Citation Nr: 18142668 Decision Date: 10/16/18 Archive Date: 10/16/18 DOCKET NO. 15-29 963 DATE: October 16, 2018 ORDER Entitlement to service connection for a right wrist strain is granted. FINDING OF FACT The Veteran’s right wrist strain began during active service. CONCLUSION OF LAW Residuals of a right wrist injury were incurred in service. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Navy from September 2006 to September 2014. Service Connection A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C. §§ 1110, 1131. To establish a right to compensation for a present disability, a Veteran must show: “(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” - the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). For the showing of 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.” When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. 3.303 (b). Service connection for a recognized chronic disease can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. Entitlement to service connection for a right wrist disability The Veteran contends that he has a right wrist disability which was caused by an in-service injury. The Veteran reports he has had ongoing right wrist pain since his puncture wound during a diving accident and subsequent debridement surgery in-service. He reports pain while working, completing household tasks and exercising. The Veteran reports pain and difficulty with turning wrenches, applying torque to bolts, painting and moving equipment all requirements of his employment. Additionally, the Veteran reports limited range of motion of his wrist and taking longer to complete tasks and regularly taking anti-inflammatory medications and using wraps and supports on his wrist. The Veteran is competent to describe his ongoing symptoms since service and his statements are credible. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). There is conflicting evidence regarding the existence of a disability. However, we resolve such doubt in the Veteran’s favor. The Board concludes that the Veteran has a current diagnosis of a right wrist strain with ongoing pain that began during active service. 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). The Veteran’s service treatment records (STRs) have been associated with the claims file. The Veteran served in the U.S. Navy with a military occupational specialty (MOS) in electrical mechanical equipment repair working as a Navy diver. STRs note the Veteran sustained a deep puncture wound to his right hand while cleaning the hull of a submarine. He was diagnosed with right dorsal hand atypical tenosynovitis and subsequently underwent a successful intrap debridement in November 2010. At separation on the report of medical assessment the Veteran reported ongoing concerns about his right wrist. In addition, at separation on his report of medical history the Veteran reported swollen or painful joints and the need for corrective devices due to his painful wrist with limited mobility. The Veteran as afforded a VA examination in December 2014. The examiner noted the Veteran had a soft tissue infection of his right hand in-service and noted no current diagnosis associated with his right wrist pain. The examiner noted the Veteran currently reported discomfort in the dorsal right hand and a loss of motion and strength in his fingers. In addition, the Veteran reported flare-ups and functional loss when exercising, working and completing household chores. Range of motion testing was normal. Specifically, the Veteran reported difficulty applying torque with a wrench one of his requirements as a diver, which limits his ability to timely complete tasks. The examiner noted that the Veteran’s employment requires use of heavy equipment and muscle strength in his hand, and his ongoing pain and weakness result in him taking longer time to complete tasks, and requires him to avoid certain tasks requiring strength. The examiner noted no signs of a residual infection or arthritis, but noted the Veteran experiences functional limitations. In a June 2015 VA supplemental opinion, the examiner noted that the Veteran did not have arthritis of the right wrist, as his injury was confined to soft tissue and did not involve the bones of the wrist. On examination arthritis was not suspected, and the examiner attributed the Veteran’s flare-ups and mild functional limitations to a right wrist strain, not arthritis. The Board notes the VA examiner conflicting findings initially noted no right wrist disability and subsequently noted that arthritis was not present and that the Veteran’s symptoms were likely attributable to a right wrist strain. The Board notes that pain alone can cause functional impairment and establish a current disability. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir., 2018). While not all pain results in a disability, herein however, pain raises to the level of functional impairment in working ability and contributes to the Veteran’s disability. As such resolving reasonable doubt in the Veteran’s favor the Board finds that a right wrist disability is present. The Board has competent and credible reports from the Veteran regarding his right wrist injury in-service and continuity of symptoms since service and a VA examination identifying a right wrist strain, pain and ongoing functional impairment. The preponderance of the evidence favors in granting the Veteran’s claim of entitlement to service connection for a right wrist disability. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Kardian