Citation Nr: 21039854 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 15-16 473 DATE: July 1, 2021 ORDER Service connection for a left thumb disorder is denied. Service connection for a bilateral hip disorder is denied. Service connection for a skin disorder of the bilateral feet is denied. Service connection for a left wrist disorder is denied. Service connection for bilateral carpal tunnel syndrome is denied. REMANDED Entitlement to service connection for a back disorder, to include as secondary to service-connected disability, is remanded. FINDINGS OF FACT 1. At no time during the pendency of the claim does the Veteran have a current disability of a left thumb disorder, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing of a claim. 2. 2. At no time during the pendency of the claim does the Veteran have a current disability of a bilateral hip disorder, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing of a claim. 3. A skin disorder of the bilateral feet is not shown to be causally or etiologically related to any disease, injury, or incident during service. 4. A left wrist disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service. 5. Bilateral carpal tunnel syndrome is not shown to be causally or etiologically related to any disease, injury, or incident during service. CONCLUSIONS OF LAW 1. The criteria for service connection for a left thumb disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a bilateral hip disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a skin disorder of the bilateral feet have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for a left wrist disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for bilateral carpal tunnel syndrome have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1976 to February 1979. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued in April 2013 and August 2015 by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2016, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In November 2018, the Board remanded the claims on appeal, as well as a claim for service connection for a musculoskeletal disorder of the bilateral feet, for additional development. While on remand, a September 2020 rating decision granted service connection for bilateral pes cavus with metatarsalgia and degenerative arthritis, and right hallux rigidus. As such represents a full grant of the benefits sought with respect to such issue, it is no longer before the Board. Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). The remaining issues now return for further appellate review. As noted in the November 2018 decision, in May 2015, the Veteran testified before a different Veterans Law Judge regarding the issues of entitlement to service connection for a bilateral shoulder disorder and an initial compensable rating for left third metatarsal fracture. Thereafter, in an August 2015 decision, the Board assumed jurisdiction over the issue of entitlement to a total disability rating based on individual unemployability (TDIU) in connection with the Veteran's initial rating claim pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009), and remanded such issues for additional development. In a December 2016 decision, the Board denied service connection for a bilateral shoulder disorder and granted an initial rating of 10 percent for residuals of a left third metatarsal fracture. At such time, the Board also noted that, as the instant appeal was pending, it would be premature to adjudicate the Veteran's TDIU claim. Consequently, it was indicated that such issue would be adjudicated at a later date. Insofar as the instant appeal pertaining to the Veteran's claim for service connection for a back disorder is not being finally adjudicated, it is still premature to address the TDIU claim at this point. The Board also observes that, while additional evidence consisting of updated VA treatment records and examination reports was received after the issuance of the September 2020 supplemental statement of the case, such are irrelevant to the matters adjudicated herein or include findings duplicative to those previously considered by the Agency of Original Jurisdiction (AOJ). 38 C.F.R. § 20.1305(c). Thus, there is no prejudice to the Veteran in proceeding with an adjudication of his claims at the present time. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). Therefore, where there is evidence showing that a disorder manifested or was incurred in service, and this disorder is not noted on the veteran's entrance examination report, this presumption of soundness operates to shield the veteran from any finding that the unnoted disease or injury preexisted service. See Gilbert v. Shinseki, 26 Vet. App. 48 (2012); Bagby v. Derwinski, 1 Vet. App. 225, 227 (1991); 38 C.F.R. § 3.304(b). Such presumption is only rebutted where the evidence clearly and unmistakably shows that the veteran's disability (1) existed before acceptance and enrollment into service and (2) was not aggravated by service. See Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); Bagby, 1 Vet. App. at 227; VAOPGCPREC 3-2003 (July 16, 2003). The two parts of this rebuttal standard are referred to as the "preexistence prong" and the "aggravation prong." Horn v. Shinseki, 25 Vet. App. 231, 234 (2012). To satisfy this second-prong requirement for rebutting the presumption of soundness, the government must show by clear and unmistakable evidence either that there was no increase in disability during service or that any increase in disability was "due to the natural progression" of the condition. Joyce v. Nicholson, 443 F.3d 845, 847 (Fed. Cir. 2006). Service connection may also 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; 38 C.F.R. §§ 3.303, 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately cause by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310(b). However, pertinent to a claim for service connection, such a determination requires a finding of a current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439 (1995); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability"). In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the United States Court of Appeals for Veterans Claims (Court) held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. 