Citation Nr: 20046529 Decision Date: 07/13/20 Archive Date: 07/13/20 DOCKET NO. 15-21 730 DATE: July 13, 2020 ORDER Entitlement to service connection for bilateral hand condition, to include carpal tunnel syndrome, is denied. FINDING OF FACT The Veteran’s bilateral hand condition is not caused by, due to, or otherwise causally related to his active duty military service. CONCLUSION OF LAW The criteria for service connection for a bilateral hand condition have not been met. 38 U.S.C. § 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Army (Army) from May 1968 to February 1970. This appeal comes to the Board of Veterans’ Appeals (Board) from a Department of Veterans Affairs (VA) June 2012 rating decision of the Agency of Original Jurisdiction (AOJ). However, the Board notes that the Veteran’s claim was initially denied in an unappealed May 2007 rating decision. That appeal did not become final because in April 2012 additional service department records were received. 38 C.F.R. § 3.156(c). In October 2018 the Veteran appeared before the undersigned Veterans Law Judge at a Board hearing. A transcript of that hearing has been reviewed by the Board, and has been associated with the claims file. In May 2019 the Board remanded the Veteran’s claim for additional development. Specifically, the Board requested that the AOJ obtain opinions from medical professionals regarding the etiology of his condition. A Board remand confers upon the appellant the right to a certain degree of compliance with that order. Stegall v. West, 11 Vet. App. 268, 271 (1998). Substantial compliance, rather than strict compliance, is required. D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). After a review, the Board finds that the AOJ conducted additional development pursuant to the May 2019 Board remand’s directives, and that there has been substantial compliance with the remand. 1. Entitlement to service connection for bilateral hand condition, to include carpal tunnel syndrome The Veteran claims his bilateral hand condition, claimed as carpal tunnel syndrome and peripheral neuropathy, is due to his military service. Service connection generally requires (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) competent evidence of a causal relationship, or nexus, between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain chronic diseases, including organic diseases or the nervous system and arthritis, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition, (e.g., a broken leg, separated shoulder, pes planus (flat feet), varicose veins, tinnitus (ringing in the ears), etc.), (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). After careful consideration of all evidence available in a given case, any reasonable doubt, meaning a point where there is an approximate balance of positive and negative evidence regarding any issue material to the determination, VA will resolve that doubt in the Veteran’s favor. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran currently has diagnoses of trigger finger, degenerative arthritis, and carpal tunnel syndrome in both hands. Additionally, the Veteran’s left hand is affected by tenosynovitis and Dupuytren’s contracture. This fulfills the first Shedden element necessary to establish service connection. The Veteran claims that his duties while in the Army included the loading and firing of artillery, which involved the loading of heavy ammunition. Furthermore, his other duties included carrying and lifting heavy objects. The Board notes that the Veteran’s military occupational specialty (MOS) is that of kitchen staff, and that it is more likely than not that the Veteran would have had to carry and lift heavy objects carrying out those duties. Furthermore, an August 1969 Award of the Army Commendation Medal for Heroism shows that the Veteran was assigned to a “105-millimeter howitzer battery.” Combined with the Veteran’s statements regarding his military duties, the Board finds the Veteran’s testimony regarding his job duties to be credible. Therefore, the second Shedden element necessary to establish service connection has been fulfilled. What is left for the Board to determine is whether there is a link, or nexus, between the Veteran’s currently diagnosed disabilities and his military service. The Veteran’s service treatment records (STRs) are absent any complaints of hand or wrist injuries or pain. At his February 1970 separation medical examination, the Veteran denied any issues with his hands or wrists, and described his health at the time as “good.” At his October 2018 Board hearing, the Veteran testified that he was “suffering from pain and numbness of both hands” after he separated from the military in February 1970. He claims that his “in-service duties directly contributed to and caused [his] left and right-hand disabilities.” The Board notes that the Veteran’s duties in the Army, during which time he was deployed to the Republic of Vietnam (RVN), involved loading artillery shells into cannons, as well as routinely having to carry heavy loads. Additionally, there were instances where the Veteran was involved in combat and had to fire his M15 for hours on end. The Board notes that the Veteran is competent to provide testimony as to the onset of his symptoms, but the determination of the etiology of his bilateral hand condition is a complex medical determination that can only be made by a trained clinician. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran’s medical record shows that he first sought treatment for his hand conditions in November 2006. In his Veteran’s Application for Compensation or Pension, filed in November 2006, the Veteran stated that his hand pain started in 2004. At his October 2018 Board hearing the Veteran testified that he did not injure his hand while in service, though he “always had like a pain and a burning sensation” since service. The Veteran did not report his condition on his separation examination because he “just wanted to go home.” The Veteran’s post-service occupation was as a “mechanic helper.” According to the Veteran, his job duties involved “help[ing] the mechanics with machines and whenever they needed help.” This job involved constant use of his hands, as well as “continuous[sic] lifting heavy stuff.” Since his discharge from the military, the Veteran had had three operations on his hands. A March 2007 letter from Dr. S., a private orthopedic surgeon who operated on the Veteran’s hands, stated that the Veteran has “repetitive use syndrome from severe hard work that he has done for many years.” It is unclear whether Dr. S. was referring to the Veteran’s military service or his post-service occupation. However, the use of the phrase “for many years” leads the Board to believe Dr. S. is referring to the Veteran’s post-service occupation, as that was a job he held for several decades rather than his relatively short military service. Continuing, Dr. S. noted that “there is some clinical evidence of carpal tunnel syndrome based on the [Veteran’s job] history.” In July 2012 the Veteran submitted another note from Dr. S. stating that the Veteran’s left-hand tendonitis is “from chronic repetitive use.” Like his previous statement, Dr. S. does not clarify whether the repetitive use occurred during the Veteran’s military service or his post-service occupation. In October 2018, Dr. S. wrote a letter on behalf of the Veteran. He noted that the Veteran had bilateral hand carpal tunnel surgery for severe neuropathy in 2007, which he developed “during his injury from military duties.” Dr. S. explained that the symptoms the Veteran had on active duty likely contributed to his neuropathy. He noted that the Veteran could have developed “this” from normal activities, but it is quite likely that military activities precipitated the problem, with no further explanation. The Board notes, however, that Dr. S.’s opinion does not address all the Veteran’s symptoms and diagnoses, his mention of injuries directly contradicts the Veteran’s testimony and a March 2007 record indicating the Veteran had no direct injury to his hands, and the examiner does not provide a complete rationale with references to the actual record. In May 2015 the Veteran was seen for a VA examination to determine the etiology of his bilateral hand conditions. The examiner noted that the Veteran had peripheral neuropathy in both of his hands, but that it was “not early onset.” The examiner opined that the Veteran’s bilateral hand conditions were not related to his military service as his STRs “did not show evidence” of any hand disability, and the Veteran’s medical record does not show any complaints or treatment of hand conditions “within one year” of the Veteran separating from service. In December 2019, pursuant to the May 2019 Board remand, the Veteran was seen for a second VA examination. At the examination the Veteran reported that following his military service he worked as an agricultural laborer as well as a “mechanics worker” for 38 years prior to retiring. According to the examiner, the Veteran developed bilateral carpal tunnel symptoms in 2006 “following 30 years of work” after separating from the Army. The examiner found that “there is no medical evidence available to suggest or conclude that the Veteran manifested, developed, or incurred either right, left, or bilateral hand pathology in service or in the period immediately post-service.” Continuing, the examiner opined that “the available medical evidence suggests that the symptoms of progressive bilateral hand ailments began decades following service … due to work as a maintenance helper” for over 35 years, and that it is “not associated with loading of bombs, lifting heavy objects or duties associated with service” between May 1968 and February 1970. In conclusion, the examiner stated that in his “medical opinion, without resorting to speculation, and not limited to any deficiencies or limitations or[sic] knowledge, that there is no medical evidence available to suggest or conclude that the Veteran manifested, developed, or incurred either right, left, or bilateral hand pathology in service or in the period immediately post-service.” The examiner addressed the effects of the Veteran’s post-service employment by noting that “had the Veteran … been experiencing the symptoms he presented with in 2006 or 2007 in service, or in the period of time immediately post-service, it would have been impossible for the Veteran to remain working as an employed maintenance worker for the years documented.” While the Veteran is certainly competent to report that he was having symptoms with his hands in service and/or in close proximity thereto, the Board finds that the most probative evidence of record does not show a chronic hand condition in service; or, one such disease manifested to a compensable degree within a presumptive period following separation from service; or, symptoms of such a disease noted in service (or within an applicable presumptive period) and with continuity of symptomatology since service that is attributed by both competent and credible evidence to the chronic disease. Although Dr. S. made competent general statements regarding the etiology of the Veteran’s bilateral hand disability, the Board finds that the accurate, comprehensive and detailed rationale provided by the December 2019 VA examiner carries more probative weight. The December 2019 VA examiner addressed the Veteran’s contentions that the Veteran was experiencing symptoms during and shortly after his military service, as well as specifically addressing how it is more likely than not that the Veteran’s post-service employment led to his current conditions rather than his service based on a review of the entire record. With the preponderance of the evidence being against the Veteran, the Board finds that the Veteran’s claim for entitlement to service connection for a bilateral hand disability, to include carpal tunnel syndrome, is denied. As the preponderance of the evidence is against the Veteran’s claims, the benefit of the doubt doctrine does not apply. Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Neville, 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.