Citation Nr: 19132018 Decision Date: 04/25/19 Archive Date: 04/24/19 DOCKET NO. 14-21 045A DATE: April 25, 2019 ORDER Entitlement to service connection for arthritis of the right wrist, to include as secondary to service-connected right wrist navicular fracture, is denied. FINDING OF FACT The Veteran’s right wrist arthritis did not have its onset during service or within one-year of discharge from service; the weight of the probative evidence does not etiologically link the Veteran’s right wrist arthritis to service or any incident therein or indicate that it was caused or aggravated by his service-connected right wrist navicular fracture. CONCLUSION OF LAW The criteria for service connection for arthritis of the right wrist have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from April 1965 to April 1967. The matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. In August 2017, the Board remanded the case to develop the claim for secondary service connection. The Board finds there has been substantial compliance with its remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). The Veteran contends that his right wrist arthritis is the result of a right wrist navicular fracture he sustained after a fall while in service. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in active military service or, if preexisting such service, was aggravated thereby. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). To establish service connection for a disability on a direct basis, the 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. Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004); 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Certain chronic diseases, to include arthritis, will be presumed related to service if they were shown as chronic (reliably diagnosed) in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303, 3.307, 3.309. Service connection may be established on a secondary basis for a disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires: (1) the existence of a current disability; (2) evidence of a service-connected disability; and (3) competent evidence that the current disability was either caused by or aggravated by a service-connected disability. 38 C.F.R. § 3.310(a); see also Allen v. Brown, 7 Vet. App. 439 (1995). The Veteran’s service treatment records (STRs) note that he fell and fractured his right wrist in May 1966. The Veteran underwent a VA examination in April 2013. The examiner noted that the Veteran was diagnosed with traumatic arthritis of the right wrist in 2011. The Veteran reported that he did not have any problems with his wrist until a few years ago. He stated that he has noticed weakness and pain with certain movements and positions. In an October 2013 VA opinion, the examiner concluded that it was less likely than not that the Veteran’s arthritis of the right wrist was incurred in or caused by the claimed in-service injury, event, or illness. The examiner indicated that the Veteran suffered a right navicular bone fracture while in service, which healed. The examiner noted that the Veteran did not develop osteoarthritis until decades later. He explained that the Veteran’s X-ray reveals degenerative (osteo) arthritis not traumatic arthritis, which develops months to about one-year after a fracture. The examiner also noted that the Veteran has degenerative arthritis of multiple joints of the right wrist in areas not involved in the fracture. He further explained that this is consistent with typical age associated degenerative arthritis. The examiner concluded that the Veteran’s right wrist arthritis was less likely than not incurred in-service or caused by the right wrist navicular fracture. The Veteran was afforded another VA examination in October 2017. The examiner opined that it was less likely as not that the Veteran’s diagnosed arthritis of the right wrist was caused by the right wrist navicular fracture. She reasoned that the Veteran’s X-ray indicates that his arthritis is age-related and has no relationship with his healed right wrist fracture sustained during service. She also noted that during service the condition was acute only. Additionally, the examiner opined that the Veteran’s arthritis of the right wrist was less likely than not aggravated beyond its natural progression by service-connected right wrist navicular fracture. She explained that there was approximately a 45-year gap from the diagnosis of the healed right wrist navicular fracture and development of age-related arthritis. After considering all of the evidence of record, to include that set forth above, the Board finds that the preponderance of the evidence is against the claim of service connection for arthritis of the right wrist. The Board concludes that, while the Veteran has right wrist arthritis, which is a chronic disease under 38 U.S.C. § 1101(3) and 38 C.F.R. § 3.309(a), it was not shown as chronic in service or within a presumptive period, it did not manifest to a compensable degree within a presumptive period, and it was not noted in service with attributable continuity of symptomatology. Treatment records show the Veteran was not diagnosed with right wrist arthritis until 2011, approximately four decades after his separation from service and well outside of the applicable one-year presumptive period. Further, service connection is not warranted under the theory of continuity of symptomatology. Right wrist arthritis was not noted in service. Likewise, the Veteran has not asserted that he has experienced symptoms of arthritis continuously since his separation from service. Moreover, the Board finds that the evidence of record does not support a finding of service connection as there is no evidence of a nexus between the Veteran’s right wrist arthritis and his military service or service-connected right wrist navicular fracture. Under a direct theory of entitlement to service connection, there is no evidence that the Veteran’s arthritis had its onset in service or was otherwise related to service. The October 2013 VA examiner opined that it was less likely than not that the Veteran’s arthritis of the right wrist was incurred in service or caused by the right wrist navicular fracture. The examiner reasoned that the Veteran did not develop osteoarthritis until decades after separation and that his condition was consistent with typical age-related degenerative arthritis. Additionally, under a secondary theory of entitlement to service connection, the evidence of record weighs against a finding that the Veteran’s right wrist arthritis was caused or aggravated by the service-connected right wrist navicular fracture. The October 2017 examiner opined that it was less likely than not that the Veteran’s arthritis was caused by the service-connected right wrist navicular fracture because the evidence indicates the Veteran’s arthritis is age-related and has no relationship to the in-service injury. The examiner also opined that the condition was less likely than not aggravated beyond its natural progression by service-connected right wrist navicular fracture. She noted that there was a 45-year gap from the diagnosis of the healed service-connected right wrist navicular fracture and development of age-related arthritis. While the Veteran believes that his right wrist arthritis is related to his military service or service-connected right wrist navicular fracture, he is not competent to provide a nexus opinion in this case. This issue is medically complex, as arthritis involves unseen systems processes and disease processes that are not observable by the five senses of a lay person, and includes various possible etiologies, one of which involves aging of the joint, and is diagnosable only by X-ray or similar specific specialized clinical testing. Therefore, under the facts presented in this case, the Veteran is not competent to opine as to its etiology, where a diagnosis of arthritis was not made until 2011. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence of the October 2013 and October 2017 VA medical opinions. The Board finds that the VA medical opinions are adequate opinions based on an accurate history and medical documentation provided in the claims file, to include the service treatment records. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (noting that most of the probative value of a medical opinion comes from its reasoning). (CONTINUED ON NEXT PAGE) Accordingly, the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Robinson, Associate Counsel