Citation Nr: 21073463 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 16-53 791A DATE: December 8, 2021 ORDER Entitlement to service connection for a left ankle disability is denied. Entitlement to service connection for amputation of the right index finger is denied. Entitlement to service connection for fracture of the left wrist is denied. Entitlement to service connection for diabetes mellitus, type II is denied. Entitlement to service connection for carpal tunnel of the left wrist is denied. Entitlement to service connection for carpal tunnel of the right wrist is denied. FINDINGS OF FACT 1. A chronic left ankle disability was not incurred during the Veteran's active service, and is not otherwise etiologically related to such service. 2. Amputation of the right finger was not incurred during the Veteran's active service, and is not otherwise etiologically related to such service. 3. Fracture of the left wrist did not have its onset during the Veteran's active service, and is not otherwise etiologically related to such service. 4. Diabetes mellitus did not manifest during the Veteran's active service or within one year of separation from active service; and there is no indication that the disability is causally related to active service. 5. Carpal tunnel of the left wrist did not have its onset during the Veteran's active service and is not otherwise etiologically related to such service 6. Carpal tunnel of the right wrist did not have its onset during the Veteran's active service and is not otherwise etiologically related to such service. CONCLUSIONS OF LAW 1. The criteria for service connection for a left ankle disability have not been met. 38 U.S.C. §§ 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2020). 2. The criteria for service connection for amputation of the right finger have not been met. 38 U.S.C. §§ 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2020). 3. The criteria for service connection for fracture of the left wrist have not been met. 38 U.S.C. §§ 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2020). 4. The criteria for service connection for diabetes mellitus, type 2 have not been met. 38 U.S.C. §§ 1131, 1137, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 5. The criteria for service connection for carpal tunnel of the left wrist have not been met. 38 U.S.C. §§ 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2020). 6. The criteria for service connection for carpal tunnel of the right wrist have not been met. 38 U.S.C. §§ 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active naval service from June 1978 to June 1982. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran was scheduled to testify at a hearing before a Veterans Law Judge (VLJ) in February 2020. The Veteran did not appear for the hearing, but contacted VA in March 2021 and indicated that he missed the hearing due to COVID-19 and another hearing was requested. In September 2021, another hearing was scheduled before a VLJ. The Veteran appeared for the hearing, but indicated that he did not wish to provide any testimony for the issues on appeal. As such, the hearing was canceled. Service Connection Left Ankle Disability The Veteran contends that he has a left ankle disability related to his active duty service. A review of the Veteran's service treatment records (STRs) reveals that clinical evaluation of the lower extremities was normal at the Veteran's entrance examination in June 1978, and on a report of medical examination dated in July 1978 for the purpose of submarine service. In November 1978, the Veteran sustained a left ankle injury. A possible bone chip was suspected, but X-rays of the left ankle were reported to be negative. Clinical evaluation of the lower extremities was normal at the Veteran's April 1982 separation examination. Post-service VA outpatient treatment records include pain in the ankle and foot. In November 2011, the Veteran was reported to have sustained a fracture of the left foot with bilateral foot pain. During an August 2012 VA examination, the Veteran reported that he had sustained two left ankle injuries during service which resolved without residuals. Diagnostic studies at that time did not reveal any abnormal findings. The examiner reported that the Veteran did not have any functional impairment of the left ankle. The examiner diagnosed left ankle sprain/strain, resolved without residual. The examiner opined that the Veteran's claimed disability was less likely than not incurred in or caused by service. The examiner's rationale was that the Veteran was assessed with a left ankle sprain in November 1978 with negative X-rays and no injury to the tibia or fibula. Additionally, the post-service treatment reports do no reveal chronicity of a left ankle condition or a persistent left tibia or fibula condition. The evidence does not indicate that a chronic left ankle disability manifested during active service. Although the Veteran sustained a left ankle injury during service, there were no follow-up records of treatment and the April 1982 separation examination indicated that lower extremities were normal, which suggests any injuries were acute and resolved without residuals prior to the Veteran's separation. Moreover, the Veteran reported to the VA examiner that his left ankle injury resolved without residuals. The first complaints of any post-service pain proximate to the left ankle was referable to the left foot and came in November 2011, many years after the Veteran left service. The Board finds that the August 2012 VA examination weighs against the claim. The examiner determined that it was less likely than not that the Veteran's claimed left ankle disability was incurred in or caused by service. The examiner considered and addressed the relevant evidence of record, the Veteran's contentions, and provided rationale for the opinion. For those reasons, the Board finds the VA examiner's opinion significantly probative. Furthermore, there are no medical opinions to the contrary. