Citation Nr: 1036232 Decision Date: 09/24/10 Archive Date: 09/30/10 DOCKET NO. 03-13 227 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for a left hand disability, to include as secondary to a left third finger disability. 2. Entitlement to service connection for a spleen disability. 3. Entitlement to service connection for left carpal tunnel syndrome, to include as secondary to a left third finger disability. 4. Entitlement to service connection for degenerative disc disease (DDD) of the cervical spine. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD J. Schroader, Associate Counsel INTRODUCTION The Veteran served on active duty from January 1971 to February 1973. These matters come before the Board of Veterans' Appeals (Board) on appeal from December 2002 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) located in St. Petersburg, Florida that denied the Veteran's claim of entitlement to service connection for left carpal tunnel syndrome and DDD of the cervical spine, and from an August 2003 rating decision that denied his claims of entitlement to service connection for a left hand disability and a spleen disability. In June 2007, a Travel Board hearing was held before the undersigned Veterans Law Judge. A transcript of the proceeding has been associated with the claims file. In January 2008, the Board remanded this matter for further development. Such development has been completed and associated with the claims file, and this matter is ready for further review by the Board. The issues of entitlement to service connection for left ulnar neuralgia and hypertension have been raised by the record but have not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over these matters, and they are referred to the AOJ for appropriate action. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran currently has a spleen disability. 2. The Veteran's left carpal tunnel syndrome is not shown by the most probative evidence of record to be etiologically related to a disease, injury, or event in service, or to have been caused or aggravated by a service-connected disability. 3. The preponderance of the evidence is against finding that the Veteran currently has a left hand disability. 4. The Veteran's DDD of the cervical spine is not shown by the most probative evidence of record to be etiologically related to a disease, injury, or event in service. CONCLUSIONS OF LAW 1. Service connection for a spleen disability is not warranted. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2009). 2. Service connection for left carpal tunnel syndrome is not warranted. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2009). 3. Service connection for a left hand disability is not warranted. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2009). 4. Service connection for DDD of the cervical spine is not warranted. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Veterans Claims Assistance Act of 2000 (VCAA) With respect to the Veteran's claims, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C.A. §§ 5102, 5103(a), 5103A, 5106 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.159, 3.326(a) (2009). Under the VCAA, when VA receives a complete or substantially complete application for benefits, it is generally required to "notify the claimant and the claimant's representative, if any, of any information and any medical or lay evidence not previously provided . . . that is necessary to substantiate the claim." 38 U.S.C.A. § 5103(a)(1) (West Supp. 2009). As part of that notice, VA must "indicate which portion of that information and evidence, if any, is to be provided by the claimant and which portion, if any, the Secretary . . will attempt to obtain on behalf of the claimant." 38 U.S.C.A. § 5103(a)(1) (West Supp. 2009). The requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between the veteran's service and the disability, degree of disability, and effective date of the disability. See Dingess v. Nicholson, 19 Vet. App. 473 (2006), aff'd sub nom. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007). The Board finds that VCAA letters dated in June 2002 and May 2003 (two) fully satisfied the duty to notify provisions (and a follow-up VCAA letter was also sent to the Veteran in June 2006). See 38 U.S.C.A. § 5103(a) (West Supp. 2009); 38 C.F.R. § 3.159(b)(1) (2009). The VCAA letters informed the Veteran of what information or evidence was needed to support his claims, what types of evidence the Veteran was responsible for obtaining and submitting to VA, and which evidence VA would obtain. A June 2006 notice letter explained how VA assigns disability ratings and effective dates, and the Veteran's claims were readjudicated by way of a May 2010 Supplemental Statement of the Case(SSOC), such that any defect as to the timeliness of the June 2006 notice is nonprejudicial. See Dingess, supra. The Board also concludes that VA's duty to assist has been satisfied. See 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). All of the Veteran's service treatment records, VA treatment records, and private treatment records have been associated with the claims file. The Veteran has not identified any additional relevant treatment records for VA to obtain. In this regard, the Board acknowledges that, as noted above, in January 2008, the Board remanded these issues for further development, to include so that copies of certain VA treatment records from the Chicago, Illinois VA medical center (VAMC) and private treatment records from Dr. J.W. could