FINGER IMPAIRMENT OF

S. HENEKS · 2026 · Case ID: 26002692

DENIED

Summary

The veteran, who served on active duty from May 1991 to May 1999, appeals the denial of service connection for a left middle finger disability, a right hand disability (including a right middle finger disability), a left arm disability manifested by pain from the left arm to the shoulder, and an upper back disability manifested by pain from the upper back to the right shoulder blade. The veteran claimed these conditions were caused by wear and tear from her military occupational specialty as a cook, involving repetitive motions and lifting heavy objects, or aggravated by existing service-connected thumb disabilities. The Board denied all claims, finding the evidence persuasively against service connection. The Board found the veteran's lay statements regarding symptom onset and continuity to be inconsistent and contradictory when compared to contemporaneous medical evidence and VA examination findings. Multiple VA examinations and addendum opinions concluded that the veteran's claimed disabilities were less likely than not related to service, citing the lack of objective findings in service treatment records and the significant delay between service discharge and symptom manifestation (approximately 16-17 years). The Board found the May 2024 and November 2023 VA opinions to be the most probative, noting that while repetitive use could contribute to such conditions, the delayed onset made a service connection unlikely. The Board also noted that the veteran's claims regarding her left arm and upper back disabilities were not supported by objective evidence of record, and the delayed manifestation of symptoms further weakened any potential nexus to service. The Board concluded that the veteran's lay assertions were outweighed by the medical evidence and that the benefit-of-the-doubt doctrine was inapplicable as the evidence was not in approximate balance.

Rationale

No objective findings in service treatment records; Delayed symptom manifestation (16-17 years post-service); VA opinions found less likely than not related to service

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

16-11 609

Full Decision Text

Citation Nr: 26002692
Decision Date: 02/25/26 Archive Date: 02/25/26

DOCKET NO. 16-11 609
DATE: February 25, 2026

ORDER

Entitlement to service connection for a left middle finger disability, to include on a secondary basis, is denied.

Entitlement to service connection for a right hand disability, to include a right middle finger disability, to include on a secondary basis, is denied.

Entitlement to service connection for a left arm disability manifested by pain from the left arm to the shoulder is denied.

Entitlement to service connection for an upper back disability manifested by pain from the upper back to the right shoulder blade is denied.

FINDINGS OF FACT

1. The Veteran's left middle finger disability did not originate in service and is not otherwise etiologically related to her active service or to any service-connected disability.

2. The Veteran's right hand disability did not originate in service and is not otherwise etiologically related to her active service or to any service-connected disability.

3. The Veteran's left arm disability did not originate in service and is not otherwise etiologically related to her active service.

4. The Veteran's upper back disability did not originate in service and is not otherwise etiologically related to her active service.

CONCLUSIONS OF LAW

1. The criteria for service connection for a left middle finger disability have not been met. 38 U.S.C. §§ 1110, 1116, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

2. The criteria for service connection for a right hand disability have not been met. 38 U.S.C. §§ 1110, 1116, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

3. The criteria for service connection for a left arm disability have not been met. 38 U.S.C. §§ 1110, 1116, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

4. The criteria for service connection for an upper back disability have not been met. 38 U.S.C. §§ 1110, 1116, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from May 1991 to May 1999, with additional service in the Army Reserve.

These matters come before the Board of Veterans' Appeals (Board) on appeal from an October 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).

In May 2019, the Veteran and her spouse testified at a Board hearing before the undersigned. A copy of the transcript of that hearing has been associated with the claims file.

By way of background, these matters were initially before the Board in December 2019. At that time, the Board reopened the Veteran's claim for entitlement to service connection for a right hand disorder and remanded all of the Veteran's service connection claims for additional development. See December 2019 BVA Decision. These matters were also before the Board in September 2021 and March 2023, when they were remanded for further development. See September 2021 BVA Decision; March 2023 BVA Decision.

