Citation Nr: 21014130 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 14-37 255 DATE: March 11, 2021 REMANDED Entitlement to service connection for bilateral carpal tunnel syndrome (CTS) is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1969 to September 1970, to include overseas service in Vietnam. The Veteran appealed an August 2012 rating decision by the Agency of Original Jurisdiction (AOJ). A Board of Veterans’ Appeals (Board) hearing was held in April 2015. A transcript is of record. In August 2017 and November 2019, the Board remanded the Veteran’s claims to the AOJ for further action consistent with the Board’s remand directives. The claims are back before the Board for further appellate proceedings. The Board finds there has been substantial compliance with its remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). However, the Board finds that additional devilment is required. Contentions have been made, as noted in previous Board decisions, that the Veteran’s bilateral CTS is related to Agent Orange exposure, due to the lifting of 5 to 10-pound pots during service, and that his CTS may be a type of neuropathy. See January 2013 notice of disagreement (NOD); April 2015 Board hearing tr. at 10; September 2017 Veteran statement. Negative nexus opinions are of record that note a bilateral diagnosis of CTS and consider Agent Orange exposure and the lifting of pots. See December 2019 VA opinion; August 2020 correspondence. The Veteran’s 1970 service treatment records (STRs) noted that the Veteran got his right finger caught which caused numbness. See also April 2015 Board hearing tr. at 10. The Veteran’s representative recently alleged that his CTS is secondary to his service-connected diabetes. See January 2021 informal hearing presentation (IHP). These theories of entitlement have not been addressed in a medical nexus opinion. Therefore, remand is required for a new VA opinion that considers these theories of entitlement. The matters are REMANDED for the following action: 1. Obtain any outstanding VA and/or private treatment records relevant to treatment the Veteran received for his bilateral CTS that are not already of record. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified, and the record clearly documented. 2. Thereafter, obtain an opinion from a qualified clinician to determine the nature and etiology of the Veteran’s bilateral CTS. The evidentiary record, including a copy of this remand, must be made available to and be reviewed by the reviewing clinician. It is up to the discretion of the reviewing clinician as to whether a new examination is necessary to provide an adequate opinion. After the record review and examination of the Veteran, if deemed necessary, the reviewing clinician is asked to respond to the following inquiries: Is it at least as likely as not that the Veteran’s CTS was incurred in, or otherwise related, to his time on active service, to include exposure to herbicide agents and the lifting of 5 to 10-pound pots? Is it at least as likely as not that the Veteran’s CTS was CAUSED by his service-connected diabetes? Is it at least as likely as not that the Veteran’s CTS was AGGRAVATED by his service-connected diabetes? In rendering these opinions, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran’s reports, he or she must provide an explanation for such rejection. The reviewing clinician is not to improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. A complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 3. After the above development has been completed to the extent possible, readjudicate the claims. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board, if otherwise in order. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Zheng, 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.