be obtained. The Board notes that the RO sent two requests in February 2008 and May 2009 to the Chicago VAMC for copies of the Veteran's treatment records, in response to which the VAMC replied in June 2009 that it had no treatment records on file relating to the Veteran. Also, the RO sent a February 2008 letter to the Veteran requesting that he complete and return a Form 21-4142 authorization so that the RO could obtain any relevant, outstanding treatment records from Dr. J.W. The February 2008 letter also advised the Veteran that he may request and submit the records directly to the RO himself. No response was received by the RO, and the RO issued a May 2010 SSOC denying both claims. Based thereon, the Board finds that the RO complied with the Board's remand directive to obtain the identified treatment records to the extent possible under the circumstances. See Stegall v. West, 11 Vet. App. 268 (1998) (duty to ensure compliance with Board remand order). The Board finds that the record contains sufficient evidence to make a decision on the claim. VA's duty to assist also includes the duty to provide a VA examination when the record lacks evidence to decide a veteran's claim and there is evidence of (1) a current disability, (2) an in-service event, injury, or disease, and (3) some indication that the claimed disability may be associated with the established in-service event, injury, or disease, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. See 38 C.F.R. § 3.159(c)(4) (2009); McLendon v. Nicholson, 20 Vet. App. 79 (2006). With regard to the Veteran's claims for service connection for left carpal tunnel syndrome and a left hand disability, the Veteran was provided with an initial VA examination in November 2002. In January 2008, the Board remanded this issue and directed that another VA examination be provided to clarify the nature and etiology of the Veteran's claimed carpal tunnel syndrome and left hand disability, to include whether these claimed disabilities were caused or aggravated by his service- connected left finger disability or was otherwise related to service. Pursuant to the Board's January 2008 remand, another examination was provided in December 2009. The December 2009 VA examination report reflects that the examiner provided the requested opinions and that he provided adequate reasoning for his conclusions. Also, the examiner noted that he reviewed the claims file, and his report reflects that he elicited a history from the Veteran and examined him. Based thereon, the Board finds that there has been substantial compliance with the Board's remand directives, and that this VA examination report is thorough and adequate upon which to base a decision with regard to the Veteran's claim. See Stegall, supra. With regard to the Veteran's claims for service connection for a spleen condition and for DDD of the cervical spine, the Board acknowledges that no VA examination has been provided. As noted above, VA's duty to assist includes providing a veteran with a medical examination when the record (1) contains competent evidence that the veteran has a current disability, (2) contains evidence indicating that the disability is related to service, and (3) does not contain sufficient medical evidence for VA to make a decision, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. See 38 C.F.R. § 3.159(c)(4) (2009); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Board finds, however, that, with regard to the claimed spleen condition, the file does not contain competent medical evidence or credible lay evidence tending to indicate that the Veteran has a current spleen condition, as explained in further detail below. Also, the Board finds, with regard to the claimed DDD of the cervical spine condition, the file does not contain any competent medical evidence or credible lay evidence tending to link his diagnosed DDD of the cervical spine to service, as explained in further detail below. Therefore, the requirements triggering VA's duty to provide a VA examination have not been satisfied and, as such, the failure to provide the Veteran with examination relating to these two claims was harmless. See id. Likewise, the Board finds that there is sufficient evidence of record to make a decision on both of these claims. As there is no indication that any failure on the part of VA to provide additional notice or assistance reasonably affects the outcome of this case, the Board finds that any such failure is harmless. See Mayfield v. Nicholson, 19 Vet. App. 103 (2005), reversed on other grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). II. Analysis The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case, the claim is denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C.A. § 1110 (West 2002). 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) (2009). 