Citation Nr: 21062510 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 16-41 488 DATE: October 7, 2021 ORDER Service connection for right carpal tunnel syndrome is denied. Service connection for left carpal tunnel syndrome is denied. FINDINGS OF FACT 1. The weight of the evidence is against a finding that right carpal tunnel syndrome was manifested during the Veteran's period of active service, or that it is otherwise the result of a disease or injury during active service, or that it is proximately due to or aggravated by a service-connected disability. 2. The weight of the evidence is against a finding that left carpal tunnel syndrome was manifested during the Veteran's period of active service, or that it is otherwise the result of a disease or injury during active service, or that it is proximately due to or aggravated by a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for right carpal tunnel syndrome have not been met. 38 U.S.C.§§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection for left carpal tunnel syndrome have not been met. 38 U.S.C.§§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1963 to October 1965, and from March 1968 to February 1970. These matters came to the Board of Veterans' Appeals (Board) on appeal from a September 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2018, November 2020, and June 2021 these matters were remanded for further development. Service Connection The Veteran seeks service connection for a bilateral hand disability, claimed as carpal tunnel syndrome and cervical nerve damage. 10/08/2010 Third Party Correspondence. He asserts that carpal tunnel syndrome is directly related to service and/or is secondary to degenerative arthritis of the cervical spine with spinal stenosis (10% 10/05/2010). Service connection is also in effect for cervical radiculopathy, left side (20% 07/29/2019). The Veteran reported bilateral hand and finger numbness since falling into a hole, with two people falling on top of him, in 1964, during service. Regarding his carpal tunnel syndrome, he could not recall a specific onset; he simply stated that he had had it for a long time. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran has current disabilities affecting the upper extremities that began during service or are at least as likely as not related to an in-service injury, event, or disease, or whether the Veteran has current disabilities that are proximately due to or the result of or were aggravated beyond the natural progress by a service-connected disability. The Board concludes that, while the Veteran has a current diagnosis of carpal tunnel syndrome, the preponderance of the evidence weighs against finding that this began during service or is otherwise related to an in-service injury, event, or disease, or that the diagnosis is proximately due to or the result of or aggravated beyond its natural progression by a service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). An August 1965 Report of Medical Examination conducted for separation purposes from his first period of service reflects that his 'upper extremities,' and 'neurologic' system were clinically evaluated as normal. 04/20/1970 Medical Treatment Record-Government Facility at 35. A February 1968 Report of Medical History reflects that he denied 'swollen or painful joints,' 'bone, joint, or other deformity,' and 'neuritis.' He checked the 'Yes' box for 'history of broken bones' and this was related to his ribs. He did not report an incident occurring in 1964. Id. at 19. February 1968, May 1969 and February 1970 Reports of Medical Examination reflect that his 'upper extremities,' and 'neurologic' system were clinically evaluated as normal. Id. at 1, 4, 22. A December 2003 VA treatment record reflects possible carpal tunnel syndrome per the Veteran's reported history. 07/07/2006 CAPRI at 336. A September 2005 C&P mental examination reflects the Veteran's report of having carpal tunnel syndrome in both arms. Id. at 316. April 2010 and August 2014 VA treatment records reflect the Veteran's report of carpal tunnel syndrome. Id. at 52, 232. A July 2019 C&P examination reflects a diagnosis of carpal tunnel syndrome, bilateral upper extremities, and left cervical radiculopathy. The Veteran reported bilateral hand and finger numbness since falling into a hole in 1964, with two people falling on top of him. He also reported bilateral arm hand numbness due to a circulatory problem with a specific onset/diagnosis not recalled. He reported having bilateral carpal tunnel syndrome, specific onset not recalled, "for a long time." He reported diabetic neuropathy of all extremities. He reported intermittent, persistent bilateral arm and hand weakness, numbness/tingling since military separation. During the examination, he reported tremors in both hands and arm; he does not have a clear recollection of when his symptoms began. There were no tremors detected on examination. Movements of upper extremities including arms and hands/fingers are normal in speed, strength, purposefulness, and fluidity. Fine motor ability of the hands appeared normal at the time of the examination. He was observed putting on his stockings without difficulty using both hands/fingers to place stockings on his feet and pull them up over lower legs. The examiner stated that there was no EMG evidence for carpal tunnel syndrome, radiculopathy, or any other neuropathy-related diagnosis was found in the current claims folder. However, subjective complaints, subjective positive results of Phalen's sign bilaterally, and claims file history of subjective complaints of carpal tunnel syndrome through the years are compatible with a diagnosis of carpal tunnel syndrome. The left cervical