Citation Nr: 21005648 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 15-08 823A DATE: February 2, 2021 ORDER Entitlement to service connection for a left hand and wrist disorder, to include as secondary to service-connected right hand and wrist disabilities, is denied. FINDING OF FACT The Veteran does not have a left hand or wrist disorder that manifested during active service, is otherwise causally or etiologically related to her active service, or was caused or aggravated by her service-connected right hand and wrist disabilities. CONCLUSION OF LAW A left hand or wrist disorder was not incurred in active service and was not proximately due to, the result of, or aggravated by a service-connected disability. 38 U.S.C. §§ 1101, 1110, 1111, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from February 1983 to February 2003. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2018 and February 2020, the Board remanded the case to the RO for further development. The case has since been returned to the Board for appellate review. Law and Analysis In response to the Board’s February 2020 remand, the Agency of Original Jurisdiction (AOJ) scheduled the Veteran for a VA examination to determine the nature and etiology of her left hand and wrist disorder. The record shows that the VA examination request was cancelled by the Veteran. Historically, the Board notes that the Veteran also declined a VA examination in July 2019 in connection with her claim. In October 2020 correspondence, the Veteran’s representative contended that the Veteran misunderstood the purpose of the examination and that she would not have cancelled the examination if she had known the importance to the appeal. However, the Veteran and her representative received copies of the February 2020 Board remand that explained the reasons for obtaining a new examination and addendum opinion. Further, in February 2020, the Board mailed notification that a claim would be rated based on the evidence, or even denied, if a claimant failed to report for an examination or reexamination without good cause. When a claimant fails to participate in a scheduled VA examination, the Board must consider (1) whether the examination was necessary to establish entitlement to the benefit sought, and (2) whether the claimant lacked good cause to miss the scheduled examination. Turk v. Peake, 21 Vet. App. 565, 568 (2008). Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant and death of an immediate family member. 38 C.F.R. § 3.655(a). The “duty to assist is not always a one-way street,” and a veteran has an obligation to actively participate in the retrieving of any information pertinent to his or her claim, to include attending scheduled VA examinations and identifying relevant records. He or she is expected to cooperate in the efforts to adjudicate the claim, and his or her failure to do so subjects him to the risk of an adverse adjudication based on an incomplete and underdeveloped record. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991); Kowalski v. Nicholson, 19 Vet. App. 171, 178 (2005). The Veteran and her representative have neither challenged the fact that she cancelled the examination request nor provided good cause for cancelling the request. Under these circumstances, the Board finds that the Veteran’s cancellation was without good cause, and the applicable regulation now requires that the claim be adjudicated based upon the evidence of record. 38 C.F.R. § 3.655(b); Turk, 21 Vet. App. 565 (2008). Given the facts of this case, the Board finds that no further notification or development action is necessary. The AOJ has met its duty to assist and attempted to complete all actions requested in the Board’s June 2018 and February 2020 remand directives. The Veteran and her representative have not raised any other issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. 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). 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 arthritis is considered to be a chronic disease for VA compensation purposes, if chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including arthritis, are presumed to have been incurred in service if they manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. A disability may also be service-connected on a secondary basis if it is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310(a). Moreover, secondary service connection may be established by any increase in severity (i.e., aggravation) of a nonservice-connected condition that is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310(b). Where a service-connected disability aggravates a nonservice-connected condition, a veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. To deny a claim on its merits, the weight of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). In considering the evidence of record under the laws and regulations as set forth above, the Board finds the Veteran’s current disability is not related to service. The Board concludes that she is not entitled to service connection for a left hand or wrist disorder. The Veteran has asserted that she developed a left hand or wrist disorder due to overuse stemming from the decreased ability of her service-connected right hand and wrist disabilities. June 2012 notice of disagreement. She stated that she “believed” there was a relationship. She has not indicated that a qualified medical expert told her that the disabilities were related, that such a relationship is within common lay knowledge, or provided a foundation for the assertion other than a post hoc rationalization. The Veteran’s service treatment records are negative for any complaints, treatment, or diagnosis of a left hand or wrist disorder. In fact, in October 2001 x-rays showed a normal left wrist. Following service, in a March 2004 military treatment facility orthopedic clinic note, the Veteran complained of pain over the second carpal bone of her left hand. The diagnosis was primary arthrosis of the left midcarpal joint. The record also includes numerous complaints of left hand and wrist pain and May 2004 military treatment facility surgical notes indicating that the Veteran had surgery to remove a left carpal boss. In April 2006, the Veteran was diagnosed with tenosynovitis of the left thumb. In January 2007, she was diagnosed with tenosynovitis of the left hand and wrist. In May 2007, she was diagnosed with tenosynovitis and DeQuervain’s syndrome in her left wrist. There are no medical opinions of record that relate the Veteran’s left wrist and hand disorder to service or her service-connected right hand and wrist disabilities. The Veteran was afforded the opportunity to present for a VA examination on two separate occasions to obtain an opinion; however, she cancelled both examination requests. The preponderance of the evidence shows that the Veteran’s left hand and wrist disability began years after service and has not been caused or aggravated by service. The Board concludes, based on the current evidence of record, that the claim for entitlement to service connection for a left hand and wrist disorder must be denied. The benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. J. B. FREEMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Osegueda, 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.