Citation Nr: 22016178 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 16-55 383 DATE: March 21, 2022 ORDER Entitlement to service connection for cervical spine degenerative disc disease (DDD), claimed as neck strain, is denied. Entitlement to service connection for right hand carpal tunnel syndrome, to include as secondary to DDD, claimed as right arm disability, is denied. FINDINGS OF FACT 1. Currently diagnosed degenerative disc disease of the cervical spine manifested more than one year after separation and is not shown to be causally or etiologically related to an in-service event, injury, or disease. 2. Currently diagnosed right hand carpal tunnel syndrome, and currently diagnosed radiculopathy, manifested more than one year after separation, and is not shown to be causally or etiologically related to an in-service event, injury, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for cervical spine, DDD, are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1154, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304(d), 3.307, 3.309. 2. The criteria for service connection for right hand carpal tunnel syndrome, to include as secondary to DDD, are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1154, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304(d), 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from May 1993 to May 1997. This case comes before the Board of Veterans' Appeals (Board) on appeal from an October 2011 rating decision by an agency of original jurisdiction (AOJ) of the United States Department of Veterans Affairs (VA). In November 2016 and July 2017, the Veteran requested a Board hearing. In September 2017, the Veteran requested to withdraw his request for a hearing. As such, the Veteran's hearing request is considered to have been withdrawn. See 38 C.F.R. § 20.704. In May 2020, the Board remanded the claims for further development, to include affording the Veteran new VA examinations. In July 2021, the Board denied entitlement to service connection for bilateral hearing loss and denied entitlement to an initial compensable rating for residuals of a right hand contusion; these issues are no longer before the Board. The Board remanded the remaining issues of entitlement for a cervical spine disorder and right hand carpal tunnel syndrome to obtain addendum opinions on their nature and likely etiology. Substantial compliance with the Board's prior remand orders is demonstrated. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999); Stegall v. West, 11 Vet. App. 268, 271 (1998). With respect to the Veteran's claims decided herein, VA has met all statutory and regulatory notice and duty-to-assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326. Neither the Veteran nor his representative has advanced any procedural arguments in relation to VA's duty to notify and assist. See Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). Service Connection Service connection is awarded for disability that is the result of a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Service connection requires competent evidence showing: (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 or aggravated during service. Shedden v. Principi, 381 F. 3d 1163 (Fed. Cir. 2004). 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. 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. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability that are subject to lay observation. 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). Some chronic diseases, including arthritis and carpal tunnel syndrome (as an organic disease of the nervous system), may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The applicable presumptive period is one year from separation. Cervical spine, Degenerative Disc The Veteran's service treatment records (STRs) show that he strained his neck in November 1996; a cervical spine x-ray showed no fracture. The Veteran reported that his neck hurt and was too stiff to move. The Veteran denied trauma or injury to the neck. Upon examination, the doctor noted spasm and pain when Veteran elevated his arm. The Veteran denied numbness/tingling to his extremities. The Veteran was diagnosed with a cervical sprain. At his April 1997 separation examination, he reported a neck injury during his active service. No other neck or spine related defects or diagnoses were reported. The Veteran's medical records show that in March 2011 he reported to his doctor that his neck pain began in service. A March 2011 cervical spine MRI showed mild disc narrowing, minimal disc bulging, osteophyte formation at C6-7, and foraminal encroachment. A March 2011 cervical spine x-ray showed minimal narrowing of the disc space at C5-6 and mild arthritic changes. In December 2011, a treating VA doctor noted that the Veteran had chronic neck and arm pain with unknown etiology. In September 2012, the Veteran submitted an August 2012 letter from a private doctor about the Veteran's neck and arm conditions. The doctor stated that "we can connect his neck to military service, his carpal tunnel, and his right arm pain. It is reasonable to think that it would take 1-2 years for this pain to fully manifest itself and become documented in the record." While the doctor refers to the Veteran's military service, it is not apparent that he had access to and reviewed the STRs. The doctor did not provide any rationale to support his conclusions. The doctor also did not note any