Citation Nr: 21076648 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 16-47 212 DATE: December 27, 2021 ORDER Entitlement to service connection for a left wrist disability is denied. FINDING OF FACT The Veteran's left wrist disability was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a left wrist disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 2001 to August 2003. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) (hereinafter agency of original jurisdiction or AOJ). The Board notes that this matter was remanded to the AOJ in June 2021 for further development, which has since been completed. See Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for a left wrist disability The Veteran seeks entitlement to service connection for a left wrist disability. To establish service connection, the evidence must generally show (1) a present disability, (2) an 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, 1167 (Fed. Cir. 2004). 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). In addition, for Veterans who have served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for certain chronic diseases, including arthritis, if the disability is manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic as per 38 C.F.R. § 3.309(a)). The Board must assess the credibility and weight of evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). The standard of proof to be applied in decisions on claims for veterans' benefits is set forth at 38 U.S.C. § 5107. A veteran is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Wise v. Shinseki, 26 Vet. App. 517, 532 (2014). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). The Veteran's service treatment records show that in April 2003 the Veteran reported left wrist pain after doing pushups, and in May 2003 he reported that the left wrist hurt after physical training. Additionally, the Veteran reported having had wrist pain on a May 2003 medical history report. However, at a June 2003 examination, the Veteran noted a history of wrist pain, but stated that it had resolved prior to separation. Also, in April 2003, a radiology examination of the wrist was conducted, where routine views of the wrist did not show fracture, dislocation, or other bone abnormality. Also, no opaque foreign body could be identified, and the soft tissues were not remarkable. Following active service, the record is absent of any evidence of a left wrist disability, including complaints of pain, until October 2015, where post traumatic left wrist osteoarthritis was noted, and the treating physician stated that the Veteran's symptoms have progressed since service. No rationale was provided for this statement. Additionally, in September 2016, the Veteran's primary care physician stated that the Veteran has a history of left wrist osteoarthritis, which causes the Veteran chronic pain. In October 2019, the Veteran's private treatment records note complaints of left wrist pain, which "stems directly from prior injury during his military service." No further explanation or rationale was provided for this opinion. Overall, the Veteran's treatment records reflect consistent complaints of wrist pain since October 2015. In connection with this claim for service connection, the Veteran was provided a VA examination in October 2019. During the examination, Veteran indicated he sprained his left wrist in 2002 while completing physical training pushups. Additionally, the Veteran stated that flare-ups occur after during cold damp weather. Further, multiple left wrist radiographs were obtained, wherein there was no evidence of any acute fracture or bony erosion, and no osteoarthritis was reported. The examiner diagnosed the Veteran with a chronic left wrist sprain. After review of the record, the examiner determined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In support, the examiner incorrectly stated that there were no active-duty records to collaborate the Veteran's claim. Following the June 2021 Board remand, the Veteran was provided an addendum VA medical opinion in July 2021. Upon review of the records, the examiner opined that the condition claimed was less likely than not (less than 50% probability) incurred in or caused by the claimed in-service injury, event, or illness. In support of this conclusion, the examiner stated that there was no evidence of an acute or chronic wrist injury in service, and the separation examination is negative for a wrist, hand, or an upper extremity condition. Further, the examiner stated that service separation examinations are notably thorough and include a history, physical, and veteran-answered history, which was specifically negative for any current upper extremity or hand conditions. Notably, the Veteran sought care for an ankle condition post-service, which is well documented. However, the Veteran did not seek treatment for a wrist disability until 2015, and given the nature of wrist conditions, it seems unlikely the Veteran could have endured over a decade without seeking care for a condition arising in service. Further, the examiner conceded that the Veteran injured his wrists during service; however, the Veteran's clinical separation examination was negative for any upper extremity disability. Further, the Veteran's private treatment records did not alter the examiner's opinion, noting an incorrect diagnosis of osteoarthritis, as shown by negative radiology examinations. Therefore, the examiner restated that it is less likely than not that the currently-diagnosed left wrist sprain is due to or incurred by events in service. On review of the record, the Board finds that the most probative evidence is the July 2021 VA addendum medical opinion. The examiner considered the description of the Veteran's symptoms and their onset in the context of the medical record, as well as the Veteran's entire medical history including his in-service treatment records. Additionally, while the examiner conceded that the Veteran injured his wrist in service, the Veteran's clinical separation examination was negative for any upper extremity conditions. Also, the Veteran's post active service treatment records, proximate to separation, were silent for any complaints, diagnosis, or treatment related to a left wrist disability. The opinion of the VA examiner was rendered by a medical professional with the expertise to opine on the matter at issue in this case. The examiner addressed the Veteran's contentions and based the opinions on a review of the claims folder to include consideration of the Veteran's medical history, the nature of the current disabilities, and medical literature. The Board finds no factual inaccuracies in the examiner's opinion. Rather, the examiner thoroughly considered the Veteran's lay statements, treatment, and post-service diagnosis. Furthermore, the Board has reviewed the lay statements, which are probative as to when the Veteran first experienced wrist pain, and which, according to the Veteran, began in 2002, but resolved prior to separation. See May 2003 service treatment record. Also, the Veteran is not shown to be competent himself to correlate such matters as establishing that his current left wrist pain is related to his in-service pain due to the medical complexity of the matter involved. Lastly, there is no competent evidence or opinion that the Veteran's left wrist pain is related to an in-service incident or began in service, or evidence of left wrist pain within one year of service discharge. As such, the Board finds that service connection based upon continuity of symptomatology under 38 C.F.R. § 3.303(b) or a left wrist disability manifesting to a compensable degree within one year of service discharge under 38 C.F.R. § 3.309(a) is not warranted. Further, the Board notes the two private medical opinions, which state that the Veteran's current wrist pain is related to service. However, the provided opinions are absent of any rationale or explanation for the stated conclusions. Therefore, the Board finds that these conclusory opinions are entitled to no probative weight, but finds that the VA examiner's addendum opinion is far more probative and persuasive as to the etiology of the Veteran's disability. Accordingly, the preponderance of the competent evidence concerning the causal relationship between the current left wrist disability and the Veteran's service weighs against the Veteran's service-connection claim for a left wrist disability. As the evidence is not roughly in equipoise, there is no doubt to resolve, and the claim is denied. 38 U.S.C. § 5107; Gilbert, 1 Vet. App at 53. A. HODZIC Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Brady, 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.