Citation Nr: 20013645 Decision Date: 02/21/20 Archive Date: 02/20/20 DOCKET NO. 13-36 381 DATE: February 21, 2020 ORDER Entitlement to service connection for a left upper extremity disability is denied. REMAND Entitlement to service connection for a right upper extremity disability, to include carpal tunnel syndrome, is remanded FINDING OF FACT The Veteran’s left upper extremity disability is not etiologically related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for a left upper extremity disability have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1968 to March 1970 and from November 1990 to April 1991. He appeals a June 2009 rating decision denying entitlement to service connection for a bilateral hand condition and a stomach condition. This matter was previously remanded by the Board in September 2017 for further development. The Board finds there has been substantial compliance with its previous remand directives as to the claimed left upper extremity condition. See Stegall v. West, 11 Vet. App. 268 (1998). During the pendency of the appeal, the Veteran was awarded service connection for his claimed stomach condition (evaluated as hiatal hernia) in a December 2019 rating decision. As this represents a complete grant of benefits regarding that issue, it is no longer before the Board. The Board has expanded the scope of the Veteran’s remaining appeal to that of service connection for bilateral upper extremity disabilities to give the Veteran the broadest possible scope of review. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) Entitlement to VA compensation may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. § 1110. To establish entitlement to VA disability compensation, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of an injury or disease; and, (3) a causal link between the present disability and the injury or disease incurred or aggravated in-service (“nexus” requirement). Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A veteran is competent to testify to that which is actually observed and is within the realm of personal knowledge. Competent lay testimony is confined to the features or symptoms of an injury or illness. See Layno v. Brown, 6 Vat. App. 465 (1994). As to the Veteran’s claimed left upper extremity condition, the Board finds the first Shedden element has been met. The medical history of record notes the Veteran was diagnosed with carpal tunnel syndrome in September 2007. See October 2019 Dr. W.H. disability benefits questionnaire (DBQ). He has received medications to treat the condition. See e.g., December 2019 medical treatment record at 430. Although the record does not specify anatomically the location of the carpal tunnel syndrome, the Board resolves all doubt in favor of the Veteran and finds a current left upper extremity disability exists. The Board finds the second Shedden element has not been met. Service treatment records are silent as to treatment for or complaints of any left upper extremity conditions in service. In fact, in April 1993, the Veteran did not report any history of left upper extremity conditions during an Army National Guard periodic physical. See November 2004 service treatment record at 76. The Veteran has asserted that he was diagnosed with left ulnar nerve neuropathy by a private physician. See April 2009 medical treatment report at 8. However, he has not submitted documentation verifying such a diagnosis or relating such to service. The record does not indicate any treatment for a left upper extremity condition prior to the Veteran’s diagnosis of carpal tunnel syndrome in September 2007, many years after his separation from service. An in-service incurrence or aggravation of an injury or disease is a fundamental requirement for entitlement to VA disability compensation. As none is found here, the service connection claim for a left upper extremity disability must be denied. REASONS FOR REMAND The Board finds further evidentiary development is necessary and remands the issue of entitlement to service connection for a right upper extremity disability to ensure compliance with the Board’s prior remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The previous Board remand ordered a VA examination be given to adequately decide the merits of the Veteran’s claim. The Veteran reports that his rifle sling caused his entire right arm, including his hand, to clamp down in 1968. The Veteran’s DD 214 confirms that he was an infantry rifleman with service in Vietnam. The Veteran argues that he had “sling palsy” in his right arm as a result. The Board notes that although the Veteran is competent to report facts he personally observed, such as numbness, he is not a medical professional and is not competent to render a complex medical diagnosis. Upon examination, no paralysis was found in the Veteran’s right arm or hand. See October 2019 Dr. W.H. DBQ. Dr. W.H. acknowledged the Veteran reported current problems gripping at times but noted that service treatment records show no complaints of the Veteran’s claimed “sling palsy” and show no established diagnosis of such condition affecting his right arm. Dr. W.H. further clarified that “sling palsy” is not a diagnosable condition. However, Dr. W.H. did acknowledge the Veteran’s September 2007 diagnosis of carpal tunnel syndrome yet failed to address whether the condition was attributable to his claimed in service rifle sling injury. Hence, the Board finds Dr. W.H.’s October 2017 DBQ is inadequate for rating purposes and a new VA examination is necessary to address the possible relation between the Veteran’s claimed in-service injury and his carpal tunnel syndrome. The matter is remanded for the following action: 1. Obtain any outstanding VA and/or private treatment records relevant to treatment the Veteran received for his right upper extremity, to include carpal tunnel syndrome, that are not already of record. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified, and the record clearly documented. 2. Thereafter, schedule the Veteran for a VA examination to determine the nature and etiology of his right upper extremity disability, to include carpal tunnel syndrome. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The opinion must include a notation that this record review took place. After the record review and examination of the Veteran, all right upper extremity disabilities present should be identified by the examiner. Then, for each identified right upper extremity disability, the examiner is asked to respond to the following inquiry: Is it as least as likely as not that the Veteran’s right upper extremity disability is the result of an injury or disease incurred during active duty, to include possible injury caused by his rifle sling? In rendering this opinion, the examiner should specifically consider the Veteran’s statements to the effect that his rifle sling would cause his right arm and hand to clamp down during service. The examiner is not to improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. After the above has been completed to the extent possible, readjudicate the claims. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Daniel Ballinger, 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.