Citation Nr: 21015955 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 13-18 406A DATE: March 18, 2021 ORDER Entitlement to service connection for a left-hand disorder, to include carpal tunnel syndrome and Raynaud's syndrome is denied. FINDING OF FACT The most probative evidence weighs against a finding that the Veteran's left-hand disorder had onset during active service, manifested within one year of service discharge, or is otherwise related to active service CONCLUSION OF LAW The criteria for service connection for a left-hand disorder have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1982 to February 1997. This case comes to the Board of Veterans’ Appeals (Board) on appeal from an April 2012 rating decision by the Department of Veterans’ Affairs (VA) Regional Office (RO) in Detroit, Michigan. In January 2017, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge (VLJ). This matter was previously before the Board in March 2018 and April 2020 when it was remanded for additional development. 1. Entitlement to service connection for a left-hand disorder, to include carpal tunnel syndrome and Raynaud's syndrome, is denied. Initially the Board notes that in accordance with the April 2020 Board remand directives, the Veteran was scheduled for a VA examination concerning his claim for entitlement to service connection for a left-hand disorder. A June 2020 correspondence from a VA medical center noted that the Veteran cancelled his scheduled examination for the left-hand disorder. A November 2020 Report of General Information noted that the RO contacted the Veteran regarding the cancelled VA medical examination. The Veteran reported that he was not aware of his left-hand claim and stated that he wanted to withdraw since he was now rated at 100 percent disabled. The Veteran reported that he would provide a signed statement to withdrawal his claim and forward as soon as possible. The RO followed up with the telephone conversation regarding the hand condition withdrawal and enclosed VA Form 21-4138 for the Veteran to complete to effectuate his withdrawal. A December 2020 email from the Veteran showed that he inquired about the proper documents to submit to withdrawal his appeal. According to 38 C.F.R. § 20.204(a), only an appellant, or an appellant's authorized representative, may withdraw an appeal. When an appeal is not withdrawn on the record at a hearing, withdrawal of an appeal must be in writing and must include the name of the Veteran, the applicable claim number, and a statement that the appeal is being withdrawn. 38 C.F.R. § 20.204(b). In this case, the email and telephone correspondence above does not satisfy the requirements for a withdrawal, as it was not presented by the Veteran or an authorized representative and does not comply with the criteria set forth in 38 C.F.R. § 20.204(b). Therefore, the Board finds that the Veteran's claim of entitlement to service connection for a left-hand disorder has not been withdrawn. The Board also notes that the Veteran cancelled his appointment for an examination concerning the etiology of his left hand disorder, and did not attempt to reschedule or provide good cause for his cancellation despite correspondence from the RO of informing him of such. He has not responded or explained in any way the reason for his failure to schedule a new VA examination. The Board emphasizes that the duty to assist a claimant is not a one-way street, and in this case the Veteran has failed to cooperate in the development of his claim. Olsen v. Principi, 3 Vet. App. 480 (1992); Wood v. Derwinski, 1 Vet. App. 406 (1991); 38 C.F.R. § 3.655. Therefore, the Board will adjudicate the claim based on the evidence of record. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303(a) (2017). 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. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2017). In addition, service connection for certain chronic diseases, including arthritis, may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137 (2012); 38 C.F.R. §§ 3.307, 3.309(a) (2017); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Additionally, for certain chronic diseases with potential onset during service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309 (2017); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Veteran alleges that during active service he broke up a fight which caused injuries to his left hand. The Veteran reported that he first sought treatment for his left hand after separation from service in 2010. The Veteran also reported his left hand being sensitive to the weather and he had been experiencing pain since separation from service. See October 2017 Board Hearing Transcript. First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The October 2019 VA examination diagnosed arthritis degenerative and Raynaud’s syndrome. Accordingly, the first element is met. Second, the Board finds that there was an in-service injury. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). A February 1984 service treatment record shows that the Veteran reported left hand pain and swelling. Accordingly, the second element is met. Third, the Board finds that the evidence of record does not support a finding that the left-hand disorder is related to active service or manifested within one year after separation from service. October 2010 private treatment records showed the Veteran reported his left hand was bitten by a dog one year prior. X-rays taken were unremarkable. The Veteran did not report or reveal that he had injured his hand during service or that he had been experiencing left hand pain since separation from service. The Veteran was afforded VA examinations in July 2011 and October 2019. The October 2019 VA examiner diagnosed arthritis degenerative and Raynaud’s syndrome affecting his left hand. After review of the evidence of record the examiner opined that it was less likely than not that the disability was caused by active service. The examiner remarked that during service, the condition was acute only. Post-service, the examiner noted left hand treatment reports in 1992, 2011, 2013 with reports of bilateral carpal tunnel and ulnar tunnel that were unrelated to the in-service left-hand crush injury. The examiner noted that Raynaud’s syndrome may be related to the crush injury but this was unknown given the properties of Raynaud’s syndrome. No evidence of chronicity of care or nexus were established. The Board finds this opinion probative as it was accompanied by a detailed explanation, and specifically noted that the Veteran’s service treatment records described an acute left hand injury with no further diagnosis, and post-service treatment concerning the left hand were not related to the inservice injury. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (holding that factors for assessing the probative value of a medical opinion are the physician’s access to the claims file and the thoroughness and detail of the opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions). However, the probative value is reduced as the examiner did not address all of the relevant evidence of record, as noted in a prior Board remand. But the Veteran cancelled his examination to attempt to obtain a more probative opinion. Furthermore, the Board finds it significant that the Veteran did not report a chronic left-hand disorder in 2010, when imaging was taken of the left hand. Treatment notes associated with the 2010 treatment indicated he experienced a dog bit one year prior and x rays were unremarkable. In this regard, the Board is not relying on the absence of evidence, but on the contemporaneous evidence, including reports by the Veteran, showing that the Veteran did not report an in-service prior injury or chronic symptoms since service. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). Consideration has been given to the assertions of the Veteran that he has a chronic left-hand disorder as a result of his active service. His statements are clearly competent to report symptoms of pain as well as injury. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331. But they are not credible in terms of continuity as they conflict with the 2010 evidence of record. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (noting that the credibility of a witness may be impeached by a showing of interest, bias, inconsistent statements, consistency with other evidence), aff’d, 78 F.3d 604 (Fed. Cir. 1996). To the extent that they describe the Veteran's hand pain, he lacks the medical training or qualification to either diagnose a chronic left-hand disorder disability or opine as to its etiology. Id. Therefore, he cannot provide the requisite nexus opinion. Accordingly, the criteria for service connection have not been met for left hand disorder. That is, the evidence does not show that a left-hand disorder was diagnosed in service or within a year of service, and the weight of the evidence is against a finding that any left-hand disorder has existed continuously since service. Therefore, the claim is denied. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Dworkin, 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.