Citation Nr: 20003558 Decision Date: 01/15/20 Archive Date: 01/15/20 DOCKET NO. 15-36 946 DATE: January 15, 2020 ORDER Entitlement to service connection for left wrist disability is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s left wrist disability began during active service, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for left wrist are not 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 served on active duty from June 1974 to December 1976. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In March 2018, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A copy of the transcript is associated with the evidentiary record. This matter was previously remanded in October 2018 for further development. See October 2018 BVA Decision. Entitlement to service connection for left wrist disability. Legal Criteria 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The existence of a chronic in-service disease may be shown through a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity during service. In order to establish the existence of a chronic disease during service, the evidence must show a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge if all of the evidence establishes that the disease was incurred during service. 38 C.F.R. § 3.303(d). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). Analysis The Veteran contends that he is entitled to service connection for a left wrist disability because he injured his wrist during service and has continued to experience left wrist pain post military service. See January 2015 NOD. Notwithstanding the Veteran’s contentions, the record does not establish entitlement to service connection for a left wrist disability. While the record shows that the Veteran has a current left wrist disability and an in-service injury of left wrist swelling and pain, the evidence as discussed below does not show a nexus between the Veteran’s current disability and his in-service injury. See October 2019 C&P Exam at 3, see also May 2014 STR-medical at 2. In service, no abnormalities were noted during the Veteran’s April 1974 enlistment exam. See May 2014 STR-Medical at 63. In June 1975 the Veteran complained of some left wrist pain and swelling in service. It was noted that the Veteran had probable early onset gonococcal arthritis. See STR-Medical at 2, 18. Approximately one week later, the Veteran’s arthritis was noted as resolved. See STR-Medical at 60. There are no subsequent complaints of or treatment for wrist pain in service. The Veteran’s November 1976 separation examination noted the Veteran’s June 1975 transient polyarthritis. However, upon clinical evaluation, the Veteran’s upper extremities were noted as normal. See May 2014 STR-Medical at 30, 32. Post-service, the record contains no complaints of wrist disability until March 2011, approximately 36 years after service; the Veteran reported pain with resisted wrist extension and long finger test over common extensor tendon. See July 2013 CAPRI at 257. The record contains a gap in treatment with respect to the Veteran’s left wrist until November 2012, when the Veteran was provided with a left wrist brace. See July 2013 CAPRI at 54. Similarly, the record contains no evidence of treatment for the Veteran’s left wrist in 2013. In fact, during an August 2013 VA appointment, the Veteran complained of back and neck pain, but denied pain or numbness in his shoulder or arm. See January 2016 CAPRI at 393. In March 2014, the Veteran presented to VA with complaints of left wrist pain, which he reported began in November. See January 2016 CAPRI at 360. Subsequent treatment records beginning March 2014 and thereafter note regular complaints and treatment for left wrist pain. See July 2014 CAPRI at 31, 45; January 2016 CAPRI at 14, 22, 29, 34, February 2017 CAPRI, June 2017 CAPRI, March 2019 CAPRI, June 2019 CAPRI. During a November 2015 VA appointment, the Veteran reported that he experienced swelling of his left wrist in 1975. The Veteran reported that the swelling was not recurrent but that he experienced pain in the left wrist and forearm. The Veteran also reported that he worked in receiving for many years, and that his job involved repetitive lifting and typing on the computer. See September 2016 CAPRI at 115. Nonetheless, a December 2015 x-ray noted that the Veteran’s wrist was normal. See September 2016 CAPRI at 103, 109. A July 2016 neurological study was normal, with no electrical evidence of carpal tunnel syndrome, ulnar neuropathy or cervical motor radiculopathy. See July 2019 Medical Treatment Record- Non-Government Facility at 2. In February 2018 the Veteran attended an appointment at a VA neurology clinic. An EMG of the Veteran’s left wrist was normal; following an examination the physician noted that the Veteran’s left arm pain, which included left medial elbow and left medial wrist pain was likely due to intermittent left ulnar nerve dysfunction at the elbow. See July 2019. In May 2019 the Veteran was diagnosed with left ulnar neuropathy and carpal tunnel syndrome and underwent left ulnar nerve decompression. See July 2019 Medical Treatment Record- Government Facility at 26. The Veteran was afforded a VA examination in October 2019. The examiner noted a diagnoses of left ulna nephropathy. The examiner opined that the Veteran’s left wrist disability was less likely than not incurred in or caused by an in-service injury as the Veteran’s in-service condition was acute, with no evidence of chronicity of care until 2014 and later. The examiner further noted that March 2019 neurology records indicate that the Veteran’s left wrist condition is likely due to ulna neuropathy. See October 2019 C&P Exam. The Board affords probative weight to this opinion as it is supported by the evidence of record. Ultimately the evidence of record does not substantiate a nexus between the Veteran’s current disability and his military service. Although the Board is mindful of the Veteran's assertions that his wrist problems have been chronic since service, the Board assigns his assertions low probative value. In addressing lay evidence and determining what, if any, probative value may be assigned to it, the Board must consider elements of both competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted"). Layno v. Brown, 6 Vet. App. 465, 469 (1994). Here, the Veteran’s contentions are outweighed by the more probative evidence of record, which shows no reports of left wrist pain post service until 2011, a denial of arm pain in August 2013, the Veteran’s March 2014 assertion alleging that his arm pain began in November 2013, normal x-rays in December 2015 and a normal EMG in February 2018. See July 2019 Medical Treatment Record Government Facility at 2. The Veteran’s contentions are further outweighed by the February 2018 VA neurology note which indicates that the Veteran’s pain is likely related to intermittent ulnar nerve dysfunction at the elbow and the Veteran’s own report that post service he was employed at a job which required repetitive lifting and typing. The Board is also persuaded by the negative etiology opinion and rationale expressed by the October 2019 VA examiner. The preponderance of the most probative evidence shows that the Veteran's in-service left wrist arthritis resolved within one week, with no subsequent complaints during service and no manifestations within one year of discharge from service. Post service, the Veteran did not report complaints of a left wrist disability until almost 36 years after service, and after being employed at a job which required repetitive lifting and typing. Further the record contains no positive etiology opinion. Ultimately, the evidence of record does not show that the Veteran’s current left wrist disability was sustained during the Veteran's active duty service, resulted from an injury or event that occurred during service, or manifested to any degree within a year from his separation from service. Entitlement to service connection for left wrist disability is denied. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Wimbish, Associate Counsel 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.