Citation Nr: 21000263 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 12-31 455A DATE: January 5, 2021 ORDER Entitlement to service connection for left wrist disability is granted. FINDING OF FACT Resolving reasonable doubt in favor of the Veteran, his left wrist disability is etiologically related to his active service. CONCLUSION OF LAW The criteria for entitlement to service connection for left wrist disability have been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1977 to January 1979. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The veteran testified before the undersigned in October 2018. The appeal was last remanded by the Board in September 2020 for additional development. A review of the claims file shows that there has been substantial compliance with the Board’s prior remand directives and thus, no further action in this regard is warranted. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for left wrist disability The Veteran contends that he injured his left wrist when he fell during bootcamp. The Veteran indicates that his wrist became swollen and that he was sent to the hospital where he was told that he had a hairline fracture and was put in a partial cast. The Veteran reported that his wrist injury was cleared after six weeks and that he was allowed to continue training. The Veteran also reported that his deployment to Germany was delayed as a result of his left wrist injury. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1131; 38 C.F.R. § 3.303. Service connection generally requires evidence satisfying three criteria: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (“nexus”) between the current disability and the disease or injury incurred or aggravated during service. Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013). Certain chronic diseases will be presumed related to service 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, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Arthritis is a chronic disease for VA purposes. See 38 C.F.R. § 3.309 (a). The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence. Therefore, the Veteran prevails in a claim when: (1) the weight of the evidence supports the claim, or (2) when the evidence is in equipoise. It is only when the weight of the evidence is against the claim that the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Factual Background The Veteran’s January 1977 entrance examination noted that his upper extremities were normal and that he had no swollen or painful joints, broken bones, joint deformity, or other deformity. The January 1977 entrance examination further noted, “[h]istory is negative for disease or injury.” The remainder of the Veteran’s service treatment records are missing. When service treatment records are lost, missing, or destroyed, in conjunction with a heightened duty to assist, VA must inform the Veteran and his representative that he can submit “alternative” sources in place of his missing service treatment records. See Washington v. Nicholson, 19 Vet. App. 362, 369-370 (2005); see also Dixon v. Derwinski, 3 Vet. App. 261, 263 (1992). In June 2018, the RO sent the Veteran a letter informing him that VA was unsuccessful in locating his service treatment records and that the Veteran could submit alternative documents to substitute for service treatment records. This same information was previously provided to the Veteran via telephone in September 2014. In October 2017, the RO prepared a memorandum on the unavailability of service treatment records, which detailed the attempts made to obtain the Veteran’s service treatment records. Based on the foregoing, the Board finds that VA has fulfilled its heightened duty to assist with regard to the Veteran’s missing service treatment records. Therefore, the Board must then look to the other evidence of record. In light of the incomplete service treatment records, VA also has a heightened obligation to consider the benefit-of-the doubt rule. No VA treatment records have been affiliated with the claims file, which is consistent with the Veteran’s reports that he used his private insurance to seek medical treatment for his wrist disability. A November 2011 private medical record notes that the Veteran underwent a wrist fusion in 1992. According to the record, the Veteran was treated with “plate and screws, this was a result of a fall and wrist fracture which occurred while in basic training in the US Army, 1977, at that point it was not surgically treated resulting in this surgery and this related disability.” The Veteran submitted a statement from his mother in January 2015 in which she expressed that the Veteran had injured his wrist in service. She reported receiving a call from the Veteran in which he explained that his assignment to Germany was being delayed due to a left wrist fracture. She reported that when he came home to work with his father and uncles in their masonry business, his wrist was not as strong as it used to be. The Veteran also submitted a statement from his father in January 2015 in which his father also expressed that the Veteran injured his wrist in the military. The Veteran’s father explained that post-service the Veteran could not help much with the family masonry business. He also reported that the Veteran later had surgery on his left wrist. The Veteran was afforded a VA examination in December 2019. The December 2019 VA examiner’s report noted diagnoses of carpal instability and mild osteoarthritis involving the first carpometacarpal joint. The December 2019 VA examiner explained that there was not enough evidence to support the Veteran’s claim because of a lack of continuing treatment records following the Veteran’s separation from the military. The December 2019 VA examiner’s report concluded, “In response, the Veteran’s left wrist fracture with fusion and retained hardware, mild osteoarthritis 1st carpometacarpal joint with carpal instability was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness.” The Veteran was afforded another in-person VA examination in September 2020. The September 2020 VA examiner’s report noted that the Veteran had a prior left wrist fusion surgery with residuals. X-rays revealed that the Veteran may have had avascular necrosis of the carpal bones such as Kienböck’s disease which necessitated the wrist fusion. The examiner explained that Kienböck’s disease can be caused by a variety of factors including trauma and that it is a slow-progressing disease with patients often having the disease for months or years before seeking treatment. The examiner explained that absent treatment records addressing the Veteran’s wrist disability an opinion would not be able to meet the standard of probability absent speculation. Accordingly, the examiner concluded that it was less likely than not that the Veteran’s left wrist disability was incurred in or caused by an event, injury, illness, or disease during service. Analysis As previously explained, most of the Veteran’s service treatment records are missing. In light of the incomplete service treatment records, VA has a heightened duty to consider the benefit-of-the doubt rule. Considering the heightened duty, the Board finds that the evidence of record, including the statements by the Veteran and his parents, supports a finding that the Veteran’s reports of an in-service injury to his left wrist are competent and credible. The Board also finds credible the reports of the veteran and his parents of continued left wrist weakness and lessened function since the service injury. In addition, the December 2019 and September 2020 VA examiner’s reports note current disabilities involving residuals from a left wrist fusion surgery. Accordingly, the question for the Board is whether the Veteran’s current left wrist disability was caused by or the result of his in-service injury. The Board acknowledges the negative nexus opinions provided in the December 2019 and September 2020 VA examiner’s reports. However, the Board also notes the September 2020 VA examiner’s explanation that Kienböck’s disease likely necessitated the Veteran’s left wrist fusion in 1992. The September 2020 VA examiner’s report explained that Kienböck’s disease can be caused by multiple factors including trauma caused by a single incident or multiple incidents. The report also explained that Kienböck’s is a slow progressing disease, can be difficult to diagnose in early stages, and that patients may wait months or years before seeking treatment. There is a years long evidentiary gap in this case between the Veteran’s separation from service and the first medical record in November 2011 documenting a left wrist disability, and even to the Veteran’s reports of a 1992 left wrist fusion surgery. Nevertheless, the veteran and his parents have given evidence addressing that time period in the form of credible recollections of left wrist dysfunction. The Board finds that the evidence of a left wrist fracture in service, coupled with the presence of left wrist dysfunction continuously since service and the explanation of the September 2020 examiner that the veteran has current evidence of a left wrist necrosis such as Kienböck’s disease that can be caused by the type of in-service trauma experienced by the Veteran, is sufficient to place the matter in equipoise. Affording the Veteran the benefit of the doubt in this case, the Board finds that it is at least as likely as not that the Veteran’s left wrist disability was caused by his in-service left wrist injury. Accordingly, as a heightened duty to consider the benefit-of-the-doubt rule is for application, the Board finds that a grant of service connection for a left wrist disability is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Palombi, 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.