Citation Nr: 21011354 Decision Date: 03/01/21 Archive Date: 03/01/21 DOCKET NO. 08-37 093A DATE: March 1, 2021 ORDER Service connection for bilateral carpal tunnel syndrome is granted. FINDING OF FACT The Veteran’s bilateral carpal tunnel syndrome is related to his service-connected diabetes mellitus. CONCLUSION OF LAW The criteria for service connection for bilateral carpal tunnel syndrome have been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from June 1972 to November 1977. In April 2011, the Veteran was afforded a hearing before the undersigned at the RO. 38 U.S.C. § 7102 (b). In June 2014, the Board denied the claim. The Veteran appealed to the U.S. Court of Appeals for Veterans Claims (Court). In May 2015, the Court issued an Order vacating the June 2014 Board decision and remanding the case for compliance with a Joint Motion for Remand (JMR). In December 2015 and October 2017, the Board remanded the claim. In June 2018, the Board denied the claim. In August 2019, the Court issued an Order vacating the June 2018 Board decision and remanding the case for compliance with a JMR. In April 2020, the Board remanded the claim for additional development. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303 (d). Service connection may be granted, on a secondary basis, for a disability, which is proximately due to, or the result of an established service-connected disorder. 38 C.F.R. § 3.310. The Veteran's service treatment records show that his upper extremities and neurological system were clinically normal on enlistment examination in April 1972. In July 1976, the Veteran was treated for complaints of intermittent left elbow pain that, on examination, were clinically determined to be muscle pain. He was diagnosed with a possible strain. In August 1976, he was treated for complaints of right-hand pain and assessed with probable tendonitis. Thereafter, no further treatment for any complaints relating to his upper extremities, including his elbows, wrists, and hands are shown for his remaining period of service, a period of about one year and two months. Upon separation examination in October 1977, the Veteran's upper extremities, and neurological system, were clinically normal. In the accompanying medical history questionnaire, he did not report having any pertinent history with regard to carpal tunnel syndrome or upper extremity symptoms. As for the post-service medical evidence, this evidence shows that the Veteran was employed as a corrections officer. The earliest recorded notation of symptoms relating to his forearms and hands is an August 1980 VA treatment note showing that the Veteran was treated for a pain affecting an unspecified finger on an unspecified hand, which he reported having for "many years" and with no history of precipitating injury. The impression was sprained finger. An October 1980 VA treatment note shows that the Veteran injured his right hand when he fell on it, producing complaints of pain and "knots." The diagnostic impression was strain of the right 3rd metacarpal digit and a ganglion cyst of the right wrist. Private medical reports, dated in July 1999, show treatment for right forearm pain following an accidental fall at the workplace. The Veteran was diagnosed with bilateral carpal tunnel syndrome (CTS), with his right forearm more symptomatic than the left. In December 1999, the Veteran underwent surgery for carpal tunnel release of his right wrist and forearm. In November 2011, May 2017, February 2018, and June 2020, negative medical opinions were obtained on a direct basis. See 38 C.F.R. § 3.303. The June 2020 VA medical opinion shows that the examiner stated the following: The Veteran has been found to have diabetes mellitus since November 1979. A review of medical literature shows that CTS and diabetic polyneuropathy are common conditions in patients with type 1 and type 2 diabetes. The prevalence of CTS is thought to be higher in patients with diabetic polyneuropathy than in the general population, and the treatment less successful. CTS and diabetic polyneuropathy are common conditions in patients with diabetes. The prevalence of CTS is thought to be higher in patients with diabetic polyneuropathy than in the general population, and the treatment is less successful. The examiner concluded that the Veteran’s CTS is not related to his military service, “but to injury and thereafter more likely to Veteran's diabetes.” Service connection is currently in effect for disabilities that include diabetes mellitus, type 2. The June 2020 VA opinion is favorable evidence that indicates that the Veteran’s bilateral CTS is related to his service-connected diabetes mellitus. See 38 C.F.R. § 3.310. There is no competent, countervailing opinion of record on the issue of secondary service connection. Given the favorable June 2020 VA medical opinion, and the absence of an negative opinion on the secondary service connection issue, the Board finds that the evidence is at least in equipoise as to whether or not the Veteran’s CTS has been caused or aggravated by his service-connected diabetes mellitus, type 2. Id. Accordingly, service connection for bilateral CTS is warranted as secondary to service-connected disability. T. STEPHEN ECKERMAN Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Alex Bardin, 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.