Citation Nr: A21019409 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 191029-45214 DATE: December 7, 2021 REMANDED Entitlement to service connection for a right hand disability is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1978 to May 1987, and from March 1991 to August 2002. The rating decision on appeal was issued in October 2019 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the October 2019 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his attorney at the July 2021 hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). 1. Entitlement to service connection for a right hand disability is remanded. The Veteran contends his right hand disability was caused by or incurred during service. Service treatment records in October 1995 and October 1997 note pain in his right wrist and a ganglion cyst. In an August 2019 statement, submitted with his claim, the Veteran reported that he had injured his right hand initially around 1993-1994. He then reported that he subsequently developed a very debilitating cyst on his right hand wrist and was referred to the naval hospital to have it removed. He stated that he subsequently began to have problems with feeling in his arm. Although he stated that some of the feeling started to return to his arm it was not 100 percent. He reported that he has experienced stiffness and pain in his wrist and hand off and on since the injury but it has now become worse. An August 2019 VA hand and finger conditions examination is of record. Although the examiner failed to diagnose a condition of the right hand, she specifically noted that there was a positive Tinel's and Phalen's sign on the right hand, indicating likely carpel tunnel syndrome which is outside the scope of the exam. She additionally noted on the report that the examination indicates a likely peripheral nerve issue, not a hand issue, which is outside the scope of the current examination. The examiner did not provide an etiological opinion stating that none was necessary as there was no diagnosis. Although the examiner failed to diagnosis a condition of the right hand, her statements on the examination report noting possible carpel tunnel syndrome and a peripheral nerve issue, contradict this finding. As a result, the issue must be remanded to afford the Veteran a new VA examination and medical opinion that completes all necessary testing and provides an etiological opinion as to whether his current right hand disabilityto include carpal tunnel syndrome or any other nerve disabilityis related to his in-service injury. The Board finds that the AOJ committed a pre-decisional duty to assist error by failing to provide the Veteran with an adequate VA examination and medical opinion. As such, a remand is necessary. The matter is REMANDED for the following action: Arrange for the Veteran to undergo a VA examination to determine the nature and etiology of his right hand disability found to be present and its relationship, if any, to his military service. Any necessary testing, including neurological testing, should be conducted. The claims file must be reviewed in conjunction with such examination, and the examiner must indicate that such review occurred. The VA examiner is asked to address the following question: Whether it is at least as likely as not (a probability of 50 percent or greater) that any right hand disability had its clinical onset during the Veteran's active duty service or is otherwise etiologically related to his active service. In rendering this conclusion, the examiner must specify whether the Veteran has a diagnosis of carpal tunnel syndrome or any other peripheral nerve disability. If no such diagnosis is found, the examiner must reconcile this with the findings of the August 2019 VA examiner. Any opinion(s) offered must be accompanied by a clear rationale consistent with the evidence of record. If the examiner finds it impossible to provide any requested opinion without resort to speculation, he or she must so indicate and must provide an explanation as to why such a finding is made. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. M. Clark, 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.