Citation Nr: 21021357 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 17-28 580A DATE: April 12, 2021 ORDER Entitlement to service connection for a right hand disorder is denied. Entitlement to service connection for headaches is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran’s right hand disorder began during active service or is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence is against finding that the Veteran’s headaches began during active service or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right hand disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for entitlement to service connection for headaches have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from August 1979 to August 1982. In December 2020, the Board of Veterans’ Appeals (Board), in pertinent part, remanded the issues of entitlement to service connection for a right hand disorder and headaches for further development, which has since been completed. Specifically, the Board instructed the Regional Office (RO) to obtain medical opinions pertaining to the Veteran’s claims. See Stegall v. West, 11 Vet. App. 268, 271 (1998). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.902(c). 38 U.S.C. § 7107(a)(2). Service Connection 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, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). 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). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When the preponderance of the evidence is against the claim, the claim must be denied. Id. 1. Right hand disorder The Veteran contends that his right hand disorder is related to service. First, the Board finds that the Veteran has a current disability. A February 2021 VA examiner diagnosed the Veteran with right hand pain. Therefore, the first element of service connection is satisfied. Shedden, 381 F.3d at 1166-67. Second, with regard to an in-service incurrence, the Veteran’s service treatment records (STRs) reflect that the Veteran injured his right third finger in May 1980 when a window came down on it, which resulted in an approximate one inch laceration. Therefore, the second element is also satisfied. Id. The remaining question is whether there is a medical nexus between the Veteran’s currently diagnosed right hand disorder and his service. After careful review of the record, the Board finds that the preponderance of the evidence is against finding a nexus. In August 2019, the Veteran underwent a VA examination, in which the examiner noted a diagnosis of right middle finger laceration with no functional residuals from May 1980. She opined that the Veteran’s right hand disorder was less likely than not related to service because the Veteran’s May 1980 hand injury was acute only and there was no evidence of chronicity of care. Contemporaneous x-rays were negative for abnormalities of the right hand. The August 2019 examiner provided an addendum opinion a few days after her initial opinion. She added that other than requiring suturing to the wound on the right middle finger, there was an absence of any other medical records pertaining to the treatment of the right hand and contemporaneous x-rays yielded normal results. A medical opinion, provided by a VA examiner from a review of available records and without an examination of the Veteran, was associated with the Veteran’s claims file in February 2021. The examiner opined that the Veteran’s right hand disorder is less likely than not related to service. In support of his opinion, he explained that though there was documentation of an injury to the Veteran’s right hand during service, there was no evidence of a fracture or any other component of the injury. The Veteran served an additional two years of service after the injury without evidence of a hand disorder. The Veteran’s separation examination was negative for residuals to that injury, and the medical officer would have had the Veteran’s STRs so it was unlikely that a significant residual hand disorder would have gone unnoted or unreported. As it was the Veteran’s dominant hand, it was unlikely that the Veteran could have completed service without complaints if residuals existed. The February 2021 examiner further explained that the 2019 x-ray was negative except for a tiny corticated ossicle at the radial side of the trapezius, and such could not have been injured at the time of service because it was remote anatomically and would not have been subject to that particular injury. The x-ray was also negative for degenerative joint disease (DJD), but the September 2019 examiner noted diffuse joint involvement with respect to the Veteran’s complaint of hand pain. The February 2021 examiner stated that it was possible the Veteran was in early stages of developing DJD, which would be age appropriate. The Veteran reported in the August 2019 VA examination that he had lifting limits of 40 pounds and difficulty operating a commercial vehicle, as well as “locking up,” which are all consistent with a diagnosis of early degenerative joint change or CTS. Additionally, the examiner noted that the onset of DJD can precede x-ray changes by one to two years. Therefore, it is more likely than not that the Veteran’s diffuse hand pain is due to normal wear and tear with regular use. The Board finds the February 2021 opinion to be probative. While only the August 2019 examiner examined the Veteran, both examiners reviewed the entire claims file and considered the Veteran’s in-service injury, his statements regarding right hand pain, and his post-service medical history. Though the August 2019 examiner’s opinion was conclusory, the February 2021 examiner supported his opinion with a reasoned medical explanation that offered alternative etiologies for the Veteran’s current right hand disorder. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). While the Veteran believes his current right hand disorder is related to his May 1980 right hand injury during service, he has not shown that he has specialized training sufficient to render a competent medical opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). The diagnosis and etiology of a right hand disorder are matters requiring medical expertise to determine. As such, the Veteran’s opinion as to the diagnosis or etiology of his right hand disorder is not competent medical evidence. Therefore, the Board finds the February 2021 VA examiner’s opinion to be significantly more probative than the Veteran’s lay assertions and submissions. See Sacks v. West, 11 Vet. App. 314, 317 (1998). The preponderance of the evidence is against a finding that the Veteran’s current right hand disorder is related to service, and the claim for service connection for a right hand disorder is denied. In reaching this conclusion, the benefit of the doubt doctrine does not apply in this case. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Headaches The Veteran contends that his headaches are related to his service. First, the Board finds that the Veteran has a current disability. An August 2019 VA examiner noted that the Veteran was diagnosed with tension headaches from July 2008. Therefore, the first element of service connection is satisfied. Shedden, 381 F.3d at 1166-67. Second, with regard to an in-service incurrence, the Veteran’s STRs demonstrate that the Veteran complained of headaches in January 1981 and reported “occasional headaches and blurriness” in January 1982. Therefore, the second element is also satisfied. Id. The remaining question is whether there is a medical nexus between the Veteran’s currently diagnosed headaches and his service. Unfortunately, the evidence does not support such a finding. The Veteran appeared for a VA examination in August 2019, during which the Veteran reported onset of headaches in 1982 and that he went to sick call and was given Tylenol for treatment. The August 2019 examiner opined that the Veteran’s headaches were less likely than not related to service because the Veteran’s 1982 report of headache was acute only and there was no documentation of medical attention for headaches until July 2008, and therefore no evidence of chronicity of care. Another VA examiner provided a medical opinion in February 2021 from a review of the Veteran’s claims file. The February 2021 examiner concluded that the Veteran’s headaches were less likely than not related to service. He noted that there were two notations of headache in January 1981 that were associated with a urinary tract infection and do not suggest a headache disorder per se. The Veteran also reported headaches associated with blurred vision at an ophthalmology examination in January 1982 and that a significant correction was made to the Veteran’s ophthalmic prescription. There was no further mention of headaches in service, and the Veteran’s separation examination was negative for a headache disorder, which included a veteran-answered questionnaire which shows a negative response for “frequent severe headaches.” This evidenced the resolution of the documented headaches, which the Veteran himself linked to his vision. The examiner acknowledged that the absence of documentation itself is not enough to deny service connection but found that any headache disorder arising in service and ultimately requiring treatment in 2008 would have required intervention sooner. There is a span of approximately 25 years from service until the Veteran sought care for headaches, which would be unusual for a significant headache disorder. It is more likely that the Veteran’s headaches in service were related to his ophthalmic prescription and abated with adjustment of his prescription, and that the Veteran’s current headache disorder began in 2008. The February 2021 opinion has high probative value because it is based on an accurate medical history and provides explanations that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In particular, the examiner’s rationale is consistent with the evidence concerning the nature and timing of the Veteran’s headaches. Additionally, the February 2021 examination is corroborated by the Veteran’s July 2008 treatment records, which shows the Veteran first reported experiencing headaches beginning January 2008. While the Veteran believes his headaches are related to his service, he has not shown that he has specialized training sufficient to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). The etiology of a headache disorder is a matter requiring medical expertise to determine. As such, the Veteran’s opinion as to the etiology of his headaches is not competent medical evidence. Therefore, the Board finds the February 2021 VA examiner’s opinion to be significantly more probative than the Veteran’s lay assertions and submissions. See Sacks v. West, 11 Vet. App. 314, 317 (1998). The Board is grateful for the Veteran’s honorable service, and this decision is not meant to detract from that service. However, given the record before it, the Board finds that evidence in this case does not reach the level of equipoise. See 38 U.S.C. § 5107(a); 38 C.F.R. § 3.102. Unfortunately, the Board concludes that service connection for headaches is not warranted at this time. In reaching this conclusion, the benefit of the doubt doctrine does not apply in this case. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). [CONTINUED ON NEXT PAGE] Of final note, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Kate E. Kovarovic Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. L. Park, Associate 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.