Citation Nr: 21075700 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 16-20 038 DATE: December 21, 2021 ORDER Entitlement to service connection for a right wrist disability is granted. FINDING OF FACT The Veteran's right wrist disability began during active duty service. CONCLUSION OF LAW The criteria for entitlement to service connection for a right wrist disability have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1983 to March 1987. The Veteran testified before the undersigned Veterans Law Judge (VLJ) in September 2021. A copy of the transcript is of record. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131. Generally, the evidence 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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a). Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d). 38 U.S.C. § 1154(a) requires that VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Specifically, "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. Saunders v. Wilkie, 886 F. 3d 1356 (Fed. Cir. 2018). 1. Entitlement to service connection for a right wrist disability. The Veteran's service treatment records reflect treatment for his right hand following a biking accident in February 1987. The Veteran was treated for a right hand abrasion and was ultimately granted service connection for a scar of the wrist, stemming from this in-service accident. See May 2014 rating decision. The Veteran testified at his September 2021 BVA hearing that he injured his right wrist in service when he fell off his bike and caught himself with his right wrist. He reported experiencing pain from this injury. He testified that the pain has increased over the years and interferes with his job. See BVA Hearing Transcript (T.) at 2. The Veteran reported that he is right-handed and his right wrist bothers him all the time but there are times where it especially hurts depending on how he uses it. See BVA Hearing T. at 4. The Veteran reported the use of over-the-counter pain medications and self-treatment. See BVA Hearing T. at 6. The Veteran was afforded a VA examination in May 2014. The Veteran reported daily pain to the palmar surface ulnar aspect of the wrist and pain to the wrist only when "putting pressure on it." The Veteran reported taking Tylenol, 500 mg, daily which provides moderate relief. He reported occasional stiffness to the right wrist that comes and goes from time to time. The VA examiner noted that the Veteran was right hand dominant. As the VA examiner found that there was no right wrist arthritis on a May 2014 x-ray, she determined that there was no nexus for service connection for right wrist arthritis. No other right wrist diagnosis was addressed. Although a causal relationship has not been demonstrated through the May 2014 VA opinion, nor otherwise shown through competent medical opinion evidence, the absence of a valid medical opinion is not an absolute bar to service connection. Davidson v. Shinseki, 581 F.3d at 1316. The Board finds the reports by the Veteran of his right wrist pain starting in service, after his February 1987 documented bike accident, and continuing to the present, to be competent and credible evidence of continuing symptoms since active service. 38 C.F.R. §§ 3.303, 3.307, 3.309. The Board notes that, under the continuity of symptoms provision, "symptoms, not treatment, are the essence of any evidence of continuity of symptom[s]." Savage v. Gober, 10 Vet. App. 488, 496 (1997) (referencing 38 C.F.R. § 3.303(b)). In the case of Saunders v. Wilkie, the United States Court of Appeals for the Federal Circuit addressed "the legal issue [of] whether pain without an accompanying pathology can constitute a "disability" under [38 U.S.C.] § 1110." 886 F.3d 1356, 1363-64 (Fed. Cir. 2018). The Federal Circuit held that the Veterans Court erred "as a matter of law in holding that pain alone, without an accompanying diagnosis or identifiable condition, cannot constitute a 'disability' under [38 U.S.C.] § 1110, because pain in the absence of a presently-diagnosed condition can cause functional impairment." Despite the Veteran not having a diagnosis of a right wrist disability, he provided competent and credible testimony of right wrist pain with functional impairment that has persisted since service. Because of this, the Board concludes that it is at least as likely as not that the Veteran's current right wrist condition began during active service and continued to the present. Accordingly, resolving all reasonable doubt in the Veteran's favor, the Board finds that service connection for a right wrist condition is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. M. Clark, 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.