Citation Nr: 21063737 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 17-49 997 DATE: October 15, 2021 ORDER Service connection for carpal tunnel syndrome (CTS) in the right hand is denied. Entitlement to a higher (compensable) initial rating for erectile dysfunction (ED) from December 28, 2015 is denied. FINDINGS OF FACT 1. The Veteran has a current disability of carpal tunnel syndrome (CTS) in the right hand. 2. The Veteran experienced an in-service repetitive use injury in the right hand during combat that is related to the duties associated with the military occupational specialty (MOS) of healthcare specialist; symptoms of the repetitive use injury were not chronic in service and did not continue after service; CTS symptoms in the right hand first appeared after service in April 2013. 3. The current CTS in the right hand did not have its onset in service and is not otherwise etiologically related to service. 4. From December 28, 2015, the ED did not manifest in penile deformity. CONCLUSIONS OF LAW 1. The criteria for service connection for CTS in the right hand have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 2. The criteria for a higher (compensable) initial rating for erectile dysfunction (ED) from December 28, 2015 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.115a, 4.115b, Diagnostic Code 7522. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 2003 to March 2005. This matter is on appeal from a May 2016 rating decision issued by the Regional Office (RO). The Veteran filed a notice of disagreement in July 2016. A statement of the case was rendered in September 2017. The Veteran filed a substantive appeal (VA Form 9) in September 2017 and requested a Board hearing at a local office. The Veterans Appeals Control and Locator System shows that the Veteran subsequently canceled a Board hearing that had been scheduled in September 2019; therefore, there is no outstanding hearing request of record. 38 C.F.R. § 20.704(e). These issues were before the Board in February 2020. The Board remanded both issues in order to obtain VA examinations. VA examinations were conducted in March and November 2020. A supplemental statement of the case in November 2020 denied service connection for CTS in the right hand. A November 2020 rating decision granted service connection for ED with a rating of 0 percent from December 28, 2015 and granted special monthly compensation (SMC K-1) based on loss of use of a creative organ from December 28, 2015. Duties to Notify and Assist The Board finds that the duties to notify and assist the Veteran in this case have been fulfilled. Neither the Veteran nor the representative has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015). 1. Service Connection for CTS in the Right Hand Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. 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. See 38 C.F.R. § 3.303(d). The Veteran contends that the CTS in the right hand is related to service. More specifically, the Veteran contends that the CTS is a repetitive use injury caused over time by his MOS duties, including lifting patients and heavy objects, suturing patients, and writing in medical charts. See July 2016 Notice of Disagreement. The evidence shows that the Veteran has a current disability of CTS in the right hand. See March 2016 VA Treatment Records. The Board finds that the Veteran experienced an in-service repetitive use injury in the right hand during combat while performing duties of the MOS of healthcare specialist. See DD Form 214 (listing the MOS as healthcare specialist). A repetitive use injury (also known as a repetitive strain injury) "is a gradual buildup of damage to muscles, tendons, and nerves from repetitive motions" that can result in the following symptoms: pain, tenderness, swelling, stiffness, tingling or numbness, throbbing, weakness, or temperature sensitivity. See https://www.healthline.com/health/repetitive-strain-injury#symptoms. The weight of the lay and medical evidence shows that symptoms of the repetitive use injury were not chronic in service. There are no complaints of or treatment for these symptoms during service, as evidenced by the histories and treatment entries in the service treatment records. In February 2005, one month prior to service separation in March 2005, the Veteran reported that his health has worsened since the last physical examination, listing specific symptoms that do not include CTS symptoms. See February 2005 Report of Medical Assessment. In the February 2005 Report of Medical Assessment, the Veteran listed several ailments and injuries to explain his worsening health but did not list any symptoms related to the repetitive use injury or CTS. The first post-service report of CTS symptoms in the right hand was in an April 2013 VA treatment record, approximately eight years after service separation. The weight of the lay and medical evidence shows that the CTS in the right hand, which was first diagnosed eight years after service, did not have its onset in service and is not otherwise etiologically related to service. The Veteran submitted to a VA examination in November 2020. The VA examiner examined the Veteran, reviewed service treatment records, and took a history from the Veteran. The VA examiner rendered a negative direct service connection nexus, reasoning that there were no CTS symptoms in service. For these reasons, the Board finds that the preponderance of the evidence is against finding a nexus between the currently diagnosed CTS in the right hand and service; therefore, the claim must be denied. 2. Rating the ED from December 28, 2015 Under Diagnostic Code 7522, which rates erectile dysfunction, provides a single 20 percent disability rating where the evidence shows deformity of the penis. The Veteran generally requests a higher (compensable) initial rating for the ED from December 28, 2015. The weight of the evidence is against finding that the service-connected ED manifested in penile deformity with loss of erectile power from December 28, 2015. During an April 2016 VA examination, the Veteran declined a penile examination but reported normal anatomy with no penile deformity or abnormality. Even the Veteran, a member of the medical profession, concedes that the penis is not deformed. VA treatment records do not indicate that the penis is abnormal or deformed. Private treatment records of record were not probative in specifically addressing this question, but did not include any evidence of penile deformity. Based on the foregoing, the preponderance of the evidence is against finding that the service-connected ED manifested in penile deformity with loss of erectile power from December 28, 2015; as such, the claim must be denied. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Costantino, 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.