Citation Nr: 20011956 Decision Date: 02/12/20 Archive Date: 02/12/20 DOCKET NO. 16-51 663 DATE: February 12, 2020 ORDER 1. Entitlement to service connection for a left wrist disability, to include carpal tunnel syndrome and carpal arthritis, is denied. 2. Entitlement to service connection for a right wrist disability, to include carpal tunnel syndrome, carpal arthritis, and ulnar nerve entrapment, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that a left wrist disability began during active service, that arthritis or an organic disease of the nervous system manifested within one year following service, or that a left wrist disability is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence is against finding that a right wrist disability began during active service, that arthritis or an organic disease of the nervous system manifested within one year following service, or that a right wrist disability is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a left wrist disability, to include carpal tunnel syndrome and carpal arthritis, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309. 2. The criteria for service connection for a right wrist disability, carpal tunnel syndrome, carpal arthritis, and ulnar nerve entrapment, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Air Force from May 1982 to July 1987 and from July 1987 to June 1988. The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge in September 2019. A transcript of the hearing was prepared and associated with the Veteran’s claims file. The Veteran had requested to leave the record open for 90 days to allow him to submit additional evidence, which request was granted. Additional evidence has been added to the file; however, it does not relate to the Veteran’s claim for service connection for a bilateral wrist disability. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). 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. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In addition, service connection may also be established under 38 C.F.R. § 3.303(b) if a chronic disease, such as arthritis and an organic disease of the nervous system, is shown in service, and subsequent manifestations of the same chronic disease at any later date, however remote, are shown, unless clearly attributable to intercurrent causes. Service connection may also be established based upon a legal presumption by showing that a disorder manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from service. 38 U.S.C. § 1101; 38 C.F.R. §§ 3.307, 3.309(a). The Board has thoroughly reviewed all the evidence in the Veteran’s claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, each piece of evidence of record. The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, regarding the Veteran’s claim on appeal. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. 1. -2. Entitlement to service connection for left and right wrist disabilities The Veteran believes that his left and right wrist disabilities had their onset in service based on unloading large mailbags while in service. The Veteran described that during the holidays the mail volume was heavy, and he was seen at the base clinic for pain in both wrists and hands associated with lifting the mail bags. During the Board hearing, the Veteran said that he had aching and stiffness in his fingers and hands. The Veteran’s representative stated that the Veteran’s bilateral wrist disability is the result of repetitive stress injuries due to his military occupational specialty as an administrative clerk. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for left and right wrist disabilities. The reasons follow. As to evidence of a current disability, a July 2015 VA examination report shows that the Veteran was diagnosed with bilateral carpal tunnel syndrome and bilateral carpal arthritis. The Veteran then underwent a nerve conduction study in July 2016, which was consistent with right ulnar nerve entrapment at the elbow, but no evidence of bilateral carpal tunnel syndrome was noted. However, the tests were incomplete, as the Veteran was intolerable of the needle. The Board finds that these facts establish current disabilities involving the right and left upper extremities, and the Veteran meets the first element of a service-connection claim. As to evidence of a disease or injury in service, the service treatment records do not show that the Veteran sustained a disease or injury to his wrists during service. Although the Veteran indicated during his Board hearing that he was seen multiple times for swelling and aching in his hands and fingers due to his work, the service treatment records do not show treatment for these complaints. During service, the Veteran complained of and was treated after a severe sprain and possible fracture on his right index finger. He was placed on restriction from using his right hand for five days in October 1983. Then in November 1986, the Veteran dislocated his index finger and was placed on temporary restriction to not type and lift over five pounds for three weeks. During the June 1988 separation examination, the Veteran filled out a Report on Medical History. He documented that he was in “fair health,” due to feeling pain in his neck, fingers, and lower back due to a recent car accident. Additionally, the Veteran reported that he had swollen or painful joints, referring to his first and second digit on his right hand. The June 1988 Report of Medical Examination shows that the Veteran’s upper extremities were found to be clinically normal. As there is evidence that the Veteran sustained injuries to his fingers, the Board will concede that the Veteran had an in-service injury. Thus, the Veteran meets the second element of a service-connection claim. As to evidence of a nexus between the current disability and service, the Board finds that the preponderance of the evidence is against such a nexus. For example, the Veteran first sought treatment from VA for his wrist pain in August 2015. During that medical visit, the Veteran reported that he had a constant dull aching pain in both wrists for over 10 years, which is approximately 17 years after service discharge. This is evidence that weighs against a finding that the Veteran’s bilateral wrist disability had its onset in service. The Veteran was afforded a VA examination in July 2015. The examiner concluded that the Veteran’s bilateral carpal tunnel syndrome and right wrist carpal arthritis is unlikely to have been incurred from his time in service, as the Veteran’s current post-service occupation requires repetitive use of his hands. The examiner noted that his manifestation of carpal tunnel syndrome is ongoing and increasing, therefore, there was no specific injury from his time in service that would be correlated with his current condition. The examiner made the same conclusion regrding the Veteran’s arthritis, as there were no signs of post-traumatic arthritis. A clarifying opinion was provided by another VA examiner in October 2015. After reviewing the Veteran’s claims file, the examiner concluded that the Veteran is unlikely to have the arthritis and carpal tunnel as a result of his time in service. The examiner explained that the Veteran’s fingers healed in an acceptable position and there was no literature on increased arthritis risk when fractures heal in acceptable alignment. Furthermore, the examiner noted that there was no literature on dislocation causing arthritis unless it is recurrent and causes loss of cartilage from the articular surface. This is evidence against a nexus between the current bilateral wrist disability and service. Additionally, there is no competent evidence that arthritis or an organic disease of the nervous system manifested within one year following service discharge. Thus, the preponderance of the evidence is against the award of service connection on a presumptive basis for a chronic disease. While the Veteran has alleged that his current bilateral wrist disability is related to service, he is not competent to directly link any current disability to service, as medical expertise is required. In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran’s own opinion is nonprobative evidence. For all the reasons laid out above, the Board finds the preponderance of the evidence is against the claim for service connection for left and right wrist disabilities. Thus, the benefit-of-the-doubt doctrine is not for application, and the claim for service connection for left and right wrist disabilities is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Griffin, 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.