Citation Nr: 18158103
Decision Date: 12/14/18	Archive Date: 12/14/18

DOCKET NO. 15-15 792
DATE:	December 14, 2018
ORDER
Entitlement to service connection for a right wrist disorder is denied.
FINDING OF FACT
A right wrist disorder is not related to service. 
CONCLUSION OF LAW
The criteria for entitlement to service connection for a right wrist disorder have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017).
REASONS AND BASES FOR FINDING AND CONCLUSION
The appellant is a veteran (the Veteran) who had active duty service from June 1963 to June 1965. 
This appeal comes before the Board of Veterans’ Appeals (Board) from a March 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee.
In September 2018, the Veteran presented testimony at a Board hearing, chaired via videoconference by the undersigned Veterans Law Judge, and accepted such hearing in lieu of an in-person hearing before a Member of the Board. See 38 C.F.R. § 20.700(e) (2017). 
At the Board hearing, the Veteran was informed of the basis for the RO’s denial of his claim and he was informed of the information and evidence necessary to substantiate the claim. 38 C.F.R. § 3.103 (2017). A transcript of the hearing is associated with the claims file.
Please note this appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c) (2017). 38 U.S.C. § 7107(a)(2) (West 2014).
Service Connection
VA law provides that, for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service, during a period of war, or other than a period of war, the United States will pay to any veteran thus disabled and who was discharged or released under conditions other than dishonorable from the period of service in which said injury or disease was incurred, or preexisting injury or disease was aggravated, compensation, except if the disability is a result of the veteran's own willful misconduct or abuse of alcohol or drugs. 38 U.S.C. §§ 1110, 1131 (West 2014). 
Entitlement to service connection on a direct basis requires (1) evidence of current nonservice-connected disability; (2) evidence of in-service incurrence or aggravation of disease or injury; and (3) evidence of a nexus between the in-service disease or injury and the current nonservice-connected disability. 38 C.F.R. § 3.303(a); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 
For specific enumerated diseases designated as “chronic” there is a presumption that such chronic disease was incurred in or aggravated by service even though there is no evidence of such chronic disease during the period of service. In order for the presumption to attach, the disease must have become manifest to a degree of 10 percent or more within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). 
Presumptive service connection for chronic diseases may alternatively be established by way of continuity of symptomatology under 38 C.F.R. § 3.303(b). However, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic in 38 C.F.R. § 3.309(a) Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).
Arthritis is included among the presumptive chronic diseases. Arthritis is primarily rated on the basis of limitation of motion. Therefore, the rating provisions addressing limitation of motion of specific joints must be considered in determining whether arthritis is manifest to a degree of 10 percent or more. Alternatively, in the case of degenerative arthritis (hypertrophic or osteo-arthritis) or arthritis due to trauma, there must be painful motion accompanied by X-ray evidence of arthritis. See 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010 (2018). 
In order for arthritis of the wrist to have become manifest to a degree of 10 percent, there must be evidence to substantiate that (1) dorsiflexion is limited to less than 15 degrees, or (2) that palmar flexion is limited in line with the forearm, or (3) there must be a diagnosis “established by X-ray findings” and “satisfactory evidence of painful motion.”  See 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5214, 5215 (2018).
After the evidence has been assembled, it is the Board's responsibility to evaluate the entire record. 38 U.S.C. § 7104(a) (West 2014). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (West 2014); 38 C.F.R. §§ 3.102, 4.3 (2017). A VA claimant need only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996).
Entitlement to service connection for a right wrist disorder. 
Service treatment records reveal no complaints, treatments, or diagnoses pertinent to a right wrist injury at any time during the Veteran’s service. At service separation in June 1965, the Veteran’s upper extremities were examined and were found to be clinically normal (Record 12/06/2013 at 4). 
A May 14, 1965, Orthopedic Clinic Note reveals that the Veteran was working with tubing that morning and forcibly laterally displaced his right ring finger. X-rays revealed a slightly medially displaced fracture of the proximal end of the proximal phalanx of the right ring finger. The prescription was a splint with a possible open reduction (Record 12/06/2013 at 22). 
