Citation Nr: 22018168 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 17-32 801 DATE: March 28, 2022 ORDER 1. Service connection for right ulnar nerve damage is granted. 2. Service connection for a right-hand old boxer fracture is granted. FINDINGS OF FACT 1. The Veteran's right ulnar nerve damage had its onset during active service. 2. The Veteran's right-hand old boxer fracture had its onset during active service. CONCLUSIONS OF LAW 1. The criteria for service connection for right ulnar nerve damage have been met. 38 U.S.C. §§ 1131, 1154(a), 5107; 38 C.F.R. § 3.303(a). 2. The criteria for service connection for a right-hand old boxer fracture have been met. 38 U.S.C. §§ 1131, 1154(a), 5107; 38 C.F.R. § 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1965 to June 1967. This matter originally came before the Board of Veterans' Appeals (Board) from a July 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was remanded by the Board for further development in February 2019. This matter is again before the Board and has been advanced on the docket pursuant to 38 C.F.R. § 20.902(c). The Board notes that in December 2021, the Veteran withdrew his request for a Board hearing. Service connection for right ulnar nerve damage and a right-hand old boxer fracture is granted. The Veteran believes that service connection for right ulnar nerve damage and a right-hand old boxer fracture is warranted. Generally, direct service connection requires competent evidence showing: (1) the existence of 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 disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Direct service connection basically means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with active service in the Armed Forces; or, if preexisting such service, was aggravated therein. See 38 C.F.R. § 3.303(a); Flynn v. Brown, 6 Vet. App. 500, 503 (1994) (noting that, in the context of service-connected disability compensation, "the element of cause and effect has been totally by-passed in favor of a simple temporal relationship between the incurrence of the disability and the period of active duty"). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the veteran will receive the benefit of the doubt. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The first element for direct service connection is the existence of a current disability. Medical evidence during the appeal period shows diagnoses of right ulnar nerve damage and a right-hand old boxer fracture. See December 2019 C&P Exam. Therefore, the first element of direct service connection is met. The second element for direct service connection is the in-service incurrence or aggravation of a disease or injury. Service records following the Veteran's separation examination show that his medical condition had changed due to a fractured finger on the right hand. There was a fracture of the fifth metacarpal. The Veteran did not want to be followed by the military for it because he was only days away from leaving service. See July 2015 Military Personnel Record; July 2015 STR - Medical. The Veteran provided a picture of his wedding which took place a few days after he left service, which showed a cast on the right hand and arm. See August 2016 Photographs; August 2016 NOD. Therefore, the second element of direct service connection is met. The third and final element for direct service connection is the causal relationship between the current disability and the disease or injury incurred or aggravated during service. Evidence in support of a relationship includes the Veteran's spouse's report that ever since the Veteran had the right-hand injury at the end of service, the injury had caused continuous concern. At first, the cast had to be wrapped so that it would not get wet, and the Veteran's spouse had to help him with activities of daily living. Over the years, the right-hand injury continued to be a problem, including problems with nerve damage. The Veteran's mother-in-law also reported that over the years, since the right-hand injury at the end of service, the Veteran had complained about nerve damage and pain. The Veteran was unable to hold objects in the right hand or would drop things. See August 2016 Buddy / Lay Statement. The Veteran also reported that after injuring the right hand at the end of service, there had been problems ever since, including problems with nerve damage. Ever since the injury, it had been very difficult to use the right hand and to hold onto things. See June 2017 Correspondence. Medical records from 2017 show that during service, the Veteran suffered a right fifth metacarpal phalangeal fracture, also known as a boxer fracture. It was treated with a short arm cast for three months and subsequently with a bone stimulator. Since that time, the Veteran had struggled with right lateral knuckle pain, which had worsened over the past few years. X-rays found an old boxer fracture of the right fifth metacarpal with some residual distortion. See June 2017 Medical Treatment Record; October 2019 Medical Treatment Record. A medical record from 2019 shows that when the Veteran fractured the right fifth metacarpal, he began to have numbness in the ulnar nerve region of the right hand. See December 2019 C&P Exam. The Board finds the Veteran and the Veteran's family members competent to make the above lay statements. The Board has no reason to doubt their credibility. The Board gives the above lay statements great probative value. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board also finds the above medical evidence highly probative. Evidence against a relationship consists of a December 2019 VA examination, which found that the right ulnar nerve damage and the right-hand old boxer fracture were not related to service because nothing on the service separation examination showed hand/bone pain or fracture. It was questionable whether the right hand had been fractured during service. Nerve damage to the right hand from the alleged right hand fracture during service was also questionable because if a fracture or joint pain took place during service, the separation examination would have mentioned it. See December 2019 C&P Exam. The Board finds the December 2019 VA examination inadequate because it did not consider all of the relevant evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Specifically, the examination did not consider service records following the separation examination which showed the right-hand fifth metacarpal fracture. See July 2015 STR Medical; July 2015 Military Personnel Record. As such, the Board gives the December 2019 VA examination no probative weight. The Board notes that it appears that the only reason for the negative nexus opinion was the perceived lack of evidence of a right-hand fracture during service, which the service records clearly show. Based on the evidence of record, the Board finds that the evidence is at least in relative equipoise as to whether the Veteran's right ulnar nerve damage and right-hand old boxer fracture had their onset during the Veteran's service. Therefore, giving the Veteran the benefit of the doubt, service connection for right ulnar nerve damage and a right-hand old boxer fracture is granted. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Dougan, 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.