Citation Nr: 1318926	
Decision Date: 06/11/13    Archive Date: 06/21/13

DOCKET NO.  11-14 473	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Medical and Regional Office Center in Fargo, North Dakota


THE ISSUE

Entitlement to service connection for bilateral carpal tunnel syndrome.


REPRESENTATION

Appellant represented by:	Veterans of Foreign Wars of the United States


ATTORNEY FOR THE BOARD

Harold A. Beach, Counsel



INTRODUCTION

The Veteran served on active duty from December 1965 to September 1967.  His primary military occupational specialty (MOS) was clerk typist.

He appealed to the Board of Veterans' Appeals (Board/BVA)l from a May 2010 rating decision of the Department of Veterans Affairs (VA) Medical and Regional Office Center (M&ROC) in Fargo, North Dakota, which, in relevant part, denied his claim for service connection for bilateral carpal tunnel syndrome (CTS).


FINDING OF FACT

The Veteran's bilateral CTS was first manifested many years after his service, and the preponderance of the competent and credible evidence of record, so the most probative, is against finding that it is in any way related to his service.  


CONCLUSION OF LAW

His bilateral CTS is not the result of disease or injury incurred in or aggravated by his service and may not be presumed to have been incurred during his service.  38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5103, 5103A (West 2002 and Supp. 2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2012).  



REASONS AND BASES FOR FINDING AND CONCLUSION

VA's Duties to Notify and Assist

Prior to considering the merits of the Veteran's appeal, the Board must determine whether VA has met its statutory and regulatory duties to notify and assist him in developing his claim.  38 U.S.C.A. §§ 5103, 5103A; 38 C.F.R. § 3.159.

In January 2010, he filed a claim of entitlement to service connection for bilateral CTS, and there is no issue as to providing him an appropriate application form or completeness of the application.

In response, VA notified him of the information and evidence necessary to substantiate and complete his claim, including the evidence to be provided by him versus the evidence VA would attempt to obtain for him.  Quartuccio v. Principi, 16 Vet. App. 183 (2002).  VA informed him of the criteria for service connection and the manner in which VA determines a disability rating and an effective date in the eventuality that service connection for the claimed disability is granted.  See Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 484 (2006), aff'd sub nom. Hartman v. Nicholson, 483 F.3d 1311 (2007) (observing that a claim of entitlement to service connection consists of five elements:  (1) Veteran status; (2) existence of a disability; (3) a connection between the Veteran's service and the disability; (4) degree of disability; and (5) effective date.  So compliance with the holding in Quartuccio requires apprising the Veteran of all five of these elements of the claim, including the "downstream" disability rating and effective date elements.  See Dingess, at 486.

Along with the provision of notice to him, VA fulfilled its duty to assist him in obtaining identified and available evidence necessary to substantiate his claim.  VA obtained or ensured the presence of his service treatment records (STRs), records concerning his post-service evaluation and treatment, and supporting lay statements dated in February 2010, including from a former fellow serviceman.

The Board also sees that, in May 2011, the Veteran's representative requested that the Veteran be scheduled for an informal hearing.  The following month, so in June 2011, the Veteran had an informal conference with a local Decision Review Officer (DRO).  The Veteran indicated he would be scheduling an appointment to obtain a medical nexus opinion regarding the nature and etiology of his bilateral CTS, presumably to substantiate his claim it is related or attributable to his military service or dates back to his service.  But, to date, so in the 2 years since, no such supporting opinion has been submitted or even appears forthcoming.

As to whether VA was required to schedule a VA compensation examination for a medical nexus opinion (either in lieu of or in addition to the Veteran himself submitting said opinion), there is a duty to provide a VA examination for a medical nexus opinion concerning etiology when the record lacks evidence needed to decide the Veteran's claim but there is evidence of:  (1) a current disability (including persistent or recurrent symptoms of disability), (2) an in-service event, injury, or disease, and (3) some indication the claimed disability may be associated with the established event, injury, or disease.  38 U.S.C.A. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); see also McLendon v. Nicholson, 20 Vet. App. 79 (2006).

