Citation Nr: 21042393 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 16-63 470 DATE: July 12, 2021 REMANDED Entitlement to service connection for left side chest pain with radiating pain down left arm is remanded. Entitlement to service connection for burning sensation to bilateral fingertips is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from May 1999 to February 2006, and from August 2006 to July 2009. These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously remanded by the Board in December 2018 for further development. The matters have now been returned to the Board for appellate consideration. 1. Entitlement to service connection for left side chest pain with radiating pain down left arm is remanded. 2. Entitlement to service connection for burning sensation to bilateral fingertips is remanded. Although the additional delay is regrettable, the Board finds that another remand is required before the Veteran's claims for service connection for a left side chest pain with radiating pain down left arm and burning sensation to bilateral fingertips can be properly adjudicated on their merits. When these matters were last before the Board in December 2018, the Board noted that although the Veteran had been afforded a VA neck conditions examination in September 2016, the nexus opinion provided by the VA examiner was inadequate. After providing a negative nexus opinion between the Veteran's claimed disabilities and his service-connected degenerative joint disease of the cervical spine the examiner explained that she could not provide an answer to the requested opinion without resorting to speculation. She suggested that the question might be better answered by a neurologist. The December 2018 Board remand directed the RO to schedule the Veteran for an examination with a neurologist or other appropriate person to determine whether the Veteran had a disability manifested by left sided chest pain and/or a burning sensation to bilateral fingertips that was at least as likely as not proximately due to or aggravated by the Veteran's service-connected cervical spine disability or service-connected left shoulder disability. Pursuant to the December 2018 remand, the Veteran was afforded a VA peripheral nerves conditions examination in November 2019. The examiner determined that the Veteran did not have a peripheral nerve condition or peripheral neuropathy, but then noted that the Veteran had symptoms attributable to a peripheral nerve condition in his left upper extremity, including moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness. The Board notes that these findings are contradictory. Although the examiner did provide negative nexus opinions for the two claimed disabilities, they did not address an orthopedic consult treatment record dated June 8, 2011 which noted that the axillary pain the Veteran had in his left upper extremities was likely related to cervical spine pathology and that his multilevel degenerative joint disease would be a "good explanation for the fingertip dysesthesia and radiating arm pain." See Medical Treatment Record Government Facility, received January 2013. Moreover, the examination was conducted by a nurse practitioner, not a neurologist as recommended by the September 2016 VA examiner and as requested by the December 2018 remand. Accordingly, on remand, the Veteran should be afforded a new VA examination with a neurologist to determine the nature and etiology of his left side chest pain with radiating pain down left arm and the burning sensation to bilateral fingertips. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination with a neurologist to determine the nature and etiology of his left side chest pain with radiating pain down left arm and the burning sensation to bilateral fingertips. The entire claims file, to include a complete copy of this remand, must be made available to reviewed by the examiner. All indicated tests should be performed, and all findings should be reported in detail. After reviewing the evidence of record, the examiner is asked to address the following: (a.) Please identify all current peripheral nerve disabilities of the left side of the chest and left upper extremities and any peripheral nerve disabilities of the left side of the chest and left upper extremities present at any time during the period on appeal. If any previously diagnosed disorder is no longer present, the examiner must provide an explanation. (b.) For each diagnosed peripheral nerve disability of the left side of the chest and left upper extremities, the examiner must opine as to whether it is at least as likely as not (50 percent or greater probability) that the diagnosed peripheral nerve disability was proximately due to the Veteran's service-connected disabilities, to include chronic left shoulder strain and degenerative disc disease of the cervical spine with mild neuroforaminal stenosis at the right C3-C4 and C5-C6 levels? (c.) If not, the examiner must opine as to whether it is at least as likely as not (50 percent or greater probability) that each diagnosed peripheral nerve disability of the left side of the chest and left upper extremities was aggravated (worsened beyond its natural progression) by the Veteran's service-connected disabilities, to include chronic left shoulder strain and degenerative disc disease of the cervical spine with mild neuroforaminal stenosis at the right C3-C4 and C5-C6 levels? The examiner is advised that a finding that the disability is aggravated beyond the normal progression due to a service-connected disability does not require evidence of permanent worsening and may encompass any additional impairment in earning capacity resulting from an already service-connected condition. In providing these opinions, the examiner is specifically asked to address the orthopedic consult treatment record dated June 8, 2011 which noted that the axillary pain the Veteran had in his left upper extremities was likely related to cervical spine pathology and that his multilevel degenerative joint disease would be a "good explanation for the fingertip dysesthesia and radiating arm pain." See Medical Treatment Record Government Facility, received January 2013. The examiner must provide any and all opinions as to etiology in the form of a probability and must provide a complete rationale for any opinion expressed. 2. After completing the above development, and any other development deemed necessary, readjudicate the issue on appeal. If any benefit sought on appeal remains denied, provide an additional supplemental statement of the case to the Veteran and his representative, and return the appeal to the Board for appellate review, after the Veteran and his representative have had an adequate opportunity to respond. T.D. JONES Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Fairlie, 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.