Citation Nr: 20074043 Decision Date: 11/18/20 Archive Date: 11/18/20 DOCKET NO. 14-04 952 DATE: November 18, 2020 ORDER Entitlement to service connection for a right wrist disability is denied. FINDING OF FACT The weight of the competent and credible evidence is against finding that the Veteran’s right wrist pain and arthritis manifested in-service, or within one year of service and is not etiologically caused by an in-service injury, event or disease. CONCLUSION OF LAW The criteria for service connection for a right wrist disability have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from March 1974 to March 1977. In addition, the Veteran served in the Army National Guard. This matter comes before the Board of Veterans’ Appeals (Board) from a June 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). An October 2017 order of the United States Court of Appeals for Veterans Claims (Court) implemented an October 2017 Joint Motion for Partial Remand (JMPR), vacating and remanding in part the June 2015 Board decision that denied entitlement to service connection for a wrist disorder, a respiratory disorder and for tinnitus. In November 2018, the claim for entitlement to service connection for a wrist disability was remanded for additional development. There has been substantial compliance with the prior remand directives, and the matter again is before the Board. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C. §§ 1110, 1131. To establish a right to compensation for a present disability, a 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” - the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 Fed. Cir. (2004). For the showing of chronic disease in service there is required 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.” When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection for a recognized chronic disease can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303 (b), 3.309. Under 38 U.S.C. § 1110 there must be a disability due to an identified personal injury suffered or disease or injury, contracted in-service. Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain and numbness in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir., 2018). Entitlement to service connection for a right wrist disability The Veteran contends that service connection is warranted for a right wrist disability due to an in-service injury. The Veteran contends that his current right wrist pain impacts his occupational functioning and is caused by an injury to his right wrist in 1975 during a training exercise where his right wrist was trapped and got sliced on barb wire. The Veteran reports ongoing pain in his right wrist since service, in part due to his in-service duties as a wheeled vehicle mechanic. The Veteran is competent to describe his current symptoms, in-service events, and the occurrence of ongoing symptoms, and to this extent, these statements are credible. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The question for the Board is whether the Veteran has a current right wrist disability that began during service or is at least as likely as not related to an in-service injury, event or disease. The Veteran has a diagnosis of right wrist pain and arthritis. The Board notes that herein the Veteran’s right wrist pain results in functional impairment as discussed in greater detail below. The Veteran’s personnel records have been associated with the claims file and note the Veteran’s military occupational specialty was a wheeled vehicle mechanic. Also, the Veteran’s service treatment records (STRs) have been associated with the claims file. A March 1976 examination noted that the Veteran was seen for right hand pain that had been ongoing for the last 6 days. Examination noted no dislocation, no infection and no tenderness. The Veteran’s hand was noted to be bruised, he was given an ace wrap and excused from physical training (PT) for 1 day, then directed to return to duty. At separation in January 1977 on the report of medical examination clinical evaluation of the upper extremities and musculoskeletal system was normal. A January 1977 report of medical history at separation noted the Veteran denied any bone, joint or other deformity, or arthritis and denied swollen or painful joints. A report of medical examination in April 1991 in preparation for enlistment in the Army National Guard notes a normal clinical evaluation of the Veteran’s upper extremities and musculoskeletal system. Further, on the report of medical history at entrance for the Army National Guard in April 1991 the Veteran denied swollen or painful joints, arthritis, a bone, joint or other deformity. He specifically denied any impaired use of the hands. Based on the Veteran’s statements the Board finds an in-service injury did occur but no clear diagnosis of a chronic wrist disorder. The Veteran was afforded a VA hand and finger conditions examination in August 2016. The Veteran reported sharp pains in his right wrist and forearm at times, when pushing or carrying things. The Veteran reported ongoing right wrist pain that occurs at least once a day, and generally lasts an hour. Then the Veteran was afforded a VA wrist examination in May 2018. The examiner noted that the Veteran did not have a current diagnosis associated with any wrist condition. The Veteran reported that he had right wrist injuries in-service after jumping out of a helicopter many times during training. He reported pain in his right wrist in the middle and at times that he has sharp pain into his right forearm. The Veteran reported the pain mostly occurs when he is pushing against or flexing his wrist. The Veteran reported left wrist pain which is due to a left elbow fracture and surgery he had while working at Electric Boat (a private shipyard) post-service in 2001. Imaging noted a mild degenerative change. The examiner noted that the Veteran’s mild