Citation Nr: 21007028 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 08-10 956 DATE: February 8, 2021 ORDER Service connection for bilateral carpal tunnel syndrome is granted. FINDING OF FACT The Veteran’s bilateral carpal tunnel syndrome began in service and has continued to the present. CONCLUSION OF LAW The criteria for service connection for bilateral carpal tunnel syndrome are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303(b), 3.309(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1992 to January 2003. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2010 rating decision. In her April 2008 VA Form 9, the Veteran requested a hearing before the Board in Washington, D.C., which was postponed at her request after being scheduled in June 2012, October 2012, and January 2013. She failed to report to the hearing scheduled in August 2013, nor explained her failure to appear. Accordingly, the hearing request is considered withdrawn. 38 C.F.R. § 20.704(d). Most recently, in June 2020, the Board remanded this issue for further development, and the case has been returned for appellate consideration. It also remanded the issue of entitlement to service connection for a left ankle and foot disability, which was granted in a November 2020 rating decision, evaluated as 10 percent disabling effective December 22, 2008. As this represents a full grant of the benefit sought, that issue is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (noting that a grant of service connection extinguishes appeals before the Board). Furthermore, the Veteran has not expressed disagreement with either the disability evaluation or effective date assigned. See 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 19.52 (formerly 20.302), 20.1103. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (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). For certain enumerated chronic diseases, such as organic disease of the nervous system, which includes carpal tunnel syndrome, service connection may be granted despite the lack of evidence of such disease during service if there is 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.” 38 C.F.R. § 3.303(b), 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (constraining § 3.303(b) to those chronic diseases listed in § 3.309(a)). When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. There must be competent medical evidence unless the evidence relates to a condition as to which lay observation is competent to identify its existence. 38 C.F.R. § 3.307(b); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The Veteran seeks service connection for bilateral carpal tunnel syndrome, contending that symptoms began during active duty service and continue to persist. September 2010 Statement in Support of Claim. VA medical records show that she was found to have bilateral carpal tunnel syndrome in July 2008. MTR, Gov’t Facility, docketed 11/20/2008. Her service treatment records show that in November 1994, when she was seen for a lacerated finger while working in the chow hall, for which she is service-connected, it was recorded that she had a history of job-related problems with her hands. Her military personnel record shows that, in April 1997, she was awarded the Air Force Achievement Medal for her work in accounting. As the evidence establishes the presence of a chronic disability and in-service onset, the first and second Shedden elements are met. The Board now turns its attention to nexus. VA medical records show that in July 2008 the Veteran was prescribed bilateral wrist splints to address numbness in the hands, particularly when typing. In March 2009, during a VA examination for spine conditions, it was noted that she worked as a secretary and reported tingling and numbness in both forearms and index fingers. Treatment records show that in September 2010, after complaint of worsening wrist/hand symptoms, the presence of mild carpal tunnel syndrome was confirmed by EMG (electromyogram) study, and, in March 2011, she was evaluated and treated by occupational therapy. When seen in July 2013 by orthopedics in relationship to her right shoulder, the presence of carpal tunnel syndrome diagnosed by EMG was noted. When she was seen in March 2018 by pain management, she reported that her carpal tunnel syndrome was helped by the prescribed Lyrica. In February 2020, the Veteran reported that her carpal tunnel syndrome had worsened, and it was discussed to change the Lyrica from 150 mg three times per day to 225 mg twice per day. In November 2020, based upon a review of the record only, a VA examiner opined that it was less likely than not that the Veteran’s bilateral carpal tunnel syndrome was related to service. It was stated that there was no medical evidence to support any in-service diagnosis, treatment, or evaluation associated with bilateral carpal tunnel syndrome. It was concluded: “As there are no contemporaneous STRs to substantiate the Veteran’s claim, there is no nexus with which to service connect the patient.” The examiner also referenced that the Veteran was discharged from service in 2003 and there was complaint of carpal tunnel syndrome in 2011. As factfinder, the Board has the responsibility to determine the credibility and weight to be given to the evidence. See Washington v. Nicholson, 19 Vet. App. 362, 367-68 (2005). Here, the Board finds that the VA medical opinion lacks probative value as its factual basis is inaccurate and incomplete. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that a medical opinion based upon an inaccurate or incomplete factual premise is not probative). First, this opinion was formulated without the benefit of an in-person examination during which the examiner could have elicited a complete medical history from the Veteran. Cf. Miller v. Wilkie, 32 Vet. App. 249 (2020) (explaining that a VA examination is inadequate if the examiner does not consider lay evidence). Second, as detailed above, the examiner was incorrect as to whether the Veteran reported symptoms consistent with carpal tunnel syndrome during service and was incorrect as to when there was medically documented presence of symptoms post-service. Furthermore, the examiner based the negative nexus opinion solely on the perceived lack of medical evidence of the condition during active duty service. However, the lack of contemporaneous service treatment records documenting a complaint or diagnosis of a claimed condition during active service, alone, is an insufficient rationale for a negative opinion. See e.g., Hensley v. Brown, 5 Vet. App. 155, 159-60 (1993) (addressing service connection for hearing loss). The Veteran is competent to report the nature of her symptoms of carpal tunnel syndrome as well as their onset, and the Board finds her credible. See 38 C.F.R. § 3.159(a)(2) (defining competent lay evidence); Charles v. Principi, 16 Vet. App. 370 (2002) (finding the veteran competent to testify to symptomatology capable of lay observation); Layno v. Brown, 6 Vet. App. 465, 469–70 (1994); Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (explaining that lay evidence is credible when it is internally consistent and consistent with other evidence of record). She has reported that symptoms began in service, and service treatment records support that contention. Evidence of record establishes that the Veteran’s occupations involved office-related work (chow hall and accounting in service and secretarial post-service), and she sought medical attention for her symptoms after service as early as 2008. Complaints of symptoms continued in 2009, 2010, 2011, 2013, 2018, and 2020, with Lyrica being used in recent years to address the condition. Consequently, the Board concludes that it is at least as likely as not that the Veteran’s bilateral carpal tunnel syndrome manifested during active duty service and there has been continuity of symptomatology since service. As the third Shedden element is met on a presumptive basis, service connection for bilateral carpal tunnel syndrome is warranted. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Leanne M. Innet, 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.