Citation Nr: 21021929 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 17-52 240 DATE: April 14, 2021 REMANDED Entitlement to service connection for chronic right wrist condition, to include as secondary to service-connected right shoulder and service-connected neck condition is remanded. REASONS FOR REMAND The Veteran served in the U.S. Army from March 2000 to March 2005. She is highly decorated, having been awarded the Army Commendation Medal, Army Achievement Medal, National Defense Service Medal, Global War on Terrorism Expeditionary Medal, Global War on Terrorism Service Medal, the Army Service Ribbon, Army Good Conduct Medal, and Overseas Service Bar. This matter comes before the Board of Veterans’ Appeals (Board) from an August 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In November 2020, the Veteran had a hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript has been associated with the electronic claims file. Although the Board sincerely regrets the additional delay, a remand is necessary to ensure that due process is followed and there is a complete record upon which to decide the Veteran’s claim so that she is afforded every possible consideration. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). 1. Service connection for chronic right wrist condition, to include as secondary to service-connected right shoulder and service-connected neck condition is remanded. The Veteran contends that she is due entitlement to service connection for a chronic right wrist condition, to include as secondary to her service-connected right shoulder and service-connected cervical spine (neck condition). Here, the Veteran has a present disability, noted as bilateral carpal tunnel syndrome. The Veteran is also diagnosed with distal ulnar neuropathy in both wrists, as well as medial epicondylitis (golfer’s elbow). The Veteran also has service treatment records (STRs) and a separation exam that show her complaints in-service about her right wrist pain. The Veteran received a VA examination in September 2017. The examination in 2017 was done before the Veteran was formally diagnosed with any of the above disabilities. Additionally, the September 2017 examination was conducted before the Veteran was found to be service connected for her right shoulder disability and her cervical spine condition. The examiner in September 2017 opined that the Veteran’s claimed right wrist condition was less likely than not incurred in or caused by an in-service injury, event, or illness. However, the examiner noted that a neurosurgical evaluation indicated that the Veteran’s wrist symptoms are neuropathic and referred from a primary shoulder condition. The Veteran also received a VA examination in April 2019. The April 2019 examiner noted the Veteran’s diagnosis of ulnar neuropathy and carpal tunnel syndrome but did not list medial epicondylitis under the current diagnoses. Electromyography (EMG) studies showed evidence of moderate carpal tunnel syndrome and distal ulnar neuropathy in the wrist. The examiner concluded the condition was less likely related to service, however, no rationale for this opinion was provided. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The issue is therefore remanded for the Veteran to be afforded a new VA medical opinion. No VA examination is to be scheduled unless the new examiner finds one to be necessary. The evidence of record raises a question of direct service connection. Therefore, the new medical opinion must offer an opinion as to direct service connection for the right wrist disability, as well as an opinion for secondary service connection of the right wrist disability, due to or aggravated by the service connected right shoulder or cervical spine condition. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding the Veteran’s right wrist disability. The claims file and a copy of this remand must be made available to the examiner, and the examiner shall indicate in the addendum that the claims file was completely reviewed. The need for another VA examination is left to the discretion of the medical professional drafting the opinion. The examiner must offer an opinion as to the following: a) whether the Veteran’s right wrist disability, to include but not limited to the carpal tunnel syndrome, distal ulnar neuropathy and medial epicondylitis, are at least as likely as not related to an in-service injury, event, or disease. In offering this direct service connection opinion, the examiner must specifically address records from the Veteran’s March 2003, June 2004, and February 2005 STRs in which the Veteran complains of pain and weakness of the right wrist. In particular, the examiner must discuss the private medical records Kinetic Institute Physical Therapy. b) whether the Veteran’s right wrist disability, to include but not limited to the carpal tunnel syndrome, distal ulnar neuropathy and medial epicondylitis, is at least as likely as not due to or aggravated by the service-connected radiculopathy of the right upper extremity associated with degenerative arthritis of the cervical spine with spinal fusion (claimed as a neck condition), as well as acromioclavicular joint osteoarthritis with supraspinatus and infraspinatus tendinitis of the right shoulder (claimed as right shoulder condition. The examiner must fully address and discuss all lay statements made by the Veteran and her spouse. A complete rationale for all opinions is required. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E.L. Aumiller, 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.