Citation Nr: 18145478 Decision Date: 10/30/18 Archive Date: 10/29/18 DOCKET NO. 10-39 773 DATE: October 30, 2018 ORDER Entitlement to service connection for residuals of a left arm injury is denied. Entitlement to service connection for residuals of a right arm injury is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran’s current residual left arm injury is due to a disease or injury in service. 2. The preponderance of the evidence is against finding that the Veteran’s current residual right arm injury is due to a disease or injury in service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for residuals of a left arm injury are not met. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 2. The criteria for entitlement to service connection for residuals of a right arm injury are not met. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from December 1970 to November 1974. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2009 rating decision. In August 2017, the Board last remanded the claims for additional development. The record reflects substantial compliance with the remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303(a). 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. 2004). Certain chronic diseases, including arthritis, may be presumed to have been incurred in or aggravated by service if manifest to a compensable degree within one year of discharge from service, even though there is no evidence of such disease during service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309(a). The Veteran presently seeks to establish service connection for residuals of left arm injuries on the basis that they were caused by, and/or related to, his military service. The Veteran also related his right arm residuals to an unreported accident in service in which another soldier fell on him. See May 2010 VA treatment note. 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. Initially, the Veteran’s medical evidence confirms current diagnoses of left ulnar neuropathy and right medial neuropathy. See, e.g., February 2009 EMG nerve conduction study. The first clinical documentation of the onset of neuropathy is dated in 2009, over 30 years after service separation from his period of military service. Id. Furthermore, in an August 2, 2010 treatment record, the Veteran complained of two years of right sided weakness in his upper extremity. The attending physician noted chronic neuropathy with no ongoing injury. In an August 18, 2010 treatment note, the Veteran indicated a history of weakness in his right arm for three to four years, with no injury. An accompanying x-ray noted degenerative changes in his right hand. Again, the first clinical documentation of the onset of arthritis is dated in 2010, over 30 years after service separation from his period of military service. Id. As it pertains to an in-service event or injury, the Veteran’s service treatment records reflect a diagnosis of left shoulder muscle strain following a fall while roller skating in August 1972. In April 1973, records indicate the Veteran suffered a left index finger injury and “left wrist sprain” playing basketball. Subsequent x-rays were negative, and there was no further treatment or recurrent episodes regarding the left wrist or hand during service. Service treatment records were silent for subsequent complaints, diagnosis, or treatment for subsequent left arm problems, including on separation examination. Additionally, the STRs, including entrance and separation examinations, are negative for any complaints, diagnoses, or treatments for a right arm disorder. The Veteran was afforded a VA examination in August 2010. The examiner noted there is no medical information indicating treatment for cramping of the left hand while on active duty. He also indicated there is no evidence of a chronic condition to the left arm. In support, the examiner noted the Veteran’s separation examination is negative for any abnormalities and shows no complaints on medical self-assessment in regard to the left upper extremity or left hand. The examiner concluded the current left-hand condition is not due to military service. The Veteran was afforded a VA opinion in October 2017. The examiner opined that it is less likely than not that any current left or right arm disability, including arthritis or neurological disorder, had its origin in service or is related to the Veteran's active service. Regarding the left arm, the examiner noted the in-service event were only one day apart, which indicates the condition was acute and transitory. The separation examination was normal, which further supports the prior condition being acute and transitory. In regard to the right arm, the examiner rationalized his opinion by noting the August 18, 2010 VA treatment record indicated “no injury” and a past history of weakness in his right arm three to four years ago. Therefore, the August 2010 treatment note confounds the etiology of this condition and chronicity and continuity cannot be demonstrated. Consequently, the medical opinion evidence is against the claim. After review of the evidentiary record, the Board finds that service connection is not warranted for residuals of left and right arm injuries. The Board concludes that, while the Veteran has current diagnoses of bilateral neuropathy and arthritis, and evidence shows that an in-service injury occurred, the preponderance of the evidence weighs against finding that the Veteran’s current disabilities began during service or are otherwise related to an in-service injury, event, or disease, from so many years ago. 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 Board finds the October 2017 VA opinion to be most probative. The VA examiner clearly reviewed the medical records in the claims folder and provided opinions that are supported by and consistent with the evidence of record. The remaining treatment records do not provide any contrary evidence. The only credible, probative medical opinion of record weigh against the claim, and neither the Veteran nor his representative has presented or identified any medical opinion or other competent evidence that, in fact, supports the Veteran’s claims. We can not ignore such evidence. The Board also finds that the Veteran is not entitled to presumptive service connection for arthritis. As stated above, the earliest post-service medical treatment records are dated from August 2010, over thirty years after service. No diagnosis of arthritis was made within one year of the Veteran’s military discharge. Thus, the presumption for service connection for chronic diseases does not apply. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a), 3.309(a). The Board acknowledges the Veteran’s belief that his left and right arm injuries are related to his service. However, as a layperson without the appropriate medical training and expertise, the Veteran has not demonstrated the competency to opine as to the etiology of neuropathy or arthritis in this matter. The onset and etiology of neuropathy and arthritis are complex questions, and the Veteran has not been shown to possess the medical training and expertise required to provide such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). (Continued on the next page)   In conclusion, based on the analysis above, a preponderance of the evidence is against the Veteran’s claim for service connection for residuals of left and right arm injuries. As the preponderance of the evidence weighs against the claims, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107 (b). John Crowley Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Kettler, Associate Counsel