The Board notes that the March 2023 Board remand included claims for entitlement to service connection for a low back disorder and a left buttocks disorder manifested by pain. See March 2023 BVA Decision. However, during the pendency of the appeal, a March 2024 rating decision granted service connection for lumbosacral strain with intervertebral disc syndrome, left lower extremity femoral nerve radiculopathy (claimed as left buttock pain), and left lower extremity sciatic nerve radiculopathy (claimed as left buttock pain). See March 2024 Rating Decision - Narrative. Accordingly, as the Veteran's service connection claims have been granted, the issues of entitlement to service connection for a low back disorder and a left buttocks disorder are no longer in appellate status as there are no cases or controversies presently before the Board. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997).

Service Connection
connection for lumbosacral strain with intervertebral disc syndrome, left lower extremity femoral nerve radiculopathy (claimed as left buttock pain), and left lower extremity sciatic nerve radiculopathy (claimed as left buttock pain). See March 2024 Rating Decision - Narrative. Accordingly, as the Veteran's service connection claims have been granted, the issues of entitlement to service connection for a low back disorder and a left buttocks disorder are no longer in appellate status as there are no cases or controversies presently before the Board. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997).

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In order to establish entitlement to service connection, there must be (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) a causal connection between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

1. Entitlement to service connection for a left middle finger disability, to include on a secondary basis, is denied.

2. Entitlement to service connection for a right hand disability, to include a right middle finger disability, to include on a secondary basis, is denied.

As an initial matter, the Board notes that in a September 2021 decision, the Board denied service connection for a bilateral wrist disorder, to include bilateral carpal tunnel syndrome. Therefore, service connection for a bilateral wrist disorder/carpal tunnel syndrome is not for consideration.

The Veteran states that her left middle finger and right hand disabilities were caused by wear and tear from performing repetitive movements and lifting heavy objects in her military occupational specialty (MOS) as a cook. In this regard, she explained that she was required to stand for eight to twelve hours per day, up to seven days per week, and to perform repetitive tasks, including repeatedly lifting heavy objects, twisting, stirring, and turning, while she was serving on active duty. See May 2019 Hearing Transcript, pages 6-11, 14, 23-25, 39-40; March 2016 VA Form 9. Alternatively, the Veteran states that her left middle finger and right hand disabilities may have been caused or aggravated by her service-connected left and right thumb disabilities. See June 2021 VA Form 21-4138 Statement in Support of Claim.

A review of the service treatment records (STRs) shows an April 1991 enlistment report of medical examination, which notes the Veteran's upper extremities to be normal. The Veteran sought emergency medical treatment for a needle stick in February 1998. She further explained that she was accidently stuck with a butterfly needle on the radial side of her right second digit at the distal interphalangeal (DIP) joint. The assessment was needle stick. In August 1999, the Veteran sought treatment for a wart on her finger. She further explained that the wart had been present for two weeks but indicated that she woke up with a burning sensation and redness. See May 2008 Medical Treatment Record - Government Facility; April 2014 STR - Medical. Thus, the Veteran's STRs are silent for any findings or diagnoses related to her claimed left middle finger and right hand disabilities.

A review of the post-service treatment records shows that the Veteran reported that the joints on some of her fingers "[got] stuck[,]" especially when she picked objects up and typed on a keyboard in March 2014. She further explained that she had been experiencing such symptoms since she was a cook serving on active duty. However, a physical examination of the Veteran's bilateral hands performed at that time was negative. The assessment included hand pain. See September 2023 CAPRI.

During a May 2014 rheumatology consultation, the Veteran endorsed hand pain and bilateral long DIP joint locking but indicated that her index and middle fingers were okay. Following the consultation, the examiner diagnosed DIP joint inflammation and enlargement in the Veteran's bilateral long fingers and a tendon nodule on her left index flexor without triggering. See September 2023 CAPRI.

In her September 2015 notice of disagreement (NOD), the Veteran reported that she did not seek treatment for her claimed disabilities in service because her symptoms did not manifest until approximately nine or ten years after she was discharged from active duty.
hands performed at that time was negative. The assessment included hand pain. See September 2023 CAPRI.

