Citation Nr: 23009707 Decision Date: 02/15/23 Archive Date: 02/15/23 DOCKET NO. 15-17 124 DATE: February 15, 2023 REMANDED The issue of entitlement to service connection for a right wrist/arm disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1989 to February 1990 and in United States Navy from April 1994 to October 2000. This matter come before the Board of Veterans' Appeals (Board) on appeal from a September 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) in which the RO, inter alia, denied service connection for right arm tendonitis. The Veteran disagreed with that determination and subsequently perfected an appeal of the issue to the Board. The instant matter was then previously before the Board in in August 2022 at which time the Board expanded the appeal to include any diagnosed disability of the right wrist and arm. The Board then remanded the matter on appeal for the agency of original jurisdiction (AOJ) to provide the Veteran with a VA examination in connection with his claim for service connection for a right wrist/arm disability. Upon completion of that development, the AOJ issued a supplemental statement of the case (SSOC) in November 2022 in which it continued to deny the Veteran's claim for service connection for a right wrist/arm disability. The matter was thereafter returned to the Board for further appellate consideration. Unfortunately, the Board finds it necessary to again remand the claim on appeal even though such will, regrettably, further delay an appellate decision on this matter. The Board observes that a remand by the Board confers on a Veteran, as a matter of law, a right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268 (1998). If the Board proceeds with final disposition of an appeal, and the remand orders have not been complied with, the Board itself errs in failing to ensure compliance. Id. The Board further notes that when the Secretary provides the claimant with a VA medical examination or opinion, he must ensure that the examination or opinion provided is adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). VA medical examination or opinion is adequate if it is "thorough and contemporaneous," considers the veteran's prior medical examinations and treatment, and "describes the disability . . . in sufficient detail so that the Board's 'evaluation of the claimed disability will be a fully informed one.'" Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007) (quoting Ardison v. Brown, 6 Vet. App. 405, 407 (1994)). As indicated above, in August 2022, the Board remanded the claim for service connection for a right wrist/arm disability for further development. Specifically, the Board pointed out that the record showed that the Veteran had undergone an exploratory surgery for a suspected ganglion cyst in the right wrist in service and that the Veteran's service treatment records (STRs) additionally showed an injury to his right hand in November 1995. The Board also noted the Veteran's complaints of pain, cracking, and popping in the right wrist since service. The Board found this to be sufficient evidence to trigger VA's duty to provide a medical examination and thus remanded the matter for the AOJ to schedule the Veteran for a VA examination to determine whether it was at least as likely as not that any diagnosed right arm or wrist disability had its onset in or was otherwise attributable to service, to include as a result of the Veteran's June 1995 in-service exploratory surgery to remove a possible ganglion cyst. The Veteran was afforded a VA wrist conditions examination in October 2022, the report of which notes a diagnosis of De Quervain's syndrome, right wrist. Regarding the likelihood that the diagnosed disability was incurred in or otherwise related to service, the VA examiner opined that the Veteran's De Quervain's syndrome is not at least as likely as not related to service, including the in-service exploratory surgery done in June 1995. Although the VA examiner provided an extensive rationale for why the Veteran's diagnosed De Quervain's syndrome was not related to the in-service exploratory surgery, the examiner did not consider whether the Veteran's right wrist disability or related symptomatology could otherwise be related to service, to include the November 1995 crush injury to the right hand. The Board also points out that VA treatment records dated in September 2002 note that Veteran's complaints of pain along the lateral aspect of the right elbow, which the VA clinician stated "could be secondary to entrapment neuropathy at the wrist or elbow." Notably, the October 2022 VA examiner does not discuss the possibility of entrapment neuropathy or discuss how she arrived at the diagnosis of De Quervain's syndrome, as opposed to entrapment neuropathy. It also does not appear that the VA examiner considered whether the Veteran had any diagnosed disability of the right arm, or whether additional examination was warranted, In the instant case, given that there appears to be an alternative diagnosis of record pertaining to the right wrist, and because the VA examiner seems to have considered only whether the diagnosed De Quervain's syndrome was related to the June 1995 exploratory surgery and did not indicate whether any disability of the right arm was present, the Board finds that the October 2022 medical opinion is inadequate to rely upon for adjudication purposes. Accordingly, the claim for service connection for a right wrist/arm disability must be remanded for the Veteran to be provided with a new VA examination and opinion that considers whether the Veteran has any disability affecting the right wrist/arm other than De Quervain's syndrome, to include entrapment neuropathy or any disability of the right arm, that may be related to service and that more fully considers whether the diagnosed De Quervain's syndrome may be related to service, to include the November 1995 crush injury to the right hand. See Barr, supra. The matter is REMANDED for the following action: Schedule the Veteran for a VA examination in connection with his claim for service connection for right wrist/arm disability. If more than one examination is necessary to determine whether any disability of the right wrist and/or right arm exists, the Veteran should be scheduled for any such additional examination. The contents of the entire, electronic claims file, to include a complete copy of this remand, must be made available to the designated individual, and the examination/opinion report should reflect consideration of the Veteran's documented medical history and assertions. All indicated tests and studies should be accomplished (with all findings made available to the examiner prior to the completion of his or her report), and all clinical findings should be reported in detail. The VA should clearly identify all disability(ies) of the right arm and wrist currently present, or present at any time pertinent to the current claim (even if now asymptomatic or resolved). The examiner is directed to consider the diagnosis of De Quervain's syndrome rendered at the time of the October 2022 VA examiner and the indication of entrapment neuropathy at the wrist or elbow noted in a September 2022 VA treatment record. The examiner should state whether he/she agrees with these diagnoses. If either diagnosis is not supported by the record or by examination of the Veteran, the examiner should explain why not. Additionally, if it is determined that the Veteran does not have a disability of the right arm, other than of the right wrist, this should be stated on the record. Then, the examiner should provide an opinion, consistent with sound medical principles, and based on full consideration of the Veteran's medical history, and assertions, as to whether it is at least as likely as not that any current right wrist or arm disability, to include pain resulting in functional impairment in earnings capacity, had its onset in, or is otherwise etiologically related to service, to include the June 1995 exploratory surgery for removal of possible ganglion cyst, the lipoma found during the surgery, and/or November 1995 crush injury to the right hand. In providing the requested opinion, the examiner should consider the October 2022 VA medical opinion. If the examiner agrees that the Veteran has De Quervain's syndrome that is less likely than not related to the June 1995 exploratory surgery, the examiner should provide an opinion as to whether it is at least as likely as not that the De Quervain's syndrome is otherwise related to service, to include the November 1995 crush injury. Additionally, if the examiner concludes that the Veteran has entrapment neuropathy at the right wrist or elbow, the examiner should provide an opinion as to whether it is at least as likely as not that that condition is related to service, to specifically include either the June 1995 exploratory surgery or the November 1995 crush injury to the right hand. The VA examiner must provide a rationale for the opinion given and is advised that the Veteran is competent to report his symptoms and injuries. 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 any current right wrist or arm disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are his reports generally inconsistent with medical knowledge or implausible? K. Conner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Neilson, 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.