Citation Nr: 22014629 Decision Date: 03/14/22 Archive Date: 03/14/22 DOCKET NO. 12-12 024 DATE: March 14, 2022 REMANDED Entitlement to service connection for left carpal tunnel syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1982 to June 1986. In September 2016 and April 2018, this appeal was remanded for further development. In June 2020, the Board denied the Veteran's claims for service connection for left carpal tunnel syndrome. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). Subsequently, by a May 2020 Order, the Court granted a Joint Motion for Partial Remand (JMPR), which partially vacated and remanded the claim to the Board for compliance with the terms of the JMPR. Specifically, the parties agreed that the Board erred by failing to obtain an adequate VA medical opinion that substantially complied with its September 2016 and April 2018 remand orders, in that the opinions of record did not provide an adequate rationale as to whether the Veteran's left carpal tunnel syndrome was aggravated by his service-connected evulsion fracture proximal phalanx of 5th digit of the left hand and did not consider or address the Veteran's lay statement of ongoing wrist pain. In September 2021, the Board remanded the appeal to obtain an VA examination and medical opinion that addresses the Veteran's lay statements and addresses whether the Veteran's left carpal tunnel syndrome was aggravated by his service-connected evulsion fracture proximal phalanx of 5th digit of the left hand. Unfortunately, the Board finds that another remand is warranted as the October 2021 medical opinion did not address whether the Veteran's left carpal tunnel syndrome was aggravated by his service-connected evulsion fracture proximal phalanx of 5th digit of the left hand. Specifically, in the October 2021 VA medical opinion, the VA examiner opined that the Veteran's left carpal tunnel syndrome was less likely than not proximately due to or the result of the Veteran's service-connected condition. The VA examiner explained that carpal tunnel syndrome is caused by the median nerve compression at the wrist level, while the fifth digit is innervated by a different nerve, the ulnar nerve. The examiner noted that the ulnar nerve does not cause carpal tunnel syndrome. However, the VA examiner did not discuss whether the Veteran's carpal tunnel syndrome was aggravated by his service-connected evulsion fracture proximal phalanx of 5th digit of the left hand, as specifically requested by the JMPR and the Board's September 2021 remand. Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: 1. Obtain an addendum opinion, from the October 2021 VA examiner, or another qualified medical professional if the October 2021 examiner is unavailable, to address the nature and etiology of the Veteran's left carpal tunnel syndrome. The VA examiner is asked to address the following: Whether it is at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran's left carpal tunnel syndrome underwent any incremental increase in disability, regardless of its permanence, (aggravated) due to the Veteran's service-connected disabilities, to include evulsion fracture proximal phalanx of 5th digit of the left hand. *In answering the above, the examiner must consider and discuss the Veteran's lay reports that he has ongoing left-hand pain since his in-service injury (October 1984 service treatment record which reflects that the Veteran injured his hand while operating a 109 howitzer). S/he should outline that history in the report. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran's reports of symptomatology, a reason for doing so must be provided. The term "incremental increase in disability" means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any "incremental increase in disability" need not be permanent. The term "at least as likely as not" does not mean "within the realm of medical possibility." Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion (e.g., etiology) as it is to find against the conclusion. 2. THE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL. IF ANY DEVELOPMENT IS INCOMPLETE, APPROPRIATE CORRECTIVE ACTION MUST BE IMPLEMENTED. IF ANY REPORT DOES NOT INCLUDE ADEQUATE RESPONSES TO THE SPECIFIC OPINIONS REQUESTED, IT MUST BE RETURNED TO THE PROVIDING EXAMINER FOR CORRECTIVE ACTION. YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Abdelbary, 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.