Citation Nr: 21007888 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 20-03 013 DATE: February 11, 2021 REMANDED Service connection for a low back condition is remanded. Service connection for right carpal tunnel syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1968 to May 1997. This matter comes before the Board of Veterans’ Appeals (Board) from multiple rating decisions issued by Department of Veterans Affairs (VA) Regional Offices (ROs). This matter has been advanced on the docket pursuant to 38 C.F.R. § 20.902(c). 1. Service connection for a low back condition is remanded. The Veteran believes that service connection for a low back condition is warranted. See August 2020 Appellate Brief. The Board notes that the Veteran’s July 2017 service connection claim for a low back condition was denied in a January 2018 rating decision. The claim was denied because there was no evidence of a current low back disability. See July 2017 Fully Developed Claim; January 2018 Rating Decision – Narrative. In May 2018, the Veteran submitted medical evidence showing a radiological impression of mild straightening of the normal lumbar lordosis with grade 1 retrolisthesis at L5 on S1 with mild straightening when in flexion. See May 2018 Medical Treatment Record. Because the Veteran presented new and material evidence within one year of the rating decision, the January 2018 rating decision never became final and the claim remained pending. Therefore, there is no need to determine whether the claim should be reopened. See 38 C.F.R. § 3.156(b). At this point in the appeal, the Veteran has not undergone a VA examination in relation to the low back condition. Generally, a VA medical examination is required for a service connection claim 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; and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service; but (4) there is insufficient competent medical evidence on file for VA to make a decision on the claim. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Medical records from 2019 and 2020 show low back pain as a problem for the Veteran and that the low back pain is chronic. See August 2020 CAPRI. Medical records from 2018 show a low back impression of mild straightening of the normal lumbar lordosis with grade 1 retrolisthesis at L5 on S1 and mild straightening when in flexion. See May 2019 Medical Treatment Record. As such, the Board finds that the first prong is met. The Veteran reported that he injured his low back during service because he had to stand the entire time during 12-hour watches. The low back pain started many years ago but was kept under control by taking medication. His current low back problems must be related to what happened during service. See December 2018 NOD; See August 2020 Appellate Brief. Service records also appear to show a back problem. See June 2017 STR – Medical – Photocopy. As such, the Board finds the second and third prongs met. Given these facts, the Board finds that a remand is necessary to obtain a VA examination to determine the etiology of the Veteran’s low back condition. See McLendon, 20 Vet. App. at 83. 2. Service connection for right carpal tunnel syndrome is remanded. The Veteran believes that service connection for right carpal tunnel syndrome is warranted. See August 2020 Appellate Brief. The Veteran underwent an examination in July 2020. The examination found that the Veteran had right carpal tunnel syndrome, which was diagnosed in 2018. The right carpal tunnel syndrome was not related to service because service records did not show a diagnosis, it was not mentioned on the separation examination, and there was no evidence of chronicity of care until years after service. See July 2020 C&P Exam. The Board finds the July 2020 examination inadequate because it did not consider/was unable to consider all the relevant evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Specifically, among other evidence, the examination did not consider/was unable to consider medical records from 2019 showing the Veteran’s report of right hand numbness and tingling for approximately 20 years and an assessment of Dequervain’s tenosynovitis; service records showing that the Veteran fell into a campfire and had 2nd and 3rd degree burns on his right forearm; the Veteran’s report that he had right hand pain since the early years of service but it was not as bad as it is now; the Veteran’s report that the problem is partly due to using radio teletype during service to send messages; the Veteran’s report that he did not recall seeking treatment for the problem on base because it was not encouraged, it would have made him appear to be trying to avoid doing his job, it was too far to travel to, there were watch stander shortages and manning requirements, and after a 12-hour shift he needed to get home and sleep; and the Veteran’s report that the couple of times he needed treatment, he went somewhere else. See May 2019 Medical Treatment Record; June 2017 STR – Medical – Photocopy; February 2020 Correspondence; December 2018 NOD. Therefore, a remand is needed for a new VA examination. The matter is REMANDED for the following action: 1. Provide the Veteran an opportunity to identify any relevant outstanding private and/or VA treatment records, including private treatment records from Dr. T.P. and Dr. D.W. See August 2020 CAPRI. After obtaining any necessary authorizations from the Veteran, make all reasonable attempts to obtain the outstanding records in accordance with 38 C.F.R. § 3.159. 2. Update VA and private treatment records. VA treatment records appear current up to September 2020. Obtain any outstanding VA treatment records from Port Richey, Florida. 