Citation Nr: 21015750 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 18-02 608 DATE: March 18, 2021 ORDER New and material evidence having been received, the claim for service connection for left carpal tunnel syndrome is reopened. REMANDED Entitlement to service connection for left carpal tunnel syndrome is remanded. Entitlement to service connection for left ulnar entrapment is remanded. Entitlement to service connection for a cervical spine disorder is remanded. Entitlement to service connection for left ear hearing loss is remanded. FINDINGS OF FACT 1. In a September 2010 rating decision, service connection for left carpal tunnel syndrome was denied on the basis that there was no evidence showing a current diagnosis. 2. Evidence received after the September 20100 denial relates to unestablished facts necessary to substantiate that claim of service connection. CONCLUSION OF LAW New and material evidence has been received to reopen the claim for entitlement to service connection for left carpal tunnel syndrome. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active service from March 1988 to March 1994, from October 2000 to April 2001, from June to September 2001, and from September 2002 to April 2003. He testified before the undersigned Veterans Law Judge during an October 2020 hearing. This matter is on appeal from an October 2016 rating decision. New and Material Evidence In this case, the Veteran did not submit a Notice of Disagreement (NOD) in response to a September 2010 rating decision denying service connection for left carpal tunnel syndrome on the basis that there was no evidence showing a current diagnosis. 38 U.S.C. § 7105. Evidence received since that decision includes a September 2016 VA examination showing a current diagnosis of left carpal tunnel syndrome. This evidence is new to the record, as it shows a current diagnosis; relates to unestablished facts necessary to substantiate that claim for service connection; and raises a reasonable possibility of substantiating the claim. The claim is thus reopened. 38 C.F.R. § 3.156(a). REASONS FOR REMAND 1. Entitlement to service connection for left carpal tunnel syndrome is remanded. The Board of Veterans’ Appeals (Board) cannot make a fully-informed decision on the issue of service connection for left carpal tunnel syndrome because no VA examiner has provided an opinion addressing the Veteran’s hearing testimony of ongoing symptoms since service. A September 2016 VA examiner provided a negative nexus opinion; the rationale included the absence of supporting evidence of a left carpal tunnel treatment/condition in the service medical records. A remand for a VA opinion addressing the Veteran’s testimony of ongoing symptoms since service is necessary. 2. Entitlement to service connection for left ulnar entrapment is remanded. The Board cannot make a fully-informed decision on the issue of service connection for left ulnar nerve entrapment because no VA examiner has provided an opinion addressing the Veteran’s hearing testimony of ongoing symptoms since service. A September 2016 VA examiner provided a negative nexus opinion; the rationale included the Veteran's service medical records not supporting the currently diagnosed condition, and the absence of supporting evidence of nerve entrapment treatment/condition in the service medical records. A remand for a VA opinion addressing the Veteran’s testimony of ongoing symptoms since service is necessary. 3. Entitlement to service connection for a cervical spine disorder is remanded. The Board cannot make a fully-informed decision on the issue of service connection for a cervical spine disorder because no VA examiner has provided an opinion addressing the Veteran’s hearing testimony of ongoing symptoms since service. A September 2016 VA examiner provided a negative nexus opinion; the rationale included the absence of supporting evidence of a cervical spine injury treatment/condition in the service medical records. A remand for a VA opinion addressing the Veteran’s testimony of ongoing symptoms since service is necessary. 4. Entitlement to service connection for left ear hearing loss is remanded. The Board cannot make a fully-informed decision on the issue of service connection for left ear hearing loss because the September 2016 VA examiner did not use the “clear and unmistakable” standard in opining whether or not preexisting left ear hearing loss preexisted service and was aggravated by service. A remand for a new VA opinion is necessary. The matters are REMANDED for the following action: 1. In accordance with the provisions of 38 C.F.R. § 3.159(c)(1), make efforts to obtain all records identified by the Veteran, including any outstanding VA treatment records. 2. Obtain an addendum medical opinion from the September 2016 VA peripheral nerve conditions and neck conditions examiner (or, if unavailable, from a medical professional with appropriate expertise) to determine the etiology of the diagnosed left carpal tunnel syndrome, left ulnar nerve entrapment, and cervical spine disorder. The examiner is requested to review the record and offer an opinion as to whether it is at least as likely as not (i.e., probability of approximately 50 percent) that the diagnosed left carpal tunnel syndrome, left ulnar nerve entrapment, and cervical spine disorder had their onset in or are due to any period of active service (March 1988 to March 1994; October 2000 to April 2001; June to September 2001; and September 2002 to April 2003). The examiner should consider the Veteran’s October 2020 testimony regarding ongoing left carpal tunnel, left ulnar nerve, and cervical spine symptoms since service. The examiner is reminded that the absence of evidence is not a sufficient rationale for a negative nexus opinion. If, and only if, a positive opinion for the cervical spine is provided, the examiner is also requested to opine as to whether it is at least as likely as not (i.e., probability of approximately 50 percent) that the diagnosed left carpal tunnel syndrome and left ulnar nerve entrapment are caused or are aggravated by the cervical spine disorder. (If left carpal tunnel syndrome and left ulnar nerve entrapment are found to have been aggravated by the cervical spine disorder, the examiner should quantify the approximate degree of aggravation.) A complete rationale should be given for all opinions and conclusions expressed. 3. Obtain an addendum medical opinion from the September 2016 VA hearing loss examiner (or, if unavailable, from a medical professional with appropriate expertise) to determine the etiology of the diagnosed left ear hearing loss. The examiner is requested to review the record and offer opinions that address the following: (a) Is there clear and unmistakable evidence (obvious, manifest, and undebatable) that any currently diagnosed left ear hearing loss preexisted any of the Veteran’s periods of active service (March 1988 to March 1994; October 2000 to April 2001; June to September 2001; and September 2002 to April 2003). (b) If so, state whether there is clear and unmistakable evidence that preexisting left ear hearing loss was NOT aggravated (i.e., permanently worsened) during service; or whether, it is clear and unmistakable that any increase in service was due to the natural progress of the disorder. (c) If left ear hearing loss is NOT found to clearly and unmistakably exist prior to the Veteran’s service, the examiner should opine as to whether it is at least as likely as not (i.e., probability of approximately 50 percent) that any diagnosed left ear hearing loss is related to the Veteran’s periods of active service. The examiner should consider the Veteran’s October 2020 testimony regarding being told he had wax in the ear at the time of his December 1987 enlistment examination possibly accounting for his left ear hearing loss noted at entry. A complete rationale should be given for all opinions and conclusions expressed. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Barstow, 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.