When determining whether a VA examination and opinion are required under 38 U.S.C. § 5103A(d)(2), the law requires competent evidence of disability or persistent or recurrent symptoms of disability, but does not require competent evidence of a nexus, only that the evidence suggest an association between the disability and service or a service-connected disability.  See Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010).

Here, though, there are only at most lay assertions of a relationship or correlation between the Veteran's bilateral CTS and his military service.  VA is not obligated to provide an examination for a medical nexus opinion simply as a matter of course where, as here, the supporting evidence of record consists only of unsubstantiated lay allegations, including especially in terms of establishing the required association between the current disability and service.  See Duenas v. Principi, 18 Vet. App. 512, 519 (2004).  In Waters, the Court held that a Veteran's conclusory generalized statement that a service illness caused his present medical problems was not enough to entitle him to a VA medical examination and opinion since all Veterans could make such a statement, and such a theory would eliminate or circumvent the carefully drafted statutory standards governing the provision of medical examinations and require VA to provide such examinations as a matter of course in virtually every disability case.  Hence, as concerning this claim for bilateral CTS, there is no legal duty to obtain a VA medical opinion on the subject of causation.  See McClendon, 20 Vet. App. at 83 (2006); Charles v. Principi, 16 Vet. App. 370 (2002).

Consequently, the Board concludes the Veteran has received all essential notice and assistance, has had a meaningful opportunity to participate effectively in the development of his claim, and is not prejudiced by any technical notice deficiency along the way.  It is difficult to discern what additional guidance VA could provide him that would assist him in substantiating his claim.  Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004).  Indeed, he has not identified any other outstanding evidence that could support his claim; and there is no evidence of any VA error in notifying or assisting him that could result in prejudice to him or that could otherwise affect the essential fairness of the adjudication.  VA notice and assistance errors are not presumptively prejudicial, even when for the sake of argument, they are shown to have occurred.  Rather, they must be judged on a case-by-case basis.  And as the pleading party attacking VA's decision, the Veteran, not VA, bears this evidentiary burden of proof of not only establishing error, but also, above and beyond that, showing how it is unduly prejudicial, meaning outcome determinative of his claim.  Shinseki v. Sanders, 129 S. Ct. 1696 (2009).  There is no such pleading or allegation in this instance.

Turning now to the underlying merits of the claim.

The Veteran contends he has bilateral CTS primarily because of the large volume of typing he had to do in service.  He remembers that, at times, his arms and wrists ached so badly that he had to let his arms hang down until he felt the numbness subside and leave his hands.  He states that, ever since his service, those same manifestations have gotten progressively worse.

Service connection is granted if it is shown the Veteran suffers from a disability resulting from an injury sustained or a disease contracted in the line of duty during his active military service, or for aggravation during service of a pre-existing condition beyond its natural progression.  38 U.S.C.A. §§ 1110, 1153; 38 C.F.R. §§ 3.303(a), 3.306.

Stated somewhat differently, to establish entitlement to direct service connection for the claimed disability, there must be:  (1) competent and credible evidence confirming the Veteran has the claimed disability - or, at the very least, showing he has at some point since the filing of the claim; (2) competent and credible evidence of in-service incurrence or aggravation of a relevant disease or an injury; and, (3) competent and credible evidence of a relationship, or nexus, between the disease or injury in service and the current disability.  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004), citing Hansen v. Principi, 16 Vet. App. 110, 111 (2002).

Certain diseases are considered chronic, per se, including organic diseases of the nervous system, and therefore will be presumed to have been incurred in service if manifested to a compensable degree of at least 10-percent disabling within one year after service.  This presumption, however, is rebuttable by affirmative evidence to the contrary.  38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a).

