Citation Nr: 20007151 Decision Date: 01/29/20 Archive Date: 01/28/20 DOCKET NO. 16-39 974 DATE: January 29, 2020 ORDER Entitlement to service connection for flexor tendinopathy of the left hand/wrist is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, his flexor tendinopathy of the left hand/wrist is at least as likely as not related to his service-connected posttraumatic stress disorder (PTSD). CONCLUSION OF LAW The criteria for service connection for flexor tendinopathy of the left hand/wrist are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from August 1965 to January 1966 and June 1968 to August 1969 with service in the Republic of Vietnam. In December 2019, the Veteran testified at a video conference hearing before the undersigned. A transcript of the hearing is of record. 1. Entitlement to service connection for flexor tendinopathy of the left hand/wrist Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence 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, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (noting that nexus may be demonstrated by a showing of continuity of symptomatology where the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a)). Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra. The Veteran claims that he is entitled to service connection for his left-hand injury on a secondary basis. Upon review of the record, the Board agrees. An August 2016 VA examination diagnosed the Veteran with flexor tendinopathy of the left hand/wrist. VA Muscle Injuries examination, August 2016. As such, the first elements of Shedden/Caluza and Wallin are met. With regard to an in-service event and/or service-connected disability, the Veteran’s service treatment records are negative for any left hand complaints. However, the Veteran does not argue that his current left hand disability is directly related to service. Rather, he argues that it is the result of a suicide attempt secondary to his service-connected PTSD. The record reflects that he is service-connected for PTSD. As such, the second elements of Shedden/Caluza and Wallin are also met. The remaining question is whether the Veteran’s current left-hand disability is due to or aggravated by his service-connected PTSD. As noted above, the Veteran was afforded a VA examination in August 2016 to address the etiology of his left-hand disability. The examiner concluded that she could only identify the residuals from his documented left upper extremity injury and was not qualified to determine whether the motor vehicle accident (MVA) that caused the injury was a suicide attempt resulting from his service-connected PTSD. VA then obtained an opinion from a psychologist in August 2016. VA opinion, August 2016. The VA psychologist was unable to link the Veteran’s left-hand injury to his service-connected PTSD because she found no documentation from the time of the MVA indicating that it was a suicide attempt. This reasoning seems to suggest that if there were contemporaneous evidence indicating that the MVA was a suicide attempt, she would have provided a positive nexus opinion. The Board’s review of the records from the time of the June 1995 MVA indicate that he was traveling at a high speed (100-120mph), was not wearing a seatbelt, and had drank alcohol and smoked marijuana prior to the MVA. L.H. treatment record, June 1995. Additionally, his wife reported to his treating physicians that she believed the MVA was probably a suicide attempt. M.H.M.C. treatment record, June 1995. The Board finds his wife’s statement particularly credible because it was made at the time of the accident to his treating providers. In addition to the contemporaneous records supporting the Veteran’s contention that the June 1995 MVA was a suicide attempt, the Board also notes that his service-connected PTSD was previously found by the Board to be manifested by chronic abuse of prescription medications and illegal drugs and disregard for his own safety. Board decision, January 1997. Even if the Veteran’s MVA was not a suicide attempt, it certainly involved abuse of alcohol and drugs and a disregard for his own safety. The Board notes that this case could be remanded to obtain an opinion that addresses the contemporaneous medical records. However, in light of these records and the Board’s prior findings, the Board finds that the evidence is, at minimum, in equipoise regarding whether the Veteran’s current left-hand disability is related to his service-connected PTSD and remand is not necessary. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310. The benefit of the doubt will be conferred in the Veteran’s favor, and the service-connection claim for left flexor tendinopathy of the left hand/wrist is granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Moore, 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.