Citation Nr: 1319963 Decision Date: 06/20/13 Archive Date: 07/02/13 DOCKET NO. 03-23 054 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Juan, the Commonwealth of Puerto Rico THE ISSUE Entitlement to service connection for a right hand disability. REPRESENTATION Appellant represented by: Puerto Rico Public Advocate for Veterans Affairs ATTORNEY FOR THE BOARD J. H. Nilon, Counsel INTRODUCTION The Veteran served on active duty from January 1969 to September 1970. The Veteran's spouse has been designated as his fiduciary or the purpose of receiving and disbursing his VA monetary benefits. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a September 1994 rating decision by a VA Regional Office (RO) that denied the Veteran's request to reopen a previously-denied claim of entitlement to service connection for a right hand disability, based on a determination that new and material evidence had not been received. The Veteran's original VA claims file has been lost, and the appeal is being adjudicated based on a reconstructed record. The Board remanded the case to the RO in June 2004, September 2005, May 2007 and July 2008 in order to reconstruct the record and otherwise develop the claim. In September 2011 the Board reopened the claim and once again remanded the case to the RO for development of the merits. In September 2012 the Board issued a decision denying the claim. The Veteran thereupon appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court), which issued an Order in February 2013 granting a Joint Motion of the Parties to vacate the Board's decision and return the case to the Board for further consideration. FINDINGS OF FACT 1. The Veteran is service-connected for carpal tunnel syndrome of the right hand; he does not otherwise have a disorder of the right hand that is etiologically related to service. 2. Degenerative arthritis of the right hand became manifest many years after service and is not etiologically related to service. CONCLUSION OF LAW A right hand disability was not incurred in or aggravated by service, and incurrence during service of arthritis may not be presumed. 38 C.F.R. 1101, 1110, 1112, 1113, 5107 (West 2002); 38 C.F.R. § 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Duties to Notify and Assist Upon receipt of a complete or substantially complete application, VA must notify the claimant and any representative of any information, medical evidence, or lay evidence not previously provided to VA that is necessary to substantiate the claim. This notice requires VA to indicate which portion of that information and evidence is to be provided by the claimant and which portion VA will attempt to obtain on the claimant's behalf. See 38 U.S.C.A. §§ 5103, 5103A, 5107; 38 C.F.R. § 3.159. The notice should inform the claimant about the information and evidence not of record that is necessary to substantiate the claim. It should also inform the claimant about the information and evidence that VA will seek to provide, and the information and evidence the claimant is expected to provide. See Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004). VA must also notify the claimant that, should service connection be awarded, a disability rating and an effective date for the award of benefits will be assigned. Dingess v. Nicholson, 19 Vet. App. 473 (2006). Here, the Veteran's claims file has been reconstructed from available records. The RO sent correspondence in June 2004, a statement of the case in December 2006, correspondence in June 2007, a supplemental statement of the case in January 2008, and a supplemental statement of the case in September 2010. These documents discussed specific evidence, the particular legal requirements applicable to the claim, the evidence considered, the pertinent laws and regulations, and the reasons for the decision. VA made all efforts to notify and to assist the appellant with regard to the evidence obtained, the evidence needed, and the responsibilities of the parties in obtaining the evidence. The Board finds that any defect with regard to the timing or content of the notice to the appellant is harmless because of the thorough and informative notices provided throughout the adjudication and because the appellant had a meaningful opportunity to participate effectively in the processing of the claim with an adjudication of the claim by the RO subsequent to receipt of the required notice. There has been no prejudice to the appellant, and any defect in the timing or content of the notices has not affected the fairness of the adjudication. In any event, the Veteran has not cited any prejudice regarding the timing or the content of the notice he received. See Shinseki v. Sanders, 129 S.Ct.1696 (2009) (reversing prior case law imposing a presumption of prejudice on any notice deficiency, and clarifying that the burden of showing that an error is harmful, or prejudicial, normally falls upon the party attacking the agency's determination). See also Mayfield v. Nicholson, 444 F.3d 1328, 1333-34 (Fed. Cir. 2006). The Veteran has also been afforded the benefit of VA's duty to assist. The Board remanded the case in September 2011 for the purpose of affording the Veteran a VA medical examination, which was performed in October 2011. The Board has carefully reviewed the examination report and finds the RO substantially complied with the requirements articulated in the Board's remand. D'Aries v. Peake, 22 Vet. App. 97 (2008); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). The Veteran has not requested a hearing before the Board. When service records are presumed to have been destroyed while in government custody, VA's duty to assist is heightened and includes an obligation to search for other forms of records that support the claimant's case. Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); Moore v. Derwinski, 1 Vet. App. 401 (1991). Review of the file shows that appropriate efforts have been made to obtain alternative forms of evidence, and that further efforts would be futile. VA has no duty to seek to obtain that which does not exist. Counts v. Brown, 6 Vet. App. 473, 477 (1994); Porter v. Brown, 5 Vet. App. 233, 237 (1993). All relevant, identified, and available evidence has been obtained, and VA has notified the Veteran of any evidence that could not be obtained. The Veteran has not referred to any additional, unobtained, relevant evidence. The most recent Joint Motion for Remand, as incorporated by the Court's Order, expressed no issues regarding duties to notice and assist; the Board is confident that if any notice or other assistance defects existed in its September 2012 decision such defects would have been brought to the Court's attention in the interest of judicial economy. Based on a review of the claims file, the Board finds that there is no indication in the record that any additional evidence relevant to the issue to be decided herein is available and not part of the claims file. See Mayfield, 499 F.3d 1317. Therefore, the Board finds that duties to notify and assist have been satisfied and will proceed to the merits of the issue on appeal. Legal Principles Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection generally requires credible and competent evidence showing: (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. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). Service connection for a chronic disease such as arthritis may be granted if manifest to a compensable degree within one year of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113; 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a). In cases where a Veteran asserts service connection for injuries or disease incurred or aggravated in combat, 38 U.S.C.A. § 1154(b) and its implementing regulation, 38 C.F.R. § 3.304(d), are applicable. This statute and regulation ease the evidentiary burden of a combat Veteran by permitting the use, under certain circumstances, of lay evidence. In this regard, VA shall accept as sufficient proof of service connection satisfactory lay or other evidence of service incurrence, if the lay or other evidence is consistent with the circumstances, conditions, or hardships of such service. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(d). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that in the case of a combat Veteran not only is the combat injury presumed, but so is the disability due to the in-service combat injury. Reeves v. Shinseki, 682 F.3d 988, 998-99 (Fed. Cir. 2012). However, the provisions of 38 U.S.C.A. § 1154(b) do not provide a substitute for medical nexus evidence or evidence of current disability, but rather serve only to reduce the evidentiary burden on combat veterans with respect to submission of evidence regarding the incurrence or aggravation of an injury or disease while in service. Kessel v. West, 13 Vet. App. 9, 16-19 (1999) (en banc). A veteran must still establish his claim through competent medical evidence showing a current disability and a nexus between that disability and those service events. Gregory v. Brown, 8 Vet. App. 563, 567 (1996); Clyburn v. West, 12 Vet. App. 296, 303 (1999); Wade v. West, 11 Vet. App. 302, 305 (1998). Thus, to establish service connection, there must be evidence of a causal relationship between the current disability and the combat injury. Reeves, 682 F.3d 988, 998-99, citing Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (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. Davidson, 581 F.3d 1313, 1316; Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). 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. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, 492 F.3d 1372, 1376-77. 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 United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C.A. § 7104(a). Moreover, the Court 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). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran's demeanor when testifying at a hearing. 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). In determining the probative value to be assigned to a medical opinion, the Board must consider three factors. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case. The second inquiry involves consideration of whether the medical expert provided a fully articulated opinion. The third and final factor involves consideration of whether the opinion is supported by a reasoned analysis. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Where service medical records are not available, case law does not establish a higher benefit-of-the-doubt standard, but rather heightens the duty of the Board to consider the benefit-of-the-doubt rule, to assist the claimant in developing his claim, and to explain its decision. Ussery v. Brown, 8 Vet. App. 64 (1995). The Board has reviewed all the evidence in the record. