Citation Nr: 21004441 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 15-46 008 DATE: January 27, 2021 ORDER Service connection for arthritis/degenerative joint disease (DJD) of the left fingers is denied. FINDINGS OF FACT 1. The Veteran had active duty service from July 1963 to June 1967. 2. The Veteran sustained a left-hand fracture in service; he is already service-connected for pain and limitation of motion of the left index, long, and ring fingers as residuals of the hand injury. 3. DJD of the left fingers was not shown in service, was not continuous since service, and was not shown to a compensable degree within one year of service. DJD of the left fingers is not causally or etiologically related to service, and was not caused by or worsened in severity by a service-connected disability. CONCLUSION OF LAW DJD of the left fingers was not incurred in service, is not presumed to have been incurred in service, and is not proximately due to, aggravated by, or the result of a service-connected disability. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran claims he has arthritis in his left-hand fingers caused by either a fracture during service, or the service-connected residuals of that fracture. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Notwithstanding the foregoing provisions regarding presumptive service connection, a veteran is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Turning to the evidence, the first element of service connection – a current disability – is met, as March 2011 VA X-ray showed DJD of the left-hand fingers, the second through fifth distal interphalangeal joints and first metacarpophalangeal joint. This diagnosis has been confirmed by multiple VA examiners and subsequent X-rays. As such, the first element of a current disorder is met. The second element – an in-service incurrence – is also met, as January 1964 service treatment records (STRs) show a fracture to the third metacarpal. Additionally, March 1964 STRs show that the Veteran dropped an oxygen bottle on his left hand. As such, the second element of service connection is met. The third element – a medical nexus – is not met as no competent medical professional has linked DJD of the left fingers to service. Rather, two VA examiners have found it was less likely than not caused by service. Specifically, a December 2019 VA examiner found it less likely than not that the current disability was caused by service because an October 1965 STR stated that the Veteran recovered well from the fracture during service, with no complaints of sequelae of the fractured left third metacarpal. The examiner opined that the fracture had healed without consequences, and that a fracture to the third metatarsal would not cause DJD changes of the distal interphalangeal joints, the location of the current DJD. This evidence weighs against the appeal. Similarly, an August 2020 VA examiner found that there was no mechanism for a non-displaced, mid-shaft fracture of the third metacarpal to cause DJD of the distal small joints of all four fingers and the MCP joint of the thumb. The examiner noted that some of the Veteran’s symptoms, including cold intolerances, were not typically associated with DJD and were more consistent with tenosynovitis. Further the examiner reflected that the Veteran’s pain was the same “Volar Plate” pain described in an August 1981 medical record, which the examiner attributed to work at a post office. The examiner concluded that that same record mentioned a diagnosis of arthritis, but this was not supported by radiographic evidence as X-rays in both 1970 and 2004 were normal. In addition, the examiner referenced medical literature that having more equivalent or more severe arthritic changes in a nondominant hand was not unusual, especially given the repetitive tasks required of the Veteran’s left, nondominant hand in his position. This evidence weighs against the appeal. There is no contradictory medical evidence of record. Based on the above, the medical evidence does not support service connection on a direct basis. As to secondary service-connection, the first and second elements are met as the Veteran has a current diagnosis of DJD of the fingers and is service connection for residuals of the hand injury; however, the medical evidence does not support a nexus between the two. Specifically, a December 2019 VA examiner found that it was less likely than not that the Veteran’s current disorder was proximately due to the service-connected hand injury because the type of injury to the third metatarsal would not cause DJD in the distal interphalangeal joints. The examiner also noted that the Veteran was not diagnosed with DJD for over 40-years after the incident and its residuals. An August 2020 VA examiner elaborated that that the type of alignment of the third metacarpal was normal, and thus would not cause abnormal stresses on the distal interphalangeal joints and the MCP joint of the thumb. The examiner also noted that the type of pain or difficulties during cold weather that the Veteran reported were not associated with arthritis but rather likely due to tenosynovitis and were associated with a different part of the hand. Further, as noted above, the August 2020 VA examiner stated that arthritis worse in the nondominant hand was not abnormal. Given that the medical evidence reflected that the Veteran’s in-service injury, and its residuals, did not cause the left fingers DJD or worsen its symptoms, the medical evidence does not support service connection on a secondary basis. As to service connection based on chronicity/continuity, DJD is a chronic disease as defined in 38 C.F.R. § 3.309, and as such, service connection on a presumptive basis will be considered. However, DJD was not shown in service. While the Veteran sustained a fracture of the hand, he is already service connected for the residuals of the fracture. Further, DJD was not shown in service and the fracture was noted to be well healed. Therefore, the medical evidence does not support presumptive service connection on a “chronic disease or injury shown in service” basis. Next, the medical evidence does not support presumptive service connected based on continuity of symptomatology since service. Specifically, DJD of the second through fifth distal interphalangeal joints and first metacarpophalangeal joint was not shown until a March 2011 X-ray, more than 40 years after discharge. Of note, medical records dated in September 1982 show that the Veteran complained of aching in his left hand beginning in 1969. As noted, he is already service connected for pain and limitation of motion of the left index, long, and finger fingers. There is no indication that the complaints in 1982 were related to DJD. Specifically, an April 2003 VA examiner reported that 1981 X-rays were negative for DJD. At the time of the 2003 examination, the Veteran reported a history of pain in the fingers of his left hand. He indicated that he was a 35 year employee of the Postal Service and worked as mail sorter. He used his left hand to hold the mail while his right hand sorted the mail. X-rays at that time of the 2003 examination reflected that the joint spaces of the fingers were well preserved, there was no erosive arthropathy, and no acute process. The final diagnoses were status/post fracture of the third metacarpal of the left hand with residual pain, painful arthralgia of the second, third, and fourth proximal interphalangeal joints of the left hand with normal X-ray of the joints. This evidence suggests that DJD was not present in the left fingers in 2003. This evidence weighs against continuity of symptomatology related to DJD. Further, DJD did not manifest itself to a degree of 10 percent or more within one year from the date of separation of service. The Veteran separated from service in 1967 but symptoms identified as DJD were not noted until 2011, with DJD specifically not found in 2003. This evidence does not support presumptive service connection on a “manifest within one-year from separation” basis. Therefore, presumptive service connection on any basis is not supported by the medical evidence. The Board has considered the Veteran’s lay statements that DJD of the left fingers was caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorder, or to interpret general medical article about the definition/causes of DJD that he submitted, due to the medical complexity of the matters involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Brendan A. Evans, 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.