Citation Nr: 21000388 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 17-00 302 DATE: January 5, 2021 ORDER Entitlement to service connection for bilateral hand disability is denied. FINDING OF FACT The preponderance of the evidence reflects that arthritis did not manifest in service, within the one year presumptive period, or for many years thereafter, and is against a finding that the Veteran's current bilateral hand disability is related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for bilateral hand disability are not met. 38 U.S.C. §§ 1101, 1110, 1112, 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 August 1971 to August 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) that, among other things, denied service connection for carpal tunnel syndrome of the left and right hand. In August 2016 the Veteran filed a Notice of Disagreement (NOD) as to his bilateral carpal tunnel syndrome. In November 2016 the RO issued a statement of the case (SOC) and in January 2017 the Veteran timely filed a substantive appeal (via VA Form 9). In May 2019 the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is associated with the record. In August 2019 the Board remanded the Veteran’s claim for further evidentiary development, specifically, to schedule the Veteran for a VA examination to determine if service connection is warranted. For the reasons stated in the discussion below, the Veteran was afforded an adequate VA examination and the RO substantially complied with the remand instructions. See Stegall v. West, 11 Vet. App. 268 (1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). In July 2020 the RO issued Supplemental Statement of Case (SSOC). Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Bilateral hand disability At a December 2019 VA examination the Veteran was diagnosed with degenerative arthritis of both hands. Thus, a current bilateral hand disability has been demonstrated. The Veteran testified at the May 2019 Board hearing that while working as an aircraft mechanic he was required to do repetitive work with his hands which caused him cramps and lingering pain. The Veteran stated that he did not report his pain while in the military because he had a job to do and just dealt with the pain. The Veteran’s military occupational specialty (MOS) was an airplane mechanic, as noted on his DD 214. Because the Veteran's MOS is associated with physical labor, the stress put on the Veteran's hands is consistent with the places, types, and circumstances of service, and is credible. See 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). Taken together, the Veteran's contention that he has suffered bilateral hand pain in service and his MOS duties provide a sufficient basis to establish the in-service injury element. The remaining question is whether a nexus exists between the Veteran’s current bilateral hand disability and an in-service injury. A December 2019 VA examiner opined that the Veteran’s bilateral hand disability was less likely than not related to an in-service injury or disease. The VA examiner explained that the Veteran’s STRs showed no objective chronic symptoms or chronic diagnosis of bilateral hand disability/pain/injury during military service and the Veteran was not treated for several decades following service. The VA examiner explained that the Veteran did not report any pain until 10 years after being discharged from the military. The VA examiner concluded that the Veteran’s bilateral hand disability was more likely than not due to his career as a heavy equipment operator following his time in service. Along with requiring a VA examination and a medical opinion, the August 2019 remand instructed the physician to accept that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinion. The December 2019 VA examiner considered the Veteran’s statements in her opinion by noting that he did not report pain until 10 years after service and thus complied with the Board’s remand instructions in this regard. The December 2019 VA examiner provided a thorough rationale explaining the reasons for her conclusion that the Veteran's bilateral hand disability is not related to his service based on an accurate characterization of the evidence of record. Thus, his opinion is entitled to substantial probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). As indicated on the August 2016 NOD, the Veteran contends his bilateral hand disability was a result of his duties as an aircraft mechanic. Also, in an October 2020 letter, the Veteran stated that he was exposed to harmful chemicals in service and does not know whether this affected his muscles or nerves. Lay witnesses are competent to opine as to some matters of diagnosis and etiology, and the Board must determine on a case by case basis whether a veteran’s particular disability is the type of disability for which lay evidence is competent. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Kahana v. Shinseki, 24 Vet. App. 428, 433, n. 4 (2011). In this case, to the extent that the Veteran is competent to opine as to whether his work as an aircraft mechanic or exposure to chemicals caused his bilateral hand disability, the specific, reasoned opinion of the December 2019 VA examiner is of greater probative weight than the Veteran’s more general lay assertions, particularly as to the an internal medical processes which extend beyond an immediately observable cause-and-effect relationship. Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010) (recognizing that in some cases lay testimony “falls short” in proving an issue that requires expert medical knowledge; Jandreau, 492 F.3d at 1376, n. 4 (“sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer”). The Board has also considered whether service connection is warranted on a presumptive basis for chronic diseases. At the May 2019 Board hearing, the Veteran testified that he first started to notice the pain in his hands about 10 years following his discharge from service. Therefore, the lay and medical evidence both reflect that bilateral hand arthritis did not manifest in service, within the one year presumptive period, or for many years thereafter. For the foregoing reasons, the preponderance of the evidence is against the claim of service connection for bilateral hand disability on a direct or presumptive basis. The benefit of the doubt doctrine is therefore not for application and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board James R. Miller, 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.