In her September 2015 notice of disagreement (NOD), the Veteran reported that she did not seek treatment for her claimed disabilities in service because her symptoms did not manifest until approximately nine or ten years after she was discharged from active duty. In this regard, she explained that her MOS required her to lift heavy objects, twist, stir, and turn, while her post-service work involved performing office work at a desk with limited computer usage. See September 2015 NOD.

In March 2016, the Veteran endorsed right hand pain and locking at the middle finger, right thumb, and left thumb and explained that she had been experiencing right hand pain since she worked as a cook in service. She also reported sharp, shooting pain that extended from her mid right hand to her wrist. On physical examination, the examiner noted pain at the Veteran's right hand, right thumb, right middle finger, and in the middle of her right hand with numbness, as well as left thumb pain. The examiner diagnosed trigger fingers and tenosynovitis with carpal tunnel syndrome. See April 2023 CAPRI.

In October 2016, the Veteran sought treatment for soreness in her hands related to the amount of time she spent on the computer. She also stated that she had been baking more, which further aggravated her hand symptoms. See September 2019 Medical Treatment Record - Government Facility.

A November 2016 physician note shows that the Veteran sought treatment for increased pain and numbness in her right hand, wrist, thumb, and fingers and indicated that her symptoms had been present since service. The examiner diagnosed arthritis and pain in the Veteran's hands and rule-out carpal tunnel syndrome. See April 2023 CAPRI.

In March 2017, the Veteran endorsed bilateral hand pain and explained that her symptoms started five years prior and indicated that they became aggravated when she used her hands for work. Nerve conduction studies and electromyography (EMG) testing performed at that time revealed electrodiagnostic evidence of moderate bilateral carpal tunnel syndrome and mild left cubital tunnel syndrome (ulnar nerve). She was subsequently diagnosed with bilateral carpal tunnel syndrome and left upper limb cubital tunnel syndrome, to include a lesion of the ulnar nerve. See May 2019 Medical Treatment Record - Government Facility; September 2019 Medical Treatment Record - Non-Government Facility.

Thereafter, an August 2017 EMG and nerve conduction history report shows that the Veteran continued to endorse left and right hand pain, to include sharp shooting pain, numbness, tingling, and locking in her palms thumbs, and middle fingers. She also endorsed forearm and shoulder pain and indicated that her symptoms had been present for five years. The Veteran also indicated that she was unemployed but reported that she previously performed work as a cook and doing office work for 13 years and 5 years, respectively. See September 2019 Medical Treatment Record - Non-Government Facility.

A June 2018 private physical therapy initial evaluation shows that the Veteran reported that she had been experiencing chronic pain in her bilateral hands for several years. She also noted that she previously did aquatic therapy and had improvements in her symptoms. The private physician diagnosed pain in unspecified hand. See September 2019 Medical Treatment Record - Non-Government Facility.

In July 2018 and August 2018, the Veteran reported that she had been experiencing right hand finger locking, swelling of the wrist, dislocation of the thumb, and pain, numbness, and tingling from her middle finger to her shoulder since 2013. In this regard, she explained that she worked as a cook while she was serving on active duty. She was subsequently diagnosed with carpal tunnel syndrome of the right upper extremity and right middle trigger finger. See September 2019 Medical Treatment Record - Government Facility.

During her May 2019 Board hearing, the Veteran testified that her upper body and hand symptoms manifested in her late 20s or early 30s and noted that she was discharged from active duty when she was 30 years old. In this regard, she acknowledged that she did not seek treatment for her disabilities until nine years after she was discharged from active duty but explained that she did not have any medical insurance and was not able to see a doctor. She further explained
, she explained that she worked as a cook while she was serving on active duty. She was subsequently diagnosed with carpal tunnel syndrome of the right upper extremity and right middle trigger finger. See September 2019 Medical Treatment Record - Government Facility.

