C & P Exam - Rater Asked For Another DBQ

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I asked a question about this C & P exam in another forum but need to ask another.  In the DBQ medical opinion request, the rater stated that he couldn't pull up an EMG from 2014.  I went to my local VA clinic this morning and asked them to print a copy of the EMG results.  The results say that I have moderate bilateral median neuropathy at the wrist as in carpal tunnel syndrome.  I phoned the DAV office, the RSO returned my call and told me to fax the results to him ASAP so he could take it to the RO as moderate vs mild was noted.   During the conversation with the RSO, I asked him which disability I would be rated on since being rated on all three would probably be pyramiding.  He said that wasn't true and that I would be rated on all three. "I've been doing this 17 years and know what I'm talking about, otherwise you could be down here doing my job."  My question:  is he correct?  The doctor also seemed to say it was three different issues.

DBQ Medical Opinion 1:

Please review the following documents and provide an opinion as to whether

or not the Veteran has a diagnosis of any type of right peripheral nerve

injury related to service or to his cervical spine.

A - Peripheral nerves examination dated 12/5/15, which references EMG from

2014 (which we can't pull up). The examiner states that the right upper

extremity symptoms are related to CTS and no other condition.

B - EMG from a private medical provider showing mild ulnar neuropathy and C7

radiculopathy of the right upper extremity

C - STRs - 10/31/2000 - showing bilatearl cervical radiculopathy, 3-22-01 -

complaints of numbness and tingling, 1-25-05 - complaints of numbness and tingling

D - STRs - 10/15/03 - Tinel's sign + over the right and left ulnar nerve

at

the elbow, 12/2/03 - bilateral ulnar nerve neuropathy diagnosed while in

service

The examiner stated that the right upper extremity is CTS; however, we have

the private EMG showing moderal CTS on the right with ulnar neuropathy and

C7 radiculopathy. Please review the evidence listed above (noting that you

are not restricted to just the evidence above) and state whether or not the

Veteran has a diagnosis of right upper extremity radiculopathy secondary to

his cervical spine, or right ulnar neuropathy directly related to military

service.

Reviewing Doctors’ Response

VBMS reviewed.

As noted, veteran appears to have cervical radiculopathy, ulnar neuropathy, and CTS. As each of these abnormalities are in anatomically different locations, they are not mutually exclusive.

 

He has STR noting bilateral cervical radiculopathy in 2000 as well as an '03 dx of ulnar neuropathy and positive exam findings for CTS.

 

 It would appear more likely than not that veteran has neuropathies involving all three anatomical locations based on exam and NCS findings and is at least as likely as not that they fit the time frame to connect to service.