Where there is a chronic disease shown as such in service or within a presumptive period under 38 C.F.R. § 3.307 so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes.  

This rule does not mean that any manifestation in service will permit service connection.  To show chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic."  38 C.F.R. § 3.303(b).  When the disease identity is established, there is no requirement of evidentiary showing of continuity.  When, however, the fact of chronicity in service is not adequately supported or legitimately questionable, then a showing of continuity of symptomatology after discharge from service is required to support the claim.  Id.  Establishing continuity of symptomatology under § 3.303(b) is an alternative method of satisfying the second and third Shedden requirements to show chronicity (permanency) of disease or injury in service and in turn link current disability to service.  See also Clyburn v. West, 12 Vet. App. 296, 302 (1999).  But to establish entitlement to service connection based on continuity of symptomatology, the claimant must have one of the "chronic" diseases specifically enumerated in 38 C.F.R. § 3.309(a).  Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

So service connection may be established either by showing direct service incurrence or aggravation or by using applicable presumptions, if available.  Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994).

A disease first diagnosed after service may be service connected if the evidence, including that pertinent to service, establishes the disease was incurred in service.  38 C.F.R. § 3.303(d).

Service connection also is permissible on a secondary basis for disability that is proximately due to, the result of, or aggravated by a service-connected disability.  38 C.F.R. § 3.310(a) and (b) (2012).  See also Allen v. Brown, 7 Vet. App. 439, 448 (1995).  Medical evidence is generally, though not always, required to associate the claimed condition with service or a service-connected disability.  See Wallin v. West, 11 Vet. App. 509, 512 (1998); Velez v. West, 11 Vet. App. 148, 158 (1998); and McQueen v. West, 13 Vet. App. 237 (1999).


The evaluation of evidence generally involves a three-step inquiry.  First, the Board must determine whether the evidence comes from a "competent" source.  The Board must then determine if the evidence is "credible", or worthy of belief.  Barr v. Nicholson, 21 Vet. App. 303 (2007) (Observing that once evidence is determined to be competent, the Board must additionally determine whether it is also credible).  Only if the evidence is both competent and credible does it ultimately have probative value.  See Layno v. Brown, 6 Vet. App. 465, 469 (1994) (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted")); Rucker v. Brown, 10 Vet. App. 67, 74 (1997) (Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, whereas credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted).  The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record.  See Baldwin v. West, 13 Vet. App. 1, 8 (1999).

Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience.  Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person.  38 C.F.R. § 3.159(a)(2).

Lay evidence may be competent and sufficient to establish a diagnosis of a condition when:  (1) a layperson is competent to identify the medical condition (i.e., when the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer); (2) the layperson is reporting a contemporaneous medical diagnosis, or; (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.  Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

In ascertaining the competency of lay evidence, the Courts generally have held that a layperson is incapable of opining on matters requiring medical knowledge.  Routen v. Brown, 10 Vet. App. 183 (1997).  In certain instances, however, lay evidence has been found competent with regards to a disease with "unique and readily identifiable features" that is "capable of lay observation."  See, e.g., Barr v. Nicholson, 21 Vet. App. 303 (2007) (concerning varicose veins); see also Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (dislocated shoulder); Charles v. Principi, 16 Vet. App. 370 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398 (1995) (flatfeet).

On the other hand, laypersons equally have been found not competent in more complex medical situations.  See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (concerning rheumatic fever).  See also Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010) (recognizing that in some cases lay testimony "falls short" in proving an issue that requires expert medical knowledge); Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010) (concluding that a Veteran's lay belief that his schizophrenia had aggravated his diabetes and hypertension was not of sufficient weight to trigger VA's duty to seek a medical opinion on the issue).

When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent.  See Kahana v. Shinseki, 24 Vet. App. 428 (2011).

Competent medical evidence, as opposed to lay evidence, is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions.  Competent medical evidence may also include statements conveying sound medical principles found in medical treatises.  It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses.  38 C.F.R. § 3.159(a)(1).


