Citation Nr: 18140953 Decision Date: 10/09/18 Archive Date: 10/09/18 DOCKET NO. 18-23 269 DATE: October 9, 2018 ORDER Entitlement to service connection for left carpal tunnel syndrome, to include as secondary to cervical spondylosis or to service-connected low back strain is denied. REMANDED Entitlement to service connection for cervical spondylosis, to include as secondary to service-connected low back strain is remanded. Entitlement to service connection for right knee joint osteoarthritis and right knee medial meniscus tear status post arthroscopy, to include as secondary to service-connected low back strain is remanded. Entitlement to service connection for left knee joint osteoarthritis, to include as secondary to service-connected low back strain is remanded. Entitlement to service connection for cervicogenic headaches, to include as secondary to cervical spondylosis or to service-connected low back strain is remanded. Entitlement to service connection for radiculopathy of the left upper extremity, to include secondary to cervical spondylosis or to service-connected low back strain is remanded. Entitlement to service connection for radiculopathy of the right upper extremity, to include as secondary to cervical spondylosis or to service-connected low back strain is remanded. Entitlement to service connection for right carpal tunnel syndrome, to include as secondary to cervical spondylosis or to service-connected low back strain is remanded. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran has left carpal tunnel syndrome. CONCLUSION OF LAW The criteria for entitlement to service connection for left carpal tunnel syndrome secondary to cervical spondylosis or to service-connected low back strain have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1970 to October 1970. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a February 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) in Guaynabo, Puerto Rico. The Board notes that evidence has been accepted into the record with waivers of initial RO consideration, in accordance with 38 C.F.R. §§ 19.9 (d)(3), 20.1304(c) (2017). The waivers are of record. See Veteran’s filings of September 2018. Duties to Notify and Assist As a preliminary matter, the Board has reviewed the claims file and finds there exist no deficiencies in VA’s duties to notify and assist that would be prejudicial and require corrective action prior to a final Board determination. See 38 U.S.C. §§ 5103, 5103A (2012); 38 C.F.R. § 3.159 (2017); see also Bryant v. Shinseki, 23 Vet. App. 488 (2010) (regarding the duties of a hearing officer); Mayfield v. Nicholson, 20 Vet. App. 537 (2006) (corrective action to cure a 38 C.F.R. § 3.159 (b) notice deficiency); Pelegrini v. Principi, 18 Vet. App. 112, 120 (2004) (timing of notification). Service Connection The Veteran contends service connection for left carpal tunnel syndrome. Service connection may be granted for disabilities resulting from disease or injury incurred or aggravated during active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for any injury or disease diagnosed after service, 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). Generally, service connection requires (1) evidence of current disability; (2) medical evidence, or in certain circumstances lay testimony, of in-service incurrence or aggravation of an injury or disease; and (3) evidence of a nexus between the current disability and the in-service disease or injury. See Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996); see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Service connection may also be established on a secondary basis. Here, there must be evidence of a current disability; evidence of a service-connected disability; and medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310. The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence, which it finds to be more persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; not every item of evidence has the same probative value. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b) (2012). The question for the Board is whether the Veteran has a current disability. The Board concludes that the Veteran does not have a current diagnosis of left carpal tunnel syndrome and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303 (a), (d). While the Veteran believes he has a current diagnosis of left carpal tunnel syndrome, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires diagnosis of left carpal tunnel syndrome and etiological link to service or a service-connected disability. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence which weighs against such a finding. In sum, the preponderance of the evidence is against the claim of service connection for left carpal tunnel syndrome. The evidence does not show that the Veteran has left carpal tunnel syndrome diagnosis. There is no other basis, either shown by the evidence or otherwise alleged, upon which to warrant a grant of service connection. REASONS FOR REMAND 1. Entitlement to service connection for cervical spondylosis, to include as secondary to service connected low back strain is remanded. Here, the Veteran was afforded a VA examination with respect to this claim in February 2015. The examiner opined that the Veteran’s cervical spondylosis was less likely than not proximately due to or the result of the Veteran’s service-connected low back strain because there is no biomechanics, nor anatomic correlation among the cervical and lumbar spine areas. The examiner noted that these are two distinct areas in terms of function, range of motion and biomechanics. The Board finds this medical opinion to be inadequate for adjudication purposes. The opinion fails to address whether the Veteran’s cervical spine disability was caused by or aggravated by the Veteran’s low back disability. Specifically, while the medical opinion addressed whether the low back disability itself was related to the Veteran’s cervical spine disability, it did not speak to whether the Veteran’s cervical spine disability developed because of or was aggravated by the effects of his low back disability. The medical opinion also failed to address the Veteran’s claim on a direct basis. After thorough review of the medical evidence the Board notes the Veteran complained of pain in his back and shoulder and the Veteran suffered from injuries to his back to include falling in the shower during service. As such, the Board cannot make a fully-informed decision on the issue and remand for an addendum medical opinion is required. 2. Entitlement to service connection for right and left knee joint osteoarthritis, cervicogenic headaches, radiculopathy of the bilateral upper extremities and right carpal tunnel syndrome, to include as secondary to cervical spondylosis or to service connected low back strain is remanded. Finally, because a decision on the remanded issue of entilement to service connection for cervical spondylosis could significantly impact a decision on the issues listed, the issues are inextricably intertwined. A remand of the claims is required. Additionally, the Board notes the RO denied the Veteran’s claim for radiculopathy of the upper extremities for lack of diagnosis. The Board notes the record reflects the Veteran has been diagnosed with cervical radiulopathy in the C6 and C8 region. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s cervical spine disability is at least as likely as not related to service or proximately due to service-connected low back strain or aggravated beyond its natural progression by the service-connected low back strain. If the examiner determines the Veteran’s cervical spine disability is related to service or aggravated by his service-connected low back strain, the examiner should opine whether his bilateral knee arthritis, radiculopathy of the bilateral upper extremities, right carpal tunnel syndrome, and cervicogenic headache disabilities are at least as likely as not related to or proximately due to or aggravated beyond it natural progression by his cervical spine disability or to his service-connected low back strain. The examiner must provide an explanation of all opinions expressed 2. Thereafter, and after undertaking any additional development deemed necessary, readjudicate the issues on appeal. If any benefit sought remains denied a supplemental statement of the case (SSOC) must be provided to the Veteran and his representative. After the Veteran has had an adequate opportunity to respond, then return the appeal to the Board for appellate review, if otherwise in order KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. McDuffie, Associate Counsel