Citation Nr: 24012425 Decision Date: 03/18/24 Archive Date: 03/18/24 DOCKET NO. 21-00 577 DATE: March 18, 2024 REMANDED The issue of entitlement to service connection for a left hand condition, to include carpal tunnel syndrome, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 2004 to October 2004, February 2005 to March 2008, and October 2009 to December 2010. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a December 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). Jurisdiction is currently with the Appeal Resource Center (ARC). Service connection for chest pain diagnosed as costochondritis, and service connection for migraine headaches was granted in a June 2021 rating decision, and service connection for obstructive sleep apnea (also claimed as sleep disturbances) and service connection for gastroesophageal reflux disease (GERD, also claimed as a digestive condition) was granted in an August 2021 rating decision. The Board finds that these grants represent complete grants of the benefits sought on appeal; thus, the aforementioned issues are no longer before the Board. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997) (holding that where an appealed claim for service connection is granted during the pendency of the appeal, a second notice of disagreement must thereafter be timely filed to initiate appellate review of the claim concerning "downstream" issues, such as the compensation level assigned for the disability and the effective date); see also 38 C.F.R. § 20.200. The Board has expanded the claim for service connection for a left hand condition to service connection for a left hand condition, to include left carpal tunnel. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled). Entitlement to service connection for a left hand condition, to include carpal tunnel syndrome, is remanded. The Board finds the December 2020 VA opinion inadequate to decide the Veteran's claim. First, the examiner confirmed a current diagnosis of left carpal tunnel syndrome but did not address the Veteran's contention that he has a left hand condition as a result of an in-service incident in which his left hand got caught between a frame and wheel while trying to move a water buffalo water trailer. The Board notes in this regard that the Veteran's service treatment records (STRs) document the in-service injury on June 24, 2015 and complaint of left hand pain. The Board also notes that the Veteran's military personnel records document that the Veteran was ordered to annual training from June 13, 2015 to June 27, 2015. Second, the examiner did not address the Veteran's contention that he has a left hand condition secondary to a chest condition. The Board notes that the Veteran is now service connected for chest pain, intercostal muscle spasm, also diagnosed as costochondritis. Therefore, an addendum opinion should be obtained on remand. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The matters are REMANDED for the following action: 1. Request that the Veteran provide or authorize VA to obtain records of his relevant treatment that have not yet been associated with the claims file, and associate with the claims file any outstanding VA treatment records. 2. Return the file to the December 2020 VA examiner for an addendum opinion. If that examiner is unavailable, the opinion should be provided by another examiner. If a clinical evaluation is deemed necessary to answer the questions presented, one should be scheduled. The claims file, and a copy of the remand, must be reviewed by the examiner. Following review of the file, and the remand, the examiner is to address the following: (a.) Is it at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran has a left hand condition that had its onset during active service or within one year of the Veteran's separation from active service, or is otherwise related to service? The examiner is asked to discuss left carpal tunnel syndrome and the Veteran's contention that he has a left hand condition as a result of an in-service incident in which his left hand got caught between a frame and wheel while trying to move a water buffalo water trailer. The examiner in this regard is asked to discuss the left hand/arm injury and complaints of left hand pain documented in the Veteran's STRs and explain whether the current findings may be attributed to the in-service injury. (b.) Was the Veteran's left hand condition caused by service connected chest pain, intercostal muscle spasm, also diagnosed as costochondritis? Please explain why or why not. Please address left carpal tunnel syndrome. (c.) Did the Veteran's left hand condition get worse because of service-connected chest pain, intercostal muscle spasm, also diagnosed as costochondritis? Please explain why or why not. Please address left carpal tunnel syndrome. All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should be explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Smith-Jennings, 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.