Citation Nr: 18147780 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 16-36 889 DATE: November 6, 2018 ORDER Service connection for Dupuytren’s Disease/Dupuytren’s Contracture of the left hand is denied. Service connection for Dupuytren’s Disease/Dupuytren's Contracture of the right hand is denied. REMANDED Service connection for diverticulitis is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that Dupuytren’s Disease and/or Dupuytren’s Contracture of the left hand began during active service, or is otherwise related to an in-service injury, event, or disease. 2. The preponderance of the evidence is against finding that either Dupuytren’s Disease and/or Dupuytren’s Contracture of the right hand began during active service, or is otherwise related to an in-service injury, event, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for Dupuytren’s Disease/Dupuytren’s Contracture of the left hand are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for Dupuytren’s Disease/Dupuytren’s Contracture of the right hand are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1968 to April 1970, to include service in the Republic of Vietnam from July 1969 to April 1970. According to a DD Form-215 in the claims file, he was awarded the Bronze Star Medal for his service. Service connection for Dupuytren’s Disease/Dupuytren’s Contracture. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus, or link, between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran has been diagnosed with Dupuytren’s Contracture. When he initially filed for service connection in January 2016, he requested compensation for Dupuytren’s Disease. However, according to a March 2016 VA telephone conversation note, a VA representative contacted the Veteran and asked him to clarify his contention. The Veteran responded that he was seeking service connection for a hand disease that caused his hand and finger to contract, pulling one or more fingers into a bent position. Based upon this conversation, the VA representative changed the Veteran’s service connection claim from Dupuytren’s Disease to Dupuytren’s Contracture. The Board takes judicial notice that Dupuytren’s Disease is essentially a precursor to the development of Dupuytren’s Contracture. Dupuytren’s disease is a condition that affects the fascia underneath the skin and in the palm and fingers. In patients with Dupuytren’s Disease, the fascia thickens, then tightens over time. See https://orthoinfo.aaos.org/en/diseases-conditions/dupuytren’s disease (June 2017). Medical articles indicate that the first symptom for many patients with Dupuytren’s Disease/Dupuytren’s Contracture is one or more lumps (nodules) developing under the skin of the palm of the hand. The developing lump may feel tender and sore at first, but this discomfort is reported as eventually goes away. The nodules then cause tough, inflexible bands of tissue to form under the skin in the palm, causing the fingers to bend and resulting in a diagnosis of Dupuytren’s Contracture. See http://www.wedmd.com/ a-to-z-guides/dupuytrens-disease-topic-overview (January 16, 2018). In this case, the Veteran has not reported that he experienced symptomatology in service such as palm pain or feeling lumps under the skin of either palm. Rather, he essentially contends that service connection should be granted in this case because his hands were never examined in service; and had they been examined, symptoms of Dupuytren’s Disease might have been discovered (i.e., “Both hands are bad. They didn’t even check them”). 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 in service. Post-service VA medical records in the claims file dated between September 2003 and April 2016 reflect that the Veteran was first diagnosed with Dupuytren’s Contracture in November 2013. The Veteran’s service treatment records dated from April 1968 to April 1970 fail to reveal any complaints, treatment, symptomatology or diagnosis of any hand, palm or finger condition. An April 1970 separation medical examination report reflects that a clinical examination of the Veteran’s upper extremities and skin/lymphatics were normal. A contemporaneous report of medical history reveals that the Veteran responded “yes” to the questions of whether he had (presently or in the past) hay fever and mumps. He marked the answer “no” in response to questions that included having any skin diseases. While earlier service medical records dated in 1968 and 1969 reflect that the Veteran sought treatment for complaints such as a running nose and cough; stomach cramps; diarrhea (gastroenteritis); a sore throat; tinea cruris; a laceration of the upper lip; and ringworm, none of the records document conditions of the left-hand palm or right-hand palm; nor is there any indication that the Veteran’s hand and fingers were contracting or that any of his fingers were “bending.” Thus, there are no lay statements from the Veteran or others attesting to the Veteran having symptomatology that could be associated with Dupuytren’s Disease or Dupuytren’s Contracture. The Veteran’s service medical records do not support his claims. The Veteran’s theory for service connection is entirely speculative in that he argues he may have been found to have Dupuytren’s Disease or Dupuytren’s Contracture if his hands had been properly examined in service. The Board cannot grant service connection based upon speculation. Therefore, the Board concludes that, while the Veteran has a current diagnosis of Dupuytren’s Contracture, the preponderance of the evidence is against finding that he manifested Dupuytren’s Disease or Dupuytren’s Contracture during active service, or that these conditions are 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). REASONS FOR REMAND Service connection for diverticulitis is remanded. In statements dated in May 2016 and July 2016, the Veteran reports that he had a severe intestinal infection in basic training for which he was hospitalized for a week. A review of his service medical records reveals that he was seen for gastroenteritis over a period of several days; however, this illness occurred in March 1970 and the Veteran was not hospitalized. Upon remand, the RO should conduct an additional search for service hospital records during the Veteran’s period of basic training. A review of VA medical records in the claims file appears to indicate that identified relevant outstanding private treatment records exist and have not been associated with the claims file. Specifically, October 2003 VA medical records from the Daytona Beach, Florida VA Outpatient Center (OPC) titled “Outside Results” reference “outside records from Florida Health Care beginning at 5/03 – chart includes office progress notes, med. List and labs. [The] chart [is] too lengthy to enter into computer. Complete record committed to paper chart.” October 2015 VA medical records also from the Daytona Beach, Florida OPC reflect that the Veteran reported seeing a non-VA outside medical provider for treatment of diverticulitis. No private medical records are contained in the claims file. A remand is required to allow VA to obtain authorization and request these records. Additionally, the Board observes that while the Veteran was afforded a VA intestinal conditions examination in April 2016, the examiner incorrectly reported that the Veteran was diagnosed with acute diverticulosis in 2009; and chronic diverticulitis in 2010 via colonoscopy. A review of the VA medical records in the claims file reveals that the Veteran complained to his medical care provider in September 2003 that he had been having abdominal cramping; and that he asked to have a colonoscopy. A May 2004 gastroenterology procedure note reflects diagnoses that included “Multiple Diverticuli Seen.” Subsequently, a November 2007 gastroenterology procedure note indicates that the Veteran was being seen at that time for anemia; and noted that he had a colonoscopy “2 years ago with [a] finding of diverticulosis.” In his examination report, the VA examiner opined that the Veteran’s post-service diverticulitis was not caused by or a result of any illness, injury, or event given (in part) the significant silent interval between the Veteran’s separation from the military and his eventual episode of diverticulitis. Given the foregoing, the Board finds that another opinion should be obtained. The matter is REMANDED for the following actions: 1. In light of the Veteran’s assertion that he was hospitalized during basic training for a severe intestinal infection, separate from the gastroenteritis he had in March 1970, the RO should conduct a search for service hospital records dated during the Veteran’s period of basic training. 2. Ask the Veteran to complete a VA Form 21-4142 for any private medical providers from whom he has received treatment in relation to his currently diagnosed diverticulitis, to include those referenced in the VA medical records cited above. Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 3. Obtain an addendum opinion to the April 2016 VA examination report. In regard to the examiner’s finding that the Veteran was diagnosed with acute diverticulosis in 2009 and chronic diverticulitis in 2010 via colonoscopy, in light of earlier diagnoses (e.g., the Veteran’s complaint to his medical care provider in September 2003 that he had been having abdominal cramping and that he asked to have a colonoscopy; a May 2004 gastroenterology procedure note reflecting diagnoses that included “Multiple Diverticuli Seen,”; and a November 2007 gastroenterology procedure note that the Veteran had a colonoscopy “2 years ago with [a] finding of diverticulosis”), the examiner is asked again to opine whether it is at least as likely as not that the Veteran’s currently diagnosed diverticulitis is related to an in-service injury, event, or disease, including the Veteran’s 1970 episode of gastroenteritis, and alleged hospitalization during basic training for a severe intestinal infection. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Talpins, Patricia