degenerative changes of the right wrist is consistent with his age and occupational history and is unlikely to be a specific residual of an injury in-service in the 1970s. The examiner attributed the Veteran’s current right wrist degenerative changes to a lifetime of use, wear and tear. The Veteran reports flare ups of his right wrist with flexion. Functional loss was noted with pain. Range of motion testing of the right wrist was normal, with no evidence of pain on weight bearing or localized tenderness or pain on palpation. No evidence of pain on passive range of motion or non-weight bearing testing was noted. Repetitive use testing did not result in any additional loss of function or range of motion. Muscle strength testing of the right wrist was 5/5 with no reduction in muscle strength and no muscle atrophy. No ankylosis was noted. The examiner noted that X-ray imaging noted mild degenerative changes in the radiocarpal joint, and mild degenerative changes in the trapeziometacarpal joint of the base of the thumb. The examiner noted that the Veteran’s right wrist condition does not impact his current employment status. The examiner found that it is less likely than not that the Veteran’s claimed wrist condition was incurred in or caused by the claimed in-service injury, event or illness. The examiner noted that the Veteran does not have a current right wrist condition. The examiner noted normal examination of the right wrist with mild degenerative findings that are not indicative of a specific injury during service in the 1970s. The examiner found that the Veteran’s degenerative changes of the right wrist are consistent with the Veteran’s age and occupational history. As such the examiner found that the Veteran does not have a right wrist condition that is at least as likely as not incurred in or caused by the claimed in-service injury, event or illness. Then, the Veteran was afforded a VA clarifying opinion in March 2019. The examiner noted that the Veteran reported ongoing right wrist pain that resulted in functional impairment. The Veteran reported only ongoing right wrist pain, not symptomatology associated with his left wrist. The Veteran has reported difficulty and pain when pushing against or flexing his wrist. The examiner noted that this is a description of a functional impairment that would require accomodation in the workplace. The examiner found that it is less likely than not that the Veteran’s right wrist pain resulting in functional impairment had its onset in, or is otherwise related to the Veteran’s military service, to include as a result of his duties as a wheeled vehicle mechanic and an injury to his wrist on barbed wire. The examiner noted that there is no evidence in the record of evaluation, diagnosis or treatment for a right wrist condition during or after service. The examiner noted that the Veteran’s duties as a wheeled vehicle mechanic would likely involve use of the right wrist including lifting and wrenching. The examiner noted that it is certainly possible to speculate that the Veteran’s current right wrist pain had its onset in this occupation. However, the examiner noted that one could also speculate that the onset began before service when the Veteran worked as a grinder for a tower building company, or after service during his decades of work building submarines. Based on an extensive review of the claims file the examiner found that there is no evidence that the Veteran’s current onset of his right wrist pain began during or right after his active service. As to presumptive service connection the examiner noted that it is less likely than not that the Veteran’s right wrist arthritis manifested within one year of his March 1977 separation from service. The examiner noted that the earliest documented manifestation of right wrist arthritis dates to the VA examination in May 2018 which noted mild degenerative changes in the radiocarpal joint. Here there was a mild degenerative change in the trapeziometacarpal joint of the base of the thumb on X-ray imaging. The examiner noted that the Veteran’s statements regarding his right wrist pain are credible and have been carefully considered here, however, the examiner found that the complaint of right wrist pain alone does not meet the diagnostic criteria of arthritis, and the Veteran’s right wrist disability did not manifest within the applicable presumptive period. VA and private treatment have been associated with the claims file. Treatment records note reports of right wrist pain at times. These treatment records do not contradict the VA examinations and are absent indications between the Veteran’s current right wrist disability and an in-service disease or injury. After consideration of all the evidence of record, the Board finds that the weight of the evidence is against finding that service connection for a right wrist disability is warranted. The Board concludes that service connection for a right wrist disability on a direct basis is not warranted as the Veteran’s current right wrist disability is not caused by service. The Veteran’s lay statements regarding his current symptoms and ongoing symptomology are credible. While the Veteran reports that his current wrist disability is related to service, the record does not reflect that he has the requisite training or expertise to offer a medical opinion linking a current disability to service and as such the Veteran is not competent to provide a nexus opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board finds that the medical evidence is more probative and credible than the lay opinions of record. The Board finds that the May 2018 VA examination and March 2019 VA opinion taken in consideration together are entitled to significant probative weight. The VA examiner in March 2019 noted that the Veteran has ongoing right wrist pain that results in functional impairment. The Veteran reported