Citation Nr: 21076053 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 15-10 296 DATE: December 22, 2021 ORDER Entitlement to service connection for bilateral carpal tunnel syndrome is denied. Entitlement to service connection for bilateral plantar fasciitis is denied. Entitlement to service connection for a left foot callus is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran's bilateral carpal tunnel syndrome began during active service, or is otherwise related to an in-service injury or disease. 2. The Veteran's plantar fasciitis did not begin during active service and is not otherwise related to an in-service injury or disease. 3. The Veteran's left foot callus did not begin during active service and is not otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral carpal tunnel syndrome are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for plantar fasciitis are not met. 38U.S.C. §§1101, 1110, 5103, 5103A, 5107;38 C.F.R. §§ 3.102, 3.159, 3.303, 3.04, 3.310. 3. The criteria for service connection for a left foot callus are not met. 38U.S.C. §§1101, 1110, 5103, 5103A, 5107;38 C.F.R. §§ 3.102, 3.159, 3.303, 3.04, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from February 1980 to September 1982. These matters comes before the Board of Veterans' Appeals (Board) on appeal from an April 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In his March 2015 Form 9, the Veteran requested a Board hearing for the issues on appeal. A hearing was scheduled for October 19, 2018, for which the Veteran did not report. Nor has the Veteran shown good cause for failing to appear at the scheduled hearing. As the Veteran was properly notified of the time, date and location of his scheduled hearing and failed to appear, his hearing request is deemed withdrawn. See 38 C.F.R. §§ 20.702(d), 20.704(d). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38U.S.C. §1110. 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). 1. Entitlement to service connection for bilateral carpal tunnel syndrome The Veteran asserts that his bilateral carpal tunnel syndrome is etiologically related to service. The question for the Board is whether the Veteran's diagnosed bilateral carpal tunnel syndrome is related to his service. A review of the Veteran's service treatment records (STRs) document no defects related to the Veteran's arms, hands, wrists, or shoulders on his August 1982 examination prior to separation. Specifically, clinical evaluation noted upper extremities and neurologic as normal. In the corresponding report of medical history, the Veteran marked "NO" on the question asking if he ever had or currently had problems with bone, joint, or other deformity, painful or "trick" shoulder or elbow, and neuritis. A July 2000 VA treatment record documents that the Veteran was hospitalized and during an examination at the time of his admission, the clinician documented Veteran's musculoskeletal and neurological problems, which included dizziness and issues with pain in the groin but no complaint for pain or numbness in the hands was noted. See November 2000 Medical Treatment Record - Government Facility. A May 2003 VA treatment record documents the Veteran's complaint of numbness in hands. See April 2004 Medical Treatment Record - Government Facility. A July 2003 VA treatment record documents tingling in hands. See id. The Veteran was provided a VA general medical exam in November 2012. See November 2012 VA Examination. On the report of medical history, the Veteran reported problems with hands and fingers. On the corresponding Hand and Finger Conditions disability benefits questionnaire (DBQ), the examiner diagnosed the Veteran with carpal tunnel syndrome and noted the date of diagnosis as 1990s. The examiner noted that the Veteran went to the emergency department in Charleston, South Carolina with bilateral hand pain and numbness and was known to have carpal tunnel syndrome in both hands. The examiner opined that the Veteran's bilateral carpal tunnel syndrome was not caused by or a result of his in-service work. The examiner reasoned that although the Veteran had a long history of carpal tunnel, there was no medically evident basis for a connection between current carpal tunnel disease and any injuries he might have sustained in the military. The Veteran was provided another VA examination in March 2021 during which he was again diagnosed with bilateral carpal tunnel syndrome. The examiner documented the Veteran's report that he has had a problem with carpal tunnel for years. In a corresponding nexus opinion, the examiner opined that the Veteran's carpal tunnel syndrome was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that service treatment records are negative for finding of carpal tunnel syndrome and that separation examination in August 1982 was negative of neurological impairment of the upper extremities or complaints of bilateral wrist area pain. The examiner acknowledged the Veteran's assertion that his bilateral carpal tunnel was due to driving tanks in service. The examiner further reasoned that service treatment records and post-service treatment records until March 2008 are silent for a diagnosis of carpal tunnel. The examiner concluded that due to the lapse in the date of discharge and the first documentation of his condition, the carpal tunnel syndrome was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The RO obtained another etiology opinion in July 2021. In this opinion, the examiner opined that it was less likely than not that the Veteran's current bilateral carpal tunnel syndrome incurred in or was caused by the claimed in-service injury, event, or illness. The examiner reasoned that there was no medical evidence that the Veteran's bilateral carpal tunnel syndrome incurred in or was caused by his service, to specifically include driving tanks in service. The examiner further reasoned that the medical record was silent for any bilateral wrist or hand neurological symptoms or injury that could have resulted in a long term chronic bilateral wrist or hand condition. The Veteran denied all symptoms of a carpal tunnel syndrome during examination at separation from service. The examiner found this pertinent and expressed that the most common cause of carpal tunnel syndrome is inflammation and compression of the median nerve within the carpal tunnel, and that symptoms would be present as soon as inflammation or compression is present. The examiner concluded that it would be unlikely that carpal tunnel syndrome symptoms or inflammation and compression of the median nerve would begin 25 years after the Veteran's drove tanks in service. The examiner