radiculopathy diagnosis was based on a very specific complaint of intermittent radiating pain, left arm which traveled from the left neck area through the anterolateral upper arm and at times extending through the forearm into the left wrist. Considering his most recent cervical spine imaging from 2019 with severe disc disease with multilevel foraminal narrowing and at least mild spinal canal stenosis, the described left arm symptoms are compatible with a cervical radiculopathy. The examiner opined that the Veteran's carpal tunnel syndrome is less likely than not related to an event or injury in service or secondary to a service-connected condition. The examiner, however, did not provide a rationale for these conclusions. Similarly, the opinion does not show adequate consideration of the Veteran's reports of symptoms since service. Therefore, the VA opinion is inadequate. A December 2020 C&P examination reflects that an examiner reviewed the claims folder. The examiner opined that bilateral carpal tunnel syndrome is less likely as not due to service. The examiner noted that the Veteran's carpal tunnel syndrome has been noted in medical histories, as reported by the Veteran. The earliest reference is December 2003. There is no documentation that supports that date of onset. The first documented examination appears to be the July 2019 C&P examination. Specific tests confirmed the diagnosis of bilateral carpal tunnel syndrome at that time. However, giving the Veteran the benefit of the doubt, it is at least likely as not that carpal tunnel syndrome had its onset in or around 2002/2003. Even given this earlier onset, it is less likely than not due to the events in service including the claimed fall in 1964. The Veteran served an additional year without evidence of an acute or chronic condition. The Veteran was reaccepted into service in 1968. This means he was asymptomatic and without physical finding, accepted as whole. There is no evidence of an event or an injury through the separation/reenlistment exam in 1969. This exam is notable as the Veteran planned immediate return to service and thus was again accepted as whole, without evidence of a neurologic/peripheral nerve condition. Military exams of this nature are notably thorough. Any possible injury in 1964 had clearly resolved. There is a span of 34 years before the first subjective evidence of carpal tunnel syndrome. The findings on the current July 2019 C&P suggest onset well after 2003, as they are mild, by definition. Decreased sensation was the only finding. Carpal tunnel syndrome tends to be progressive, including motor findings. Therefore, it is less likely than not that the Veteran's carpal tunnel syndrome had its onset in service, including the claimed injury in 1964. It is more likely than not that the Veteran's carpal tunnel syndrome has arisen relatively recently. However, even if 2003 or slightly earlier is accepted, in view of the limited findings, the same rationale applies. Though the Veteran claims an onset during service with chronicity, the evidence above does not support that claim. A July 2021 C&P examination reflects that an examiner reviewed the claims folder and opined that there is no credible medical evidence of a causal link between the Veteran's degenerative arthritis of the cervical spine with stenosis, cervical radiculopathy or bilateral lumbar radiculopathy and the diagnosed carpal tunnel syndrome. The examiner explained that carpal tunnel syndrome is caused by compression of the median nerve at the wrist. It is not associated with any condition of the cervical or lumbar spine, to include radiculopathy. A nexus is not established. The examiner opined that there is no credible medical evidence of any pathological mechanism to allow aggravation, beyond the natural progression, of the Veteran's diagnosed carpal tunnel syndrome by the degenerative arthritis of the cervical spine with stenosis, cervical radiculopathy or bilateral lumbar radiculopathy. The examiner explained that carpal tunnel syndrome is caused by compression of the median nerve at the wrist. It is not associated with, or aggravated by, any condition of the cervical or lumbar spine, to include radiculopathy. A nexus is not established. In support of the opinions, the examiner cited to an article regarding carpal tunnel syndrome etiology and epidemiology. As detailed above, bilateral carpal tunnel syndrome was initially diagnosed over three decades after separation from service. Further, the December 2020 and July 2021 examiners provided negative etiological opinions on a direct and secondary basis. The collective opinions are probative, as such were based on an accurate medical history and provide explanations that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There are no contrary opinions of record. (Continued on the next page) While the Veteran believes his carpal tunnel syndrome is due to service or due to a service-connected disability, the Veteran is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body/anatomical relationships/pathology/interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Based on the Veteran's assertions, medical opinions were sought addressing direct and secondary etiology which were negative. As detailed, a medical diagnosis of carpal tunnel syndrome is documented decades after separation from service. The Veteran's contentions are outweighed by the clinical findings documented many years after separation from service, and the lack of diagnosis or complaints reflected in the medical records, and the opinions of trained medical professionals. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.W. Kreindler, 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.