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) (2009). To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service" - the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A. Spleen The Veteran served on active duty in the Navy from January 1971 to February 1973. He claims that he incurred a "spot on his spleen" as a result of an injury in service that involved his back. See Statement, July 2003; Informal Claim, December 2002. As an initial matter, the Board notes that the Veteran's service treatment records are silent as to any spleen problem or condition. The Board does acknowledge complaints of back and low back pain that are documented in the Veteran's service treatment records. See, e.g., Service Treatment Records, March 1972, April 1972, May 1972, July 1972, January 1973, June 1973. The Board notes that there is no competent evidence of record that the Veteran has any spleen condition, and there is not even one medical record reflecting any complaints of any spleen condition. Rather, a May 2002 VA CT scan report prepared due to complaints of left flank pain reflects that the Veteran's spleen was unremarkable. Likewise, an April 2004 ultrasound performed to rule-out hepatitis reflects that the Veteran's spleen was normal. Also, a September 2005 VA treatment record reflects that the Veteran complained of chronic upper left abdominal pain, and notes that a January 2005 computer tomography showed that his spleen was not enlarged. The threshold requirement for service connection to be granted is competent medical evidence of the current existence of a claimed disorder. See Degmetich v. Brown, 104 F.3d 1328 (1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992). Without a current diagnosis of a spleen condition, there may be no service connection for the claimed disability. See id. The Board has considered all of the Veteran's lay statements, including that he was told by a clinician that he has a "spot" on his spleen. As noted above, however, none of the medical evidence of record shows that there is any diagnosed spot, clot, or mass, or other density or any other condition involving the Veteran's spleen. Rather, all testing shows that the Veteran's spleen is normal, as noted above. In fact, the Veteran testified at the DRO hearing in March 2004 that he had never been treated for any spleen condition, which is contrary to his assertion above. See Transcript at 10. Certainly, the Veteran is competent to report experiencing pain or other symptomatology capable of lay observation, and that he may also be competent to diagnose certain simple disorders capable of lay observation. See Charles v. Principi, 16 Vet. App. 370 (2002). The Veteran is not competent, however, to diagnose a more complex disorder clearly requiring medical expertise, such as, in this case, a disability involving the spleen. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (explaining in footnote 4 that a veteran is competent to provide a diagnosis of a simple condition such as a broken leg, but not competent to provide evidence as to more complex medical questions). Furthermore, despite the Veteran's assertion that he was told by a clinician that he had a spot on his spleen, the Board also notes that it is not entirely clear whether the Veteran intended to claim that he had a "spot" on his spleen as opposed to his kidney, or both, in the first instance. The Veteran claimed service connection for a kidney condition and a spleen condition together on his December 2002 informal claim, and, as noted above, the May 2002 CT scan showed a calcification around his kidney but that his spleen was normal. When asked for clarification by his own representative at the March 2004 DRO hearing, the Veteran replied "that's a good question," and that he did not know how any claim for service connection for a kidney condition had been filed. Specifically, the DRO hearing transcript reflects as follows: REP: Tell us about your spleen, now when you say you got this clot, was this clot on your spleen or on your kidney? It was your spleen? Am I understanding that correctly? VET: It was on my spleen. REP: Okay, so where does the kidney come into play with this? VET: That's a good question. REP: Okay, because you're asking for service connection for a kidney condition. So what type of kidney condition do you feel you have? VET: I don't know how they got in that part. See DRO Hearing Transcript, March 2004 at 9. The Board notes in this regard that the August 2003 RO decision separately adjudicated and denied service connection claims for both a kidney and a spleen condition, and the Veteran has not appealed the decision relating to his kidney claim. In fact, his representative noted at the DRO hearing that the Veteran did not intend to pursue any kidney claim. See DRO Hearing Transcript, March 2004 at 9. In any event, however, given the vague nature of the Veteran's recollections, and in light of the specific findings contained in the report of CT scan, the Board must find his assertion that he had been told in the past that he had a spot on his spleen to not be credible. For these reasons, the Board concludes that the preponderance of the evidence is against granting service connection for a spleen condition, and the benefit of the doubt rule is not for application. B. Left Carpal Tunnel Syndrome The Veteran claims that he incurred left carpal tunnel syndrome (and a left hand disability, discussed below) as a result of catching himself with his left hand when he tripped and fell going across a hatch of a ship in service. See Form 9 Appeal; see also DRO Hearing Transcript, February 1994 at 2-3 (description of accident). In the alternative, the Veteran alleges that he developed left carpal tunnel syndrome secondary to his service-connected left third finger injury. VA treatment records reflect that the Veteran underwent left carpal tunnel release surgery in July 2002 and again in June 2006 at the VA medical center (VAMC). Clearly, the Veteran has a left carpal tunnel syndrome disability. The Board will now address whether the Veteran's left carpal tunnel syndrome is related to service, to include whether it is related to his service-connected left