Citation Nr: 18124071
Decision Date: 08/06/18	Archive Date: 08/03/18

DOCKET NO. 13-09 673
DATE:	August 6, 2018
Entitlement to service connection for a right wrist disorder is remanded. 
The Veteran had active duty service in the United States Air Force from July 1967 to January 1971. 
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2011 rating decision.
The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge in September 2015.  A transcript of that proceeding is associated with the record.
In December 2015, the Board, in relevant part, reopened and remanded a claim for service connection for a right wrist disorder.  In November 2016, the Board again remanded the claim for additional development.  The case has since been returned to the Board for appellate review.
The Board finds that a remand is necessary to obtain an adequate VA medical opinion in compliance with the November 2016 remand.  See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Stegall v. West, 11 Vet. App. 268, 271 (1998).  
In January 2017, a VA examiner provided a negative nexus opinion.  In so doing, the examiner stated that the only indication of a wrist problem in the Veteran’s medical records was noted in a 2013 VA primary care record.  However, a March 2003 VA primary care record noted that the Veteran complained of wrist pain.  In addition, the examiner stated that 2012 x-ray findings showed degeneration of the wrist that could be secondary to a previous post-service fracture and aging.  However, the Board notes that the examiner’s opinion is speculative in nature.  See, e.g., McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006) (finding doctor’s opinion that “it is possible” and “it is within the realm of medical possibility” too speculative to establish medical nexus).  The Board further notes that the examiner did not reconcile these findings in his March 2017 addendum opinion.
In addition, in June 2017, the Veteran provided contact information for his private treatment providers, including Dr. P.  On remand, the Agency of Original Jurisdiction (AOJ) should afford the Veteran an additional opportunity to submit authorization for VA to obtain any outstanding private medical records.  
The matter is REMANDED for the following action:
1.  The AOJ should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for his right wrist disorder.  A specific request should be made for authorization to obtain records from Dr. P.  The AOJ should notify the Veteran that he must submit proper authorization in order for VA to attempt to obtain his private treatment records from the locations identified in his June 2017 correspondence.  
After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file.
The AOJ should also secure any outstanding, relevant VA medical records.
2.  After completing the preceding development in paragraph 1, obtain a VA medical opinion from a qualified examiner on the etiology of the Veteran’s right wrist disorder.  The claims files must be made available to the examiner.  The examiner is requested to review all pertinent records associated with the claims file. 
The examiner should note that the Veteran’s is competent to attest to observable symptomatology.  If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation.
The examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s right wrist arthritis manifested during active service or is otherwise related to active service.  
In rendering this opinion, the examiner must specifically address the Veteran’s contentions of continuous right wrist pain since service, his reported in-service injuries, and his military occupational specialty doing masonry.  The examiner should also address the private x-ray received on July 23, 2012, and the December 2012 VA x-ray report.
3.  Review the medical opinion to ensure that it is in compliance with the directives of this remand.  If the medical opinion is deficient in any manner, the AOJ must implement corrective procedures.  Stegall v. West, 11 Vet. App. 268, 271 (1998).
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	M. Wulff, Associate Counsel

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