After determining the competency and credibility of evidence, the Board must then weigh its probative value.  In this function, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant.  Caluza at 511-512 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table); see also Madden v. Brown, 125 F.3d 1447 (Fed Cir. 1997) (holding that the Board has the "authority to discount the weight and probative value of evidence in light of its inherent characteristics in its relationship to other items of evidence").  As fact finder, when considering whether lay evidence is satisfactory, the Board may not only consider internal inconsistency of statements, facial plausibility, consistency with other evidence submitted on 
behalf of the Veteran, but also the Veteran's demeanor when testifying at a hearing when he has testified.  See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996).  See, too, Macarubbo v. Gober, 10 Vet. App. 388 (1997) (similarly holding that the credibility of lay evidence can be affected and even impeached by inconsistent statements, internal inconsistency of statements, inconsistency with other evidence of record, facial implausibility, bad character, interest, bias, self-interest, malingering, desire for monetary gain, and witness demeanor).

In ultimately rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds to be persuasive or unpersuasive, and provide the reasons or bases for its rejection of any material evidence favorable to the claimant.  See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990).  To this end, the Board is charged with the duty to assess the credibility and weight given to evidence.  Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001).  Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the Federal Circuit Court, citing its decision in Madden, recognized that the Board had inherent fact-finding ability.  Id., at 1076; see also 38 U.S.C.A. § 7104(a) (West 2002).  Moreover, the Court similarly has declared that, in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence.  Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992).

A medical opinion is generally based on the scope of the examination or review, as well as the relative merits of the expert's qualifications and analytical findings.  The probative weight of a medical opinion may be reduced if the examiner fails to explain the basis for an opinion.  Sklar v. Brown, 5 Vet. App. 140 (1993).  In this regard, contemporaneous evidence has greater probative weight than a history reported by the Veteran.  Curry v. Brown, 7 Vet. App. 59, 68 (1994).  However, medical evidence that is speculative, general or inconclusive in nature cannot support a claim.  See Obert v. Brown, 5 Vet. App. 30, 33 (1993).

CTS is a complex of symptoms resulting from compression of the median nerve in the carpal tunnel, with pain and burning or tingling paresthesia in the fingers and hand, sometimes extending to the elbow.  Wilson v. Brown, 7 Vet. App. 542, 544 (1995).

A review of the record on appeal is unremarkable for any suggestion of complaints or clinical findings of CTS during the Veteran's service, including in the reports of his September 1965 military entrance examination and later August 1967 military separation examination.  Indeed, during those examinations, he responded "No" when asked whether he then had, or had ever had, swollen or painful joints; arthritis or rheumatism; bone, joint, or other deformity; or neuritis (which is inflammation of a nerve, a condition attended by pain and tenderness over the nerves, anesthesia and paresthesia, paralysis, wasting, and disappearance of the reflexes.  Barclay v. Brown, 4 Vet. App. 161, 163 (1993)).  On examination, his upper extremities and neurologic processes were found to be normal.  

Although a former fellow service member attests to the amount of typing the Veteran did in service, the Veteran did not first complain of finger, hand, wrist or elbow pain until August 2003, when he received VA treatment for such complaints.  He reported arthritis-type pain in his left elbow radiating to his wrist.  The diagnosis at the time was arthralgia.  CTS was not diagnosed in either wrist until 2006, when it was noted to be present, bilaterally.

Even assuming, for the sake of argument, that the Veteran's August 2003 complaints of left elbow and wrist pain were the first manifestations of his CTS, that still was many years after his separation from service in September 1967 (indeed, some 36 years after the conclusion of his service, so more than 31/2 decades), and there is no evidence in the record suggesting a nexus or correlation between his post-service complaints and any incident of his service, including especially his MOS responsibilities as a clerk typist.  The record is equally unremarkable insofar as establishing the required etiological linkage between his bilateral CTS, even once eventually diagnosed in 2006, and his service and this particular type of activity during his service.

