Citation Nr: 21028498 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 16-10 674 DATE: May 11, 2021 ORDER Entitlement to service connection for a right upper extremity condition, to include carpal tunnel syndrome (CTS) and right elbow degenerative joint disease (DJD), is granted. FINDING OF FACT The Veteran's right upper extremity condition is related to his active duty service. CONCLUSION OF LAW With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for right upper extremity condition, to include CTS and right elbow DJD, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1984 to August 1984, and from August 1987 to January 2011. This matter is before the Board of Veterans' Appeals (Board) on appeal from a February 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2019, the claim was remanded by the Board to the agency of original jurisdiction (AOJ) for further development. After accomplishing the above, the AOJ continued to deny the Veteran's claim (as reflected in an April 2020 supplemental statement of the case (SSOC)). Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for a right upper extremity condition The Veteran contended that his right upper extremity condition, to include CTS and right elbow DJD, is related to his active service. The Veteran's service treatment records (STRs) dated in August 1997 noted complaints of numbness and weakness in the Veteran's wrists or hands. A November 1998 STR indicated that the Veteran had a diagnosis of right CTS. An October 2000 STR noted that the Veteran's military occupational specialty (MOS) was structural maintenance craftsman and that he complained of weakness, tingling, numbness, or pain in his extremity. May 2001 and June 2001 STRs documented bilateral CTS symptoms. In a November 2003 STR the Veteran again complained of weakness and numbness in his hands. In an STR dated December 2006, the Veteran complained of right shoulder popping. Post-service, an August 2014 treatment record noted pain in his right upper arm with stiffness of joint treated. A September 2014 letter from Dr. H.A., the Veteran's family physician, noted that the Veteran has moderate arthrosis on his right elbow and extensive DJD of the right elbow. The Veteran was noted to be in occupational therapy for treatment of his symptoms. Pursuant to the Board remand, the Veteran underwent VA examination in November 2019. The examiner noted a right upper extremity condition, noting the Veteran's complaints that it was related to service. He opined that the Veteran's condition was less likely than not related to his active service. As rationale, he stated that although there were STRs documenting CTS and continued hand pain and numbness, there were "[n]o records noted in review to support an ongoing condition other than subjective statements." However, the Board finds that this opinion is flawed because contrary to the examiner's assertions, a Veteran's "subjective statements" of continuous symptoms in and since service can be sufficient to establish a nexus between his documented in-service right upper extremity complaints and current disability which has been noted as DJD. See Buchanan v. Nicholson, 451 F. 3d 1331, 1335 (Fed. Cir. 2006) ("nothing in the regulatory or statutory provisions [relating to evidence to be considered] require both medical and competent lay evidence; rather, they make clear that competent lay evidence can be sufficient in and of itself"). Therefore, there has not been substantial compliance with the June 2019 remand. In his April 2015 Notice of Disagreement (NOD), the Veteran stated that his current right arm/hand pain had its onset due to his MOS of structural maintenance specialist. He contended that in that capacity he "used his right arm extensively" using various hand tools and as a result "can no longer straighten my right arm." As noted above, Dr. H.A found a diagnosis of right elbow arthrosis and DJD. In addition, as noted above, the Veteran's STRs document his in-service right-hand CTS and complaints of pain and numbness in his extremities related to his MOS. In addition, he has stated that he has suffered from right upper extremity pain since discharge from service. The Veteran is competent to say that he has experienced right upper extremity pain since service and the Board finds his statements credible. Given the competent and credible lay statements as to the Veteran's continuous right upper extremity condition since service, and the inadequate negative nexus opinion, the evidence is at least evenly balanced as to whether the Veteran's right upper extremity condition, to include right elbow DJD and CTS is related to his service. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for a right upper extremity condition is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Kovacs, 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.