Citation Nr: 18147851 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 12-00 807 DATE: November 6, 2018 ORDER Entitlement to service connection for a right elbow condition is denied. FINDING OF FACT The Veteran’s right elbow condition is neither proximately due to nor aggravated beyond its natural progression by his service-connected cervical spondylosis, and is not otherwise related to an in-service injury, event, or disease. CONCLUSION OF LAW The criteria for service connection for a right elbow condition are not met. 38 U.S.C. §§ 1110, 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 from February 1974 to October 1992. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. A hearing was held before the undersigned Veteran’s Law Judge in August 2013. This claim for service connection was first remanded by the Board in October 2014 to obtain a VA examination and nexus opinion. In November 2015 the claim was remanded a second time because the VA examiner’s opinion did not include an opinion regarding whether the Veteran’s disability was aggravated by his cervical spine disability. The Board again remanded this claim in February 2017 because the obtained addendum opinion still did not address aggravation. Most recently, the Board remanded the Veteran’s elbow disability claim due to a lack of substantial compliance with the previous remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). Finding substantial compliance with remand directives and adequate opinions from the VA examiner, the Board now addresses the issue of entitlement to service connection for a right elbow disability on the merits. EMG-NCV exams were completed. Additionally, an opinion regarding secondary service connection, including aggravation has been provided. The Veteran asserts that his right elbow condition is related to service. 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. The Board concludes that the Veteran has a current diagnosis of right cubital tunnel syndrome as indicated by the Veteran’s March 2018 VA examination. The Board finds that the VA examiner is competent to diagnose such a condition because of their education and experience. The Board similarly finds the diagnosis credible because the Veteran has received the same diagnosis across multiple examinations and such a diagnosis of right cubital tunnel syndrome is consistent with the rest of the Veteran’s records. The exception in the record is the April 2017 VA examination which reported no diagnosis of cubital tunnel syndrome. While the VA examiner is competent and credible for the above-stated reasoning, the April 2017 opinion is given little probative weight because the opinion did not address the previous diagnosis of cubital tunnel syndrome already on record. The Veteran’s DD-214 shows that the Veteran worked as an M1 Abrams Armor Crewman during active duty service, which he claims as his in-service event. During his hearing, the Veteran stated that he repeatedly fell and hit his elbow while manning the tank turret. The Veteran is competent to report what regularly occurred during his active duty service. His account is credible as it does not conflict with the rest of the Veteran’s record. However, the preponderance of the evidence weighs against finding that the Veteran’s disability is related to those injuries or is 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). Taken together, the several VA opinions of record, including the most recent addendum, establish that the Veteran’s right elbow condition is not at least as likely as not related to an in-service injury, event, or disease, including his time serving as an M1 Abrams Armor Crewman. The March 2018 VA examiner opined that the Veteran’s right elbow condition was not at least as likely as not related to the Veteran’s service because the elbow pain reported during service was acute and did not receive treatment again for several years. The April 2016 VA examiner similarly opined that the Veteran’s right cubital tunnel syndrome was not at least as likely as not related to the Veteran’s service. The rationale was that the Veteran reported elbow pain one time in March 1985 and not again until the claim was filed in December 2009. The July 2015 VA examiner provided the same reasoning and other examiners on record provided no rationale for their findings. The examiners’ combined opinions are probative, because they are based on an accurate medical history and provide explanations that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). While the Veteran believes his right elbow condition is related to an in-service injury, event, or disease, including his service as an M1 Abrams Armor Crewman, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the VA examiners’ opinions discussed above. Even though direct service connection cannot be granted here, the Veteran may argue secondary service connection in the alternative. The question for the Board is now whether the Veteran’s elbow condition is proximately due to, or aggravated beyond its natural progress by the Veteran’s service-connected disability of cervical spondylosis. The April 2016 VA examiner opined that the Veteran’s right elbow condition is less likely than not related to his service-connected spine condition. The VA examiner stated that the two conditions have different presentations in that pain radiates from and to different locations on the body with no causal connection. The May 2018 VA examiner came to the same conclusion regarding causation, but was the first examiner to address aggravation. In addressing aggravation, the May 2018 VA examiner indicated that there is no evidence present to suggest that the Veteran’s elbow condition was aggravated by his service-connected spine condition. As is the same with direct service connection, while the Veteran believes his right cubital tunnel syndrome is proximately due to or aggravated beyond its natural progression by his cervical spondylosis, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight   to the April 2016 and May 2018 VA examiners. As a result, entitlement to service connection for a right elbow condition on a secondary basis is denied. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Hebert, Law Clerk