Citation Nr: 18139903 Decision Date: 10/01/18 Archive Date: 10/01/18 DOCKET NO. 09-35 888 DATE: October 1, 2018 ORDER Entitlement to service connection for a lumbar spine disability is denied. Entitlement to service connection for a nerve condition of the left arm, to include carpal tunnel syndrome, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has a lumbar spine condition due to a disease or injury in service. 2. The preponderance of the evidence is against finding that the Veteran has nerve condition of the left arm, to include carpal tunnel syndrome, due to a disease or injury in service. CONCLUSIONS OF LAW 1. The criteria for service connection for a lumbar spine condition are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for nerve condition of the left arm, to include carpal tunnel syndrome, are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from October 1972 to June 1973. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d, 78 F.3d 604 (Fed. Cir. 1996). It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 3.102. 1. Entitlement to service connection for a lumbar spine disability The Veteran contends that he developed a lower back disability during active service as a result of carrying heavy packs. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of lumbar spine spondylosis during the appeal period, the preponderance of the evidence weighs against finding that the Veteran’s currently diagnosed condition began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Veteran’s service treatment records (STRs) do not document injury or treatment for a lower back condition. A letter from a medical doctor to the Veteran’s personal injury attorney dated January 2007 explained that the Veteran was involved in a motor vehicle accident in March 2006 and that in the doctor’s opinion “within a reasonable degree of medical certainty,” the accident resulted in the final diagnosis of lumbar strain and sprain. Private medical treatment records from 2006 show the Veteran sought treatment after the accident for lumbar back symptoms just after the car accident and throughout the rest of the year. A general VA examination in January 2009 included X-rays that showed no degenerative joint disease in the lumbar spine. The examiner noted tenderness to palpation in the lumbar spine. The Veteran explained to the examiner that he had some injuries to the lower back during a motor vehicle accident in July 2007. At an April 2009 disability determination examination for the Social Security Administration, the Veteran explained that he had lower back pain since active service from carrying heavy packs, but that the pain had gotten worse after a motor vehicle accident in July 2007. A June 2009 VA treatment note documents that the Veteran stated he had lower back pain for about 10 years with no specific trauma claimed, he “just woke up with it one morning.” The note also referred to the January 2009 X-rays of the spine, stating that the bones appears osteoporotic and indicate an old fracture of the L4 transverse process. The heights of the vertebral bodies and intervertebral disc spaces appeared maintained. At the May 2013 Board hearing, the Veteran testified that he considered his lower back problems to be a result of wearing heavy packs in service and that he went to sick call many times during active service with complaints of back problems and was put on light duty as a result. The Veteran also testified that he sought treatment for his lower back problems immediately upon separating from active service. The Veteran testified that he had one motor vehicle accident in 2007 that was unrelated to his back problems. While the Veteran is competent to report having experienced symptoms of spinal pain, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of a previous injury in service. The issue is medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Board sought an additional medical opinion that was provided in June 2018. The medical doctor reviewed the Veteran’s medical records and opined that it is less likely than not that the Veteran’s lower back disability had onset or is otherwise related to active service. The L4 transverse process fracture is not an injury that occurs by carrying heavy packs or general physical activities. The doctor noted that the Veteran was involved in two motor vehicle accidents, in March 2006 and July 2007, and it was at least as likely as not that the Veteran’s lumbar strain and sprain resulted from the 2006 motor vehicle accident. The Board finds that the evidence favors a conclusion that the Veteran’s current lumbar spine condition is the result of post-service motor vehicle accidents and is unrelated to active service, for this reason service connection is not warranted. The June 2018 is highly probative as it included a review of the entire evidence of record and contained a detailed rationale that accounted for the Veterans medical history. The Board notes that arthritis is considered by VA to be a chronic disease. 38 C.F.R. 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). However, there is no evidence or assertion that the Veteran developed arthritis of the spine during service or in the year after his separation from active duty. Thus, application of the presumption related to chronic diseases is not warranted in this case. 38 C.F.R. 3.309(a). In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim for a lumbar spine disability, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b) (West 2014); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 2. Entitlement to service connection for carpal tunnel syndrome of the left wrist The Veteran contends that he developed carpal tunnel syndrome in the left wrist as a result of injury during active service activities such as push-ups and general physical training. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of carpal tunnel syndrome in the left wrist, the preponderance of the evidence weighs against finding that the Veteran’s currently diagnosed condition began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Veteran’s STRs show that after an altercation in service in 1973, the Veteran had a laceration on the left forearm that was treated with one suture. The Veteran’s records document that he was involved in a motor vehicle accident in March 2006. An April 2006 private treatment note states that the Veteran’s left wrist had sharp pain with certain movements and the doctor assessed left wrist tenosynovitis. A letter dated June 2006 from a medical doctor who had evaluated the Veteran for nerve damage in the arms stated that there was no nerve conduction abnormality in the ulnar, median, or radial nerves in either arm. A general VA examination in January 2009 documented that the Veteran complained of left thumb pain since July 2007 when he was involved in a motor vehicle accident where he stated his left thumb was jammed against part of the automobile during the accident. At an April 2009 disability determination examination for the Social Security Administration, the Veteran explained that left shoulder and left hand pain started after the motor vehicle accident in July 2007. The Veteran testified at the May 2013 Board hearing that he went to sick call on many occasions during active service to get treatment for his left wrist pain and that he received a bandage and pain medication. The Veteran testified that as a result of general physical training in service, he developed carpal tunnel syndrome. While the Veteran is competent to report having experienced symptoms of left wrist pain, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of a previous injury in service. The issue is medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Board sought an additional medical opinion that was provided in June 2018. The medical doctor reviewed the Veteran’s medical records and opined that it is less likely than not that the Veteran’s left arm condition with carpal tunnel syndrome had its onset in service or is otherwise related to active service. The doctor referenced the suture in the left forearm in active service, treatment after a fight, and opined that this injury would not cause the left arm carpal tunnel syndrome. Additionally, the doctor noted that the EMG study in June 2006 was normal in the upper extremities. The Board finds that the evidence favors a conclusion that the Veteran’s current left wrist carpal tunnel syndrome developed post-service and is unrelated to active service, for this reason service connection is not warranted. The weight of the competent evidence of record associates the Veteran’s current neurological complaints of the left upper extremity to his post service automobile accident. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim for a left wrist carpal tunnel syndrome disability, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b) (West 2014); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Miller, Erin (BVA)