Citation Nr: 21026137 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 17-08 760 DATE: April 29, 2021 REMANDED Entitlement to service connection for a left wrist disability is remanded. REASONS FOR REMAND This matter was most recently before the Board of Veterans’ Appeals (Board) in October 2020, when it was remanded for a new opinion due to a February 2020 VA examiner’s failure to comply with the Board’s December 2019 remand directives regarding the Veteran’s service connection claim for a left wrist disability. In December 2019, the Board directed the selected examiner to address the following when opining on the etiology of the claimed disability: service treatment records containing a notation of left wrist pain in May 1994; an April 1994 report of left wrist x-rays that were negative for pathology; a June 1994 treatment record for left wrist pain, at which time the Veteran reported a 10-year history of left wrist pain; a July 1983 occupational health clinic report noting a hobby of weightlifting; a service notation of muscle overuse strain in August 1996; the Veteran’s athletic endeavors during his 21 years of active service from August 1976 to May 1997; his post-service activities; and his reported history of continuous left wrist symptoms since separation from active service. In its October 2020 remand, the Board explicitly noted an opinion based solely on the absence of documented treatment following separation from active service is inadequate to make an informed decision on the Veteran’s claim, reiterating the fact that the Veteran did not seek treatment for a left wrist disability for a duration of time is not, on its own, dispositive evidence that his in-service symptoms did not persist following his separation from active service, and stressed the requirement that the selected examiner address the Veteran’s full medical history in his or her opinion. The Board also included three specific questions in its October 2020 remand directives to assist the selected examiner in providing the need information, to include an inquiry regarding a potential nexus based on a continuity of symptomatology. Yet, the sole rationale provided by the post-remand, November 2020 VA examiner is “there is no documentation since military service of ongoing treatment for an acute or chronic left wrist condition until 2014 which is over 16 years.” The November 2020 VA examiner also failed to address the Board’s inquiry regarding a continuity of symptomatology. Since there has not been substantial compliance with the Board’s prior remand directives, the Veteran’s appeal must be remanded for a new opinion. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matter is REMANDED for the following action: Schedule the Veteran for a new examination regarding his service connection claim for a left wrist disability. All necessary testing must be performed, to include imaging studies. The selected examiner must review the claims file, to include the Board’s prior remands, before providing the requested opinion. The selected examiner must provide an opinion addressing whether the Veteran’s current left wrist disability is at least as likely as not (50 percent probability or greater) the result of an in-service disease or injury. If the Veteran is determined to have arthritis after imaging studies are completed, the examiner must also address whether arthritis at least as likely as not (50 percent probability or greater) manifest within one year of separation from service or was noted during service with continuity of the same symptomatology since service. The Board notes a condition is considered to be “noted during service” when there is symptoms indicative of, but not dispositive of, a chronic disease. (Continued on the next page)   The examiner must be advised the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran’s reports, he or she must provide a reason for doing so. The examiner must address the Veteran’s lay statements regarding continuity of symptomatology since onset and/or since discharge from service or the examination report should be returned to the examiner as incomplete. The examiner may not dismiss the Veteran’s report of symptoms capable of lay observation, such as pain, solely on the basis that they are not recorded in contemporaneous medical records. An opinion based solely on a lack of documented treatment following separation from service will be deemed inadequate. The examiner must at a minimum discuss the following in the context of his or her rationale: service treatment records containing a notation of left wrist pain in May 1994; an April 1994 report of left wrist x-rays that were negative for pathology; a June 1994 treatment record for left wrist pain, at which time the Veteran reported a 10-year history of left wrist pain; a July 1983 occupational health clinic report noting a hobby of weightlifting and a service notation of muscle overuse strain in August 1996; the Veteran’s athletic endeavors during his 21 years of active service from August 1976 to May 1997; his post-service activities; and his reported history of continuous left wrist symptoms since separation from active service. If the foregoing is not discussed in the context of the examiner’s rationale, the examination report must be returned to the examiner as incomplete. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. S. Kyle, 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.