Citation Nr: 21040089 Decision Date: 07/02/21 Archive Date: 07/02/21 DOCKET NO. 16-60 328 DATE: July 2, 2021 ORDER Entitlement to a disability rating in excess of 10 percent for service-connected right hand carpal tunnel syndrome (CTS) is denied. Entitlement to service connection for irritable bowel syndrome is granted. FINDINGS OF FACT 1. The Veteran's right hand CTS has been characterized by no more than mild incomplete paralysis. 2. Affording the Veteran the benefit of the doubt, her irritable bowel syndrome is etiologically related to her active duty service. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating in excess of 10 percent for service-connected right hand CTS have not been met. 38 U.S.C. § § 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.85, 4.124, DC 8515. 2. The criteria for entitlement to service connection for irritable bowel syndrome have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 2009 to February 2015. The record shows that the Veteran was schedule for a videoconference hearing on June 9, 2021. In correspondence dated June 3, 2021, the Veteran requested that her upcoming videoconference hearing be canceled in light of her 100 percent disability rating. In light of the foregoing, the Board deems his request for a Board hearing to be withdrawn. See 38 C.F.R. § 20.704. Entitlement to a disability rating in excess of 10 percent for service-connected right hand CTS At the outset, the Board notes that the Veteran has been in receipt of a 100 percent disability rating effective September 18, 2018. The Board must addressed the remaining issues. The Veteran is currently in receipt of a 10 percent disability rating for service-connected right hand CTS under 38 C.F.R. § 4.124a, DC 8515. The Veteran's right-hand is her dominant hand and, thus, considered her "major" hand. Paralysis of the median nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, DC 8515. Under these criteria, mild incomplete paralysis is rated as 10-percent disabling for both the major and minor extremity. Moderate incomplete paralysis is rated as 30-percent disabling for the major extremity and as 20-percent disabling for the minor extremity. Severe incomplete paralysis is rated as 50-percent disabling for the major extremity and as 40-percent disabling for the minor extremity. For complete paralysis, meaning the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand (ape hand); pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; pain with trophic disturbances, the major extremity is rated at 70 percent and the minor extremity is rated at 60 percent. 38 C.F.R. § 4.124a. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, combine with application of the bilateral factor. Id. These descriptive terms "mild," "moderate," "moderately severe" and "severe" are not more specifically defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. Turning now to the relevant evidence of record, the Veteran underwent a nerve conduction study in November 2014 which found right medical neuropathy at the wrist which was consistent with a diagnosis of moderate CTS. The Veteran underwent both a VA wrist condition examination and a VA peripheral nerves examination in August 2015. The examiner acknowledged the Veteran's positive EMG study in 2014 and diagnosed the Veteran with right hand carpal tunnel syndrome. Range of motion and strength of the right wrist was normal. The Veteran was noted to wear an assistive device, namely a splint, on a regular basis. On examination of the right wrist, the Veteran reported mild constant pain, mild paresthesias/dysesthesias and mild numbness. Both Tinel's sign and Phalen's sign were negative at the time of the examination. The examiner indicated the Veteran had what amounted to mild incomplete paralysis of the right median nerve. Subsequent treatment records show that the Veteran continued to get treatment consisting of medication and splinting, but there is no indication in treatment records that the Veteran's right hand CTS more closely approximated a moderate level of impairment. Based on the totality of the record, the Board concludes the evidence indicates the Veteran's right CTS is appropriately rated at the currently assigned 10 percent level. The Board finds that the disability is primarily manifest by mild incomplete paralysis of the median nerve with pain, numbness and paresthesias. Strength test found normal results, and no muscle atrophy or trophic changes were noted. The Board thus finds that the level of impairment is most analogous to mild incomplete paralysis of the median nerve. In conclusion, the preponderance of the evidence is against the Veteran's claim for a rating in excess of 10 percent for right hand CTS, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Entitlement to service connection for irritable bowel syndrome The Veteran contends that she suffers from irritable bowel syndrome that is etiologically related to her active duty service. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish service connection for the claimed disorder, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection can also be established on the basis of continuity of symptomatology. Continuity of symptomatology may be shown by demonstrating "(1) that a condition was 'noted' during service or any applicable presumption period; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology." Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). However, the Federal Circuit held that the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic in 38 C.F.R. § 3.309(a), such as organic diseases of the nervous system to include tinnitus. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). At the outset, the Veteran has been diagnosed by treating providers with irritable bowel syndrome for several years. See VA treatment notes dated August 21, 2015. However, on a VA intestinal condition examination, also on August 21, 2015, the examiner did not diagnose IBS, noting instead that the diagnosis was unclear between IBS, constipation or ovarian cyst, with testing ongoing at the time of the examination. The Veteran has alleged that she suffers from this condition and that it is a continuation of the symptoms she endorsed while on active duty. Treatment records during her active duty service show repeated complaints of abdominal pain, as well as alternating constipation and diarrhea. While in-service treatment records considered other potential abdominal diagnoses, October 2014 treatment notes indicate the Veteran had a normal abdominal CT scan as well as a normal pelvic sonogram. Post-treatment records show the Veteran has sought and received treatment for irritable bowel syndrome and digestive system issues since her separation from service. In this case the Board finds that service connection is warranted for irritable bowel syndrome. The Board attributes great probative value to the Veteran's statements regarding the onset of symptoms. The Board recognizes that the Veteran was not diagnosed with irritable bowel syndrome until after her separation from active duty. However, regulations provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d). Accordingly, the Board finds that the evidence is in relative equipoise as to whether the Veteran's irritable bowel syndrome had its onset in service. Resolving reasonable doubt in the Veteran's favor, service connection is granted. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Woehlke 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.