Citation Nr: A21018580 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 200229-71969 DATE: November 22, 2021 ORDER Entitlement to service connection for bilateral carpal tunnel and Guyon syndrome is granted. Entitlement to service connection for sleep disturbance, as secondary to carpal tunnel and Guyon syndrome, is denied. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, his bilateral carpal tunnel and Guyon syndrome is at least as likely as not related to the duties he performed during his military service. 2. The preponderance of the evidence of record is against finding that the Veteran has had a diagnosed sleep disorder at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. Resolving all reasonable doubt in favor of the Veteran, the criteria for service connection for bilateral carpal tunnel and Guyon syndrome have been met. 38 U.S.C. §§ 1101, 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 2. The criteria for service connection for a sleep disturbance disorder, as secondary to his carpal tunnel syndrome, are not met.. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303 (a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from June 1966 to March 1970. On August 23, 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55 (to be codified as amended in scattered sections of 38 U.S.C.), 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA). The AMA became effective on February 19, 2019. This case comes before the Board of Veterans Appeals (Board) from a November 2019 rating decision. As such, it is automatically considered under the AMA framework. The Veteran filed a timely Form 10182 Notice of Disagreement (NOD) in February 2020, wherein he selected the Hearing docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). The Veteran was afforded a hearing before the undersigned Veterans Law Judge in July 2021. A transcript of that hearing has been associated with the claims file. Also, within 90 days of the July 2021 hearing, the Veteran submitted additional evidence which is considered herein. 1. Entitlement to service connection for bilateral carpal tunnel and Guyon syndrome. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also 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. 38 C.F.R. § 3.303(d). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran's claims file establishes that he has a diagnosis of a current disability. Specifically, postservice treatment records, a November 2019 VA examination report, and an August 2021 private Disability Benefits Questionnaire (DBQ) for the wrist reflect diagnoses of bilateral carpal tunnel syndrome and/or Guyon syndrome. Therefore, what remains for the Board to determine is whether this condition is etiologically related to in-service event, injury or disease. At the July 2021 Board hearing, the Veteran testified that he served in service as a yeoman, which he described as essentially a Navy secretary who did mostly typing and taking care of officer's records and correspondence. See July 2021 Hearing Transcript. In particular, he recounted that in 1968 he was working for Captain S., who asked him to type of 75 resumes for him to send out. The Veteran described that he spent weeks typing for 12 hours a day, overnight. He says this is when his wrists and hands began to bother him and although he reported this to his Master Chief, he was told to "suck it up". Id. The Veteran reported further that, after his time with Captain S., he was assigned to the USS Petrel. The Veteran described how the typewriters on the ship were extremely old and stiff, and thus the carriage of the typewriter would not climb up the return on the upward role of the vessel. Finally, the Veteran testified that following service he worked in retail, retail management, or construction management and did not work in any jobs that required a lot of typing. See July 2021 Hearing Transcript. The Veteran's service personnel records show that he served as a clerk and yeoman, and that his duties included performing a variety of relief or assisting tasks, including typing of correspondence, directives, and processing of incoming and outgoing correspondences. Postservice treatment records show that the Veteran had surgery on his right hand and wrist to release the nerve as a result of his carpal tunnel and Guyon syndrome in May 2016. See May 2016 private medical records. The Veteran underwent a VA examination in November 2019; bilateral carpal tunnel syndrome was diagnosed. The examiner opined it was less likely than not this condition was incurred in or caused by an in-service injury, event or illness. As rationale, the examiner stated that after reviewing the records and physically examining the Veteran there were no medical records showing a diagnosis or treatment for bilateral carpal tunnel syndrome in service other than the fact that the Veteran said he was clerk which the examiner stated was not very specific to carpal tunnel syndrome. Despite noting that the Veteran had reported being a clerk in service, the November 2019 VA examiner did not otherwise consider the effects of the Veteran's in-service duties as a clerk on his current bilateral carpal tunnel and Guyon syndrome. For this reason, the Board affords this medical opinion limited probative weight. In support of his claim, and following the July 2021 Board hearing, the Veteran submitted two private DBQs for the wrist and for the hands and fingers, both dated in August 2021 and completed by the same private physician. The private physician at that time endorsed a diagnosis of advanced carpal tunnel and Guyon syndrome as evidenced by atrophy in both hands, ulnar nerve at the wrist in the right hand, and pain and weakness of the bilateral hands. The private physician recounted the Veteran's contentions of excessive typing in 1968 and ultimately opined that it was at least as likely as not the Veteran's carpal tunnel and Guyon syndrome were caused by his excessive typing on the manual machines and excessive typing over a two-week period as described in the Veteran's statement. Given the above, the Board resolves all reasonable doubt in the favor of the Veteran and finds that his bilateral carpal tunnel and Guyon syndrome disability is related to his active service. The Veteran provided competent and credible evidence of repetitive stress and strain on his wrist and hands resulting in bilateral symptoms of pain and numbness during service that have recurred since service separation. The Veteran's statements are reflected in the August 2021 private DBQs, which the Board finds to be highly probative. The private physician provided a favorable nexus opinion which considered and discussed the Veteran's military history as credibly related by the Veteran. The private physician also provided an opinion that was within their scope of practice and in consideration of all the evidence. In conclusion, the Board finds that the criteria for service connection for a bilateral carpal tunnel and Guyon syndrome disability have been met. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Entitlement to service connection for sleep disturbance, claimed as secondary to carpal tunnel and Guyon syndrome. Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either proximately caused by or proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). The Veteran contends he has sleep disturbances which are the direct result of pain due to his bilateral carpal tunnel and Guyon Syndrome. See July 2021 Hearing Transcript. His wife has also recounted how in the 30 years she has known him his wrists and hands have been so painful that he cannot get a good night's sleep. See September 2020 Lay Statement (received August 2021). After reviewing the relevant evidence of record, which includes the Veteran's postservice treatment records, the Board finds that service connection is not warranted. Although the Veteran is now service-connected for bilateral carpal tunnel and Guyon syndrome, there is no current diagnosis of a sleep disorder. In fact, at the July 2021 hearing, the Veteran testified he did not have a sleep disorder as such that he was aware of. Instead, he described how his hand and wrist pain from carpal tunnel syndrome affected his ability to sleep. He recounted that, in order to get a good night's sleep, he would engage in self-hypnosis. He also described a history of using alcohol to numb the pain, and a current use of over-the-counter pain pail and CBD oil, as well as braces, to manage the pain. See July 2021 Hearing Transcript. Moreover, the August 2021 private DBQs reflect the Veteran's report of having trouble sleeping due to pain in his wrists. The Board does not question the Veteran's sincerity or credibility in relaying that he experiences difficulty sleeping due to pain from his bilateral carpal tunnel and Guyon syndrome; however, as noted, the evidence does not show that he has a diagnosis of a sleep disorder. The Veteran, himself, is not competent as a lay person to provide a diagnosis in this case. The ability to diagnose a sleep disorder requires specialized medical education and the ability to conduct and interpret complicated diagnostic medical testing. Where the evidence does not support a finding of a current disability upon which to predicate a grant of service connection, including secondary service connection, there can be no valid claim for that benefit. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In this case, the Board concludes the Veteran does not have a current diagnosis of a sleep disorder and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). (Continued on the next page) Accordingly, as the preponderance of the evidence is against the claims, the benefit of the doubt doctrine is not for application and the claims must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Stuedemann, Angela L. 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.