Citation Nr: 21002241 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 11-26 864 DATE: January 13, 2021 ORDER Entitlement to service connection for a right wrist disorder is denied. Entitlement to service connection for a left wrist disorder is denied. Entitlement to service connection for a right hand disorder is denied. Entitlement to service connection for a left hand disorder is denied. FINDINGS OF FACT 1. The Veteran’s right wrist disorder was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; the disability is not otherwise etiologically related to an in-service injury or disease; and it is not secondary to service-connected benign hand tremors. 2. The Veteran’s left wrist disorder was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; the disability is not otherwise etiologically related to an in-service injury or disease; and it is not secondary to service-connected benign hand tremors. 3. The Veteran’s right hand disorder was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 4. The Veteran’s left hand disorder was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a right wrist disorder are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 2. The criteria for service connection for a left wrist disorder are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 3. The criteria for service connection for a right hand disorder are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for a left hand disorder are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from May 1976 to October 1990. She testified before the undersigned Veterans Law Judge during a July 2013 hearing. This matter is on appeal from an October 2010 rating decision and was previously remanded by the Board of Veterans’ Appeals (Board) in October 2014, February 2018, and September 2020. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases 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. §§ 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). 1. Entitlement to service connection for a right wrist disorder 2. Entitlement to service connection for a left wrist disorder The Veteran contends that she has a bilateral wrist disorder due to her military service or that is secondary to her service-connected benign essential tremors. July 2013 Hearing Transcript. The Veteran has a current diagnosis of bilateral osteoarthritis as evidenced by a May 2016 VA examination. Arthritis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. VA treatment records show the Veteran was not diagnosed with arthritis in her left wrist until September 2009 and in her right wrist until February 2010, decades after her separation from service, and decades outside of the applicable presumptive period. While the Veteran is competent to report having experienced symptoms of bilateral wrist pain since service, she is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of arthritis, as the Veteran has not demonstrated the necessary medical expertise. The issue is medically complex, as it requires interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Indeed, arthritis is a disability established by X-ray findings. 38 C.F.R. § 4.71a, Diagnostic Code 5003. Service connection for arthritis may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s bilateral wrist arthritis and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. The October 2020 VA examiner opined that the Veteran’s bilateral wrist arthritis is not at least as likely as not related to an in-service injury, event, or disease. The rationale was the Veteran was seen in service for bilateral hand tremor with reported bilateral wrist pain and was diagnosed with bilateral hand tremor. A separation examination done in March 1992 notes the Veteran reported no for any bone or joint complaints, and had a normal exam. The diagnosis of arthritis was significantly post service and did not have onset in service or within one year of discharge from duty. The Veteran's arthritis is more consistent with age-related changes. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. However, the preponderance of the evidence is against finding that the Veteran’s bilateral wrist arthritis is proximately due to or the result of, or aggravated beyond its natural progression by service-connected benign essential tremors. Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The May 2016 VA examiner opined that arthritis of the wrists is not aggravated by, caused by, or a result of the Veteran’s service-connected benign essential tremors as there is no anatomic or physiologic nexus with which to connect the conditions. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. The Veteran believes her bilateral wrist arthritis is related to service and/or is proximately due to or the result of/aggravated beyond its natural progression by service-connected benign essential tremors. However, she lacks the training and credentials to render a competent opinion on such a medical matter. Jandreau, 492 F.3d at 1377 n.4; see also Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Consequently, the Board gives more probative weight to the VA examiners’ opinions in denying these claims. 3. Entitlement to service connection for a right hand disorder 4. Entitlement to service connection for a left hand disorder The Veteran contends that she has a bilateral hand disorder due to her military service. July 2013 Hearing Transcript. The Veteran has a current diagnosis of bilateral arthrosis as evidenced by a May 2016 VA examination. Arthrosis is a form of arthritis, an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. VA treatment records show the Veteran was not diagnosed with arthritis in her left hand until September 2009 and arthrosis in her right hand until May 2016, decades after her separation from service, and decades outside of the applicable presumptive period. While the Veteran is competent to report having experienced symptoms of bilateral hand pain since service, she is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of arthritis, as the Veteran has not demonstrated the necessary medical expertise. The issue is medically complex, as it requires interpretation of complicated diagnostic medical testing. Jandreau, 492 F.3d at 1377 n.4. Indeed, arthritis is a disability established by X-ray findings. 38 C.F.R. § 4.71a, Diagnostic Code 5003. Service connection for arthritis may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s bilateral hand arthrosis and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303. The October 2020 VA examiner opined that the Veteran’s bilateral hand arthritis is not at least as likely as not related to an in-service injury, event, or disease. The rationale was that the Veteran was seen in service for bilateral hand tremor with reported bilateral wrist pain and was diagnosed with bilateral hand tremor. A separation examination done in March 1992 notes that the Veteran reported no for any bone or joint complaints, and had a normal exam. The diagnosis of arthritis was significantly post-service and did not have onset in service or within one year of discharge from duty. The Veteran’s arthritis is more consistent with age-related changes. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. The Veteran believes her bilateral hand arthritis is related to service. However, she lacks the training and credentials to render a competent opinion on such a medical matter. Jandreau, 492 F.3d at 1377 n.4; see also Kahana, 24 Vet. App. at 435. Consequently, the Board gives more probative weight to the VA examiner’s opinion in denying these claims. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Barstow, 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.