Citation Nr: 21005433 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 13-04 436 DATE: February 1, 2021 ORDER Entitlement to service connection for a disability manifested by numbness and tingling of the bilateral hands, to include as secondary to a cervical spine disability is denied. FINDING OF FACT Numbness and tingling of the bilateral hands was not shown in service or within one year following discharge from service, is attributable to a known clinical diagnosis and is not secondary to service-connected cervical spine disability. CONCLUSION OF LAW The criteria for establishing service connection for a disability manifested by numbness and tingling of the bilateral hands have not been met. 38 U.S.C. §§ 1110, 1112, 1117, 1118, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309(a), 3.310, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1974 to September 1982 and from August 1990 to July 1991. This matter comes before the Board of Veterans’ Appeals (Board) from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In November 2015, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. The case was last before the Board in December 2019, and has returned to the Board for further appellate review. 1. Entitlement to service connection for a disability manifested by numbness and tingling of the bilateral hands Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Generally, to prove service connection there must be: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Moreover, where a veteran served continuously for 90 days or more during active service, and organic disease of the nervous becomes manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be established for a disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). Further, a disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown. Allen v. Brown, 7 Vet. App. 439 (1995). Additionally, under legislation specific to Persian Gulf War veterans, service connection may be established for a qualifying chronic disability resulting from an undiagnosed illness that became manifest during active service in the Southwest Asia theater of operations during the Persian Gulf War or to a degree of 10 percent or more no later than December 31, 2021. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1). The term “qualifying chronic disability” means a chronic disability resulting from any of the following (or any combination of any of the following): (A) an undiagnosed illness; (B) a medically unexplained chronic multi-symptom illness that is defined by a cluster of signs or symptoms, such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome; or (C) any diagnosed illness that the Secretary determines in regulations prescribed under subsection (d) warrants presumptive service-connection. 38 U.S.C. § 1117(a)(2); 38 C.F.R. § 3.317(a)(2)(i). Such chronic disability must not be attributed to any known clinical diagnosis by history, physical examination, or laboratory tests. 38 C.F.R. § 3.317(a)(1). Objective indications of a chronic disability include both “signs,” in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a six-month period will be considered chronic. 38 C.F.R. § 3.317(a)(4). Manifestations of an undiagnosed illness may include, among other things, signs or symptoms involving the upper or lower respiratory system. 38 C.F.R. § 3.317(b)(8). Compensation shall not be paid, however, if there is affirmative evidence that an undiagnosed illness was not incurred during active military, naval or air service in the Southwest Asia theater of operations during the Persian Gulf War; or if there is affirmative evidence that an undiagnosed illness was caused by a supervening condition or events that occurred between the appellant’s most recent departure from active duty in the Southwest theater of operations during the Persian Gulf War and the onset of the illness; or if there is affirmative evidence that the illness is the result of the appellant’s own willful misconduct or the abuse of alcohol or drugs. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(c). The Veteran seeks service connection for a disability manifested by numbness and tingling of the hands, which he asserts is related to his service-connected cervical spine disability. Alternatively, the Veteran asserts that his claimed disability is an undiagnosed illness attributable to his service in the Persian Gulf. The Veteran does not contend, and the evidence does not reflect, that his claimed disability arose during service or within one year after discharge from service. See 38 C.F.R. §§ 3.303, 3.307, 3.309(a). As an initial matter, the Veteran’s DD Form 214 confirms his service in the Southwest Asia theatre of operations during the Persian Gulf War. Therefore, he qualifies for consideration for presumptive service connection for disabilities resulting from an undiagnosed illness or medically unexplained chronic multi-symptom illness. Upon review of the record, the Board finds that service connection is not warranted on a presumptive basis under legislation specific to Persian Gulf War veterans under 38 C.F.R. § 3.317, because the Veteran’s symptoms have been attributed to a known clinical diagnosis, ulnar nerve compressive neuropathy. Additionally, the Board finds that service connection is not warranted on a secondary basis. The Veteran underwent a VA examination in September 2012, during which he reported numbness and tingling in his ring and pinky fingers nightly, lasting two to five minutes. The examiner noted that the Veteran’s neurological examination was normal and concluded that there was insufficient evidence to support a diagnosis of radicular neuropathy of the cervical spine. During a January 2016 VA neck conditions examination, the examiner noted decreased sensation in the Veteran’s hands and fingers, but indicated the Veteran did not have radicular pain or other signs or symptoms due to radiculopathy. In March 2016, a VA examiner noted that a cervical neck x-ray did not show encroachment of the nerves at C6, C7, or C8. The examiner explained that the numbness in the Veteran’s ring and pinky fingers appears to be from a more distal nerve impingement of his upper extremities. The examiner further explained that distal upper extremity nerve impingement is biomechanical in nature and unrelated to environmental exposures in Southwest Asia. During a March 2020 VA examination, the Veteran reported that his ring and pinky fingers become numb only at night, with symptoms relieved by waking up and moving his neck, arms, and hands. The examiner indicated that the Veteran had a diagnosis of ulnar nerve compressive neuropathy of the right hand and found no objective evidence of a left hand neurological condition. Based on the Veteran’s report that his symptoms only occur at night, two to three times per week, the examiner opined that Veteran’s claimed disability was less likely than caused or aggravated by his cervical spine disability. The examiner explained that there are no symptoms to suggest a cervical nerve radiculopathy pattern related to his C5-C7 cervical fusion and x-rays do not suggest any compression of the C8 nerve which goes to the little fingers. Furthermore, the examiner explained that the pattern of hand numbness only at night in two fingers, which is easily relieved by motion can be related to compression of the ulnar nerve peripherally during sleep and is unrelated to his cervical fusion. Moreover, the examiner opined that such a mechanical nerve compression in the arms is the result of physical compression only, and cannot be related to any factor related to his service or any other undiagnosed illness consistent with service in the Persian Gulf or elsewhere. To the extent that the Veteran believes that his current disability is related to service, as a lay person, the Veteran has not shown that he has specialized training sufficient to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the diagnosis and etiology of neurological conditions are matters that require medical training and expertise to determine. Thus, the opinion of the Veteran regarding the etiology of numbness and tingling in his hands and fingers is not competent medical evidence. Moreover, while the Veteran is competent to report sensory or observed symptoms, the Board finds the lay assertions are significantly outweighed by the lack of competent medical evidence linking the Veteran’s bilateral hand numbness and tingling to his service-connected cervical spine disability or Persian Gulf War service. In sum, the preponderance of the competent and probative evidence is against the claim, and service connection is denied. In reaching the above conclusion, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the claim, the doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Lance, 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.