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on her behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Evidence and Analysis The Veteran contends that he has a right hand disability that is related to service. He specifically maintains that he injured his right hand during combat while serving with the 578th Supply and Service (S&S) Company in Vung Tau, Vietnam in December 1969 or January 1970. He reports that he was treated in the dispensary at that time for debridement and removal of shell fragments, but he developed a wound infection for which he was hospitalized and treated with antibiotics. As noted above, the Veteran's claims file has been reconstructed from available records. The Veteran's DD Form 214 reflects that he served in Vietnam from July 1969 to September 1970, and his duty military occupational specialty (MOS) at that time was food storage specialist. The Veteran's available service personnel records do not contain any affirmative indication that he was in combat. The Veteran's service treatment records are incomplete. The second page of what appears to be a separation examination report does not refer to any right hand problems. A September 1970 Physical and Mental Status on Release from Active Service report reflects that the Veteran received a U-1 PUHLES profile at that time. (The "PULHES" profile reflects the overall physical and psychiatric condition of an individual on a scale of 1 to 4, with "1" being a high level of fitness and "4" being a medical condition or physical defect below the level of fitness required for retention in the military service. The "U" indicates "upper extremities," so the U-1 profile shows the Veteran had a high level of fitness of the upper extremities at the time of separation from service. See generally Hanson v. Derwinski, 1 Vet. App. 512, 514 (1991), for an explanation of the military medical profile system.) In October 1970 the Veteran filed a claim for entitlement to service connection for a right hand injury. He reported that in December 1969 or January 1970, he injured his right hand while serving in Vung Tau, Vietnam, although he did not specifically refer to a combat injury at that time. An October 1970 VA history and physical (H&P) examination report noted that the Veteran had been recently hit by a car on the right side of his body. The Veteran reported that he lost consciousness for a while and complained of pain in the right leg. The clinical impression was multiple body trauma and rule out a brain concussion. There was no reference to any current right hand problems. A concurrent VA neurology consult in October 1970 reflects that the Veteran was struck by a car on the right side of his body and that he suffered trauma to the pelvis and right knee. The examiner reported that examination of the Veteran's extremities showed a tender right leg with limited motion due to pain and no deformities seen. The impression was multiple body traumas. Once again there was no reference to any current right hand complaints. The first medical evidence of record regarding right hand complaints is a VA radiological report dated in November 1996 in which the Veteran complained of a clinical history of joint swelling and pain in both hands. The impression was bilateral soft tissue swelling without evidence of bony involvement. A March 2005 VA neurological examination report notes that the Veteran's claim file was reviewed. The Veteran reported that he had observed numbness and paresthesias in the (right) hand that would go away when he would shake, or open and close, the hand. He reported that he had difficulty holding, and that he would frequently drop, objects in his (right) hand. The diagnoses included mild carpal tunnel syndrome in the right upper extremity, as likely as not of a diabetic etiology. A June 2005 VA treatment entry reflects that the Veteran complained of a cyst in the right hand. The examiner reported, as to a review of the Veteran's extremities, that he had a small ganglion cyst on the dorsum of the right hand which was not painful. The assessment included a suspected ganglion cyst in the dorsum of the right hand. The examiner indicated that the Veteran did not want referral for surgery and that he had requested a splint. In his substantive appeal, received in July 2005, the Veteran reported that he was treated for a right hand injury during his military service. He stated that he was serving with the 758th Supply and Service Company in Vung Tau, Vietnam when the injury occurred and that he was treated at the dispensary. A December 2005 VA treatment entry notes that the Veteran complained of pain in the right hand at the knuckles, with no trauma. The assessment included arthritis with complaints of pain in the small joints of the right hand, without objective evidence of inflammation. A June 2007 VA rheumatology treatment report indicates that the Veteran had suffered from several episodes of inflammatory arthritis that affected both ankles, both knees, and the right wrist/hand during the previous years. As to an impression, the examiner indicated that the Veteran had intermittent inflammatory arthritis attacks which had involved both lower extremities (knees and ankles), and the right wrist. The examiner reported that overall findings were suggestive of a crystal-induced arthritis such as gout or pseudogout. It was noted that the possibility of multiple septic joints was unlikely given the present findings. The Veteran had a VA examination of the hand and fingers in October 2011, performed by a physician who reviewed the claims file. The Veteran reported that he suffered a right hand injury when he was wounded in combat in Vietnam. He stated that he was hospitalized and treatment with