Citation Nr: 21009302 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 14-20 480 DATE: February 22, 2021 REMANDED Issue of entitlement to service connection for a left wrist disability, including De Quervain’s tenosynovitis, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1986 to April 1995, March 2003 to May 2004, and May 2014 to February 2016. The Veteran also has reserve service with periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). This appeal to the Board of Veterans’ Appeals (Board) arose from a February 2011 rating decision issued by the Department of Veterans Affairs (VA). See February 2012 Notice of Disagreement (NOD); April 2014 Statement of the Case (SOC); May 2014 Substantive Appeal (VA Form 9). In June 2018, the Board remanded the claim for another VA examination for his left wrist disability. June 2018 Board decision. In November 2019, the Board remanded the claim to verify any periods of ACDUTRA and INACDUTRA between August and October 2009. November 2019 Board decision. In November 2020, the Board remanded the claim for an opinion on whether the Veteran’s left wrist disability was aggravated by his November 2014 injury during a period of active duty. The Agency of Original Jurisdiction developed the evidence and continued the denial of the Veteran’s claim. December 2020 Supplemental Statement of the Case. The claim is now back before the Board. Issue of entitlement to service connection for a left wrist disability, including De Quervain’s tenosynovitis, is remanded. The Board regrets the additional delay in this matter, but a remand is again necessary to obtain an addendum opinion by a VA examiner. The September 2020 Board decision remanded the claim for an addendum opinion on whether the November 2014 service treatment records showing an in-service fall aggravated the Veteran’s left wrist disability. An October 2020 addendum opinion was obtained, in which the VA examiner opined that the Veteran’s left wrist De Quervain’s tenosynovitis was not aggravated beyond its natural progression by his November 2014 fall injury. October 2020 VA examination medical opinion. However, the VA examiner’s rationale is only that the Veteran was also diagnosed with carpal tunnel syndrome and a June 2015 wrist x-ray showed normal bilateral wrists. See id. The VA examiner does not discuss the Veteran’s continued use of splints for his left wrist symptoms, albeit noted with a diagnosis of carpal tunnel syndrome. See, e.g., January 2015 Service treatment record. In addition, the October 2020 VA examiner found the Veteran not capable of ascribing his reported wrist symptoms as due to his current left wrist disability, but the examiner does not discuss the cause of those symptoms and if they could, in his opinion, be due to the Veteran’s current left wrist disability. See October 2020 VA examination medical opinion. The Board finds that further clarification is needed as to whether the evidence supports aggravation of the Veteran’s left wrist disability or disabilities due to his November 2014 fall injury. The Board also finds that it is unclear what current left wrist disabilities are shown by the evidence. As noted by the October 2020 VA examiner, the Veteran has a diagnosis of carpal tunnel syndrome. October 2020 VA examination medical opinion. The medical evidence also suggests that the Veteran was diagnosed with bilateral wrist sprain. See July 2015 VA examination for wrist conditions; August 2015 Physical Evaluation Board Proceedings. Clarification is needed as to what current left wrist disabilities are support and if there is a medical link to service. Finally, the Board notes that the September 2020 Board decision found no evidence of a period of ACDUTRA that corresponds with the Veteran’s reported wrist injury from a falling shelf in August or September 2009. However, the evidence does show the Veteran had a period INACDUTRA in September 2009 that would allow entitlement to service connection based on an injury in the line of duty. May 2020 VA Form 21-0820C; 38 U.S.C. § 101(24)(C); 38 C.F.R. § 3.6(a). The Veteran has also asserted to including his wrists while exercising in October 2009, which also corresponds to a period of INACUDTRA. See June 2010 VA examination; May 2020 VA Form 21-0820C. In resolving any reasonable doubt in favor of the Veteran, the Board finds that the Veteran’s reported wrist injuries from a falling shelf and while exercising occurred during a period of INACDUTRA. The question remaining here is whether there is a medical link between the Veteran’s current left wrist disability or disabilities and his injuries during his periods of INACDUTRA. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate medical professional to determine the nature and cause of the Veteran’s current left wrist disabilities. The medical professional should respond to the following: (a) Identify what left wrist disabilities the Veteran has or has had during the period on appeal. The examiner should specifically discuss De Quervain’s tenosynovitis, carpal tunnel syndrome, and wrist sprain. (b) For each identified left wrist disability, is it at least as likely as not (a 50 percent or greater probability) that it began in (or is otherwise related to) the Veteran’s military service? For the purpose of this opinion, the examiner should assume that the Veteran’s report to his December 2009 private treatment provider that he injured his wrist from a falling shelf around September 2009 to have occurred during a period of INACDUTRA. The examiner should also consider the Veteran’s report to the June 2010 VA examiner that he injured his wrist exercising in October 2009 as having occurred during a period of INACDUTRA. A rationale is requested for any opinion given. (c) For each of the identified left wrist disabilities, the examiner should also provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the disability is aggravated (permanently made worse) during a period of active duty. The examiner should specifically discuss the November 2014 Statement of Medical Examination and Duty Status showing that the Veteran had a fall injury to his wrist and ankle. The examiner should consider and discuss the Veteran’s lay testimony and assertions regarding any pertinent complaints and symptoms. (Continued on the next page)   A rationale is requested for any opinion given. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Lin 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.