Citation Nr: 21004194 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 14-40 853 DATE: January 26, 2021 ORDER Entitlement to service connection for carpal tunnel right wrist is denied. REMANDED Entitlement to service connection for internal derangement of left shoulder is remanded. Entitlement to a total disability evaluation based upon individual unemployability (TDIU) prior to October 2, 2019 is remanded. FINDING OF FACT The probative medical evidence of record has not shown that the Veteran’s right wrist carpal tunnel syndrome is the result of any in-service event, injury, or disease. CONCLUSION OF LAW The criteria for entitlement to service connection right wrist carpal tunnel syndrome have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.104. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from May 1999 to November 1999; August 2004 to October 2004; July 2005 to December 2005; and October 2007 to October 2009. This appeal to the Board of Veterans' Appeals (Board) arose from rating decisions from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran was provided with a hearing before the undersigned Veterans Law Judge (VLJ) in September 2017. A copy of the transcript has been associated with the claims file and reviewed accordingly. This claim was previously before the Board in May 2018 and April 2020, at which times it was remanded for additional development. That development having been completed; this claim is once again before the Board. While on remand, the issues of entitlement to service connection for migraine headaches, a right hip disability, and a gastrointestinal disability, which were previously before the Board, were granted in full in an October 2020 rating decision by the RO. As such, these issues have been completely resolved and require no further adjudication by the Board. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303 (a). Service connection may also be warranted for any disease diagnosed after discharge, 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). Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. 38 C.F.R. § 3.303 (a); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). In each case where a Veteran is seeking service connection for any disability, due consideration shall be given to the places, types, and circumstances of such service as shown by the service record, the official history of each organization in which the Veteran served, his or her treatment records, and all pertinent medical and lay evidence. See 38 U.S.C. § 1154 (a). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrent symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). The claimant bears the burden of presenting and supporting his/her claim for benefits. 38 U.S.C. § 5107 (a). See Fagan v. Shinseki, 573 F.3d 1282 (Fed. Cir. 2009). The Board shall consider all information and lay and medical evidence of record. 38 U.S.C. § 5107 (b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board shall give the benefit of the doubt to the claimant. Id; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran contends that he currently suffers from right wrist carpal tunnel syndrome. He attributes it to his military service, to specifically include a right wrist injury in service. A review of the Veteran's service treatment records shows that the Veteran injured his right wrist in May 2009. There were no follow-up records showing any further treatment beyond that date. A review of the Veteran's post-service outpatient treatment records show that the Veteran was provided with electromyography (EMG) in November 2011. The impression was very minimal right carpal tunnel syndrome. The Veteran was provided with an additional EMG in January 2015. The impression was right median neuropathy (carpal tunnel syndrome). There was no discussion of any relationship to an earlier injury to the right wrist in military service. The Veteran was provided with a VA examination in October 2020. At the examination, the Veteran was diagnosed with right wrist carpal tunnel syndrome. The examiner opined that it was less likely than not that the Veteran’s carpal tunnel syndrome was the result of the in-service 2009 injury to his right wrist. It was explained that the in-service injury was merely acute and did not result in any last residuals. Additionally, it was noted that there were no indications in the service treatment records of any neuropathies or sensory complaints of the right wrist that would have been a more likely precursor to the later development of carpal tunnel syndrome. The Board finds that service connection for right wrist carpal syndrome is not warranted. The Veteran does have a current diagnosis, as shown by the 2011 and 2015 EMGs as well as the October 2020 VA examination. Additionally, there is an in-service injury as evidenced by the May 2009 right wrist injury documented in service. As such, the inquiry turns upon a finding of nexus between the two. Here, the most probative medical evidence of record, via the opinion of the October 2020 VA examiner, showed that the Veteran’s initial in-service injury was unrelated to the later development of carpal tunnel syndrome a couple of years after service. This was because the initial injury was acute and resolved without residuals. Additionally, had the Veteran’s carpal tunnel syndrome began in service, he would have shown some sensory complaints, for which the current record is devoid. Accordingly, it is less likely than not that the current right wrist carpal tunnel syndrome is the result of military service. Last, the Board notes that the Veteran is competent to testify as to a condition within his knowledge and personal observation. Barr v. Nicholson, 21 Vet. App. 303, 308-310 (2007). However, it is clear, based on a detailed review of the statements overall, that the Veteran has no actual specialized knowledge of medicine in general and that he is merely speculating as to whether his current right wrist carpal tunnel syndrome is the result of military service. In this regard, he is not competent to diagnose such disability, as it requires specialized medical knowledge and specific testing. See 38 C.F.R. § 3.159 (stating that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). As such, the Veteran's statements to the effect that his current right wrist carpal tunnel syndrome is the result of military service are lacking in probative value. Therefore, the most probative evidence of record reflects that the Veteran lacks a nexus between his military service and his currently diagnosed right wrist carpal tunnel syndrome. For the reasons provided above, the preponderance of evidence is against the Veteran's claim. The evidence in this case is not so evenly balanced so as to allow application of the benefit-of-the-doubt rule as required by law and VA regulation. Gilbert, 1 Vet. App. at 49; 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Left Shoulder In regard to the Veteran’s left shoulder disability claim, previous inquiries were focusing on when the Veteran’s left shoulder disability had its onset, given service treatment records reflecting complaints in 2004. VA examinations in 2010 and 2020 concluded the disability had its onset in 2006, during an interval between periods of active duty. However, no opinion was provided addressing whether the shoulder complaints noted during the 2007 – 2009 period of service should be considered as demonstrating aggravation of the pre-service disability. Further opinion should be sought as set out below. 2. TDIU As to the issue of entitlement to a TDIU, the claims being remanded herein are inextricably intertwined with the Veteran's claim for a TDIU. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). The issues on remand must be addressed by the agency of original jurisdiction before the Board renders a decision on the TDIU, as the outcome will affect whether the Veteran's entitlement is warranted. The matters are REMANDED for the following action: 1. The Veteran should be requested to identify any additional records of treatment he wishes considered in connection with his appeal, which records should be sought. 2. After these records have been retrieved and associated with the claims file, the Veteran’s claims file should be returned to the VA examiner who conducted the October 2020 VA examination of the Veteran’s left shoulder disability. If that examiner is no longer available, the claims filed should be forwarded to an examiner of like skill and qualification. After considering the record, the examiner is asked to render an opinion as to whether the Veteran’s left shoulder disability that was diagnosed with its onset in 2006 increased in severity beyond its natural progression during the 2007 to 2009 period of active duty service. In particular, the examiner should consider the treatment records from the 2007 to 2009 period of active duty service showing treatment for the left shoulder as previously cited in the October 2020 VA examination. A complete rationale for all opinions expressed should be provided. 3. After completing the above action, and any other development as may become indicated, the claim, including entitlement to TDIU benefits, should be re-adjudicated. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Dodd, Ryan 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.