Citation Nr: 22011631 Decision Date: 03/01/22 Archive Date: 03/01/22 DOCKET NO. 16-27 095 DATE: March 1, 2022 REMANDED Entitlement to service connection for bilateral carpal tunnel syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1984 to April 1988. In February 2017, the Veteran testified at a hearing before a Veterans Law Judge (VLJ) of the Board who is no longer employed at the Board; therefore, the Veteran was given opportunity to testify at another hearing before a different VLJ of the Board who ultimately would decide this appeal. But, in February 2022, the Veteran chose not to have another hearing. A transcript of the February 2017 hearing is of record. In December 2020, the Board denied this claim, and, in response, the Veteran appealed to the higher U. S. Court of Appeals for Veterans Claims (Court/CAVC). In a September 2021 Order, the Court vacated the Board's decision denying this claim and remanded it back to the Board for further development and readjudication pursuant to agreement in a Joint Motion for Partial Remand (JMPR). In the JMPR, the contesting parties agreed there was error in not ensuring that VA had complied with its duty to assist by obtaining an adequate medical opinion. Of record is a November 2019 Disability Benefits Questionnaire (DBQ) in which the examiner found no etiologically link between the carpal tunnel syndrome being claimed and the Veteran's military service because there were no symptoms noted in his service treatment records (STRs). However, the examiner did not reconcile this unfavorable opinion with a March 2017 private opinion or adequately discuss the Veteran's work in service as it may or may not relate to his carpal tunnel syndrome. The Veteran asserts that his duties as an aircraft mechanic during service caused his current carpal tunnel syndrome. He testified that his duties as an aviation structural mechanic involved painting airplanes, cleaning them, manufacturing parts, and repetitive motion throughout the day from holding a bucking bar and driving rivets. The Veteran's STRs do not show any complaint of carpal tunnel syndrome. His March 1988 separation examination of his upper extremities and neurologic system determined they were normal. On the corresponding Report of Medical History, he denied neuritis, arthritis, rheumatism, or bursitis and did not note any complaints suggestive of neurologic symptoms or wrist trouble. The Veteran separated from service in April 1988. The Board finds that any contention of relevant symptoms in service and continuing since service is not credible. Not only are there no STRs suggesting relevant complaints, but the Veteran has been inconsistent as to the onset date. When he filed his claim in 2011, he asserted his disability had begun in 1999 (which would have been approximately ten years after his separation from service and while working as a pipefitter). See VA Form 21-526. When testifying in 2017, he asserted instead that the symptoms had begun in approximately 1989 while working for the Civil Service/Native Alameda, but still a year after his military service ended, and that he had release surgery in 1993 or 1994. When seeing an examiner for compensation purposes in 2019, he asserted that the onset was a year into service (which would be in approximately 1985). Given the earliest clinical record in 2004, the conflicting onset dates, and the lack of STRs noting any relevant complaints, the Board finds that the Veteran is not credible in asserting the onset of his carpel tunnel syndrome during his service. Nevertheless, to comply with the Court-granted JMPR, a VA examiner must provide more rationale than the prior examiner did. Service connection is permissible for a disorder initially diagnosed after service if the evidence, including that pertinent to service, shows it was incurred in service. See 38 C.F.R. § 3.303(d). Social Security Administration (SSA) records recount that the Veteran was employed as a pipefitter from July 1994 to October 2010, working ten hours a day, six days per week. A 2004 private record (Dr. D. Slepyan) shows that, on testing, the Veteran had neuropathy. A 2005 private medical record indicates he had carpal tunnel syndrome requiring a left carpal tunnel release in November 2004. A November 2005 record (Dr. T. Havener) shows he has a "[Labor & Industries] related injury secondary to pipe fitting." L&I records, if available, therefore should be obtained so that they, too, may be considered. In November 2010 correspondence, Dr. D. Slepyan stated that the Veteran "is a pipefitter and works rather vigorously with his hands. He had significant carpal tunnel syndrome." After surgery, he went to college but then "went back to pipefitting. He now has increasing symptoms of the previous carpal tunnel and polyneuropathy." In May 2017 correspondence, Dr. D. Slepyan surmised the Veteran's service in the Navy was "the beginning of the damage to his Carpal Tunnel" due to daily duties that were "very repetitious and strainful to his hands" and that other (post-service) careers also had some bearing on his carpal tunnel syndrome. Dr. Slepyan did not expound any further. Thus, an addendum to the November 2019 DBQ is needed. The examiner should discuss whether it is as likely as not that, if the Veteran had carpal tunnel syndrome in service (including from drilling rivets and pipefitting), he would have had symptoms in service, or the symptoms would have first manifested years later. Accordingly, this claim REMANDED for the following additional development and consideration: 1. Ask the Veteran to provide authorization for VA to obtain all records related to his Washington State Labor & Industries claim or case for carpal tunnel syndrome in approximately 2004/2005 and in 2010/2011. 2. Obtain all VA clinical records, if any, prior to September 2005. 3. Thereafter, obtain a supplemental opinion to the November 2019 DBQ when the examiner concluded that it is less likely than not the Veteran's carpal tunnel syndrome is due to his military service. More rationale is needed, regardless of whether this more recent examiner agrees or disagrees with that conclusion. So, to this end, this current examiner should opine on the following: a. If the Veteran had carpal tunnel syndrome in service (as he alleges he did), is it as likely as not (50 percent or greater probability) that he would have had symptoms in service? If so, why or why not? b. If his duties and responsibilities in service (including drilling rivets on aircraft and pipefitting) caused him to have carpal tunnel syndrome, is it as likely as not (50 percent or greater probability) that the symptoms would first manifest years later rather than during his service? If so, why or why not? c. Is it instead more likely the Veteran's carpal tunnel syndrome is due to post-service, long-term employment as a pipefitter rather than doing that during his service? If so, why or why not? When responding, regardless of whether favorably or instead unfavorably, it is essential the examiner provide rationale preferably citing to findings or other evidence in the file supporting conclusions and/or accepted medical authority. To assist in making these important determinations, the clinician should consider the pertinent evidence to include: i) SSA records noting the Veteran was a pipefitter from 1994-2010 (after service) working ten hours a day, six days per week; ii) 2004 and 2005 private records noting carpal tunnel release and neuropathy; iii) a November 2005 record (Dr. T. Havener) indicating the Veteran had an "L&I [Labor & Industries] related injury secondary to pipe fitting"; iv) November 2010 correspondence from Dr. D. Slepyan indicating the Veteran is a pipefitter and works rather vigorously with his hands; v) May 2017 correspondence from Dr. D. Slepyan surmising the Veteran's prior service in the Navy was "the beginning of the damage to his Carpal Tunnel"; v) the Veteran's 1988 Report of Medical Evaluation; and vi) his separation from service in 1988, and the earliest clinical evidence of carpal tunnel syndrome. KEITH W. ALLEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Wishard 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.