third finger condition. As an initial matter, December 1972 service treatment records reflect that the Veteran reported that he sprained his left hand and wrist two weeks prior when he caught himself falling with his left hand. An x-ray revealed an avulsion fracture of the third digit (a.k.a. ring finger), but examination otherwise revealed a normal hand (and the Veteran is currently service-connected for his left third finger injury). The Veteran's January 1973 separation examination report, however, is silent as to any complaints of any left wrist, left hand, or left arm problems. The first post-service treatment record reflecting any complaints of any upper left extremity problems is an August 1981 VA examination report (relating to an increased rating claim for the Veteran's left third finger), which reflects that the Veteran complained of right hand pain. Physical examination revealed had no gross deformity of the left hand, normal limitation of motion of his fingers, wrist, and elbow, and no atrophy of the upper left extremity. No left hand, left wrist, or left arm diagnosis was recorded (although residuals of a left third finger fracture were noted). An April 1982 orthopedic consultation report relating to complaints of left hand problems reflects "no clinical evidence of abnormality whatsoever." No left hand, left wrist, or left arm diagnosis was recorded. An October 1984 VA examination report (relating to an increased rating claim for his left third finger) reflects that the Veteran complained that his hand would "give out" due to the fall in service. On physical examination however, he was found to have equal grip strength in both his left and right hands, no disturbance in skin sensation of the left hand, good apposition of all fingertips to the thumb, no disturbance in pronation or supination of the wrist, normal palmar dorsiflexion and palmar flexion, and normal ulnar and radial deviation. Again, no left hand, left wrist, or left arm diagnosis was recorded. An August 1992 VA examination report (relating to an increased rating claim for his left third finger) reflects that the Veteran complained of experiencing left hand pain, numbness, and weakness. On examination, no gross pathology was noted, although limitation of flexion of the fingers of his left hand was noted as limited by not being able to touch the palmar crease by about one half-inch in contrast to the right hand. No weakness on grip was noted. A diagnosis of "rule-out osteoarthritis of the left hand" was recorded. A November 1993 VA treatment record reflects that the Veteran complained of pain in his left hand since the in-service (December 1972) falling accident. A diagnosis of left hand pain was recorded. Another November 1993 VA treatment record reflects the Veteran was referred for further evaluation, including nerve conduction studies, and that a provisional diagnosis of left arm and hand numbness was recorded. January 1994 VA treatment records reflect that a nerve conduction study of the left upper extremity, including the median and ulnar nerves, was normal. An impression of pain most likely secondary to arthritic joint pain was recorded. February 1995 VA treatment records reflect that the Veteran complained of pain in his neck and pain and numbness in his left arm, and that he would not raise his arm above shoulder level due to complaints of pain. It was noted in the record, however, that he did not appear to be in pain despite rating it a 9/10, and no muscle atrophy, normal appearance, and intact motor function were noted. An impression of degenerative joint disease of the cervical spine was recorded. An August 1995 VA examination report (relating to an application for nonservice connected pension) reflects that the Veteran reported his in-service trip and fall accident. He also reported fracturing his left third (ring) finger. He complained of progressively worsening pain in his shoulder, arm, and hand since the in-service accident and that he occasionally would lose feeling in his hand and forearm. Also, the Veteran reported a history of an automobile accident in June or July of 1981 in which he was a passenger and the brakes failed and the vehicle hit a brick expansion. He reported that he sprained his left shoulder and arm in the automobile accident, and that since that time he developed progressive pain, weakness, and numbness of his left hand and upper left extremity. The examiner noted that, in 1994, nerve conduction studies were normal. The examiner recorded a diagnosis of anterior spinal stenosis with probable radiculopathy to the left upper left extremity secondary to brachial plexus (at C4/5, C5/6). A February 1997 private facility record reflects that a nerve conduction study revealed abnormal findings, and an impression of evidence of generalized peripheral neuropathy of both upper extremities was recorded. December 1997 VA medical center records reflect that the Veteran was hospitalized for two weeks after presenting with complaints of neck pain and left arm numbness. A diagnosis of rule-out coronary artery disease was recorded on admission, and a history of alcohol and cocaine abuse was noted. A July 2001 VA neurology record reflects that the Veteran reported pain in his neck that extended down his left shoulder and arm with tingling and numbness radiating to his fingers, and that he reported a history of a motor vehicle accident in 1981. An impression of possible nerve root compression at C5/6 was recorded. A subsequent July 2001 VA neurology