Citation Nr: 23047751 Decision Date: 08/30/23 Archive Date: 08/30/23 DOCKET NO. 20-04 614 DATE: August 30, 2023 ORDER Entitlement to service connection for a left wrist/arm disability is granted. REMANDED Entitlement to service connection for a right foot disability is remanded. FINDING OF FACT The evidence is at least in equipoise concerning whether the Veteran's left wrist/arm disability is etiologically related to his active duty service. CONCLUSION OF LAW The criteria for entitlement to service connection for a left wrist/arm disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from July 1991 to July 1994. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2018 rating decision of the Department of Veterans Affairs (VA) regional office (RO), which, in pertinent part, denied entitlement to service connection for a left arm disability and for a right foot disability. The Veteran timely appealed. While the Veteran's initial claim specified a left arm condition, he has been variously diagnosed with chronic left wrist sprain status-post scaphoid fracture. As noted in Clemons v. Shineski, 23 Vet. App. 1 (2009), Veterans as lay persons are not expected to know whether their observable symptoms are due to a particular disorder. A sympathetic reading of an appellant's pleadings cannot be based on a standard that requires legal sophistication beyond that which can be expected of a lay claimant. A claimant's intent in filing a claim is paramount to construing its breadth, especially because a claimant knows what symptoms he is experiencing that are causing him difficulty. The Board notes that some wrist symptomatology is experienced up and through the arm, thus it has expanded the claim to include all diagnoses affecting the Veteran's left wrist and arm. Service Connection-Applicable Laws and Regulations Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303, 3.304. The three-element test for service connection requires evidence of: (1) 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 in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). In determining whether service connection is warranted, the Board shall consider the benefit-of-the-doubt doctrine. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. That is, the claimant is entitled to the benefit of the doubt when the evidence is in "approximate" balance, i.e., "nearly equal," but does not require that the evidence be in exact equipoise. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 1. Entitlement to service connection for a left wrist/arm disability is granted. The Veteran maintains entitlement to service connection for a left wrist/arm disability, which he believes had its onset during service. As an initial matter, the Veteran has been diagnosed with chronic left wrist sprain status-post scaphoid fracture. Thus, the Board finds that first element of service connection has been met. Further, the several service treatment records from September 1991 document the Veteran's left wrist pain after falling down a set of stairs and a suspected scaphoid fracture. A July 1993 service treatment record notes continued left wrist pain, the Veteran's request for a brace, and the Veteran's report that he injured his wrist two years prior. Thus, the Board finds that the second element of service connection has also been met. At issue in this case is whether there is an etiological relationship between the Veteran's current chronic left wrist sprain and the documented in-service left wrist injury. In April 2019, the Veteran underwent an evaluation by a private physician. Following a clinical examination, an interview, and a review of the Veteran's service and post-service medical records, the private clinician determined that it is at least as likely as not that the Veteran's current left wrist disability stems from his left wrist injury during service. He reasoned that the Veteran's current symptomatology is consistent with that which he experienced in service following his injury. While the private physician's rationale is admittedly limited, the Board resolves all reasonable doubt on this point in the Veteran's favor and finds that the opinion provides a sufficient basis upon which to establish causal nexus. Accordingly, the Board finds that the third element of service connection has been met, and the claim of entitlement to service connection for a left wrist/arm disability is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 2. Entitlement to service connection for a right foot disability is remanded. The Veteran maintains entitlement to service connection for a right foot disability, which he believes had its onset during service. The medical record reflects a current diagnosis of seronegative rheumatoid arthritis and generalized osteoarthritis affecting the bilateral feet. Additionally, service treatment records from March 1993 note blunt trauma to the Veteran's right foot with pain and swelling of the small toe metatarsophalangeal joint. As the Veteran has a current foot disability and there is documentation of an in-service foot injury, there is a reasonable possibility that an etiological relationship exists between them. As such, the Board finds that a VA examination and medical opinion should be obtained that discusses the nature and etiology of the Veteran's right foot disability. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matter is REMANDED for the following action: Schedule the Veteran for a VA examination for his claimed right foot disability. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is the Veteran's current right foot disability at least as likely as not related to service, including the March 1993 blunt trauma to the right foot, or to the Veteran's reported duties as a paratrooper as discussed in the September 2021 correspondence? Provide a rationale to support the opinion. In providing the requested opinion, consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? Melanie J. Mann Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Bush 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.