Citation Nr: 21030732 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 18-17 707 DATE: May 19, 2021 ORDER Entitlement to service connection for a right hand disability is denied. Entitlement to service connection for a left hand disability is denied. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has had a right and/or left hand disability at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. The criteria for service connection for a right hand disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303 2. The criteria for service connection for a left hand 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 CONCLUSIONS The Veteran served on active duty from November 1960 to May 1961 and from October 1961 to August 1962. These matters come to the Board of Veterans' Appeals (Board) from an October 2017 rating decision which, in pertinent part, denied entitlement to service connection for right and left hand disabilities. In September 2019 and November 2020, the Board remanded the claims for further development, to include obtaining a VA examination and medical opinion. Service Connection 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). 1. Entitlement to service connection for a right hand disability. 2. Entitlement to service connection for a left hand disability. The Veteran contends that service connection is warranted for a bilateral hand disability. Specifically, he asserts that he injured his hands serving as combat aggressor while training for almost nine months. He further asserts that he injured his hands by falling and by lifting and carrying heavy equipment and weapons during field exercises at Fort Hood. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. After careful review of the evidence, the Board finds that service connection is not warranted. The Board concludes that the Veteran does not have a current diagnosis for either his right or left hand and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Without a current diagnosis, service connection cannot be granted. See Brammer v. Derwinski, 3 Vet. App. 233, 225 (1992). The Board has considered whether the Veteran's reports of hand pain and weakness may be considered a disability in and of itself but finds it may not. Pain alone, without any functional impairment or underlying diagnosis, is not a service connectable disability. Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999), vacated in part, dismissed in part by Sanchez-Benitez v. Principi, 259 F.3d 1356 (Fed. Cir. 2001). The Board is mindful of Saunders v. Wilkie, 886 F.3d 1356, 1364-65 (Fed. Cir. 2018) in which the Federal Circuit explained that where pain alone results in functional impairment that affects earning capacity, even if there is no identified underlying diagnosis, it can constitute a disability. However, in this case, the evidence does not show that the Veteran's hand pain or weakness has resulted in functional impairment affecting his earning capacity at any point during the appeal period. The Veteran was afforded a VA examination in December 2019. The Veteran reported he first noticed that his thumbs were more anterior to his other fingers in 2010, and that his father hands were similar. The Veteran denied pain or functional impairment and the Veteran's hands, including range of motion and grip strength testing, were normal upon objective examination. Although the Veteran's hands were normal, the examiner referred to the Veteran's location of his thumbs anterior to the other fingers bilaterally as a deformity. Ultimately, the examiner concluded that the Veteran did not have a current diagnosis associated with the claimed disability and as such, the Veteran's hands were not related to service. In November 2020, the Board found that the December 2019 examiner failed to explain why the Veteran did not have a diagnosable disability despite the deformity and remanded the claims for a new examination and medical opinion that adequately considered the Veteran's contentions. The Veteran was afforded a VA examination in January 2021. The Veteran reported that his hand condition began with a fall into a ravine at Ft. Hood. He explained that symptoms began with his hands hurting and losing strength. The Veteran described his functional impairment as weakness in his hands. Upon examination, the Veteran's hands, to include range of motion and grip strength testing, were normal. Upon evaluation of the Veteran, the examiner, who considered the Veteran's assertions regarding injuries to his hands during service, remarked that there was no diagnosis for either hand because there was no pathology, and as such, the Veteran's claimed disability was not related to service. In a February 2021 addendum opinion, the examiner further explained that based on the examination, the Veteran did not have a right or left hand deformity to be noted on examination. The examiner stated that she was unable to give the Veteran a diagnosis for his right and left hand because there was not a deformity present. The examiner reiterated her prior opinion that no diagnosis of a right or left hand deformity was rendered or warranted on examination because there was no pathology. The Board gives probative weight to the January 2021 VA examination, the February 2021 addendum opinion, and the other objective medical evidence of record. The examiner found no pathology of the right or left hand, to include that of a deformity, from which to render a diagnosis. The examiner considered the Veteran's history, to include his military service and assertions regarding injuries during service, and his treatment records. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008). Moreover, the examiner is qualified through education, training, and experience to offer medical diagnoses, statements, or opinions. The only probative evidence of record evaluating the Veteran's claimed bilateral hand disability is the January 2021 VA examination and February 2021 addendum opinion. As noted, the VA examiner expressly stated that there was no deformity present in the Veteran's hands and no pathology from which to render a diagnosis. Without a current diagnosis, service connection for a right or left hand disability is not warranted. In reaching this conclusion, the Board has considered the Veteran's statements in support of his claim. However, the Board finds the objective medical evidence more probative in this instance. Service treatment records (STRs) are silent for complaints of or treatment related to a hand disability. While the Veteran reports an onset of pain and weakness in his hands around 2010, post-service treatment records do not contain any diagnosis for a hand disability. Furthermore, the Veteran reported onset of his claimed disability as 2010, nearly fifty years after his period of active service. Additionally, the Veteran did not claim a right or left hand disability on an earlier, May 2004 claim for compensation and despite mentioning other conditions affected by a fall into the ravine in his March 2018 substantive appeal, he did not mention his hands until later, an indication that his story has changed over time. As such, the Board does not find the Veteran's report of a fall in a ravine or other in-service injury as the cause of his asserted bilateral hand disability or reports of symptomatology since service particularly credible. While the Veteran believes he has a current disability, to include pain or weakness in his hands, due to his military service, he is not competent to provide a diagnosis or a medical nexus in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence as discussed above The competent medical evidence of record does not show a current bilateral hand disability for which service connection can be granted. Even if the Board were to presume the Veteran has pain and weakness in his hands, the Veteran has not asserted, nor provided any supporting evidence of, that such resulted in functional impairment affecting his earning capacity. Thus, the preponderance of the evidence is against the claims. (Continued on next page) As such, the benefit of the doubt doctrine is not for application, and the claims of service connection for a right and left hand disability must be denied. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). Stephanie M. Owen Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Telamour, 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.