1. Entitlement to service connection for a left thumb disorder, to include as secondary to service-connected disability. The Veteran asserts that he began to experience, and sought treatment for, left thumb pain during service. In the alternative, he alleges that such is secondary to a left wrist disorder that pre-existed service and was aggravated therein. However, as he does not have a current diagnosis of a left thumb disorder at any point pertinent to the pendency of his claim, service connection for such claimed disorder is not warranted. In this regard, prior to the receipt of the instant claim in September 2010, the Veteran's post-service treatment records reflect complaints of numbness in the left thumb in January, March, April, and October 2006, with the latter record showing slight swelling on examination, but no diagnosis referable to the left thumb was made. During the pendency of the claim, it was noted that the Veteran had some knots at the base of his left thumb in March 2011 and he complained of left thumb pain in December 2016; however, no diagnosis pertinent to the left thumb was rendered. Further, in November 2019, after reviewing the record, interviewing the Veteran, and conducting a physical examination with diagnostic testing, a VA examiner found the Veteran did not have a diagnosis related to his left thumb. Specifically, while he noted that the Veteran's left hand and thumb were immovable due to carpal tunnel syndrome hand cramping, he found that there was no objective evidence to support a diagnosis of a left thumb disorder at such time. Furthermore, no functional impairment, to include on his ability to work, was found in regard to the Veteran's reported symptoms. Moreover, the Veteran, as a lay person, is not competent to offer a diagnosis of a left thumb disorder as he does not possess the requisite specialized knowledge. In this regard, such a diagnosis requires the administration and interpretation of diagnostic tests. Therefore, as such is a complex medical question, the Veteran is not competent to diagnose a left thumb disorder. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Consequently, his statements as to the presence of a current left thumb disorder are afforded no probative weight. Therefore, based on the foregoing, the Board finds that at no time during the pendency of the claim does the Veteran have a current disability of a left thumb disorder, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing of a claim. McClain, supra; Romanowsky, supra. Thus, where, as here, there is no probative evidence indicating that the Veteran has the disability for which service connection is sought, there can be no valid claim for service connection. See Brammer, supra. Consequently, service connection for a left thumb disorder is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable and service connection for a left thumb disorder must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 2. Entitlement to service connection for a bilateral hip disorder, claimed as secondary to service-connected disability. The Veteran contends that he has a bilateral hip disorder secondary to his service-connected bilateral pes cavus with metatarsalgia, degenerative arthritis, and stress fracture of the left third metatarsal and right hallux rigidus, to include the treatment thereof, and/or his nonservice-connected back disorder. However, as he does not have a current diagnosis of a bilateral hip disorder at any point pertinent to the pendency of his claim, service connection for such claimed disorder is not warranted. In this regard, prior to the receipt of the instant claim in June 2014, the Veteran's post-service treatment records reflect a possible assessment of right trochanter bursitis in 2006, which was later determined to be radiculopathy related to his back disorder. Specifically, in April 2006, he exhibited right trochanteric tenderness; however, his right and left hip showed no abnormality on X-ray. Similarly, a July 2006 VA treatment record reveals an assessment of chronic trochanter bursitis; however, his hip X-rays were within normal limits. In November 2006, it was noted that the Veteran had previously been treated for trochanteric bursitis with possible lumbar radiculopathy, but only right leg radicular pain probably related to L3/4 disc pathology was noted. Moreover, an additional November 2006 VA treatment record notes that the Veteran was being seen for right trochanteric bursitis that was not responding to typical treatment and his right hip X-ray was negative. Thus, the physician ultimately determined that the Veteran's description was suggestive of radiculopathy rather than bursitis. During the pendency of the claim, a May 2015 private treatment record reveals that, upon examination, both of the Veteran's hips showed full, free, and easy range of motion