Citation Nr: 18143992 Decision Date: 10/22/18 Archive Date: 10/22/18 DOCKET NO. 16-31 086 DATE: October 22, 2018 ORDER Entitlement to service connection for bilateral carpal tunnel syndrome is granted. FINDINGS OF FACT Competent medical evidence establishes that the Veteran has bilateral carpal tunnel syndrome (CTS) and that it is likely etiologically related to his duties in service. CONCLUSION OF LAW Service connection for bilateral CTS is warranted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.156(c); 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSION The appellant is a Veteran who served on active duty from June 2001 to January 2006. This case is before the Board of Veterans’ Appeals (Board) on appeal of a November 2010 Department of Veterans Affairs (VA) rating decision. Service connection for bilateral CTS is granted. An unappealed November 2010 rating decision denied service connection for bilateral arm disability, based essentially on findings that a disability was not shown and that there also was no evidence that it might be related to his service. In March 2015, additional service treatment records (STRs) were received and show that during service the Veteran was seen for complaints of numbness and tingling in his hands. While the circumstances of the addition of these records to the Veteran’s VA electronic record are not clear from the record, they clearly existed at the time of, and were not considered in, the November 2010 rating decision. Under 38 C.F.R. § 3.156(c)(1), the claim denied by the November 2010 rating decision must be considered de novo, encompassing consideration of the additional records, and whether new evidence has been received to reopen the claim is not for consideration. Service connection may be granted for a disability resulting from a disease or injury incurred or aggravated by service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To substantiate a claim of service connection, there must be evidence of (1) a current disability (for which service connection is sought); (2) incurrence or aggravation of a disease or injury in service; and (3) a causal connection between the disease or injury in service and the current disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2003). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Veteran contends that his diagnosed bilateral CTS became manifest in service, and resulted from his duties as a heavy wheeled vehicle mechanic during service. His DD Form 214 shows that his military occupational specialty (MOS) was wheeled vehicle mechanic. In an October 2015 written statement in support of his claim, he explains that during his second deployment he worked on M1070 vehicles used to haul M1 Abrams tanks; began experiencing numbness and tingling in his hands and forearms; and would wake up with numbness and tingling in both hands and forearms, which he would have to shake out to relieve the symptoms. The Veteran’s STRs note complaints of experiencing numbness and tingling in his hands in October, November, and December 2005. In an October 2005 post-deployment health assessment, he reported that he developed numbness or tingling in his hands or feet during the deployment. In November 2005 Report of Medical History, he explained that he would wake up and his hands would be numb and tingling. In his June 2010 Application for VA Compensation or Pension disability, the Veteran reported numbness, lack of coordination, and fatigue in his arms. Post-service treatment records include a January 2011 private medical record, which notes numbness of upper extremities, right greater than left; CTS was diagnosed. On April 2015 VA Peripheral Nerves DBQ examination, the Veteran related that while stationed in Iraq in 2005 he worked as a heavy wheeled vehicle mechanic, experienced intermittent tingling of both hands, and continued to experience intermittent hand tingling and numbness afterwards. He indicated that he was not experiencing symptoms in his hands when the exam was conducted; diagnostic studies were not conducted. The examiner opined there was no evidence of CTS at the time of the exam based on a lack of physical findings indicative of CTS. June 2015 electromyography (EMG) of the upper extremities was interpreted as showing mild grade lesions of the bilateral median nerves at the wrist, slightly worse on the right, confirming a diagnosis of bilateral CTS. The Veteran reported that bilateral arms paresthesias and weak grip have been recurring since 2006 and that he wakes up with the numbness. In July 2015 the Veteran’s private doctor opined that his bilateral CTS is directly related to his duties in service. The provider noted he reviewed the Veteran’s STRs and current treatment records, and observed that he worked as a mechanic in service, which involved significant stress to both wrists with turning and twisting motions. It was noted that the Veteran’s symptoms developed in the army and were exacerbated by further work as a mechanic, and that there is evidence of CTS on nerve conduction studies. On August 2015 VA examination the examiner opined that the Veteran’s bilateral CTS is less likely than not related to his military service, and explained that weight gain and manual work are risk factors for CTS. The August 2015 examiner noted that an August 2004 periodic exam was the latest STR available for review (and that later STRs and a service separation examination are not available). As the record includes pertinent STRs from 2005, that opinion is based on an incomplete record and lacks probative value. [And the manual work risk factor for CTS identified was noted by the Veteran’s private provider to have been one inherent with the Veteran’s duties in service.] Regarding the etiology of the bilateral CTS the Board finds probative (and persuasive) the 2015 opinion by a private doctor in support of the claim. It reflects familiarity with the record, and the Veteran’s lay accounts, and includes rationale that cites to accurate factual data. Service connection for bilateral CTS is warranted. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Naumovich, Law Clerk