Citation Nr: 23014133 Decision Date: 03/08/23 Archive Date: 03/08/23 DOCKET NO. 18-51 359 DATE: March 8, 2023 REMANDED Entitlement to an initial compensable rating for carpal tunnel syndrome, right (major) wrist, prior to December 18, 2020, and in excess of 10 percent, thereafter, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 2008 to May 2013, including service in the Southwest Asia theatre of military operations In March 2020, the Veteran testified before the undersigned Veterans Law Judge in Washington, D.C. A copy of the hearing transcript is of record and has been reviewed. A January 2021 rating decision granted a 20 percent rating for Osgood Schlatter's disease, right knee, effective December 18, 2020, and a 10 percent rating for carpal tunnel syndrome (CTS), right (major) wrist, effective December 18, 2020. In April 2022, the Board granted a 10 percent rating for Osgood Schlatter's disease prior to December 18, 2020, but denied a rating in excess of 20 percent thereafter, and remanded the instant increased rating claim for further development. The Board's decision as to the ratings for Osgood Schlatter's disease is final. See 38 U.S.C. §§ 7103(a), 7104; 38 C.F.R. § 20.1100(a). Pursuant to the Board's April 2022 remand, the Veteran was afforded new VA examinations in August 2022 to determine the severity of her right wrist CTS. The examination reports are of record and have been reviewed. However, the Board finds there has not been substantial compliance with its April 2022 remand directives. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that there must be substantial compliance with the terms of a Court or Board remand); Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand confers on the claimant, as a matter of law, the right to compliance with the remand order). In responding to the Board's remand question "whether there is any limited range of motion in the right wrist that can be attributed at least in part to the CTS," the August 2022 VA examiner stated, that limited range of motion "would not be attributed significantly to any carpal tunnel syndrome," suggesting that at least some limited range of motion can be attributed to CTS. Additionally, the VA examiner noted that, "with severe carpal tunnel syndrome it would be expected that [a] electromyography/nerve conduction test would be conducted to determine severity of neuropathy ..." Although the examiner determined the severity of incomplete paralysis of the Veteran's median nerve due to CTS to be "mild," his remarks suggest that nerve electromyography/nerve conduction testing may help determine the degree of limited motion that can be attributed to CTS, although this is not entirely clear. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion comes from its being factually accurate, fully articulated, and having a sound reasoning for the conclusion). Accordingly, clarification is needed to assess whether there is any limited range of motion of the Veteran's right wrist that can be attributed to her CTS, and whether electromyography/nerve conduction testing is needed in this regard. 38 C.F.R. § 3.159(c)(4); Stegall, supra. The matters are REMANDED for the following action: 1. Ensure that all outstanding VA treatment records are associated with the claims file. 2. Then, obtain an addendum opinion from the same VA physician who provided the August 2022 VA Wrist Conditions, Peripheral Nerves Conditions, and Medical Opinion DBQs, if available. If the same examiner is unavailable, request an addendum opinion from an appropriately qualified VA physician (M.D.). Access to the Veteran's electronic claims file, which shall include a copy of this Remand, must be made available to the examiner for review, and be reviewed, in connection with the examination. *The need for another examination(s) is left to the discretion of the medical professional offering the addendum opinion. After a complete review of the claims file, the examiner is asked to provide an opinion with complete rationale addressing the following: (a) Clarify whether the examiner's answer in the August 2022 VA Medical Opinion DBQ ("Answer Question 10" on page 5) that the Veteran's right wrist limitation of motion "would not be attributed significantly to any carpal tunnel syndrome," indicates an affirmative answer to the Board's question "Determine whether there is any limited range of motion in the right wrist that can be attributed at least in part to the CTS." (b) If the answer to (a), above, is affirmative, then estimate the limited range of motion in the right wrist in degrees dorsiflexion AND palmar flexion attributable to CTS. (c) Clarify whether the statement reflected in the August 2022 VA Medical Opinion DBQ ("Answer Question 11" on page 5) that a "electromyography/nerve conduction test would be conducted to determine the severity of neuropathy" indicates that such testing is warranted to more accurately determine the severity of the Veteran's service-connected right wrist CTS. (d) If the answer to (c), above, is affirmative, schedule the Veteran for electromyography/nerve conduction testing. All examination and test results should be associated with the Veteran's electronic claims file. If the examiner is unable to provide any of the requested determinations without resort to speculation, the examiner should explain whether the inability is due to the limits of the examiner's medical knowledge, medical knowledge in general or there is evidence that, if obtained, would permit the opinion to be provided. (Continued on the next page) 3. Thereafter, ensure that the examiner has substantially responded to the questions posed by the Board, and if not, take corrective action. 4. Then, readjudicate the remanded claim. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Farrell, 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.