Citation Nr: 21022070 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 17-19 524 DATE: April 14, 2021 ORDER Entitlement to service connection for chronic right-hand condition is denied. FINDING OF FACT The preponderance of the evidence is against finding that a chronic right-hand condition began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for entitlement to service connection for chronic right-hand condition have not been met. 38 U.S.C. §§ 1110, 1117, 1131, 5107; 38 C.F.R. §§ 3.303, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1987 to August 1991 and from May 1994 to February 1999, including service in Southwest Asia. The Veteran attended a videoconference hearing before the undersigned Veterans Law Judge in February 2020. A transcript of the hearing is of record. This matter was previously remanded by the Board of Veterans’ Appeals (Board) in April 2020. In consideration of the appeal, the Board is satisfied there was substantial compliance with the remand directives and will proceed with review. See, Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for chronic right-hand condition The Veteran claims that service connection is warranted for his claimed right-hand disability. The Veteran specifically contends that his current right-hand symptoms are due to his frequent parachuting in-service, which required him to frequently and firmly grasp parachute risers. Service connection may be granted for 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). The Board notes that in addition to the regulations pertaining to service connection, there are additional regulations in place for Persian Gulf War veterans. In this respect, service connection for chronic, undiagnosed illnesses arising from service in Southwest Asia during the Persian Gulf may be established under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317. Under those provisions, service connection may be established for objective indications of a chronic disability resulting from an undiagnosed illness or illnesses, provided that such disability (1) became manifest in service on active duty in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021; and (2) by history, physical examination, and laboratory tests cannot be attributed to a known clinical diagnosis. To fulfill the requirement of chronicity, the illness must have persisted for six months. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. Signs and symptoms which may be manifestations of undiagnosed illness include, but are not limited to: fatigue, signs or symptoms involving skin, headache, muscle pain, joint pain, neurologic signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper or lower), sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. 38 C.F.R. § 3.317 (b). In August 2015, the Veteran stated that over the past couple of years he has developed a condition in his right hand, where his fingers lock into place and he needs to use his left hand to pry his fingers open. The Veteran further stated that this condition happened to him during the military while on an Airborne jump, “because you have to pull down on riser of parachute in order to steer yourself in a certain direction”. The Veteran further stated that his has experienced this condition in his hand for years and that it also occurred while in the military. Review of the VA treatment records from January 2004 note that the Veteran injured his right hand by punching a fish tank. VA treatment records from January 2009 note that the Veteran injured his right hand when weights fell on his right hand. The Veteran’s physician noted that the Veteran had just gotten over another fracture in his hand that was treated with internal fixation. X-rays showed a comminuted fracture at the base of the 5th metacarpal with an old fracture transversely through the 4th metacarpal. An August 2009 medical treatment record noted that the Veteran had sustained multiple fractures to the right 4th metacarpal. The Veteran reported no dysfunction of his hand or digit and uses it without any restrictions throughout the day during his work. Treatment records from July 2010 note that the Veteran has broken his right hand twice by punching things and cut his right hand by punching through a fish tank. The Veteran was afforded an examination for his claimed right-hand disability in September 2018. The September 2018 examiner confirmed a diagnosis of fracture, 4th and 5th metacarpals with residual traumatic arthritis of the right hand. The examiner stated that this condition is the direct result of a traumatic injury to the right hand, and that there is no medical body of literature linking the development of right-hand condition to any environmental exposure during service in Southwest Asia. Accordingly, the examiner opined that it was less likely than not that the Veteran’s right-hand condition was related to or represents a pattern of disability caused by any exposure event experienced by the Veteran during service in Southwest Asia. VA treatment records from September 2018 note that x-rays demonstrate evidence of healed right-hand fractures with residual traumatic arthritis. The physician stated that these findings are consistent with the injury the Veteran reported sustaining in approximately 2007. The Veteran testified at the February 2020 Board hearing that his right-hand condition “pretty much came on over the past like, I want to say about ten years”. The Veteran further testified that he could be doing something repetitive and the joints in my right hand would just “lock up” and he would have to pry his fingers open. Additionally, the Veteran testified that only his right hand locks up. The Veteran further testified that he believes that his current right-hand condition is related to the repetitiveness of grasping risers while parachuting in the military. The Veteran stated that he had over 100 jumps out of airplanes during his active service. In accordance with the April 2020 Board remand, the Veteran had an examination for his claimed right-hand disability in July 2020. The examiner opined that it was at least as likely as not that the Veteran’s claimed right-hand disability