radial side of the wrist and there was no evidence of medial or ulnar wrist pain in a January 1997 examination report. The September 2016 examiner found the TFCC tear to be a new, separate condition most likely due to the Veteran's occupation and participation in very physical obstacle course races. See September 2016 Wrist Conditions Disability Benefits Questionnaire (DBQ), at 2, 8. That VA clinician affirmed the opinion that all of the left wrist ligament disorders were unrelated to the service-connected left wrist fracture and attributed the injuries to the Veteran's participation in physical competitions and other strenuous exercise in an April 2017 addendum medical opinion. However, a January 1997 VA examination noted the Veteran's left wrist cracked with certain movements and was uncomfortable after heavy lifting with X-ray findings including a "small, ovoid calcific density ... just proximal to the medial aspect of the carpal triquetrum (consistent with old fracture fragment or post-traumatic calcification)" and a suggestion that the pronator quadratus fascial plane was displaced. Further, a May 2016 VA treatment record noted an X-ray report revealed an oval ossification between the ulna and triquetrum. Neither VA clinician provided an opinion regarding the significance of the January 1997 and May 2016 X-ray findings nor the January 1997 examiner's indication of a pronator quadratus muscle condition and whether such reflects that the service-connected left wrist disability encompasses symptomatology relating to the medial or ulnar sides of the left wrist and ligament conditions. Moreover, the VA clinicians have not considered the Veteran's statements regarding the consistency of his symptoms and lack of any additional left wrist injury since service. Layno, 6 Vet. App. at 469. Remand for another medical opinion is warranted. The matter is REMANDED for the following actions: 1. Obtain any outstanding VA treatment records relevant to treatment the Veteran received for a left wrist condition that are not already of record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified. 2. After completing the directive above, obtain an opinion from an appropriately qualified clinician to determine the etiology of the Veteran's left wrist scapholunate, lunotriquetral, and TFCC tears. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the clinician. It is up to the discretion of the reviewing clinician as to whether a new examination is necessary to provide an adequate opinion. After the record review and examination of the Veteran (if deemed necessary by the reviewing clinician), the reviewing clinician must opine on: Whether it is at least as likely as not that the Veteran's left wrist scapholunate, lunotriquetral, and TFCC tears are (1) related to an in-service injury, event, or disease; (2) proximately due to service-connected left wrist condition; (3) aggravated beyond its natural progression by his service-connected left wrist condition. The reviewing clinician is advised that the Veteran is competent to report his symptoms and history, such as consistent left wrist pain since service and no additional left wrist injuries. Such reports must be acknowledged and considered in formulating any opinion along with the January 1997 and May 2016 X-ray findings described in the body of this remand. If the reviewing clinician rejects the Veteran's reports, he or she must provide an explanation for such rejection. The reviewing clinician is also advised that a finding that left wrist scapholunate, lunotriquetral, and TFCC tears was aggravated beyond the normal progression due to the service-connected left wrist condition may encompass any additional incremental increase in disability resulting from the left wrist condition regardless of its permanence. If an opinion cannot be provided without resorting to speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must 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. (Continued on the next page) After completing the directives to the extent possible, readjudicate the claim. If the benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Odya-Weis 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.