Citation Nr: 18153927 Decision Date: 11/28/18 Archive Date: 11/28/18 DOCKET NO. 15-00 125 DATE: November 28, 2018 ORDER Service connection for a left wrist disability is denied. FINDING OF FACT Any current left wrist disability was not manifest in service and is unrelated to service. CONCLUSION OF LAW The criteria for service connection for a left wrist disability have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1981 to September 2001 in the United States Air Force. The Board sincerely thanks him for his service. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a December 2011 rating decision by a Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran presented testimony before the undersigned Judge at a hearing on July 9, 2018, and a transcript of the hearing is associated with his claims folder. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c) (2016). 38 U.S.C. § 7107(a)(2). 1. Service connection for a left wrist condition Establishing service connection generally requires medical or, in certain circumstances, lay evidence of: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). Service connection may be awarded on a presumptive basis for certain chronic diseases listed in 38 C.F.R. § 3.309(a) that manifest to a degree of 10 percent within 1 year of service separation. 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331, 1337 (Fed.Cir.2013). Evidence of continuity of symptomatology may be sufficient to invoke this presumption if a claimant demonstrates (1) that a condition was “noted” during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007) (citing Savage v. Gober, 10 Vet. App. 488, 496–97(1997)); see 38 C.F.R. § 3.303(b). The Veteran’s Service Treatment Records (STRs) show he received treatment for a pulled left wrist incurred while weight-lifting. The record does not clearly list a date, but the Veteran stated at his hearing that this injury occurred in the 1980s. The physician’s notes show the wrist had full range of motion and the Veteran was instructed to return if there was no improvement to the condition; no follow-up treatment occurred. In 1992, the STRs show the Veteran fractured the 4th metacarpal in his left hand. The x-ray report for the left hand and wrist showed no damage to any other structures. The Veteran wore a cast which was removed after three weeks, at which time the Veteran reported the hand “feels good.” In 1999, the Veteran reported the left hand fracture in his medical history and stated “no problems since,” and he did not mention any other left wrist issues. The STRs contain no other record of continuing symptoms or further injury to the left wrist. In his 2014 Form 9, the Veteran claimed that he fractured his left wrist while stationed at Whiteman AFB between 1992 and 1997, and that he had x-rays at the base hospital. In his 2018 hearing before the Board, the Veteran testified that he believes he fell into a missile silo and put his wrist down and believes he went to medical after the incident. He was unsure if he got x-rays as it “was back in the 90s” but reported problems since that time with popping and swelling. When the Veteran’s representative sought clarification on whether the cast was for his wrist or his 1992 left hand fracture, the Veteran responded “I couldn’t be specific.” A 2014 VA Exam showed mild degenerative joint disease (DJD) of the left wrist, with x-rays showing normal bone architecture and no other significant degenerative change. Although the examiner initially found the DJD was connected to a prior fracture, the RO sought clarification because the examiner was referring to a right wrist fracture described in the STRs. The examiner clarified his opinion by stating the left wrist DJD “is less likely as not either incurred or caused by or a continuation of the complaints and treatment that occurred while in service,” because the x-ray findings did not support a finding that the minimal DJD had onset in service, and there was no record of a chronic condition during service. The Board finds this exam adequate, and therefore assigns a high degree of probative weight to the examiner’s rationale. The Board acknowledges the Veteran’s claim of a left wrist fracture during service. Lay persons are competent to provide opinions on some medical issues. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). There is no indication that he has the requisite medical training and/or expertise needed to diagnosis a bone fracture that is not apparent to the naked eye. There is nothing to suggest that the Veteran’s reported left wrist fracture was observable. At times, X-ray examination is necessary to detect the fracture. Given the complexity of diagnosing a left wrist fracture, the Board concludes that the Veteran's statements regarding any such diagnosis are not competent evidence. The Veteran's lay statements alone are not sufficient to establish that he had a left wrist fracture in service. Thus, the Board finds that the Veteran's statements as to a diagnosis of a bone fracture are not competent. The Veteran is competent to state that he fell on his wrist and the STRs reflect a pulled left wrist. However, the preponderance of the evidence is against a finding that his current diagnosis of DJD of the left wrist is related to service. The most probative evidence of record is the October 2014 negative VA medical opinion which provides a rationale for the conclusion provided following a review of the file, including the left wrist complaints and treatment in service. Despite the Veteran’s testimony that his left wrist has been symptomatic since service, and particularly since the 1992 left hand fracture, the Board finds that the preponderance of the evidence is against a finding of continuity of symptomology with respect to his recent diagnosis of arthritis. The statements as to continuity lack credibility as they are inconsistent with contemporaneous statements made by the Veteran, including a STR dated in approximately 1999 which noted “broke left hand worse cast [in 1992] no problems since.” Also, the preponderance of the evidence is against a finding that arthritis manifest to a compensable degree within one year of service. The Veteran’s representative suggested during the hearing that there may be some relationship between the Veteran’s current left wrist arthritis and his left fourth metacarpal in-service fracture. As an initial matter, the Board does not find that further examination or medical opinion is necessary as a result of this contention. First, the October 2014 medical opinion reviewed the STRs and concluded that the Veteran’s left wrist DJD was not related to any in-service complaints. Second, as suggested by the representative during the hearing, there is no competent evidence in the record that indicates any relationship between the left finger fracture and the later development of left wrist arthritis. STRs show that the left wrist bony structures were normal at the time of the left finger fracture and the Veteran reported a number of years after the 1992 left finger fracture that he had no residual problems. The preponderance of the evidence is against this claim and there is no doubt to be resolved. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1991). While the benefit sought on appeal cannot be granted, the Board would like to thank the Veteran for his service and wish him well in the future. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. McCormick, Associate Counsel