Citation Nr: 22013133 Decision Date: 03/08/22 Archive Date: 03/08/22 DOCKET NO. 09-38 439 DATE: March 8, 2022 ORDER Entitlement to service connection for a bilateral hand disorder, characterized as degenerative changes to the carpometacarpal joints and trigger finger, is denied. Entitlement to service connection for a bilateral wrist disorder, characterized as wrist sprain, is denied. Entitlement to service connection for a right shoulder disorder, characterized as acromioclavicular joint arthritis, is denied. FINDINGS OF FACT 1. The Veteran's bilateral hand disorder, characterized as degenerative changes to the carpometacarpal joints and trigger finger, was not shown in service and is otherwise unrelated to his active-duty service. 2. The Veteran's bilateral wrist disorder, characterized as wrist sprain, was not shown in service and is otherwise unrelated to his active-duty service. 3. The Veteran's a right shoulder disorder, characterized as acromioclavicular joint arthritis, was not shown in service and is otherwise unrelated to his active-duty service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a bilateral hand disorder, characterized as degenerative changes to the carpometacarpal joints and trigger finger, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for a bilateral wrist disorder, characterized as wrist sprain, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for a right shoulder disorder, characterized as acromioclavicular joint arthritis, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant served on active duty from June 1971 to June 1974. These matters return to the Board of Veterans' Appeals (Board) following the issuance of an October 2021 Board remand which directed the Regional Office (RO) to undertake additional development. Additionally, these claims have been previously remanded by the Board in June 2014, January 2017, December 2017, March 2019, and June 2020. Service Connection The law provides that service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, establishing service connection requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) 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 Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) a current disability; (2) a service-connected disability; and (3) a nexus between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1988). As to the third Wallin element, the current disability may be either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). 1. Entitlement to service connection for a bilateral hand disorder, characterized as degenerative changes to the carpometacarpal joints and trigger finger 2. Entitlement to service connection for a bilateral wrist disorder, characterized as wrist sprain 3. Entitlement to service connection for a right shoulder disorder, characterized as acromioclavicular joint arthritis The Veteran is seeking service connection for a bilateral hand, bilateral wrist, and right shoulder disorders. Specifically, the Veteran asserts that these disorders began in service following a 1974 motor vehicle accident. As an initial matter, the Board notes that the Veteran has confirmed diagnoses for the disorders on appeal. Following a review of the evidence of record, the Board concludes that service connection is not warranted for any of the claims on appeal. The Veteran's service treatment records do not contain any diagnoses or treatment regarding any of the disorders on appeal. Importantly, there are no noted injuries to the Veteran's right shoulder, hands, or wrists in the medical notes discussing the 1974 motor vehicle accident. Moreover, the Veteran's June 1974 separation examination is similarly silent for any noted injuries to these areas. Finally, while the Veteran's self-reported report of medical history does list several symptoms and injuries, it does not contain any self-identified symptoms or injuries to the Veteran's right shoulder, hands, or wrist. The first diagnoses for the disorders on appeal came decades following the Veteran's active-duty service, with diagnoses for: bilateral hand disorders in April 2012; a disorder of the right shoulder came in December 2015; and bilateral wrist disorders in September 2019. The large gap in treatment for the disorders on appeal weighs against the Veteran's service connection claims. See Kahana v. Shinseki, 24 Vet. App. 428, at 439-40 (2014) (The Board may weigh silence in a medical record against lay testimony if the alleged injury, disease, or related symptoms would ordinarily have been recorded in the medical record being evaluated). Moreover, the Veteran's in-service records do not reflect signs, symptoms, treatment, or a diagnosis of any disorders of the right shoulder, hands, or wrists. The Board notes and acknowledges the statements from the Veteran made in connection with his claim regarding continuous symptoms. However, the Board is unable to grant service connection purely on his statements alone. Specifically, While the Veteran has asserted continuous symptoms, the medical evidence of record weighs heavily against his testimony. Therefore, based on the clinical evidence of record, service connection cannot be established through continuity of symptomatology or the Veteran's statements. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007). Next, although the evidence does not reflect that the Veteran's symptoms were continuous since service, service connection may nonetheless be established if a relationship is otherwise demonstrated by competent evidence, including medical evidence and opinions. Here, the competent evidence fails to establish a relationship between active duty and the Veteran's current right shoulder, bilateral hand, and bilateral wrist disabilities. To this end, the Veteran was afforded VA medical examinations in December 2015, February 2017, August 2018, and October 2019. In January 2021 the RO obtained an opinion from a clinician regarding the nature and etiology of the Veteran's claimed disorders. However, the examinations conducted in December 2015, February 2017, August 2018, and October 2019 have been previously determined to be inadequate and will thus not be discussed below. In the January 2021 opinion, the clinician opined that the Veteran's bilateral wrist, bilateral hand, and right shoulder disorders were less likely than not related to the Veteran's active-duty service. For the Veteran's wrist disorders, the clinician noted that they were separate from the Veteran's upper extremity radiculopathy and cited the presented symptoms of pain as opposed to numbness. The clinician further noted that the Veteran's wrist disorders should be considered as generalized wear and tear and that there was no relation between them and the Veteran's active-duty service, citing the lack of treatment in service and the large gap in time between separation and diagnosis. The clinician also noted that the Veteran's wrist symptoms were not caused or aggravated beyond the natural course expected of them by another disability. For the Veteran's bilateral hand disorders, the clinician opined that the etiology of the disorders was generalized wear and tear. The clinician noted that there were no noted hand injuries or symptoms documented in the Veteran's service treatment records and that the symptoms of the Veteran's bilateral hand disorders fell within the normal projected history and were thus not caused or aggravated beyond their natural course by another disability. For the Veteran's right shoulder disorder, the clinician opined that the etiology of the disorder was generalized wear and tear. The clinician noted that there were no indications for a right shoulder disorder in the Veteran's service treatment records, and that there was no evidence to suggest that the disorder was caused or aggravated by another disability. Following the review of the evidence discussed above, the Board concludes that service connection is not warranted for the Veteran's right shoulder, bilateral hand, and bilateral wrist disorders. In arriving at its conclusion, the Board has also considered the statements made by the Veteran relating his right shoulder, bilateral hand, and bilateral wrist disorders to his active-duty service. The Federal Circuit has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau, 492 F.3d at 1377). In this case, however, the Veteran is not competent to provide testimony regarding the etiology of his right shoulder, bilateral hand, and bilateral wrist disorders. See Jandreau, 492 F.3d at 1377, n.4. Although he can provide competent testimony regarding symptoms observable to his own senses, these are not disorders that can be diagnosed by unique and identifiable features as they do not involve simple identification that a layperson is competent to make. In any event, the diagnoses of dysfunctions and disorders, and their respective etiologies, are medical determinations and generally must be established by medical findings and opinion. See Id. at 1376-77. Thus, to the extent that the Veteran believes that his right shoulder, bilateral hand, and bilateral wrist disorders are related to his active-duty service, he is a lay person without appropriate medical training and expertise to provide a medical diagnosis and etiological opinion. Accordingly, the evidence is persuasively against the claims. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the evidence is against the claims, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102. Service connection for the Veteran's right shoulder, bilateral hand, and bilateral wrist disorders is not warranted. The Veteran's appeal is denied. 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. Amanda Christensen Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Q. Hernan, Attorney Advisor 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.