Citation Nr: 21040497 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 10-41 718 DATE: July 3, 2021 ORDER Entitlement to service connection for right hand Dupuytren's contractures is denied. FINDING OF FACT The Veteran's right hand Dupuytren's contracture disability did not have onset in service and is not otherwise etiologically related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for right hand Dupuytren's contractures have not been met. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1987 to August 1991 and from August 1992 to December 2002. He additionally served in the Army Reserves from December 2002 to April 2008, to include active duty for training (ACDUTRA)from February 6, 2003 to February 23, 2003. With the exception of the ACDUTRA period in February 2003, the Veteran served in an inactive duty status in the Army Reserves from December 17, 2002 to April 1, 2008. In May 2013, the appeal was remanded by the Board for additional development. In March 2020, the appeal was again remanded for VA examinations and opinions. The issue has been returned to the Board for appellate review. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § § 3.303 (a). To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either proximately caused by or proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Entitlement to service connection for right hand Dupuytren's contractures The Veteran contends that service connection is warranted for his diagnosed right hand Dupuytren's contracture. Specifically, the Veteran asserts that his right hand Dupuytren's contracture is either a result of exposure to chemicals and daily hand stressors in service, or in the alternative related to his service-connected left hand Dupuytren's contracture. A review of the Veteran's service treatment records (STRs) shows that in May 1995, the Veteran was seen for trauma to his right middle finger. No fracture or dislocation was noted at that time and there are no further treatment notes regarding the injury. The Board notes that shortly after separation from service the Veteran was found to have a lump in his left palm which was initially diagnosed as a ganglion cyst but later diagnosed as Dupuytren's contracture in 2003. Service connection has been awarded for the left hand as the VA examiner determined the ganglion cyst likely was present in service since it was treated and diagnosed two months after separation. As for the right hand, the Veteran was diagnosed with Dupuytren's contracture in 2006. A January 2015 private treatment note from The Catholic University of Korea St. Mary's Hospital shows that the Veteran complained of right little finger contracture that reportedly had been present for 7-8 years. The presumptive diagnosis was Dupuytren's contracture, little finger, right hand. The Veteran was advised to consider surgery. A February 2021 VA muscle injury examination reflects a diagnosis of Dupuytren's contracture, a non-penetrating muscle injury, in the right hand. A February 2021 VA hand and finger examination reflects a diagnosis of bilateral Dupuytren's contracture with the left hand diagnosed in 2003 and the right diagnosed in 2006. The Veteran reported that in 2003 he was seen during Army training for difficulties with his left hand which was injected with a steroid. He reported his right hand began to have problems a couple of years later and over time progressively worsened with the right 5th digit being completely contracted at the time of examination. The VA examiner provided a positive opinion for the left hand with a complete rationale. For the right hand, the examiner opined it was less likely than not the Veteran's Dupuytren's contracture was incurred in or caused by the claimed in-service injury, event, or illness. No rationale was specifically provided for the opinion for the right hand. The examiner did address the issues of an injury to the hand and repeated hand use in relation to the cause of Dupuytren's contracture. As for an injury to the hand, the examiner noted the possible connection between and injury of the hand and the onset of Dupuytren's contracture has been frequently discussed but it is difficult to prove cause and effect in individual cases. Regarding repeated use or work-related damage, the examiner stated people also develop Dupuytren's contracture without ever being exposed to heavy manual work. The examiner also noted there is a view, although a lack of evidence, that repeated hand trauma from repeated hand uses for certain occupations is the cause of Dupuytren's contracture. Pursuant to the Board's March 2020 remand, a VA addendum medical opinion was obtained in April 2021. The examiner opined the right hand Dupuytren's contracture is less likely than not related to active duty. The rationale provided was multifaceted. First, the examiner stated the exact cause of Dupuytren's contracture is unknown and there is no evidence to establish the Veteran's right hand condition occurred during active duty service. The examiner did note that a number of factors are believed to increase one's risk of the disease including age (most commonly after age 50), being male, being of northern European descent, a family history, having diabetes, and tobacco and alcohol use. The examiner also stated that there is no evidence that hand injuries or occupations that involve vibrations to the hands cause the condition. As for whether the right Dupuytren's contracture is the result of injury or repeated trauma, the examiner stated there is no data to establish occupational trauma caused the condition. Lastly, as for whether the condition has progressed from the left hand to the right hand the examiner stated there is no relation between hands as being causative as they are independent and separate and unrelated etiologies. The examiner stated a left hand condition does not cause a right hand condition because they are separate anatomically and unrelated. The Board finds the VA medical opinion to be probative as to whether the Veteran's right hand Dupuytren's contracture is etiologically related to service or to his left hand service-connected Dupuytren's contracture. The examiner interviewed the Veteran, reviewed the claims file, discussed the medical evidence of record, and provided an opinion supported by a well-reasoned rationale. Additionally, the Board finds there is no medical evidence linking the origin of the Veteran's right hand Dupuytren's contracture to his military service. The Board has also considered the Veteran's contentions that a nexus exists between his right hand condition and service and/or his service-connected left hand Dupuytren's contracture. As a lay person, however, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the cause of the medically complex disorder of Dupuytren's contracture. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011) (recognizing ACL injury is a medically complex disorder that required a medical opinion to diagnose and to relate to service). For the reasons discussed above, the Board finds based on the competent, credible, and probative evidence of record, that the Veteran's right hand disorder was not incurred in service and not otherwise etiologically related to service. Additionally, his right hand disorder was not caused by his left hand Dupuytren's contracture as they are separate and independent of each other. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107 (b) is not applicable, as there is no approximate balance of evidence. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Mitchell, 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.