Citation Nr: 21014886 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 16-10 554 DATE: March 16, 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 on active duty in the United States Air Force from March 1, 1982 to March 2006. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an October 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. In June 2019, the Board remanded the claims to obtain examinations with medical opinions on direct and secondary service-connection. August 2020 rating decision by the RO granted service connection for lower left extremity radiculopathy. Thus, the issue is no longer in appellate review. 1. Entitlement to service connection for left upper extremity carpal tunnel syndrome. 2. Entitlement to service connection for right upper extremity carpal tunnel syndrome. The Veteran contends that his left and right upper extremity carpal tunnel syndrome is related to service. Upon remand, in June 2020, a VA examiner opined that the Veteran’s medical records support that the currently diagnosed bilateral carpel tunnel syndrome is less likely than not (less than 50 percent probability) incurred in or caused by the specific in-service illness, event, or injury. The examiner stated that service records are silent for diagnosis or treatment for carpel tunnel syndrome. The examiner further opined that the medical records support that the claimed left upper extremity carpal tunnel syndrome diagnosed as bilateral carpel tunnel syndrome is less likely than not (50 percent or greater probability) proximately due to or the result of his service-connected disabilities. The examiner stated that the medical literature is silent for a causal relationship for left upper extremity carpal tunnel syndrome, right ulnar neuropathy and OA of thoracolumbar spine with bilateral sacroiliitis and lumbar IVDS or with right ulnar neuropathy. The examiner stated that these are two separate body systems that do not affect one another, and this well known in the medical community. The examiner was unable to establish a causal relationship. Regarding aggravation, the examiner opined that bilateral upper extremity carpal tunnel syndrome is less as likely than not aggravated beyond its natural progression by his service-connection disabilities. The examiner stated that the medical literature is silent for a causal relationship between left upper extremity carpal tunnel syndrome and the disabilities. Carpel tunnel syndrome comes from median nerve compression which affects the peripheral nerve system which is unrelated to the Thoracolumbar spinal system, IVDS and radiculopathy. The examiner concluded that there is no causal relationship. The Board regrets the further delay but finds that a remand is necessary in this appeal to afford the Veteran full consideration of his claims. The direct service opinion is inadequate because it does not provide a rationale to support the conclusion. Lack of in-service documentation of complaints or diagnosis, by itself, is insufficient rationale to adjudicate the issues on appeal. Additionally, the secondary opinion on aggravation discusses a causal relationship instead of a discussion on progression. For those reasons, new medical opinions are needed to address direct service connection and aggravation of a service-connected disability, with discussion of the Veteran’s medical history, not merely medical literature. A detailed rationale should be provided to support any conclusion reached. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. After completing directive #1, request a supplemental medical opinion from an appropriate clinician to determine the nature and etiology of bilateral upper extremity carpal tunnel syndrome. A new examination should be undertaken if deemed necessary. The examiner should review the claims file, then opine on the following: Is it at least as likely as not (50 percent or greater probability) that the Veteran’s left and right upper extremity carpal tunnel syndrome is caused by or incurred in military service? Is it at least as likely as not (50 percent or greater probability) that the Veteran’s left and right extremity carpal tunnel syndrome is aggravated beyond its natural progression by service-connected disabilities?   The opinion should include a discussion of the Veteran’s medical history and address his lay reports. A detailed rationale should be provided to support the conclusion. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Wilson, 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.