Citation Nr: 18158301 Decision Date: 12/18/18 Archive Date: 12/14/18 DOCKET NO. 16-35 416A DATE: December 18, 2018 ORDER Entitlement to service connection for left hand and arm pain is denied. Entitlement to service connection for right hand and arm pain is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has left hand and arm pain which is etiologically related to active military service. 2. The preponderance of the evidence is against finding that the Veteran has right hand and arm pain due to a disease or injury in service. CONCLUSIONS OF LAW 1. The criteria for service connection for left hand and arm pain are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for right hand and arm pain are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Marine Corps from June 1977 to August 1978. This case comes before the Board of Veterans' Appeals (Board) on appeal from an August 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an 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). Entitlement to service connection for left hand and arm pain and right hand and arm pain is denied. The Veteran contends that he is entitled to service connection for pain in his bilateral hand and arms due to a fall he had during service. His claim was received by VA in July 2012. He reported in his application for compensation that the disabilities began in 1993 and consisted of bilateral arm and hand pain when gripping objects. In a June 2016 letter, the Veteran wrote that his injuries occurred in January 1978 when he stepped into a hole approximately 15 to 20 feet deep. Since the injury, he had had problems with his neck. He wrote that the injury is now affecting the use of both hands and his left foot. He wrote that MRI examination was conducted which revealed a pinched nerve. The Veteran believes the pinched nerve in his neck is what is causing his bilateral hand pain. The Veteran does not allege that he injured his hands and arms during active duty. The service treatment records (STRs) are silent as to complaints of, diagnosis of or treatment for hand and/or arm pain. The records document that the Veteran did seek treatment after a fall but they do not reference, in any way, problems with the hand and arms. The first evidence of problems with the hands and arms is dated many years after discharge. The record demonstrates that the Veteran has been treated for bilateral hand and wrist pain since 2007. The post-service medical evidence does not indicate that the Veteran injured his hands and arms during active duty. The records support the determination that the hand and wrist problems began after active duty. On his VA 21-526, the Veteran reported that his bilateral hand and arm pain began in 1993. An August 2007 progress note from the Veteran's private medical records reveals he was seen for complaints of right wrist pain after he reported that he “smashed it” two days ago. Later, in September 2007; the Veteran was seen for pain in his right hand’s 4th digit. He denied any history of trauma. The medical record reported that the etiology of the pain was unclear. In January 2008, the Veteran reported persistent pain in his bilateral hands that came after grabbing the steering wheel of the car for a long period of time. The record referenced an injury date of December 2007and it was also written that the hand sprain and pain had an unknown etiology. A February 2016 progress note demonstrates that the Veteran came to establish care for his bilateral hand weakness and pain. He reported that he had stiffness, pain, and weakness for six years (approximately 2010) which led to him undergoing a surgical release of bilateral cubital and carpal tunnel; yet he had no relief of his symptoms. The Board finds the evidence of record, to include the Veteran's statements, demonstrates that the hand and arm symptoms were not present during active duty, were not continuously present from discharge to the present and began years after discharge. The Board further finds there is no competent evidence of record linking current hand and arm symptoms to active duty. The Veteran has argued that his hand and wrist symptoms were secondary to a neck injury which occurred after a fall during active duty. Service connection is not in effect for residuals of a neck injury. While the Veteran has undergone an examination in April 2018 for his left shoulder, the Board acknowledges the Veteran has not undergone a VA examination for his claims. However, the current fact pattern does not trigger the VA’s duty to assist and provide a VA examination. Generally, VA has a duty to provide a medical examination or obtain a medical opinion if the evidence indicates the existence of a current disability, or persistent or recurrent symptoms of a disability that may be associated with an event, injury, or disease in service, but the record does not contain sufficient medical evidence to decide the claim. 38 U.S.C. § 5103A(d)(2) (2012); 38 C.F.R. § 3.159(c)(4)(i) (2015); McClendon v. Nicholson, 20 Vet. App. 79, 81 (2006). In this case, the Veteran's claim does not meet the requirements to provide an examination or to obtain a medical opinion. As discussed, there is no evidence of an in service event, injury or disease pertaining to the hands and arms and service connection is not in effect for a neck disability so an opinion based on secondary service connection would not be probative. (Continued on the next page)   Accordingly, service connection for the bilateral hand and arm condition is not warranted. As the preponderance of the evidence is against the Veteran's claims, the doctrine of reasonable doubt is not applicable. See 38 C.F.R. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Wade, Associate Counsel