Citation Nr: 22016165 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 17-44 786 DATE: March 21, 2022 ORDER Service connection for left wrist tendinitis is granted. Service connection for right wrist tendinitis is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, his left wrist tendinitis is at least as likely as not related to service. 2. Resolving reasonable doubt in the Veteran's favor, his right wrist tendinitis is at least as likely as not related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for left wrist tendinitis are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for right wrist tendinitis are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 2007 to October 2011. This appeal comes before the Board of Veterans' Appeals (Board) from a May 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2021, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A hearing transcript is associated with the record. In September 2021, the Board remanded the claims for further development. The Board finds that there has been substantial compliance with its prior remand. See Stegall v. West, 11 Vet. App. 268 (1998). During remand status, a November 2021 rating decision granted service connection for left knee tendonitis. The Board finds that the Veteran's claimed symptoms are encompassed by the RO's grant. In this regard, at the November 2021, VA examination, the Veteran described his left knee symptomology as: Joint pain, leg stiffness, and limited motion that increases in severity during periods of flares. The Veteran's left knee disability is rated pursuant to Diagnostic Code 5261, which considers limitation of motion of the knee. See 38 C.F.R. § 4.71a; see also 38 C.F.R. § 4.59 (providing that consideration should be given to, among other things, painful motion in evaluating musculoskeletal disabilities). Thus, as the RO granted in full the benefit sought by the Veteran in this matter, there is no remaining allegation of error of fact or law for appellate consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (noting that a grant of service connection extinguishes appeals before the Board). The RO, additionally, sent to the Veteran a November 2021 supplemental statement of the case that addressed the remaining above issues on appeal. 1. Entitlement to service connection for left wrist disability. 2. Entitlement to service connection for right wrist disability. Issues 1-2. The Veteran, and his representative, contends that his current bilateral wrist disability stems from service. In this regard, the Veteran argues that his bilateral wrist disability is related to in-service injury, described as an over-use injury from climbing vertical ladders during service. In support of his claims, the Veteran submitted buddy statements. A June 2016 buddy statement from M.G. in support of the Veteran's claim. It reflects that as a shipmate of the Veteran he witnessed the Veteran complain about wrist pain when using hand tools and taking Ibuprofen for pain that continued to bother him after their return from a 2011 deployment. See VA Form 21-4138 (July 2016). A December 2021 buddy statement from K.K. reveals that during service, the Veteran was required to perform "Shaft Alley Patrol," in which, he had to go up-and-down seven decks of vertical ladders to perform security duties. The lay statement further describes eyewitness accounts, in which, the servicemember witnessed the Veteran experience wrist symptoms. See VA Form 21-4138 (December 2021). Also, in support of his claims, the Veteran submitted a favorable medical opinion, discussed in more detail below. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) A current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Resolving reasonable doubt in favor of the Veteran, the Board finds that the Veteran's diagnosed wrist tendinitis of the wrists is related to service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. The Board has carefully reviewed the evidence of record. The Veteran's service treatment records (STRs) no complaints, treatment or abnormal pathology of either wrist. The Veteran denied having or ever having had painful joints in October 2007, April 2008, July 2009, and October 2010. Also, while there are documented knee complaints related to ladder use while aboard the U.S.S. Vinson there are no documented wrist complaints. The first documented indication of any wrist disorder is in December 2014 when VA received the Veteran's original VA disability compensation application. See VA Form 21-526EZ (December 2014). After this, he sought to enroll in VA health care. In relevant part, the VA treatment records reflect as follows. A December 2014 VA Primary Care Note reflects "Issues/Events: Separated from Navy in 2011; has not been seeing a doctor since. Not taking any meds. Recently filed claims for SC and was encouraged to get a PCP. See PMH for details of his issues." By history, he had "bilateral wrist pain: stiffness, climbed a lot of ladders and thats when it started, no finger numbness. Pain with typing." Clinical evaluation showed negative Tinel's sign and Phalen's test