In this circumstance, the Board may consider the absence of any indication of a relevant medical complaint until so relatively long after service as one factor, albeit not the only or sole factor, in determining whether a disease or an injury in service resulted in chronic or persistent residual disability.  See Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000).  See, too, Mense v. Derwinski, 1 Vet. App. 354 (1991) (holding that VA did not err in denying service connection when the Veteran had failed to provide evidence demonstrating continuity of symptomatology since service and had failed to account for the lengthy time period following the conclusion of his service during which there was no clinical documentation of the claimed disorder).

In Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006), the Federal Circuit Court recognized lay evidence as potentially competent to support the presence of the claimed disability, both during service and since, even where not corroborated by contemporaneous medical evidence such as actual treatment records.  The Federal Circuit Court went on to indicate in Buchanan, however, that the Board retains the discretion to make credibility determinations and otherwise weigh the evidence submitted, including lay evidence.  Consider also that, for non-combat Veterans providing non-medical related lay testimony regarding an event during service (or, here, where the event in question - namely, clerk typing - is not alleged to have occurred in combat), Buchanan is distinguishable; the lack of 

documentation in service records must be weighed against the Veteran's statements.  See Bardwell v. Shinseki, 24 Vet. App. 36 (2010).  So it is permissible in this circumstance for the Board to draw a negative inference from the absence of any documented complaints or findings in the STRs and intervening post-service evaluation and treatment records, assuming, as concerning the STRs, they are complete or substantially complete in relevant part, which by all indications this Veteran's are.  See Kahana v. Shinseki, 24 Vet. App. 428 (2011).  The Federal Circuit Court has recognized the Board's "authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other items of evidence."  Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997).

That said, negative evidence, meaning actual evidence weighing against a party, must not be equated with the absence of substantive evidence.  Forshey v. West, 12 Vet. App. 71, 74 (1998), aff'd sub nom. Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002) (noting that the definition of evidence encompasses "negative evidence" which tends to disprove the existence of an alleged fact).  Still though, ultimately, the Board must consider all the evidence relevant to the claim, including the availability of medical records, the nature and course of the disease or disability, the amount of time that has elapsed since military service, and any other pertinent facts.  Cf. Dambach v. Gober, 223 F.3d 1376, 1380-81 (Fed. Cir. 2000).  Thus, when appropriate, the Board may consider the absence of evidence during and since service, prior to when first shown, when engaging in a fact-finding role.  See Jordan v. Principi, 17 Vet. App. 261 (2003) (Steinberg, J., writing separately) (noting that the absence of evidence may be considered as one factor in rebutting the aggravation part of the section 1111 presumption of soundness).


Moreover, to reiterate, there is no competent and credible evidence in the file establishing the required nexus or correlation between the Veteran's eventual diagnosis of bilateral CTS and anything, including clerk typing, which occurred many years earlier during the course of his military service.  And establishing his entitlement to service connection not only requires proving he has the disability claimed, but also showing it is attributable to a disease, an injury or an event during his military service - hence, the nomenclature "service connection."  See Watson v. Brown, 4 Vet. App. 309, 314   (1993) ("A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service.").

As already alluded to, during his informal hearing with the local DRO, the Veteran stated that he was going to schedule a medical appointment so he could obtain such a supporting medical nexus opinion.  He therefore evidenced both his knowledge and understanding of the need to have this type of evidence supporting his claim and provided a clear expression of his intent to submit it.  See Dalton v. Nicholson, 21 Vet. App. 23, 30-31 (2007) (actual knowledge is established by statements or actions by the claimant or the claimant's representative demonstrating an awareness of what is necessary to substantiate a claim).  He unfortunately never did, however, for whatever reason, so the lack of evidence of a competent medical nexus opinion in his favor further militates against his claim.

