Citation Nr: 21004532 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 17-50 665 DATE: January 27, 2021 ORDER Entitlement to service connection for a bilateral hand disability, to include trigger fingers and carpal tunnel syndrome, is denied. FINDING OF FACT The Veteran’s trigger finger and carpal tunnel syndrome did not have their onset during service, were not aggravated by service, and are not otherwise related to active duty. CONCLUSION OF LAW The criteria for service connection for a bilateral hand disability, to include trigger fingers and carpal tunnel syndrome, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. Continued on next page REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from September 1973 to September 1976, May 1979 to July 1992, and February 2003 to November 2003. This matter comes before the Board of Veterans Appeals (Board) on appeal from an April 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This issue was previously remanded in July 2018 for further development. Specifically, the Board instructed VA to obtain two medical records that were referenced in a November 2015 VA examination, but which had not been associated with the claims file for the Board’s review. These records have now been added to the Veteran’s file, in compliance with the Board’s remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The July 2018 Board remand also remanded the issue of entitlement to service connection for a low back disability. In February 2020, the RO granted service connection for degenerative disease of the spine, sacroiliitis, lumbosacral IVDS/Radiculopathy, and laminectomy also claimed as lumbar strain. As that decision represents a total grant of the benefit sought on appeal with respect to that issue, the issue is no longer on appeal and is not before the Board at this time. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Entitlement to service connection for a bilateral hand disability, to include trigger finger and carpal tunnel syndrome Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Regulations provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). To establish entitlement to service connection for a disability, a Veteran typically 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, the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). As an initial matter, the Board acknowledges that the Veteran has been diagnosed with bilateral carpal tunnel syndrome and bilateral trigger fingers. Therefore, the current disability requirement has been satisfied. The next question is whether the Veteran suffered an in-service incurrence or aggravation of a disease or injury of the hands. The Board finds that he did not. The Veteran’s service treatment records are silent for any complaints of carpal tunnel syndrome, trigger fingers, or other hand conditions. The earliest evidence of a hand condition in the record is a medical record from May 2002, nearly ten years after the Veteran’s previous period of active service, when he was diagnosed with “mild” carpal tunnel syndrome and prescribed a resting splint. The Veteran did not complain of a hand condition at any point during his final period of active service. The record does not indicate another complaint related to a hand condition until June 2004, when the Veteran complained of numbness in his hands. The Veteran was diagnosed with trigger finger of the third digit in his left hand in April 2005. The Veteran was afforded a record-only VA examination by a physician in November 2015. (An in-person examination was conducted by a VA physician in October 2015, but that examination only evaluated the severity of the Veteran’s trigger fingers without offering an opinion as to its cause or progression.) After reviewing the record, the November 2015 VA examiner found that it was less likely than not that the Veteran’s carpal tunnel syndrome and trigger fingers were related to his military service. The examiner based this opinion on the lack of evidence of an in-service event, the long gap between the Veteran’s 1992 separation and the first evidence of carpal tunnel syndrome, and the lack of “complaints, evaluations or surgical interventions related to carpal tunnel syndrome during the Veteran’s last period of active service” that would suggest aggravation during that period. The Board finds that the November 2015 VA opinion to be highly probative, as it is based on an explicit review of the Veteran’s claims file and medical history, and is supported by adequate reasoning and medical basis. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The record also does not contain any medical opinions in favor of service connection, to include any medical evidence provided by the Veteran that speak to any potential etiological nexus of the claimed hand condition. To this end, while service records do not always document every in-service occurrence that may entitle a Veteran to service connection, the Veteran has provided no lay testimony or other evidence of any in-service injury, illness, or event that might have caused or aggravated his current hand disabilities. The Veteran has not alleged that his hand disabilities manifested during service, or that he experienced a worsening of symptoms during his final period of service. See 38 USCS § 1153. The Board notes that the Veteran did provide lay testimony in his Notice of Disagreement and Form 9 regarding his low back disability (for which service connection was later granted,) but did not take the opportunity to offer testimony in support of his simultaneous claim for a bilateral hand disability. Therefore, the Board finds that the preponderance of the evidence is against a finding of entitlement to service connection for a bilateral hand disability. Therefore, the benefit of the doubt doctrine does not apply, see Gilbert v. Derwinski, 1 Vet. App. 49 (1990), and the claim is denied. Zi-Heng Zhu Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Shermila Sundquist 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.