Citation Nr: 23023975 Decision Date: 04/26/23 Archive Date: 04/26/23 DOCKET NO. 19-15 791 DATE: April 26, 2023 ORDER Service connection for right wrist carpal tunnel syndrome is denied. Service connection for left wrist carpal tunnel syndrome is denied. FINDINGS OF FACT 1. The evidence of record weighs against finding that the Veteran's right wrist carpal tunnel syndrome began during his active service, or is otherwise related to an in-service event, injury, or disease. 2. The evidence of record weighs against finding that the Veteran's left wrist carpal tunnel syndrome began during his active service, or is otherwise related to an in-service event, injury, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection to right wrist carpal tunnel syndrome have not been met. 38 U.S.C. § §§ 1101, 1110; 38 C.F.R. § §§ 3.102, 3.303. 2. The criteria for service connection to left wrist carpal tunnel syndrome have not been met. 38 U.S.C. § §§ 1101, 1110; 38 C.F.R. § §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1977 to July 1997. These matters are on appeal from a March 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2022, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing has been associated with the claims file. As an initial matter, the Board notes that the March 2018 rating decision denied service connection for right and left wrist carpal tunnel syndrome and service connection for tinnitus. In May 2019, VA received the Veterans substantive appeal (VA Form 9), and it listed the appeal for service connection for right and left wrist carpal tunnel syndrome. However, the Veteran did not list tinnitus. At the August 2022 Board hearing he stated he did not want to testify about his claim for tinnitus. As the Veteran has not appealed the issue for service connection for tinnitus, it is not currently before the Board. Service Connection 1. Service connection for right wrist carpal tunnel syndrome 2. Service connection for left wrist carpal tunnel syndrome Applicable Law Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303(a) (2019). To establish a right to compensation for a present disability, a Veteran must show: (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 - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be established for any disease initially diagnosed after service, when the evidence establishes that the disease was incurred in-service. 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 503 (1992). The disease entity for which service connection is sought must be chronic rather than acute and transitory in nature. For the showing of chronic disease in service, a combination of manifestations must exist sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic. While the Board must provide reasons and bases supporting a decision, there is no need to discuss, in detail, the evidence submitted by or on behalf of the Veteran. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (Board must review the entire record but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence of record. The Veteran should not assume that the Board has overlooked pieces of evidence that are not explicitly discussed. Timberlake v. Gober, 14 Vet. App. 122 (2000). Discussion The Veteran asserts that his carpal tunnel syndrome is due to his military service. See March 2018 notice of disagreement. Specifically, he argues that his duties as a cook during service, which included stirring, mixing, washing dishes, cutting meats, and processing meals daily, caused his bilateral carpal tunnel syndrome. Id. First, the Board finds there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). He has a current diagnosis of bilateral dupuytren's contracture. See February 2018 VA examination. Accordingly, the first element of service connection is met. Based on a review of the evidence the Board finds that service connection for bilateral carpal tunnel syndrome is not warranted as there is an absence of competent medical evidence establishing a nexus to service. Second, regarding an in-service incurrence, service treatment records (STRs) are silent for complaints, treatment, diagnosis, or symptoms related to carpal tunnel syndrome. Thus, the lack of evidence of an in-service injury or disease indicates that the second element of service connection is not met. His DD 214 reflects his military occupational specialty (MOS) included fifteen years a bachelor quarters specialist (cook). The Board acknowledges he believes his bilateral carpal tunnel syndrome is related to the years spent as a cook. However, for the reasons discussed below, the Board finds that the Veteran's assertion that his carpal tunnel syndrome is related to duties as cook during service is outweighed by the medical opinion to the contrary. Third, the Board finds that the evidence does not support finding that the Veteran's bilateral carpal tunnel syndrome is related to active service. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran received a February 2018 VA examination. The examiner opined that there is no nexus between the Veteran's condition and his active-duty service. She explained that there is no objective evidence of carpal tunnel syndrome or surgery during service or within a close proximity of retirement. Further, the examiner reasoned that based on the Veteran's statements and the medical evidence of record the onset of the condition was years after retirement. Although the rationale contained in the February 2018 VA examination is somewhat brief, it is overall understandable and flows from the facts and information given. Therefore, Board finds assigns significant probative value to 23042623 this opinion as the examiner demonstrated a detailed understanding of the Veteran's medical history and medical records, the opinion is supported by an explanation, and the examiner considered the Veteran's lay statements. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (holding that factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion); Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). There is no competent medical evidence to the contrary. The Board has not overlooked the Veteran's statements that his bilateral carpal tunnel syndrome is related to service, to include his duties as a cook and a grease-related burn incurred during his cooking duties. While the Veteran is competent to observe his bilateral wrist symptoms, he does not have the medical training or credentials to provide a competent opinion as to the cause of his current condition or whether it is related to active service. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Accordingly, the most probative evidence of record persuasively weighs against the claim of entitlement to service connection for a bilateral carpal tunnel syndrome or other bilateral wrist disorder. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt rule does not apply and service connection for a bilateral carpal tunnel syndrome is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Braxton, 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.