During her May 2019 Board hearing, the Veteran testified that her upper body and hand symptoms manifested in her late 20s or early 30s and noted that she was discharged from active duty when she was 30 years old. In this regard, she acknowledged that she did not seek treatment for her disabilities until nine years after she was discharged from active duty but explained that she did not have any medical insurance and was not able to see a doctor. She further explained that she did not file a service connection claim when her symptoms manifested because she did not believe she was eligible for VA disability compensation because she never served in combat. In addition, the Veteran's husband indicated that he had been married to the Veteran for 19 years and testified that he had seen her conditions progressively worsen over the preceding 10 years. See May 2019 Hearing Transcript, pages 6-11, 14, 23-25, 39-40.

In a May 2019 statement, the Veteran reported that she began experiencing right hand pain while cooking, approximately nine or ten years after she was discharged from active duty. However, she indicated that she did not see a doctor for her symptoms at that time because she did not have insurance. She further explained that symptoms related to her left ring finger disability, to include swelling, loss of strength, and pain, manifested in 2015. See May 2019 VA Form 21-4138 Statement in Support of Claim. In support of her claim, the Veteran submitted a statement from her husband in May 2019. See May 2019 Buddy/Lay Statement.

The Veteran underwent a VA examination for hand and finger conditions in February 2020. The examiner noted that the Veteran had been diagnosed with bilateral thumb osteoarthritis of the interphalangeal joint but did not identify any other diagnoses pertaining to her right hand or left or right middle fingers. During the examination, the Veteran reported that she began experiencing locking in some of her fingers in or around 2009 and indicated that she subsequently developed pain and swelling in both of her fingers and hands. She further explained that she saw a rheumatologist, who found no inflammatory arthritis, ankylosis, or triggering of the fingers, in 2014 and a neurologist, who performed EMGs and told the Veteran that she had carpal tunnel syndrome, in 2018.

After performing an examination and reviewing the evidence of record, the examiner opined that it was less likely than not that the Veteran's claimed hand and finger disabilities were incurred in or caused by the claimed in-service injury, event, or illness. In support of her opinion, the examiner explained that the Veteran did not have a documented middle finger disability and emphasized that there were no records showing that she had any arthritic deformities in her middle fingers. She further stated that no triggering was demonstrated when the Veteran saw a rheumatologist in 2014 or during the examination. In addition, the examiner also noted that the Veteran had full range of motion of all her fingers and that no evidence of inflammation of either hand or of any digits was found on examination. Thus, the examiner found that it was less likely than not that the Veteran's claimed left and right middle finger disabilities, to include ankylosis of the middle fingers, were incurred in or caused by her in-service MOS as there is no objective evidence to warrant a diagnosis. See February 2020 C&P examination.

The Veteran was also afforded a VA examination for hand and finger conditions in April 2022. The examiner noted that the Veteran had been diagnosed with bilateral degenerative arthritis, other than post-traumatic. However, the examiner subsequently explained that the Veteran had been diagnosed with osteoarthritis in the interphalangeal joints of her thumbs only and did not note any other diagnoses related to her right hand or left or right middle fingers. During the examination, the Veteran reported that her symptoms, to include pain and stiffness in her hands, manifested in 2009. See April 2022 C&P examination.

After performing an examination and reviewing the evidence of record, the examiner opined that it was less likely than not that the Veteran's claimed left middle finger disability was incurred in or caused by the claimed in-service injury, event, or illness. In support of his opinion, the examiner explained that the Veteran's medical records lacked sufficient evidence to find that her claimed middle finger disability was proximately due to her active service. In this regard, the examiner acknowledged that the Veteran reported multiple complaints, including long finger symptoms, during her rheumatology consultation, but emphasized that she did not report any symptoms related to her middle fingers during the examination and that no objective findings related thereto were found on physical examination. Thus, the examiner found that there were no objective findings related to the Veteran's middle fingers to support a nexus between the subjective pain symptoms the Veteran reported during prior consultations and her active service. Rather, the examiner found that it was more probable that her reported left middle finger symptoms were not related to her active service.

