Citation Nr: 21008455 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 15-03 727 DATE: February 17, 2021 ORDER Entitlement to service connection for a neck condition is denied. Entitlement to service connection for a left arm condition is denied. Entitlement to service connection for headaches is denied. Entitlement to service connection for bilateral carpal tunnel syndrome is denied. FINDINGS OF FACT 1. The Veteran’s neck condition is not secondary to service-connected right shoulder ankylosis, and is not otherwise related to an in-service injury or disease. 2. The preponderance of the evidence of record is against finding that the Veteran has had a left arm condition at any time during or approximate to the pendency of the claim. 3. The Veteran’s occipital headaches are not secondary to service-connected right shoulder ankylosis, and are not otherwise related to an in-service injury or disease. 4. The preponderance of the evidence of record is against finding that the Veteran has had a neurologic disorder of the bilateral upper extremities, diagnosed as peripheral neuropathy or carpal tunnel syndrome, at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. The criteria for service connection for a neck condition secondary to service-connected right shoulder ankylosis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for service connection for a left arm condition secondary to service-connected right shoulder ankylosis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 3. The criteria for service connection for occipital headaches secondary to service-connected right shoulder ankylosis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 4. The criteria for service connection for bilateral carpal tunnel syndrome secondary to service-connected right shoulder ankylosis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from November 1969 to September 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a hearing in February 2018. A transcript is of record. The Board remanded the above claims for additional development in June 2018 and May 2020. 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. Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The Veteran is currently service-connected for severe right shoulder ankylosis. At the February 2018 hearing, the Veteran testified that he would like to limit the consideration of his left arm, bilateral wrist carpal tunnel syndrome, neck, and headaches conditions to a secondary service connection basis. See Hearing Transcript, 17-18. Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). 1. Entitlement to service connection for a neck condition The Veteran contends that his neck condition is secondary to his service-connected right shoulder condition. Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board’s adjudication will consider only entitlement to secondary service connection. Upon review of all the evidence of record, the Veteran has a current diagnosis of cervical discogenic disc disease as evidenced by VA treatment notes showing a medical history of cervical disc disease with neck pain. At a January 2018 visit, the Veteran reported continued neck pain and associated headaches. At a July 2013 VA examination, an examiner provided a diagnosis of cervical degenerative disc disease and concluded this was not related to service or due to the Veteran’s service-connected right shoulder disability. An adequate rationale was not provided. The Veteran was afforded a VA examination in July 2019. The examiner noted a medical history indicating gradual onset of neck pain in the 1980’s. The examiner opined that there was no evidence on exam for a diagnosis of a neck condition. The examiner noted X-rays showed no acute bony abnormality was identified; C5/C6-mild disc space effacement was present. He concluded the X-rays did not document degenerative joint disease. He concluded it is less likely than not these claimed conditions are due to the service-connected right shoulder. As noted in the June 2018 Board remand, the examiner did adequately reconcile the current diagnosis of cervical degenerative disc disease in VA treatment notes with the finding that there was no diagnosis of a neck condition. A VA examiner reviewed the claim file and offered an addendum opinion in May 2020. The examiner opined that no diagnosis was made at the July 2019 VA examination. Therefore, he concluded that there is no condition that could be due to service. He noted that records make note of cervical degenerative changes, but indicated that he could not opine without speculation why these were not noted on VA exam. The May 2020 addendum opinion does not adequately reconcile the current diagnosis of cervical degenerative disc disease in VA treatment notes with the July 2019 VA examination report. In September 2020, the VA examiner offered a second addendum opinion. The examiner opined that regardless of the absence of a diagnosis, the shoulder condition would not cause a cervical spine condition, unless such occurred at the time of the dislocation. This would have been readily evidence at the time of the initial injury. Therefore, he concluded that it is less likely than not that there has been a cervical spine condition at any time since 2013, and that no cervical spine condition was documented prior to 2013. He further opined that a condition of the shoulder would not aggravate any cervical spine condition. He explained that this is established medical knowledge and practice, supported by standard texts such as Wheeless. He indicated that the shoulder and cervical spine are anatomically separate, and pathology of one does not cause or aggravate pathology of the other. Although the July 2019 VA examination did not diagnosis a cervical spine disability, and the May 2020 and September 2020 addendum opinions similarly conclude no cervical spine condition exists, report, other VA treatment providers have determined that the Veteran does meet the criteria for a cervical disc disease diagnosis based on their clinical assessments. The May 2020 addendum opinions also noted that the Veteran was not noted to have a cervical condition at the VA examination, but that longitudinal medical records did show a history of cervical disc disease though it did not reveal ongoing care for a cervical condition. Thus, resolving reasonable doubt in the Veteran’s favor, a current disability has been established. See Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). However, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s cervical disc disease and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. Further, to