Citation Nr: 21027622 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 17-07 280 DATE: May 6, 2021 ORDER Entitlement to service connection for a right wrist disability is granted. Entitlement to service connection for a left wrist disability, claimed as secondary to right wrist disability, is granted. FINDINGS OF FACT 1. The evidence is in relative equipoise as to whether the Veteran's disability of the right wrist, to include osteoarthritis, is causally related to her active service. 2. The evidence is at least in equipoise as to whether the Veteran's left wrist disability, to include osteoarthritis, was caused by her now service-connected right wrist disability. CONCLUSIONS OF LAW 1. Resolving all doubt in the Veteran's favor, the criteria for entitlement to service connection for a right wrist disability, to include osteoarthritis, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for a left wrist disability, to include osteoarthritis, on a secondary basis are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1987 to October 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), which reopened and denied the claim of entitlement to service connection for a right wrist disability, and denied the claim of entitlement to service connection for a left wrist disability. The Veteran filed a notice of disagreement (NOD) in July 2015 and a statement of the case (SOC) was issued in January 2017. She perfected a timely appeal in February 2017. In May 2019, the Veteran presented sworn testimony during a videoconference hearing, which was chaired by the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the Veteran's VA claims file. In a February 2020 decision, the Board reopened the claim of entitlement to service connection for a right wrist disability and remanded that matter, as well as the claim of entitlement to service connection for a left wrist disability for further evidentiary development. As will be discussed below, a review of the record reflects substantial compliance with the Board's Remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). A supplemental statement of the case (SSOC) was issued in July 2020. The Veteran's VA claims file has been returned to the Board for further appellate proceedings. Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty, or from or aggravation of a pre-existing injury suffered or disease contracted in line of duty. See 38 C.F.R. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to prevail on the issue of service connection for any particular disability, there must be evidence of a current disability; evidence of in-service occurrence or aggravation of a disease or injury; and medical evidence, or in certain circumstances, lay evidence, of a nexus between an in-service injury or disease and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for a disability that is proximately due to, the result of, or aggravated by a service-connected disability. See 38 C.F.R. § 3.310(a); see also Harder v. Brown, 5 Vet. App. 183, 187 (1993). Additional disability resulting from the aggravation of a nonservice-connected condition by a service-connected condition is also compensable under 38 C.F.R. § 3.310(a). See Allen v. Brown, 7 Vet. App. 439, 448 (1995). The Board notes that there has been an amendment to the provisions of 38 C.F.R. § 3.310. See 71 Fed. Reg. 52,744 -47 (Sept. 7, 2006). The amendment sets a standard by which a claim based on aggravation of a non-service-connected disability by a service-connected one is judged. The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons 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); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. 1. Entitlement to service connection for a right wrist disability. 2. Entitlement to service connection for a left wrist disability, claimed as secondary to right wrist disability. In this matter, the Veteran has asserted that she suffered disabilities of the right and left wrists due to her active duty service. See, e.g., the Board hearing transcript dated May 2019. She has further asserted that her left wrist disability is due to her right wrist disability. Id. at page 3. For the reasons set forth below, the Board finds that service connection for a right wrist disability is warranted. The Board additionally concludes that service connection for a left wrist disability is warranted as secondary to the right wrist disability. The Veteran served on active duty from November 1987 to October 1989. Her service treatment records (STRs) show that, in April 1988, she reported experiencing right wrist pain for two months. A September 1988 x-ray of the right wrist was negative for fractures or abnormalities. The Veteran continued to experience pain at the radial side of the right wrist. See the STRs dated September 1988 and November 1988. A diagnosis of tenosynovitis of the right wrist was indicated in November 1988. See also the STR dated December 1988. In April 1989, the Veteran was diagnosed with de Quervain's tenosynovitis; she was prescribed a right wrist splint. The diagnosis of de Quervain's tenosynovitis of the right wrist was again indicated in August 1989. The Veteran's August 1989 Report of Medical History at separation from active duty noted bursitis of the right wrist in 1988. The Veteran was afforded a VA examination in November 1989 at which time the examiner noted the Veteran's report of right wrist pain with a history of bursitis. The examiner indicated that there was no limitation of motion of the Veteran's right wrist and x-ray of her wrist was negative for abnormalities. Post-service treatment records dated in July 1999 documented the Veteran's right and left forearm pain on the flexor surface of the wrists. Private treatment records dated in November 2002 noted the Veteran's complaint of left wrist pain in November 2002. She reported right wrist pain in August 2004 with mild weakness in the right hand. An August 2004 x-ray of the right wrist showed "[n]o evidence of acute abnormalities." A flare-up of right arm and hand pain was noted in May 2006. VA treatment records dated in June 2013 noted the Veteran's report of intermittent wrist pain from typing and working. In September 2013, the Veteran described experiencing bilateral wrist pain dating from the military secondary to strain of the wrists. See the VA treatment records dated September 2013. In a lay statement dated October 