Citation Nr: 21007651 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 12-31 501 DATE: February 10, 2021 ORDER Entitlement to service connection for a bilateral hand disability is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s bilateral hand disability had its onset in service or is otherwise related to his military service, to include as secondary to his service-connected cervical spine disability and bilateral wrist disabilities. CONCLUSION OF LAW The criteria for service connection for a bilateral hand disability, as due to service or service-connected cervical spine disability and bilateral wrist disabilities, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1966 to August 1969. This matter comes before the Board of Veterans’ Appeals (Board) following February 2015, December 2017 and June 2019 Board Remands. This matter was originally on appeal from a March 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. In June 2013, the Veteran testified before the undersigned at a video conference hearing. A copy of the transcript has been associated with the claims file. 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; 38 C.F.R. § 3.303. In order to prevail on a claim of service connection, generally, there must be (1) evidence of a current disability; (2) evidence of in-service occurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra 1. Entitlement to service connection for bilateral hand disability The Veteran contends that he has a bilateral hand disability that is secondary to his neck surgery. Specifically, the Veteran stated in his June 2013 hearing that his hand symptoms have a lot to do with the surgery on his neck. In addition, the Veteran stated that doctors told him they believed that the reason he is sometimes unable to move his hands when he tries to do something is due to nerve damage as a result of his neck surgery. Of note, service connection is now in effect for right wrist ulnar neuropathy associated with cervical spondylosis with discectomy and left wrist sprain with carpal tunnel syndrome associated with cervical spondylosis with discectomy. The Veteran’s service treatment records (STRs) do not contain complaints of a hand disability or symptoms thereof. The Veteran’s August 1969 Report of Medical Examination indicates the examiner found the Veteran’s spine, other musculoskeletal to be normal. The Veteran reported he did not experience arthritis in an August 1969 Report of Medical History. In an April 2011 statement, Dr. R.G stated that the Veteran suffers from osteoarthritis in the hands with stiffness, pain and edema. Dr. R.G concluded that the years spent in service as a mechanic and injuries/trauma suffered in Vietnam may have precipitated or played a contributing factor in these conditions. The December 2017 Board remand found this opinion to be speculative and not sufficient in and of itself to warrant a grant of service connection. A November 2013 private treatment record shows that the Veteran’s chronic condition included unspecified arthropathy involving the hand. The Veteran was afforded a VA hand conditions examination in May 2015. The examiner concluded that there was no objective evidence to warrant a diagnosis of the claimed condition. The examiner stated that the Veteran noted no hand condition. The examiner stated that the Veteran adamantly denied a hand condition. The December 2017 Board remand found this opinion to be insufficient because the examiner did not address the April 2011 private notation of osteoarthritis or the November 2013 private notation of unspecified arthropathy involving the hand. Following the December 2017 Board remand the Veteran was afforded a VA examination in August 2018. The examiner opined that the Veteran’s hand condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated that no hand conditions were documented in service; carpal tunnel syndrome was noted in 2008; and symptoms started after service. STRs are silent to symptoms related to the claimed condition. Although the Veteran may have a current diagnosis, there is no evidence that the claimed condition was incurred/caused by an in-service injury, event or illness. The June 2019 Board remand found this examination to be insufficient because the examiner had not substantially complied with the prior remand directives by addressing whether the Veteran’s osteoarthritis of the bilateral hands and unspecified arthropathy involving the hand are at least as likely as not related to the Veteran working as a mechanic and the conceded 1968 mortar explosion in the barracks. A February 2019 VA treatment note indicates the Veteran complained of arthritic knuckles on both hands. Following the June 2019 Board remand, the Veteran was afforded a new VA examination in December 2019. The examiner indicated that he was not able to determine a baseline of severity for the Veteran’s hand condition and that the Veteran’s hand condition was not at least as likely as not aggravated beyond its normal progression by a service-connected condition. The examiner stated that the Veteran’s osteoarthritis is a degenerative condition of wear and tear of the joint. The cervical spine disability does not have bearing on wear and tear of the hand joint. The ulnar entrapment that may be related to cervical spine radiculopathy is not related to development of osteoarthritis of a separate joint. The Veteran’s median neuropathy is from local entrapment at the wrist, related to carpal tunnel syndrome, carpal tunnel syndrome does not cause or worsen osteoarthritis. The examiner also opined that the Veteran’s hand condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated that the Veteran has a diagnosis of right carpal tunnel syndrome, there is no diagnosis found of right-hand osteoarthritis. There is no indication of a right-hand numbness, tingling, pain, or weakness at the time of separation. The Veteran reports that there are symptoms of left-hand tingling, and no right-hand symptoms in 2008, more than 40 years after separation from service. There is no relationship between the Veteran’s right-hand carpal tunnel syndrome and the claimed service work as a mechanic or mortar injury. There is no evidence of osteoarthritis, nor would this condition of degenerative wear and tear be associated with the three years in service reported. Further, the