Citation Nr: 21001660 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 17-25 437 DATE: January 11, 2021 ORDER Entitlement to service connection for a right arm disability initially claimed as right carpal tunnel syndrome is denied. FINDING OF FACT The probative evidence does not reflect that the Veteran has right hand carpal tunnel syndrome that was manifested in service and/or is otherwise related to his active service. CONCLUSION OF LAW The criteria for right carpal tunnel syndrome are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from June 1983 to March 2011. The issue comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO), which denied the claim. The Veteran testified at a videoconference Board hearing in February 2020, before the undersigned Veterans Law Judge (VLJ). The record was held open for an additional 60 days to allow the Veteran time to supplement the record. A copy of the transcript is of record. In May 2020, the issue was remanded by the Board to afford the Veteran a VA examination. The examinations of September 2020 are adequate for adjudication purposes. Thus, there has been substantial compliance with the remand directive. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for a right arm disability initially claimed as right carpal tunnel syndrome is denied. 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. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303. If there is no showing of a resulting chronic condition during service, then a showing of the continuity of symptomatology after service is required to support a finding of chronicity for certain diseases. 38 C.F.R. §§ 3.303 (a), (b), 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also 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). To establish service connection for the claimed disorder, there must be (1) medical 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) medical, or in certain circumstances, lay evidence of a nexus between the claimed in-service disease or injury and the current disability. 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The requirement of a current disability is “satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim.” McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a “competent” source. The Board must then determine if the evidence is credible or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). The third step of this inquiry requires the Board to weigh the probative value of the evidence considering the entirety of the record. The standard of proof to be applied in decisions on claims for veterans’ benefits is outlined in 38 U.S.C. § 5107 (2012). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. Alemany v. Brown, 9 Vet. App. 518 (1996). The Veteran’s service treatment records (STRs) dated in December 1984 notes that he was evaluated for an injury to the right index finger while at work. Upon X-ray testing, the clinician noted no fracture. He was assessed with a laceration to the right index finger, which was repaired with sterile strips and a splint. Post-service treatment records indicate treatment in April 2016 treatment from HC Family Health System. The attending clinician noted the Veteran’s chronic right forearm carpal tunnel syndrome, with his complaint of pain level 4 to 6 on a scale of 10, shooting pain, and tingling sensation. It was also reported that the Veteran does a lot of typing, and the pain is getting worse because of the typing, and he was previously given a forearm brace to help with the pain. The Veteran has credibly and competently testified at his Board hearing that he started to experience pain in his right arm toward the end of his tenure in the Air Force, around November/December 2010. He also testified that he sought treatment in service for it at the Hingham Clinic, and was then sent to Tipplers Prosthetics Department to get an appliance to hold one muscle in place while strengthening other muscles. The brace did not work, and he continued to have forearm pain, which has now worsened to include “shooting [pains] down to [his] trigger finger, too.” Furthermore, he testified that in his current job, involves a lot of typing, and his disability impairs that ability, for he is forced to stop work, get up, and leave. When it gets really bad, he takes Ibuprofen and rubs the arm with Deep Blue, an organic oil treatment. The Veteran underwent VA peripheral nerves and hand and fingers examinations in September 2020. The examiner acknowledged a review of the entirety of the record, including the Veteran’s Board hearing testimony. She thereafter diagnosed degenerative arthritis of the right hand, based on “X-ray of the hand taken today [finding] mild 1st CMC joint osteoarthritis.” During the peripheral nerves DBQ, the Veteran reported right forearm pain and locking of the right index finger, which caused shooting pain to his forearm. He also reported normal right forearm per a March 2020 MRI finding, absent carpal tunnel syndrome. He reported that he was at the examination for constant, dull right forearm pain, rated 1-2. The examiner noted no peripheral nerve and/or peripheral neuropathy right hand disability. She concluded that there are no findings, signs, and or symptoms to support a diagnosis of right carpal tunnel syndrome. The Board finds that the September 2020 medical opinion provides probative evidence against the claim for service connection for right carpal tunnel syndrome. The examiner found the Veteran to have mild 1st CMC joint osteoarthritis based on a review of the medical records, X-ray findings, and the Veteran’s lay statements and provided an adequate rationale. As a result, the Board affords it high probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (noting that the probative value of a medical opinion comes from its being factually accurate, fully articulated, and having a sound reasoning for the conclusion.). The Veteran is deemed competent and credible in his description of his observable symptoms. However, the Board must determine on a case by case basis whether a particular condition is the type of condition that is within the competence of a layperson to provide an opinion as to etiology. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428 (2011). The Veteran, in this case, is not competent to self-diagnose right hand carpal tunnel syndrome. Diagnosing right hand carpal tunnel syndrome involves an understanding of internal physical processes not observable to a layperson. The record does not show that he has the experience, skills, or medical training needed to self-diagnose this disability. Further, his contentions were investigated by a credible medical examiner who found no nerve conditions but rather arthritis. The VA examiner’s opinion is more probative than the Veteran’s lay assertions. At the September 2020 VA examination for hand and finger conditions, the Veteran reported that he had pain in the area of his first CMC joint that radiated to his forearm and “…is worsened after a day’s work where he types a lot.” This addresses the functional impairment the Veteran credibly discussed during his hearing, where he stated that his pain was worse when he typed a lot. In an October 2020 Decision Review Officer rating decision, the AOJ granted service connection for osteoarthritis of the first CMC joint, based on the VA examiner’s opinion. This compensates him for these symptoms. Accordingly, as the probative and competent medical evidence does not reflect that the Veteran currently has right carpal tunnel syndrome, the first element of a service connection claim is not met. Shedden, 381 F.3d 1163. Thus, service connection for right hand carpal tunnel syndrome is not warranted. The existence of a current disability is the cornerstone of a claim for VA disability compensation. Degmetich v. Brown, 104 F. 3d 1328 (Fed. Cir. 1997); Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). In the absence of evidence of a current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); McClain v. Nicholson, 21 Vet. App. 319 (2007). (Continued on the next page)   Accordingly, the preponderance of the evidence of record is against the claim, and as such, service connection for right hand carpal tunnel syndrome must be denied. In arriving at its conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. Gilbert, 1 Vet. App. 49 (1990); 38 U.S. § 5107 (b) (2012); 38 C.F.R. § 3.102. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Stevens, 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.