Citation Nr: 18158227 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 13-10 524 DATE: December 14, 2018 ORDER Entitlement to service connection for bilateral carpal tunnel syndrome is granted. FINDING OF FACT The most probative evidence of record supports a finding that the Veteran’s bilateral carpal tunnel syndrome was caused by active service. CONCLUSION OF LAW The criteria for entitlement to service connection for bilateral carpal tunnel syndrome are met. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (2018).   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the Army from January 1967 to December 1968. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2011 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO) in Reno, Nevada. In May 2013 the Veteran presented testimony at a travel board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that proceeding has been associated with the claims file. In 2015, the Board remanded the issue on appeal as well as the issues of entitlement to service connection for bilateral hearing loss and bilateral ear infections. In a June 2015 rating decision, service connection for bilateral hearing loss and bilateral ear infections was granted. This represents a full grant of the benefits sought, and these issues are no longer in appellate status. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). The record contains no indication that the Veteran has disagreed with the initial ratings or effective dates assigned, thus, those matters are not in appellate status. See Grantham, 114 F. 3d at 1158 (holding that a separate notice of disagreement must be filed to initiate appellate review of “downstream” elements such as the disability rating or effective date assigned). Duties to Notify and Assists As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.326(a) (2018). In light of the Board’s favorable decision, however, any deficiencies in VA’s duties to notify and assist the Veteran with his claim decided herein are moot. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303(a) (2018). 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. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2018). The Veteran alleges that his carpal tunnel syndrome is related to the use of tools in service. Specifically, during the May 2013 Board hearing, the Veteran stated he used a pneumatic rivet gun and other tools in service. First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The June 2015 VA examination showed a diagnosis for bilateral carpal tunnel syndrome. Second, the Board finds that there was an in-service injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran testified at the May 2013 Board hearing that his military occupational specialty (MOS) as an airframe repairman on helicopters involved the use of pneumatic rivet guns and shop tools. The Veteran stated this caused difficulties with his wrists that began in service, to include pain. The Veteran testified that this work, including pounding with tools, was done consistently for more than a year and had a significant impact on his wrists. A review of the Veteran’s DD-214 confirmed an MOS of air frame repairman. At a June 2015 VA examination, the Veteran reported wrist pain, numbness, and tingling since service discharge. The Veteran is competent to report as to factual matters of which he or she has first-hand knowledge, to include events he witnessed during service. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). The Board finds the Veteran’s statements credible as they are consistent with the circumstances of his service and have been consistent over time. See 38 U.S.C. § 1154 (2012); Caluza v. Brown, 7 Vet. App. 498, 511 (1995). Third, the Board finds that the evidence of record supports a finding that the bilateral carpal tunnel syndrome is related to active service. The Veteran was afforded a VA examination in June 2015. The Veteran reported frequent wrist pain and hand tingling and numbness since discharge from service. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury or event, noting that there was no documentation of wrist or hand complaints or treatments in service or the many years following service. The Board does not assign this opinion any probative value as the examiner did not consider the Veteran’s competent and credible lay statements regarding in-service injury or a continuity of symptoms, but instead relied primarily on the absence of in-service records. Where the Veteran has provided lay testimony of an in-service injury, an examiner cannot ignore that lay evidence and base his or her opinion that there is no relationship to service on the absence of in-service corroborating medical records. Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007). In February 2018, the Board requested a VA healthcare (VHA) system expert medical opinion. The expert provided an opinion and an addendum opinion that it is at least at likely as not that the Veteran’s carpal tunnel syndrome began as a result of the Veteran’s service. The expert stated that the Veteran’s MOS as a helicopter airframe repairman would likely require repetitive manipulation of hand tools and could conceivably contribute to the development of carpal tunnel syndrome. The opinion provider based his opinion on the Veteran’s endorsement of wrist pain, tingling, and numbness since service discharge. The Board affords the expert medical opinion great probative weight as the expert reviewed the relevant medical records, considered the Veteran’s competent and credible lay statements, and provided a supporting rationale. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (holding that factors for assessing the probative value of a medical opinion are the physician’s access to the claims file and the thoroughness and detail of the opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions). Accordingly, service connection is granted. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Bruton, Associate Counsel