MEDIAN NERVE PARALYSIS

K. J. ALIBRANDO · 2021 · Case ID: 21017651

MIXED

Summary

The veteran, who served in the U.S. Army from September 1976 to September 1979 with additional Reserve service through 2009, appealed the denial of service connection for bilateral carpal tunnel syndrome (CTS) of the right and left hands. The veteran contended that his military occupational specialty as a teletype operator caused his CTS, or alternatively, that it was due to or aggravated by his claimed cervical spine disability or his service-connected lumbar spine disability. The Board found that while the veteran had a current CTS diagnosis, the preponderance of the evidence weighed against a service connection. Service treatment records did not reflect any wrist or hand complaints during active service, and a separation examination showed normal upper extremities. Although the veteran later reported experiencing right-hand numbness for many years, the Board gave greater weight to contemporaneous service records and the veteran's explicit denial of neuritis symptoms. The Board also noted the veteran's report of CTS symptoms after service, but found no identified hand or wrist injury during active duty or Reserve training. The Board afforded greater weight to the contemporaneous service records over the veteran's later reports. A December 2020 VA examination concluded that the bilateral CTS was less than 50% likely related to service, finding an unrelated pathophysiology and anatomical area. The Board denied direct service connection. For secondary claims, the Board found the evidence weighed against a connection to service-connected lumbar or cervical spine disabilities, citing the examiner's opinion that CTS has an unrelated focal median nerve entrapment. The Board denied service connection for bilateral CTS.

Rationale

No in-service complaints of wrist/hand issues; Separation exam showed normal upper extremities; Contemporaneous service records weigh against later reports

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

15-13 843

Full Decision Text

Citation Nr: 21017651
Decision Date: 03/25/21 Archive Date: 03/25/21

DOCKET NO. 15-13 843
DATE: March 25, 2021

ORDER

Service connection for carpal tunnel syndrome of the right hand is denied.

Service connection for carpal tunnel syndrome of the left hand is denied.

REMANDED

Entitlement to service connection for a cervical spine disability, to include as secondary to lumbar spondylosis and degenerative disc disease, is remanded.

FINDINGS OF FACT

1. The preponderance of the evidence is against finding that the Veteran’s carpal tunnel syndrome (CTS) of the right hand began during active service, is otherwise related to an in-service injury or disease, or is secondary to any service-connected disability.

2. The preponderance of the evidence is against finding that the Veteran’s carpal tunnel syndrome (CTS) of the left hand began during active service, is otherwise related to an in-service injury or disease, or is secondary to any service-connected disability.

CONCLUSIONS OF LAW

1. The criteria to establish service connection for CTS of the right hand due to service or service-connected disease or injury are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria to establish service connection for CTS of the left hand due to service or service-connected disease or injury are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from September 1976 to September 1979 with additional Reserve service through 2009.

The Veteran appeared before the undersigned Veterans Law Judge in a videoconference hearing in June 2018 to present testimony on the issues on appeal.

This appeal was last before the Board of Veterans’ Appeals (Board) in December 2020 at which time additional evidentiary development was requested to comply with due process requirements. With regard to the claims seeking service connection for bilateral CTS, the evidentiary record has been adequately developed in substantial compliance with all prior Board remand instructions and is now returned to the Board for further appellate review.

Service Connection

1. Service connection for carpal tunnel syndrome of the right hand is denied.

2. Service connection for carpal tunnel syndrome of the left hand is denied.

The Veteran contends that his military occupational specialty as a teletype operator caused his currently diagnosed carpal tunnel syndrome. Alternatively, he contends that the diagnosed CTS is due to or aggravated by his claimed cervical spine disability, or his service-connected lumbar spine disability.

Service connection may be granted on a direct basis 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. 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).

The question for the Board is whether the Veteran has a current disability that began during active service or is at least as likely as not related to an in-service injury, event, or disease.\

The Board concludes that, while the Veteran has a current diagnosis of CTS, and evidence does confirm that he served as a telecommunications center specialist during his active service, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of CTS began during service or is otherwise related to an in-service injury, event, or disease.

Service treatment records do not reflect any complaint related to the wrist or hands during active service. At the time of a report of medical history provided by the Veteran during active service, the Veteran explicitly denied ever experiencing any neuritis (inflammation of a nerve causing sensations such as pain, tenderness, numbness, or tingling). See also Dorland’s Illustrated Medical Dictionary 1282 (31st ed. 2007) (defining neuritis). An August 1979 medical examination also shows that the Veteran’s upper extremities were clinically evaluated to be normal at the time of his separation from active service.

diagnosis of CTS began during service or is otherwise related to an in-service injury, event, or disease.

