Citation Nr: 21012593 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 15-43 987 DATE: March 4, 2021 ORDER Entitlement to service connection for a right wrist disorder is denied. FINDING OF FACT The evidence does not support a finding that the Veteran’s right wrist disorder began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a right wrist disorder are not met. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty for training from April 1976 to July 1976 and served on active duty from July 1980 to June 1995. In November 2018, the Board remanded these issues for additional development. The Board finds that there was substantial compliance with the November 2018 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, a Veteran 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”—the so-called “nexus requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38U.S.C. §5107 (2012); 38C.F.R. §3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, a preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Entitlement to service connection for a right wrist disorder. The Veteran contends that his right wrist disorder is related to an injury in-service. The Board respectfully disagrees. STRs dated August 1992 note a right wrist and forearm complaint. Findings were consistent with a sprain and “possible early” carpal tunnel syndrome of the right wrist. A sprain or the right wrist was noted in September 1992, without further findings. In September 1993 he was seen for a laceration of this right forearm following a fall. It was noted that sensation in the fingers was normal before and after sutures were applied. There are no additional complaints in-service to suggest a finding of chronic symptomatology, although the Veteran was seen for numerous other complaints through the remainder of his service. In February 1995 the Veteran underwent a thorough and extensive retirement examination. The Veteran did not report, nor was he diagnosed with a right wrist disorder. Normal evaluation was reported in pertinent part. When filing a claim for disabilities shortly after service, the Veteran did not include any wrist complaints. A post service joints examination in February 1996 revealed no pertinent complaints or findings. In a May 2010 VA orthopedic examination, the examiner diagnosed the Veteran with carpal tunnel and ulnar syndrome of the right wrist. The examiner noted that the Veteran’s diabetes contributes to his loss of sensation in his right hand. In an October 2010 private examination, the Veteran presented with complaints of right arm numbness. The Veteran reported that he retired from service after twenty-one years with a 50 percent disability rating due to a right hand disorder. The Veteran also reported that during a electromyography (EMG) procedure, he was diagnosed with carpal tunnel syndrome; however, the Veteran explained that he does not recall a particular in-service injury that caused the onset of his right wrist disorder. In a February 2011 VA examination, the Veteran presented with complaints of soreness, stiffness, and cramps in his right wrist. The Veteran reported that he was treated in 1990 for a twisted right wrist during a fall while stationed at Fort Benning. During the examination, the examiner diagnosed the Veteran’s right wrist as normal with associated joint problems indicating a very subtle, but old Colles fracture and possible injury to the scapholunate ligament. The examiner also noted pain with no evidence of functional limitations and no findings of degenerative arthritis of the Veteran’s right wrist. However, the examiner noted that a clinical correlation is needed to determine whether the Veteran has a history of prior right wrist trauma. In an April 2012 VA wrist addendum opinion, the regional office (RO) requested that the examiner determine whether the Veteran’s right wrist disorder is as least as likely as not caused by the Veteran’s history of right wrist injuries. The examiner opined that the Veteran’s right wrist disorder is less likely than not related to his right wrist injury in-service. The examiner explained that during the examination, the Veteran’s right wrist displayed full range of motion. The examiner also noted that the Veteran’s complaints of subjective neurosensory of his right wrist is most likely related to his ulnar neuritis which was diagnosed as a separate entity in an EMG procedure. July 2012 VA outpatient treatment records reveal that the Veteran underwent a right wrist surgical procedure for his carpal tunnel syndrome. In a January 2013 lay statement, the Veteran reported that his right wrist disorder has worsened since his July 2012 carpal tunnel surgical procedure. July 2013 VA radiological findings indicate no acute abnormalities or significant changes of the Veteran’s right wrist since his last February 2011 right wrist findings. In a January 2014 private examination, the examiner diagnosed mild carpal tunnel syndrome of the Veteran’s right wrist. In a July 2015 VA orthopedic follow-up examination, the examiner noted that the Veteran’s carpal tunnel symptoms revealed negative a Tinel’s and Phalen’s testing of the right wrist. Negative median nerve compression of the right wrist with no evidence of thenar atrophy or tenderness. In a September 2019 VA wrist conditions examination, the examiner diagnosed the Veteran with a Colles’ fracture of the right wrist and an injury to the scapholunate ligament. Pain which causes functional loss was noted during the examination. In a September 2019 VA peripheral nerve conditions examination focused on the Veteran right wrist disorder, the examiner diagnosed the Veteran with carpal tunnel syndrome of the right wrist and peripheral neuropathy of the upper right extremity. Pain with numbness and a tingling sensation in the right hand was noted. Intermittent pain of the right wrist was noted as severe. Taking into account both of the above examinations, the examiner opined that the Veteran’s carpal tunnel syndrome is less likely than not related to his time in-service. The examiner explained that the Veteran’s STRs dated August 1992 notes a single right wrist complaint consistent with carpal tunnel syndrome of the right wrist; however, there are no additional complaints in-service to suggest a chronicity. The examiner also opined that the Veteran’s old Colles’ fracture with a possible injury to the scapholunate ligament is less likely than not related to his time in-service. The examiner explained that x-rays indicate and old Colles’ fracture, but not a timeline concerning the onset. Lastly, the examiner opined that the Veteran’s large-fiber peripheral neuropathy manifested with the loss of joint position and vibration sense and sensory ataxia which was not diagnosed as being present during the Veteran’s time in-service. To summarize, the Veteran’s STRs dated August 1992 note a right wrist complaint consistent with possible early carpal tunnel syndrome of the right wrist; however, there are no additional complaints in-service to suggest a continuity of symptomology. There is no indication of any complaints or treatments for any right wrist disorders related to service or for several years post-service. See Mason v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of many years between discharge from active service and the medical documentation of a claimed disability is evidence against a claim of service connection). This premise is further evidenced by the fact that the Veteran did not submit a compensation and pension application for his service-related right wrist disorder until many years after separation from service. In fact the initial claim for disability compensation did not include reference to the right wrist. The Board also reviewed the Veteran’s lay statements that the onset of his right wrist is related to his time in-service. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to his senses. However, the Board must emphasize that the Veteran is not competent to interpret accurately clinical findings pertaining to a right wrist disorder as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Therefore, the foregoing summary of the treatment record reveals no possibility for service connection for a right wrist disorder on a direct basis. Although the Veteran’s STRs dated August 1992 notes a right wrist complaint a sprain was found and at no time in service are there any findings consistent with any fracture of the right wrist. Furthermore, the Board acknowledges the most recent September 2019 VA medical opinion. The examiner explained that with the exception of a single August 1992 treatment in-service for right wrist pain, there are no other record of in-service treatment to suggest a continuity of symptomology. The examiner also explained that x-ray diagnosing the Veteran’s old Colles’ fracture did not have a timeline to determine the onset. However, the Board notes that there is no record of treatment in the Veteran’s STRs for an old Colles’ fracture. Lastly, the examiner noted that the Veteran’s large-fiber peripheral neuropathy manifested with the loss of joint position and vibration sense and sensory ataxia which was not diagnosed as being present during the Veteran’s time in-service. Although the Veteran received treatment for a right wrist pain in-service, it resolved prior to discharge with no residuals reported at his thorough and extensive separation examination. As there is not a significant documented correlation between the Veteran’s in-service treatment for right wrist pain and his diagnosed right wrist disorder many years after service, the Board finds that the Veteran’s right wrist disorder is less likely than not related to an injury, event, or occurrence in-service. Significantly, there is no examiner opinion to the contrary. As a pathology for the onset of a right wrist disorder has not been shown to be related to the Veteran’s time in-service, the Board concludes that the clinical evidence does not support the Veteran’s contentions for a granting of service connection on a direct basis.   Based on this evidence, the Board finds service connection is not warranted. The Board has considered the benefit-of-the-doubt doctrine; however, the Board does not perceive an approximate balance of positive and negative evidence. The preponderance of the evidence is against the claim, the doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107 (b) (2012); 38 C.F.R. § 4.3. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Harris, Michael E. 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.