Citation Nr: 21020781 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 15-07 064 DATE: April 8, 2021 REMANDED Entitlement to service connection for right hand disability, diagnosed as carpal tunnel syndrome, is remanded. Entitlement to service connection for left hand disability, diagnosed as carpal tunnel syndrome, other than service-connected ulnar neuropathy, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from October 1981 to October 2007. In June 2018 and April 2020, the Board remanded the appeal for additional evidentiary development. Unfortunately, the Board finds that another remand is necessary in order to fully comply with the prior remand directives. Entitlement to service connection for right hand disability, diagnosed as carpal tunnel syndrome, and a left hand disability, diagnosed as carpal tunnel syndrome, other than service-connected ulnar neuropathy, are remanded. In relevant part, most recently, the Board remanded these issues for an addendum opinion as the December 2018 medical opinion concerning the Veteran’s carpal tunnel syndrome was inadequate. The Board directed the examiner to specifically address the service treatment records showing September 2006 left hand/arm complaints and a November 2006 right upper extremity EMG, as well as the Veteran’s complaints of continuous symptoms since service. In an October 2020 opinion, the examiner opined that the Veteran’s right hand pain was due to carpal tunnel syndrome. However, the Veteran’s carpal tunnel syndrome was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner rationalized that a review of the medical records do not provide documentation indicating that the Veteran complained of or was treated for carpal tunnel syndrome or any associated symptoms during his military service. In a subsequent November 2020 opinion, the examiner provided an additional rationale that there were no complaints or treatment found for the right hand; therefore, right hand rationale should be negative and state less likely than not. Review of the 2006 EMG does not change the current negative right upper extremity opinion. However, the examiner did not address the abnormal findings on the EMG that showed reduced SNAP amplitude for the right ulnar nerve and whether this was an early indication of carpal tunnel syndrome. Likewise, the examiner did not address the lay evidence of continuing symptomatology as well as the medical evidence showing obviously some sort of symptoms in 2006 for the Veteran to be referred for an EMG as well reports of hand pain shortly after the Veteran’s retirement from service in 2008. Importantly, at the December 2018 examination, the Veteran reported the onset of his symptoms in 2005. Accordingly, these opinions are inadequate for appellate review as the examiner failed to consider all of the relevant medial and lay evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Likewise, with respect to the left hand, the examiner found the Veteran’s pain was attributable to left ulnar neuropathy, which was related to service. However, the Veteran has already been awarded service connection for this disability. Importantly, the examiner failed to provide an etiological opinion with respect to the Veteran’s left carpal tunnel syndrome. In light of the above, the Board finds that a new VA examination with opinion is necessary to address the etiology of the Veteran’s bilateral carpal tunnel syndrome. The Board find an examination is needed so that a full description of the Veteran’s symptoms and onset of such symptoms can be obtained. The matters are REMANDED for the following action: 1. Obtain additional VA clinical records. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his right and left carpal tunnel syndrome. The claims file must be reviewed. The examiner must opine whether it at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, (3) was noted during service with continuity of the same symptomatology since service, or (4) related to an in-service injury, event, or disease, including the Veteran’s duties. The examiner must provide a detailed rationale for any opinion expressed. The examiner should specifically address the service treatment records showing September 2006 left hand/arm complaints and November 2006 right upper extremity EMG showing reduced SNAP amplitude for the right ulnar nerve, as well as the Veteran’s complaints of continuous symptoms since service beginning in 2005. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.N. Moats 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.