Fourteen days later on May 28, 1965, the Veteran was referred to “cast-orthopedics” for a broken cast. The location of the cast was not stated (Record 12/06/2013 at 29).   
The Veteran has testified that the service treatment records are mistaken; what was noted as an injury to the right ring finger in May 1965 was actually a mistaken recording of the right wrist injury. The Board finds that this is not plausible. The May 14, 1965, treatment record is very precise in the description of the injury. There is not simply one description of the location, but several, each of which is consistent with the others. Indeed, the description on May 14, 1965, of the proximal end of the proximal phalanx of the right ring finger is simply too detailed to be a typo. While the reference to a broken cast is not specific, the fact that it comes 14 days after the injury to the ring finger, upon which a splint was applied, strongly suggests that it is related to that injury. 
The Board has considered the possibility that the right wrist was also injured during this event, but that the injury was simply omitted from the examination report. However, the Board finds that this possibility is unlikely. It is reasonable to expect that the initial post-injury examination will record all complaints and will note all physical findings pertinent to the injury. This is particularly true in a case such as this, where X-rays of the area were taken. The Board is entitled to presume the competence of medical professionals. The Board finds that it is more likely that a competent medical professional would note a right wrist injury, in the context of an examination of the right hand, than it is for such an injury to be errantly omitted from the report. Accordingly, the Board finds that the Veteran’s assertion that the May 1965 injury was actually a right wrist injury, and not a finger injury, is not credible. The Veteran has not described any other injury affecting the right wrist. 
Based upon the service treatment records, which record an injury to the right ring finger, but which do not mention the right wrist, and which show normal findings for the upper extremities at service separation, the Board finds that there was no injury or disease affecting the right wrist during service. As there was no injury or disease of the right wrist during service, there is no duty to obtain an VA examination or medical opinion. 
The Veteran has a current right wrist disorder. An X-ray taken in September 2013 reveals mild degenerative changes (Record 11/27/2013 at 84). At that time, the Veteran reported having fractured his right wrist in the military in September 2013. He complained of a worsening pain in the right wrist with associated weakness over the previous year (Record 11/27/2013 at 8). However, this is the first reference to such an injury; and, it is notable that he had filed his claim for service connection one month prior, in August 2013. Thus, there is a correspondence in time between the initial complaint of symptoms, the initial report of an in-service injury, and the filing of the claim for service connection. 
There is no notation of arthritis of the right wrist in service. With reference to the criteria set out above, the Board finds that arthritis of the right wrist did not become manifest to a degree of 10 percent or more within one year of service separation. Accordingly, the presumptions associated with chronic diseases, including, arthritis, do not apply. 
There is no medical opinion that purports to relate a current right wrist disorder to service. The only evidence in favor of this etiology comes from the Veteran. As noted above, his theory of etiology is based on a non-credible account. To the extent he relates the temporally remote onset of symptoms to the in-service finger injury, the Board finds that this is not competent evidence. 
Generally, lay evidence is competent with regard to identification of a disease with unique and readily identifiable features which are capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007). A lay person may speak to etiology in some limited circumstances in which nexus is obvious merely through observation, such as sustaining a fall leading to a broken leg. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). 
Lay persons may also provide competent evidence regarding a contemporaneous medical diagnosis or a description of symptoms in service which supports a later diagnosis by a medical professional. However, a lay person is not competent to provide evidence as to more complex medical questions, i.e., those which are not capable of lay observation. Lay statements are not competent evidence regarding diagnosis or etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); Jandreau, at 1377, n. 4 (‘sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer’); 38 C.F.R. § 3.159(a)(2). 
The Board finds that relating a current right wrist disorder to a remote finger injury in service is not the equivalent of relating a broken bone to a concurrent injury to the same body part (Jandreau, at 1377). Such an opinion requires specialized medical knowledge, and is not a matter which is capable of lay observation. Accordingly, the Veteran’s lay statements are not competent evidence of an etiologic relationship between the claimed wrist disorder and service.
In sum, the Board finds that there was no injury or disease of the right wrist in service; and, that a current right wrist disorder is not related to service. In light of these findings, the Board concludes that service connection for the claimed right wrist disorder is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56.
 
JONATHAN B. KRAMER
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	L. Cramp