record reflects that the Veteran's complaints of sensory disturbances in his left arm could not be explained by examination. A September 2001 VA neurology record reflects that the Veteran reported that the pain went away for a period of time after the 1981 accident until around 1996 or 1997, when it recurred without intercurrent trauma, and that he also reported a 1985 injury to his head from falling off a ladder. An impression of cervical spondylosis was recorded. A December 2001 VA EMG study report reflects that the study was performed to rule out left cervical radiculopathy versus left arm entrapment, and that the study revealed evidence of left median nerve entrapment (carpal tunnel) at the wrist, and no evidence of left cervical radiculopathy. A July 2002 VA surgical note reflects that left carpal tunnel release surgery was performed. A brief September 2002 VA treatment record prepared by a nurse practitioner reflects that the Veteran reported that he felt that his problems with his left hand were due to his in service accident, and that it was conceivable that the Veteran's median nerve entrapment was aggravated or enhanced by the previous injury and that it could not be ruled out. A November 2002 VA examination report (relating to an increased rating claim for his left third finger as well as his service connection claim for carpal tunnel syndrome) reflects that the Veteran reported a history of his in-service accident as well as the 1981 motor vehicle accident ("in which he hurt his neck"). He reported that recently he had been diagnosed with left carpal tunnel syndrome and that he had surgery in July 2002. He reported he had been experiencing left hand numbness, followed by numbness coming down his neck do his left hand and all through his left arm. When asked if his left hand numbness improved after the carpal tunnel release surgery, the Veteran stated that it was too early to tell. The examiner noted a healed scar on the Veteran's left wrist from the carpal tunnel surgery, that he had a good fist and grasp bilaterally, that he was able to close his fingers and thumb, and that he reported sensation in both hands, but better in his right than his left. No left hand tenderness or deformity were noted. Impressions of a history of a left third finger (ring) fracture, a history of a 1981 car accident with cervical spine injury and bulging discs, and a history of carpal tunnel syndrome release done in 2002 were noted. The examiner added that the Veteran's carpal tunnel syndrome could not be related to his diagnosed history of a left third finger fracture without resorting to mere speculation. A May 2003 VA treatment record reflects continued complaints of neck and left forearm pain. A December 2005 letter written to the Veteran form a VA physician reflects that EMG study results showed nerve problems in the(left) wrist and elbow not due to the Veteran's neck, but rather as a result of carpal tunnel syndrome and nerve entrapment at the elbow. A May 2006 VA examination report (relating to the Veteran's increased rating claim relating to his left third finger) reflects that the examiner noted when prompted as to "symptoms in left hand relating to the left ring finger fracture," the examiner opined that the Veteran's ulnar nerve entrapment and carpal tunnel syndrome caused his left hand and left forearm problems, and that this was "a separate issue from the past fracture of the left ring finger." A June 2006 VA surgical report reflects that another left carpal tunnel release surgical procedure, as well as a cubital tunnel release, were performed. A post-operative diagnosis of median and ulnar neuropathy was recorded. A December 2009 VA examination report reflects that the Veteran reported to the examiner his history of the falling accident in service. The examiner noted that the Veteran sprained his left wrist and fractured his left third finger as a result of the accident. He examined the Veteran's left upper extremity as well as the claims file, and opined that the Veteran had left carpal tunnel syndrome and ulnar entrapment that was less likely than not related to service, to include the left wrist sprain and left third finger fracture the Veteran incurred in the falling accident. He noted that the Veteran's January 1973 separation examination was silent as to any problems, an October 1984 orthopedic evaluation reflected only a diagnosis of an old left third finger fracture, and a 1994 EMG evaluation was normal. The Board finds the above December 2009 VA examiner's opinion to be the most probative evidence of record with regard to whether the Veteran's left carpal tunnel syndrome is related to service or to his service-connected left third finger disability, as he based his opinion on his own examination of the Veteran and review of the claims file, and because he provided an adequate rationale for his conclusion. The Board notes that there is no persuasive medical opinion that contradicts the opinion of the December 2009 examiner with regard to the etiology of the Veteran's carpal tunnel syndrome. In fact, the Board notes that this is consistent with the conclusion of the November 2002 VA examiner who also noted that he could not relate the Veteran's carpal tunnel syndrome to his diagnosed history of a left third finger fracture without resorting to mere speculation. This is also consistent with the finding of the May 2006 VA examiner who noted that the Veteran's ulnar nerve entrapment and carpal tunnel syndrome caused his left hand and