Citation Nr: 0812398 Decision Date: 04/15/08 Archive Date: 05/01/08 DOCKET NO. 04-38 298A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUE Entitlement to service connection for carpal tunnel syndrome and/or sensory neuropathy of the upper extremities, secondary to a cold weather injury. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Robert L. Grant, Associate Counsel INTRODUCTION The veteran had active service from May 1968 to May 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of the VA Regional Office (RO) in Los Angeles, California which denied entitlement to the benefits sought. FINDINGS OF FACT 1. A cold weather injury was not manifested during service, and the veteran is not currently shown to have a cold weather injury, or residuals of a cold weather injury. 2. Carpal tunnel syndrome and/or sensory neuropathy of the upper extremities was not manifested during service, and any currently diagnosed carpal tunnel syndrome and/or sensory neuropathy of the upper extremities is not shown to be causally or etiologically related to service. CONCLUSION OF LAW Carpal tunnel syndrome and/or sensory neuropathy of the upper extremities was not incurred in or aggravated by active service, and is not proximately due to, or the result of, a service-connected disease or injury. 38 U.S.C.A. §§ 1110, 1131, 1154, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.310 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSION Before addressing the merits of the veteran's claim on appeal, the Board is required to ensure that the VA's "duty to notify" and "duty to assist" obligations have been satisfied. See 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2007). The notification obligation in this case was accomplished by way of a letter from the RO to the veteran dated in June 2003. While this notice does not provide any information concerning the disability evaluation or the effective date that could be assigned should service connection be granted, Dingess v. Nicholson, 19 Vet. App. 473 (2006), since this decision affirms the RO's denial of service connection, the veteran is not prejudiced by the failure to provide him that further information. The RO also provided assistance to the veteran as required under 38 U.S.C.A. § 5103A and 38 C.F.R. § 3.159(c), as indicated under the facts and circumstances in this case. The veteran and his representative have been kept informed of the RO's actions in this case by way of the Statement of the Case, and been informed of the evidence considered, the pertinent laws and regulations and a rationale for the decision reached in denying the claims. The veteran and his representative have not made the RO or the Board aware of any additional evidence that needs to be obtained in order to fairly decide this appeal, and have not argued that any error or deficiency in the accomplishment of the duty to notify and duty to assist has prejudiced him in the adjudication of his appeal. Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). Therefore, the Board finds that the duty to notify and duty to assist have been satisfied and will proceed to the merits of the veteran's appeal. The veteran essentially contends that he contracted frostbite during active service, and that he currently suffers from carpal tunnel syndrome and/or sensory neuropathy of the upper extremities as a result. A review of the veteran's military service records does not indicate that the veteran ever complained of, or was treated for, a cold weather injury including frostbite, or numbness or pain in the upper extremities during active service. Based upon a review of the veteran's service records there is no medical evidence that the veteran sustained a cold weather injury during active duty. Post-service, the first documentation of upper extremity pain occurred in January 2002 when the veteran was treated at the Long Beach VA hospital. At that time the veteran complained of numbness and tingling and occasional pain in both hands and right and left first to third digits, of approximately three months duration. The veteran reported that he had started a new job approximately three months prior that involved a lot of repetitive wrist motion. The veteran also reported a history of being exposed to severe cold and resultant bilateral frostbite, although the date of the alleged exposure relative to the examination was not noted. A nerve conduction study was performed and said to be abnormal and suggestive of sensory peripheral neuropathy. The examiner stated that the sensory peripheral neuropathy could be secondary to a previous history of frostbite, and offered an impression of carpal tunnel syndrome. The veteran returned to the Long Beach VA hospital in November 2003. Medical records from that date indicate a diagnosis of bilateral carpal tunnel syndrome with sensory neuropathy. Office notes indicate that the veteran continued to have problems with his hands because of carpal tunnel syndrome and was pursuing a workers compensation claim. Later office notes indicate that the veteran settled his compensation claim for the sum of $7,000. A VA examination was conducted in March 2007. The veteran reported numbness in his hands at night, partially alleviated by wrist braces. The veteran stated that he was exposed to cold while on field trips in sub zero temperatures in 1969- 1971. The veteran advised that he was not bothered with numbness of the fingers when he began working at an auto plant in 2001. Work at the auto plant involved using repetitive motion of his hands, and the veteran started to feel numbness every night. The veteran stated that during service he experienced numbness in his fingers and was on sick calls several times, but the veteran could not recall exactly when and did not recall any particular treatment for that condition. The March 2007 VA examiner requested additional nerve conduction studies, which were again said to be abnormal, suggestive of generalized sensory polyneuropathy, and evidence of bilateral sensory and motor median neuropathy with sensory slowing across the carpal tunnel segment. The examiner stated that the veteran had evidence of sensory generalized