Citation Nr: 22040137 Decision Date: 07/13/22 Archive Date: 07/13/22 DOCKET NO. 17-29 808 DATE: July 13, 2022 REMANDED Entitlement to service connection for a right hand disorder is remanded. Entitlement to service connection for a left hand disorder is remanded. Entitlement to service connection for a right elbow disorder is remanded. Entitlement to service connection for a left elbow disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from November 19, 1968 to November 17, 1972; May 10, 1976 to July 5, 1976; November 20, 1976 to April 30, 1977; June 6, 1977 to July 15, 1977; June 5, 1978 to July 14, 1978; November 19, 1968 to November 17, 1972; August 4, 1979 to November 8, 1979; and from November 9, 1979 to January 30, 1991, with additional periods of reserve service. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). In January 2020, the Veteran testified at a video-conference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing has been associated with the claims file. In June 2020, October 2021, and March 2022, the Board remanded this matter for further development. That development having been completed, this matter has returned to the Board for further appellate review. 1. Entitlement to service connection for a right hand disorder is remanded. 2. Entitlement to service connection for a left hand disorder is remanded. 3. Entitlement to service connection for a right elbow disorder is remanded. 4. Entitlement to service connection for a left elbow disorder is remanded. The Board remanded these matters, in pertinent part, to obtain a clarifying opinion regarding the nature and etiologies of the Veteran's bilateral upper extremity disorders. As stated in previous remands, there have been inconsistent findings as to whether the Veteran's bilateral hand disorders were attributed to peripheral neuropathy or cervical radiculopathy. The April 2022 VA examiner stated that the claims file indicated the Veteran's upper extremity symptoms were related to his cervical radiculopathy. However, the examiner did not explain the rationale behind this finding, nor did they address the previous VA examination findings that the Veteran's upper extremity symptoms were indicative of peripheral neuropathy. The Board notes that mere conclusory opinions, which do not provide a rationale or address contradictory information, are considered inadequate. Bloom v. West, 12 Vet. App. 185, 187 (1999); Stefl v. Nicholson, 21 Vet. App. 120 (2007). Furthermore, in addressing whether the Veteran's impaired fasting glucose was related to his in-service herbicide exposure, the examiner merely stated there was no presumption for this disorder as related to herbicide exposure. The Board notes that although impaired fasting glucose is not presumptively associated with herbicide exposure under 38 C.F.R. § 3.309(e). However, that does not obviate the need to determine whether a direct relationship exists. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The Board also remanded these matters to obtain nexus opinions addressing all of the Veteran's current bilateral elbow disorders. The April 2022 VA examiner provided a negative opinion, reasoning that there is no documentation of an elbow disorder in the Veteran's service treatment records. However, as the examination report did not address the Veteran's statements regarding the onset and continuity of his elbow symptoms since his active duty service, the Board finds it inadequate. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (an examination was inadequate where the examiner relied on the absence of evidence in the Veteran's service medical records to provide a negative opinion). The Veteran's representative raised questions relating to the April 2022 VA examiner's qualifications and requested a copy of their curriculum vitae that demonstrates they were competent to provide opinions on the issues on appeal. See June 2022 Appellate Brief; Francway v. Wilkie, 930 F.3d 1377, 1380 (Fed. Cir. 2019). However, the request and argument submitted by the Veteran's representative is not sufficiently specific as to any dispute with the qualifications of the examiner. In addition, since the Board has determined the examinations are inadequate, they will not be relied upon. Thus, the examiner's qualifications need not be addressed. The opinions on remand MUST be provided by different examiners. Finally, as this matter is being remanded, the Veteran's updated VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Make arrangements to obtain the Veteran's VA treatment records, from April 2022, forward. 2. Thereafter, obtain medical opinions from an appropriate clinician, other than the clinician who rendered the prior opinions. The Veteran should not be scheduled for an examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) unless deemed necessary by the VA medical professional rendering an opinion on this claim. The entire claims file must be reviewed by the examiner in conjunction with the opinion. The examiner should confirm in the examination report that he or she has reviewed the folder in conjunction with the supplemental opinion. The examiner should answer the following: (a) Left and Right Elbow (i) Identify, by diagnosis, all elbow disorders found to be present, to include lateral epicondylitis, and to include those that have resolved during the period on appeal. (ii) For each elbow disorder found, provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the disorder had its clinical onset during service or is related to any incident of service, to include the Veteran's flight training (including parasailing with hard landings) and/or duties involving lifting, carrying and loading heavy equipment. (b) Left and Right Hand (i) Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's bilateral upper extremity peripheral neuropathy is related to his in-service exposure to herbicide agents. (ii) If the examiner determines that the answer to (i) is no, the examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) that the disorder is related to his impaired fasting glucose, and, if so, whether it is at least as likely as not (50 percent or greater probability) that the Veteran's impaired fasting glucose is related to his in-service herbicide exposure. * In reaching these opinions, the examiner should consider and address the Veteran's statements regarding the onset of his musculoskeletal symptoms during active duty service as well as his statements as to why he did not seek medical attention for those symptoms during service. * The examiner is advised that it is not sufficient to state that there is no nexus between the Veteran's impaired fasting glucose disease and his exposure to herbicide agents merely because impaired fasting glucose is not on the list of diseases presumptively associated with exposure to herbicide agents. See Combee v. Principi, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Any opinions expressed by the examiner must be accompanied by a complete rationale. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. M. Stedman, 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.