without restriction. A December 2018 private treatment record reflects that the Veteran exhibited tenderness over the right postero-lateral region of his hip (area behind the greater trochanter), and an assessment of tendinitis involving the right hip abductors was noted. However, in November 2019, after reviewing the record, interviewing the Veteran, and conducting a physical examination with diagnostic testing, the examiner found the Veteran did not have a diagnosis related to his hips. In this regard, the Veteran reported that he was diagnosed with trochanteric bursitis. which was subsequently determined to be radicular pain from his back. Further, the examiner indicated that, while the Veteran's back pain made range of motion assessment difficult, he was able to flex/extend and abduct/adduct his thigh well on gait analysis. He further indicated that the right hip X-rays dated in October 2019 were normal. The examiner concluded that all of the abnormalities during the examination (trochanter pain/tenderness) were attributed to the Veteran's back disorder, and there was no objective evidence of a diagnosis related to the Veteran's hips. Here, the examiner noted that the Veteran had ongoing hip complaints following service until approximately 2004, when he was diagnosed with bursitis and treated with steroid injections that were ineffective. He further noted that the Veteran's pain was then thought to be radicular in nature, originating from his lumbar spine, and improved after his nucleotomy in 2007, and there was no evidence of structural damage in the hips. Furthermore, no functional impairment, to include on his ability to work, was found in regard to the Veteran's reported symptoms. While the December 2018 private treatment record reflects an assessment of tendinitis involving the right hip abductors, the Board observes that such was based on the same symptoms the Veteran consistently reported since 2006 and had ultimately been attributed to his back disorder. In this regard, the Board affords great probative weight to the November 2019 VA examiner's opinion in such regard as it considered all of the pertinent evidence of record, to include the statements of the Veteran and relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Furthermore, the Veteran, as a lay person, is not competent to offer a diagnosis of a bilateral hip disorder as he does not possess the requisite specialized knowledge. In this regard, such a diagnosis requires the administration and interpretation of diagnostic tests. Therefore, as such is a complex medical question, the Veteran is not competent to diagnosed a bilateral hip disorder. See Jandreau, supra; Woehlaert, supra. Consequently, his statements as to the presence of a current bilateral hip disorder are afforded no probative weight. Therefore, based on the foregoing, the Board finds that at no time during the pendency of the claim does the Veteran have a current disability of a bilateral hip disorder, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing of a claim. McClain, supra; Romanowsky, supra. Thus, where, as here, there is no probative evidence indicating that the Veteran has the disability for which service connection is sought, there can be no valid claim for service connection. See Brammer, supra. Consequently, service connection for a bilateral hip disorder is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable and service connection for a bilateral hip disorder must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. 3. Entitlement to service connection for a skin disorder of the bilateral feet. The Veteran asserts he has a current skin disorder of the bilateral feet that first manifested in service. In this regard, his service treatment records (STRs) reflect that he had a red patch on his right foot in November 1978. A February 1979 STR indicates that he had bilateral blisters and cracking of the skin to the upper surfaces of his feet and between his toes. Post-service VA treatment record includes a notation of an itchy rash on the Veteran's foot with an assessment of fungal rash/athlete's foot in September 2007. At a November 2019 VA examination, a diagnosis of tinea pedis was rendered; however, following an interview with the Veteran, a review of the record, and a physical examination, the examiner opined that such skin disorder of the bilateral feet was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In support thereof, he reported that the Veteran had multiple bouts of cellulitis and ankle ulcers requiring hospitalization during service, likely due to footwear that did not accommodate his pes cavus and military training. Here, he explained that cellulitis would often look like a red, itchy scaly rash, but the Veteran had no rash on the current examination. Thus, based on the Veteran's history that his symptoms resolve with dry, airy conditions, and the presence of nail fungus, his current diagnosis was athlete's foot (tinea pedis). The examiner further found that no records supported a diagnosis of tinea pedis except for the Veteran's history of an on/off occurrence, and there was no evidence of such a diagnosis during his military service. The Board affords great probative weight to the November 2019 VA examiner's opinion as such considered all of the pertinent evidence of record, to include the Veteran's statements and treatment records, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, he offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez, supra; Stefl, supra. Notably, there is no medical opinion to the contrary. The Board has also considered the Veteran's assertion as to the etiology of his skin disorder of the bilateral feet; however, as a lay person, he does not have the requisite training and experience necessary to address such a complex medical matter. See Jandreau, supra. In this regard, the etiology of such disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. Thus, such matter may not be competently addressed by lay statements. See Woehlaert, supra. Moreover, whether the symptoms the Veteran experienced during or after service are in any way related to his currently diagnosed skin disorder of the bilateral feet is a matter that also requires medical expertise to determine. See generally Clyburn v. West, 12 Vet. App. 296, 303 (1999) ("although the veteran is competent to testify to the pain he has experienced since his tour in the Persian Gulf, he is not competent to testify to the fact that what he experienced in service and since service is the same condition he is currently diagnosed with."). Accordingly, the Veteran's opinion as to the onset and etiology of his skin disorder of the bilateral feet is not competent and, consequently, is afforded no probative weight. Therefore, the Board finds that a skin disorder of the bilateral feet is not shown to be causally or etiologically related to any disease, injury, or incident during service. Thus, service connection for such disorder is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable and service connection for a skin disorder of the bilateral feet must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. 4. Entitlement to service connection for a left wrist disorder. 5. Entitlement to service connection for bilateral carpal tunnel syndrome, to include as secondary to service-connected disability. The Veteran asserts that he broke a bone in his left wrist prior to service, and began to experience, and sought treatment for, pain of the left wrist during service which continued following his discharge. Here, the Veteran indicated that he believed his previous wrist fracture did not heal completely and was aggravated during his military service due to training, which caused his bilateral carpal tunnel syndrome. The Veteran's STRs are negative for any complaints, treatment, or diagnoses referable to the left wrist or carpal tunnel syndrome. However, an April 2010 X-ray examination report shows an impression of an old, ununited ulnar styloid fracture. Thus, in light of the Veteran's allegations and such notation on X-ray, the Board has considered whether a left wrist disorder and/or bilateral carpal tunnel syndrome clearly and unmistakably pre-existed service. Here, the Veteran's February 1976 enlistment examination report indicates examination of the upper extremities was normal. Further, in November 2019, a VA examiner found the Veteran's currently diagnosed triangular fibrocartilagenous complex (TFCC) injury and synovitis of the left wrist, and bilateral carpal tunnel syndrome did not clearly and unmistakably pre-exist service. Specifically, he indicated that, although the Veteran likely had a pre-existing left wrist fracture, there was no evidence that any of his current diagnoses existed before his military service. Here, the examiner noted that, per the Veteran's history, he fell as a youth and fractured his left wrist (borne out via radiographic evidence of an old, ununited left styloid process fracture); however, he had no wrist/carpal tunnel complaints at service entrance and there was no record of a left wrist or carpal tunnel issue at enlistment. Given the above, the Board finds that a left wrist disorder and bilateral carpal tunnel syndrome did not clearly and unmistakably pre-exist service. Consequently, the question at issue in the instant case is whether a current left wrist disorder and/or bilateral carpal tunnel syndrome was incurred in service. In this regard, following a determination that a March 2014 private opinion by Dr. R.R., which indicated that the Veteran developed a problem with his left wrist during service, was inadequate to establish service connection as the Veteran's STRs were silent for any complaints, treatment, or diagnoses referable to the left wrist, in November 2018, the Board found it necessary to afford the Veteran VA examinations so as to determine the nature and etiology of his claimed left wrist disorder and bilateral carpal tunnel syndrome. Thereafter, at a November 2019 VA examination, the examiner noted diagnoses of TFCC injury and synovitis of the left wrist, and bilateral carpal tunnel syndrome. However, he found that such disorders were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In support thereof, the examiner reported that there was no record of a left wrist or carpal tunnel issue or complaints during service or at separation. Here, he noted that the Veteran was seen numerous times over the course of his military career for different ailments; however, there were no STRs reflecting left wrist or carpal tunnel symptoms during service. The examiner further noted that it would stand to reason that, if a significant hand/wrist issue existed during service, he would have availed himself of the system, especially since it was "much worse" per his reported history shortly after separation. In this regard, the examiner indicated that, even at separation when the Veteran's reported symptoms were "much worse," there was no record of an investigation into such issues for many years, and it was unlikely that the Veteran would have waited 25 years (carpal tunnel surgery in 2006) for treatment