Citation Nr: 20005258 Decision Date: 01/24/20 Archive Date: 01/22/20 DOCKET NO. 16-47 551 DATE: January 24, 2020 ORDER Entitlement to service connection for carpal tunnel syndrome, right wrist (claimed as bilateral carpal tunnel syndrome) is granted. REMANDED Entitlement to service connection for carpal tunnel syndrome, left wrist (claimed as bilateral carpal tunnel syndrome) is remanded. FINDINGS OF FACT 1. The Veteran offered competent testimony regarding experiencing carpal tunnel syndrome during service through the current appeal period. 2. The Veteran was diagnosed with carpal tunnel syndrome of his right wrist within three months of discharge from service. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran's favor, the criteria for service connection for carpal tunnel syndrome, right wrist have been met. 38 U.S.C. §§ 1110, 1112, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served active duty in the U.S. Navy from February 1983 to February 1987. This case comes before the Board of Veteran’s Appeals (Board) on appeal from an April 2014 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge in September 2019. The hearing transcript is associated with the electronic claims file. Entitlement to service connection for carpal tunnel syndrome, right wrist, (claimed as bilateral carpal tunnel syndrome) is granted. Generally, to establish direct service connection, there must be competent evidence showing: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the in-service injury incurred or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303 (b). If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303 (b). In determining whether service connection is warranted, the Board shall consider the benefit-of-the-doubt doctrine. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Alemany v. Brown, 9 Vet. App. 518 (1996); Gilbert v. Derwinski, 1 Vet. App. 49 (1991). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran's disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him or her through the senses. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. The first element of service connection, a current disability of carpal tunnel syndrome of the right wrist is confirmed by the evidence of record. The Veteran testified regarding the numbness in his hands as something that he has learned to live with for a long time by limiting both his typing and use of a mouse, taking anti-inflammatories, and using wrist splints. During flare-ups he is unable to hold his cellphone, brush his teeth, drive long distances or do anything that involves using his hands for any length of time. The Board finds that the Veteran’s testimony regarding his symptomatology is both competent and probative as it establishes the presence of observable symptomatology that is capable of lay observation. With respect to a nexus between an in-service injury and the Veteran’s current disability, the Veteran provided a copy of an invoice addressed to him dated May 1987 from Walker Regional Medical Center which the Veteran identified as an invoice for a nerve conduction study. In addition, the Veteran provided letters from Dr. O dated in July 1987 and January 2014 which highlighted the date of May 1987 linking the diagnosis of right carpal tunnel syndrome to the invoice for the nerve conduction study. See Third Party Correspondence and Non-government Medical Treatment Record. Dr. O testified regarding the Veteran’s right carpal tunnel syndrome and offered his opinion that once a patient is diagnosed with carpal tunnel syndrome, the condition will not resolve without surgery. If treated conservatively, the condition is quiet until there is increased movement of the wrist and fingers at which point the symptoms return in full force. The Veteran, in turn, testified that he elected not to undergo carpal tunnel release surgery after service as he could not afford it, was unaware of his eligibility for VA benefits, and was told there were no guarantees as to the success of surgery. See Hearing Transcript. Although the record lacks formal medical evidence demonstrating the onset of carpal tunnel syndrome during active duty, medical evidence of a diagnosis of carpal tunnel syndrome of the right wrist within one year of separation from service shows continuity of symptomatology such that service connection is warranted on that basis. The Veteran is competent to report that he first experienced finger numbness when he trained as a high-speed Morse code interpreter and that it persisted when he resumed his duties as a basic seaman chipping and scraping away old paint aboard the submarine. The military corpsmen aboard the submarine treated the condition conservatively with anti-inflammatory medication and removal from the painting detail. The Veteran’s lay observations support the subsequent diagnosis of carpal tunnel syndrome of the right wrist made by Dr. O. See Hearing Transcript. The Board finds that the Veteran has a current disability with symptoms that began during tasks performed in service (based on his primary and secondary MOS), that was diagnosed within the presumptive period of one year of service discharge and that has continuity of symptomatology from discharge through the appeal period. Accordingly, the Board will resolve all reasonable doubt in the Veteran’s favor, finding that entitlement to service connection for carpal tunnel syndrome of the right wrist is warranted. REASONS FOR REMAND Entitlement to service connection for carpal tunnel syndrome, left wrist (claimed as bilateral carpal tunnel syndrome) is remanded. Based on a review of the electronic claims folder, the Board finds that additional development is needed prior to adjudication of the claim. The Veteran was diagnosed with carpal tunnel syndrome of the right wrist with nerve conduction studies three months after discharge. The documentation specifically excludes mention of the left wrist. The Veteran’s testimony is that he experienced carpal tunnel syndrome of the right wrist beginning with his Morse Code training and both of Dr. O’s letters after service refer exclusively to carpal tunnel syndrome of the right wrist. The Veteran claims to have experienced left wrist symptoms in service with scraping and chipping paint on the submarine, however, there is no evidence that he complained of left wrist symptoms nor is there a diagnosis of left wrist carpal tunnel syndrome evident in the record in the year after service. In order to establish a current diagnosis and to show continuity of left wrist symptomatology since service, further development is needed to establish that the Veteran has carpal tunnel syndrome of the left wrist during the appeal period, that it developed while in service, whether during the paint removal tasks or otherwise, or that it was diagnosed within a year of separation from service. As such, a remand is warranted in order to obtain a VA examination. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination by an appropriately qualified VA health care professional to determine the nature and etiology of any disability of the Veteran’s left wrist including carpal tunnel syndrome. All necessary testing should be performed. After reviewing all available records, the examiner should opine whether the Veteran has a current diagnosis of carpal tunnel syndrome of the left wrist and whether it is at least as likely as not (i.e. a 50 percent probability or greater) related to an in-service injury, event, or disease. The examiner must consider that the Veteran is competent to report the nature and status of his symptoms of the left wrist during service and subsequent to service. The examination report must include a complete rationale for all opinions provided. If the examiner cannot provide the requested opinion(s) without resorting to speculation, the report should expressly indicate as such and the examiner should explain why an opinion cannot be provided without resorting to speculation. 2. After completing the requested actions, and any additional notification and/or development deemed appropriate, readjudicate the issue on appeal. If the benefit sought on appeal remains denied, furnish to the Veteran and his representative an appropriate supplemental statement of the case (SSOC) that includes clear reasons and bases for all determinations, and afford them the appropriate time period for response before the claims file is returned to the Board for further appellate consideration. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Denise Adams Hill, 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.