Citation Nr: 23019463 Decision Date: 03/29/23 Archive Date: 03/29/23 DOCKET NO. 16-40 630 DATE: March 29, 2023 REMANDED The service connection claim for right wrist arthritis is remanded. The service connection claim for left wrist arthritis is remanded. For the period prior to December 21, 2015, the appeal for an increased disability rating, in excess of 50 percent disabling, for post-traumatic stress disorder (PTSD) is remanded. For the period beginning December 21, 2015, the appeal for an increased disability rating, in excess of 70 percent disabling, for PTSD is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from November 1991 to November 1996. This matter comes before the Board of Veterans' Appeals (Board) from an October 2014 rating decision from the Department of Veterans Affairs (VA) Regional Office in San Diego, California. In December 2020, the Board remanded the case to the Regional Office for further evidentiary development. Subsequently, the matter returned to the Board for final adjudication, and in a December 2021 decision, the Board denied service connection for bilateral wrist arthritis; denied an increased rating in excess of 50 percent for the period prior to December 21, 2015; and granted a rating that is no higher than 70 percent disabling, for the period beginning December 2015. Thereafter, the Veteran appealed the December 2021 Board decision with the United States Court of Appeals for Veterans Claims ("Court"). In an October 2022 joint motion for partial remand, the parties stipulated that a vacateur is warranted for the part of the December 2021 decision that denied the Veteran's service connection claim for bilateral wrist arthritis, his increased rating claim, in excess of 50 percent disabling, for the period prior to December 21, 2015, and in excess of 70 percent disabling, for the period beginning December 21, 2015, for PTSD. Accordingly, in an October 2022 Order, the Court granted the parties' October 2022 joint motion for a partial remand. In this regard, the Board shall remand this appeal for additional developments, in a manner consistent with the October 2022 joint motion for partial remand and Court Order. 1. Outstanding Medical Records The evidence of record is incomplete, as the evidence of record indicates that the Veteran underwent group therapy for his PTSD, whereas those group therapy treatment records have not yet been associated with the claims file. Specifically, for example, a December 2015 VA examination report for PTSD notes that the Veteran underwent group talk therapy at VA for approximately 4 - 6 weeks; and that the Veteran reported that he was undergoing individual therapy at Redlands for a months, but once a month. Further, VA treatment records also indicate that the Veteran participated in group therapy. See e.g. February 2015 Primary Care Note. Thus, as the Board cannot render a fully informed decision on the severity of the Veteran's service-connected PTSD, without these outstanding treatment records, a remand is required. Once this issue returns to the Board for reconsideration, the Board shall then address all probative evidence documenting the Veteran's PTSD symptoms, as reflected in medical records, including and not limited to, a December 2013 progress note, and a May 2014 VA examination report, per the directives from the October 2022 joint motion for partial remand, and as adopted by the October 2022 Court Order. 2. Inadequate VA Examination/Opinion In January 2021, the Veteran was afforded a VA examination for right and left wrist (bilateral wrist) conditions. After this examination, the VA examiner provided a negative nexus opinion on the Veteran's bilateral wrist arthritis and concluded that "recent x-rays show no evidence of arthritis." In rendering this VA opinion, the VA examiner, however, failed to address evidence of several other bilateral wrist arthritis diagnoses, which include, for example, a February 2014 VA examination, which reflects diagnoses of osteoarthritis in the bilateral wrist; a September 2014 VA examiner's opinion, which notes "wrist pain consistent with mild arthritis, but x[-]rays [ ] show mild degeneration at best,"; a January 2015 VA MRI indicating, "[d]egenerative change noted at the pisotriquetral joint[,]"; and a May 2016 VA MRI noting "[m]inimal degenerative changes of the radiocarpal joint." Thus, as this January 2021 is inadequate for determining this claim, a remand is required for a new VA opinion on the Veteran's bilateral wrist arthritis. 3. Issuance of Supplemental Statement of the Case Pertinent to the issues on appeal, numerous pieces of evidence were added to the claims file, since the last time the Regional Office issued a February 2021 supplemental statement of the case, and pertinently, since the October 2022 Court remand. When the Regional Office receives additional evidence after a claim on appeal has been transferred to the Board, the Regional Office shall provide the Veteran and his representative, if appointed one, a supplemental statement of the case, unless the additional evidence is duplicative or it is not relevant to the issue on appeal. 38 C.F.R. §§ 19.31, 19.37(b). Thus, as additional, relevant pieces of evidence, which are not duplicative, were added to claims file since the last, February 2021 supplemental statement of the case, a remand is required for the Regional Office to consider these new pieces of evidence, in the first instance, for the pertinent, above-mentioned issues on appeal; and provide the Veteran with a supplemental statement of the case. The matters are REMANDED for the following action: 1. Obtain the requisite authorization and release and obtain all outstanding VA and/or private treatment records regarding the Veteran's group therapy (and individual therapy) treatment, including and not limited to records from Redlands." 2. After completing the above-mentioned developments, obtain a new VA opinion on the Veteran's bilateral wrist arthritis from a qualified clinician (VA examiner). If the VA examiner finds a new VA examination is necessary, please schedule the Veteran for another examination. In rendering the requested opinion, the VA examiner must review a complete claims file and must note that review in the report. A copy of this REMAND must also be provided to the VA examiner. The VA examiner must undertake the following: a. Opine whether it is at least as likely as not the Veteran's right wrist arthritis, and then, left wrist arthritis, is the result of an in-service injury, illness or event; was incurred in active service; and/or is otherwise related to his active service. b. Also, opine whether it is at least as likely as not the Veteran's right wrist arthritis, and then, left wrist arthritis, is caused by his service-connected right wrist and or/left wrist disability. c. Also, opine whether it is at least as likely as not the Veteran's right wrist arthritis, and then, left wrist arthritis, is aggravated by his service-connected right wrist and or/left wrist disability. "Aggravation" means an increase in severity of the disorder beyond any medically established baseline. d. In rendering these opinions, please consider all probative medical evidence, including and not limited to treatment records which reflect evidence of bilateral wrist arthritis, such as, for example, a February 2014 VA examination, a September 2014 VA examiner's opinion, a January 2015 VA MRI, and a May 2016 VA MRI. e. A detailed explanation is requested for all opinions. If it is not possible to render an opinion without resorting to speculation, please provide an explanation as to why this is this case, and what additional evidence, if any, would make it feasible to render such an opinion. 3. Thereafter, the Regional Office must review all additional evidence that have been updated to the claims file since the last, February 2021 supplemental statement of the case, for the service connection claim for bilateral wrist arthritis, for the staged rating, increased rating claims for PTSD. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V-N. Pratt, 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.