Citation Nr: 21022044 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 17-31 081 DATE: April 14, 2021 ORDER Entitlement to service connection for a left elbow condition is granted. Entitlement to service connection for a left upper extremity condition, as secondary to left elbow condition, is granted. FINDINGS OF FACT 1. The Veteran’s left elbow condition is etiologically related to her service. 2. The Veteran’s left upper extremity condition is associated with her service-connected left elbow condition. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a left elbow condition have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.102, 3.303. 2. The criteria for entitlement to service connection for a left upper extremity condition, as secondary to left elbow condition, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Marine Corps from August 1992 to April 1993. In June 2020, the Veteran testified at a virtual hearing before the undersigned. A transcript of the hearing is associated with the claims file. 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. 1. Left elbow condition The Veteran contends that her left elbow condition is related to service. First, the evidence shows a current disability. Specifically, the Veteran has been diagnosed with chronic left distal biceps tear, as well as left biceps tendon partial tear (chronic), left triceps tendonitis, and left lateral epicondylitis. See July 2020 Third Party Correspondence; July 2017 Medical Treatment Record – Non-Government Facility, p. 4. Therefore, the first element of service connection is satisfied. Shedden, 381 F.3d at 1166-67. Second, with regard to the in-service element, the Veteran’s service treatment records (STRs) have been reviewed and reflect that the Veteran injured her right elbow in March 1993. The Veteran credibly testified that she injured her left elbow, not her right, in March 1993 during physical training after she let go of the pull-up bars. See June 2020 Hearing Transcript. In fact, she testified that she has never injured her right arm. Id. In addition, a June 2020 statement provided by the Veteran’s father was associated with the Veteran’s claim file in July 2020. He stated that the Veteran called him in March 1993 and spoke about sustaining a left arm injury on the pull-up bars and that she was having pain in her left arm but no pain in her right arm. Although the Veteran’s assertions cannot be corroborated by her STRs, the Board finds that the Veteran is competent to report experiencing pain in her left arm, not right arm, and that her assertions are credible. Therefore, affording the Veteran the benefit for the doubt, the second element of service connection is also satisfied. Id. The remaining question is whether there is a medical nexus between the Veteran’s currently diagnosed left elbow condition and her service. On this matter, the evidence preponderates in favor of nexus. In July 2020, a June 2020 private opinion provided by Dr. J.T.G., the Veteran’s treating physician, was associated with the Veteran’s claims file. Dr. J.T.G. noted that history, imaging, and exams were consistent with a chronic left distal biceps tear. He opined that it was greater than 50 percent probability and at least as likely as not that the Veteran’s current left arm symptoms and conditions are due to the injury she sustained while in the Marine Corps as described by the Veteran. He explained that the MRI of the left elbow from April 2016 shows that the injury is chronic in nature as the thickening and scarring of the tendon does not indicate an acute injury. After careful consideration, and with no conflicting evidence, the Board finds that the evidence regarding nexus is at least in equipoise. When the evidence for and against a claim is in relative equipoise, the Board has an obligation to resolve all reasonable doubt in favor of the Veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Resolving all reasonable doubt in the Veteran’s favor, the Board finds that the third element of service connection is established. See Shedden, 381 F.3d at 1166-67. As all three elements of service connection are met, service connection for a left elbow condition is warranted. 2. Left upper extremity condition The Veteran asserts that her left upper extremity condition is secondary to her left elbow condition. Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra. First, the record shows the Veteran was diagnosed with left ulnar neuritis/cubital tunnel in May 2017. See July 2017 Medical Treatment Record – Non-Government Facility, p.4. Thus, the first element of secondary service connection has been met. Wallin, 11 Vet. App. at 512. Second, as the Board has granted service connection for the Veteran’s left elbow condition in the above discussion, the second element of secondary service connection is met. Wallin, 11 Vet. App. at 512. The remaining question is whether there is a medical nexus between the Veteran’s currently diagnosed left upper extremity condition and her service-connected left elbow condition, and the evidence preponderates in favor of nexus. In that May 2017 progress note, the Veteran’s treating physician, Dr. C.L.D., noted that the Veteran complained of intermittent left upper extremity numbness and tingling throughout her left hand and diffuse pain of the left elbow. He diagnosed the Veteran with left biceps tendon partial tear (chronic), left triceps tendonitis, left lateral epicondylitis, and left ulnar neuritis/cubital tunnel, which appeared to be associated with inflammation and trauma that the Veteran previously sustained. He found that the inflammation from the Veteran’s tendonitis/biceps tendon injury appeared to be affecting her ulnar nerve and causing irritation/cubital tunnel symptoms. After careful consideration, and with no conflicting evidence, the Board finds that the evidence regarding nexus is at least in equipoise. When the evidence for and against a claim is in relative equipoise, the Board has an obligation to resolve all reasonable doubt in favor of the Veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Resolving all reasonable doubt in the Veteran’s favor, the Board finds that the third element of secondary service connection is established. See Wallin, 11 Vet. App. at 512. As all three elements of secondary service connection are met, service connection for a left upper extremity condition is warranted. A. S. CARACCIOLO 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.