Citation Nr: 22049243 Decision Date: 08/30/22 Archive Date: 08/30/22 DOCKET NO. 14-21 516 DATE: August 30, 2022 ORDER Entitlement to service connection for a cyst of the mouth is denied. Entitlement to service connection for a right wrist sprain is denied. FINDINGS OF FACT 1. The Veteran's cyst of the mouth is not etiologically related to service. 2. The Veteran's right wrist sprain is not etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for a cyst of the mouth have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a right wrist sprain have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1979 to July 2001. This case comes to the Board of Veterans' Appeals (Board) from a December 2012 rating decision that denied service connection for a cyst of the mouth and from a November 2018 rating decision that denied service connection for a right wrist sprain. In August 2017, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In May 2018, the Board remanded the claim of service connection for a cyst of the mouth for further development. In January 2021, the Board remanded the claims of service connection for a cyst of the mouth and a right wrist sprain for further development. In December 2021, the Board remanded the claims of service connection for a cyst of the mouth and a right wrist sprain for further development. Following remand, the agency of original jurisdiction (AOJ) substantially complied with the remand directives by updating the Veteran's VA treatment records, providing the Veteran with a VA Form 21-4142 for private dental treatment, and scheduling new VA examinations. D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268, 271 (1998). The December 2021 decision also remanded the claims of service connection for a left ankle disability and right lateral epicondylitis. A June 2022 rating decision granted service connection for both disabilities. Accordingly, the claims of service connection for these disabilities are no longer before the Board. Service connection, generally Service connection may be granted for disability resulting from an event during active duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection generally requires competent evidence of (1) a current disability; (2) an in-service event; and (3) a causal relationship between the current disability and the in-service event. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). A current disability is established if a disability existed during the pendency of the claim even if the disability resolves before the claim is adjudicated. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013). In making this determination, the Board must determine whether evidence is competent and, if so, determine the probative value of the evidence. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. 38 C.F.R. § 3.159(a). This includes statements about conveying sound medical principles found in medical treatises. Id. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Id. Lay evidence is competent if it is provided by a person who has knowledge of facts and circumstances and conveys matters that can be observed and described by a lay person. Id. A fully articulated and sound opinion as to the etiology of a disability is entitled to probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). A veteran is competent to provide an opinion as to etiology if he or she has the eduction, training, or experience to provide such an opinion. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). When there is an approximate balance of positive and negative evidence regarding any material issue, the benefit of doubt will be resolved in favor of the veteran. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. A cyst of the mouth The Veteran asserts that service connection is warranted for a cyst of the mouth because this disability is related to wisdom teeth extraction during service. The Veteran was in sound condition at the entry to service because a May 1979 entrance examination noted no a cyst of the mouth. The evidence of record is conflicting whether the Veteran presently has a cyst of the mouth. In May 2019 and April 2022, VA examiners Dr. Q.W. and Dr. F.H., both dentists, respectively opined that a cyst of the mouth could not be observed on clinical examination or radiographic testing. In a July 2022 letter, the Veteran stated that he could not explain why the cyst was not observed on x-ray and that other dentists, to include private dentist Dr. G.P., previously informed him of the cyst. The Board does not have to decide whether the Veteran presently has a cyst of the mouth because, at the very least, the evidence of record shows that he had a cyst of the mouth during the pendency of the claim. The Veteran is competent to report that dentists informed him that he had a cyst of the mouth. Moreover, in a referral received by the AOJ in June 2014, Dr. G.P. referred the Veteran to Northwest Oral and Maxillofacial Surgery for cyst where #17 wisdom tooth was extracted during service. Dr. Q.W. did not opine on whether the Veteran had a cyst of the mouth at any point during the pendency of the claim. Dr. F.H. provided a conflicting opinion because he stated that a diagnosis of a cyst of the mouth was less likely than not during the pendency