Citation Nr: 21013809 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 19-00 316A DATE: March 10, 2021 ORDER The claim for an initial disability rating in excess of 10 percent for degenerative arthritis of the right knee is denied. The claim for an initial compensable rating of shortening of the right leg, as secondary to the service-connected degenerative arthritis of the right knee, is denied. The claim of service connection for carpal tunnel syndrome of the right hand and wrist is denied. The claim of service connection for arthritis of the right wrist is denied. FINDINGS OF FACT 1. The Veteran’s right knee disability has not been shown to result in extension being functionally limited to 15 degrees or worse; or flexion being functionally limited to 30 degrees or less. There is no evidence of ankylosis, recurrent subluxation or lateral instability, dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the joint, impairment of the tibia and fibula, or genu recurvatum, or any meniscus injury. 2. For the entire period on appeal, the Veteran’s right leg length discrepancy has measured between 1.5 to 2 centimeters. 3. The preponderance of the evidence is against a finding that the Veteran’s carpal tunnel syndrome of the right hand and wrist had an onset in service or was otherwise related to his active military service. 4. The preponderance of the evidence is against a finding that the Veteran’s arthritis of the right wrist disability had an onset in service or is otherwise related to his active military service. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating in excess of 10 percent for degenerative arthritis of the right knee have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5010, 5260. 2. The criteria for entitlement to an initial compensable disability rating for shortening of the right leg, as secondary to the service-connected degenerative arthritis of the right knee, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, Diagnostic Code (DC) 5275. 3. The criteria for service connection for carpal tunnel syndrome of the right hand and wrist have not been met. 38 U.S.C. § 1101, 1110, 1131, 5103, 5103A; 38 C.F.R. §§ 3.303, 3.307, 3.309. 4. The criteria for service connection for arthritis of the right wrist have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5103, 5103A; 38 C.F.R. § 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from August 1962 to September 1988. In April 2020, the Board remanded the issues for additional development. Such development was undertaken, and the case is returned to the Board for further consideration. See Stegall v. West, 11 Vet. App. 268 (1998). Increased Rating 1. The claim for an initial disability rating in excess of 10 percent for degenerative arthritis of the right knee The Veteran seeks an increased rating in excess of 10 percent for his right knee disability. The Veteran’s right knee disability is rated at 10 percent for degenerative arthritis 38 C.F.R. § 4.71a, Diagnostic Codes (DCs) 5010-5260 on the basis of traumatic arthritis with noncompensable limitation of motion. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating assigned. 38 C.F.R. § 4.27. Here, the Veteran’s right knee disability has been partially described as traumatic arthritis (DC 5010), which has been rated on the basis of limitation of knee flexion under DC 5260. For VA compensation purposes, normal range of motion for the knee is flexion to 140 degrees and extension to zero degrees. 38 C.F.R. § 4.71, Plate II. Diagnostic Codes 5260 and 5261 provide for rating based on limitation of motion. Evaluations for limitation of flexion of a knee are assigned as follows: flexion limited to 45 degrees is assigned a10 percent rating; flexion limited to 30 degrees is assigned a 20 percent rating; and flexion limited to 15 degrees is assigned a 30 percent rating. 38 C.F.R. § 4.71a DC 5260. Evaluations for limitation of extension of the knee are assigned as follows: extension limited to 10 degrees is assigned a 10 percent rating; extension limited to 15 degrees is assigned a 20 percent rating; extension limited to 20 degrees is assigned a 30 percent rating; extension limited to 30 degrees is assigned a 40 percent rating; and extension limited to 45 degrees is assigned a 50 percent rating. 38 C.F.R. § 4.71a, DC 5261. VA General Counsel has also held that separate ratings may be assigned under DC 5260 and DC 5261, where a Veteran has both a limitation of flexion and limitation of extension of the same leg; limitations must be rated separately to adequately compensate for functional loss associated with injury to the leg. VAOPGCPREC 9-2004 (Sept. 17, 2004). DC 5257 pertains to other impairment of the knee involving recurrent subluxation or lateral instability and provides a 10 percent rating for slight impairment, a 20 percent rating for moderate impairment, and a 30 percent rating for severe impairment. 38 C.F.R. § 4.71a, DC 5257. The terms slight, moderate, and severe as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence. 38 C.F.R. § 4.6. It should also be noted that use of terminology such as severe by VA examiners and others, although an element to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. Under Diagnostic Code 5258, dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint will be rated as 20 percent disabling. 38 C.F.R. § 4.71a, Diagnostic Code 5258. Under Diagnostic Code 5259, removal of semilunar cartilage that is symptomatic will be assigned a 10 percent disability rating. 38 C.F.R. § 4.71a, Diagnostic Code 5259. Under Diagnostic Code 5262, malunion of the tibia and fibula with moderate knee or ankle disability will be assigned a 20 percent disability rating, malunion of the tibia and fibula with marked knee or ankle disability will be assigned a 30 percent disability rating, and nonunion of the tibia and fibula with loose motion, requiring a brace, will be assigned a 40 percent disability rating. 38 C.F.R. § 4.71a, Diagnostic Code 5262. VA General Counsel has held that separate ratings may be assigned for arthritis and instability under Diagnostic Codes 5003 and 5257. See VAOPGCPREC 23-97 (July 1, 1997). The criteria for evaluating degenerative arthritis are set forth at 38 C.F.R. § 4.71a, DC 5003. Degenerative arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, DC 5003. In the absence of limitation of motion, a 10 percent rating is warranted for x-ray evidence of arthritis with evidence of involvement of two or more major joints or two or more minor joint groups, and a 20 percent rating is warranted for x-ray evidence of arthritis with evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations. Id. The 20 percent and 10 percent ratings based on x-ray findings will not be combined with ratings based on limitation of motion. Id., Note 1. In addition, the 20 percent and 10 percent ratings based on x-ray findings will not be utilized in rating conditions listed under diagnostic codes 5013 to 5024. Id., Note 2. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the United States Court of Appeals for Veterans Claims (Court) held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing “for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint.” The spine has no opposite joint. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination.] The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for the service-connected right knee degenerative arthritis. With regard to a rating of 20 percent for limitation of flexion under DC 5260, VA examinations, conducted in February 2017, July 2020 and January 2021, reveal that the Veteran's flexion of the right knee was limited, at most, to 110 degrees despite the pain, which is significantly greater than the 30 degrees required for a 20 percent rating. As such, a rating in excess of 10 percent under Diagnostic Code 5260 is not available. With regard to a higher rating of 20 percent for limitation on extension under DC 5261, these VA examinations show that the Veteran had full extension of the right knee. A 20 percent rating would require extension to be limited to 15 degrees or greater, which is not supported by the record. According, a higher 20 percent rating under Diagnostic Code 5261 is not warranted. The Board also considered whether a higher disability evaluation is warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of the right knee joint under 38 C.F.R. §§ 4.40 and 4.45. See DeLuca v. Brown, 8 Vet. App. 202 (1995). Here, the Veteran consistently complained of pain and tenderness of the right knee. However, the VA examinations reflect that despite these complaints, the Veteran still demonstrated range of right knee motion to 120, 100 and 110 degrees of flexion in February 2017, July 2020 and January 2021, respectively. In addition, he was consistently able to complete repetitive motion testing at all three examinations without any additional loss of range of motion. Pain, weakness, etc. were not shown to otherwise limit the range of motion in the Veteran's right knee such that a high disability rating would be warranted at any time. VA and private treatment records do not show range of motion results which substantively differ from the findings at the VA examinations during the course of the appeal. The Board has also considered the other Diagnostic Codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). Specifically, disabilities of the knee and leg may also be evaluated under Diagnostic Codes 5256, 5258, 5257, 5259, 5262 or 5263. However, the medical and lay evidence shows that the Veteran’s right knee disability is not manifested by ankylosis, a meniscal condition, or any impairment of the tibia and fibula or genu recurvatum. The Board also finds that the weight of the evidence is against finding instability symptoms for a separate rating of the right knee under Diagnostic Code 5257. During the pendency of the appeal, the rating criteria for evaluating recurrent subluxation or lateral instability of the knee under 38 C.F.R. § 4.71a, Diagnostic Code 5257 were amended, effective February 7, 2018. 85 Fed. Reg. 76453. It is noted that on February 7, 2021, during the course of this appeal, revisions to the Schedule for Rating Disabilities that addresses the musculoskeletal system went into effect. The United States Supreme Court has held that statutes generally may not be construed to have retroactive effect unless their language requires that result. See Landgraf v. USI Film Products, 511 U.S. 244 (1994). In Karnas, the Federal Circuit held that the more favorable regulations should apply to the Veteran. See Karnas v. Derwinski, 1 Vet. App. 308 (1991). However, the Federal Circuit overruled Karnas to the extent that it allowed for retroactive application and conflicted with U.S. Supreme Court and Federal Circuit precedents. Specifically, in Kuzma, the Federal Circuit held that the Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Thus, Karnas allows the old criteria to be applied before and after the effective date of the amendment, if such is more favorable to the Veteran. But, in light of Kuzma, the amended regulation cannot be applied prior to the effective date unless it explicitly provides otherwise. In other words, the old and new regulations are for consideration with regard to rating the Veteran’s disability, and he is entitled to the more favorable regulation; however, if the revised criteria are more favorable to the Veteran and provide for an increased rating, that award may not be made effective before the effective date of the change. See 38 U.S.C. § 5110 (g); VAOPGCPREC 3-00. Here, the amendments to the rating schedule do not have any retroactive application. Therefore, the Board will consider the Veteran’s claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021, and the criteria that is more favorable to the Veteran will be applied. Prior to February 7, 2021, Diagnostic Code 5257 evaluated recurrent subluxation or lateral instability of the knee. It provided a 10 percent disability rating for slight recurrent subluxation or lateral instability. A 20 percent disability rating was warranted for moderate recurrent subluxation or lateral instability. Severe recurrent subluxation or lateral instability warranted a 30 percent disability rating. The Court recently held that nothing in Diagnostic Code 5257, under the pre-amendment rating criteria, provided that objective medical evidence is required or is to be favored over lay evidence in determining whether to assign a rating for lateral instability of the knee. English v. Wilkie, 30 Vet. App. 347, 349 (2018).  As of February 7, 2021, under the amended criteria, Diagnostic Code 5257 evaluates knee, other impairment of, which may be rated under separate criteria for recurrent subluxation or instability or, alternatively, patellar instability. Under the amended criteria for rating recurrent subluxation or instability, a 10 percent disability rating is warranted for a sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g. cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent disability rating is warranted for either: (a) a sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or (b) an unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation warrants a maximum 30 percent disability rating. Under the amended criteria for rating patellar instability, a 10 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: a brace, cane, or walker warrants a 20 percent rating. A maximum 30 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. Diagnostic Code 5257, Note (1), as amended, defines the patellofemoral complex as consisting of the quadriceps tendon, the patella, and the patellar tendon. Note (2) instructs that a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). According to the VA examinations conducted during the appeal period, the Veteran's right knee did not show any evidence of instability on examination. The examiners consistently found no instability or laxity and normal Lachman's and anterior and posterior drawer test results. All of the instability test results were normal. He has never been found to have any injured or torn ligaments. There is no evidence of recurrent subluxation. Finally, there is no evidence of subluxation, or a sprain, incomplete ligament tear, or complete ligament tear resulting in persistent instability. The Board has considered the Veteran's reports of having to use a knee brace but finds this report outweighed by the multiple medical providers' findings of no instability and negative test results. Moreover, the medical providers have the training and experience to best characterize symptoms. Accordingly, a separate disability rating for the right knee instability is not warranted under either the pre-amendment or amended criteria under Diagnostic Code 5257. In conclusion, the preponderance of the evidence is against the assignment of a disability rating in excess of 10 percent for the service-connected right knee disability. In denying such a rating, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. The claim for an initial compensable disability rating of shortening of the right leg, as secondary to the service-connected degenerative arthritis of the right knee The Veteran contends that he is entitled to an initial compensable disability rating for shortening of the right leg, evaluated under Diagnostic Code 5275. Under Diagnostic Code 5275, shortening of the bones of a lower extremity between 1.25 and 2 inches warrants a 10 percent rating. A 20 percent rating is warranted for 2 to 2.5 inches; a 30 percent rating is warranted for 2.5 to 3 inches; a 40 percent rating is warranted for 3 to 3.5 inches; a 50 percent rating is warranted for 3.5 to 4 inches; and a 60 percent rating is warranted for more than four inches. 38 C.F.R. § 4.71a, Diagnostic Code 5275. After reviewing the relevant medical and lay evidence and applying the above laws and regulations, the Board finds that an initial compensable disability rating is not warranted for shortening of the right leg. A VA examination in February 2017 indicates a right leg length of 87.5 cms and a left leg length of 89 cms, or a difference of 1.5 cms. The VA examinations in July 2020 and January 2021 revealed right leg length of 87 cms and a left leg length of 89 cms, or a difference of 2 cms. Based on the foregoing evidence, the Board finds that a compensable rating is not warranted under Diagnostic Code 5275 because the weight of the competent and probative evidence, as described above, is against a finding that the right leg was 1.5 to 2 cms shorter than the left leg at any point during the period on appeal. 38 C.F.R. § 4.71a, Diagnostic Code 5275. All possibly applicable diagnostic codes have been considered but the Veteran could not receive higher and/or additional evaluations for shortening of the right leg based on the evidence. See 38 C.F.R. § 4.71a. Indeed, when a disorder is listed in the Rating Schedule, rating by analogy is not appropriate. Copeland v. McDonald, 27 Vet. App. 333, 336-37 (2015). The Board notes that the benefit of the doubt has been applied, where applicable. Service Connection Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). In general, service connection requires (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310 (a). Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310 (b); see Allen v. Brown, 7 Vet. App. 439, 448 (1995). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection may also be granted for chronic disabilities if such are shown to have been manifested to a compensable degree within one year after the Veteran was separated from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. As an alternative to the nexus requirement, service connection for a chronic disability may be established through a showing of continuity of symptomatology since service. 38 C.F.R. § 3.303 (b). The option of establishing service connection through a demonstration of continuity of symptomatology rather than through a finding of nexus is specifically limited to the chronic disabilities listed in 38 C.F.R. § 3.309 (a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 1. The claim of service connection for carpal tunnel syndrome of the right hand and wrist 2. The claim of service connection for arthritis of the right wrist The Veteran contends that his carpal tunnel syndrome of the right hand and wrist are the result of carrying out his military duties which involved the use of a computer. He stated that he had surgery for his carpal tunnel syndrome which subsequently led to arthritis of the right wrist. Service treatment records show the Veteran reported injury and several complaints regarding his right hand. According to the July 1965 treatment note, the Veteran reported hand complaints, where a metallic foreign body and a paint chip were removed from the right hand. In March 1988, the service treatment records reflect that the Veteran also reported as having back pain as a result of sitting at the typewriter. The May 1988 Report of Medical Examination and Report of Medical History at separation was absent of any on-going right-hand disability. In November 1989, the Veteran was afforded a VA orthopedic examination where he stated he sustained a “crushing injury to his right hand” involving a fracture of the distal fifth metacarpal and had open reduction internal fixation of this joint. An examination of the right hand revealed there was a healed incision over the medial aspect of the 5th metacarpal joint. There were no reports of symptomatology pertaining to carpal tunnel syndrome of the right hand and wrist, or of arthritis of the right wrist. The Veteran was afforded a VA examination of his hand and fingers where opinions were obtained in October 2016 and December 2016 regarding his claim for service connection of a fracture of the right metacarpal with sprain. However, these opinions did not provide an opinion regarding the Veteran’s claims for carpal tunnel syndrome of the right hand and wrist and arthritis of the right wrist. Therefore, in April 2020 the Board determined that given the Veteran’s current diagnosed disabilities of carpal tunnel syndrome of the right hand and wrist, and arthritis of the right wrist, evidence supporting the Veteran’s statements regarding the use of the computer, and complaints of the right hand problems during service, a medical opinion should be obtained. Pursuant to the Board remand, in August 2020 the Veteran was afforded VA examinations where a diagnoses of carpal tunnel syndrome and arthritis of the right wrist were confirmed. Upon examination, a review of the evidence of record, and the Veteran’s lay statements, the VA examiner determined that it was less likely than not (less than 50 percent probability) that the carpal tunnel syndrome or the right wrist arthritis incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner explained that there was no medical record to indicate direct event of symptoms of carpal tunnel syndrome of the right wrist soon after separation from military service. While it was possible that the Veteran developed carpal tunnel syndrome due to extensive typing in service, there was no evidence during or immediately after service. Furthermore, the VA examiner explained that the right wrist arthritis was not related to service as there was no medical evidence that carpal tunnel release surgery led to arthritis of the wrist. However, although carpal tunnel syndrome did not lead to arthritis of the wrist, the VA examiner determined that the Veteran’s right wrist arthritis at least as likely as not aggravated beyond its natural progression by carpal tunnel syndrome. The VA examiner stated that based on private treatment records detailing extensive arthritis of the wrist, due to limited motion of the hand from carpal tunnel release surgery, the degenerative joint disease of the wrist “occurred with significant inflammation of the wrist.” Upon review of the record, the Board finds that service connection for carpal tunnel syndrome of the right hand and wrist and for arthritis of the right wrist are not warranted. Here, the criteria for service connection have not been met for carpal tunnel syndrome of the right hand and wrist or for arthritis of the right wrist. That is, the evidence does not show that these disabilities were diagnosed in service or within a year of service and the weight of the evidence is against a finding that they have existed continuously since service. While the Veteran believes his disabilities began during service, the contemporaneous evidence does not support such a conclusion. First, while the Veteran was treated for injuries to the right-hand during service, any residuals of these injuries or symptoms of carpal tunnel syndrome of the right hand or wrist were not shown by the Report of Medical History or Report of Medical Examination at separation. Second, the November 1989 VA orthopedic examination did not indicate of any presence or symptomatology of carpal tunnel syndrome or right wrist arthritis. This contemporaneous evidence weighs against the Veteran’s contentions offered approximately three decades after separating from service. Finally, the Board acknowledges the VA examiner’s finding that it was possible that the Veteran developed carpal tunnel syndrome due to extensive typing in service. However, the VA examiner nevertheless opined it was less likely than not as there was no evidence of such during or immediately after service. The only evidence of record in support of the Veteran claim consists of his own lay statements. The Veteran is considered competent to report the observable manifestations of his claimed disabilities. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). However, the Veteran is not competent (meaning medically trained) to opine on the diagnosis or etiology of his bilateral hip disabilities. Where a determinative issue involves medical causation or a medical diagnosis, competent medical evidence is required. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In this case, the etiology of the current right hand and wrist disabilities is a complex medical question that is not within the competence of a layperson. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). Furthermore, regarding the question of whether the Veteran’s arthritis of the right wrist was secondary to the carpal tunnel syndrome, the Board concludes that service connection is not warranted. Insofar as the condition to which the Veteran claims this disability is secondary has not been service connected, the claim for secondary service connection must fail. See 38 C.F.R. § § 3.310. The Board acknowledges that the VA examiner determined that the Veteran’s arthritis of the right wrist had been aggravated by his carpal tunnel syndrome release surgery. Unfortunately, as adjudicated above, the Veteran’s carpal tunnel syndrome of the right hand and wrist has not been service connected. For this reason, the claim for secondary service connection must be denied as without legal merit. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Accordingly, the Board finds that the preponderance of the evidence weighs against the claims for service connection for carpal tunnel syndrome of the right hand and wrist, and arthritis of the right wrist, and the claims must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Carole R. Kammel Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Yoo, 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.