Citation Nr: 21003788 Decision Date: 01/22/21 Archive Date: 01/22/21 DOCKET NO. 18-47 538 DATE: January 22, 2021 ORDER Entitlement to service connection for right carpal tunnel syndrome (CTS), to include as secondary to a service-connected disability, is denied. FINDING OF FACT The Veteran’s right CTS did not have onset in service or within one year of service discharge, nor is it related to any aspect of service, nor is CTS shown to be secondary to a service-connected disability. CONCLUSION OF LAW The criteria for service connection for right CTS have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1989 to March 2010. In October 2020 the Board remanded the appeal for additional development, which has been completed. Beyond the above, it is valuable to note that the Veteran has already been found to be 100 percent disabled by VA and is receiving a 100 percent disability, individual unemployability and special monthly compensation. Entitlement to service connection for right CTS Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service, or if preexisting service, was aggravated therein. 38 C.F.R. § 3.303(a). Service connection may 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 a disability, there must be competent evidence of the following: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the present disability and the disease or injury incurred or aggravated during service. Horn v. Shinseki, 25 Vet. App. 231, 236 (2010); Shedden, 381 F.3d at 1167; Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)). In many cases, medical evidence is required to meet the requirement that the evidence be “competent”. However, when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination “medical in nature” and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Service connection for certain chronic diseases may be presumed to have been incurred in service by showing that the disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Such a chronic disease is presumed under the law to have had its onset in service even though there is no evidence of that disease during the period of service. 38 C.F.R. § 3.307(a). When a chronic disease is shown in service, sufficient to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303 (b). To be “shown in service,” the disease identity must be established and the diagnosis must not be subject to legitimate question. Walker v. Shinseki, 708 F.3d 1331, 1335 (Fed. Cir. 2013); see also 38 C.F.R. § 3.303 (b). There is no “nexus” requirement for compensation for a chronic disease which was shown in service, so long as there is an absence of intercurrent causes to explain post-service manifestations of the chronic disease. Walker, 708 F.3d at 1336. Certain evidentiary presumptions - such as the presumption of service incurrence for certain diseases, which manifest themselves to a degree of disability of 10 percent or more within a specified time after separation from service - are provided by law to assist Veterans in establishing service connection for a disability or disabilities. 38 U.S.C. §§ 101, 1112; 38 C.F.R. § 3.304 (b), 3.306, 3.307, 3.309. Service connection may also be granted on a secondary basis for a condition that is not directly caused by the Veteran’s service. 38 C.F.R. § 3.310. In order to prevail under a theory of secondary service connection, the evidence must demonstrate an etiological relationship between (1) a service-connected disability or disabilities and (2) the condition said to be proximately due to the service-connected disability or disabilities. Buckley v. West, 12 Vet. App. 76, 84 (1998); see also Wallin v. West, 11 Vet. App. 509, 512 (1998). In addition, secondary service connection may also be found in certain instances when a service-connected disability aggravates another condition. See Allen v. Brown, 7 Vet. App. 439 (1995); 38 C.F.R. § 3.310(b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran claims service connection for his right CTS, to include as secondary to the service-connected cervical spine disability with right upper extremity radiculopathy. Service treatment records show that the Veteran was seen for a ganglion cyst on his right wrist over the carpal bones in February 1987. In March 1996, he reported occasional wrist swelling. After service, electrodiagnostic testing in May 2017, revealed right CTS. Here, the Veteran was not shown to have carpal tunnel of the right wrist in service or within one year following discharge from service, as such, service connection cannot be established for arthritis on a presumptive basis. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. The Court has indicated that the normal medical findings at the time of separation from service, as well as the absence of any medical records of a diagnosis or treatment for many, many, years after service is probative evidence against the claim. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board where it found that Veteran failed to account for the lengthy time period after service for which there was no clinical documentation of low back condition); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (A prolonged period without medical complaint can be considered, along with other factors concerning a claimant’s health and medical treatment during and after military service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability.). Accordingly, competent evidence linking the current disability to service is needed to substantiate the claim. On the question of a nexus between the current right CTS and service or a service-connected disability, the evidence weighs against the claim. A VA examiner in December 2017 opined that the Veteran’s right CTS was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner based the opinion on the finding that right hand weakness was due to CTS, which was impingement of the median nerve across the wrist supported by EMG testing performed in May 2017. Thus, it was not due to the neck disability. To fully address this issue, a VA addendum opinion was obtained in October 2020 to address direct service connection and whether the Veteran’s right CTS was aggravated by a service-connected disability. Following a review of the claims file, the examiner opined that it was as not at least as likely as not that the Veteran’s right CTS had onset or was otherwise related to any aspect of the Veteran’s active service. The examiner based the opinion on the finding that there was no documentation of carpal tunnel syndrome during service or until many years after discharge therefrom in 2017, when an EMG revealed right CTS. The examiner noted that the service treatment records documented a ganglion cyst in the right hand, this condition was distinct and separate from CTS and thus unrelated to his currently diagnosed CTS. The examiner further opined that it was less likely than not hat the Veteran’s right CTS was caused or aggravated by a service-connected disability, to include the cervical spine disability, upper extremity radiculopathy and/or right shoulder disability. The examiner explained that CTS was caused by compression of the median nerve at the level of the wrist and therefore it was unrelated and not caused by cervical or shoulder pathologies, nor was it etiologically related to radiculopathy of the upper extremities because that was a separate disease process involving peripheral neuropathy by entrapment. The Board finds the 2020 VA examiner’s opinion to be highly probative. The opinion was based on a thorough review of the claims file, including the service treatment records, and the opinion is internally consistent and consistent with other evidence of record. Moreover, the examiner provided adequate rationale for the opinion. Accordingly, the VA examiner’s opinion is entitled to great probative weight. See Nieves-Rodriguez, 22 Vet. App. at 304. Significantly, there is no competent medical opinion of record linking the right CTS with service or a service-connected disability. The Board has considered the statements from the Veteran. He is certainly competent to report as to the observable symptoms he experiences and their history, but the ultimate questions in this case are related to an internal medical process which extends beyond an immediately observable cause and effect relationship that is of the type that the courts have found to be beyond the competence of lay witnesses. Layno v. Brown, 6 Vet. App. 1994); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (2006); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Board finds that the specific, reasoned opinion of the VA examiner of greater probative weight than the more general lay assertions in this regard. The examiner has training, knowledge, and expertise on which she relied to form the opinions, and the examiner provided adequate rationale for the conclusions reached. As noted, there is no competent medical evidence that supports the claim. While it is clear that the Veteran has problems, the key issue is what has caused those problems. Simply stated, both the best medical evidence in this case, and the facts of this case, provide highly probative evidence against the claim. For the reasons set forth above, the Board finds that the most probative evidence weighs against a finding that the Veteran’s right CTS is related to his military service, or to a service-connected disability. Thus, service connection for right CTS is denied. As such, the benefit of the doubt rule does not apply. See 38 U.S.C. § 5107 (b); Gilbert, supra. John J. Crowley Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Azizi, T. 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.