of the claim, but also stated that the 2014 cyst condition resolved. The Board accords more probative weight to the latter statement because it is consistent with the referral. The evidence of record shows an in-service event because the Veteran's wisdom teeth, to include tooth #17, were extracted in 1984. The Board must therefore determine whether this disability is related to the wisdom teeth extraction. Service dental records following the wisdom teeth extraction noted no cysts. The Veteran denied any severe tooth or gum trouble in a December 2000 Report of Medical History. A December 2000 dental examination noted no cysts, and a December 2000 separation examination noted no mouth abnormalities. At a May 2019 VA examination, Dr. Q.W. reviewed the claims file and examined the Veteran. Dr. Q.W. was asked to opine whether a cyst of the mouth (which clearly and unmistakably existed prior to service) was aggravated beyond its natural progression by the dental work in service. Dr. Q.W. provided a negative opinion stating that, while the Veteran's wisdom teeth were extracted in 1984, service dental records were silent for a cyst of the mouth. At an April 2022 VA examination, Dr. F.H. reviewed the claims file and examined the Veteran. Dr. F.H. opined that a cyst of the mouth was less likely than not related to service, to include wisdom teeth extraction. Dr. F.H. stated that the wisdom teeth extraction during service was not due to a dentigerous cyst. Dr. F.H. cited medical research stating that cyst recurrence has been noted to occur nearly 10 years after the original extraction. Dr. F.H. stated that there was no chronic disability shown in the service dental records or separation examination and that the referral to Northwest Oral and Maxillofacial Surgery Associates was more than 10 years after the original extraction. In written pleadings and at the August 2017 hearing, the Veteran asserts that a cyst of the mouth is related to the wisdom teeth extraction during service, to include that Dr. G.P. informed him that this was the cause of a cyst of the mouth. The Board finds that a cyst of the mouth is not related to the wisdom teeth extraction during service. The Board accords probative weight to Dr. F.H.'s fully articulated and sound opinion. Nieves-Rodriguez, 22 Vet. App. at 304. Dr. F.H. has specialized knowledge as a dentist, and this opinion was based on an examination of the Veteran, a review of the claims file, and consideration of the Veteran's lay statements. Dr. F.H. stated that, while cyst recurrence had been noted to occur 10 years after the original extraction, the service dental records through separation in 2001 (more than 10 years after original extraction) noted no cyst of the mouth and the referral was more than 10 years after original extraction. While it is not clear why Dr. Q.W. was asked to provide an opinion on aggravation of a pre-existing disability, Dr. F.H.'s opinion is consistent with Dr. Q.W.'s statement that service dental records were silent for a cyst of the mouth. The Board has considered the Veteran's lay statements and contentions. While the Veteran asserts that a cyst of the mouth is related to the wisdom teeth extraction during service, he does not have the eduction, training, or experience to provide an etiology opinion. Jandreau, 492 F.3d at 1377, 1377 n.4. While the Veteran is competent to state that Dr. G.P. informed him that this was the cause of a cyst of the mouth, the Board finds this statement less probative than Dr. F.H.'s fully-articulated and sound opinion. Nieves-Rodriguez, 22 Vet. App. at 304. As the probative evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the Board denies the claim of service connection for a cyst of the mouth. Right wrist sprain The Veteran asserts that service connection is warranted for a right wrist sprain because this disability is related to injuries during service. The Veteran was in sound condition at the entry to service because a May 1979 entrance examination noted no right wrist abnormalities. The evidence of record shows a current disability because the Veteran has been diagnosed with a right wrist sprain, to include at the April 2022 VA examination. The Board must determine whether this disability is related to service. Service treatment records noted a superficial laceration to the right wrist in November 1985. The Veteran reported right wrist and forearm pain from a chain fall accident in March 1986. The x-ray was negative, and the Veteran was diagnosed with a soft tissue injury that resolved in April 1986. Two July 1996 records noted an injury to the left hand. The Veteran did not report a right wrist injury in a December 2000 Report of Medical History, and a December 2000 separation examination showed no upper extremity abnormalities. In August 2001, the Veteran filed a claim of service connection for several disabilities, to include a left-hand injury that occurred in July 1996. At an August 2001 examination, the Veteran reported problems with his right forearm that began six years earlier. He also reported a left-hand injury from 1996. At an October 2018 VA treatment session, the Veteran reported right wrist pain. At a November 2018 VA examination, Dr. W.B. reviewed the claims file and examined the Veteran. The