Citation Nr: 24031908 Decision Date: 10/17/24 Archive Date: 10/17/24 DOCKET NO. 19-23 946 DATE: October 17, 2024 REMANDED Entitlement to service connection for left wrist condition is remanded. Entitlement to service connection for right wrist condition is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1979 to July 1981. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a September 2016 rating decision from a Department of Veteran Affairs (VA) Regional Office (RO). The Veteran requested a video hearing before a Veterans Law Judge (VLJ) in his July 2019 substantive appeal. The Veteran testified at a hearing before the undersigned VLJ in April 2021. A transcript of the hearing has been associated with the claims file. In January 2023, the Board denied the Veteran's claims for bilateral wrist ganglion cyst (previously wrist surgery). The Veteran appealed the denial to the Court of Appeals of Veterans Claims (Court). In January 2024, VA and the Veteran filed a joint motion for remand (JMR), which was granted by the Court, requesting further development and readjudication of the issue. In February 2024, the Veteran's attorney requested another video hearing. The Veteran testified at a hearing before the undersigned VLJ in August 2024. A transcript of the hearing has been associated with the claims file. The matter now returns to the Board for further consideration. 1. Entitlement to service connection for left wrist condition is remanded. 2. Entitlement to service connection for right wrist condition is remanded. In the Veteran's original December 2015 claim, the Veteran contended that he had pain in his left hand in service such that he could hardly use it and then after service, had surgery on the left. In a September 2016 rating decision and June 2019 statement of the case (SOC), the RO denied the claims, characterizing the condition as wrist surgery. In a July 2019 supplemental statement of the case (SSOC), the RO characterized the condition as a wrist disability. At the April 2021 Board hearing, the Veteran testified that he experienced soreness in his left wrist and that he could hardly use it. See VBMS, document labeled Hearing Transcript, receipt date 4/8/2021, page 4 of 24. In May 2021, the Veteran's attorney submitted a post hearing memorandum, where she characterized the Veteran's claims as entitlement to service connection for left and right wrist limitation of motion. See VBMS, document labeled Third Party Correspondence, receipt date 5/27/2021. The Veteran's VA medical treatment records documented the Veteran's wrist condition as a ganglion cyst. See VBMS, document labeled CAPRI, receipt date 7/26/2016, page 13 of 381 (documenting an ER visit noting ganglion cyst on wrist); see VBMS, document labeled CAPRI, receipt date 9/22/2016, page 744 of 2057 (documenting complaints of mass of left wrist x8 to 9 months; states mass is painful; states size has been gradually increasing, and; also has the same type mass on the right wrist, but this does not bother him, because it is small). As such, in the January 2023 Board decision, the Veteran's condition was characterized as a bilateral wrist ganglion cyst. Given the aforementioned evolution of how the Veteran's bilateral wrist disability has been described and documented, the parties agreed to the January 2024 JMR that the Veteran's claim shall be recharacterized as wrist disabilities manifested by pain, weakness, and limitation of motion of the wrists. At the August 2024 Board hearing, the Veteran testified to pain and limitation of motion of his bilateral wrists. Additionally, the Veteran testified to having a diagnosis of cysts; then had surgery on his wrists after military service; that he still has pain and numbness in both wrists, and; that he now wears a brace on his left wrist, and he believes it is more than just cysts. The Veteran further testified that while in service, he used to unload ice trucks, threw ice, unloaded crates, and used shovels. See VBMS, document labeled Hearing Transcript, receipt date 8/13/2024, pages 2, 3, 4, 6, 7, 9 of 11. The Board finds that remand is warranted for additional medical development to determine the full scope of the Veteran's bilateral wrist disabilities, and whether they are related to his service. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination to determine the nature and etiology of any and all current bilateral wrist conditions, to include wrist ganglion cysts, and disabilities causing pain, weakness, and/or limitation of motion. Both orthopedic and neurological examination is to be conducted to determine the full scope of any wrist condition. The claims file, a copy of this remand, and JMR must be made available to and be reviewed by the examiner. The examiner is asked to opine as to the following: (a.) Whether it is at least as likely as not that any bilateral wrist condition diagnosed (orthopedic or neurological) is related to his service. The examiner is requested to review the following: - See VBMS, document labeled Hearing Transcript, receipt date 4/8/2021, pages 4 to 11 of 24 (where the Veteran testified to in-service soreness and other history regarding the cyst formation). - See VBMS, document labeled Hearing Transcript, receipt date 8/13/2024 (where the Veteran testified about his in-service duties requiring heavy lifting, throwing ice, using shovels, and carrying crates, as well as current symptoms of pain with limitation of motion). The examiner must not rely solely on the absence of diagnosis or treatment in service, or the lack of medical documentation, as the basis for a negative opinion. The Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the likelihood is at least approximately balanced or nearly equal, if not higher. An examiner's report that he or she cannot provide an opinion without resort to speculation is inadequate unless the examiner provides a rationale for that statement. As such, if the examiner is unable to offer an opinion, it is essential that the examiner provide a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide the opinion is based on the limits of medical knowledge. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Smith, 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.