Citation Nr: 21075715 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 17-49 796 DATE: December 21, 2021 ORDER Entitlement to service connection for peripheral neuropathy of the right upper extremity, to include consideration of ulnar nerve entrapment, is denied. Entitlement to service connection for peripheral neuropathy of the left upper extremity, to include consideration of ulnar nerve entrapment, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the Veteran has a diagnosed disability of the right upper extremity, distinct from his already service-connected thoracic outlet syndrome. 2. The preponderance of the evidence is against a finding that the Veteran has a diagnosed disability of the left upper extremity, distinct from his already service-connected thoracic outlet syndrome. CONCLUSIONS OF LAW 1. The criteria for establishing service connection for right upper extremity peripheral neuropathy, to include ulnar nerve entrapment, have not been met. 38 U.S.C. §§ 1131, 1154(a), 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for establishing service connection for left upper extremity peripheral neuropathy, to include ulnar nerve entrapment, have not been met. 38 U.S.C. §§ 1131, 1154(a), 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active air service from April 1982 to January 2008. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The present issues were previously before the Board in April 2019 and April 2020, at which times they were remanded for additional development. The case has now been returned to the Board for further appellate consideration. Service Connection Right and Left Upper Extremity Peripheral Neuropathy The Veteran asserts that he has a bilateral upper extremity peripheral neuropathy condition which is related to his active service. As is relevant to the discussion below, the Board notes that the Veteran is service-connected for thoracic outlet syndrome of the bilateral shoulders, with bilateral shoulder strain, each with a non-compensable (zero percent) rating effective as of January 2, 2008, and a 20 percent rating as of August 3, 2015. See April 2020, Board Decision (denying earlier effective date for implementation of 20 percent rating for either right or left thoracic outlet syndrome of the shoulder). Considered within the symptomatology for those disabilities is numbness of the upper extremities experienced when doing overhead work. See November 2017, VA Examination Report Addendum; March 2021, VA Examination Report. Repeated VA examination reports confirm that this symptom is attributable to the diagnosed bilateral thoracic outlet syndrome. See November 2017, VA Examination Report and Addendum; March 2021 VA Examination Report. The issues of service connection for right and left upper extremity peripheral neuropathy were previously recharacterized to include consideration of ulnar nerve entrapment as a disability, based upon testing results from the November 2017 VA examination. The Veteran's symptoms of numbness of the hands and forearms while lying down or in a recliner with his weight on his elbows were specifically defined as being separate from the symptoms of arm and hand numbness associated with his service-connected bilateral thoracic outlet syndrome. See November 2017, VA Examination Report and Addendum; March 2021 VA Examination Report. The November 2017 VA examiner referenced that the numbness and tingling in the hands and forearms when lying down is due to compression of the ulnar nerve, alternatively referenced within the November 2017 addendum opinion as ulnar nerve entrapment. The examiner, however, did not further discuss compression or entrapment of the ulnar nerve and did not address whether the symptoms were part of an overall diagnosis or whether entrapment of the nerve was a continuous condition experienced by the Veteran which created functional impairment. Notably, those opinions were elicited through the course of a shoulder and arm examination and did not otherwise include discussion or analysis of upper extremity peripheral neuropathy considerations and/or symptoms. These omissions were addressed by the March 2021 VA examiner, who upon in-person examination of the Veteran and review of the claims file and medical history, explained that the evidence does not support a finding that the Veteran indeed suffers from a damaged nerve condition. Physical examination and testing revealed no symptoms attributable to any nerve condition of the upper extremities, including ulnar nerve entrapment. Rather, the examiner explained that the acute symptoms that the Veteran experiences are merely the result of compression and direct pressure at specific nerve points which leads to the sensation of tingling or numbness. The examiner also explained that the fact that the symptoms are alleviated by merely changing position further negates a diagnosis of a nerve condition, including chronic ulnar nerve entrapment. These findings are mirrored in previous VA examination reports which also note, upon in-person testing, that the Veteran does not exhibit any symptoms of the upper extremities attributable to a nerve disability aside from thoracic outlet syndrome. See November 2013 and November 2015, VA Examination Reports; 2008-present, VA Treatment Records; 2013-2016, Private Treatment Records. A symptom or physical complaint is not in and of itself a recognized disability for consideration of service connection. While the Board is mindful of the Court's holding in Saunders v. Wilkie, acknowledging that pain alone may amount to a disability, the threshold requirement in such application is that the experienced pain diminishes the body's ability to function. Saunders v. Wilkie, 886 F.3d 1356 (2018). Such is not the case here, where there is no functional impairment established. The Board finds that the March 2021 VA examination report is the most probative evidence of record as it provides explanation for the etiology of the Veteran's symptoms and addresses the previous references to ulnar nerve entrapment. The findings and opinions provided therein are also fully supported by the Veteran's medical history. As discussed by the examiner, the Veteran's symptoms are transitory and passive, based solely upon holding a specific position for an extended period of time. Quite specifically in this case, those positions include laying down while sleeping, with the Veteran's forearms across his chest, he experiences the numbness in his forearms and hands, referred to by many as the sensation of an extremity "falling asleep." Likewise, when the Veteran has been applying pressure to his elbows for an extended period while sitting in a recliner, he experiences the same sensations. Simply changing positions alleviates the symptom. As the examiner duly noted, this is not a disability, and the Board agrees. Although the November 2017 examiner referenced the numbness in the hands and forearms, as just described, as occurring from ulnar nerve compression or entrapment, there was no further explanation or discussion of such reference. For this reason, the Board finds that in this regard, the November 2017 report and addendum provide little probative value. Finally, it is recognized that the Veteran is competent to report his symptoms, but lacks the medical training and knowledge necessary to diagnose a disability. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Considering the evidence as a whole, the Board finds that the preponderance of the evidence, and the most probative evidence of record, does not support a finding that the Veteran has a disability of the upper extremities, aside from those for which he is already service-connected. Intermittent feelings or experiences of symptoms are not diagnoses. The existence of a current disability is the cornerstone of a claim for VA disability compensation. In the absence of a present disability, service connection is not warranted. See, e.g., Degmetich v. Brown, 104 F.3d 1328 (1997). Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for peripheral neuropathy of the right and left upper extremities, to include ulnar nerve entrapment, is not warranted. 38 U.S.C. § 5107 (b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Sutherell, 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.