Citation Nr: 18155773 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 17-01 341 DATE: December 6, 2018 ORDER Entitlement to service connection for a right hand/finger disability is denied. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal a right hand or finger disability. CONCLUSION OF LAW The criteria for a right hand/finger disability are not met. 38 U.S.C. §§ 1111, 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 in the U.S. Air Force from October 1975 to October 1979. Service Connection A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C. §§ 1110, 1131. 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “Chronic.” When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. 3.303 (b). Service connection for a recognized chronic disease can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. Entitlement to service connection for a right hand/finger disability The Veteran contends that service connection is warranted for a right hand/finger disability, which is a residual of an in-service injury. The Veteran contends he has ongoing residuals of an in-service right index finger fracture including reduced range of motion and flexion of his fingers. In a March 2014 statement, the representative contended that an injury to two unspecified right-hand fingers occurred in 1979 which imbedded glass in the fingers that required three surgical procedures for removal. Further, the Veteran contends he has had ongoing symptoms since his in-service injury including pain and tenderness. The question for the Board is whether the Veteran has a current right hand/finger 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 does not have a current diagnosis of a right hand/finger disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The Veteran’s service treatment records (STRs) have been associated with the claims file. The Board notes the Veteran reports ongoing right hand and finger pain, and the Veteran’s STRs note an in-service injury to the Veteran’s hand. In October 1976 the Veteran was seen for a soft tissue injury to his right index finger due to trauma. Treatment included an ice pack, splint and X-rays. The following day a clinician noted a soft tissue injury and swelling in the right index finger after the Veteran injured his hand in a karate tournament. X-rays noted a non-displaced fracture of the proximal end of the right index finger. At separation, in an August 1979 report of medical examination clinical evaluation of the upper extremities was normal and the examiner noted in October 1976 the Veteran was treated for trauma to his right index finger which had no complications or sequela. On the report of medical history, the Veteran denied swollen or painful joints, a bone or other joint deformity, or arthritis. There is no record of an injury in 1979 involving glass imbedded in two right hand fingers requiring three surgical procedures. The Veteran was afforded a VA examination in June 2014. The VA examiner evaluated the Veteran and noted that the Veteran reported difficulty bending his right ring and little finger which he attributed to an in-service injury. Examination noted no deformity, mal-alignment, drainage, tenderness, painful motion, weakness, abnormal movement, fatigue, incoordination, instability or pertinent abnormal weight bearing. On repetitive use testing the examiner noted no loss of function. The examiner noted the Veteran’s in-service fracture of his right index finger resolved without current residuals. Range of motion testing noted painful motion affecting the right ring and little fingers. Range of motion testing noted a gap between the thumb pad and fingers of 1 to 2 inches with pain and a gap between the fingertips and the proximal transverse crease of the palm of less than 1 inch. Pain and tenderness of the joints was noted. Muscle strength testing was 5/5 with no ankylosis of the thumb or fingers. The examiner noted that any abnormality in range of motion testing of the Veteran’s right hand, fingers and thumb was unrelated to his claimed right index finger injury in-service. Examination of the right index finger was within normal limits, nontender and without deformity. Imaging of the right hand noted an old right hand healed 5th metatarsal fracture, with no acute fracture, dislocation or bony destructive lesions. The examiner found that the Veteran’s right hand, thumb or finger condition does not impact his ability to work. The examiner noted the Veteran’s in-service right index finger fracture however found that there was insufficient evidence to find a diagnosis of residuals of a right index finger disability. The examiner noted that no current disability was found. The Veteran does not have a current right hand/finger disability. The Board notes the Veteran’s reports of ongoing pain, limitation of motion and tenderness. However, there is no evidence that the Veteran’s reported pain and tenderness interferes with functioning as evidenced by the VA treatment records and examination. Under 38 U.S.C. § 1110 there must be a disability due to an identified personal injury suffered or disease or injury, contracted in-service. Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir., 2018). Here there is no functional limitation. Further, not all pain results in a disability, as in here, or rises to the level of impairment of working ability. The Board notes the Veteran’s reports regarding his current symptoms and ongoing manifestations of pain and tenderness which he is competent to report. Further, the Board notes the Veteran’s contentions that the June 2014 VA examiner failed to fully consider his contentions that the examination was incomplete and that he was not fully examined by the appropriate medical professional. However, the Board finds the preponderance of the evidence is against the Veteran’s claim for service connection for a right hand/finger disability. While the Veteran believes his symptoms of pain, tenderness and limited motion are indicative of a right/hand finger disability and related to an in-service injury he is not competent to provide a nexus opinion in this case. The record does not reflect that he has the requisite training or expertise to offer a medical opinion diagnosing a right hand/finger disability and linking his current symptoms to an in-service injury and as such he is not competent to provide an opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board notes that the medical evidence is more probative and more credible than the lay opinions of record. The June 2014 VA examination did not find any indication of a current right hand/finger disability, and on examination noted the Veteran’s symptoms of limited motion, pain and tenderness at times. However, the examiner found that the Veteran’s in-service fracture of his right index finger resolved without current residuals and that any abnormality in range of motion testing of the Veteran’s right/hand fingers and thumb is unrelated to his claimed right index finger injury in-service. The examiner noted the Veteran’s in-service right index finger fracture however found that there was insufficient evidence to find a diagnosis of residuals of a right index finger disability. The examiner found no current disability. Further, VA treatment records are absent indication of a right hand/finger disability. Thus, the more probative evidence of record indicates the Veteran does not have a current right hand/finger disability and service connection is not warranted. As such, the Board finds that service connection for a right hand/finger disability is not warranted. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Kardian