antibiotics. The Veteran reported that he was hospitalized for three months and was then sent back to duty in a maintenance unit until his discharge from the service. The Veteran stated that one year before his discharge from service he filed a claim with the VA and that it was documented that he had a right hand injury. He reported that approximately three years later, although he did not remember the details, he had a medical evaluation and that he was given a pain killer and follow-up appoints at that time. The Veteran maintained that despite all of the years that had passed since the injury, he suffered from recurrent swelling and pain of the right hand. The Veteran also reported that one month after his discharge from service he was hit by a car as a pedestrian and sustained a fracture of his left leg, but he denied any concurrent injury to the right hand. The Veteran reported that he had been diagnosed with gout at a VA facility and that he would have gout attacks in his great toes, feet, and knees but he denied having gouty attacks in his right hand. The examiner performed a clinical examination and noted observations in detail. The examiner diagnosed right carpal tunnel syndrome; mild periarticular osteopenia and subchondral bony erosions that might represent nonspecific degenerative changes (arthritis); a ganglion cyst; and, bilateral soft tissue swelling of the hands. The examiner stated an opinion that it was less likely as not that the Veteran's current right hand disabilities either began or were caused by the Veteran's military service. As rationale, the examiner indicated that in the Veteran's available service treatment records and claims file, there was no evidence of a right hand condition during service and that the separation examination was silent regarding a right hand condition. The examiner also noted that there was no evidence of treatment for a right hand condition for several years after the Veteran's period of service, which showed that any condition in service was acute and transitory and resolved with the military treatment given at that time. The examiner thus concluded that the criteria of continuity of treatment or chronicity of the condition were not met. Review of the evidence in this case shows the Veteran has a right hand disability including carpal tunnel syndrome (CTS), for which he is already service-connected and rated as 10 percent disabled. In addition to the service-connected CTS he had been diagnosed with nonspecific degenerative arthritis and a ganglion cyst. Thus, the first element of service connection - medical evidence of a claimed disability - is met. However, a veteran seeking disability benefits must establish not only the existence of a disability, but also an etiological connection between his military service and the disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); D'Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000). The Veteran has made much of having been wounded in combat, presumably to avail himself of the "combat presumption" for an otherwise undocumented injury. The Board observes that the relaxed standard for a combat veteran to prove service connection does not equate to a relaxed standard to prove combat service. Stone v. Nicholson, 480 F.3d 1111 (Fed. Cir. 2007). The Board notes at the outset that there is no indication of any disorder of the right hand indicative of a wound received in combat. There is no indication of scarring, retained shell fragments, muscle damage or other tissue damage showing a missile injury. In that regard, the Veteran has been extremely reticent to provide any details about the purported injury, such as nature of the injury (penetrating injury due to shell fragment or gunshot, crushing injury, etc.) or the circumstances of the injury (indirect fire, direct fire, convoy, patrol action, perimeter guard, etc.). It is accordingly impossible for VA to pursue verification of the incident, and similarly impossible to tell an examiner what residuals should be anticipated. The Veteran's service personnel record is devoid of any indication of having participated in combat, and neither his MOS (subsistence storage specialist) nor his assignment history (to various quartermaster units) shows routine exposure to combat. The Board acknowledges that engagement in combat is not necessarily determined simply by reference to the existence or nonexistence of certain awards or MOSs. Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996). However, the Board particularly notes that the Veteran's service personnel record refutes his assertion that he was wounded while assigned to the 758th S&S Company, that he was hospitalized for three months and was then sent back to duty in another unit until his discharge from the service. The Veteran's service personnel record demonstrates that in December 1969-January 1970, the time the Veteran asserts he was wounded, he was in fact serving in a laundry-bath unit; the Veteran was assigned to that laundry-bath unit until he was transferred to the 758th S&S Company in May 1970, and he remained in that unit until he was returned to the United States for discharge. The service personnel record also does not reflect a three-month hospitalization. The Board notes at this point that service personnel record shows the Veteran participated in an "unnamed campaign" in Vietnam. Campaign participation, in and of itself, shows physical presence in a combat zone but does not show personal participation in combat. Numerous entries in the Veteran's