Citation Nr: 25005338 Decision Date: 04/21/25 Archive Date: 04/21/25 DOCKET NO. 20-10 918 DATE: April 21, 2025 REMANDED The claim for entitlement to service connection for right upper extremity carpal tunnel syndrome claimed as neuropathy is remanded. The claim for entitlement to service connection for left upper extremity carpal tunnel syndrome claimed as neuropathy is remanded. REASONS FOR REMAND The Veteran honorably served on active duty in the United States Army from July 1999 to April 2001. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a January 2019 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in June 2021, December 2021, March 2023, and December 2024. In February 2025, the RO issued a supplemental statement of the Case (SSOC). This matter is now properly before the Board. 1. Entitlement to service connection for right upper extremity carpal tunnel syndrome claimed as neuropathy. See paragraph 2 below. 2. Entitlement to service connection for left upper extremity carpal tunnel syndrome claimed as neuropathy. The Veteran contends that he should be service connected for right and left upper extremity carpal tunnel syndrome, claimed as neuropathy. In December 2024, the Board remanded these matters for further development. The Board specifically requested that all necessary tests and studies, to include an electromyography (EMG) be conducted. The Board also requested that as part of the examination and opinion, the examiner must consider all prior diagnoses in the record and nexus opinions and explain or distinguish any variations in findings and conclusions. The Board also asked the examiner to provide an opinion if a formal diagnosis could not be provided, stressing that the examiner should consider whether the Veteran's condition manifests in symptoms that cause functional impairment and should consider them a "disability" for the purpose of providing the requested opinions. In January 2025, the Veteran was afforded a new VA examination. The examiner noted that special testing for the median nerve was conducted and that the Phalen's sign and Tinel's sign for both right and left were negative. The examiner found that there was no functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis. The examiner made a positive finding on the ulnar nerve compression test, which was noted in the right upper extremity only and consistent with peripheral neuropathy. The examiner noted that the EMG studies were not performed, contrary to the Board's explicit remand directives. The examiner noted that the Veteran's peripheral neuropathy impacts is ability to work. The examiner noted that the Veteran gets arm paresthesias when raising his arm overhead. The examiner stated that this could affect the Veteran's ability to do a job requiring significant overhead work. The examiner noted that the only diagnosis found on examination was diagnosis of right arm ulnar nerve neuropathy. The examiner noted that the Veteran has no objective findings to confirm a diagnosis of carpal tunnel syndrome in either arm. The Board notes that the examiner did not conduct the requested testing for carpal tunnel syndrome. The examiner found that the Veteran had a positive test for ulnar nerve compression in his right arm above the elbow. The examiner discussed radiculopathy of upper extremities and lower extremities. The Board notes that this is not the issue that was before the examiner. The examiner noted that the Veteran's records from service show he had complained of numbness/tingling in both arms after falling on his head in 2000, without continued objective evidence, a neuropathic or radicular diagnosis for his left arm cannot be continued. The examiner further noted that the Veteran's cervical magnetic resonance image (MRI) from 2018 showed a completely normal neck. The examiner stated that the evidence does not have radiculopathy in either arm from his cervical spine. The Board finds that the January 2025 VA examiner's examination was inadequate as it focused on diagnosis of radiculopathy/neuropathy which the Veteran is already service connected for. Furthermore, the examiner did not conduct the requested testing. The January 2025 VA examiner marked both a positive and negative nexus opinion. The examiner's rationale indicated that no opinion will be given for the Veteran's left upper extremity neuropathy/carpal tunnel syndrome as no objective evidence or records in his file exist to confirm the diagnosis. The Board notes that there is evidence of a diagnosis of carpal tunnel syndrome within the Veteran's record from prior examinations, which the examiner was asked to review and consider in the Board's prior remand directives. The examiner did provide an opinion that the Veteran's right upper extremity ulnar nerve neuropathy, claimed as carpal tunnel syndrome of the right upper extremity is at least as likely as not caused by an in-service event or injury. The Board notes that the examiner's opinion was not relevant to the requested opinion as the Veteran is already service connected for radiculopathy/neuropathy of the right upper extremity. Thus, the January 2025 VA examiner's opinion is inadequate. The Board notes that the specific condition that an opinion was requested for was the Veteran's carpal tunnel syndrome. The Board notes that the January 2025 VA examiner did not adequately address the Board's prior remand directives. Specifically, the examiner did not discuss or consider all prior diagnoses of carpal tunnel syndrome within the record. The examiner did not discuss whether the Veteran's condition manifests in symptoms that cause functional impairment, as a disability, although the examiner did note the functional impairment the examiner did not address the condition in terms of a disability. Finally, the Board specifically requested that an electromyography be conducted in testing for carpal tunnel syndrome. The January 2025 examiner did not provide an electromyography test to the Veteran. Although further delay is regretted, the Board finds that a remand is necessary to ensure compliance with the Board's prior remand directives. Additionally, the Board notes that the examiner provided an extensive opinion regarding neuropathy and radiculopathy both of which the Veteran is already service connected for and the question before the examiner was the nature and etiology of the Veteran's claimed carpal tunnel syndrome. The examiner was also asked to address conflicting medical opinions of record in regard to the Veteran's claimed carpal tunnel syndrome and the electromyography must be completed. The Board previously provided specific remand instructions, which the examiner did not comply. As a matter of law, a remand by the Board confers upon the Veteran the right to compliance with the Board's remand order. Stegall v. West, 11 Vet. App. 268, 270-71 (1998). As such, in accordance with Stegall, remand for full compliance with the Board's prior remand is warranted, specifically to afford the Veteran the ordered examination. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination with a qualified clinician with the necessary knowledge and experience to determine the nature and etiology of the Veteran's claimed right and left upper extremity carpal tunnel syndrome. The examiner should be one who has not previously examined the Veteran. The examiner must review all prior VA examinations, all prior Board remands, the examiner must be provided a copy of this Remand, and a copy of all service treatment records. A review of all required records and any other records made available to the examiner should be noted in the examination report. All necessary tests and studies, to include an electromyography are to be conducted. The examiner must address the following: (a) Does the Veteran have a diagnosis of carpal tunnel syndrome? Discuss the nature and etiology of the Veteran's claimed carpal tunnel syndrome and discuss the conflicting evidence of records where some examiners have found the Veteran has a diagnosis of carpal tunnel syndrome and other examiners have found the Veteran does not have a diagnosis of carpal tunnel syndrome. (b) Is it at least as likely as not (i.e., the likelihood is at least approximately balanced or nearly equal, if not higher), that the Veteran's bilateral upper extremity carpal tunnel syndrome was incurred in, caused by or is otherwise related to active service? (c) Is it at least as likely as not (i.e., the likelihood is at least approximately balanced or nearly equal, if not higher), that the Veteran's bilateral upper extremity carpal tunnel syndrome was caused by or aggravated by his service-connected disabilities? (d) The examiner must reconcile all conflicting opinions of record. Any opinion offered must be accompanied by a complete rationale. If any requested opinion cannot be offered without resorting to speculation, the examiner should indicate such in the examination report and explain why a non-speculative opinion cannot be offered. The examiner should also identify what, if any, additional information or evidence would allow for a more definitive opinion. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s). 2. Thereafter, re-adjudicate the Appellant's claim. If any benefit sought remains denied, provide the Veteran with a supplemental statement of the case and an adequate opportunity to respond before returning the matter to the Board for further adjudication, if otherwise in order. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Counsel, H. Hailu 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.