Instead, VA treatment records show the Veteran was not diagnosed with rule out carpal tunnel syndrome until September 2013, decades after his separation from service, although in 2013 he reported experiencing right hand numbness for many years. Despite this non-specific report of experiencing “many years” of right-hand numbness in September 2013, the Veteran is not shown to have reported experiencing any hand numbness during service or experiencing continuity of such symptoms for the 34-year period since service. To the extent that the Veteran later reports experiencing hand numbness for some duration of time after service, the Board affords greater weight to the contemporaneous records during active service that reflect no such symptoms, and the Veteran’s explicit denial or reported absence of such symptoms of neuritis. The Board also notes the Veteran’s report attributing a recurrence or aggravation of his CTS symptoms during his post-service occupation with the Postal Service. See Veteran’s statement, August 2015.

The Board also acknowledges the Veteran has indicated that he experienced CTS symptoms after service and before September 2013, which could include an indefinite portion of his period of Reserve service between September 1979 and January 2009. However, he has not identified any hand or wrist injury occurring during a period of active duty for training, or inactive duty for training during his Reserve period of service. As a result, the Board addresses only the claimed relationship to the active duty portion of the Veteran’s military service in this decision.

Furthermore, while the Veteran is competent to report having experienced symptoms of intermittent hand numbness for some duration since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of carpal tunnel syndrome. The issue is medically complex, as it requires knowledge of the interaction between multiple body systems and the interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).

The December 2020 VA examiner opined that the Veteran’s diagnosed bilateral CTS is less than 50 percent likely (i.e., “less likely as not”) related to an in-service injury, event, or disease. The rationale was that after review of all available evidence, including the service treatment records, the evidence did not suggest a nexus or medical relationship between the Veteran’s current CTS and his military service. The examiner’s opinion is probative, because it is based on a review of the Veteran’s medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

In all, a preponderance of the evidence weighs against finding that the Veteran’s currently diagnosed bilateral CTS began during active service, or is otherwise related to an in-service injury or disease. Service connection on a direct basis is denied. The Board now turns to the Veteran’s contentions that his bilateral CTS is caused or aggravated by a service-connected disability.

Service connection may be granted on a secondary basis for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310.

The question for the Board is therefore whether the Veteran’s diagnosed bilateral CTS is proximately due to or the result of, or was aggravated beyond its natural progress by a service-connected disability.

The Board concludes that, while the Veteran has a current bilateral CTS disability, the preponderance of the evidence is against finding that this disability is proximately due to or the result of, or aggravated beyond its natural progression by any service-connected disability, including the service-connected lumbar spine disability as asserted by the Veteran. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a); see also Veteran’s statement, February 2021 (arguing that CTS is secondary to his
of, or was aggravated beyond its natural progress by a service-connected disability.

The December 2020 VA examiner opined that the Veteran’s CTS disability is not proximately due to or aggravated by any service-connected disability, and although the opinion provided additional detail regarding the Veteran’s argued relationship between CTS and his reported cervical spine disability, the offered medical rationale is applicable to both the Veteran’s spine segments. The examiner stated that CTS has an unrelated pathophysiology and anatomical area and is based upon focal medial nerve entrapment at the wrist level that is unrelated to the Veteran’s cervical spine condition. While this examiner did not specifically address the Veteran’s lumbar spine disability, he is found to have adequately addressed the issue in finding the Veteran’s CTS to be less likely as not secondary to “any” service-connected disability and offering the rationale provided which involved the cervical spine which is closer in anatomical area than the lumbar spine. The service-connected lumbar spine disability was also implicitly addressed by the examiner in finding that the Veteran’s diagnosed CTS disability was less likely as not related to any service-connected disability.

Although the Veteran believes his CTS is due to or aggravated by a spine disability (either the service-connected lumbar spine or as yet nonservice-connected cervical spine disability), the Veteran in this case is not competent to provide a nexus opinion regarding this issue, because as described above, the issue is medically complex and is outside the competence of the Veteran because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the medical opinion of record. As the evidence weighs against the claim of service connection for CTS on both a direct and secondary basis, and the appeal must be denied.

REASONS FOR REMAND

Entitlement to service connection for a cervical spine disability, to include as secondary to lumbar spondylosis and degenerative disc disease, is remanded.

The Board cannot make a fully-informed decision on the issue of service connection for the Veteran’s cervical spine disability because no VA examiner has adequately opined whether the diagnosed cervical spine condition is proximately caused or aggravated by the Veteran’s service-connected lumbar spine disability.

The Board’s previous December 2020 remand of this issue found the September 2019 VA opinion to be incomplete and inadequate, in part because the examiner did not provide a medical rationale to support the conclusion that there was no medical relationship between the lumbar and cervical spine disabilities. The Board mistakenly omitted a specific question on that legal element in the remand directives, and an additional remand is necessary to obtain an addendum medical opinion on this particular matter. Although the Board regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran’s claim so that he is afforded every possible consideration.

The matters are REMANDED for the following action:

Obtain an addendum opinion regarding whether the Veteran’s cervical spine disability is at least as likely as not proximately due to any service-connected disability or aggravated beyond its natural progression by any service-connected disability, specifically to include the Veteran’s service-connected lumbar spine disability.

K. J. ALIBRANDO

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board K. McDonald, 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.

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