In addition, the examiner opined that it was less likely than not that the Veteran's claimed right hand disability, to include her claimed right middle finger disability, was incurred in or caused by the claimed in-service injury, event, or illness. In support of his opinion, the examiner explained that the Veteran's medical records lacked sufficient evidence to find that her claimed right hand disability was proximately due to her active service. In this regard, the examiner acknowledged that the Veteran reported that she experienced right middle finger symptoms, to include locking, while she was serving on active duty during her 2014 rheumatology consultation; however, he found that the objective evidence was insufficient to find that the Veteran had a current right hand disability.

In this regard, the examiner explained that subjective pain was not enough to overcome a speculative opinion in medicine. He also acknowledged the Veteran's subjective reports of thumb pain, but found that the medical evidence of record was insufficient to show that he had a current right hand disability which was incurred in or proximately due to his active service. Rather, the examiner reiterated that the evidence of record only included speculative evidence of right hand pain and that there was no objective evidence of a right hand disability, to include pain behavior or functional loss, documented during the Veteran's examinations, to support her claim. See April 2022 C&P examination.

VA obtained an addendum medical opinion in August 2023. After reviewing the evidence of record, the examiner opined that it was less likely than not that the Veteran's left middle finger or right hand disabilities were incurred in or caused by the claimed in-service injury, event, or illness, to include as due to wear and tear from performing repetitive motions and lifting and moving heavy objects as a cook while she was serving on active duty. In support of his opinion, the examiner explained that there was no objective evidence that the Veteran's reported left middle finger or right hand disabilities manifested in service or that any of her claimed disabilities were related to her in-service activities.

In this regard, he stated that there was no evidence that the Veteran's MOS, which was associated with repetitive motion and lifting and moving heavy objects, would have caused her claimed symptoms, which manifested years after she was discharged from active duty, without any evidence showing that the Veteran reported complaints or received treatments, during service. In addition, the examiner found that the Veteran's reported left middle finger and right hand symptoms did not produce functional impairment. In this regard, he emphasized that the April 2022 VA examination report did not demonstrate any evidence of functional loss or impairment. See September 2023 C&P examination.

The Veteran underwent a VA examination for hand and finger conditions in November 2023. The examiner diagnosed bilateral hand strain, bilateral middle trigger finger, and right index finger trigger. During the examination, the Veteran reported that her left middle finger and right hand disabilities manifested in service but explained that she did not seek treatment until her symptoms became unbearable in or around 2007 or 2008.

After performing an examination and reviewing the evidence of record, the examiner opined that it was less likely than not that the Veteran's left middle finger disability was incurred in or caused by her active service. In this regard, the examiner acknowledged that the Veteran had a superficial cut on her left thumb while she was serving on active duty in November 1994 but emphasized that her STRs did not show any reports or findings related to her left middle finger. She further acknowledged that the Veteran's MOS as a cook involved chopping and lifting with her fingers and hands and noted that occupations and
middle finger and right hand disabilities manifested in service but explained that she did not seek treatment until her symptoms became unbearable in or around 2007 or 2008.

After performing an examination and reviewing the evidence of record, the examiner opined that it was less likely than not that the Veteran's left middle finger disability was incurred in or caused by her active service. In this regard, the examiner acknowledged that the Veteran had a superficial cut on her left thumb while she was serving on active duty in November 1994 but emphasized that her STRs did not show any reports or findings related to her left middle finger. She further acknowledged that the Veteran's MOS as a cook involved chopping and lifting with her fingers and hands and noted that occupations and hobbies that involved repetitive hand use and prolonged gripping may increase the risk of trigger finger. However, the examiner emphasized that the Veteran was discharged from active duty in 1999 and that she began reporting symptoms related to a left middle finger disability in or around 2016 or 2017. Thus, although she acknowledged that the job duties required in the Veteran's MOS as a cook could have caused an issue, the examiner found that such would not have manifested 17 years after service.