3. Schedule one or more appropriate VA examinations for the Veteran’s right carpal tunnel syndrome and low back pain. The need for an in-person examination of the Veteran is left to the discretion of the examiner. Following a review of the claims file and a copy of this Remand, the reviewing examiner is requested to furnish an opinion with respect to the following: (A) Identify all right carpal tunnel related disabilities, including Dequervain’s tenosynovitis, existing at any point during the pendency of the appeal (i.e. since May 2018), even if they are currently asymptomatic or have resolved during the pendency of the appeal. (B) Identify all conditions associated with the Veteran’s low back pain existing at any point during the pendency of the appeal (i.e. since July 2017), even if they are currently asymptomatic or have resolved during the pendency of the appeal. (C) If the examiner cannot identify a low back condition, the examiner shall determine whether the pain the Veteran experiences in the low back results in a functional loss or impairment to the Veteran. (D) For each identified right carpal tunnel related disability, is it at least as likely as not (a 50 percent or greater probability) that the disability is related to the Veteran’s service? (E) If the examiner determines that the Veteran has a current low back disability, or that the Veteran’s low back pain results in a functional loss or impairment, the examiner shall then determine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s low back pain/disability is related to the Veteran’s service? In addition to the other relevant evidence of record, the examiner is asked to consider the following information with a caution that this list is not a substitute for a review of the record: Right carpal tunnel syndrome (1) The Veteran’s report that the right carpal tunnel syndrome was caused by prolonged use of Morse Code transmission key sets during service. See August 2020 Appellate Brief. (2) 2020 medical records showing that the Veteran had right carpal tunnel syndrome and that surgery was recommended. See August 2020 CAPRI. (3) A 2020 medical record showing the Veteran’s report that the right carpal tunnel syndrome began in 1970. Over many years of doing teletype and Morse coding, he developed pain in the right hand. He saw a relative who was a local doctor for it. He continued to have right hand pain and weakness. In 2018, he was diagnosed with right median palmar sensory latency prolonged that was abnormal and consistent with right median nerve entrapment at the wrist. He had right carpal tunnel syndrome. See July 2020 C&P Exam. (4) The Veteran’s report that the pain in the right wrist and arm had been around for the last 15 to 20 years. The pain had always been there since the early days of service, but it was not as bad then as it currently was. One of the causes was the frequent and continuous use of his wrist and fingers for typing, which was one of his main jobs during service. He had to continuously use his wrist and fingers to send/receive Morse Code or use the radio teletype for sending messages. The Morse Code keys involved the continuous use of the arm, fingers, and wrist. These movements caused his problem. Carpal tunnel syndrome was due to his 28 years in service as a radioman. See February 2020 Correspondence. (5) The Veteran’s report that in 1968, he was trained on Morse Code. For 6 months, all he did was sit and use a typewriter to translate Morse Code. In 1969, sending Morse Code was his job. In 1970 and for the next 15 years, he either sent Morse Code messages or sent teletype messages. During this time, his ailments and carpal tunnel syndrome were treated by a relative, who was a physician, located about one mile from his house. Other times, he went to a clinic. He did not recall going to the base clinic or to sick call for the problem. He was not encouraged to do that while on watch, because it would look like he was trying to get out of work. The carpal tunnel syndrome has been present since the early 1980s due to his work activities during service. The watches he was on during service were for 12-straight hours. His relative no longer had record of those visits during service. Id. (6) Pictures of the Morse Code keys. See February 2020 Photographs. (7) 2019 medical records showing the Veteran’s report of right-hand numbness and tingling for about 20 years. There was an assessment of carpal tunnel syndrome, right upper extremity. The Veteran also had Dequervain’s tenosynovitis. See May 2019 Medical Treatment Record. (8) The Veteran’s report that when not doing Morse Code during service, he typed during 12-hour watches. The Veteran explained further why he did not go to the base clinic for the carpal tunnel syndrome. The couple of times it required treatment, he went to his relative’s clinic, which was much closer than the base facility. The condition was due to the continuous typing, retyping, and answering/composing messages with all the different teletypes. He was not aware of service connection until his retirement seminar, and now it is difficult to prove a relationship to service. See December 2018 NOD. (9) Service records showing the Veteran’s jobs in communications and as a radioman. See September 2017 Military Personnel Record. (10) Service records showing that the Veteran fell into a campfire and had 2nd and 3rd degree burns on the right forearm. A needle was also put in the right arm. See June 2017 STR – Medical – Photocopy. (11) All other relevant lay and medical evidence. Low back (12) The Veteran’s report that he injured the low back during service and currently suffers from a low back disability. See August 2020 Appellate Brief. (13) Medical records from 2019 and 2020 showing low back pain, which was chronic. See August 2020 CAPRI. (14) 2017 medical records showing the Veteran’s report of increased low back pain and that the Veteran was in service for 28 years. See November 2019 CAPRI. (15) 2018 medical records showing a low back impression of mild straightening of the normal lumbar lordosis with grade 1 retrolisthesis at L5 on S1 with mild straightening when in flexion and unchanged in extension. There was no acute process. See May 2019 Medical Treatment Record. (16) The Veteran’s report that during service, he stood the entire time during 12-hour watches. The low back problem must have been related to that. The pain started many years ago and should be considered chronic. It was always kept under control by taking medication. See December 2018 NOD. (17) Service records showing CVA tenderness for the back. See June 2017 STR – Medical – Photocopy. (18) All other relevant lay and medical evidence. A complete rationale for all opinions offered should be provided. Address the Veteran’s documented history and assertions. All necessary tests and studies should be conducted. If the examiner cannot provide an opinion without resorting to mere speculation, the examiner should provide an explanation stating why. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is due to the limits of the medical community’s knowledge or due to the limits of the examiner’s medical knowledge. The Veteran is competent to attest to factual matters of which the Veteran has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. 4. Readjudicate the issues on appeal. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Dougan, 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.