medical evidence that the Veteran had or reported any neck pain 1-2 years after service. In September 2016, the Veteran was afforded a VA neck examination. The VA examiner noted there was insufficient evidence to show that a traumatic soft tissue condition would cause multilevel degenerative disc disease and spondylosis. She also added that degenerative changes are common with age. In August 2017, an x-ray of the cervical spine showed minimal C5-6 degenerative change with the note "no change." In December 2020, the Veteran was afforded another VA neck examination. The examiner reported that there was no chronic cervical spine disorder and the Veteran's symptoms were subjective only. However, under the diagnosis section, the examiner reported that the Veteran was diagnosed with cervical spine arthritis and herniated discs. This exam is inadequate for rating purposes due to its inconsistency, failure to consider the objective medical evidence, and failure to consider the Veteran's lay statements. In November 2021, the VA obtained an addendum opinion by an examiner who reviewed the Veteran's entire claims file. The examiner concluded, "There is no evidence that [the November 1996] atraumatic soft tissue muscle strain would cause multilevel degenerative disc disease and spondylosis, seen on 2011 XR and MRI studies." The examiner explained, "As we age, it is not uncommon for degenerative changes to occur and are frequently seen radiological findings after age 30." The Veteran asserts there is a nexus between a muscle strain in service and his currently diagnosed degenerative disc disease of cervical spine. While a lay person is competent to testify about their symptoms, or to report what a doctor has told him, only a medical professional is competent to provide a diagnosis. As a lay person, the Veteran is not competent to render an opinion as to the etiology of his claimed conditions as he is a layperson lacking the necessary training and knowledge to do so. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Additionally, the Board finds the August 2012 private medical opinion to have little probative value. While the opinion found the Veteran's degenerative disc disease of the neck to be caused by service, there is no indication the examiner reviewed the Veteran's STRs, which contain only one instance of non-traumatic neck pain. Further, the stated rationale, that a connection was "reasonable" fails to actually provide reasoning. The first documented indication of degenerative disc disease in treatment records occurred over 10 years after Veteran's separation from service. STRs contain a single instance of a muscle sprain of the neck; Veteran's separation exam noted no other instances of neck injury or pain. As explained by the November 2021 examiner, degenerative changes are frequently seen radiological findings after age 30 and the Veteran's single instance of atraumatic soft tissue muscle strain would not cause multilevel degenerative disc. Because there is no competent evidence which links the Veteran's conditions to service, to include evidence of continuity, direct service connection is not warranted, and as there is no diagnosis within one-year post-separation, presumptive service connection is not warranted. As there is no evidence to support any finding of a nexus between service and Veteran's current of conditions, service connection is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine; the weight of the evidence is persuasively against the Veteran's claim, and the doctrine is not applicable. 38 U.S.C. § 5107(b). Right arm/hand condition - carpal tunnel syndrome In February 1994, STRs note that the Veteran dropped a brake rotor on his right hand and sought treatment a few days later. The x-ray was negative for fracture; the Veteran was treated with a splint for seven days. STRs noted redness on the posterior right hand with minor swelling. Veteran exhibited full range of motion, good strength, and no neurological deficits. In April 2011, the Veteran reported to his doctor that he had experienced right arm pain for more than 10 years. A March 2011 x-ray of the Veteran's right hand was noted to be normal with no bony abnormality. An October 2011 electromyography (EMG) confirmed right arm radiculopathy. The Veteran's VA treatment records show that he had normal finger movements at physical examinations in January 2012, February 2017, May 2017, September 2017, February 2018, March 2019, September 2019, and January 2020. The March 2011, September 2016, and December 2020 VA examiners indicated that the Veteran did not have any ankylosis of the right hand and he retained normal range of motion. The September 2016 and December 2020 VA examiners indicated that the Veteran did not have any additional contributing factors of disability. Finally, the Veteran denied having flare-ups at the March 2011, September 2016, and December 2020 VA examinations. At a January 2012 neurology appointment with his VA doctor, the Veteran complained of right arm pain. An EMG showed mild right radiculopathy and the Veteran was diagnosed with right suprascapular pain radiating right arm. The August 2012 private doctor concluded that the Veteran's right arm pain is the result of his carpal tunnel pain radiating from the right hand. The doctor also concluded the Veteran carpal tunnel was separate from the Veteran's pain in his right arm from the Veteran's "original hand crush injury" in service. In February 