along with normal finger strength. A January 2015 VA Nursing Telephone Encounter note reflects that the Veteran called to request "PT/OT for bilateral wrist pain that he has had since 2010." He described intermittent pain that hurts most when he is typing on the computer. An August 2015 VA treatment note reflects the Veteran's report that "he has not had wrist pains in a while because he has been out of class, not typing or doing activities that activate that" although he later reported in April 2016 that he had pain in the wrist of 4 on a 0 to 10 scale. An April 2022 VA treatment note reflects complains of intermittent wrist pain without tingling or weakness. A July 2017 VA Wrist Disability Benefits Questionnaire reflects a diagnosis of bilateral wrist tendonitis. By history, the Veteran's bilateral wrist pain began when he was aboard the U.S.S. Carl Vinson; he had pain with use of tools or climbing ladders; and he treated with Motrin. The Veteran reported that he had pain with gripping and holding heavy items. At his June 2021 Board hearing, the Veteran testified that he believed his bilateral wrist condition was due to overuse from climbing up and down vertical ladders aboard ship in while in service. The Veteran recollected that the wrist symptoms had their onset during service and addressed the Shaft Alley Patrol watch of climbing vertical ladders several decks long. The Veteran his symptoms continued since that time. VA obtained a November 2021 medical opinion that concluded the Veteran's bilateral wrist tendonitis less likely than not related to the Veteran's active duty, explaining that there was insufficient "objective medical evidence" to endorse continuation and/or persistence of the wrist pain without resorting to mere speculation. In December 2021, VA received from the Veteran a medical opinion from his VA medical provider, also dated in December 2021, finding otherwise. The December 2021 medical opinion reflects that the Veteran's condition was related to his active duty and climbing up and down rungs of ladders repeatedly. On weighing the evidence, the Board finds that it is roughly in equipoise and, therefore, all doubt is resolved in the Veteran's favor to grant the claims for service connection for tendonitis of each wrist. First, there is evidence of a current disability. VA examination report, dated in November 2021, reveals that the Veteran was diagnosed with bilateral wrist tendinitis. Second, there is evidence of an in-service event or injury. Here, the Veteran has provided competent and credible lay statements and testimony regarding in-service duties requiring the climbing of vertical ladders during prolong periods of time. His reports of in-service injury are also corroborated by the buddy statements provided on behalf of the Veteran. Thus, the Board finds competent, credible evidence of in-service injury, described as an over-use injury from climbing vertical ladders during service. Layno v. Brown, 6Vet. App.465, 470 (1994); see Caluza v. Brown, 7 Vet. App. 498 (1995) Third, the Board finds that the evidence is at least in equipoise as to whether the Veteran's current bilateral wrist disability is related to service. In that regard, the law is clear. Pursuant to the "benefit-of-the-doubt" rule, where there is "an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter," the claimant shall prevail upon the issue. 38 U.S.C. § 5107(b). Here, there is medical evidence both for and against the claim. The Board acknowledges that neither opinion is perfect in its explanation to support the conclusion reached. However, the Board finds that they are sufficient to decide the appeal. The negative November 2021 VA medical opinion notes, among other things, that the Veteran's service treatment records are silent for signs or symptoms of the claimed condition. The favorable December 2021 medical opinion notes the Veteran's complaints and treatment history as they pertain to his wrists, and that the clinician is his primary care provider. It is noted that there is no "treating physician rule" requiring the Board to give deference to the private medical opinion over the VA medical opinion. Both the U.S. Court of Appeals for the Federal Circuit and the U.S. Court of Appeals for Veterans Claims have specifically declined to adopt a "treating physician rule" that would give preference to statements from a treating physician. See White v. Principi, 243 F.3d 1378 (Fed. Cir. 2001); Guerrieri v. Brown, 4 Vet. App. 467 (1993). That said, in this circumstance where the evidence supporting the claims is as probative as the evidence against the claims this reasonable doubt is resolved in the Veteran's favor and the claims granted rather than denied. The Board, therefore, concludes that, with the benefit of the doubt resolved in the Veteran's favor, a grant of service connection bilateral wrist tendinitis is warranted. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). (Continued on the next page) Accordingly, the claims are granted. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Griffey, 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.