Citation Nr: 21027251 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 17-58 389 DATE: May 5, 2021 REMANDED Service connection for numbness and pain of the right foot, to include gout, is remanded. Service connection for numbness and pain of the left foot, to include gout, is remanded. Service connection for numbness and pain of the right wrist and right hand, to include gout, is remanded. Service connection for numbness and pain of the left wrist and left hand, to include gout, is remanded. Whether new and material evidence has been presented to reopen a claim for service connection for bilateral carpal tunnel syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1988 to August 1991. These matters come before the Board of Veterans' Appeals (Board) on appeal from August 2015 and May 2016 rating decisions. In March 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. 1. Service connection for numbness and pain of the right foot, to include gout, is remanded. 2. Service connection for numbness and pain of the left foot, to include gout, is remanded. 3. Service connection for numbness and pain of the right wrist and right hand, to include gout, is remanded. 4. Service connection for numbness and pain of the left wrist and left hand, to include gout, is remanded. The Veteran is seeking service connection for numbness and pain of the bilateral feet, wrists, and hands. He claims these conditions are due to cold-related injuries he experienced during his active service and/or secondary to medication taken to treat his service-connected herpes simplex II. See March 2021 Board Hearing Testimony. See also August 2016 Correspondence. Further, he asserts that the numbness and pain of his wrists and hands is secondary to the numbness and pain of his feet, including gout. Service connection may be granted for a disability resulting from disease or injury incurred in, or aggravated by, active military service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2019). Service connection may also be granted for any disease initially diagnosed after service when the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d) (2019). To establish direct service connection for such a disability, the record must reflect: (1) competent evidence of the current existence of the disability for which service connection is being claimed; (2) competent evidence of a disease contracted, an injury suffered, or an event witnessed or experienced in active service; and (3) competent evidence of a nexus or connection between the disease, injury, or event in service and the current disability. Shedden v. Principi, 381 F.3d 1163 (2004). First, the Board notes the Veteran's CAPRI records reflect diagnoses of pain in the joint involving the ankle and foot, paresthesia of the foot, pain of the left foot, polyneuropathy, and gout. Further, the Veteran's service medical records from December 1989 reflect complaints of bilateral toe pain for two weeks, which he reported began after being exposed to cold and wet weather for two weeks. He reported complaints of throbbing pain of the toes, numbness, and discomfort. He was assessed for mild frostbite due to exposure to cold temperatures. Regarding a nexus between the in-service event and the Veteran's current conditions, the Veteran received a VA examination in April 2016. The examiner provided a negative opinion. The examiner found the Veteran's peripheral neuropathy of the hands and feet is attributed to the Veteran's use of alcohol. The examiner notes the Veteran has a history of alcohol and substance abuse, which began at the age of 16 and continued into his military service. The examiner also notes the Veteran was incarcerated three time due to substance abuse and has continued to use alcohol and drugs since that time. The Board finds the examiner's opinion to be inadequate because the examiner did not provide sufficient rationale as to why or how the Veteran's current conditions are connected to any alcohol abuse. The Veteran's attorney has stated that the Veteran spent significant time incarcerated and away from alcohol. See March 2021 Board Hearing Transcript. Further, no opinion was provided as to whether the Veteran's claimed conditions are related to his medication taken for service-connected herpes simplex II, e.g., Acyclovir. See September 2018 Correspondence. As such, a remand is required for an addendum medical opinion. 5. Whether new and material evidence has been presented to reopen a claim for service connection for bilateral carpal tunnel syndrome is remanded. In an August 2015 rating decision, the RO found that new and material evidence had not been presented to reopen the Veteran's claim for service connection for carpal tunnel syndrome of the left and right upper extremities. The Veteran was notified of this decision and of his appellate rights by letter dated August 20, 2015. He submitted a timely notice of disagreement as to the denial of his petition to reopen his claims for service connection for bilateral carpal tunnel syndrome on August 12, 2016. To date, VA has not issued a statement of the case. The AOJ must issue a statement of the case (SOC) and provide the Veteran with instructions on perfecting his appeal of this claim to the Board, if he so chooses. See Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records and associate them with the electronic claims file. 2. Then, schedule the Veteran for an appropriate VA examination of his hand/wrists and feet. The entire claims folder must be made available to the examiner for review. A notation to the effect that this record review took place must be included in the report of the examiner. The examination must include any necessary diagnostic testing or evaluation, and the examiner must fully set forth all current complaints, pertinent clinical findings, and diagnoses. The examiner must also elicit and document a complete history of the Veteran's subjective symptoms within the examination report. (a.) The examiner should identify all disorders manifested by pain and numbness of the feet and hands/wrists (other than carpal tunnel syndrome), to include gout, polyneuropathy, etc. (b.) The examiner is requested to render an opinion as to whether it is least as likely as not (i.e., a 50 percent or higher probability) that any disorder manifested by pain and numbness of the feet and hands/wrists (other than carpal tunnel syndrome), to include gout, polyneuropathy, etc., had its onset during service or is related to any incident of service, to include the Veteran's exposure to cold weather for two weeks and his in-service diagnosis of "frostbite due to prolonged exposure to cold." See December 1989 Service Treatment Record. In developing these opinions, the examiner should consider: i. The Veteran's statements regarding onset and continuity of symptomatology of his claimed disabilities, i.e., since the in-service incident. See e.g., March 2021 Board Hearing Transcript; and ii. The journal article submitted in March 2021 titled "Chronic non-freezing cold injury results in neuropathic pain due to sensory neuropathy"; and iii. The Veteran's assertion that he did not use alcohol while he was imprisoned for approximately 11 years post service. * The examiner must consider the Veteran's description of his in-service cold injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? (c.) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) any disorder manifested by pain and numbness of the feet and hands/wrists (other than carpal tunnel syndrome), to include gout, polyneuropathy, etc., was caused by the Veteran's herpes simplex 2 to include by the medication he takes for this condition, e.g., Acyclovir. See September 2018 Correspondence. (d.) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) any disorder manifested by pain and numbness of the feet and hands/wrists (other than carpal tunnel syndrome), to include gout, polyneuropathy, etc., is/was aggravated (i.e., worsened) by the Veteran's herpes simplex 2 to include by the medication he takes for this condition, e.g., Acyclovir. (e.) If it is determined that any disorder manifested by pain and numbness of the feet, to include gout, polyneuropathy, etc., is related to service or to the Veteran's service-connected herpes simplex 2, then the examiner should also provide an opinion as to whether any disorder manifested by pain and numbness of the hands/wrists (other than carpal tunnel syndrome) was either caused by, or aggravated by, that bilateral foot disability. A complete explanation must be provided in support of the conclusion reached. 3. Furnish the Veteran with a statement of the case regarding the petition to reopen his claims for service connection for carpal tunnel syndrome of the left and right upper extremities. Provide the Veteran with written instruction on perfecting his appeal to the Board. P. M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Denton, Buck 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.