Citation Nr: A25041220 Decision Date: 05/06/25 Archive Date: 05/06/25 DOCKET NO. 200623-94321 DATE: May 6, 2025 ORDER Entitlement to service connection for left carpal tunnel syndrome, to include as secondary to left wrist tendinitis, is denied. FINDING OF FACT The Veteran's left carpal tunnel syndrome is not secondary to service-connected left wrist tendinitis, is not otherwise related to an in-service injury or disease, nor did it manifest to a compensable degree within one year of service discharge. CONCLUSION OF LAW The criteria for service connection for left carpal tunnel syndrome due to service or left wrist tendinitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Marine Corps from July 1996 to July 2000. This matter is before the Board of Veterans' Appeals (Board) from a May 2020 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The May 2020 rating decision was issued after a higher-level review which identified a duty to assist error. In the June 23, 2020, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on May 23, 2024, and the transcript has been associated with the file. Therefore, the Board may only consider the evidence of record at the time of the May 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 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). Service connection may be established on a secondary basis for a disability that is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. El-Amin v. Shinseki, 26 Vet. App. 136, 138 (2013); Allen v. Brown, 7 Vet. App. 439, 448 (1995); see also Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and instead holding a "but for" causation or aggravation is enough to show entitlement to secondary service connection). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). 1. Entitlement to service connection for left carpal tunnel syndrome as secondary to left wrist tendinitis is denied. The Veteran states that he is entitled to service connection for left carpal tunnel syndrome secondary to left wrist tendinitis. After a careful review, the Board has determined that the appeal must be denied. At the Veteran's May 2024 Board hearing, the Veteran testified regarding his symptomatology. He stated that his left hand was his dominant hand and the hand in which he experiences his medical problems. He reported that his fingers are weak and numb. He stated that he has difficulty eating, drinking, and holding cards, and that his left hand is weak, and he has trouble holding onto a utensil to eat. He was advised to wrap a paper towel around his utensil until it was big enough for him to hold. He finds it difficult to do anything that requires a thumb and a fingertip movement because his fingers are numb, and his thumb has arthritis. He stated that he cannot write with his left hand or perform any of the functions that one would normally perform with their dominant hand. He cannot hold a ball to throw it, has difficultly driving, picking up a cup to drink, and tying his shoelaces. He utilizes both hands now for tasks that would have only required the left hand because his left hand is unreliable. He testified that his doctor explained to him that there are nerves which run from the elbow to the right side of the hand. He reported that his middle finger, pointer finger, and thumb are all constantly numb. He stated that he has had pain in both his thumb and his wrist. The Veteran stated that his carpal tunnel syndrome causes his numbness. He reported that he feels like he is wearing a glove and that feeling has intensified since he's had two surgeries for carpal tunnel syndrome. He testified that the cortisone shots that he has received in his shoulder have helped with his wrist pain. At his Board hearing, the Veteran maintained that service connection should be granted, even without a nexus opinion, because there was so much damage to the left hand during service that there must be a connection to his current left hand carpal tunnel syndrome. The Board notes that the Veteran is competent to testify to facts or circumstances that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2); Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). It is also well established that lay persons without medical training, such as the Veteran, are not competent to provide medical opinions on matters requiring medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). Thus, while the Board acknowledges the Veteran's statements as to the severity of his disability and his belief that his symptoms are caused by his active service, such testimony is not competent to establish a nexus to service. The first element of secondary service connection requires a current disability. In the May 2020 rating decision, the RO made the favorable finding that the Veteran's medical records showed a diagnosis of left carpal tunnel syndrome with carpal tunnel release surgery in 2019, left ulnar neuropathy, cubital tunnel, and ulnar subluxation. Favorable findings are binding on the Board. 