Citation Nr: 21015604 Decision Date: 03/18/21 Archive Date: 03/17/21 DOCKET NO. 08-29 430 DATE: March 18, 2021 REMANDED Entitlement to service connection for a left wrist disability is remanded. REASONS FOR REMAND The Veteran served on active duty for training (ACDUTRA) in the Alabama Army National Guard from July 1988 to November 1988 and had active duty service from November 1990 to September 1991. This matter was previously remanded in June 2017. The Board denied the claim in September 2019. The Veteran appealed to the Court of Appeals for Veterans Claims (CAVC). In September 2020 CAVC approved a Joint Motion for Remand (JMR), returning the matter to the Board. 1. Entitlement to service connection for a left wrist disability is remanded. The June 2017 Board remand directed the RO to afford the Veteran a VA examination, including all reasonable measures if the Veteran is incarcerated. This included examination at the prison by: (1) VHA personnel; (2) prison medical providers VA expense; or (3) fee-basis providers contracted by VHA. If no such examination could be provided, the RO was directed to have the Veteran’s records provided to a VA examiner for review and a medical nexus opinion. The September 2019 Board decision noted that the Veteran was not able to be transported and that outside personnel were not permitted to conduct the examination at the prison. However, as noted by the parties in the September 2020 JMR, there was no record of whether the examination could be conducted by prison medical providers at VA’s expense. There is no explanation in the record as to why this could not be done. There was similarly no indication that the Veteran’s records were reviewed for a medical opinion. As such, a remand is necessary to comply with the June 2017 remand directives. The matter is REMANDED for the following action: 1. Obtain any outstanding medical records from the Alabama Department of Corrections, to include the Frank Lee Correctional Facility, the Elmore Correctional Facility, and the W.E. Donaldson Correctional Facility. 2. Attempt to obtain a VA examination from prison medical personnel. The purpose of the examiner is to determine the nature and etiology of the Veteran’s left wrist disability. The claims files must be made available and reviewed by the examiner. All necessary tests and studies should be performed and reported in detail. If the Veteran cannot be afforded an examination by prison medical personnel, such should be noted in the claims file with an explanation and then the Veteran’s records should be provided to a VA evaluator for review and a medical nexus opinion must be provided. The examiner’s attention is specifically directed to the service treatment records, to include the May 1988 examination report, the January 30, 1991 treatment report of a left wrist x-ray findings, the Veteran’s report of a left wrist injury in 1987, the February 1991 medical evaluation board report, the November 1991 private physician statement regarding treatment for the left wrist sprain in November 1986, operative reports dated in January 1991 and August 1993, the June 1993 CT scan report and post service VA treatment records, including May 29, 1993 and February 16, 2001 VA clinical treatment notes. After reviewing the claims file and examining the Veteran, the examiner should specifically address the following: (a) Identify any left wrist disability that pre-existed the veteran’s period of active duty from November 1990 to September 1991. A complete explanation for any such opinion must be provided. (b) With respect to any pre-existing disability of the left wrist, the examiner must indicate whether it is at least as likely as not that any such disability was aggravated during this period of service from November 1990 to September 1991. “Aggravation” of a preexisting disability refers to an identifiable, incremental, permanent worsening of the underlying condition, as contrasted with temporary or intermittent flare-ups of symptomatology. A complete explanation for any such opinion must be provided. (c) If there was aggravation, the examiner must indicated whether or not it is clear and unmistakable (i.e. undebatable) that the permanent aggravation was due to the natural progress of the disease. A complete explanation for any such opinion must be provided. (d) If the examiner finds the Veteran has a disability of the left wrist that did not pre-exist the period of active service from November 1990 to September 1991, the examiner should opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s left wrist disability is etiologically related to, or was incurred during, his active military service. A detailed rationale for each portion of the opinion must be provided. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Rekowski 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.