Citation Nr: 22013160 Decision Date: 03/08/22 Archive Date: 03/08/22 DOCKET NO. 15-09 064 DATE: March 8, 2022 ORDER Service connection for a left wrist disorder is denied. FINDINGS OF FACT 1. The Veteran served on active duty from August 1979 to August 1983 and from December 1986 to February 1988. 2. A left wrist disorder clearly and unmistakably existed prior to service and clearly and unmistakably was not aggravated beyond its natural progression either during service or by a service-connected disability. CONCLUSION OF LAW A preexisting left wrist disorder was not aggravated beyond its natural progression either by active service or by a service-connected disability. 38 U.S.C. §§ 1101, 1111, 1112, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a procedural matter, the Veteran testified at a May 2018 hearing before the undersigned Veterans Law Judge. A copy of the transcript has been associated with the claims file. In May 2020, the Board remanded the issue for additional development. The appeal has now been returned to the Board for further appellate action. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Additionally, veterans are considered to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders "noted" at entrance into active service, except where clear and unmistakable evidence demonstrates that an injury or other disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111. Thus, veterans are presumed to have entered service in sound condition as to their health. Only such conditions as are recorded in examination reports are considered as "noted." 38 C.F.R. § 3.304(b). Where conditions are "noted" at entrance into service, the presumption of soundness does not apply and presumptive service connection based on symptoms that are "chronic" or "continuous" since service or manifest within one year of separation from service is similarly inapplicable. 38 U.S.C. § 1111; 38 C.F.R. §§ 3.303(b), 3.306, 3.307. Rather, the veteran may be granted service connection only if his preexisting disability was aggravated by active service. A preexisting disability will be considered to have been aggravated by active service where there is an increase in disability during service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306; see also Wagner v. Principi, 370 F.3d. 1089 (Fed. Cir. 2004). Clear and unmistakable (obvious or manifest) evidence is required to rebut the presumption of aggravation where the pre-service disability underwent an increase in severity during service. However, aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all of the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 C.F.R. § 3.306. Temporary or intermittent flare-ups of a preexisting injury or disease are not sufficient to be considered in-service aggression unless the underlying condition, as contrasted with its symptoms, has worsened. Jensen v. Brown, 4 Vet. App. 304 (1993); Green v. Derwinski, 1 Vet. App. 320 (1991); Hunt v. Derwinski, 1 Vet. App. 292 (1991). Thus, "a lasting worsening of the condition"- that is, a worsening that existed not only at the time of separation but one that continues to currently exist is required. Routen v. Brown, 10 Vet. App. 183 (1997); Verdon v. Brown, 8 Vet. App. 529 (1996). Turning to the evidence, the Veteran was noted to have had a left wrist fracture upon entry into service. In this regard, a review of the service treatment records (STRs) reveal that a clinician noted a history of a left wrist fracture in a March 1979 Report of Medical History associated with the entrance examination; however, he was found fit for duty. Accordingly, a left wrist fracture was noted upon entry into service, the presumption of soundness does not attach, and the claim may only be considered on the basis of aggravation. To that end, the threshold question is whether the Veteran's preexisting left wrist disorder was aggravated beyond its natural progression by service. As to aggravation, the Veteran reported in a January 1983 STR that he had wrist pain for the previous two years. He explained that he fractured his wrist in 1978 and said that he had pain and decreased strength when lifting items. However, a clinician observed that his left wrist had full range of motion and did not diagnose a left wrist disorder. Moreover, to the extent that the January 1983 STR established an increase in the severity of the Veteran's preexisting left wrist disability, it did not demonstrate that the increase was beyond the natural progression of the disorder. Many years after service, September 2019 and September 2020 VA examiners offered that the Veteran's post-separation record demonstrated no signs that a left wrist disorder was aggravated beyond its natural progression. While they acknowledged the January 1983 complaints, they noted that he had no other complaints of left wrist pain until August 2014 and did not receive any treatment for his wrist prior to 2014. They observed that he reported in August 2014 that he had no then-recent injury or trauma of his left wrist and that subsequent appointments found his left wrist to be stable and manageable. The September 2019 and September 2020 examiners thoroughly reviewed the claims file and addressed the evidence of record, to include whether the Veteran's left wrist disorder was aggravated beyond its natural progression by service, considered the Veteran's assertions, and provided a thorough supporting rationale for the conclusions reached. As such, the September 2019 and September 2020 examinations are assigned high probative value. Based on the above, the medical evidence does not support a finding that the Veteran's left wrist disorder was aggravated by service. While a left wrist disorder was identified prior to enlistment and in-service wrist pain was noted, the medical evidence does not establish that the disorder worsened beyond its natural progression in service. The issue is not whether his left wrist disorder is worse now but rather whether it was aggravated in service. As the severity of his left wrist disorder did not increase beyond its natural progression, the medical evidence does not support the claim on an aggravation basis. The Veteran has argued that his left wrist disability was caused or aggravated by his service-connected right knee and left ankle disorders. Specifically, in a May 2018 statement, he described losing his balance and falling as a result of his service-connected disabilities and using his left hand and wrist to brace his falls. In May 2018 testimony, he asserted that the instability of his service-connected right knee and left ankle caused him to frequently lose his balance and fall, and that his left wrist and fingers were injured as a result. However, in July 2020 and September 2020 VA examinations, the examiner opined that it was less likely than not that the Veteran's left wrist disorder was aggravated beyond its natural progression by a service-connected disability. The examiner noted that the Veteran did not receive any treatment for his wrist prior to 2014 and that at that time, there was no evidence of degenerative changes. The examiner further observed that the Veteran fractured his wrist as a child and denied any other acute injuries since that time. The examiner ultimately opined that the left wrist disorder was more likely than not due to his childhood wrist injury. The July 2020 and September 2020 examinations, when read together, thoroughly reviewed the claims file and addressed the evidence of record, to include whether the Veteran's left wrist disorder was aggravated beyond its natural progression by a service-connected disorder, considered the Veteran's assertions, and provided a thorough supporting rationale for the conclusions reached. As such, the July 2020 and September 2020 examinations are assigned high probative value. The medical record does not otherwise establish that his left wrist disorder was aggravated beyond its natural progression by a service-connected disability; therefore, the medical evidence does not support the claim on the basis of secondary aggravation. In sum, the weight of the medical evidence does not establish that the Veteran's left wrist disorder was aggravated beyond its natural progression by either service or a service-connected disability. The Board has considered the lay statements and testimony offered by the Veteran regarding the etiology of his left wrist disorder. He is competent to report symptoms and describe his observations because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of any current disorder due to the medical complexity of the matters involved. Such competent evidence has been provided by the medical personnel who have examined the Veteran during his current appeal and by service and clinical records obtained and associated with the claims file. Here, the Board attaches greater probative value to the clinical findings than to the lay statements that have been submitted. Accordingly, service connection is not warranted, the appeal is denied, and there is no doubt to be otherwise resolved. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Spigelman, 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.