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board has also considered the lay evidence of record. The Veteran is competent to describe what he has personally observed or experienced. However, the ultimate questions of diagnoses and etiology in this case extend beyond an immediately observable cause-and-effect relationship and are beyond the competence of lay witnesses. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). For these reasons, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for a left ankle disability is not warranted. 38 U.S.C. § 5107 (b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Service Connection - Amputation of Right Index, Fracture of Left Wrist, Diabetes Mellitus, and Carpal Tunnel of Left and Right Wrists The Veteran contends that he has amputation of the right index finger, a left wrist fracture, diabetes mellitus, and carpal tunnel of the left and right wrist related to his active duty service. A review of the Veteran's STRs reveals a normal clinical evaluation of all relevant body systems at the Veteran's entrance examination dated in June 1978, a July 1978 report of medical examination for the purpose of submarine service, and the separation examination dated in April 1982. Laboratory testing for sugar was also reported to be negative at those times. The records do not reveal any complaints, findings, or treatment for an injury to the right finger or right wrist, treatment for diabetes mellitus, or any complaints related to carpal tunnel or either wrist. Post-service VA outpatient treatment reports dated in March 2004 reveal that the Veteran's right index finger was amputated. The earliest reference to a diagnosis of diabetes mellitus came in September 2009. Carpal tunnel syndrome was included on a problem list on records dated from March 2004 to October 2013. The Veteran was reported to have sustained a left wrist fracture closed reduction without surgery or casting in the 1990s. As an initial matter, the Board notes that the Veteran was not provided with a VA examination in conjunction with the claims for service connection for amputation of the right index, fracture of the left wrist, diabetes mellitus, carpal tunnel of the left wrist, and carpal tunnel of the right wrist. VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies; and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability; but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. See 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, however, the evidence does not indicate that the Veteran's amputation of the right index, fracture of the left wrist, diabetes mellitus, carpal tunnel of the left wrist, and carpal tunnel of the right wrist may be associated with his service. See McLendon, 20 Vet. App. at 83; see also Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010). There were no complaints of any finger problems, wrist problems, elevated blood sugars, or carpal tunnel during service. At his separation examination, clinical evaluation of all relevant body systems was noted as normal and there is no medical evidence otherwise linking amputation of the right index, fracture of the left wrist, diabetes mellitus, carpal tunnel of the left wrist, and carpal tunnel of the right wrist to service. Accordingly, the Board finds that VA examinations are not warranted. The Board finds the most probative evidence weighs against the claims. The evidence does not indicate that the Veteran's amputation of the right index, fracture of the left wrist, diabetes mellitus, type 2, carpal tunnel of the left wrist, and carpal tunnel of the right wrist manifested during active service and with regard to diabetes mellitus, within one year of the Veteran's separation from service. After service, the first documentation of the claimed disabilities occurred many years after he left service. The passage of time between discharge from active service and the medical documentation of a claimed disability is a factor that tends to weigh against the claims for service connection in this case. The Board has also considered the lay evidence of record. The Veteran is competent to describe what he has personally observed or experienced. However, the ultimate questions of diagnoses and etiology in this case extend beyond an immediately observable cause-and-effect relationship and are beyond the competence of lay witnesses. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). (Continued on the next page) Accordingly, the Board finds that the preponderance of the evidence is against the claims and entitlement to service connection for amputation of the right index, fracture of the left wrist, diabetes mellitus, carpal tunnel of the left wrist, and carpal tunnel of the right wrist is not warranted. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Cryan, 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.