Citation Nr: 21031547 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 16-27 476A DATE: May 24, 2021 ORDER Entitlement to service connection for right upper extremity carpal tunnel syndrome is denied. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has had right upper extremity carpal tunnel syndrome at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for right upper extremity carpal tunnel syndrome are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably from July 1974 to May 1977. This case comes before the Board of Veterans Appeals (the Board) from a February 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran participated in a July 2019 hearing at the Board before the undersigned Veterans Law Judge. A transcript of said hearing is of record. The Board remanded this matter in September 2019 for further development, to include a VA examination. 1. Entitlement to service connection for right upper extremity carpal tunnel syndrome The Veteran contends she has a right upper extremity carpal tunnel disability that is related to service. See July 2019 hearing transcript. 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). 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. The Board concludes that the Veteran does not have a current diagnosis of right upper extremity carpal tunnel syndrome, 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). The Veteran was afforded a hearing before the undersigned in July 2019, wherein she testified that she experienced weakness in her right hand, including her palm, starting around 1976, as she had to lift and transfer patients all the time. She testified she was diagnosed with right carpal tunnel syndrome in 1976. She further testified she received several injections and has had an ongoing problem with her right wrist since that time, including inability to hold things in her hand, swelling and weakness. Additionally, the Veteran described her duties in service as a nurse, which were strenuous on her wrist. The Veteran was afforded a VA examination in January 2020 to assess the nature and etiology of her claimed carpal tunnel disability. The examiner indicated that an in-person examination and review of the claims file were conducted. The Veteran reported that the claimed condition began in 1974 and has been treated with anti-inflammatory medications, support and physical therapy, and that she continues to experience symptoms, including inability to grasp, clean or do housework. The examiner opined that the Veteran does not have a current diagnosis of right upper extremity carpal tunnel syndrome. In this regard, the examiner explained that there are no findings, signs or symptoms to support such a diagnosis. More specifically, the examiner acknowledged the diagnosis of carpal tunnel syndrome in the claims file. However, the examiner reviewed the EMG conducted in November 2016, which showed no evidence of a right sided peripheral neuropathy or cervical radiculopathy. It was further noted that the April 1977 separation report of medical history did not indicate any wrist condition. The examiner concluded that the Veteran's right upper extremity symptoms are all attributable to her separately service-connected cervical radiculopathy of the right upper extremity. After a review of the above, the Board finds that the evidence of record does not establish a current diagnosis of carpal tunnel. Therefore, in the absence of proof of a present disability, there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). Indeed, September 2016 VA treatment records do show an assessment that the Veteran has carpal tunnel syndrome. However, this assessment is prior to the November 2016 EMG. A September 2017 VA treatment note reiterates that despite the Veteran's reports of weakness when holding items in her right hand, carpal tunnel syndrome was ruled out by testing, including EMG. As such, there is no indication that the VA provider who assessed that the Veteran had right upper extremity carpal tunnel syndrome did so on the basis of diagnostic testing. This assessment appears to be based on the Veteran's self-reported medical history and is inconsistent with the subsequent EMG testing, which ruled out the presence of carpal tunnel syndrome. The Board gives more probative weight to the VA examiner's findings of January 2020, as they are based on a review of the totality of the record, including lay statements and an in-person physical examination. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board also acknowledges the holding of Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the Federal Circuit held that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. Indeed, the Veteran has consistently expressed symptoms of right upper extremity weakness, difficulty gripping and grasping items. However, though said symptoms may be productive of a functional impact, the January 2020 VA examiner makes clear based on a review of diagnostic testing and medical records that these symptoms are produced by the Veteran's already service-connected upper extremity cervical radiculopathy and not a carpal tunnel disability. While the Veteran believes she has a current diagnosis of right upper extremity carpal tunnel syndrome, despite her background in nursing, she is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires the conducting of diagnostic testing and the review of said testing. 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 of record, and specifically, the January 2020 VA examination. Accordingly, as the Veteran is not shown to have a diagnosis of right upper extremity carpal tunnel syndrome separate from her cervical radiculopathy, the Board finds that the Veteran's complaints are being compensated for related to this other service-connected disability and they cannot be separately evaluated. The evaluation of the same manifestation of a disability, under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). For these reasons, the Board finds that a preponderance of the evidence is against the Veteran's claim for service connection for right upper extremity carpal tunnel syndrome, and the claim must be denied. As the preponderance of the evidence is against the claim for service connection, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Comninos, Georgio 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.