Citation Nr: 1328490 Decision Date: 09/06/13 Archive Date: 09/16/13 DOCKET NO. 10-48 763 ) DATE ) ) On appeal from the Department of Veterans Affairs Medical and Regional Office Center in Fargo, North Dakota THE ISSUES 1. Entitlement to service connection for a disability manifested by numbness and tingling in the hands. 2. Entitlement to service connection for a left knee disorder. 3. Entitlement to service connection for a right knee disorder. 4. Entitlement to service connection for migraine headaches. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD L. Barstow, Counsel INTRODUCTION The Veteran had active military service from April 2004 to October 2009. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2010 rating decision of the VA Regional Office (RO) in Fargo, North Dakota. In June 2011, the Veteran testified at a hearing conducted before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. FINDINGS OF FACT 1. The Veteran has bilateral cuboid tunnel syndrome that is as likely as not related to his active duty. 2. The Veteran has bilateral patellofemoral syndrome that is as likely as not related to his active duty. 3. The Veteran has migraine headaches that are as likely as not related to his active duty. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral cuboid tunnel syndrome have been met. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). 2. The criteria for service connection for bilateral patellofemoral syndrome have been met. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). 3. The criteria for service connection for migraine headaches have been met. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In light of the fully favorable determination in this case, no discussion of compliance with VA's duty to notify and assist is necessary. Service connection may be granted for disability resulting from disease or injury incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110. Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Pursuant to 38 C.F.R. § 3.303(b), when a chronic condition is present, a claimant may establish the second and third elements by demonstrating continuity of symptomatology. The term "chronic disease," whether as shown during service or manifest to a compensable degree within a presumptive window following service, applies only to those disabilities listed in 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 1. Disability Manifested by Numbness and Tingling of the Hands The Veteran's service treatment records (STRs) include an October 2006 post-deployment health assessment in which the Veteran answered yes to having numbness and tingling in the hands both currently and during deployment. A June 2007 post-deployment health assessment shows that the Veteran did not answer yes to whether numbness and tingling in hands were a health concern or condition he felt was related to his deployment. A VA treatment record in March 2010 shows that the Veteran reported that numbness of his right hand began when he was in Iraq. He was diagnosed with right ulnar nerve entrapment. No left hand complaints were made. An April 2010 VA general medical examination shows that the Veteran reported that the onset of his right hand complaints was in 2005 during service. He did not report any left hand complaints. The Veteran was diagnosed with cuboid tunnel syndrome; no opinion regarding the etiology was provided. A May 2010 neurology note shows that studies showed slowing of the motor conduction velocity of the left ulnar nerve across the elbow; left ulnar nerve distal sensory response were normal and studies of the right ulnar and bilateral median nerves were normal. At his June 2011 hearing, the Veteran testified that he had symptoms in both hands, but the right was more problematic. June 2011 Hearing Transcript (T.) at 7-8. Based on a review of the evidence, the Board concludes that service connection for bilateral cuboid tunnel syndrome is warranted. The Veteran has a post-service diagnosis of cuboid tunnel syndrome, within one year from the date of his discharge from service. Although the April 2010 diagnosis does not specify that it was bilateral or unilateral, considering the Veteran's reports of symptoms in both hands, after affording the Veteran the benefit-of-the-doubt, the Board concludes such diagnosis applies to both hands. Also when affording the Veteran the benefit-of-the-doubt, the evidence of record supports a finding that the Veteran's bilateral cuboid tunnel syndrome was incurred in service. Although cuboid tunnel syndrome is not listed as a chronic illness in 38 C.F.R. § 3.309(a), the Board has considered his statements that the onset of the numbness and tingling in his hands began during service to prove the nexus element of a service connection claim under 38 C.F.R. § 3.303(a) and (d). The Veteran's statements regarding the onset of his disability is supported by his STRs showing that he reported numbness and tingling in his hands during a deployment. Furthermore, although cuboid tunnel syndrome is not a disability subject to presumptive service connection, the fact that the Veteran was diagnosed by a VA examiner with such disorder in April 2010, less than one year after he was discharged in October 2009, supports the Board's finding that the onset of the bilateral cuboid tunnel syndrome began in service. There is no indication that the Veteran incurred an event, injury or disease to his hands between his discharge and the initial diagnosis in April 2010. Thus, after considering all of the evidence of record, the Board concludes that a finding of service connection is warranted. Service connection for bilateral cuboid tunnel syndrome is, therefore, granted. See 38 U.S.C.A §5107 (West 2002 & Supp. 2012). 