Citation Nr: 22013607 Decision Date: 03/10/22 Archive Date: 03/10/22 DOCKET NO. 16-32 322 DATE: March 10, 2022 ORDER Entitlement to service connection for bilateral carpal tunnel syndrome as secondary to service connected posttraumatic stress disorder (PTSD) with alcohol use disorder is granted. FINDING OF FACT The Veteran's bilateral carpal tunnel syndrome is aggravated beyond its natural progression by his service-connected PTSD with alcohol use disorder. CONCLUSION OF LAW The criteria for service connection for bilateral carpal tunnel syndrome as secondary to service-connected PTSD with alcohol use disorder are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1998 to July 2006. This appeal comes to the Board of Veterans' Appeals (Board) from a September 2014 rating decision of the Department of Veterans' Affairs (VA) regional office (RO). The Board previously remanded the instant matter for additional development in July 2019 and September 2021. The Veteran contends his bilateral carpal tunnel syndrome is related to his active service. Specifically, he claims his military occupational specialty (MOS) as an aviation operations specialist and secondary MOS as an aerial observer and gunner required constant typing, emailing, use of databases and charts, lifting of heavy equipment, and maintaining a constant physical fitness routine. Alternatively, he contends that his bilateral peripheral nerve paralysis is aggravated by his service-connected PTSD with alcohol use disorder. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may be granted based on evidence of (1) a current 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 or aggravated during service. 38 C.F.R. § 3.304. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a 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) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439 (1995). VA has amended 38 C.F.R. § 3.310 to explicitly incorporate the holding in Allen, except that it will not concede aggravation unless a baseline for the claimed disability can be established with evidence created prior to any aggravation. 38 C.F.R. § 3.310(b). The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104(a); Baldwin v. West, 13 Vet. App. 1 (1999). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). A November 2014 VA progress note shows the Veteran has a current disability of bilateral carpal tunnel syndrome. The January 2021 VA examiner noted a risk factor for peripheral neuropathy is excessive alcohol abuse. The October 2021 VA examiner found that his peripheral neuropathy, diagnosed as carpal tunnel syndrome, is clearly aggravated by his ethanol abuse disorder. The Veteran is currently service connected for PTSD with alcohol use disorder, severe. In sum, the Veteran has a current diagnosis of bilateral carpal tunnel syndrome. There is only one probative etiology opinion of record, which is in support of the Veteran's claim for entitlement to service connection. Moreover, there is no sufficient basis for the Board to reject this supportive opinion and to further develop the claim. Cf. Mariano v. Principi, 17 Vet. App. 305, 312 (2003) (holding that, because it is not permissible for VA to undertake additional development to obtain evidence against an appellant's case, VA must provide an adequate statement of reasons or bases for its decision to pursue such development where such development could be reasonably construed as obtaining additional evidence for that purpose). (Continued on the next page) Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current bilateral carpal tunnel syndrome is aggravated beyond its natural progression by his service-connected PTSD with alcohol use disorder. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for bilateral carpal tunnel syndrome is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. M. Donahue Boushehri, 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.