It is additionally worth noting that he did not file his claim of entitlement to service connection for bilateral CTS until January 2010, more than 40 years after his separation from service.  It is reasonable to expect that, had he in fact been experiencing chronic manifestations of CTS during all of those prior intervening years dating back to his service, he would have filed a claim for service connection at some earlier point in time.  After all, he certainly knew how to do so.  In October 1967, the month after his separation from service, he filed claims of entitlement to service connection for cysts in his crotch, warts on his right arm and left foot, stomach trouble.  That he did not also do so with respect to CTS for more than 40 years strongly suggests he was not having associated wrist or arm pain during that time.  While not altogether dispositive, the failure to file a claim for so many years after service constitutes additional probative evidence against his claim.

In sum, the preponderance of the evidence is against finding the Veteran's bilateral CTS originated during his service or is otherwise related or attributable to his service.  As such, he does not meet the criteria for service connection for this condition.  Therefore, service connection is not warranted, and his appeal is denied.

In arriving at this decision, the Board again acknowledges that he has not been examined by VA to determine the nature and etiology of his bilateral CTS, including especially in terms of whether it is related or attributable to his military service or dates back to his service and, in particular, to his clerk typing in service.  Such examinations are scheduled when the medical evidence accompanying a particular claim is inadequate for rating purposes.  38 C.F.R. 3.326(a) (2012).  In this case, however, the medical evidence in service is adequate for rating purposes as it is completely devoid of any complaints or clinical findings of CTS, and this is the type of condition that ordinarily would have been reported in the course of the Veteran's service.  The same is true for many years after service, indeed, decades.  Moreover, there is no competent and credible evidence otherwise suggesting a relationship or correlation between his CTS and service.  To schedule a VA examination under such circumstances would be tantamount to a fishing expedition to determine whether there might be some unspecified information that could possibly support the claim.  See Gobber v. Derwinski, 2 Vet. App. 470, 472 (1992).  VA's duty to assist the Veteran in the development of his claim does not extend to fishing expeditions.  VA's duty to assist is not a one-way street.  Olsen v. Principi, 3 Vet. App. 480 (1992).  Rather, VA's duty is just what it states, a duty to assist, not a duty to prove a claim with the claimant only in a passive role.  If a Veteran wants help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence.  Wood v. Derwinski, 1 Vet. App. 406 (1991).  


For these reasons and bases, further development in the way of an examination and opinion would unnecessarily impose additional burdens on VA with no reasonable possibility of any benefit flowing to the Veteran, especially since the VA examiner necessarily could only make medical as opposed to factual findings, so necessarily would have to rely on the Board's determination of whether the Veteran's lay testimony concerning his purported symptoms in service (not just his being a clerk typist), even if competent, is also credible to ultimately have probative value.  And the Board does not find the lay testimony concerning the Veteran having experienced relevant symptoms in service credible.  Where, as here, the Board makes a finding that lay evidence regarding an in-service event or injury is not credible, a VA examination and opinion are not required.  See Bardwell v. Shinseki, 24 Vet. App. 36 (2010).  See also Livesay v. Principi, 15 Vet. App. 165, 178 (2001) (en banc) (observing that "the VCAA is a reason to remand many, many claims, but it is not an excuse to remand all claims.").  See, too, Reyes v. Brown, 7 Vet. App. 113, 116 (1994) and Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (both observing circumstances when a remand would not serve any useful or meaningful purpose or result in any significant benefit to the claimant).

Lastly, the doctrine of reasonable doubt is only invoked where there is an approximate balance of evidence that neither proves nor disproves the claim.  In this case, however, the preponderance of the evidence is against the Veteran's claim.  Therefore, the doctrine of reasonable doubt is inapplicable.  38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102 (2012).



ORDER

The claim of entitlement to service connection for bilateral CTS is denied.



____________________________________________
KEITH W. ALLEN
Veterans Law Judge, Board of Veterans' Appeals



Department of Veterans Affairs