Citation Nr: 22014974 Decision Date: 03/15/22 Archive Date: 03/15/22 DOCKET NO. 17-16 612 DATE: March 15, 2022 REMANDED Entitlement to service connection for left upper extremity carpal tunnel syndrome (CTS) is remanded. Entitlement to service connection for right upper extremity CTS is remanded. REASONS FOR REMAND The Veteran served on active duty from January 2003 to December 2003 and from August 2004 to November 2005. These matters come before the Board of Veterans' Appeals (Board) from a July 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Lincoln, Nebraska. In March 2019 and August 2021, the Board remanded this appeal for remedial development. 1. Entitlement to service connection for left upper extremity carpal tunnel syndrome (CTS) is remanded. 2. Entitlement to service connection for right upper extremity CTS is remanded. Unfortunately, there has not been substantial compliance with the Board's previous remand directives regarding these issues. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). In August 2021, the Board remanded the bilateral CTS claims for a VA opinion. In October 2021, the Veteran was afforded a medical opinion. The examiner provided a negative nexus opinion, reasoning that the Veteran complained of CTS symptoms prior to his active duty and had spent many years in the National Guard. The examiner seems to imply that the Veteran's bilateral CTS pre-existed his active military service. However, the VA examiner failed to provide an opinion of whether the bilateral carpal tunnel syndrome was a pre-existing condition, and if so, whether the pre-existing service condition clearly and unmistakably preexisted service, and if so, whether the bilateral CTS was not clearly and unmistakably aggravated by service. Also, the October 2021 VA examiner did not discuss the Veteran's contentions that his duties while in the military caused his bilateral CTS. Also, the October 2021 VA examiner found that the Veteran did not have a current diagnosis of left side CTS, but failed to discuss the May 2019 diagnosis of left side CTS at the May 2019 VA examination. Upon remand, an adequate VA examination and medical opinion must be obtained. The matters are REMANDED for the following actions: 1. Schedule the Veteran for a VA examination for his currently diagnosed bilateral carpal tunnel syndrome. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: (a) Did the bilateral CTS clearly and unmistakably (undebatable) preexist the Veteran's service? (i) If the examiner finds the bilateral CTS did clearly and unmistakably preexist service, was the bilateral CTS clearly and unmistakably not aggravated by service? (ii) If the examiner finds that the bilateral CTS either did not clearly and unmistakably preexist service or was not clearly and unmistakably not aggravated by service, the examiner must opine whether the bilateral CTS is at least as likely as not related to service, including the Veteran's contentions that his duties as a mechanic caused his disability. In providing the requested opinions, consider the Veteran's description of his in-service 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 injury and symptoms in service and thereafter represented the onset of his current disabilities, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disabilities are known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? (b) Is it at least as likely as not that the bilateral CTS (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? Provide a rationale to support the opinions. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If the benefits sought are not granted to the Veteran's satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. S. M. WATKINS Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kelsey Love, 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.