Citation Nr: 21021130 Decision Date: 04/09/21 Archive Date: 04/09/21 DOCKET NO. 18-39 402 DATE: April 9, 2021 ORDER Entitlement to service connection for carpal tunnel syndrome, right wrist, is denied. FINDING OF FACT The preponderance of the evidence does not show a current diagnosis of carpal tunnel syndrome, right wrist. CONCLUSION OF LAW The criteria for service connection for carpal tunnel syndrome, right wrist, have not been met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.304, 3.385. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from July 2013 to July 2017. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of an January 2018 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. This appeal was previously before the Board and was remanded in April 2019 and September 2020 for additional development. The Board finds there has been substantial compliance with the remand instructions as to the matters of service connection for carpal tunnel syndrome (CTS) of the right wrist. Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Notwithstanding the lack of evidence of disease or injury during service, service connection may still be granted if all of the evidence, including that pertinent to service, establishes that the disability was incurred in service. See 38 U.S.C. § 1113(b); 38C.F.R. §3.303(d); Cosman v. Principi, 3 Vet. App. 503 (1992). To establish a right to compensation for a present disability, 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. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement for a current disability is satisfied if the disability is shown at any time proximate to or subsequent to filing the claim, even if not shown currently. McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013). 1. Entitlement to Service Connection for Carpal Tunnel Syndrome of the Right Wrist The Veteran contends that she has been treated for a right wrist injury and issued a splint for use while in active duty and therefore she is entitled to compensation for carpal tunnel syndrome. See January 2019 VA Form 646, Statement of Accredited Representative in Appealed Case. The initial threshold matter before the Board is whether there is competent evidence that the Veteran currently has (or proximate to or during the pendency of the claim has had) carpal tunnel syndrome. The Veteran has undergone several VA examinations. Of these, only one, the November 2020 contracted VA examination, notes a history or diagnosis of carpal tunnel syndrome or ulnar nerve impingement. In noting this history, however, the November 2020 examiner failed to identify, address, or reconcile a November 2018 diagnosis of right forearm overuse syndrome with the conflicting medical evidence, specifically several other VA examiners’ determinations that the Veteran’s reported symptoms do not coincide with carpal tunnel syndrome. See October 2020 VA Examination Report; February 2020 VA Examination Report; January 2018 VA Examination Report; April 2017 VA Examination Report. Each of these four prior examinations found no pathology consistent with carpal tunnel syndrome. The February and October 2020 VA examinations attributed the Veteran’s symptoms to her right forearm overuse syndrome, for which she has been awarded service connection. A December 2020 VA addendum opinion addressed the apparent conflicting findings. The examiner attributed the Veteran’s reported signs and symptoms to her service-connected right forearm overuse syndrome. The December 2020 VA examiner’s opinion echoed that of the October 2020 examiner, that the Veteran’s right wrist sprain is part and parcel of right arm overuse syndrome and there is no pathology to warrant or support a diagnosis of right wrist carpal tunnel syndrome. Both examiners opined that the signs and symptoms noted during service on January 7, 2016, and January 19, 2016, are not consistent with nerve distribution in carpal tunnel syndrome. The examiners further explained that all of the additional work-up for nerve impingement, such as x-rays and ultrasounds, yielded normal results. Both examiners also opined that the Veteran’s overuse syndrome is related to her service-connected right wrist disorder. In fact, the December 2020 VA examiner’s report cited to current medical literature, including publications from the American Academy of Orthopedic Surgeons, Summit Medical Group, and Cleveland Clinic, identifying that overuse syndrome can be a cause of wrist sprains and other soft tissue injuries. The December 2020 VA examiner further explained that there is no separate diagnosis for service-connected right wrist sprain, right forearm, and hand disorder. The claimed conditions involve adjacent muscles and ligaments and are part of the forearm overuse syndrome, which is already service-connected. Based on the foregoing evidence, the Board finds that the preponderance of the competent evidence of record demonstrates that Veteran does not have carpal tunnel syndrome of the right wrist, and that the complained of symptoms are already service-connected as part of the Veteran’s right wrist sprain. The Veteran is competent to attest to factual matters of which she has first-hand knowledge (e.g., experiencing pain or numbness). To this extent, the Board finds that the Veteran is competent to report that she has current right wrist/arm pain. Kahana v. Shinseki, 24 Vet. App. 428 (2011). Further, the Board has considered her statement in July 2020 that she has difficulty with her right hand, having to squeeze a stress ball to prevent her hand/fingers from locking up. However, as a lay person without extensive medical training and experience, she is not competent to establish a medical diagnosis of carpal tunnel syndrome. Such an opinion is a medical question beyond the scope of lay observation and requires specialized medical expertise and training. Jandreau v. Nicholson, 429 F.3d 1372 (Fed. Cir. 2007). The Veteran lacks such expertise and does not cite to any supporting medical treatise evidence. Further, the Veteran’s statements attributing her symptoms to carpal tunnel syndrome are provided no credible weight. The October and December 2020 VA examiners opinions accounted for the Veteran’s symptoms and found them inconsistent with carpal tunnel syndrome. These signs and symptoms are accredited to her service-connected right wrist sprain which is part of her diagnosed right arm overuse syndrome. As such, the Veteran’s lay observed signs and symptoms are found credible, but her attribution or diagnosis of an underlying condition is not. It is noted that the January 2019 VA Form 646, Statement of Accredited Representative in Appealed Case, argues for application of Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), based on the Veteran’s complaints of arm and wrist pain. As determined in Saunders, pain without a diagnosed condition can be service connected if it results in functional loss that impairs a veteran’s earning capacity. Id. at 1367-68. However, Saunders is inapplicable here as the signs and symptoms have already been rated based on functional disability for the Veteran’s right wrist strain. The medical evidence does not show a separate disability, to include pain due to function loss, for which service connection is warranted. For the foregoing reasons, the preponderance of the evidence establishes that the Veteran does not have a current diagnosis of carpal tunnel syndrome as required for service connection. See Brammer, 3 Vet. App. at 225. The Veteran’s current signs and symptoms are already accounted for by her service-connected right wrist strain. The benefit of the doubt rule does not apply because the preponderance of the evidence is against the Veteran’s claim. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Therefore, the Veteran’s claim for service connection for carpal tunnel syndrome must be denied. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Boushehri, Darjush M. 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.