the extent cervical degenerative disc disease may suggest a chronic disease such as arthritis, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. VA treatment records show the Veteran was not diagnosed with cervical disc disease until approximately 2013, decades after his separation from service and decades outside of the applicable presumptive period. The September 2020 VA examiner opined that the Veteran’s cervical spine condition, even if it were present, is not at least as likely as not related to an in-service injury, event, or disease, including right shoulder ankylosis. The examiner explained that the right shoulder condition would not cause a cervical spine condition, unless it occurred at the time of the dislocation. Further, he indicated that the shoulder would not aggravate a cervical spine condition, because they are anatomically separate and pathology of one does not cause or aggravate pathology of the other. While the Veteran believes his cervical condition is related to an in-service injury, event, or disease, including secondary to his service-connected right shoulder ankylosis, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. The preponderance of the evidence therefore is against the claim, and his claim for service connection for a cervical spine disability is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for a left arm condition The Veteran seeks service connection for a left arm condition. He contends that he his left arm condition is secondary to his service-connected right shoulder condition. At his hearing, the Veteran testified that he primarily uses his left arm and overcompensates for his right arm due to his right shoulder disability. Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board’s adjudication will consider only entitlement to secondary service connection. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or is aggravated beyond its natural progress by service-connected right shoulder ankylosis. The Veteran was afforded a VA examination in July 2019. The Veteran reported gradual onset of left arm pain starting in the 1990’s. Physical examination of the left arm was normal. Based on the examination, the examiner found that the Veteran does not have a current diagnosis associated with the left arm. The Board concludes that the Veteran does not have a current diagnosis of a left arm condition and has not had one at any time during the pendency of the claim or recent to the filing of the claim. See Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Without a current diagnosis, service connection for a left arm condition cannot be granted. See Brammer v. Derwinski, 3 Vet. App. 233, 225 (1992). Indeed, on examination, the July 2019 VA examiner indicated that the Veteran’s left arm condition does not impact his ability to perform any type of occupational task, though he does have pain. There is no assertion or evidence to show that the Veteran’s left arm pain impedes his earning capacity. Further, despite his left arm pain, the Veteran had normal clinical findings for the left arm at his VA examination. As there is no evidence of impaired earning capacity due to left knee pain, and no competent evidence of a chronic left knee underlying disability, service connection is not warranted. See Saunders v. Wilkie, 886 F.3d 1356, 1364-65 (Fed. Cir. 2018). In reaching this conclusion, the Board has considered the Veteran’s statements in support of his claim. While the Veteran believes he has a left arm condition related to his service-connected right shoulder ankylosis, the Board finds the objective medical evidence more probative in this instance. While the Veteran is competent to report symptoms during and since service, he is not competent to make a diagnosis in this case as he has not been shown to possess the necessary education or training. Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). In contrast, the Board notes the July 2019 VA examination was completed by a qualified examiner with the education, training, and experience to offer medical diagnoses. The examiner’s finding of no current left arm diagnosis is consistent with the Veteran’s treatment records, which do not indicate complaints of, treatment for, or a diagnosis of a left arm condition. The preponderance of the evidence therefore is against the claim, and his claim for service connection for a left arm disability is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to service connection for headaches The Veteran seeks service connection for headaches. He contends that his headaches are secondary to his service-connected right shoulder disability. Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board’s adjudication will consider only entitlement to secondary service connection. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or is aggravated beyond its natural progress by service-connected right shoulder ankylosis. The Veteran was afforded a VA examination in July 2013. The examiner noted that the Veteran had a history of occipital headaches with onset around 2010 to 2011. The examiner opined that the headaches are more likely cervical discogenic and not related to the right shoulder, but as noted in a prior Board remand did not offer an explanation in support of his opinion. The Veteran was afforded a VA examination in July 2019. The examiner diagnosed migraine headaches. He opined that it is less likely than not that the migraines are due to the Veteran’s service-connected right shoulder ankylosis. The examiner also opined that the headaches are less likely than not aggravated by the service-connected right shoulder ankylosis. He explained that there is no medical connection for the Veteran’s migraines to the right shoulder ankylosis. The Board concludes that, while the Veteran has a current disability occipital or migraine headaches, the preponderance of the evidence is against finding that the Veteran’s headaches are proximately due to or the result of, or aggravated beyond its natural progression by service-connected right shoulder ankylosis. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The July 2019 VA examiner opined that the Veteran’s headaches are not proximately due to or aggravated by his right shoulder ankylosis. The examiner explained that there is no medical connection for the Veteran’s migraines to his right shoulder ankylosis. The Veteran believes his headaches are proximately due to or the result of, or aggravated beyond its natural progression by a service-connected disability. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships and pathology. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the July 2019 VA examiner’s opinion. The preponderance of the evidence therefore is against the claim, and his claim for service connection for a headache disability is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to service connection for bilateral carpal tunnel syndrome The Veteran seeks service connection for bilateral upper extremity peripheral neuropathy. He contends that his upper extremity neuropathy, also claimed as carpal tunnel syndrome, is secondary to his service-connected right shoulder ankylosis. Alternatively, for the right hand only, he asserts that he suffered an injury during service and had to go on light duty for a period of time. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or is aggravated beyond its natural progress by service-connected right shoulder ankylosis. Service treatment records are silent for right hand or right wrist peripheral neuropathy complaints. Service treatment records reflect multiple right shoulder dislocation injuries. In May 1970, the Veteran injured his shoulder when he fell on some stairs. However, examination notes specifically indicate that the Veteran’s forearm and hand were normal. VA treatment records reflect a history of carpal tunnel syndrome, right greater than left, in 2007. However, there is no indication of ongoing treatment or complaints related to carpal tunnel syndrome in treatment records from 2012 to the present. The Veteran was afforded a VA examination in July 2013. The Veteran reported numbness and tingling in both arms. The VA examiner assessed carpal tunnel syndrome that was not related to the service-connected right shoulder. An EMG was not performed. The Veteran was afforded a VA examination in July 2019. The Veteran reported bilateral wrist numbness. The examiner noted normal EMG studies from 2006 and 2008 for both upper extremities. The examiner found that the Veteran did not have a diagnosis of carpal tunnel syndrome. However, the VA examiner not adequately reconcile the current diagnosis of carpal tunnel that was noted in the prior VA examination report. In May 2020, a VA examiner offered an addendum opinion. The examiner opined that diagnosis was made at the July 2019 VA examination. Therefore, he concluded that there is no condition that could be due to service. Again, this opinion not adequately reconcile the current diagnosis of carpal tunnel that was noted in the prior July 2013 VA examination report. In September 2020, the examiner offered a second addendum opinion. The examiner explained that the VA exams in 2013 and 2019 are both negative for CTS, radiculopathy, or other peripheral neuropathy condition. He further noted that EMG testing in the record was negative for carpal tunnel syndrome. Therefore, he concluded that there is no evidence of a peripheral neuropathy disorder. Further, he opined that it is less likely than not the claimed peripheral nerve or carpal tunnel syndrome disorder is due to the Veteran’s shoulder condition, including dislocation, reconstructive surgery, and resultant degenerative joint disease. He explained that shoulder conditions do not cause bilateral carpal tunnel syndrome or neuropathy, in general. He noted that in rare instances, brachial plexus injury can occur with shoulder dislocations, but explained that such injuries would be evident at the time of the shoulder injury or shortly thereafter, and would also be unilateral. The Board concludes that the Veteran does not have a current diagnosis of a peripheral neuropathy or carpal tunnel condition and has not had one at any time during the pendency of the claim or recent to the filing of the claim. See Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Without a current diagnosis, service connection for a peripheral nerve condition cannot be granted. See Brammer v. Derwinski, 3 Vet. App. 233, 225 (1992). Indeed, on examination, the September 2020 VA examiner indicated that despite the positive assessment of carpal tunnel at the July 2013 VA examination, the Veteran’s clinical history and EMG testing was negative for carpal tunnel or peripheral neuropathy conditions. There is no assertion or evidence to show that the Veteran’s wrist numbness and pain impedes his earning capacity. Further, despite his numbness and pain, the Veteran had normal clinical physical examination findings for the wrist at his July 2019 VA examination. As there is no evidence of impaired earning capacity due to wrist pain and numbness, and no competent evidence of a chronic carpal tunnel syndrome underlying disability, service connection is not warranted. The Board also finds it is less likely than not that the claimed peripheral nerve or carpal tunnel syndrome disorder is due to the Veteran’s shoulder condition, including dislocation, reconstructive surgery, and resultant degenerative joint disease. The September 2020 examiner explained that shoulder conditions do not cause bilateral carpal tunnel syndrome or neuropathy, in general. He noted that in rare instances, brachial plexus injury can occur with shoulder dislocations, but explained that such injuries would be evident at the time of the shoulder injury or shortly thereafter, and would also be unilateral. In reaching this conclusion, the Board has considered the Veteran’s statements in support of his claim. While the Veteran believes he has a peripheral neuropathy condition related to his service-connected right shoulder ankylosis, or an acute hand injury during active service, the Board finds the objective medical evidence more probative in this instance. While the Veteran is competent to report symptoms during and since service, he is not competent to make a diagnosis in this case as he has not been shown to possess the necessary education or training. Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). In contrast, the Board notes the July 2019 VA examination and clarifying September 2020 addendum opinion were completed by qualified examiners with the education, training, and experience to offer medical diagnoses. The examiner’s finding of no current peripheral nerve diagnosis is consistent with the Veteran’s treatment records, which contain normal EMG clinical testing and do not indicate complaints of, treatment for, or a diagnosis of peripheral nerve condition since 2012 when the Veteran filed his claim. The preponderance of the evidence therefore is against the claim, and his claim for service connection for a peripheral nerve disability is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Lauritzen, 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.