2015, the Veteran complained of right hand pain that radiated up his arm to his elbow. His private doctor diagnosed him with lateral epicondylitis. The September 2016 examiner concluded that a blow to the dorsal hand would not cause injury of any type to the median nerve. Moreover, the examiner highlighted that the Veteran had a history of working in the food service and computer industry for many years, which are common for the predisposition for the developed of carpal tunnel. The examiner concluded that the Veteran's carpel tunnel syndrome was unrelated to the Veteran's active-duty service. The December 2020 examiner concluded that the Veteran had no chronic diagnosis for carpal tunnel syndrome. The examiner noted symptoms are subjective only and that objective testing showed no symptoms. However, the examiner marked mild, incomplete paralysis of the right and left internal saphenous nerve. The examiner also noted the Veteran had abnormal EMG studies and neuropathy of right upper extremity. The Veteran reported that he started having right arm numbness in 1997 and none of his treatment has helped. This exam is inadequate for rating purposes due to its inconsistency, failure to consider the objective medical evidence, and failure to consider the Veteran's lay statements. In September 2021, an x-ray of Veteran's right hand showed no acute osseous findings compared to March 2011. In October 2021, at a follow-up appointment with his VA neurologist, the doctor noted the Veteran has some chronic sensory changes in his hands, in part related to carpal tunnel syndrome, at least on the left side. He wears a left wrist splint at night. The doctor reported that the Veteran see an orthopedist for joint issues of his right hand. The November 2021 examiner explained, "There is no mechanism by which elbow epicondylitis would result from a cervical spine condition. EMG in 2011 did show evidence of a mild C7-8 radiculopathy. However, these findings were 15 years post the veteran's reports neck pain and stiffness in 1996. This may cause pain to refer down the back of the arm to the region of the elbow, and down to the hand. The radiculopathy is likely the result of the degenerative DDD/spondylosis seen on imaging." The Veteran asserts there is a nexus between a hand injury in service and his currently diagnosed carpal tunnel syndrome in his right hand. The Veteran also asserts there is a connection between his military occupational specialty (MOS) of Administrative Specialist and carpal tunnel syndrome. The Veteran also asserts neuropathy in his right hand is secondary to his cervical neck condition. As discussed above, the Veteran is not competent to render an opinion as to the etiology of his claimed conditions as he is a layperson. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). As above, the Board finds the August 2012 private medical opinion to have little probative value. While the opinion found the Veteran's carpal tunnel syndrome to be caused by service, there is no indication the examiner reviewed the Veteran's STRs, which contain only one instance of a hand injury. The Board affords more probative weight to the September 2016 examiner who reviewed the Veteran's STRs, current treatment records, and examined the Veteran. The examiner highlighted that the Veteran had a history of working in the food service and computer industry for many years after service, and explained those occupations are common for the predisposition for the developed of carpal tunnel syndrome. The examiner also concluded that a blow to the dorsal hand would not cause injury of any type to the median nerve. The first documented indication of right arm pain in treatment records occurred over 10 years after Veteran's separation from service. STRs contain a single injury to the Veteran's right hand, for which is he is service connected. The Veteran's separation exam noted no other instances of neck injury or pain. As explained by the November 2021 examiner, elbow epicondylitis is not a result from a cervical spine condition and the Veteran's radiculopathy is likely the result of his degenerative DDD/spondylosis diagnosis. As the Board has not found service connection is warranted for the Veteran's DDD, secondary service connection is not warranted. Because there is no competent evidence which links the Veteran's conditions to service, to include competent and credible evidence of continuity, direct service connection is not warranted, and as there is no diagnosis within one-year post-separation, presumptive service connection is not warranted. As there is no evidence to support any finding of a nexus between service and Veteran's current of conditions, service connection is not warranted. In the absence of evidence, there cannot be even equipoise, and there can be no resolution of doubt. The Veteran still ultimately bears some burden of production. 38 U.S.C. § 5107(a); Cromer v. Nicholson, 455 F.3d 1346 (Fed. Cir. 2006). As there is no evidence to support any finding of a nexus between service and carpal tunnel syndrome or other radiculopathy of the Veteran's right hand/arm, entitlement to the benefit sought is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine; the weight of the evidence is persuasively against the Veteran's claim, and the doctrine is not applicable. 38 U.S.C. § 5107(b). WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lauren Barletta 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.