Citation Nr: 21007334 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 15-36 102 DATE: February 9, 2021 ORDER Entitlement to service connection for right upper extremity carpal tunnel syndrome is granted. Entitlement to service connection for left upper extremity carpal tunnel syndrome is granted. FINDINGS OF FACT 1. The Veteran’s right upper extremity carpal tunnel syndrome is related to his active service, to include periods of active duty for training (ACDUTRA). 2. The Veteran’s left upper extremity carpal tunnel syndrome is related to his active service, to include periods of ACDUTRA. CONCLUSIONS OF LAW 1. The criteria for service connection for right upper extremity carpal tunnel syndrome are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for left upper extremity carpal tunnel syndrome are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from December 1987 to May 1992 and from March 1, 2009 to March 11, 2009, with additional service in the Air Force Reserve and National Guard from 1993 to 2013. The matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2016, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the proceeding is associated with the record. The Board remanded the matter for further development in September 2018 and October 2020. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). Service Connection 1. Entitlement to service connection for right upper extremity carpal tunnel syndrome 2. Entitlement to service connection for left upper extremity carpal tunnel syndrome The Veteran contends that his bilateral carpal tunnel syndrome is due to the cumulative effects of his duties during active service and service in the Guard and Reserve. Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated during active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). In general, service connection requires: (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of an in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge when all evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Active service includes any period of active duty for training (ACDUTRA) during which the individual was disabled from a disease or an injury incurred in the line of duty, or a period of inactive duty training (INACDUTRA) during which the person was disabled from an injury incurred or aggravated in the line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident occurring during such training. 38 U.S.C. § 101 (24); 38 C.F.R. § 3.6 (a). In other words, with respect to National Guard or Reserve service, service connection may only be granted for a disability resulting from disease or injury incurred or aggravated while performing ACDUTRA, or an injury incurred or aggravated while performing INACDUTRA. Annual training is an example of ACDUTRA, while weekend drills are considered INACDUTRA. At the time of his retirement in 2013, military personnel records indicate the Veteran had accrued almost seven years of active duty service including his four and a half years of active duty Air Force service and the cumulation of approximately two and a half years of ACDUTRA from 1993 to 2013. Though the record does not indicate every period of ACDUTRA over his 20-year Guard and Reserve history, the Veteran’s contention does not pertain to any particular period but rather the cumulative effect of his entire military service. Thus, the Board turns to the three elements of service connection. Service Treatment Records (STRs) indicate the Veteran has a current disability of bilateral carpal tunnel syndrome as shown by a September 2011 nerve conduction study. The Veteran testified at the August 2016 Board hearing that he worked with his hands during his entire military career, to include working with instruments in the operating room as well as working as a field medic and air lab technician. The Veteran’s military occupational specialties were surgical service journeyman, aerospace medical services manager, and medical services superintendent. Thus, the Board finds the Veteran’s testimony regarding his duties to be competent, credible and consistent with the circumstances of his service. Additionally, military personnel records reveal a December 2011 National Guard Line of Duty Determination Report documenting a fall while on INACDUTRA during a weekend drill in January 2008 causing an injury to the right shoulder. The report indicated that the Veteran had “bilateral hand numbness and carpel tunnel symptoms.” Additional evidence reveals the Veteran fell on his outstretched arm and hand, causing severe pain, numbness and tingling in the entire right arm, and that he reported carpal tunnel symptoms since this accident. See July 2012 VA/DoD Joint Disability Evaluation Board Claim; February 2014 Statement in Support of Claim; September 2019 VA Examination. In December 2020 the Veteran submitted a private opinion by Dr. K.C. Dr. K.C. opined that, over years of military service, the cumulative damage to the Veteran’s cervical spine and peripheral nerves was more likely than not a cause of the Veteran’s bilateral carpal tunnel syndrome. She explained that the Veteran’s job duties required prolonged upper extremity and neck positions that resulted in chronic injuries, as well as sustaining acute injuries during his time in service. The Board acknowledges the three prior VA examinations and opinions in July 2012, July 2019, and October 2020 that opined against relation to service on both direct and secondary bases. In the September 2018 and October 2020 Board remands, the Board found the July 2012 and July 2019 VA opinions to be conclusory and therefore inadequate. The Board now finds that the October 2020 VA opinion regarding direct service connection was also conclusory, and therefore inadequate. Regarding direct service connection, the examiner opined that bilateral carpal tunnel syndrome was less likely than not related to the Veteran’s service because he was not seen and diagnosed with carpal tunnel in service, and there are no medical records indicating that his condition is due to service. The Board notes that inadequate examinations and opinions include those that provide insufficient supporting rationale or contain only data and conclusions. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Board has attempted to obtain an adequate opinion, but conflicting evidence remains. Although the December 2020 private opinion is not in the preferred language, the Board finds that a remand to again seek an adequate opinion is unnecessary as the Veteran’s reports of having to perform repetitive movements with his arms and hands are consistent with the circumstances of his service, and he has a bilateral carpal tunnel syndrome disability reflective, in part, of such duties. It is not necessary that service duties be the only cause of the current disability.   Given the inadequacies of the VA examinations and the absence of any other evidence of record that is determinative of the Veteran’s bilateral carpal tunnel syndrome and its relationship to service, the Board finds the preponderance of evidence weighs in favor of granting the Veteran’s claim. Accordingly, after resolving all doubt in favor of the Veteran, service connection for left and right carpal tunnel syndrome is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K.L. Blevins, 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.