reasoned that most likely cause of the Veteran's bilateral carpal tunnel is post-military service inflammation and compression of the median nerve within the carpal tunnel from a post military service workplace injury, diabetes, or a genetic predisposition. The Board finds the medical opinions provided by the examiners, particularly that of the July 2021 examiner, to be highly probative because the examiners considered the relevant history of the Veteran's bilateral carpal tunnel syndrome, provided a sufficiently detailed description of the symptoms experienced by the Veteran, and provided a clear rationale to support the offered opinions. The Board understands that it is the Veteran's sincere belief that his bilateral carpal tunnel syndrome resulted from driving tanks in service. Although lay persons are competent to provide opinions on some medical issues, the issue in this case is outside the realm of common knowledge of a lay person because it involves a complex medical issue that goes beyond a simple and immediately observable cause-and-effect relationship. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The VA medical opinions, particularly that of the July 2021 examiner, are the most probative evidence of record, and they are not favorable to the Veteran's claim. There is no competent lay or medical evidence of record indicating that the Veteran's bilateral carpal tunnel syndrome is related to service. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection, and, thus, the benefit of the doubt provision is not applicable. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The claim must be and is denied. 2. Entitlement to service connection for bilateral plantar fasciitis is denied. 3. Entitlement to service connection for a left foot callus is denied. The Veteran has been diagnosed with bilateral plantar fasciitis and a left foot callus. In a January 2014 notice of disagreement, the Veteran asserted that his foot conditions were caused by him driving tanks during service. The question for the Board is whether the Veteran's disability began during service or is at least as likely as not related to an in-service injury, event, or disease. The preponderance of the evidence is against finding that the Veteran's bilateral plantar fasciitis and a left foot callus began during active service, or are otherwise related to an in-service injury, event, or disease. The Veteran's STRs were silent for treatment or complaints of plantar fasciitis and a left foot callus, including his August 1982 separation examination. A January 1982 STR documents that the Veteran had a callus on the right foot. A July 2000 VA hospital admission examination documents the Veteran's complaints of groin and knee pain. He did not report any pain in his feet and otherwise denied any other major joint pain or muscular weakness. Post treatment records are otherwise silent for any problems of the feet. On a November 2012 VA examination for a bilateral foot disability, the examiner concluded that the Veteran did not have a current disability. On a July 2021 foot conditions DBQ, the examiner diagnosed the Veteran with bilateral plantar fasciitis and bilateral calluses. In the corresponding etiology opinion, the examiner opined that the Veteran's bilateral plantar fasciitis and left foot callus, each, were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. With regard to the reasoning for the left foot callus, the examiner reasoned that there was no medical evidence that the left foot callus incurred in or was caused by his service, to specifically include driving tanks during service. The examiner also reasoned that the Veteran's service-connected right foot callus had no impact on the left foot callus because calluses are not contagious or spread from one foot to another. The examiner concluded that it was most likely that the cause of the Veteran's left foot callus is the natural aging process as the arches naturally decrease allowing pressure from bones to create friction and ultimately callus. With regard to the reasoning for the bilateral plantar fasciitis, the examiner reasoned that there was no medical evidence the Veteran's bilateral plantar fasciitis incurred in or was caused by his service, to specifically include driving tanks. The examiner reasoned that the Veteran had a normal physical examination at separation from service with no complaints of fascia symptoms or conditions. The examiner then reasoned that the most likely cause of the Veteran's bilateral plantar fasciitis was the prolonged standing, poor footwear, low levels of physical activity or complications from his other chronic medical conditions, such as diabetes mellitus. The Veteran is competent to report the symptoms that he may experience as a layperson. However, there is no evidence in the record that the Veteran is competent to opine whether his currently diagnosed bilateral plantar fasciitis or a left foot callus is related to service, to specifically include driving a tank during service. Providing an etiology of plantar fasciitis and a left foot callus is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body as well as interpretation of complicated diagnostic medical testing. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he has personal knowledge), Jandreau, 492 F.3d at 1377 n.4; see also Kahana, 24. Vet. App. 428. The Veteran has not demonstrated he has the knowledge, education or training to provide an opinion in such a complicated matter and therefore his opinion as to an etiology of his plantar fasciitis and a left foot callus is not competent evidence. Id. The Board finds the medical opinion provided by the July 2021 examiner to be highly probative because the examiner considered the relevant history of the Veteran's bilateral plantar fasciitis and a left foot callus, provided a sufficiently detailed description of the symptoms experienced by the Veteran, and provided a clear rationale to support the offered opinions. (Continued on the next page) The VA medical opinions are the most probative evidence of record, and they are not favorable to the Veteran's claims. There is no competent lay or medical evidence of record indicating that the Veteran's bilateral plantar fasciitis or a left foot callus are related to service. Accordingly, the Board finds that the preponderance of the evidence is against the claims for service connection, and, thus, the benefit of the doubt provision is not applicable. Gilbert, 1 Vet. App. 49. The claims must be and are denied. L. BARSTOW Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Hammad Rasul, 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.