left forearm problems, and that this was "a separate issue from the past fracture of the left ring finger." The Board did consider the brief September 2002 VA treatment record prepared by a nurse practitioner that reflects that she opined "that it was conceivable that the Veteran's median nerve entrapment was aggravated or enhanced by the previous injury and that it could not be ruled out." However, the language used by the nurse practitioner is clearly very speculative by its terms, noting that such a relationship is "conceivable" and can not be ruled out. The Board notes that a connection that is merely "conceivable" or one based on mere speculation is too tenuous a basis on which to grant service connection. The reasonable doubt doctrine requires that there be a "substantial" doubt and "one within the range of probability as distinguished from pure speculation or remote possibility." 38 C.F.R. § 3.102 2009); Obert v. Brown, 5 Vet. App. 30, 33 (1993); Beausoleil v. Brown, 8 Vet. App. 459, 462 (1996); Libertine v. Brown, 9 Vet. App. 521, 523 (1996). The Board also acknowledges several lay statements made by the Veteran, to include that he injured his left hand, wrist, and arm in service in the 1972 falling accident, and that his carpal tunnel syndrome was either caused by that accident directly or is secondary to the left third finger fracture he incurred in the accident. Certainly the Veteran is competent to report events and symptoms capable of lay observation, to include the fact that he tripped and fell on a hatch in service and experienced pain in his left hand, wrist, and arm. In fact, as noted, the specific fall to which the Veteran refers is documented in the record. However, the Board finds any assertion of a continuity of symptomatology since that fall to be not credible in light of the fact that he has reported to several clinicians, as noted above, different stories as to when he began to experience pain in the areas of his left hand, wrist, and arm (e.g., he told several clinicians that he injured his upper left extremity in a 1981 automobile accident and, coincidentally, there is no record of complaint of any left hand, wrist, or arm problems until 1981). In summary, the Board finds that the preponderance of the evidence is against granting service connection for left carpal tunnel syndrome, and the benefit-of-the-doubt rule is not for application; there is not an approximate balance of evidence. See 38 U.S.C.A. § 5107(b); See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). C. Left Hand Disability The Veteran also claims that he incurred a left hand disability as a result of the in-service trip and fall accident in December 1972, or, in the alternative, that he developed a left hand disability secondary to his service-connected left third finger injury. See Claim, April 2002; Statement, April 1994; DRO Hearing Transcript, February 1994 at 2-3. As noted above, in January 2008, the Board remanded this issue so that another VA examination could be provided to clarify the nature and etiology of any left hand disability found on examination. The December 2009 VA examiner related all of the Veteran's complaints of left hand and forearm problems to his diagnosed left carpal tunnel syndrome and ulnar nerve entrapment, neither of which are service-connected conditions, and the examiner did not find any other left hand condition on examination. As noted above, the threshold requirement for service connection to be granted is competent medical evidence of the current existence of a claimed disorder. See Degmetich v. Brown, 104 F.3d 1328 (1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992). Without a current diagnosis of a left hand condition, there may be no service connection for the claimed disability. See id. The Board finds that the preponderance of the evidence shows that the Veteran does not have a left hand disability. All but one of the medical records reflect that the Veteran's left hand is normal (except for his left third finger). See, e.g., VA Radiological Report, August 1981 (left hand x-ray showed no abnormality other than residuals of old third finger injury), VA Orthopedic Evaluation, April 1982 ("no clinical evidence of abnormality whatsoever"), VA Radiological Report October 1984 (no evidence of fracture or deformity except for third finger mild deformity that could be related to old fracture); VA Examination Report, November 2002 (left hand was without tenderness or deformity, and no diagnosed disability recorded). While the Board does acknowledge that the one treatment record, the January 1994 VA treatment record, reflects an impression of left hand pain "most likely" secondary to arthritic joint pain, the Board finds that this record has no probative value because no rationale is provided, it does not indicate that the diagnosis is based on any radiological testing to verify the presence of a left hand arthritic condition, and, most significantly, all of the x-rays of the Veteran's left hand of record were found to be normal. The Board has considered all of the Veteran's lay statements, including that he caught himself falling with his left hand in service and has a current left hand disability as a result, or, in the alternative, that he has a left hand disability secondary to his service-connected left third finger disability. The Board finds, however, the opinions of all of the clinicians noted above who evaluated the Veteran for the left hand and arm complaints since 1981 to be far more probative