Citation Nr: 22044865 Decision Date: 08/08/22 Archive Date: 08/08/22 DOCKET NO. 12-12 024 DATE: August 8, 2022 ORDER Entitlement to service connection for left carpal tunnel syndrome is granted. FINDING OF FACT The Veteran's left carpal tunnel syndrome, diagnosed as left shoulder impingement syndrome, had its onset in service. CONCLUSION OF LAW The criteria for service connection for left carpal tunnel syndrome, diagnosed as left shoulder impingement syndrome, are met. 38 U.S.C. §§ 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from August 1982 to June 1986. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2009 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. In a June 2020 decision, the Board denied service connection for left carpal tunnel syndrome. The Veteran appealed the Board's June 2020 decision to the United States Court of Appeals for Veterans Claims (Court), which in a May 2021 order, granted the parties' joint motions for partial remand (JMPR), vacating in part the Board's June 2020 decision and remanding the claim for compliance with the terms of the JMR. In compliance with the Court's order, the Board remanded this matter in September 2021 and March 2022. 1. Entitlement to service connection for left carpal tunnel syndrome. The Veteran contends that his left shoulder injury was incurred while in service. The Board concludes that the Veteran has a current disability that began during active service. 38 U.S.C. §§ 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).\ An October 1984 service treatment record notes the Veteran's left anterior hand was injured by the breach of a 109mm howitzer. It was noted that the palm of the left hand had prominent swelling, discoloration and discontinuity when compared to the right hand. Pain on contact to area of palm and wrist, full range of motion, mild edema, distal paresthesias in the left finger pads were also noted. An October 1984 service x-ray report notes a small bony avulsion at the base of the proximal phalanx of the 5th digit, radial aspect. A November 1984 service treatment record notes the Veteran reported left hand pain and swelling that increase with pressure but was resolving. A March 1985 service treatment record notes the Veteran reported left hand pain, palm and wrist, when he lifts something. In his April 2012 appeal to the Board, the Veteran asserted that his left carpal tunnel syndrome was caused by his injury due to the recoil of a 109mm howitzer. An October 2009 VA examination report notes the Veteran reported that after sustaining a left-hand crush injury in 1984 while on active duty he has experienced increasing pain in the palm radiating into the forearm and numbness and tingling in the hand and fingers, as well as decreased strength. Diagnoses of left-hand carpal tunnel syndrome as well as evulsion fracture proximal phalanx of 5th digit left hand were noted. A June 2017 VA examination report reflects that the Veteran was diagnosed with bilateral carpal tunnel syndrome. The examiner opined the Veteran's left carpel tunnel syndrome was less likely as not due to service because there was no objective evidence of a chronic debilitating left wrist carpel tunnel syndrome condition beginning in service and the very same condition continuing after service. The examiner also noted there was no objective evidence of aggravation. The examiner further noted that a June 2010 electromyography showed a normal study of the left upper extremity and therefore a link to military service or chronicity was not shown. A May 2019 VA examination report notes the Veteran sustained a hand injury from a howitzer while in service for which he sought treatment. He further stated that the symptoms began in 1988. The examiner then opined that the Veteran's left carpal tunnel syndrome was not caused or aggravated by his left 5th digit fracture, noting that the anatomy of the 2 sites, proximal phalanx of 5th digit and carpel tunnel sheath, are anatomically unrelated. The examiner then noted that the injury would not cause a nerve compression condition 35 years later. In an October 2021 addendum, the contract examiner stated that they considered the Veteran's "concerns," and reviewed the medical statements. They stated that the Veteran's hand pain is most likely related to carpal tunnel, but that it is not caused or related to the 5th finger injury, noting that the 5th finger is innervated by the ulnar nerve, and not the median nerve that is responsible for carpal tunnel. The Veteran was afforded a VA examination in April 2022. It was noted that the Veteran is service connected for avulsion fracture proximal phalanx of the 5th digit left hand as a result of an in-service hand injury. The examiner noted that the pain documented in service was below the carpal tunnel and that no signs or symptoms of carpal tunnel noted. It was further noted that no diagnosis of carpal tunnel was made in service and that an EMG was conducted after the injury. The examiner then opined that left hand carpal tunnel is less likely than not due to his service. Initially, the Board notes that the VA examination reports are all inadequate in that they do not contain any meaningful discussion of the Veteran's reports of symptoms since leaving the service. The Board notes that the absence of contemporaneous medical evidence is one factor in determining credibility of lay evidence, but lay evidence does not lack credibility merely because it is unaccompanied by contemporaneous medical evidence. See, Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (lack of contemporaneous medical records does not serve as an absolute bar to the service connection claim); Barr v. Nicholson, 21 Vet. App. 303 (2007) (the Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms). In its role as a finder of fact, the Board finds the lay statements are credible. See 38 C.F.R. § 3.159 (a)(2); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Layno v. Brown, 6 Vet. App. 465 (1994). The Board finds that the medical and lay evidence is consistent with other evidence of record, and further finds that it is competent and credible. The Board finds that the evidence, including the Veteran's statements, are consistent with the service and other medical evidence of record and thus support his claim that his left carpal tunnel syndrome had its onset in service and has been recurrent since that time. His account is also supported by corroborating lay evidence. In light of the foregoing, because the competent and credible evidence shows that the Veteran's left carpal tunnel syndrome is related to the Veteran's service, the Board finds that the Veteran's left carpal tunnel syndrome is related to the left hand crush injury the Veteran sustained during his period of military service. As such, service connection is warranted. See, Flynn v. Brown, 6 Vet. App. 500, 503 (1994) (noting that "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"); see also 38 C.F.R. § 3.303(a) (Service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces). STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Keeley, Brian 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.