Citation Nr: 21005561 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 17-37 118 DATE: February 2, 2021 REMANDED Entitlement to service connection for left upper extremity carpal tunnel syndrome is remanded. Entitlement to service connection for right upper extremity carpal tunnel syndrome is remanded. REASONS FOR REMAND The Veteran served honorably in the Navy from June 1953 until June 1957. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2014 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO) in Milwaukee, Wisconsin. In April 2018 the Veteran presented testimony at a travel board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that proceeding has been associated with the claims file. This issue was previously remanded in a November 2020 Board decision. This appeal has been advanced on the docket. 38 U.S.C. §7107 (2012); 38 C.F.R. §20.900(c) (2018). 1. Entitlement to service connection for left upper extremity carpal tunnel syndrome is remanded. 2. Entitlement to service connection for right upper extremity carpal tunnel syndrome is remanded. Although the Board regrets the additional delay, remand is required for an adequate VA examination opinion. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The Board is also obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. The Veteran was provided with a VA examination in November 2020. The examiner determined that the Veteran’s bilateral carpel tunnel syndrome was less likely than not related to service. The examiner began by restating all the previous medical opinions of record, both positive and negative. He then noted that as the Veteran separated from service in 1957 and was not diagnosed with carpal tunnel until 2012, nexus was unlikely. The examiner then reiterated the opinion from a previous VA examination, noting that the Veteran had other potential risk factors for carpal tunnel such as obesity and diabetes. The examiner then again reiterated the point from a previous opinion that the Veteran was able to work as a carpenter and assembly line cook until the 1980s without complaints. The Board finds this opinion and rationale to be inadequate. The examiner’s statement that there was no nexus as the Veteran did not receive a diagnosis until many years later is insufficient as it merely considered the absence of treatment records to support the conclusion. Additionally, the opinion failed to address the Veteran’s lay statements from the April 2018 hearing in which he stated that he had continuous symptoms, such as tingling, following service. The opinion is also inadequate as the examiner failed to address the April 2018 medical opinion, as instructed by the November 2020 Board remand directives. The physician in the April 2018 VA record opined that it was at least as likely as not that the Veteran’s bilateral carpal tunnel syndrome started with and was a result of his jackhammer operation and other construction work while on active duty. While the examiner restated the positive opinion from the April 2018 record, he did not actually address it in his own opinion. As such, remand is required for an opinion that adequately addresses the April 2018 opinion as directed by the previous Board decision. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding the etiology of the bilateral carpal tunnel syndrome from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the bilateral carpel tunnel syndrome had onset in, or is otherwise related to, active service. The examiner must address the following: 1) the Veteran’s statements regarding onset of symptoms in-service; 2) the April 2018 Board hearing testimony regarding post-service career; 3) the October 2018 statement from the Veteran clarifying his job history; and 4) the April 2018 VAMC medical opinion. 2. If an examination is deemed necessary, notify the Veteran that it is his responsibility to report for any scheduled examination and to cooperate in the development of the claim, and that the consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§3.158, 3.655 (2018). In the event that the Veteran does not report for any scheduled examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Ashley Ki 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.