Citation Nr: 22015093 Decision Date: 03/16/22 Archive Date: 03/16/22 DOCKET NO. 16-46 484 DATE: March 16, 2022 REMANDED Entitlement to an increased rating for cervical radiculopathy into the left upper extremity and carpal tunnel syndrome is remanded. Entitlement to an increased rating for cervical radiculopathy into the right upper extremity and carpal tunnel syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1992 to November 2012. The Department of Veterans Affairs (VA) is grateful for her service. The appealed issues arise from May 2015 and July 2015 VA Regional Office (RO) rating decisions. The Veteran testified before the undersigned Veterans Law Judge at a hearing conducted in March 2019. A transcript of the hearing is of record. In January 2021, the Board of Veterans' Appeals (Board) in pertinent part, denied increased ratings from the 20 percent ratings assigned for cervical radiculopathy into each upper extremity. The Veteran appealed that decision, and by a November 2021 Order the United States Court of Appeals for Veterans Claims (Court) approved a Joint Motion for Partial Remand (Joint Motion) vacating and remanding that portion of the Board's January 2021 decision which denied these cervical radiculopathy increased rating claims. However, by a June 2021 decision, the Board granted service connection for carpal tunnel syndrome for each upper extremity. The combined rating for each upper extremity, now the subject of appeal, is explained below. 1. Entitlement to an increased rating for cervical radiculopathy into the left upper extremity and carpal tunnel syndrome is remanded. 2. Entitlement to an increased rating for cervical radiculopathy into the right upper extremity and carpal tunnel syndrome is remanded. As noted above, in the January 2021 decision, the Board denied increased ratings in excess of the assigned 20 percent ratings for cervical radiculopathy into each upper extremities, which the Board noted affected the median nerves and hence the upper radicular group of each upper extremity. The Board found that moderate incomplete paralysis was not shown for each upper extremity, so that the next higher, 40 percent rating under Diagnostic Code 8510 was not warranted for each upper extremity. The Board's January 2021 decision was substantially based on a VA examination in January 2020 addressing radiculopathy into the upper extremities. The Veteran then reported pain radiating from her arms to her fingers and difficulty lifting or carrying heavy or large objects due to weakness. The Veteran also reported intermittent mild pain, paresthesias and/or dysesthesias, and numbness in her arms. The examiner found mild incomplete paralysis of the right and left upper radicular group, specifically the median nerves. However, the Joint Motion determined that in its January 2021 decision the Board had provided inadequate reasons and bases by failing to explain adequately what constituted moderate, incomplete paralysis of the upper radicular group including under Diagnostic Code 8510. By a June 2021 decision, the Board found that service connection for bilateral carpal tunnel syndrome was warranted as secondary to service-connected cervical disability with radiculopathy, based on conflicting evidence; the Board recognized some evidence of interrelated pathology. A Decision Review Officer (DRO) at the Office of Administrative Review (OAR) by a July 2021 decision effectuated the Board's decision by granting service connection for bilateral carpal tunnel syndrome and rating the carpal tunnel syndrome of each wrist together with the Veteran's cervical radiculopathy into each upper extremity, assigning a 20 percent rating for each upper extremity based on this combined disability, and hence not granting an increase based on the additional assigned carpal tunnel syndrome. The Board notes that the Veteran is also now granted service connection for upper extremity radiculopathy on each side for all radicular groups, not merely the upper radicular groups. Hence, the Board should rate these combined disabilities, to avoid piecemeal adjudication. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). However, the nature and severity of the Veteran's carpal tunnel syndrome and the nature and severity of combined effect of the Veteran's cervical radiculopathy and carpal tunnel syndrome in each upper extremity have yet to be addressed by a VA examiner for rating purposes. Accordingly, remand is required for this purpose. The matters are REMANDED for the following actions: 1. Obtain any VA treatment records and any pertinent private treatment records not yet associated with the claims file. The Veteran's authorization or assistance should be requested, as appropriate. All requests, responses, and records received should be documented in the claims file. If any records cannot be obtained, the Veteran and her representative should be appropriately notified. 2. Schedule the Veteran for a new in-person examination to address the nature and severity of cervical radiculopathy into each upper extremity together with disability associated with carpal tunnel syndrome in each upper extremity. The claims file should be reviewed, including in particular examinations addressing the cervical spine, upper extremity radiculopathy, and disabilities of the upper extremities. Any necessary tests or studies should be conducted, and pertinent findings should be reported in detail in the examination report. The examiner is asked to address the combined effect of cervical radiculopathy into each upper extremity and carpal tunnel syndrome of each upper extremity. However, each upper extremity should be addressed separately. If other conditions affecting functioning of the upper extremities are distinguishable in their symptoms and effects on functioning from the cervical radiculopathy and carpal tunnel syndrome, then the examiner should not include the symptoms and effects on functioning of such other conditions when addressing the symptoms and effects on functioning of cervical radiculopathy and carpal tunnel syndrome. If symptoms and effects on functioning of other conditions are not distinguishable from those of cervical radiculopathy or carpal tunnel syndrome, then these symptoms and effects on functioning should be addressed by the examiner as part of symptoms and effects on functioning of cervical radiculopathy or carpal tunnel syndrome. The examiner must also document and consider the Veteran's own statements regarding her disability, since a layperson is competent to address symptoms as experienced and her recollections of past history and treatment. If the examiner has reason based on other evidence of record or medical knowledge to question the Veteran's self-reported history, the examiner should so state and provide a complete explanation why this is so. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important "that each disability be viewed in relation to its history [,]" 38 C.F.R. § 4.1, copies of all pertinent records in the Veteran's claims file, or in the alternative, the claims file, must be made available for review. 3. Thereafter, readjudicate the appealed claims. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Schechter 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.