Citation Nr: 21027124 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 17-37 086 DATE: May 4, 2021 REMANDED Entitlement to service connection for bilateral carpal tunnel is remanded. REASONS FOR REMAND The Veteran honorably served on active duty in the United States Marine Corps from February 1999 to July 2003. This matter is before the Board of Veterans' Appeals (Board) on appeal from a November 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In April 2016, the Veteran filed a timely Notice of Disagreement (NOD). In June 2017, the RO issued a Statement of the Case. In July 2017, the Veteran filed a timely VA Form 9 appeal to the Board and requested a hearing at a local VA office. In February 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ). This matter was remanded by the Board to the RO in July 2019 and again in September 2020. This matter is now properly before the Board. In January 2020, the Board's remand instructions specifically asked whether the Veteran's carpal tunnel syndrome, status post left carpal tunnel release, began in or is otherwise caused by his active service. The examiner was also asked to consider the Veteran's lay statements, documented treatment for bilateral shoulder pain and bursitis during service. Furthermore, the examiner was asked to address whether the Veteran's carpal tunnel syndrome was either caused by his service-connected bilateral foot disabilities, including use of crutches or, was aggravated by the Veteran's service-connected bilateral foot disabilities or use of crutches. In determining whether the Veteran's bilateral foot disabilities or use of crutches was a source of aggravation of the Veteran's carpal tunnel syndrome, the examiner must attempt to establish a baseline level of severity of the carpal tunnel syndrome prior to aggravation by the service-connected disability. A new VA opinion was obtained indicating that the claimed condition was less likely than not incurred in or caused by the claimed in service injury, event, or illness. The rationale provided was that the Veteran's medical records do not support that any current diagnosed conditions related to the Veteran's claimed bilateral carpal tunnel syndrome are at least as likely as not incurred in or caused by the bilateral carpal tunnel syndrome during service. The examiner noted that the Veteran was diagnosed with carpel tunnel syndrome in 2014, that the separation examination in 2003 was silent for wrist or hand pain and numbness, and that the only evidence of record was when the Veteran reported that he went on sick call for his wrist pain while in service in which Motrin was prescribed. The examiner referred that obesity could be a risk factor for carpal tunnel syndrome. The examiner also provided an opinion based on secondary service connection. The examiner opined that there were no medical bases to support that the shoulder strain caused compression of the Veteran's median nerve. The examiner determined that there was no evidence to say that the shoulder pain caused or aggravated his Carpal Tunnel Syndrome. The Veteran underwent plantar fasciitis release of both the left foot (in July 2000) and the right foot (in September 2002). Separation examination in 2003 is completely silent for wrist or hand pain and numbness. The examiner further noted that there are no medical records on file to support that the Veteran continued to have chronic wrist pain or numbness in service and in the first few years after discharge. The Veteran did not report wrist pain or numbness during compensation and pension exam in 2003. The examiner further opined that these facts support that the pain and numbness the Veteran experienced in service, whether it was associated with the use of crutches or not, was a temporary condition and resolved before discharge. The examiner also addressed the issue of aggravation of a nonservice connected condition by a service-connected condition. The examiner opined that there is no evidence to support that the numbness or pain the Veteran experienced in service after using crutches in 2001 or 2002 related to the numbness and pain of Carpal Tunnel Syndrome. The examiner opined that the onset was from 2013 or 2014. The examiner also opined that the Veteran's obesity and diabetes which can cause and aggravate carpal tunnel syndrome. The Board provided specific remand instructions in which the August 2020 VA examiner did not comply. The examiner failed to address whether the Veteran's bilateral carpal tunnel syndrome, status post left carpal tunnel release, began in or otherwise caused by his active service. The examiner opined that the "claimed condition was less likely than not incurred in or caused by the claimed in service injury, event, or illness." The rationale provided was that the Veteran's medical records do not support that any current diagnosed conditions related to the Veteran's claimed bilateral carpal tunnel syndrome, are at least as likely as not incurred in or caused by the bilateral carpal tunnel syndrome during service. The rationale provided by the examiner does not answer the question as to whether it is at least as likely as not that the Veteran's bilateral carpal tunnel syndrome status post left carpal tunnel release began in or was otherwise caused by his active service. The Veteran has provided testimony that his military occupation was one that required repetitive motion. The Veteran has also provided testimony before the undersigned VLJ that he had symptoms of numbness in and since service. The question before the examiner is particular whether it is at least as likely as not that the Veteran's symptoms in and since service are related to his active service. The examiner's answer seems to indicate that the carpal tunnel syndrome felt while in service is not related to the carpal tunnel that the Veteran has after service. The Board requests that the examiner provide a new opinion as to the nature and etiology of the Veteran's symptoms of carpal tunnel syndrome while in service which continued after service. Compliance with remand directives is not optional or discretionary, and the Board errs as a matter of law when it fails to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). Therefore, remand is necessary to consider the Veteran's symptoms in and since service and the nature and etiology of the Veteran's currently diagnosed carpal tunnel syndrome. The matters are REMANDED for the following action: 1. Obtain medical records related to the Veteran's carpal tunnel syndrome, and ensure that all medical records from Austin, Dallas and Sherman VAMCs are obtained. 2. Once the medical records are received and associated with the Veteran's claims file, obtain an addendum medical opinion from an appropriate clinician. If the examiner determines whether a physical examination is necessary to provide the requested opinions such should be scheduled. The entire claims file must be made available to the reviewing examiner and the examiner shall indicate in the report that the claims file was reviewed. The examiner must address the following questions: a. Is the Veteran's carpal tunnel syndrome at least as likely as not related to any in-service injury, event or disease? Please consider the Veteran's lay statements that he felt numbness and pain in his wrists in and since service. b. Please provide an opinion as to the nature and etiology of the numbness and pain the Veteran felt in his wrists during service and the likelihood that the same nature and etiology is related to the cause of the Veteran's current diagnosis of carpal tunnel syndrome. c. Please provide an opinion as to whether the Veteran's military occupational specialty, and the repetitive motion required for the Veteran's military occupational specialty could have caused or aggravated the Veteran's carpal tunnel syndrome. The examiner should recognize that the Veteran is competent to testify as to his pain and symptoms while in service and since service. 3. A complete rationale must be provided for all opinions. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should provide an explanation stating why this is so. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Hellina Y. Hailu, 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.