Citation Nr: 22010255 Decision Date: 02/23/22 Archive Date: 02/23/22 DOCKET NO. 14-19 959 DATE: February 23, 2022 ORDER Entitlement to service connection for a left wrist condition is granted. FINDING OF FACT The Veteran's left wrist condition is at least as likely as not etiologically related to his active-duty service CONCLUSION OF LAW The criteria for establishing entitlement to service connection for a left wrist condition have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from April 1980 to April 1984. He died in May 2020. The Appellant has been granted substitution. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). When this case was before the Board in October 2021, it was remanded for additional development. Specifically, the RO was instructed to obtain a medical opinion regarding the etiology of the Veteran's left wrist disability. A relevant medical opinion was obtained. As such, the Board finds that the AOJ substantially complied with the directives in the October 2021 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service ConnectionLegal Criteria 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 present disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Analysis The Appellant seeks service connection for the Veteran's claimed left wrist condition which she contends originated in service. The medical evidence confirms that the Veteran had current diagnoses of left wrist degenerative arthritis and atherosclerosis of arteries of the left extremity. See December 2016 VA Wrist Conditions examination. The central issue that must be resolved is whether the Veteran's current disability originated in service or was otherwise related to service. See Newhouse v. Nicholson, 497 F.3d 1298 (Fed. Cir. 2007); Gonzalez v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Initially, the Board notes that the Veteran's service treatment records (STRs) contain complaints of, and treatment for, his left wrist. Specifically, the Board notes an October 1980 treatment note for left wrist pain for 2 days with limited range of motion, a March 1982 treatment record noting the Veteran experienced left wrist pain for one week and noted he had a ganglion cyst, an August 1983 treatment record noting the Veteran had left wrist pain and noted a possible dislocation of navicular bone versus chip fracture of the metacarpophalangeal index finger, and an October 1983 treatment record noting the Veteran experienced left wrist pain which increased with range of motion. The Veteran's post-service treatment records document the Veteran's complaints of left wrist pain. The Board specifically notes an August 2012 X-Ray imaging report wherein the Veteran complained of left wrist pain and the imaging studies showed some calcifications in the soft tissues just lateral to the navicular bone of the left wrist and noted that they could be artifacts or result of old trauma. The Board notes that the Veteran has also provided lay statements throughout the record wherein he indicated that he injured his wrist in service and had experienced wrist pain ever since his injury. The Board notes that the Veteran has been provided with VA examinations and medical opinions in March 2014, December 2016, and January 2019. However, these opinions have been found to be inadequate for the purposes of adjudication by both the Board, in prior remands, and the Court of Appeals for Veteran's Claims (Court) in a February 2021 Joint Motion for Remand. However, the Board does note that during these medical examinations the Veteran consistently reported injuring his wrist in service, experiencing left wrist pain, and having that pain continue until present day. In response to an October 2021 Board Remand, the RO obtained a November 2021 Acceptable Clinical Evidence (ACE) Review Medical opinion regarding the etiology of the Veteran's left wrist disability. The examiner opined that the Veteran's left wrist disability was less likely than not (less than a 50 percent probability) etiologically related to his active-duty service. The rationale provided was that the Veteran's in-service wrist complaints are related to his ganglion cyst. Further, the examiner noted that the Veteran did not have left wrist degenerative joint disease in the 2012 x-ray findings, which indicate it is a new condition arising after 2012. The examiner noted the soft tissue calcifications but stated they were not germane to the Veteran's current diagnoses. Further the examiner noted that there was no evidence of a chronic condition after service or within one year of service. The examiner opined that it is more likely the Veteran's condition began in 2012. In this case, the Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a 3-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303 (2007) (Observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record. The Board also notes that under certain circumstances, lay evidence may be sufficient to establish a nexus. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); see also Layno v. Brown, 6 Vet. App. 465, 469 (1994). Lay evidence has been found to be competent with regard to a disease that has "unique and readily identifiable features" that are "capable of lay observation." See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007); see also Petitti v. McDonald, 27 Vet. App. 415, 427-28 (2015) (where the Court of Appeals for Veterans Claims found objective evidence of pain need not come from a medical professional; a lay person may provide the requisite confirmation). The November 2021 VA examiner's opinion was based on a lack of medical evidence of a chronic condition from the Veteran's service. However, the Board notes, "symptoms, not treatment, are the essence of any evidence of continuity of symptomatology." Savage v. Gober, 10 Vet. App. at 496. As noted below, the Veteran has offered competent and credible evidence of continuity of symptomatology. Further, the Board notes that the examiner did not discuss the Veteran's competent lay statements addressing his left wrist pain from service to present day. Therefore, the medical opinion is based on a lack of review of the entire treatment record regarding the Veteran's left wrist and is of limited probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (noting that the Board may afford weight to an opinion based on factors such as reasoning employed, whether the opinion is based on sufficient facts and data, and whether the opinion is based on medical principles applied to the facts of the case). The Board has considered the Veteran's lay statements in support of his claim. He was competent to report symptoms, such as pain, because this required only personal knowledge as it came to him through his senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, he was not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matter involved. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462. In this case, the Veteran reported that he experienced left wrist pain since his injuries in service, which had persisted ever since. The Board finds the Veteran competent to report such manifestations. It is generally within the competence of a lay person to identify and observe the effect of a disability under the ordinary conditions of daily life. Many symptoms are readily observable by a lay person. Additionally, the Veteran's lay statements are consistent with other medical evidence in the record. Accordingly, the lay evidence provided by the Veteran is unquestionably competent evidence. In this respect, the Board finds the Veteran's own reports of experiencing ongoing pain to be at least as probative as the above-noted VA examiners' findings, as the Veteran is truly the only person capable of such observation. Given the evidence discussed above, the Board finds that the evidence of record is approximately evenly balanced as to whether the Veteran's left wrist disability is at least as likely as not etiologically related to his active-duty service. The evidence is thus at least evenly balanced as to whether the Veteran's current left wrist disability is related to the in-service reports of, and treatment for, his left wrist. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for a left wrist condition is granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Gresham 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.