neuropathy, probably on the basis of diabetes, but also had evidence of old carpal tunnel syndrome. The examiner went on to offer the opinion that whether exposure to cold contributed to development of neuropathy was "hard to say" as the veteran was not bothered by numbness between 1970-2001. The examiner concluded that cold exposure's contribution to numbness was probably less than 50 percent. Applicable law provides that service connection will be granted if it is shown that a veteran suffers from a disability resulting from an injury suffered or a disease contracted in the line of duty, or for aggravation of a pre- existing injury suffered or disease contracted in the line of duty, in the active military, naval or air service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Generally, to prove service connection, the record must contain: (1) Medical evidence of a current disability, (2) medical evidence, or in certain circumstances, lay testimony, of an in-service incurrence or aggravation of an injury or disease, and (3) medical evidence of a nexus or a relationship between a current disability and the in-service disease or injury. Pond v. West, 12 Vet. App. 341 (1999); Caluza v. Brown, 7 Vet. App. 498 (1995). Under section 3.310(a) of VA regulations, service connection may be established on a secondary basis for a disability which is proximately due to or the result of service- connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995). Based upon a review of the above, it is clear that the veteran has a current disability in the form of carpal tunnel syndrome and/or sensory neuropathy of the upper extremities. The question remaining before the Board is whether the evidence is sufficient to show that the veteran's current disability was proximately caused by a service-connected disability. A thorough review of the veteran's medical records does not indicate a service-connected disability in the form of a cold-related injury during or after service. The Board has considered the veteran's own assertions regarding contraction of frostbite. Although the veteran is competent to testify as to his in-service experiences, such as exposure to cold, and his symptoms, where the determinative issue involves a question of medical diagnosis or causation, only individuals possessing specialized medical training and knowledge are competent to render such an opinion. The evidence does not reflect that the veteran possesses medical knowledge which would render their opinion as to etiology and a medical diagnosis competent. See Bostain v. West, 11 Vet. App. 124, 127 (1998), citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992). See also Routen v. Brown, 10 Vet. App. 183, 186 (1997). Thus, any lay personal opinion that the disability at issue began in service or that it is otherwise related to service is not a sufficient basis for awarding service connection. Additionally, a review of the record in this cause does not indicate medical evidence of a nexus or a relationship between the veteran's carpal tunnel syndrome and/or sensory neuropathy of the upper extremities and the asserted exposure to cold while in service. A VA physician stated in July 2003 that the veteran's sensory peripheral neuropathy "could be" secondary to a history of frostbite. However, this opinion was based upon a history of frostbite offered by the veteran that is not supported by the medical record. Moreover, this opinion only indicates the possibility of a relationship, not that such relationship is as likely as not. The Board notes that a medical opinion based upon a subjective history provided by the veteran need not be accepted by the Board. See Boggs v. West, 11 Vet. App. 334 (1998) (VA medical opinion was not probative where it was based on history supplied by the veteran where that history is unsupported by the medical evidence); Swann v. Brown, 5 Vet. App. 229 (1993) (Board not bound to accept opinions of two doctors who made diagnoses of post-traumatic stress disorder almost 20 years following appellant's separation from service and who necessarily relied on history as related by appellant because their "diagnoses can be no better than the facts alleged by appellant"); see also Black v. Brown, 5 Vet. App. 177 (1993) (medical evidence was inadequate where medical opinions were general conclusions based on history furnished by appellant and on unsupported clinical evidence). Based upon the above, the Board finds the opinion offered by the VA physician in July 2003 to be based upon a history supplied by the veteran and not supported by the record. As such, the Board finds the physician's opinion not probative in this matter. The Board notes that the March 2007 VA examiner stated that the veteran's sensory peripheral neuropathy was "probably" related to the veteran's diabetes. Medical records indicate that the veteran's symptoms appeared after he became employed in an auto factory performing repetitive work. These facts weigh against a finding of evidence of a nexus between the veteran's carpal tunnel syndrome and/or sensory neuropathy of the upper extremities and an alleged cold weather injury in service. The March 2007 examiner also stated that the question of whether cold-exposure contributed to the veteran's neuropathy was "hard to say." As such, the examiner appears unable to provide an opinion that the veteran's alleged neuropathy was as likely than not proximately caused by the veteran's alleged cold injury. Absent evidence of such a nexus, a finding of service connection is not warranted. The examiner also noted that the veteran was not bothered by numbness for thirty-one years between 1970 and 2001. Based upon the above, the Board concludes that the evidence in this matter does not support a finding of service connection for carpal tunnel syndrome and/or sensory neuropathy of the upper extremities secondary to a cold weather injury. ORDER Service connection for carpal tunnel syndrome and/or sensory neuropathy of the upper extremities secondary to a cold weather injury is denied. ____________________________________________ V. L. JORDAN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs