Citation Nr: 21041009 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 14-03 186 DATE: July 7, 2021 ORDER Entitlement to service connection for right wrist carpal tunnel syndrome, to include as secondary to a service-connected right elbow disability, is denied. Entitlement to service connection for left wrist carpal tunnel syndrome, to include as secondary to a service-connected right elbow disability, is denied. FINDING OF FACT The competent and probative evidence of record fails to link the Veteran's bilateral carpal tunnel syndrome to his active service or service-connected right elbow disability. CONCLUSION OF LAW The criteria for entitlement to service connection for bilateral carpal tunnel syndrome, to include as secondary to service-connected right elbow disability, have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty from August 1989 to November 1998. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran provided testimony before the undersigned Veterans Law Judge in January 2017. The Board of Veterans' Appeals (Board) issued a decision denying the claims listed above as well as increased rating claims for a right elbow disability in October 2017. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (CAVC). In August 2018, the Court issued an Order, granting a joint motion for partial remand (JMPR), remanding the claims to the Board for action consistent with the JMPR. The Board remanded the matters for development, consistent with the JMPR, in April 2019 and November 2020, and rendered a decision regarding the right elbow increased rating claim in November 2020 and the service connection claim for hypertension in April 2021. As such, the only issues before the Board are the service connection claims noted above. Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. Where a service-connected disability aggravates a nonservice-connected condition, a Veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. The Board must consider all the evidence of record and make appropriate determinations of competence, credibility, and weight. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). VA shall give the benefit of the doubt to the claimant when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Veteran asserts that his bilateral carpal tunnel syndrome (CTS) is related to his military service, or otherwise related on a secondary basis to his service-connected right elbow disability. Post-service medical records indicate the first sign of a CTS diagnosis to be in early 2001, with a definitive diagnosis thereafter. As such, a current disability has been shown. As to evidence of an in-service injury, event, or illness, service treatment records (STRs) show that the Veteran complained of or was treated for a right wrist pain, and notations indicate a stress fracture in March 1990 and diagnosis of right wrist strain. As the Veteran's STRs show that there were complaints of right wrist pain and an injury during service, the facts establish that the second element of a service connection claim is met. As to evidence of a nexus between the current bilateral CTS disability and service, the Board finds that the preponderance of the evidence is against a nexus. Regarding direct service connection, a November 2020 VA medical opinion found that it is less likely than not that the Veteran's bilateral CTS incurred in or caused by an in-service injury, event, or illness. The examiner reviewed the Veteran's STRs and acknowledged the Veteran's in-service complaints regarding his right wrist pain and March 1990 stress fracture. The examiner stated that medical records from a week after the stress fracture indicate that it had resolved. The examiner further explained that CTS is caused by the compression of the medial nerve as it travels down the carpal tunnel and develops in response to risk factors that irritate the nerve, and that prior to the Veteran's diagnosis in 2001, the evidence of the record does not show signs, symptoms or a diagnosis of CTS. In addition, a March 2000 medical record specifically notes the Veteran did not have signs or symptoms of CTS. Moreover, the Veteran's diagnosis of bilateral CTS in 2001 is attributed to the Veteran's occupational risk factors of working "at a computer all day." Regarding secondary service connection, a May 2021 VA addendum medical opinion stated that it is less likely than not that the Veteran's bilateral CTS is caused or aggravated beyond natural progression by the Veteran's service-connected right elbow disability. The examiner explained that the Veteran's bilateral CTS is symmetric, or bilateral, and therefore unlikely to be caused or aggravated by the condition of one upper extremity, in this case, the Veteran's right upper extremity. Furthermore, the examiner noted the Veteran's diagnosis of bilateral CTS in 2001 was while he was working at a job known to have high risk of CTS development, which was keyboarding or being at a computer all day, as noted above. Moreover, the examiner stated the record does not show evidence of progression or aggravation, to include beyond the normal rate, of the Veteran's bilateral CTS over the span of almost two decades. The opinion includes citations to the pertinent medical evidence of record with notations to support the conclusions reached. The Board finds the November 2020 and May 2021 VA medical opinions probative, as the examiner had reviewed the Veteran's STRs, post-service medical records, and cited to the pertinent evidence of record to support the conclusions reached. In addition, the examiner's conclusions were supported by medical treatise evidence and were consistent with the verifiable facts regarding the Veteran's bilateral CTS. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value to a medical opinion). The VA examiner also considered the Veteran's lay statements and thoroughly reviewed his pertinent medical history. No additional evidence was provided to support the Veteran's contentions. After a full review of the record, the Board finds that the claim must be denied. The preponderance of the evidence weighs against a finding that the Veteran's bilateral CTS was incurred in service or was related on a secondary basis to his service-connected right elbow disability. Moreover, the record does not contain any competent evidence that shows the Veteran's bilateral CTS was incurred in service or was caused or aggravated by his service-connected right elbow disability. In this regard, the Board has considered the Veteran's lay contentions. While the Board finds him to be credible, the Board also observes that he lacks the medical training and credentials needed to provide a competent opinion. The lay contentions thus lack probative value and are substantially outweighed by the cited VA examination opinions. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Accordingly, service connection for bilateral carpal tunnel syndrome 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 this claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53. Thus, the claim is denied. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Ariasaif, 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.