of an issue that existed in 1979. The examiner further reported that, although the Veteran did develop significant wrist issues later in life, there was no evidence to support a service origin for such issues. He concluded that it was more likely that the Veteran's left wrist disorder and bilateral carpal tunnel syndrome developed later in life and were a result of his physical occupation with the forest service as evidenced by: (1) the development of a bilateral shoulder disorder requiring surgery in 2000 shortly before the development of bilateral carpal tunnel syndrome and (2) a documented July 2010 incident involving a coworker that injured his left wrist. The examiner stated that it was noteworthy that the Veteran's carpal tunnel syndrome developed bilaterally rather than just on the left side if one were to consider a service origin for such disorder. The Board affords great probative weight to the November 2019 VA examiner's opinions as such considered all of the pertinent evidence of record, to include the Veteran's statements and treatment records, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, he offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez, supra; Stefl, supra. Furthermore, as indicated previously, Dr. R.R.'s March 2014 opinion is afforded no probative weight as it is based on an inaccurate factual premise as it was contradicted by the contemporaneous STRs. Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (holding that medical opinions based on inaccurate factual premise are not probative). The Board has also considered the Veteran's assertion as to the onset and etiology of his left wrist disorder and bilateral carpal tunnel syndrome; however, as a lay person, he does not have the requisite training and experience necessary to address such a complex medical matter. See Jandreau, supra. In this regard, the etiology of such disorders involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. Thus, such matter may not be competently addressed by lay statements. See Woehlaert, supra. Accordingly, the Veteran's opinion as to the onset and etiology of his left wrist disorder and bilateral carpal tunnel syndrome is not competent and, consequently, is afforded no probative weight. In conclusion, the Board finds that a left wrist disorder and bilateral carpal tunnel syndrome did not clearly and unmistakably pre-exist service, but are not shown to be causally or etiologically related to any disease, injury, or incident during service. Thus, service connection for such disorders is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claims, that doctrine is not applicable and service connection for a left wrist disorder and bilateral carpal tunnel syndrome must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. REASONS FOR REMAND 6. Entitlement to service connection for a back disorder, to include as secondary to service-connected disability. As noted in the November 2018 remand, the Veteran has asserted multiple theories of entitlement in regard to the etiology of his back disorder. In this regard, he asserts he developed back pain during service, which has continued to the present time, as a result of marching and ill-fitting boots. Additionally, he contends that his back disorder is secondary to his service-connected bilateral pes cavus with metatarsalgia, degenerative arthritis, and stress fracture of the left third metatarsal and right hallux rigidus, to include the treatment thereof. As he had not previously been provided a VA examination addressing his multiple theories of entitlement, the Board remanded the case in order to afford him such examination with corresponding etiological opinions. In November 2019, the Veteran underwent a VA examination, at which time the examiner noted diagnoses of degenerative arthritis of the spine, intervertebral disc syndrome, spinal fusion, spinal stenosis, and spondylolisthesis. Bilateral lower extremity radiculopathy was also noted as related to the Veteran's back. While the examiner adequately addressed the Veteran's theories of entitlement pertaining to direct service connection, and secondary service connection as related to his service-connected left third metatarsal status post stress fracture, he did not address whether his back disorder was secondary to his now service-connected bilateral pes cavus with metatarsalgia and degenerative arthritis, and/or right hallux rigidus. Thus, a remand is necessary in order to obtain an addendum opinion addressing such theory of entitlement. The matters are REMANDED for the following action: Forward the record, to include a copy of this Remand, to the November 2019 VA examiner who conducted the examination pertaining to the Veteran's back disorder so as to obtain an addendum opinion addressing the etiology of such disorder. Following a review of the record, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's back disorder (diagnosed as degenerative arthritis of the spine, intervertebral disc syndrome, spinal fusion, spinal stenosis, and spondylolisthesis) is caused or aggravated by his service-connected bilateral pes cavus with metatarsalgia and degenerative arthritis, and/or right hallux rigidus. For any aggravation found, the examiner should state, to the best of his or her ability, the baseline symptomatology and the amount, quantified if possible, of aggravated beyond the baseline symptomatology. A rationale should be offered for any opinion provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Koria B. Stanton, 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.