38 U.S.C. § 5104A. The rating decision also noted a January 2020 VA examination in which the Veteran was diagnosed with bilateral carpal tunnel. Next, the Veteran must show that his current left carpal tunnel disability is proximately caused by or proximately aggravated by a service-connected disability, which here, the Veteran states is his left-hand tendinitis. In the Veteran's October 2019 VA Form 21-526EZ, the Veteran sought service connection for left-hand carpal tunnel as secondary to left hand tendon and extension and ulnar collateral ligament tear. In April 2020, the Veteran was afforded a VA examination to determine if his left-hand carpal tunnel syndrome was proximately due to the Veteran's service-connected left wrist tendinitis. The VA examiner stated that carpal tunnel syndrome refers to the complex set of symptoms and signs brought on by compensation of the median nerve as it travels through the carpal tunnel. The carpal tunnel is a narrow passageway on the palm side of the wrist that is comprised of bones and ligaments. The median nerve, which controls sensation and movement in the thumb and first three fingers, runs through this passageway, along with tendons to the fingers and thumb. Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. The VA examiner explained that contributing factors include trauma or injury to the wrist that causes swelling, or a sprain or fracture. Other contributing factors include an overactive pituitary gland, underactive thyroid gland, or rheumatoid arthritis. The VA examiner stated that other factors which may contribute to the compression include mechanical problems in the wrist joint, repeated use of vibrating hand tools, or a tumor or a cyst within the canal. It was noted that often, no single cause can be identified. The VA examiner went on to explain that carpal tunnel and tendinitis have similar or overlapping symptoms but are two separate and distinct conditions. The VA examiner stated that a review of the Veteran's service treatment records showed no complaints of wrist pain. The Veteran reported that his wrist pain did not start until 2015. The VA examiner stated that current medical literature does not suggest wrist tendinitis as a cause for carpal tunnel syndrome. The VA examiner found that the Veteran's service and treatment records do not suggest any kind of casual relationship between the two conditions. The VA examiner concluded that the Veteran's left-hand carpal tunnel syndrome is less likely than not proximately due to the Veteran's service-connected condition of left hand tendinitis. While the opinion did not separately address aggravation, the Board finds that the VA examiner's rationale encompasses both causation and aggravation. Here, an opinion as to aggravation was incorporated in the VA examiner's rationale as the examiner clearly explained why carpal tunnel and tendinitis are two separate and distinct conditions. The Board finds this opinion to be well-reasoned and probative of the matter at issue. This opinion is adequate to find a negative nexus in this case. It is also noted that, in July 2023, the Veteran submitted a private opinion regarding the etiology of his left carpal tunnel syndrome. This private opinion was received after the May 2020 rating decision on appeal, but prior to the Board hearing. It was also not resubmitted within 90 days following the Board hearing. As such, it was not received within the evidence window and cannot be considered. The Veteran is also not entitled to service connection on a direct basis. The first element of service connection on a direct basis is that there is a current disability. In the May 2020 rating decision, the RO made the favorable finding that the Veteran's medical records showed a diagnosis of left carpal tunnel syndrome. Next, the Veteran must show an in-service incurrence. The Veteran's service treatment records are silent for left carpal tunnel syndrome. He was not diagnosed with the condition until years after service in 2019. Finally, there must be a nexus between the two. Here, there cannot be a nexus because there was no in-service incurrence. Regardless, the January and April 2020 VA examinations issued negative nexus opinions. The VA examiners reviewed the Veteran's service treatment records, as well as medical records documenting his later diagnosis of left carpal tunnel syndrome and found that there was no connection to service. They noted that the Veteran's service treatment records were silent for not only any diagnosis of left carpal tunnel syndrome, but also for any symptoms of the condition. The Board finds these opinions probative. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (holding that a medical opinion obtains probative weight from "factually accurate, fully articulated, sound reasoning for the conclusion"). The Veteran has a current diagnosis of left carpal tunnel syndrome as evidenced by his 2019 medical records. Carpal tunnel syndrome is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. Indeed, the Veteran does not so contend. In addition, private treatment records show the Veteran was not diagnosed with left carpal tunnel syndrome until 2019, years after separating from service and years outside of the applicable presumptive period. Therefore, service connection is not established under direct, secondary, or chronic theories of entitlement and the appeal must be denied. The Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the evidence persuasively weighs against the claim, the benefit of the doubt rule does not apply. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). L.M. YASUI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Fleming, Shelley M. 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.