Citation Nr: 21008776 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 14-04 655 DATE: February 18, 2021 REMANDED Entitlement to service connection for gout is remanded. Entitlement to service connection for bilateral carpal tunnel syndrome is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1968 to June 1970. In May 2017, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the proceeding is in the record. This matter was previously before the Board, most recently in September 2020, at which time the claims were remanded to afford him VA examinations and obtain medical opinions. There has not been substantial compliance with the remand directives and the claims must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for gout is remanded. 2. Entitlement to service connection for bilateral carpal tunnel syndrome is remanded. In November 2020, a VA nurse practitioner provided negative nexus opinions with respect to the above claims. In both cases, the examiner provided improper conclusory opinions. Remand is needed to obtain adequate opinions. With respect to the gout, the examiner stated that that the gap of 26 years between the Veteran’s service and subsequent diagnosis of gout meant that an intercurrent injury or disease could not be ruled out as an etiology. However, the Board’s question did not ask the examiner to rule out any alternative potential causes of the Veteran’s gout diagnosis but rather to state whether there was a 50 percent or greater probability that gout was either incurred in or otherwise related to service. While the examiner listed a number of risk factors for developing gout, the opinion failed to address whether any of those risk factors either applied to the Veteran or weighed against a finding that his gout is related to active duty service. With respect to the carpal tunnel syndrome claim, the examiner similarly stated that the gap of 37 years between the Veteran’s service and subsequent diagnosis meant that an intercurrent injury or disease could not be ruled out as a cause. The examiner then concluded without explanation that the Veteran’s work history as a mechanic was the most likely cause of his carpal tunnel syndrome. Supplemental VA opinions are needed to provide more responsive explanations that specifically considers his lay statements concerning the onset and progression of his symptoms. 3. Entitlement to a TDIU is remanded. As the issue of entitlement to TDIU is inextricably intertwined with the Veteran’s service connection claims, adjudication of the TDIU issue will be deferred until the above-noted service connection issues are adjudicated. See Harris v. Derwinski, 1 Vet. App. at 183 (1990). The matters are REMANDED for the following action: 1. Obtain supplemental opinions from appropriate VA clinicians – preferably a rheumatologist and orthopedic hand specialist – regarding the etiology of the Veteran’s diagnosed gout and bilateral carpal tunnel syndrome. Copies of all pertinent records must be made available to the examiner for review. The examiner is requested to address the following questions: (a.) Is it at least as likely as not (50 percent or higher degree of probability) that the Veteran’s gout had its onset in or is etiologically related to his active duty service? (b.) Is it at least as likely as not (50 percent or higher degree of probability) that the Veteran’s bilateral carpal tunnel syndrome had its onset in or is etiologically related to his active duty service? The examiner should provide a complete rationale for any opinion provided and should specifically comment on the Veteran’s lay statements concerning the onset and progression of his symptoms. In attempting to comment on this determinative issue of causation, past VA examiners impermissibly relied on the absence of service treatment records documenting any nexus to military service while failing to evaluate the Veteran’s statements that he has experienced intermittent gout and carpal tunnel since his active duty service. A clear rationale for any opinions expressed and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined TDIU claim. M. E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Jack S. Komperda, 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.