than the Veteran's lay statements. Moreover, the Board notes that while the Veteran is certainly competent to report experiencing left hand pain or numbness other symptomatology capable of lay observation, he is not necessarily competent to attribute those symptoms to a specific underlying disability of the left hand. See Charles v. Principi, 16 Vet. App. 370 (2002); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board again acknowledges the Veteran's reports that he has experienced pain, weakness, and numbness in his left hand ever since the in-service accident. See Claim, April 2002, Board Hearing Transcript, June 2007 at 20- 21. However, as noted above, the Veteran also made statements to several clinicians that he his pain in his left hand first began following an automobile accident in 1981, and he also reported to some that the pain than went away for a long period of time before recurring in 1996. Given these contradictions in his various statements, the Board must find any assertion of a continuity of symptomatology since service not credible. For these reasons, the Board concludes that the preponderance of the evidence is against a finding of a current left hand disability or granting service connection for a left hand disability, and the benefit of the doubt rule is not for application. D. DDD of the Cervical Spine The Veteran claims that he incurred DDD of the cervical spine as a result of service. As noted above, a February 1995 VA examination report (relating to the veteran's claim for nonservice connected pension) reflects that a diagnosis of DDD of the cervical spine was recorded. Clearly, the Veteran has a current DDD of the cervical spine disability. The Board will now address whether the Veteran's current DDD of the cervical spine is related to service. As an initial matter, the Veteran's service treatment records are silent as to any complaints of any neck or cervical spine problems. The first records of complaint of any neck problems are the above noted February 1995 VA examination report, as well as a radiological report prepared in connection with the examination. A June 2001 VA MRI report relating to the Veteran's cervical spine reflects a history of a motor vehicle accident in 1981 and an impression of degenerative changes in the mid cervical spine with disc space narrowing, osteophytes, disc bulging at multiple levels, and 30 percent cord indentation. As noted above, a July 2001 VA neurology record reflects that the Veteran reported pain in his neck that extended down his left shoulder and arm with tingling and numbness radiating to his fingers, and that he reported, again, the history of a motor vehicle accident in 1981. An impression of possible nerve root compression at C5/6 was recorded. Likewise, as noted above, a September 2001 VA neurology record reflects that the Veteran reported that the pain went away for a period of time after the 1981 accident until around 1996 or 1997, when it recurred without intercurrent trauma, and that he also reported a 1985 injury to his head from falling off a ladder. An impression of cervical spondylosis was recorded. The November 2002 VA examination report (relating to his left third finger his claim for carpal tunnel syndrome) reflects that the Veteran reported a history of hurting his neck in the 1981 motor vehicle accident, and the examiner noted an impressions of a history of a 1981 car accident with cervical spine injury and bulging discs. Again, an October 2003 VA treatment record reflects that the Veteran reported a history of neck pain secondary to the motor vehicle accident. In light of the above, the Board finds that there is no medical evidence credible evidence of record suggesting a link between the Veteran's DDD of the cervical spine and service. The Board acknowledges several lay statements made by the Veteran, including his testimony at the June 2007 Board hearing to the effect that he injured his neck in service due to hitting his head several times (10 to 12) on an overhead rack with a small helmet on. He reported that he would experience headaches afterward, and that he reported to sick bay with complaints of headaches. The Board notes, however, that there is no record of any complaints of headaches or hitting his head in service. Also, the Board notes all of the above discussed treatment records that show that the Veteran reported to clinicians, several times, that his neck problems were related to a 1981 automobile accident, not service. Generally, statements made for the purpose of medical diagnosis or treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive a proper diagnosis or treatment. See White v. Illinois, 502 U.S. 346, 356, 112 S.Ct. 736 (1992). In light of the contradictory statements made by the Veteran and relating his neck problems to a post-service motor vehicle accident, the Board finds the Veteran's statements to lack probative value. For these reasons, the Board concludes that the preponderance of the evidence is against granting service connection for DDD of the cervical spine, and the benefit of the doubt rule is not for application. ORDER Entitlement to service connection for a spleen disability is denied. Entitlement to service connection for carpal tunnel syndrome is denied. Entitlement to service connection for a left hand disability is denied. Entitlement to service connection for DDD of the cervical spine is denied. ____________________________________________ MICHAEL LANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs