Citation Nr: 18151253 Decision Date: 11/19/18 Archive Date: 11/16/18 DOCKET NO. 06-26 041 DATE: November 19, 2018 ORDER Service connection for a right hand disability, claimed as residuals of frostbite, is denied. FINDING OF FACT The Veteran’s right hand disability, claimed as residuals of frostbite, was not incurred in or otherwise the result of military service, to include cold exposure therein. CONCLUSION OF LAW The criteria for entitlement to service connection for a right hand disability, claimed as residuals of frostbite, have not been met. 38 U.S.C. §§ 1110, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from September 1962 to September 1964. He had additional service from September 1964 to April 1971, from which he received a discharge under conditions other than honorable. This matter comes before the Board from a May 2004 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). Most recently, in June 2017, the Board remanded the matter for additional evidentiary development, and the case has been returned to the Board at this time for further appellate review following substantial compliance with the previous remand directives. See Stegall v. West, 11 Vet. App. 268 (1998) (A remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand order). Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). “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.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The appellant contends that the Veteran’s right hand disability were residuals of his frostbite suffered during active service. In June 1964, the Veteran stated that he had second degree frostbite on his Report of Medical History, without specifying the body part affected. There are no other records of frostbite or residuals of frostbite on any other documents from service, including his medical examination reports in February 1971. The Veteran claimed in October 2003 that he had residuals of frostbite on both hands as well as peripheral neuropathy on his right hand and fingers secondary to cold exposure in Alaska. In February 2004, he stated that he had “second and third degree frostbite while stationed in Alaska in 1962.” Throughout his treatment at the VA medical center, he complained of weakness in his left hand, and numbness of both hands. In February 2005, a VA physician thought there was a possibility of hyperesthesia of his left hand. In the March 2006 VA examination, the examiner found mild to moderate weakness on the Veteran’s left hand but not his right hand during an “aid and attendance or housebound examination.” In June 2006, the Veteran’s hands were examined for cold injury. Although the Veteran had normal range of motion on both hands, his left hand showed worse reflexes and was diagnosed as having residuals of a cold injury. His right hand was not diagnosed with a disability. The Veteran’s right hand was not examined after June 2006. He received an examination for brain and spinal cord in June 2007, where the examiner noted that the Veteran had “normal muscle mass, strength and tone in the right upper extremity,” compared to the left upper extremity where he showed “lagging.” In January 2018, a VA examiner gave an addendum opinion following the Board’s June 2017 remand directives, finding that the Veteran’s right hand symptomatology was less likely than not related to his active service. The examiner reviewed the Veteran’s VA claims file; his September 1962 Report of Medical Examination documenting normal extremities; June 1964 Report of Medical History noting a history of illness or injury due to second degree frostbite; treatment records of the Veteran’s right hand numbness from December 2003, January 2004, and February 2004; February 2005 stroke and treatment records; June 2006 VA examination; and July 2006 statement by the Veteran that he had the same cold exposure in his right hand as in his service-connected left hand due to frostbite. Specifically, the examiner found that the Veteran’s right hand symptomatology was at least as likely as not related to his complicated and progressive endocrine and cardiovascular conditions based on the facts of the case and medical knowledge. The examiner first noted that the Veteran passed away of “Septic Shock associated with end stage renal disease and Diabetes Mellitus,” and had a history of “Diabetic Peripheral Neuropathy, Hepatitis C … chronic renal insufficiency” and coronary artery disease. Then, the examiner opined that the Veteran’s symptoms “clearly and unmistakably demonstrated clinical manifestation related to uncontrolled Diabetes Mellitus with peripheral neuropathy, chronic renal insufficiency, cardiovascular disease and two cerebral vascular accidents,” and that “current internal medicine and cardiovascular literature associates clinical signs and symptoms of hand and digital numbness with complications of uncontrolled and/or long-standing Diabetes Mellitus, viral infections related to Hepatitis C, chronic renal insufficiency and [end stage renal disease], [coronary artery disease] and progressive cardiovascular disease.” Initially, the Board reflects that it appears that the Veteran had a current right hand disability during the appeal period in this case characterized by weakness and numbness. Additionally, the Veteran has already been service connected for cold injury residuals of the left hand in this case; the Board therefore concedes that the Veteran had cold exposure during his period of military service. Thus, the first two elements of service connection have been met in this case. The sole issue before the Board in this case is whether the current right hand disability has a nexus to service. The Board finds that it does not. The Board notes that there is no medical evidence of record that linked the Veteran’s right hand symptomatology with residuals of frostbite from service. The Veteran was afforded examinations and constant treatment from the VA, and he was service-connected for his left hand disability that the June 2006 examiner opined was due to residuals of a cold injury. The same examiner, performing an examination using “cold injury protocol,” also found that the Veteran did not have a disability in his right hand due to cold exposure/cold injury. This assessment is also supported by the record as the Veteran consistently complained only of weakness in his left hand. In addition to the June 2006 medical opinion, the January 2017 medical opinion found that the Veteran’s right hand symptomatology was not connected to his service as it was more likely to have been connected to the Veteran’s other illnesses, such as diabetes mellitus, hepatitis C, renal disease, and coronary artery disease. The examiner supported his opinion by pointing out that the Veteran’s diseases, none of which were service connected, were known to cause the Veteran’s right hand symptomatology. The Board has also considered the Veteran’s statements to the effect that his right hand symptomatology was a result of his in-service frostbite. Lay witnesses are competent to provide testimony or statements relating to symptoms or facts that are observable and within the realm of his or her personal knowledge. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Although the Veteran was competent to describe that he suffered from, and likely treated for, frostbite during service, his statements are insufficient to establish that his right hand symptomatology after active duty were residuals of said frostbite, as such a finding is a medical question that is not subject to lay observation alone. The Board finds that both the examiners’ opinions are highly probative given the contemporaneous nature of the June 2006 medical opinion that examined both of the Veteran’s hands specifically looking for cold injury residuals, but only found the left hand to have a disability, and the comprehensive nature of the January 2017 medical opinion that was supported by both the facts of the case and by medical knowledge. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Significantly, there is no competent evidence which contradicts the examiners’ conclusions or otherwise suggests a relationship between the Veteran’s right hand symptomatology and his history of frostbite. Accordingly, service connection for a right hand disability, characterized by weakness and numbness (claimed as residuals of frostbite), must be denied based on the evidence of record at this time. See 38 C.F.R. § 3.303. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claims, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD H. Yun, Associate Counsel