Citation Nr: 21025803 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 16-27 462 DATE: April 29, 2021 ORDER Entitlement to service connection for residuals of a left wrist fracture is denied. FINDING OF FACT A left wrist fracture clearly and unmistakably preexisted service, and clearly and unmistakably was not aggravated during service. CONCLUSION OF LAW The criteria for service connection for residuals of a left wrist fracture have not been met. 38 U.S.C. §§ 1110, 1111, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 17, 1971 to June 24, 1971. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office. In October 2018, the Board reopened this claim and remanded it for further development. Left Wrist Fracture The Veteran contends that he has residuals of a left wrist fracture that occurred during active military service. In May 2015, he wrote that he suffered an injury to his left wrist during bootcamp. He wrote that while playing football another player hit him and he heard his wrist pop, causing it to swell. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F. 3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Cases in which the condition is noted on entrance to service are governed by the presumption of aggravation contained in 38 U.S.C. § 1153. This statute provides that a preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during such service, unless clear and unmistakable evidence shows that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. When a disability is not “noted” at entrance to service, VA must show by clear and unmistakable evidence that the disability preexisted service, and if so, whether it clearly and unmistakably was not aggravated during service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). In this case, the Board finds that the Veteran’s left wrist fracture clearly and unmistakably preexisted service, and the residuals of this fracture clearly and unmistakably did not undergo any increase in severity of during his service. The Veteran’s service treatment records show that in the first week of the Veteran’s basic training, he complained of pain and inability to extent his left wrist. He stated that one year prior to induction, he had sustained a hyperextension injury to the left wrist from falling off a truck. He stated that he never sought medical care for this, but since the injury he had pain over the radial aspect of the wrist and inability to fully extend it. Physical examination found that there was tenderness, and ulnar and radial deviation were limited to 50 percent. X-rays showed nonunion of an old navicular fracture. The Veteran was placed on a physical profile for nonunion of left wrist navicular fracture. The Veteran was found to be unfit for service and recommended for separation. His DD Form 214 notes that his reason for discharge was failure to meet medical fitness standards at time of enlistment. While the Veteran’s January 1971 pre-induction examination did not note any disorder of the left wrist, and therefore the condition was not noted on entrance into service, the Board finds that the evidence does clearly and unmistakably establish that the Veteran’s left wrist injury preexisted his military service. This is well documented in the service treatment records, based on both the Veteran’s reports at that time and the findings of his treating medical providers. The evidence also shows that the fracture residuals clearly and unmistakably were not aggravated during service. The service treatment records show that the Veteran reported that he had pain and limitation of extension in the left wrist ever since the fracture, and therefore these were not new symptoms which had begun only during his military service. While the Veteran has claimed that he incurred an injury while playing football in service, there is no evidence to support his assertion that he incurred an additional injury that added to, or aggravated his preexisting injury. The Veteran’s complaints related to left wrist pain are very well documented, and his wrist was given X-rays, but found no instance of a new injury or increased injury from what preexisted service. The Board finds that these records outweigh the Veteran’s assertions that he incurred a wrist injury in service, which are not found to be credible. See, e.g., Kahana v. Shinseki, 24 Vet. App. 428 (2011) (the Board may consider a lack of notation of a medical condition or symptoms where such notation would normally be expected). The only medical opinion of record also weighs against the claim and finds that the Veteran’s left wrist fracture clearly and unmistakably preexisted service and clearly and unmistakably was not aggravated by service. The Veteran attended a VA examination in December 2019. The Veteran denied any current symptoms associated with his left wrist, but the examiner did find that the Veteran had a diagnosis of left wrist arthritis from October 2019. The examiner found that the condition was less likely than not incurred in or caused by service, and it had also clearly and unmistakably preexisted the Veteran’s entry into service. She explained that the Veteran went to sick call during his first week of training, and reported having a history of chronic left wrist pain. X-rays showed an old fracture. The examiner also explained that the disorder was clearly and unmistakably not aggravated to a permanent degree beyond that which would be due to the natural progression of the disease, and that the service treatment records were silent for any such worsening and there was no history of residuals or sequalae of this disorder afterwards. The Board finds the VA examiner’s opinion to be highly probative evidence that weighs against the claim.  The opinion, which was based on review of the Veteran’s documented and asserted medical history and an in-person examination, constitutes probative evidence on the medical nexus question, including whether the disorder preexisted service and was aggravated by service.  See Prejean v. West, 13 Vet. App. 444 (2000). The Board finds that this medical opinion was fully supported by the evidence of record, and the examiner provided adequate rationale for her findings. There are no contradictory medical opinions of record which came to a different conclusion regarding the Veteran’s left wrist disorder. The Veteran has not submitted any other medical evidence regarding the etiology of his left wrist fracture residuals and arthritis.  While the Veteran may believe that his left wrist disorder is related to service or was aggravated by service, such lay assertions do not constitute probative medical evidence.  The Veteran is competent to describe his symptoms as he perceives them, but as a lay person, he is not competent to provide a medical diagnosis of his current left wrist arthritis or whether his preexisting left wrist fracture was permanently aggravated by his military service. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).  To the extent that he argues his left wrist disorder did not preexist service but was instead from an injury incurred during basic training, his assertions are not found to be credible in light of the extensive documentation in his service treatment records regarding a preexisting left wrist fracture. The Board also acknowledges that the Veteran received a diagnosis of arthritis in his left wrist in 2019, and this is potentially a new diagnosis, separate from just the residuals of wrist fracture which preexisted his service. Although arthritis is a chronic disease, there is no basis to grant service connection for left wrist arthritis on a direct or presumptive basis.  See Walker v. Shinseki, 708 F.3d 1336 (Fed. Cir. 2013).  There is absolutely no evidence that arthritis manifested in service or to a compensable degree within one year of discharge from a period of active duty.  38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Moreover, the December 2019 examiner opined that the Veteran’s arthritis is not due to his military service, an opinion the Board finds probative because it was based on consideration of the pertinent evidence and supported by sufficient medical rationale. Therefore entitlement to service connection for left wrist arthritis is also not warranted. For the foregoing reasons, the Board finds that the evidence demonstrates that the Veteran’s left wrist fracture clearly and unmistakably preexisted his military service, and the evidence also clearly and unmistakably demonstrates that it was not aggravated by his military service. The claim for service connection is denied. In reaching this decision the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the appellant’s claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mary E. Rude, 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.