2014, J.W. reported that she was stationed with the Veteran from 1988 to 1989. She reported that, during that time, the Veteran wore a brace on her right wrist and exhibited wrist pain. In a lay statement dated February 2015, T.B. reported that she also served with the Veteran and witnessed her wrist problems. She indicated that the Veteran wore bilateral braces on her wrists to alleviate pain. In a lay statement dated October 2014, V.Q. reported that she was stationed with the Veteran and witnessed the Veteran wearing wrist braces and exhibiting functional impairment due to her bilateral wrist symptoms. The Veteran was afforded a VA examination in December 2016 at which time the examiner reported that the Veteran does not have a current diagnosis associated with the bilateral wrists. The examiner indicated that physical examination of the Veteran's bilateral wrists was unremarkable, with normal imagining. In a separate medical opinion, the December 2016 VA examiner stated, "[t]he condition claimed was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness." The examiner explained, "[t]here is no evidence of right wrist injury in service, and examination today is normal. Veteran complained of both wrist[s] bothering her in 2013, due to current (non-service) typing and 'work.' Exam and imaging [were] normal in 2013." Private treatment records dated in December 2017 and April 2018 documented the Veteran's report of continuing bilateral wrist/hand pain. The April 2018 treatment provider stated that x-rays revealed periarticular osteopenia and mild degenerative changes in the carpometacarpal (CMC) joints. At the May 2019 Board hearing, the Veteran testified that she repeatedly incurred right wrist pain during service as a result of repetitive typing and manual secretarial-type work. See the Board hearing transcript, pg. 3. She reported that her left wrist symptoms did not begin until after service. Id. Pursuant to the February 2020 Board Remand, the Veteran was afforded a VA examination in February 2020 at which time the examiner confirmed a diagnosis of osteoarthritis of the bilateral wrists. In a separate February 2020 VA medical opinion, the examiner explained that she had reviewed the available medical evidence, including the Veteran's STRs, and noted that her medical history did not corroborate her contention of chronicity dating from her military service. The VA examiner cited to VA treatment records dating from 2013 and stated that the Veteran's records were silent for complaints for the wrist conditions long after military service. The examiner therefore concluded that the right wrist disability is less likely than not due to the Veteran's military service. Significantly, the February 2020 VA examiner mischaracterized the Veteran's medical history and failed to acknowledge her report of continuing right wrist pain documented by the November 1989 VA examiner. The February 2020 VA examiner also failed to recognize private treatment records documenting complaints of bilateral wrist pain dating from July 1999. See the private treatment records dated July 1999, November 2002, August 2004, and May 2006. Accordingly, in light of these deficiencies, the February 2020 VA examiner's negative nexus opinion as to the right wrist is of little probative value. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) ("It is the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion"). The February 2020 VA examiner also rendered a separate medical opinion as to the etiology of the diagnosed left wrist disability. The examiner explained that the Veteran is right-hand dominant and "over-compensation of the left wrist because of the affect[ed] right wrist can aggravate beyond [its] natural progression. Therefore, based on medical records review and current assessment, I opine that the left wrist condition is at least as likely than not due to the right wrist condition." Critically, as detailed above, the Veteran has also provided substantial evidence of continuity of symptomatology including the medical evidence outlined above as well as the Board hearing testimony in which she reported that she experienced symptoms of right wrist pain dating from her military service. To this end, the Board observes that the Veteran is competent to report experiencing symptoms such as pain dating from her military service. See Jandreau v. Shinseki, 492 F.3d 1372, 1376 (Fed. Cir. 2007) (lay witness capable of diagnosing dislocated shoulder); Barr v. Nicholson, 21 Vet. App. 303, 308-9 (2007). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("Although interest may affect the credibility of testimony, it does not affect competency to testify"). Moreover, the Veteran's contentions of continuing symptomatology have been corroborated by the STRs documenting a continuing diagnosis of de Quervain's tenosynovitis, the November 1989 VA examination noting the Veteran's continuing complaints of right wrist pain and a history of bursitis, as well as private treatment records dating from July 1999 documenting the Veteran's complaints of right wrist symptomatology. The Veteran's contentions are further supported by the lay statements of J.W., T.B., and V.Q. (Continued on the next page) Accordingly, the Board has weighed the probative evidence of record and finds that the evidence is at least in equipoise as to whether the diagnosed right wrist disability, to include osteoarthritis, initially manifested during the Veteran's military service and continued thereafter. The benefit-of-the-doubt rule is therefore for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Board will resolve the reasonable doubt in the Veteran's favor and find that the evidence supports the grant of service connection for a right wrist disability to include osteoarthritis. See 38 U.S.C. § 5107. Moreover, the evidence of record demonstrates that the Veteran's diagnosed left wrist disability, to include osteoarthritis, is secondary to her now service-connected right wrist disability. See the VA medical opinion dated February 2020. Absent any evidence to the contrary, the Board therefore finds that service connection for a left wrist disability, to include osteoarthritis, is warranted. See 38 C.F.R. § 3.310(a); see also Harder v. Brown, 5 Vet. App. 183, 187 (1993). K. Conner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. K. Buckley, 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.