In addition, the examiner opined that it was less likely than not that the Veteran's claimed right hand disability was incurred in or caused by her active service. In support of her opinion, the examiner explained that the Veteran's STRs did not show any complaints of right hand pain in service. She further emphasized that the Veteran left service in 1999 and that she first sought treatment for right hand symptoms in or around 2016 or 2017. Thus, although she acknowledged that the physical demands of the Veteran's MOS, to include repetitive lifting, could have caused a right hand disability, the examiner found that such would not have caused a right hand disability to manifest approximately 17 years after service. See February 2024 C&P examination.

VA obtained an addendum medical opinion in May 2024. After reviewing the evidence of record, the examiner acknowledged that acute injuries, to include fracture or strain, could lead to chronic issues over time but found that it was not likely that the Veteran's diagnosed left middle finger and right hand disabilities were related to her active service. In this regard, the examiner emphasized that no left middle finger or right hand injuries were documented in the Veteran's STRs and that her post-service treatment records showed that she initially sought treatment for her claimed disabilities in or around 2016 or 2017, approximately 16 or 17 years after she was discharged from active duty. The examiner further acknowledged that repetitive use could lead to issues, but explained that they would normally manifest less than 17 years after service.

In this regard, the examiner noted that carpal tunnel syndrome, and symptoms related thereto, could take between 6 months and 2 years to manifest depending on activity but emphasized that the absence of any complaints in service or for 16 years thereafter made it less likely that the Veteran's symptoms were related to her active service. She further stated that human bodies often have a stress response following a car accident and noted that the response and release of endorphins and adrenaline could give an individual a boost of energy and hide symptoms of even severe injuries. However, although she stated that it was normal for many symptoms to be delayed or to show up days or weeks after an accident, the examiner emphasized that such situations would not commonly hide symptoms for 15 or 16 years. To the contrary, the examiner stated that the Veteran's reported in-service injuries, to include her repetitive use injuries, should have been noticed within the first few years after service. Thus, as the Veteran initially sought treatment for left middle finger and right hand disabilities approximately 17 years after she was discharged from active duty, the examiner found that there was nothing in medical research to establish a nexus between the Veteran's left middle finger and right hand disabilities and her active service. See May 2024 C&P examination.

VA also obtained an addendum medical opinion in July 2024. After reviewing the evidence of record, the examiner opined that it was less likely than not that the Veteran's diagnosed left middle finger and right hand disabilities, to include bilateral middle trigger fingers and right index trigger finger, were etiologically related to her active service. In support of her opinion, the examiner noted that May 2014 and April 2018 medical records showed that the Veteran endorsed bilateral finger locking with no known etiology. She further noted that the Veteran was diagnosed with bilateral long finger inflammation/enlargement during her May 2014 rheumatology consultation, with right middle trigger finger in July 2018, and with right hand finger locking, swelling of the wrist, and dislocation of the thumb following her August 2018 EM
evidence of record, the examiner opined that it was less likely than not that the Veteran's diagnosed left middle finger and right hand disabilities, to include bilateral middle trigger fingers and right index trigger finger, were etiologically related to her active service. In support of her opinion, the examiner noted that May 2014 and April 2018 medical records showed that the Veteran endorsed bilateral finger locking with no known etiology. She further noted that the Veteran was diagnosed with bilateral long finger inflammation/enlargement during her May 2014 rheumatology consultation, with right middle trigger finger in July 2018, and with right hand finger locking, swelling of the wrist, and dislocation of the thumb following her August 2018 EMG study. In addition, the examiner acknowledge that the Veteran had been reporting pain, numbness, and tingling from her middle finger up to her shoulder since 2013 and indicated such was consistent with carpal tunnel syndrome and possible C6-7 radiculopathy. She also acknowledged that the Veteran reported numbness in the middle of her right hand in November 2016 and that a March 2017 EMG study revealed bilateral carpal tunnel syndrome with left medial cubital tunnel syndrome (ulnar nerve) but did not show any evidence of C8-T1 radiculopathy.