was related to his active service. The examiner noted that the Veteran stated that during his service years he was required to grip parachute lines during his military service, and this resulted in chronic right-hand pain and cramping which continued after his separation. The examiner further noted that imaging completed in 2009 revealed old right 4th and 5th metacarpal fractures as well as arthritis. Furthermore, the Veteran continued to have right hand pain and was treated in 2009 and 2015. The examiner stated that there is no record of right hand complaints while in the service, but noted that the Veteran is considered competent to describe any symptoms he has experience since his discharge and the lay contentions are to be weighed in making this determination. The examiner concluded that since the Veteran has stated that his right hand symptoms began in the service and have continued since separation, his claimed chronic right hand condition, diagnosed as degenerative arthritis, Open reduction and internal fixation of the 4th and 5th proximal metacarpal fracture with PCP pinning, and Overuse Syndrome, are at least as likely as not caused by the right hand condition during service. However, an updated examination from the July 2020 examiner as well as an addendum medical opinion were obtained in September 2020 due to additional evidence received regarding the Veteran’s January 2009 right-hand injury following a weightlifting accident. The examiner noted that the Veteran stated that during his service years he was required to grip parachute lines during his military service, and this resulted in chronic right-hand pain and cramping which continued after his separation. However, the examiner further noted that it was also reported on January 7, 2009 that the Veteran dropped weights on his right hand and subsequent imaging revealed fractures of the 4th and 5th metacarpals. The examiner opined that as there is no documentation of right hand complaints while in the service or in the five years post separation, his current right hand complaints are more likely due to the healed fractures of the right hand and the arthritis which has developed in the areas of the healed fractures. Accordingly, the examiner opined that the Veteran’s current claimed chronic right-hand condition is less likely than no caused by his active duty service. In September 2020, the Veteran stated that he injured his right hand while parachuting when he hit his hand on a tree branch. The Veteran further stated that the last year or so before he got out of the military he noticed that if he was on a ruck march or a jump, his right hand would stiffen up and his fingers would lock like he was gripping something. Additionally, the Veteran stated that after separation he was experiencing pain in his hand. He stated that he would go to my local primary care, and that he filed a claim in 2002 because of what he was going through with my back and hand but was denied. Furthermore, the Veteran stated that he did break his right hand in 2007 and “you can see the fractures in it”, but noted that him breaking his hand has “no bearing on the joint locking of my right hand” and it was “just coincidental that it was that hand which broke”. The Board finds that the preponderance of the evidence is against the claim for entitlement to service connection for a right-hand disability. The Board finds that the September 2020 examiner’s opinion carries significant probative weight. The September 2020 examiner’s opinion was based on a comprehensive clinical examination and evidentiary review of the file and indicated familiarity with the Veteran’s pertinent medical and lay history. The examiner noted there was no evidence in-service of the claimed disorder and provided a rationale as to the etiology of the Veteran’s diagnosed disorder. For these reasons, the Board finds the September 2020 examiner’s opinion to be highly probative. The Board has also considered the Veteran’s statement in support of his claim that his right-hand condition is the result of injuring his hand while in service from repeated parachuting, hitting a tree, and repeated gripping of parachute risers. The Veteran is competent to report when he first noticed his right-hand condition symptoms and provide comment on his in-service experiences. However, the Veteran is not competent to opine regarding the etiology of his diagnosed right-hand condition as this requires medical expertise. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Furthermore, while the Veteran has stated that he has had right-hand pain and “locking” since service, the Board finds his lay statements lack significant probative weight, as the contemporaneous records call into question their credibility. In a September 2020 statement, the Veteran stated that he filed a claim for his right-hand condition in 2002; however, the earliest claim for service connection for the Veteran’s right-hand condition was received in August 2015. Furthermore, the Veteran’s statements regarding the onset of his right-hand condition symptoms have been inconsistent. The Veteran stated in August 2015, that his right-hand condition developed “over the past couple of years” while also occurring in the military. Additionally, the Veteran testified at the February 2020 Board hearing that his right-hand condition “pretty much came on” over the past ten years. Treatment records described above confirm intercurrent causes for the fractures – namely punching objects. Accordingly, the Board finds the Veteran’s statements that his right-hand condition began during service and has continued since separation to lack significant probative weight. Additionally, because the Veteran’s fracture of the 4th and 5th metacarpals with residual traumatic arthritis of the right hand is a diagnosed condition with a defined etiology, the provisions of 38 C.F.R. § 3.317 regarding undiagnosed illness are not applicable. Accordingly, the criteria for service connection are not met and the claim must be denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board David M. Sebstead, 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.