Citation Nr: 20009804 Decision Date: 02/06/20 Archive Date: 02/05/20 DOCKET NO. 10-09 455 DATE: February 6, 2020 ORDER Service connection for carpal tunnel syndrome of the right wrist, to include as secondary to the service-connected right index finger is denied. Service connection for arthritis of the right hand, to include as secondary to the service-connected right index finger is denied. FINDINGS OF FACT 1. The Veteran's right wrist carpal tunnel is not related to service. 2. The Veteran's right-hand arthritis is not related to service. CONCLUSIONS OF LAW 1. The criteria for service connection of right wrist carpal tunnel syndrome have not been met. 38 U.S.C. § § 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2018). 2. The criteria for service connection of right-hand arthritis have not been met. 38 U.S.C. § § 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in active duty in the United States Army from November 1979 to November 1982. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 2008 rating decision from the Department of Veterans Affairs (VA) Winston-Salem, NC (RO). This case was previously before the Board in September 2013 and remanded for additional developments. The Board requested an expert from the Veterans Health Administration, a response to which was received in October 2019. The Veteran was given 60 days to respond. As such, the Board will adjudicate the merits of this appeal. Service Connection 1. Carpal tunnel syndrome in right wrist and arthritis in right hand The Veteran seeks service connection for carpal tunnel syndrome in his right wrist and arthritis in the right hand. He reports that his current conditions are a result of his service-connected right index finger. See Notice of disagreement (February 2009). Generally, service connection will be granted if the evidence demonstrates that a current disability resulted from a disease or injury incurred in active military service. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (a). Establishing service connection requires evidence of a current disability, an in-service incurrence, disease or injury and a causal relationship between the current disability and the in-service incurrence, disease or injury. See Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Also, service connection may also be found on a secondary basis where the following criteria is met: (1) a current disability that is not already service-connected; (2) at least one service-connected disability; and, (3) evidence that the non-service-connected current disability is either proximately due to or as the result of a service connected disability; or, aggravated beyond its natural progress by a service connected disability. See 38 C.F.R. § 3.310 (2018); see also El-Amin v. Shinseki, 26 Vet. App. 136 (2013); Allen v. Brown, 7 Vet. App. 439 (1995). 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. See 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. See Alemany v. Brown, 9 Vet. App. 518 (1996). Arthritis is classified as a "chronic disease" under 38 C.F.R. § 3.309 (a). Presumptive service connection for chronic diseases must be considered on three bases: chronicity during service, continuity of symptomatology since service, and manifestations within one year of the appellant's separation from service. See 38 C.F.R. § 3.303 (b); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Here, the record in service is absent for competent evidence relating the Veteran's current condition to his active service. The types of evidence that indicate that a current disability may be associated with military service include, but are not limited to, medical evidence that suggests a nexus, but is too equivocal or lacking in specificity to support a decision on the merits; or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The record does not have credible evidence that the Veteran's current arthritis and carpel tunnel manifested in service or are otherwise associated with his injury in service. The Veteran's private treatment records does not suggest any nexus between the Veteran's current disabilities and his active military service. In addition, there is no evidence of continuity of symptomatology since service. The evidence reflects treatment for degenerative arthritis of the right index finger and carpal tunnel starting in 2008, many years after the Veteran's discharge from service in 1982. See Non-VA medical records (February 2008). While the Veteran is competent to testify as to his observations, the record does not indicate that he has the medical expertise to provide an opinion regarding the etiology of his carpal tunnel syndrome in his right wrist and arthritis in the right hand. See Jandreau v. Nicolson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Jones v. West, 12 Vet. App. 460, 465 (1999). Additionally, the Veteran was provided a VA medical examination and an expert medical opinion where the examiners stated that his current conditions are less likely than not related to service. See VA medical examination (October 2013) and expert medical opinion (October 2019). To the extent the Veteran has been diagnosed with carpal tunnel and arthritis in his right hand, service connection on a presumptive basis is not warranted as the record does not show evidence of recurrent problems during and since service, continuity of symptomatology since service or a diagnosis of carpal tunnel and arthritis within one year of the Veteran's separation from active duty. See 38 C.F.R. §§ 3.307, 3.309. As noted, the service treatment records are silent for complaints of carpal tunnel and arthritis and the record indicates that the Veteran was diagnosed with this condition in 2008, many years after service. Accordingly, the Board concludes that the weight of the evidence is against a finding of service connection on a presumptive basis. In addition, the Board finds that secondary service connection is not warranted. Here, the Veteran satisfies the first two elements of secondary service connection. The Veteran has a current disability, carpal tunnel and arthritis in his right hand, and is service-connected for right index finger. However, there is no medical or other evidence in the Veteran's record to satisfy the third element of secondary service connection. In October 2013, a VA examiner concluded that the Veteran's current carpal tunnel and arthritis in his right hand was less likely than not "due to, the result of, or aggravated beyond natural progression" by his service-connected right index finger. See VA medical examination (October 2013). The examiner stated that the plethora of medical evidence does not suggest osteoarthritis of a single finger contributes to carpal tunnel. Id. Additionally, in October 2019 a VHA hand specialist also concluded that the Veteran current conditions are less likely related to service. The VHA specialist stated that the residual issues of the right index finger injury was slight motion loss and no neurologic deficits. Moreover, the VHA specialist discussed that the medical article referred by the Veteran does not apply in this case. The reasoning was that the article applies to dislocation of hands since a hand dislocation can cause damage to the median nerve and cause carpel tunnel. However, in this case the Veteran suffered an injured finger and not a dislocation of the hand. See Expert medical opinion (October 2019). The Board acknowledges that the Veteran is considered competent to report symptoms that he can personally observe, such as pain and weakness. See Layno v. Brown, 6 Vet. App. 465 (1994). However, while service connection may be established by competent and credible lay evidence provided by the Veteran, the Board finds that the question regarding the potential relationship between the Veteran's carpal tunnel and arthritis in his right hand and his service-connected disability to be complex in nature. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the Veteran is not competent to provide evidence as to more complex medical questions. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). The Veteran does not possess the medical knowledge to attribute his arthritis and carpal tunnel to his service-connected disability. Therefore, the Veteran's contention that his carpal tunnel and arthritis in his right hand is related to his service-connected right index finger is not competent and consequently less probative than the medical evidence of record. (Continued on the next page)   As the most probative evidence of record shows that the Veteran's carpal tunnel and arthritis in his right hand is not related to service or a service-connected disability, the preponderance of the evidence is against the claim, and service connection for a carpal tunnel and arthritis in his right hand is denied. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Alvarado- 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.