Citation Nr: 20002768 Decision Date: 01/13/20 Archive Date: 01/13/20 DOCKET NO. 14-33 329 DATE: January 13, 2020 ORDER Service connection for right upper extremity carpal tunnel syndrome is granted. FINDING OF FACT The evidence is in relative equipoise that the Veteran’s right upper extremity carpal tunnel syndrome is etiologically related to service. CONCLUSION OF LAW The criteria for service connection for right upper extremity carpal tunnel syndrome are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from May 1966 to December 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2012 by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2016, the Veteran testified before the undersigned; a transcript of the hearing is record. The Board remanded the case to the Agency of Original Jurisdiction (AOJ) in March 2018 for additional development. The case has been returned to the Board for appellate review following substantial compliance by the AOJ with the remand directives. Right Upper Extremity Carpal Tunnel Syndrome The Veteran contends that his carpal tunnel syndrome is related to his work as a jet engine mechanic in service or in the alternative was caused or aggravated by his service-connected Bell’s palsy of the right face. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. In addition, service connection may be granted for any disease 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). Service connection may be established for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. The Board notes that the Veteran’s military occupational specialty (MOS) was Jet Engine Mechanic. The Veteran’s service treatment records do not indicate complaint, treatment, or diagnosis of a right-hand carpal tunnel syndrome. The Veteran’s post-service private treatment records indicate that in March 1987 the Veteran complained of numbness in the right arm and in particular relation to the usage of his right hand. The Veteran’s treating physician found no hard neurological abnormalities. In November 1987, the Veteran underwent an EMG examination. The EMG was normal, and the nerve condition studies of the right upper extremity were normal. VA treatment records indicate that the Veteran complained of a sprained right wrist in April 2007. The Veteran reported he strained his wrist while playing golf. The Veteran complained of moderate to severe pain in his hand. In December 2008, VA treatment records notes that the Veteran had tingling in his right arm. Treatment records noted positive response to arm paresthesias. In January 2009, the Veteran complained of tingling and pain in his right arm and hand. The Veteran provided testimony at a September 2016 Board hearing. The Veteran testified that he worked on jet engines in service. The Veteran stated he had right arm issues for 20 years. The Veteran testified he did not have a diagnosis of carpal tunnel syndrome. The Veteran stated that after service he did a lot of chopping, but he did not do the kind of repetitive motions as he did in-service as a jet mechanic. In May 2018, the Veteran’s private physician, Dr. D., stated that he had treated the Veteran since June 1987 for right arm and shoulder weakness and pain. Dr. D. stated the Veteran felt his right extremity was caused initially by his work as a mechanic in-service and it gotten worse through the years. Dr. D. sent the Veteran to neurologists who felt that the condition was secondary to facial synkinesis and myokymia. Dr. D. stated that he felt it was reasonable to conclude that extensive use of hand, shoulder, and arm while working on engines in service was a contributing factor to the continuous pain in the right arm and shoulder. Dr. D. also agreed with the neurologist’s Dr. B.’s conclusion that the Veteran’s right upper extremity was likely related to facial synkinesis and myokymia. In March 2019, the Veteran underwent a VA examination. The examiner diagnosed the Veteran with right upper extremity carpal tunnel syndrome. The examiner opined that the Veteran’s right extremity carpal tunnel syndrome was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that the Veteran’s separation examination did not note any hand pain. The examiner noted that over the years, the Veteran had seen his non-VA provider for carpal tunnel pain and there are no documented notes of having any treatment or referrals to orthopedics for evaluation. The examiner opined that the carpal tunnel syndrome is less likely than not due to or the result of the Veteran’s service-connected condition (Bell’s palsy). The examiner reasoned that the two conditions are not medically related. The claimed disorder is a separate entity entirely from the service-connected condition and unrelated to it. The medical literature does not support a medical relationship and a nexus has not been established. The examiner also stated that medical literature does not support Bell’s palsy aggravating a right hand or wrist condition, therefore it is less likely than not the right-hand condition was aggravated beyond its natural progression by the bell’s palsy. The examiner reasoned that arm and hand pain can be caused by cervical spine pathology, trauma, injury, repetitive strain injury, nerve damage, compression of nerve root of cervical spine. The examiner noted that the Veteran used his hands extensively working with jet engine repairs which most likely any of the above would be the cause of his hand/ arm disability rather than the Bell’s palsy. In August 2019, the Veteran stated that he spent half his time working on jet engines. The Veteran explained that he worked with his hands constantly tightening, torqueing, and wiring nuts and bolts continuously. The Veteran concluded he believed extensive use of hands in serve led to the pain to his right hand and arm. Upon review of the evidence, the Board finds that the Veteran has right upper extremity carpal tunnel syndrome because the March 2019 VA examiner diagnosed the Veteran with right extremity carpal tunnel syndrome. Providing the Veteran the benefit of the doubt, the Board finds the Veteran’s work as a jet engine mechanic as likely as not caused his carpal tunnel syndrome. Notably, Dr. D. found that it was reasonable to conclude that extensive use of hand, shoulder, and arm while working on engines in service was a contributing factor to the continuous pain in the right arm and shoulder. Although the March 2019 VA examiner ultimately provided a negative opinion, she stated that the Veteran’s work using his hands extensively in repairing jet engine was included among the most likely causes of the Veteran’s hand/arm disability. Accordingly, the Board finds that the evidence for and against the claim is at least in equipoise. Therefore, reasonable doubt must be resolved in favor of the Veteran and entitlement to service connection right upper extremity carpal tunnel syndrome is warranted. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). (Continued on the next page)   The Board notes that the Veteran argued that right arm disability is secondary to the service-connected Bell’s palsy of the right face. However, as the Veteran’s appeal has been granted in full based upon direct service connection any secondary service connection claim is moot. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Batten, Robert The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.