Citation Nr: 19123700 Decision Date: 04/01/19 Archive Date: 03/29/19 DOCKET NO. 13-05 212 DATE: April 1, 2019 ORDER Entitlement to service connection for a right wrist disorder is denied. REMANDED Entitlement to service connection for a right hand disorder is remanded. FINDING OF FACT The Veteran’s right wrist disorder is not causally or etiologically due 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. §§ 1110, 5107 (2012); 38 C.F.R. § 3.303 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from August 1998 to August 2004. This matter comes before the Board of Veterans’ Appeals (BVA or Board) from an August 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. The Veteran requested a hearing before the Board. The requested hearing was conducted in August 2016 by the undersigned Veterans Law Judge. A transcript is associated with the claims file. In a September 2017 decision, the Board denied the issues on appeal. The Veteran appealed the Board decision to the United States Court of Appeals for Veterans Claims (Court). An October 2018 Joint Motion for Partial Remand vacated the Board’s decision for the issues of entitlement to service connection for right wrist and right hand disorders and remanded the claims to the Board for readjudication. Service Connection Entitlement to service connection for a right wrist disorder is denied. The Veteran seeks entitlement to service connection for a right wrist disorder. She asserts her current right wrist disorder had an onset during service. Under the relevant laws and regulations, service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a). In general, service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618(1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49(1990). Equal weight is not necessarily accorded to each piece of evidence contained in the record; not every item of evidence necessarily has the same probative value. Furthermore, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49(1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of matter, the benefit of the doubt will be given to the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence submitted by the Veteran or on her behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81(Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). Rather, the Board's analysis below will focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant). First, the Veteran has a current diagnosis of mild, incomplete paralysis of the right median nerve, which the VA examiner stated is likely carpal tunnel syndrome. See July 2014 VA examination. As such, Shedden element (1), current diagnosis, is met. As for the second requirement for service connection, that a disease or injury was incurred or aggravated during service, the Board finds that there is sufficient evidence of an in-service event. In November 2003, the Veteran sought treatment for right wrist pain with extension activities. She was provided with a splint for immobilization. An x-ray of the wrist was negative. She was assessed with right wrist pain of unknown etiology, possible tendonitis. Therefore, the Board finds that Shedden element (2) is met. Unfortunately, Shedden element (3), nexus, is not met. The Veteran was afforded a VA examination in July 2014, at which time she was assessed with mild, incomplete paralysis of the right median nerve, which was likely carpal tunnel syndrome. The examiner noted the Veteran’s in-service right wrist complaints and treatment. The examiner opined that the Veteran’s current right wrist disorder is less likely than not due to her in-service likely wrist sprain because they are two different disease processes, which is congruent with medical literature. The Board finds the VA opinion highly probative because the examiner had the appropriate training, expertise and knowledge to evaluate the claimed disorder. The examiner also reviewed the records, performed a clinical examination, and considered the Veteran’s statements regarding the nature and history of her condition. Significantly, the Veteran has not provided documented evidence of a medical opinion that directly contradicts the conclusions reached by the examiner in the July 2014 VA examination report. The only evidence of record which relates the Veteran’s claimed disorder to her active military service are her own statements. The Veteran’s statements are competent evidence as to observable symptomatology, including numbness and pain. See Barr, 21 Vet. App. at 307. However, the Veteran’s statements that her current disorder was incurred during or as a result of active service is a medical conclusion which the Veteran is not qualified to make. Although lay statements are competent evidence to provide opinions on some medical issues, the etiology of the Veteran’s claimed right wrist disorder falls outside the realm of common knowledge of a lay person due to the complexity of the nexus question presented. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see also Jandreau, 492 F.3d at 1377. Moreover, the July 2014 VA examiner considered the Veteran’s statements when providing the aforementioned medical examination report and concluded that her disorder is not likely due to her time in service. Accordingly, service connection for a right wrist disorder is not warranted. The evidence of record does not establish that the Veteran’s claimed disorder had an onset or was caused by her military service. In arriving at the decision to deny the claim, 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. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). REASONS FOR REMAND Entitlement to service connection for a right hand disorder is remanded. The Veteran asserts she has a right hand disorder that had an onset during service. In November 2014, VA treatment records indicate the Veteran complained of twitching in her right hand and that it was difficult to carry objects. A December 2014 VA treatment note indicates the Veteran again complained of right hand pain and requested pain medication for her hand. She was prescribed a pain reliever; however, treatment records do not contain any diagnosis of a right hand disorder. Although the Veteran was afforded a VA examination in July 2014 that contained some results pertaining to the right hand, the examination focused mainly on the right wrist. On appeal, the Veteran should be afforded a VA examination specifically for the right hand, to clarify her diagnosis and to obtain a medical opinion. The matter is REMANDED for the following action: Afford the Veteran a VA examination for her claimed right hand disorder. All testing deemed necessary by the examiner should be performed and the results reported in detail. The claims folder must be made available to the examiner for review in conjunction with the examination. The examiner should respond to the following: a) Please identify (by diagnosis) each disorder of the right hand found/shown by the record and current examination. b) Please identify the likely cause for each right hand disorder diagnosed. Specifically, is it at least as likely as not (a 50 percent or greater probability) that any such disorder had an onset during service or is any way causally or etiologically related to service? The examiner is asked to comment on the documented in-service right wrist symptoms. c) The examiner is asked to review the lay statements as they relate to the development of any right hand disorder and provide comment/information as to how the statements comport with generally accepted medical norms. d) If a right hand disorder is deemed to be unrelated to service, the examiner should, if possible, identify the cause considered more likely and explain why that is so. e) If there is no current diagnosis, but there is evidence of functional limitation, opine as to whether the functional limitation is at least as likely as not (50 percent probability or greater) caused by or is otherwise related to the Veteran’s active duty service, to include her right wrist treatment during service, and explain why. f) A detailed explanation (rationale) is requested for all opinions provided, citing to supporting clinical data and/or medical literature, as appropriate. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Andersen, Counsel