2. Bilateral Knee Disorders The October 2006 post-deployment health assessment shows that the Veteran answered yes to having swollen, stiff or painful joints during his deployment. A mental health treatment record in May 2007 reveals that the Veteran reported knee pain. A June 2007 post-deployment health assessment indicates that he believed that swollen, stiff or painful joints were a health concern he felt was related to deployment. A treatment record in June 2007 again shows that the Veteran reported having painful knees. The Veteran complained of bilateral knee pain in March 2010. At the April 2010 VA examination, he reported that the onset of his knee problems was in approximately April 2006. He was diagnosed with bilateral patellofemoral syndrome; no opinion regarding the etiology was provided. At his June 2011 hearing, he described incurring trauma to his knees due to his military duties. T. at 9-12. Based on a review of the evidence, the Board concludes that service connection for bilateral patellofemoral syndrome is warranted. The Veteran has a post-service diagnosis of bilateral patellofemoral syndrome, within one year from the date of his discharge from service. When affording the Veteran the benefit-of-the-doubt, the evidence of record supports a finding that the Veteran's bilateral patellofemoral syndrome was incurred in service. Although bilateral patellofemoral syndrome is not listed as a chronic illness in 38 C.F.R. § 3.309(a), the Board has considered his statements that the onset of the knee symptoms began during service to prove the nexus element of a service connection claim under 38 C.F.R. § 3.303(a) and (d). The Veteran's statements regarding the onset of his disability is supported by his STRs showing that he reported swollen, stiff or painful joints during a deployment, in addition to another records showing knee pain in service. Furthermore, although patellofemoral syndrome is not a disability subject to presumptive service connection, the fact that the Veteran was diagnosed by a VA examiner with such disorder in April 2010, less than one year after he was discharged in October 2009, supports the Board's finding that the onset of the bilateral patellofemoral syndrome began in service. There is no indication that the Veteran incurred an event, injury or disease to his knees between his discharge and the initial diagnosis in April 2010. Thus, after considering all of the evidence of record, the Board concludes that a finding of service connection is warranted. Service connection for bilateral patellofemoral syndrome is, therefore, granted. See 38 U.S.C.A §5107. 3. Migraine Headaches The October 2006 post-deployment health assessment shows that the Veteran answered yes to having headaches currently and during his deployment. The June 2007 post-deployment health assessment shows that the Veteran did not answer yes to whether headaches were a health concern or condition he felt was related to his deployment. The Veteran complained of occasional headaches with dizziness in March 2010. At the April 2010 VA examination, he reported that the onset of his headaches was in late 2005. He reportedly self-treated his migraines. He was diagnosed with migraines. A medical opinion from a different examiner was obtained in March 2011. The examiner opined that based on only one report of headaches in 2006, a denial of headaches in 2007, that he never reported migraines to primary care or neurology and that he never sought treatment for migraines, the reported migraines were less likely related to his time in service or to the one report of headaches in service. At his June 2011 hearing, he reiterated that he self-treated his headaches. T. at 4. Based on a review of the evidence, the Board concludes that service connection for migraine headaches is warranted. The Veteran has a post-service diagnosis of migraine headaches, within one year from the date of his discharge from service. When affording the Veteran the benefit-of-the-doubt, the evidence of record supports a finding that the Veteran's migraine headaches were incurred in service. Although migraine headaches are not listed as a chronic illness in 38 C.F.R. § 3.309(a), the Board has considered his statements that the onset of the migraine headaches began during service to prove the nexus element of a service connection claim under 38 C.F.R. § 3.303(a) and (d). The Veteran's statements regarding the onset of his disability are supported by his STRs showing that he reported headaches during a deployment. Furthermore, although migraine headaches are not a disability subject to presumptive service connection, the fact that the Veteran was diagnosed by a VA examiner with such disorder in April 2010, less than one year after he was discharged in October 2009, supports the Board's finding that the onset of the migraine headaches began in service. There is no indication that the Veteran incurred an event, injury or disease to his head between his discharge and the initial diagnosis in April 2010. The Board acknowledges the negative March 2011 opinion. The rationale for that opinion was, in part, that the Veteran did not seek treatment. However, the Veteran reported to the April 2010 examiner as well as testified at his hearing, that he self-treated, which is a reasonable explanation for a lack of post-service treatment. Therefore, as the negative opinion was premised, in part, on a lack of treatment, the Board finds that it lacks probative value. Thus, after considering all of the evidence of record, the Board concludes that a finding of service connection is warranted. Service connection for migraine headaches is, therefore, granted. See 38 U.S.C.A §5107. ORDER Entitlement to service connection for bilateral cuboid tunnel syndrome is granted. Entitlement to service connection for bilateral patellofemoral syndrome is granted. Entitlement to service connection for migraine headaches is granted. ____________________________________________ MILO H. HAWLEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs