Citation Nr: 21014462 Decision Date: 03/12/21 Archive Date: 03/12/21 DOCKET NO. 17-44 076 DATE: March 12, 2021 ORDER Entitlement to service connection for bilateral carpal tunnel syndrome is granted. Entitlement to service connection for tinnitus is granted. REMANDED Entitlement to an increased evaluation higher than 10 percent for left knee chondromalacia patella is remanded. Entitlement to an increased evaluation higher than 10 percent for right knee chondromalacia patella is remanded. Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded. FINDINGS OF FACT 1. Resolving reasonable doubt, the Veteran’s bilateral carpal tunnel syndrome is etiologically related to his service. 2. Resolving reasonable doubt, the Veteran’s tinnitus is etiologically related to his military noise exposure. CONCLUSIONS OF LAW 1. The criteria for establishing service connection for bilateral carpal tunnel syndrome have been met. 38 U.S.C.§ 1110, 5107; 38 C.F.R. § 3.303. 2. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1112, 1131, 1154(a), 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from August 1975 to July 1995. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In August 2020, a Video Conference Board hearing was held before the undersigned. A transcript of the hearing is associated with the Veteran’s claims file. Service Connection 1. Entitlement to service connection for bilateral carpal tunnel The Veteran has asserted he suffers from bilateral carpal tunnel syndrome that originated during his time in service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. Certain chronic diseases, including organic diseases of the nervous system, may be presumed to have been incurred in or aggravated by service if manifest to a compensable degree within one year of discharge from service, even though there is no evidence of such disease during service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309(a). In addition, when chronic disease shown as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributed to intercurrent causes. 38 C.F.R. § 3.303 (b). Continuity of symptomatology is required only where the condition noted during service is not, in fact, shown to be chronic or when the diagnosis of chronicity may be legitimately questioned. Id. STRs are negative for any complaints or reports related to his hands. Private treatment records from Mercer Medical center, detail treatment for his bilateral upper extremities. An EMG was done in November 1995, following complaints of numbness in his hands. He was diagnosed with moderate to severe bilateral median nerve entrapment at the wrist. A December 1995 treatment note diagnosed him with moderate to severe bilateral carpal tunnel syndrome. He had carpal tunnel release surgery on his right arm December 1995 then left arm in February 1996. At a January 2017 VAMC visit, the Veteran reported bilateral carpal tunnel syndrome dating back to service that continued to cause him pain and discomfort. At the Board hearing he reported undergoing carpal tunnel surgery within two months of discharge. He reported experiencing numbness in his fingers, and sharp pains that ran up his arms during service. He reported working as a professional recruiter, which required doing mail outs and typing regularly. Following service discharge, he had treatment at Mercer Buck Orthopedics. The first operation was in December 1995 on his right hand, and the left hand was done in February 1996. It has been documented on multiple occasions that the Veteran experienced pain dating back to his time in service. There is evidence within one year of discharge of bilateral carpal tunnel syndrome, and a release. He has reported the same symptoms and functional impairment since the date of initial filing, and has been consistent in his reporting. Resolving reasonable doubt in favor of the Veteran, there is competent evidence of a bilateral carpal tunnel syndrome within one year of his separation from active service. The criteria for service connection for bilateral carpal tunnel syndrome are met and the claim is granted. 38 U.S.C. § 1112, 5107(b); 38 C.F.R. §§ 3.102, 3.303(b), 3.307, 3.309. 2. Entitlement to service connection for tinnitus The Veteran contends that he suffers from tinnitus that can be attributed to noise exposure sustained during service. The Veteran’s service personnel records document that during service his specialty was Navy recruiter canvasser, and advanced undersea maintenance weapons man. He was also an advanced torpedo technician and sharpshooter. His service treatment records (STRs) do not contain reports of tinnitus. In November 2015, the Veteran underwent an examination. The Veteran reported tinnitus for the prior 15 years. The examiner indicated that in the absence of objectively verifiable noise injury, the association between tinnitus and noise exposure is speculative. At a March 2016 cardiology visit, the examining provider indicated the Veteran suffered from tinnitus. At the Board hearing the Veteran testified to experiencing tinnitus ever since his time in service. The Veteran reported serving in the weapons department. He stated his general quarters station was inside the gun mount, and he was the gun captain. He reported then serving as a torpedoman, and being on the main deck during the firing of the weapons. He reported exposure to loud noise. He reported experiencing buzzing, and humming in his hears during service and ever since. Based on the Veteran’s competent and credible statements and evidence of his in-service occupation and service, the Board finds that exposure to hazardous noise levels to be consistent with the places and circumstances of her service. Therefore, the remaining inquiry is whether there is a nexus, or link, between the Veteran’s tinnitus and such in-service noise exposure. Although there is no positive opinion of record, the Veteran has conceded noise exposure, hearing related complaints since service, current complaints of tinnitus since service. There is competent and credible testimony indicating ongoing hearing problems since service. As such, all reasonable doubt is resolved in the Veteran’s favor, and service connection for tinnitus is granted. REASONS FOR REMAND 1. Entitlement to an increased evaluation higher than 10 percent for left knee chondromalacia patella is remanded. 2. Entitlement to an increased evaluation higher than 10 percent for right knee chondromalacia patella is remanded. At the Board hearing the Veteran testified to a worsening of his bilateral knee symptoms. He reported extreme pain when going up or down stairs. He also reported popping in his knees, and instability. His last examination was in July 2017. Therefore, a new examination is needed to determine the current state of his bilateral knee conditions. 3. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is remanded. He had a psychiatry consult in January 2017, at which time he was noted as having depressive disorder, and rule/out PTSD. At the Board hearing the Veteran reported being stationed in Djibouti. He stated a shipmate fell off of a truck and died from a head injury. He reported having nightmares of visualizing his shipmates fall and ultimate death. He reported having depression and anxiety issues for a long time. An examination is needed to determine the etiology of his claimed psychiatric disorder. The matters are REMANDED for the following action: 1. Schedule the Veteran for an appropriate VA examination to evaluate the current severity of his right and left knee chondromalacia patella. The examiner is asked to ensure that the examination includes the findings required by Correia v. McDonald, 28 Vet. App. 158 (2016), Sharp v. Shulkin, 29 Vet. App. 26 (2017). 2. Schedule the Veteran for an examination for acquired psychiatric disorder, to include PTSD. The examiner is asked to answer the following: Is it at least as likely as not that any diagnosed acquired psychiatric disorder, to include PTSD, is related to his service? The examiner is asked to provide a rationale for any opinions rendered. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Skiouris, 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.