only ongoing right wrist pain, not symptomatology associated with his left wrist. The Veteran has reported difficulty and pain when pushing against or flexing his wrist. The examiner noted that this is a description of a functional impairment that would require accomodation in the workplace. The VA examiner in May 2018 noted that the Veteran’s mild degenerative changes of the right wrist is consistent with his age and occupational history and is unlikely to be a specific residual of an injury in-service in the 1970s. The examiner attributed the Veteran’s current right wrist degenerative changes to age and a lifetime of use, wear and tear. The examiner noted that X-ray imaging noted mild degenerative changes in the radiocarpal joint, and mild degenerative changes in the trapeziometacarpal joint of the base of the thumb. The examiner found that it is less likely than not that the Veteran’s claimed wrist condition was incurred in or caused by the claimed in-service injury, event or illness. Th examiner noted normal examination of the right wrist with mild degenerative findings that are not indicative of a specific injury during service in the 1970s. The examiner noted that the Veteran’s degenerative changes of the right wrist are consistent with the Veteran’s age and occupational history. As such the examiner found that the Veteran does not have a right wrist condition that is at least as likely as not incurred in or caused by the claimed in-service injury, event or illness. Further, the VA opinion in March 2019 provided clarification noting that it is less likely than not that the Veteran’s right wrist pain resulting in functional impairment had its onset in, or is otherwise related to the Veteran’s military service, to include as a result of his duties as a wheeled vehicle mechanic and an injury to his wrist on barbed wire. The examiner noted that there is no evidence in the record of evaluation, diagnosis or treatment for a right wrist condition during or after service. The examiner also noted that the Veteran’s duties as a wheeled vehicle mechanic would likely involve use of the right wrist including lifting and wrenching. However, the examiner found that based on an extensive review of the claims file that there is no evidence that the Veteran’s current onset of his right wrist pain began during or right after his active service. As to presumptive service connection the examiner noted that it is less likely than not that the Veteran’s right wrist arthritis manifested within one year of his March 1977 separation from service. The examiner noted that the earliest documented manifestation of right wrist arthritis dates to the VA examination in May 2018 which noted mild degenerative changes in the radiocarpal joint. Here there was a mild degenerative change in the trapeziometacarpal joint of the base of the thumb was seen on X-ray imaging. The examiner noted that the Veteran’s statements regarding his right wrist pain are credible and have been carefully considered here, however, the examiner noted that the complaint of right wrist pain alone does not meet the diagnostic criteria of arthritis. The Board finds that direct service connection is not warranted as the Veteran’s right wrist disorder was not onset in or caused by service. The Board notes STRs note at separation in January 1977 on the report of medical examination clinical evaluation of the upper extremities and musculoskeletal system was normal. The Board has considered the Veteran’s lay statements however the Board gives more probative weight to the competent medical evidence especially the May 2018 and March 2019 VA examination and opinions. As such the Board finds the Veteran’s current right wrist disability is less likely than not caused by active service. As to presumptive service connection, the Veteran’s right wrist arthritis did not manifest until many years post-service. The Board concludes that, while the Veteran has arthritis, which fall within a chronic disease under 38 U.S.C. § 1101 (3)/38 C.F.R. § 3.309(a), however such was not chronic in service nor did these manifest to a compensable degree in service or within the presumptive period, and continuity of symptomatology is not established. Arthritis of the wrist was not noted during service or within one year of separation. See Walker, 708 F.3d 1331. At separation in January 1977on report of medical examination clinical evaluation of the upper extremities and musculoskeletal system was normal. Also, at separation in January 1977 on the report of medical history the Veteran denied a bone joint or other deformity, or arthritis and denied swollen or painful joints. A report of medical examination in April 1991 for enlistment in the Army National Guard notes a normal clinical evaluation of the Veteran’s upper extremities and musculoskeletal system. Further, on the report of medical history at entrance for the National Guard in April 1991 the Veteran denied swollen or painful joints, arthritis, a bone joint or other deformity. Service records do not support an onset of the Veteran’s right wrist arthritis in active service. Based on the probative evidence of record the Board finds that the Veteran’s low back disability did not manifest within the one-year period after service and service connection is not warranted on a presumptive basis. VA treatment records note the Veteran was not noted to have right wrist arthritis until 2018, which is almost 40 years after separation from service. In addition, in weighing the evidence of record the Board finds the competent and credible evidence of record is against finding continuity of symptomatology. As a result, service connection based on continuity of symptomology is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for a right wrist disability. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Kardian, 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.