Citation Nr: 21023004 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 15-18 962 DATE: April 19, 2021 ORDER Entitlement to service connection for a bilateral hand condition is denied. FINDING OF FACT The Veteran’s current bilateral hand condition disability was not incurred in or aggravated by the Veteran’s military service. CONCLUSION OF LAW The criteria for service connection for a bilateral hand condition disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from June 2002 through June 2010, with an honorable discharge. The records reflect that the Veteran served during the Gulf War Era in the Marine Corps. The Board of Veterans’ Appeals (BVA) remanded two of the Veteran’s claims for service connection in September 2020: a bilateral hand condition claim and a bilateral hearing loss claim. In a November 2020 rating decision, the Regional Office (RO) granted service connection for a bilateral hearing loss disability. This was a full grant of the benefits sought and accordingly this issue is no longer before the Board on appeal. For that reason, the Board will adjudicate solely the service connection for bilateral hand condition claim in this decision. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Certain chronic diseases, although not shown in service, may be presumed to have incurred in or aggravated by service if they become manifested to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. To prevail on the issue of service connection, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of inservice incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107 (2014); 38 C.F.R. § 3.102 (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the benefit of the doubt will be given to the Veteran. Id. Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). When considering whether lay evidence may be competent, the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue. Entitlement to service connection for a bilateral hand condition. The Veteran is seeking service connection for a bilateral hand condition. He contends that during service he sought treatment for a stab wound to his left hand that occurred during martial arts training. The Veteran contends that he was exposed to cold weather and hit his hands on metal objects during service. The Veteran suffers from a current diagnosis of bilateral hand strains. An August 2011 examination diagnosed the Veteran with bilateral hand strains. The record reflects that during the examination, the Veteran reported that he had been diagnosed with osteoarthritis in his hands at a VA facility. During his February 2016 Board hearing the Veteran continued to assert that he had been diagnosed with osteoarthritis. In December 2020 the Veteran was afforded a VA examination with regard to his claimed bilateral hand condition. The examiner reviewed the record, conducted an examination including updated x-ray views, and interviewed the Veteran. The VA examiner then offered an opinion with supporting rationale. The examiner was asked to identify with specificity all hand disabilities that are currently manifested, or that have been manifested at any time since March 2011. The December 2020 examiner identified a current diagnosis of bilateral hand strain. The examiner noted normal range of motion when the Veteran gave his ID card to the provider and again with measurements. The examiner noticed no weakness when gripping the providers finger or when applying resistance to extended fingers. The examiner noted brisk capillary refills, normal coloring no rash or open skin, small 2 centimeters scar between the Veteran’s thumb and index fingers in the web area. The examiner noted that the Veteran was able to unzip his jacket without difficulty and did not experience tenderness upon palpation. With regard to hand injury or disease during service, the Veteran reported to the examiner that when he was in service, he had pain in both hands and went to see a corpsman and was given motrin. He reported that no x-rays were undertaken at the time and there was no trauma to the area. While in the service, in November 2004, the Veteran reported that he was stabbed in the left hand while performing martial arts activities. He stated that he received some sutures and he believed the incident damaged his tendon. However, there are not any service treatment records (STR’s) that corroborate any of the Veteran’s reports. The Veteran reported that he has periodically sought treatment from his primary care provider with regard to pain in his hands and used Motrin 800 mg to control the pain. In December 2020, imaging studies of the hands where performed. The x-ray reports show “minimal osteoarthritic changes at the thumb including the MCP joint” in both hands. The impression was “No advanced or significant arthritis pattern and no acute bony abnormality or injury.” Thus, the x-rays show some osteoarthritic changes, but they were not considered to be representative of advanced or significant arthritis. There was no objective evidence of pain on passive range of motion testing or when the joint was used in non-weight bearing for either hand. The Veteran’s medical treatment records associated with his claims file are consistent with the December 2020 VA examiner’s findings. The examiner in December 2020 considered the medical information and opined that although the Veteran made reports, there was no evidence in the treatment records supporting arthritis in August 2011 from a provider at a VA facility in Hampton VA. Further, the examiner remarked that the Veteran’s claim file contained an x-ray of the Veteran’s hands that was negative with no degenerative changes, dislocation or soft tissue problems noted. With regard to STR’s, the examiner in December 2020 concluded that she did not locate any evidence in the file to support the Veteran’s contention that he experienced a stab wound to his left hand in service during martial arts training. In August 2017 the file notes indicated that the Veteran had a cervical spine x-ray and the results were normal with no evidence of arthritis. There was no documentation of any hand injury during service time and no other medical visits with regard to hand pain. In December 2020, the examiner concluded that the Veteran’s claimed bilateral hand condition was less likely than not (less than 50 percent probability) incurred in or caused by any claimed in-service injury, event, or illness. The examiner supported the conclusion by reporting that there was no chronic diagnosis for bilateral hand strain while in service or within a year after separation. There was no documentation of injury in the claims file to support any incidents while in service or at any time shortly thereafter. An x-ray showed no advanced or significant arthritis pattern or acute bony abnormality or injury. Accordingly, the examiner opined that a nexus was not established. The determination of whether the requirements of service connection have been met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). In making these determinations, the Board must consider and assess the credibility and weight of all the evidence in the claim file, including the medical and lay evidence, to determine its probative value. In doing so, the Board must provide its reasoning for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Barr v. Nicholson, 21 Vet. App. 303 (2007). In light of the above, the Board finds the December 2020 medical opinion is dispositive of the bilateral hand disorder claim. While the Veteran does suffer from a current diagnosis of bilateral hand strain, the weight of the evidence does not support his contentions that a disease or injury occurred to either of his hands during service or within a year thereafter. The file contains no contrary medical opinion and the Veteran himself is not shown to possess the requisite medical expertise to provide a medical nexus opinion pertaining to his claim. The probative value of a medical opinion is generally based on the scope of the examination or review, as well as the relative merits of the expert’s qualifications and analytical findings, and the probative weight of a medical opinion may be reduced if the examiner fails to explain the basis for an opinion. See Sklar v. Brown, 5 Vet. App. 140 (1993). In this case, the VA examiner reviewed the Veteran’s STR’s, his VA treatment records, and the medical records contained in his VA claims file. The examiner is well qualified to render such an opinion. The Board considered the Veteran’s statements that he was treated in service, but the examiner explained that the Veteran’s medical records do not indicate any bilateral hand condition in service. The VA examiner thoroughly reviewed the evidence in the claims folder, and the Board finds that the December 2020 VA opinion was based on the entirety of the record. The preponderance of the evidence weighs against the Veteran’s service-connection claim for a bilateral hand condition. Consequently, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.M. Schneider 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.