Citation Nr: 21029271 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 16-57 754 DATE: May 13, 2021 REMANDED Entitlement to service connection for a bilateral elbow disability is remanded. Entitlement to service connection for a disability of the left hand is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from December 1971 to October 1973. His decorations include the Vietnam Service Medal and the Combat Action Ribbon. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 2013 rating decision issued by the Department of Veterans Affairs (VA) Lincoln Day One Brokering Center in Lincoln, Nebraska (hereinafter referred to as the "Regional Office" or "RO"). In January 2020, the Veteran testified at a Board video-conference hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. In April 2020, the Board reopened the previously denied claim for service connection for bilateral proximal radial ulnar synostosis and remanded the matter to the agency of original jurisdiction (AOJ) for additional development, along with the issue of entitlement to service connection for a disability of the left hand. After taking further action, the AOJ confirmed and continued the prior denials and returned the case to the Board. 1. Entitlement to service connection for a bilateral elbow disability is remanded. 2. Entitlement to service connection for a disability of the left hand is remanded Although the Board sincerely regrets the additional delay, another remand is necessary to ensure that adequate VA medical opinions have been rendered in compliance with the Board's prior remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). Pursuant to the Board's April 2020 remand, a VA medical opinion was obtained in November 2020. However, the Board finds the opinion inadequate for purposes of adjudication. First, the VA examiner's opinions appear to be based, at least in part, on an inaccurate factual history. The VA examiner expressly stated, "Veterans right elbow did not develop cubital tunnel syndrome. He did not develop ulnar neuropathy of his right arm." See November 2020 VA opinion; see also November 2020 VA examination report (noting the surgical history for the left elbow only). However, VA treatment records reflect that the Veteran underwent a right ulnar nerve release from the cubital tunnel in February 1994. See VA treatment record and operative report (expressly diagnosing extensive scarring, fragmentation, and atrophy of the right ulnar nerve within the cubital tunnel, with evidence of ulnar nerve compression). The VA examiner also determined that the Veteran's bilateral radial ulnar stenosis "is in the nature of a defect (i.e., a structural or inherent abnormality which is more or less static in nature)" as opposed to a disease. However, the VA examiner also found that "it is at least as likely as not that the ulnar neuropathy as a result of the cubital tunnel, left arm is a progression of the congenital left radial ulnar stenosis." Without an adequate rationale in explanation thereof, the noted "progression" of the radial ulnar stenosis appears to be contradictory with the examiner's initial conclusion that radial ulnar stenosis is a defect "more or less static in nature." On remand, the Veteran's recent VA treatment records should be associated with the electronic claims file. These matters are REMANDED for the following action: 1. Obtain copies of records pertaining to any VA treatment the Veteran has received since the time that such records were last procured, following the procedures set forth in 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the record. 2. In accordance with the directives set forth in the April 2020 Board remand, have a VA clinician with appropriate experience review the claims file for purposes of providing opinions with respect to each of the following: (a.) Is it clear and unmistakable that the noted bilateral radial ulnar synostosis preexisted service? (b.) Please indicate whether the Veteran's bilateral radial ulnar synostosis is in the nature of a defect (i.e., a structural or inherent abnormality which is more or less static in nature) or a disease (i.e., a condition capable of improving or deteriorating). (c.) If it is in the nature of a defect, is it as least as likely as not (i.e., is it 50 percent or more probable) that an additional disability became superimposed on the defect during service? If so, please identify the superimposed disability. (d.) If it is in the nature of a disease, is it clear and unmistakable that the condition(s) did not permanently increase in severity beyond the natural progress of the disease? (e.) Is it at least as likely as not that the Veteran currently suffers from symptoms attributable to service, including any disability superimposed upon the noted bilateral radial ulnar synostosis as a result of service? (f.) Is it at least as likely as not that the Veteran has a disability of his left hand that has been (i) caused or (ii) aggravated (i.e., worsened beyond natural progression) by his bilateral radial ulnar synostosis? (g.) Does the Veteran have a disability of the left hand that is otherwise at least as likely as not attributable to service? The need for another examination and/or telephonic or video interview of the Veteran is left to the discretion of the examiner(s) selected to offer the requested opinions. A complete medical rationale for all opinions expressed must be provided. 3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issues on appeal should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Gielow, 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.