Veteran reported that he dropped a large chain on his right arm in 1986 and injured his right wrist while using a winch in 1996. Dr. W.B. opined that a right wrist sprain was less likely than not related to service because the injuries noted in service treatment records, to include in November 1985 and March 1986, were mild and resolved during service with no follow up after resolution. At a July 2021 VA examination, A.J. reviewed the claims file and examined the Veteran. The Veteran reported that he slashed his right wrist in the 1980s and later dropped a winch and chains on his right arm. A.J. opined that a right wrist sprain was less likely than not related to service because there were no complaints during service and right wrist issues were not noted until 2018. At an April 2022 VA examination for right lateral epicondylitis, K.H. reviewed the claims file and examined the Veteran. The Veteran reported that he injured his right elbow in 1985. K.H. opined that right lateral epicondylitis was as likely as not related to service because, while there was a gap in complaints related to this disability, the August 2001 record showed that a chronic condition existed. At an April 2022 VA examination for the right wrist, K.H. reviewed the claims file and examined the Veteran. The Veteran reported that he injured his right wrist during physical training in 1984 causing an open wound. K.H. opined that a right wrist sprain was less likely than not related to service because the Veteran's complaints documented during active duty were acute without long-term sequelae. K.H. noted specific medical records, to include the August 2001 record, to indicate that there was no sign of continuation of symptoms during service or after separation from service. In written pleadings, the Veteran asserts that a right wrist sprain is related to injuries during service. At the August 2017 hearing, the Veteran did not testify specifically about his right wrist, but stated that he fractured his right hand while using a winch. In a December 2018 Notice of Disagreement, the Veteran stated that he injured his right wrist when his hand slipped off a winch in 1996. In a December 2019 VA Form 9, the Veteran stated that he injured his right wrist in 1986. In a January 2022 VA Form 21-4142a, the Veteran stated that he broke his right hand in 1996. He attached two 1996 records noting a left-hand injury with handwritten comments that the injury was to the right hand; these handwritten comments are not on the original documents. In a July 2022 letter, the Veteran stated that he injured his right wrist in November 1985 and March 1986. The evidence of record shows several right wrist injuries during service, to include in November 1985 and March 1986. The Veteran has provided conflicting reports about the date of the injury involving a winch. While the Veteran asserts that the 1996 records identified the incorrect hand, it is unlikely that multiple records identified the incorrect hand. Moreover, these records were consistent with the August 2001 claim and record noting a left-hand injury in 1996. Regardless of whether the 1996 records identified the incorrect hand, the Veteran is competent to identify this injury, and the VA examiners considered the Veteran's lay statements about this injury. The Board concludes that this injury occurred even if it is not the injury noted in the 1996 records. The Board finds that right wrist sprain is not related to service. The Board accords probative weight to K.H.'s fully articulated and sound opinion. Nieves-Rodriguez, 22 Vet. App. at 304. This opinion was based on an examination of the Veteran, a review of the claims file, and consideration of the Veteran's lay statements. When read in conjunction with the opinion on right lateral epicondylitis, K.H. explained why the evidence of record, to include the August 2001 record, showed that right lateral epicondylitis was related to injuries during service (and, thus, was service connected), but complaints of right wrist sprain documented during active duty were acute without long-term sequelae. While Dr. W.B.'s and A.J.'s opinions were found inadequate in prior Board decisions, these opinions are consistent with K.H.'s opinions and provide additional support for the Board's finding. Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2017) (stating that "even if a medical opinion is inadequate to decide a claim, it does not necessarily follow that the opinion is entitled to absolutely no probative weight"). The claims file contains no medical opinion stating that right wrist sprain is related to service. The Board has considered the Veteran's lay statements and contentions. While the Veteran asserts that a right wrist strain is related to service, he does not have the eduction, training, or experience to provide an etiology opinion. Jandreau, 492 F.3d at 1377, 1377 n.4. The Board instead accords probative weight to K.H.'s fully-articulated and sound opinion. Nieves-Rodriguez, 22 Vet. App. at 304. As the probative evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the Board denies the claim of service connection for a right wrist sprain. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Ormson, 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.