examiner stated, based on medical records reviewed, the claimed condition of osteoarthritis right hand, is less likely than not incurred in or caused by the claimed in service injury or events. Furthermore, the examiner opined that the Veteran’s hand condition is less likely than not proximately due to or the result of the Veteran’s service-connected conditions. The examiner stated the Veteran has a diagnosis of right carpal tunnel syndrome. The EMG indicated there was median nerve entrapment at the wrist, which is unrelated to the cervical spine. The Veteran’s ulnar nerve entrapment was found to not be in the arm, namely the elbow, and is more likely than not related to cervical radiculopathy or shoulder impingement. There is no bearing on the contralateral joint by the left wrist sprain and carpal tunnel syndrome, and they are unrelated. Based on medical records reviewed, the claimed condition of right-hand carpal tunnel syndrome, is less likely than not proximately due to the claimed cervical spine disability, right wrist ulnar neuropathy or left wrist sprain with carpal tunnel syndrome. The examiner indicated that he was able to determine a baseline of severity for the Veteran’s hand condition prior to aggravation or the earliest medical evidence following aggravation by right wrist ulnar neuropathy. The examiner stated the earliest medical evidence following aggravation by right wrist ulnar neuropathy was the 2008 EMG showing median neuropathy of the right wrist. However, the examiner stated the current severity of the Veteran’s hand condition is not greater than the baseline. The examiner further stated the Veteran’s EMG showed median neuropathy with entrapment at the wrist. The Veteran’s right ulnar neuropathy did not show entrapment in the arm; it is more likely than not related to cervical radiculopathy or shoulder impingement. The Veteran’s left wrist sprain and carpal tunnel syndrome has no bearing on median nerve entrapment of the contralateral joint. The preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s bilateral hand arthritis/arthropathy and either his active duty service or cervical spine disability and bilateral wrist disabilities. In light of the negative nexus opinion and lack of an adequate positive opinion to contradict the negative evidence, there is no basis for a grant of service connection for a bilateral hand disability. In reaching this conclusion, the Board finds the December 2019 VA examination report to have great evidentiary weight, as the opinion reflects a comprehensive and reasoned review of the entire evidentiary record. The VA examiner reviewed the Veteran’s claims folder and medical history before rendering the medical opinion. Consideration has been given to the Veteran’s contentions that his bilateral hand disability is related to his service-connected cervical spine disability or service. Although laypersons are sometimes competent to provide opinions on certain medical questions, the specific issue in this case falls outside the realm of common knowledge of a layperson. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Although the Veteran is certainly competent to report that he has experienced difficulty moving his hand, he is not competent to link those complaints to a particular etiology. His assertions are therefore not competent evidence of a medical nexus. Dr. R.G. stated in the April 2011 statement that the Veteran suffers from osteoarthritis in the bilateral hands and concluded that the years spent in service as a mechanic and injuries/trauma suffered in Vietnam may have precipitated or played a contributing factor in these conditions. However, the May 2015 examiner stated that the Veteran adamantly denied a hand condition. In addition, the December 2019 examiner stated there is no evidence of osteoarthritis, and in any event, this condition of degenerative wear and tear would not be associated with the three years in service reported. Additionally, the VA examiner found no connection between the Veteran’s hand condition and his cervical spine disability. The April 2011 private opinion is not given greater probative weight because the examiner’s opinion was speculative and not sufficient in and of itself to warrant a grant of service connection. See Polovick v. Shinseki, 23 Vet. App. 48, 54 (2009) (holding that a doctor's statement that a veteran's brain tumor "may well be" connected to Agent Orange exposure was speculative); Bloom v. West, 12 Vet. App. 185, 187 (1999) (noting that the use of the term "could," without other rationale or supporting data, is speculative); Obert v. Brown, 5 Vet. App. 30, 33 (1993) (noting that a medical opinion expressed in terms of "may" also implies "may or may not" and is too speculative to establish a causal relationship). Although the December 2019 VA examiner referenced the Veteran’s right hand in stating there is no diagnosis found of right-hand osteoarthritis, in the examiner’s following statement he noted there is no evidence of osteoarthritis, and in any event, this condition of degenerative wear and tear would not be associated with the three years in service reported. It can be assumed that the same would be true in regard to the Veteran’s claimed left hand arthritis. Certain chronic diseases will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2012). There is no persuasive medical evidence or persuasive credible lay evidence that the Veteran's claimed disorder manifested to a compensable degree within a year of his separation from service or had its onset in service and continued ever since service. To the extent the Veteran’s statements may be construed that he suffered from an arthritic condition of the hands in service and ever since service, this theory has been rendered unfounded by the VA medical expert. Therefore, service connection based on presumptive service connection for a chronic disease or based on a theory of continuity of symptomatology is not warranted. Based on the foregoing, the Veteran’s claim of entitlement to service connection for a bilateral hand disability is denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2019); see also Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001). (continued on next page) TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Daley, 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.