VA psychiatric and medical treatment records refer to the Veteran as a being a "combat veteran," but such entries do not constitute an acknowledgement by VA of service in combat. Such entries recount a veteran's subjective reports of his service experiences for clinical treatment purposes. The Veteran's account to medical providers and examiners is considered along with all other evidence of record, such as correspondence to VA, in determining a veteran's actual service history. The Board is not required to accept a veteran's uncorroborated account of his active service experiences. Wood v. Derwinski, 1 Vet. App. 190, 192 (1991). As the Veteran's account of having been wounded in service is inconsistent with the service personnel record, the Board finds the Veteran is not shown to have been wounded in the right hand in combat as he now asserts. Where service medical records were destroyed, the veteran is competent to report about factual matters about which he had firsthand knowledge, including experiencing pain during service, reporting to sick call, and undergoing treatment. Washington v. Nicholson, 19 Vet. App. 362 (2005). However, once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, 6 Vet. App. 465 (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"). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. Caluza, 7 Vet. App. 498. The Board may weigh the absence of contemporaneous medical evidence against the lay evidence in determining credibility, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The Board may not ignore a veteran's testimony simply because he or she is an interested party and stands to gain monetary benefits; personal interest may, however, affect the credibility of the evidence. Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991). The Veteran in this case is not deemed to be credible in reporting treatment for a combat-related injury to the right hand. As noted above, his account is inconsistent with objective evidence of record in the form of his service personnel record. Further, the Veteran's reliability as a historian is eroded by his documented history of somatic complaints, his history since at least 1972 of schizophrenia with hallucinations and delusions, and his longstanding incompetence to manage his own affairs. An injury during service may be verified by medical or lay witness statements; however, the presence of a current disability requires a medical diagnosis, and, where an opinion is used to link the current disability to a cause during service, a competent opinion of a medical professional is required. Caluza, 7 Vet. App. 498. In this case the competent and uncontroverted medical opinion of record, in the form of the October 2011 VA examination report, states the Veteran does not have a current disability residual to such an injury. The findings of a physician are medical conclusions that the Board cannot ignore or disregard. Willis v. Derwinski, 1 Vet. App. 66 (1991). Further, the Board notes the VA examination report meets the criteria cited by Nieves-Rodriguez for probative value in that the examiner was fully informed of the pertinent factual premises of the case and provided a fully-articulated opinion that was supported by a reasoned analysis. The Veteran has stated his belief that his current right hand disability is related to trauma during service. However, there is no diagnostic indication that he has any traumatic residuals, whether characterized as combat-related or noncombat-related. The Veteran has three current pathologies in the right hand, of which one (CTS) is already service-connected; neither degenerative arthritis nor ganglion cyst is consistent with remote trauma. Further, degenerative osteoarthritis, rheumatoid arthritis, cellulitis, gout and pseudogout of the joints have all been diagnosed at various times, and it is beyond the competence of a layperson to provide an etiological opinion in regard to multiple pathologies with overlapping symptoms. Kahana, 24 Vet. App. 428. The Board observes at this point that the Veteran did not have arthritis in the VA radiological study in November 1996, which was several decades after his discharge from service. The Board accordingly finds he did not have arthritis in service or to a compensable degree within the first year after discharge from service, so presumptive service connection for arthritis under the provisions of 38 C.F.R. § 3.309(a) is not for application. The Veteran has not alleged, and the evidence does not show, any relationship between the service-connected right carpal tunnel syndrome and his other current right hand pathologies (degenerative arthritis and a ganglion cyst). Therefore, service connection on a secondary basis is not implied. 38 C.F.R. § 3.310. In sum, based on the evidence and analysis above, the Board has found that the weight of the competent medical evidence demonstrates that any right hand problems during service were not chronic and that the currently claimed right hand disability began many years after the Veteran's period of service and was not caused by any incident of service. The Board concludes that a right hand disability was not incurred in or aggravated by service. As the preponderance of the evidence is against the claim for service connection, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet.App. 49, 54. ORDER Service connection for a right hand disability is denied. ____________________________________________ MICHAEL E. KILCOYNE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs