Citation Nr: 21011457 Decision Date: 03/01/21 Archive Date: 03/01/21 DOCKET NO. 13-22 226A DATE: March 1, 2021 ORDER Entitlement to service connection for a muscle injury to the left hand to include Dupuytren’s contracture is denied. Entitlement to service connection for nerve damage to the left hand to include carpal tunnel syndrome is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that a muscle injury to the left hand to include Dupuytren’s contracture began during active service, or is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence is against finding nerve damage to the left hand to include carpal tunnel syndrome began during active service, or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a muscle injury to the left hand to include Dupuytren’s contracture are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for nerve damage to the left hand to include carpal tunnel syndrome are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Navy from April 1982 to March 1985. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (noting that nexus may be demonstrated by a showing of continuity of symptomatology where the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a)). 1. Entitlement to service connection for a muscle injury to the left hand to include Dupuytren’s contracture With regard to a present disability, an October 2019 VA examiner diagnosed the Veteran with Dupuytren’s contracture. Thus, the first service connection element is met. With regard to an in-service disease or injury, the Veteran’s service treatment records (STRs) show the veteran sought treatment for an injury to the left hand in July 1982. The Veteran was treated following an accident where he tripped and landed on a 7cm piece of glass. Accordingly, the second service connection element is also met. Turning to nexus, the evidence of record does not support that the Veteran’s current left-hand muscle injury to include Dupuytren’s contracture is etiologically related to his active service. In December 2012, the Veteran was afforded a VA examination of the hand. The examiner opined the Veteran’s current residual impairment of the left hand is most likely due to his Dupuytren’s contracture and resulting surgical treatment and not his left-hand scarring and foreign body retention due to his injury in the military. The examiner noted the Veteran’s surgery to the left hand in 2009 was performed to correct loss of motion, stiffness, and pain, which was due to the Dupuytren’s contracture. Following Board remand, the Veteran was afforded an additional VA examination in October 2019. The examiner stated that there was insufficient evidence to support that the Veteran has a residual muscle damage to his left hand as a result of the left-hand injury sustained in military service or from the subsequent foreign body removal. The examiner noted that specifically there is no evidence of muscle related injuries other than those related to his Dupuytren’s contracture. Following another Board remand, in July 2020, a VA examiner opined there was insufficient evidence to support that the Veteran’s Dupuytren’s contractures are due to or related to the injury to the left hand sustained in military service. The examiner noted that the Veteran has evidence of bilateral Dupuytren’s contractures for which he underwent left hand operative intervention in 2007. The examiner further noted while the exact cause of Dupuytren’s contractures is not known, it is generally thought to be secondary to conditions other than a laceration to the palm. The examiner stated that it would be unlikely that the Veteran’s left-hand laceration, residual glass, and/or foreign body removal would be responsible for the bilateral, symmetric condition of Dupuytren’s contractures which is affecting is fourth and fifth fingers. Therefore, the examiner opined it is less likely than not that the Veteran’s Dupuytren’s contractures are related to service. In February 2018, the Veteran, through his representative, submitted a statement regarding the claim for service connection for his left-hand injuries. Specifically, the Veteran stated that the 2009 surgery for his left hand was due to the foreign bodies in his left hand rather than the Dupuytren’s contracture. Further, the Veteran noted that the Dupuytren’s contracture in his left hand is more severe than his right hand. The Veteran’s own lay opinion in this matter (that his left-hand muscle condition is related to his in-service injury) is not probative evidence. Lay persons are competent to provide opinions on some medical issues; however, the diagnosis and etiology of a hand condition is complex and could have multiple possible causes and thus, falls outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 429 F.3d 1372 (Fed. Cir. 2007). While the Board does not discount the Veteran’s issues with his left hand as a result of the in-service injury, the preponderance of the available medical evidence does not support that the Veteran’s current left-hand muscle impairment is related to service. There have not been any probative medical opinions which have provided a positive nexus opinion. While the Board notes the Veteran believes his left-hand muscle injury is a result of his in-service injury, the Board must afford less weight to his lay opinion in this matter as he does not possess the requisite medical expertise to provide such an opinion as noted above. Accordingly, the Board finds that the weight of the evidence is against finding the Veteran’s left-hand muscle injury and Dupuytren’s contractures are related to his active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. As the preponderance of the evidence is against the claim, further application of the benefit-of-the-doubt doctrine is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Board is grateful for the Veteran’s honorable service, and this decision is not meant to detract in any way from the Veteran’s service. Unfortunately, however, for the reasons and bases discussed above, the competent and probative evidence of record preponderates against a finding that the Veteran’s left-hand muscle injury and Dupuytren’s contraction is service connected. 2. Entitlement to service connection for nerve damage to the left hand to include carpal tunnel syndrome With regard to a present disability, an October 2019 VA examiner diagnosed the Veteran with carpal tunnel syndrome. Thus, the first service connection element is met. With regard to an in-service disease or injury, the STRs show the veteran sought treatment for an injury to the left hand in July 1982. The Veteran was treated following an accident where he tripped and landed on a 7cm piece of glass. Accordingly, the second service connection element is also met. Turning to nexus, the evidence of record does not support that the Veteran’s current left-hand nerve condition to include carpal tunnel syndrome is etiologically related to his active service. The Veteran was afforded a VA examination of the peripheral nerves in October 2019. The examiner stated that there was insufficient evidence to support that the Veteran had residual nerve damage to his left hand as a result of the left-hand injury sustained in military service or from the subsequent foreign body removal. The examiner found that there is no evidence of nerve related injuries other than those related to his carpal tunnel syndrome. In July 2020, a VA examiner opined there was insufficient evidence to support that the Veteran’s left-hand nerve condition, carpal tunnel syndrome, is due to or related to the injuries or events sustained in the Veteran’s military service. The examiner stated that carpal tunnel syndrome is due to compression of the median nerve, generally as it runs through the carpal tunnel, and is generally associated with repetitive motions, such as those that would be present with his post-service job as an E-Bay consultant. The examiner opined the Veteran’s carpal tunnel syndrome is thereby less likely than not due to the left-hand injury sustained in service. The examiner noted carpal tunnel was the Veteran’s the only diagnosed nerve condition of the left hand. Accordingly, the Board finds that the weight of the evidence is against finding the Veteran’s left-hand nerve condition to include carpal tunnel syndrome is related to his active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. As the preponderance of the evidence is against the claim, further application of the benefit-of-the-doubt doctrine is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Board is grateful for the Veteran’s honorable service, and this decision is not meant to detract in any way from the Veteran’s service. Unfortunately, however, for the reasons and bases discussed above, the competent and probative evidence of record preponderates against a finding that the Veteran’s left-hand nerve condition to include carpal tunnel syndrome is service connected. Zi-Heng Zhu Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Laura C. Owens 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.