Citation Nr: 24013231 Decision Date: 03/28/24 Archive Date: 03/28/24 DOCKET NO. 17-22 197A DATE: March 28, 2024 REMANDED Service connection for a right wrist disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from February 1983 to February 1986 and from January 1987 to September 1992. He has additional service in the Army Reserve. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision by a Department of Veterans Affairs (VA) regional office, which is the Agency of Original Jurisdiction (AOJ). In February 2023, the Board denied service connection for a right wrist disability. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (CAVC). In December 2023, CAVC issued an Order granting the joint motion for partial remand (JMPR) and remanded the issue of service connection for a right wrist disability to the Board for action consistent with the terms of the JMPR. ? Service connection for a right wrist disability is remanded. The claims file does not include an adequate VA examination and medical opinion addressing the Veteran's claim for service connection for a chronic right wrist strain. When the VA undertakes to provide a veteran with an examination or obtain a medical opinion, it must ensure that the examination and/or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The JMPR points out that the Board provided an inadequate statement of reasons or bases in its decision. See December 2023 CAVC Decision. The Board did not provide an adequate statement of reasons or bases for its finding that the November 2022 VA medical opinion was adequate. Specifically, the Board found the VA medical opinion adequate in part because the examiner completed a thorough review of the record despite the fact that the examiner referred to a condition (arthritis) that the Veteran did not have. The Board also did not provide an adequate statement of reasons or bases when addressing the credibility of the Veteran's lay statements. Specifically, the Board did not address the Veteran's statements that he had wrist pain in service and that his symptoms continued after service. On remand, the Board was instructed to provide a statement of reasons or bases addressing the adequacy of the November 2022 VA medical opinion and address the Veteran's lay statements related to chronicity of his symptoms. The Board finds that additional development is necessary before the Board can readjudicate this matter consistent with the JMPR. The Veteran was afforded a VA examination of his wrists in June 2022. See August 2022 C&P Exam. The diagnosis was chronic right wrist strain of the dominate hand. The Veteran reported in part that his wrist pain initially started in 1988. He fell multiple times during training but only sought treatment on one occasion because he thought his thumb had dislocated. He has symptoms four times a week with five flare-ups in the last 12 months, each of which lasted two days. The examination was abnormal, including a reduced range of motion. The examiner noted the Veteran reported that he occasionally used a brace. The examiner found no significant diagnostic findings related to the claimed condition in the claims file and indicated that no imaging was performed because they "were not clinically indicated." Of note, the VA examiner indicated that the Veteran reportedly denied any issues with his left wrist but stated that testing of the left wrist could not be completed because it was "damaged." Id. No explanation for the inconsistency was provided. In a September 2022 medical opinion, the same VA examiner opined that the claimed "degenerative arthritis, right wrist" condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated that "[a]ll available records were reviewed" but that no complaints related to the right wrist were found; the service treatment records (STRs) showed the Veteran complained only of left wrist problems. The examiner diagnosed a right wrist strain based on the physical examination. In the first November 2022 addendum medical opinion, a second VA examiner opined that it was less likely than not that the Veteran's "right wrist condition, diagnosed as a chronic right wrist strain," was directly related to his active service, manifested within one year of discharge, or that there was continued symptomatology since service. The examiner reasoned that the available record contained no mention of a right wrist complaint, diagnosis, or injury until the June 2022 examination. There was no evidence of right wrist degenerative arthritis. The Veteran's post-military occupation was that of a boat worker "which requires repetitive movement of the wrist and is likely a contributing factor to his right wrist pain." In a second November 2022 (corrected) addendum opinion, a third VA examiner stated that no nexus could be established. The STRs did not show an injury or complaint related to the right wrist. The first complaint was not reported until the VA examination in 2022, which is 30 years after the Veteran separated from service. Without documentation in the interim, a new condition cannot be excluded. The Veteran's report of wrist symptoms during service did not align with how the currently diagnosed "arthritic" disabilities are known to develop and does not result from an acute fall or injury. The Board finds the VA examination and three separate medical opinions inadequate. The AOJ either did not obtain and provide the examiners with a complete copy of the Veteran's VA treatment records or the examiners did not thoroughly review the records. Specifically, during an April 2018 encounter, the VA treatment records show that the Veteran did report right wrist pain for a duration of two months. See December 2023 CAPRI. Another treatment note shows he was prescribed a brace for his right wrist in February 2022. Moreover, none of the examiners provided a thorough rationale about whether it was at least as likely as not that the right wrist strain is related to the Veteran's active service, including his reports of falls. In light of the inconsistencies within the June 2022 VA examination report itself, the Board finds it necessary to remand this matter for a new examination as well as a new medical opinion based on a review of the pertinent medical evidence and lay statements. The matter is REMANDED for the following action: Schedule an examination by an appropriate clinician to determine the nature and etiology of the Veteran's right wrist disability. The examiner must review the entire claims file, including a copy of this remand, and note such in the accompanying report. The examination should include any appropriate diagnostic testing. The examiner is asked to opine whether is it at least as likely as not (i.e., likelihood is at least approximately balanced or nearly equal, if not higher) that the right wrist disability is etiologically related, in whole or in part, to an in-service injury, event, or disease, to include the Veteran's report of falls during training? The examiner must provide a thorough rationale for all opinions expressed and cite to supporting clinical data and medical literature as appropriate. The examiner should not rely on the absence of complaints in the STRs. Because the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including events that occurred in service and when his symptoms started, the examiner should consider the Veteran's lay statements and provide a fully reasoned explanation if there is a medical basis that supports or calls into doubt the Veteran's reported history of his symptoms. If the examiner is unable to provide an opinion, the examiner should indicate whether there is any additional evidence that would facilitate an opinion, or whether the examiner's inability to opine is based on the limits of the examiner's medical knowledge. T. V. Casey Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Burden, 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.