Citation Nr: 21031594 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 17-66 894 DATE: May 24, 2021 ORDER Entitlement to service connection for left brachial plexus (claimed as damaged radial nerve, left arm) is granted. Entitlement to service connection for left wrist carpal tunnel syndrome is granted. REMANDED Entitlement to service connection for right knee condition is remanded. FINDINGS OF FACT 1. Resolving all doubt in favor of the Veteran, left brachial plexus, claimed as damaged radial nerve, left arm was acquired as a result of in-service injury in 2002. 2. Resolving all doubt in favor of the Veteran, the Veteran's left wrist carpal tunnel syndrome was manifested in and since service as a result of an in-service injury in 2002. CONCLUSIONS OF LAW 1. The criteria for service connection for left brachial plexus, claimed as damaged radial nerve, left arm have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.310. 2. The criteria for service connection for left wrist carpal tunnel syndrome have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran honorably served on active duty from June 24, 2002 to March 6, 2006. This matter comes before the Board of Veterans Appeals on appeal of a December 2015 rating decision issued by the Department of Veterans' Affairs (VA) Regional Office (RO). The Veteran filed a timely notice of disagreement (NOD) in August 2016 and filed a VA Form 9 in December 2017. The Veteran requested a virtual hearing and was afforded one in February 2021 before the undersigned Veterans Law Judge (VLJ). SERVICE CONNECTION Service connection is warranted where the evidence of record establishes that an injury or disease resulting in a disability was incurred in the line of duty during active military service or, if an injury or disease pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995). Service connection may also be granted for any disease diagnosed after the military discharge, when all the evidence, including that pertinent to the period of military service, establishes that the disease was incurred during the active military service. 38 U.S.C. §§ 1113(b); 38 C.F.R. §§ 3.303(d). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. In order to prevail on the theory of secondary service connection, there must be evidence of a current disability; evidence of a service-connected disability; and evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for the 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). 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. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the Veteran. 1. Left brachial plexus. The Veteran contends that her left brachial plexus should be service connected. The Veteran's medical records indicate that in August 2002 the Veteran did have a left shoulder nerve compression with multidirectional instability. The Veteran indicates that the left radial nerve was damaged during basic training while marching with rifles above the head. In a November 2015 VA examination, the examiner noted that the left arm is weaker than the right arm. The examiner noted that there is a noticeable difference in strength between the right and left arm. The Veteran also reported shooting pain down the left arm to the hand. The examiner indicated that the Veteran has to drop her left hand down from the steering wheel when driving to reduce her symptoms. In February 2021, the Veteran was afforded a hearing before the undersigned Veterans Law Judge. The Veteran's represented noted that the Veteran did suffer an injury during basic training of the brachial plexus condition. The Veteran testified during the February 2021 hearing that her left arm has tingling and numbness that comes and goes. She noted that the pain is not predictable. The Veteran noted that she tends to drop things she is holding in her hand. The Veteran testified that after her injury her left arm was 'basically paralyzed'. The Veteran indicated that the pain is bothersome. The Veteran noted that she did not seek medical care immediately because she did not have any health insurance. The Veteran managed her pain with over the counter medications such as Tylenol, Advil, as well as ice and heat. The Veteran also testified that she could never hold her six-month-old in her left arm. The Veteran testified that she has had these limitations in her left arm since military service. The Veteran also testified that she has had pain in and since military service. The Board finds that the Veteran did have an in-service injury in August 2002 on the left arm. The Board also finds that the Veteran was diagnosed with brachial plexus. The Board finds that the Veteran's testimony reporting her symptoms of pain in the left arm coupled with the Veteran's service treatment records are sufficient evidence to support a finding that the Veteran's symptoms of brachial plexus began in service and have continued since service. The November 2015 noted that the Veteran's symptoms began in August 2002. Additionally, the Veteran testified during the February 2021 hearing that she has had pain in and since service. The Board finds the Veteran's testimony as to pain to be competent, credible and highly probative. Therefore, the Board finds that there is sufficient evidence in the record to establish a nexus between the Veteran's current diagnosis and in-service injury. After weighing all the evidence, the Board finds that the evidence is at least in equipoise that the Veteran's brachial plexus is due to the Veteran's active service. Accordingly, resolving all reasonable doubt in favor of the Veteran, the Board finds that the Veteran is entitled to service connection for brachial plexus left arm. 2. Left wrist carpal tunnel syndrome. The Veteran contends that her left wrist carpal tunnel syndrome should be service connected. In the November 2015 VA examination the Veteran noted that carpal tunnel pain was in the hands and the wrists. The Veteran reported that pain increased after performing an activity such as typing, but not during the activity. The Veteran's hand was also reported to swell with use. The Veteran is right hand dominant. The Veteran's pain is on the left hand and arm. The November 2015 examiner found that it was less likely than not that the Veteran's left arm pain was a result of military service. In February 2021, the Veteran was afforded a hearing before the undersigned Veterans Law Judge. During the Veteran's hearing the Veteran's representative noted that the Veteran's left carpal tunnel was noted in the service treatment records three weeks into basic training. The Veteran was diagnosed with left carpal tunnel in 2015. The Veteran testified that the pain from left carpal tunnel is bothersome. The Veteran testified she did not seek medical care immediately because she did not have any health insurance. The Veteran managed her pain with over the counter medications such as Tylenol, Advil, as well as ice and heat. The Veteran also testified that she could never hold her six-month-old in her left arm. The Veteran testified that she has had pain in service and since military service. The Board finds that the Veteran does have a current diagnosis of carpal tunnel syndrome. The Board finds that the Veteran's service treatment records sufficiently document the Veteran's in-service incurrence of the left arm injury. Additionally, the Veteran's left carpal tunnel syndrome was documented within the Veteran's service treatment records. The Board also finds that the Veteran's testimony reporting her symptoms of pain in the left wrist is competent, credible, and highly probative. Coupled with the Veteran's service treatment records there is sufficient evidence to support a finding that the Veteran's pain related to carpal tunnel syndrome began in service and has continued since service. The November 2015 noted that the Veteran's symptoms began in August 2002. Additionally, the Veteran testified during the February 2021 hearing that she has had pain in and since service. Therefore, the Board finds that there is sufficient evidence in the record to establish a nexus between the Veteran's current diagnosis and in-service injury. After weighing all the evidence, the Board finds that the evidence is at least in equipoise that the Veteran's brachial plexus and carpal tunnel syndrome are due to the Veteran's active service. Accordingly, resolving all reasonable doubt in favor of the Veteran, the Board finds that the Veteran is entitled to service connection for carpal tunnel syndrome of the left wrist. REASONS FOR REMAND 1. Right Knee Condition. The Veteran contends that her right knee condition should be service connected. In November 2015 the Veteran was afforded a VA examination. The November 2015 provided a negative nexus opinion indicating that there was no clinical pathology found on exam or radiology study to render a diagnosis of right knee condition. In February 2021, the Veteran attended a hearing before the undersigned Veterans Law Judge. The Veteran requested 30 days from the date of the hearing to submit additional medical records in support of her claim for service connection of the right knee condition. In a letter dated March 30, 2021 and received by the Board in April 2021, the Veteran's treating physician wrote a letter briefly describing the Veteran's treatment with the physician's office. The physician noted that the Veteran was last seen in 2018 for orthopedic treatment. The physician stated that the Veteran apparently had a meniscal tear several years ago which was treated conservatively. The physician stated that the Veteran had an MRI ordered in 2016 by the VA that showed some arthritic change to the medial compartment of the knee associated with Baker Cyst. The physician noted that the Veteran was treated conservatively by the physician's office with injections and anti-inflammatories. The physician could not provide a clear etiology between the Veteran's time in service and the Veteran's right knee condition. The Board finds that in light of the physician's statement, additional records are necessary to determine the nature and etiology of the Veteran's right knee condition. Additionally, considering the substantial amount of time that has passed since the Veteran's last VA examination, the Board finds that the Veteran should be provided an additional VA examination to take into consideration the March 2021 physician note, additional records and the current status of the Veteran's right knee condition. The matters are REMANDED for the following action: 1. Obtain any outstanding VA and private treatment records that are not already associated with the claims file. If any record identified cannot be obtained, the Veteran and his representative should be notified of this in writing to include all efforts taken by the VA to attempt to obtain such a record. 2. Schedule the Veteran for a new examination by an appropriate clinician to determine the nature and etiology of the Veteran's right knee condition. The Veteran's claim file and a copy of this remand should be provided to the examiner and the examination report should reflect that these items were reviewed. 3. The examiner must offer the following opinions: (a) Whether it is at least as likely as not that the Veteran's right knee condition manifested during or as a result of active military service? (b) Whether it is at least as likely as not that the Veteran's right knee condition was caused by any of the Veteran's service-connected disabilities? (c) Whether it is at least as likely as not that the Veteran's right knee condition was aggravated by any of the Veteran's service-connected disabilities? (d) In consideration of all of the Veteran's statements and all pertinent medical records, the examiner is also asked to offer an opinion as to whether it is at least as likely as not that his right knee condition was either caused or aggravated beyond the natural progression by any of the Veteran's service-connected disabilities? 4. A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any would allow for a more definitive opinion. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Hailu, 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.