Citation Nr: 21002617 Decision Date: 01/14/21 Archive Date: 01/14/21 DOCKET NO. 15-27 832 DATE: January 14, 2021 ORDER Service connection for bilateral shin splints is granted. REMANDED Entitlement to service connection for left carpal tunnel syndrome is remanded. FINDING OF FACT The evidence is at least in equipoise that the Veteran’s bilateral shin splints were incurred in service. CONCLUSION OF LAW The criteria for service connection for bilateral shin splints are met. 38 U.S.C. §§ 101(24), 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 2003 to March 2005 and August 2008 to October 2009, with a period of active duty for training from March 2003 to July 2003 and additional service in the National Guard. This matter is on appeal from a July 2015 decision of a Department of Veterans Affairs (VA) Regional Office (RO). In September 2018, the Veteran appeared for a hearing before the undersigned. A transcript of the hearing is of record. The case was previously before the Board in March 2019 when it was remanded for further development. In a July 2020 decision, the agency of original jurisdiction (AOJ) bifurcated the Veteran’s claim for service connection for bilateral carpal tunnel syndrome and granted service connection for right carpal tunnel syndrome. However, in an October 2020 Supplemental Statement of the Case (SSOC), the AOJ denied service connection for left carpal tunnel syndrome. Thus, only the issue of entitlement to service connection for left carpal tunnel syndrome remains in appellate status for the original claim for bilateral carpal tunnel syndrome. Shin Splints The Veteran contends that he is entitled to service connection for bilateral shin splints. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing service connection requires evidence of: (1) a current disability; (2) a disease, injury, or event in service; and (3) a causal link (nexus) between the claimed disability and the disease, injury, or event in service and the present disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). “Active military, naval, or air service” includes active duty; any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty; or any period of inactive duty for training (INACDUTRA) in which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident occurring during such training. 38 U.S.C. § 101(24); 38 C.F.R. § 3.6(a). Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may include statements conveying sound medical principles found in medical treatises. Competent medical evidence may also include statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. For example, lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing observable symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In this case, a January 2020 VA examination reflects that the Veteran has a diagnosis of bilateral shin splints. Thus, the first element of Shedden is satisfied. In an October 2013 Notice of Disagreement (NOD), the Veteran stated that his shin splints developed in basic training and advanced individual training (“AIT”). During the September 2018 hearing, the Veteran stated that he experienced aching in his shins during basic training. He also stated that the condition continued after basic training and that he had a permanent profile for his running. The Board finds the Veteran’s lay testimony to be both competent and credible, and his reports are consistent with the circumstances of his service. Although it is unclear from the statements provided whether the Veteran’s shin splints onset during his initial period of ACDUTRA in 2003 or during a period of active duty, the onset of shin splints would reflect, at the very least, wear and tear injury to the shin; therefore, even if it occurred during his period of ACDUTRA, it would qualify as an injury incurred in the line of duty. Thus, the second element of Shedden is satisfied, as well. In January 2020, the Veteran was provided with a VA examination to evaluate the etiology of his shin splints. The examiner stated that the Veteran’s bilateral shin splints are less likely than not related to an in-service condition, since no records were found with any complaints of shin splints until February 2010. However, he stated that it is likely the shin splints began, as the Veteran stated, in basic training but that the records did not survive. Although this opinion begins by indicating that it was less likely than not that the Veteran’s shin splints were related to service, that conclusion was based on a lack of in-service treatment records. The examiner’s ultimate opinion that it was likely the Veteran’s shin splints began in service was based on consideration of the Veteran’s competent and credible lay statements regarding his shin splints and his circumstances of service. Thus, the Board assigns a high degree of probative value to the VA examiner’s opinion that the Veteran’s shin splints likely began in basic training. Accordingly, the Board finds that the evidence is at least in equipoise that the Veteran’s bilateral shin splints were incurred in service. Thus, having resolved all reasonable doubt in the Veteran’s favor, the Board concludes that service connection for bilateral shin splints is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.   REASONS FOR REMAND Entitlement to service connection for left carpal tunnel syndrome is remanded. The Veteran contends that he is entitled to service connection for left carpal tunnel syndrome. In January 2020, the Veteran was provided with a VA examination in which the examiner opined that the Veteran’s right carpal tunnel syndrome is at least as likely as not related to service; however, he opined that the left carpal tunnel syndrome is less likely than not related to service. He stated that the left wrist is non-dominant and that there were no complaints present during service. During the January 2020 examination, the Veteran reported that numbness and tingling in both hands began in 2004 or 2005, but that symptoms on the left side had begun later than symptoms on the right side. Similarly, during the September 2018 hearing, the Veteran stated that he experiences the same symptoms in both wrists, albeit less severe in the left wrist, with numbness and tingling from the wrist down to the fingertips and that he had been experiencing such symptoms since service. The Veteran is competent to report readily observable symptoms, such as numbness and tingling in his wrists and the Board finds that his statements are credible. See, e.g., Washington v. Nicholson, 21 Vet. App. 191, 195 (2007). As the examiner’s opinion regarding left carpal tunnel syndrome is based on a finding that there were no complaints present during service, and the Veteran’s statements indicate that he did experience symptoms during service, the January 2020 opinion is inadequate as it is based on an inaccurate factual premise. Thus, remand for an addendum opinion is necessary. Additionally, as noted above, a July 2020 rating decision awarded service connection for right carpal tunnel syndrome. This award of service connection raises a new theory of entitlement to service connection as to whether the Veteran’s left carpal tunnel syndrome was caused or aggravated by his right carpal tunnel syndrome. Hence, an opinion addressing that theory of entitlement should also be obtained on remand. The record also reflects the Veteran receives VA treatment; thus, updated VA treatment records should be associated with the claims file.  The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from May 2020 to the present. 2. Return the claims file to the January 2020 VA examiner, or another appropriate clinician if that examiner is not available, for review and an addendum medical opinion for the left carpal tunnel syndrome. An in-person examination (or telehealth interview) is only necessary if deemed so by the examiner. The reviewing clinician should be requested to provide an opinion (based on a review of the record) to answer the following: (a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s left carpal tunnel syndrome was incurred in service or is otherwise related to an in-service injury, disease, or event? In providing an opinion on this question, the examiner is asked to consider the Veteran’s reports of beginning to experience numbness and tingling in the left wrist at a later time than in the right wrist, but still during service as competent and credible. (b) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s left carpal tunnel syndrome is caused or aggravated (i.e., any increase in the severity of the condition beyond its natural progression) by his service-connected right carpal tunnel syndrome? A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. H. White, 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.