Citation Nr: 22006205 Decision Date: 02/03/22 Archive Date: 02/03/22 DOCKET NO. 14-35 044 DATE: February 3, 2022 ORDER Entitlement to service connection for bilateral carpal tunnel syndrome is granted. FINDING OF FACT The evidence is in equipoise that the Veteran's bilateral carpal tunnel syndrome is due to service. CONCLUSION OF LAW The criteria for service connection for bilateral carpal tunnel syndrome have been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Army from August 1974 to August 1994. This claim comes before the Board of Veterans' Appeals (Board) on appeal of a December 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at an October 2017 hearing, and a transcript of this hearing is associated with the claims file. This matter was previously before the Board in March 2018, July 2020, and April 2021, and all times it was remanded for additional development. During the pendency of the appeal, the Veteran was granted service connection for bilateral knee disabilities in a July 2021 rating decision. Because these grants represent a full grant of the benefits sought, these issues are no longer on appeal. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). 1. Entitlement to service connection for a neurological disorder of the bilateral upper extremities, to include carpal tunnel syndrome Service connection will be granted if the evidence in the record demonstrates that a current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) an in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). The Veteran contends that his bilateral upper extremity pain is related to service, to include as related to the repetitive motions associated with his duties as a mechanic on missile systems. The Veteran's service treatment records are silent regarding any pain or neurological symptoms in his upper extremities. The Veteran did complain of a sore right wrist after bowling in April 1986, but there was no diagnosed condition. The Veteran's military personnel records note his military occupational specialty (MOS) was missile systems mechanic. The Veteran underwent VA examinations in March 2013, April 2019, and July 2021. However, the March 2013 examination was determined to be inadequate in the Board's March 2018 decision, and the April 2019 examination was determined to be inadequate in the Board's July 2020 decision. In the July 2021 examination, the examiner noted a diagnosis of bilateral carpal tunnel syndrome which they dated to 2015. The examiner noted that while the Veteran's 2015 EMG testing did not indicate that he had carpal tunnel, or at least indicated he did not require any surgery for his bilateral upper extremity pain, his reported symptoms indicate that he does have carpal tunnel. The Veteran reported that he had radicular pain in his arms and hands, issues with grip strength, and difficulty with tasks such as typing, using a computer mouse, washing dishes, and household chores that involve the forced dorsiflexion of his hands. The Veteran also had positive Phalen's sign in both wrists, further indicating the Veteran has a current diagnosis of carpal tunnel. The examiner opined the Veteran's bilateral carpal tunnel was less likely than not related to his service. However, the examiner did note that the Veteran's carpal tunnel was a likely outcome and longterm consequence of his frequent heavy lifting, moving of heavy equipment, and using tools to maintain strike systems, per the veteran's report of his job and associated duties in service. In his October 2017 hearing, the Veteran testified that he was a mechanic on radar for air defense weapons systems during service. He reported that this maintenance involved repetitive movements through the use of screwdrivers and other hand tools. He believes that these repetitive movements caused his current upper extremity neurological symptoms. After reviewing the evidence of record, the Board finds the evidence is in equipoise that his bilateral upper extremity neurological disorder, diagnosed as carpal tunnel syndrome, is related to his service. The Veteran has a current diagnosis of bilateral carpal tunnel syndrome, fulfilling the first element of service connection. Additionally, the Veteran testified that he performed repetitive movements with his arms, wrists, and hands as a part of his duties as a missile systems mechanic, and the Board finds this testimony to be competent and credible. As such, the second element of service connection is met. Regarding a nexus between the Veteran's carpal tunnel syndrome and his service, the Board acknowledges that the July 2021 examiner indicated the condition was less likely than not related to service. However, the examiner's rationale also indicates a relationship between the Veteran's carpal tunnel syndrome and the activities associated with his MOS as a missile systems mechanic. While the Veteran was not diagnosed with carpal tunnel syndrome until the July 2021 examination, with a noted onset in 2015, the examiner noted this condition was a "likely outcome" and "long-term consequence" of the Veteran's physical demands of his MOS. Therefore, although the examiner provided a negative nexus opinion when they indicated the Veteran's carpal tunnel syndrome was less likely than not due to service, the Board finds the examiner's rationale to clearly indicate a positive nexus between the Veteran's condition and his service. Accordingly, the Board finds that the preponderance of the evidence is in favor of finding the Veteran's bilateral carpal tunnel syndrome is related to his service. As such, the claim of service connection for a neurological disorder of the bilateral upper arms, diagnosed as bilateral carpal tunnel syndrome, is granted. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Gabrielle Ongies, 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.