However, the examiner emphasized that the Veteran's STRs did not show any complaints or treatments related to her left middle finger or right hand disabilities in service and that her post-service treatment records showed that her symptoms did not develop until more than ten years after she was discharged from active duty. Thus, although she acknowledged that the Veteran's MOS as a cook required repetitive lifting and use, the examiner stated that it was unlikely to cause symptoms after such a long period following service. Thus, the examiner found that a nexus between the Veteran's diagnosed left middle finger and right hand disabilities and her active service had not been established. See August 2024 C&P examination.

After a review of the evidence of record, the Board finds that service connection for the Veteran's left middle finger and right hand disabilities is not warranted.

In this regard, the Board finds the July 2024 VA examiner's opinion, considered in connection with the May 2024 VA medical opinion, to be the most probative evidence of record as such considered all pertinent evidence, to include the Veteran's statements and his relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the opinions include clear conclusions with supporting data, as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions").

In this regard, the Board recognizes that the May 2024 examiner incorrectly identified the first post-service treatment record addressing left middle finger and right hand complaints as being dated in or around 2016 or 2017 versus a March 2014 date. However, the Board finds that the omission is harmless as it does not change the examiner's rationale, which the Board finds to be well-supported by the evidence of record.

In reaching the above conclusions, the Board acknowledges and has considered the Veteran's reports that her left middle finger and right hand disabilities manifested in service or shortly thereafter and that she has continued to experience related symptoms since that time. See, e.g., May 2019 Hearing Transcript, pages 6-11, 14, 23-25, 39-40. However, the Board finds that the Veteran has provided inconsistent, and in some instances directly contradictory, statements regarding the onset and continuity of her symptoms.

In this regard, the Board notes that the Veteran reported that the joints on some of her fingers "[got] stuck[,]"and indicated that she had been experiencing such symptoms since she was a cook serving on active duty in March 2014. See September 2023 CAPRI. In addition, the Veteran explained that she had been experiencing right hand pain since she worked as a cook in service in March 2016, and a subsequent November 2016 physician note shows that the Veteran reported that her finger and hand symptoms had been present since service. See April 2023 CAPRI. In addition, during her May 2019 Board hearing, the Veteran testified that her upper body and hand symptoms manifested when she was in her late 20s or early 30s, during or shortly after she was discharged from active duty. See May
and indicated that she had been experiencing such symptoms since she was a cook serving on active duty in March 2014. See September 2023 CAPRI. In addition, the Veteran explained that she had been experiencing right hand pain since she worked as a cook in service in March 2016, and a subsequent November 2016 physician note shows that the Veteran reported that her finger and hand symptoms had been present since service. See April 2023 CAPRI. In addition, during her May 2019 Board hearing, the Veteran testified that her upper body and hand symptoms manifested when she was in her late 20s or early 30s, during or shortly after she was discharged from active duty. See May 2019 Hearing Transcript, pages 6-11, 14, 23-25, 39-40. The Board further notes that the Veteran reported that her left middle finger and right hand disabilities manifested in service and that she waited until her symptoms became unbearable in or around 2007 or 2008 to seek treatment during her November 2023 VA examination. See February 2024 C&P examination.

However, the Veteran reported that she did not seek treatment for her claimed disabilities in service because her symptoms did not manifest until approximately nine or ten years after she was discharged from active duty in her September 2015 NOD. See September 2015 NOD. The Board further notes that the Veteran reported that her symptoms had been present for five years in March 2017 and August 2017 and that a June 2018 private physical therapy initial evaluation shows that the Veteran reported that she had been experiencing chronic pain in her bilateral hands for several years, but not that such had been present for 18 years or since service. See May 2019 Medical Treatment Record - Government Facility; September 2019 Medical Treatment Record - Non-Government Facility. In addition, the Veteran reported that she had been experiencing right hand finger locking and pain, numbness, and tingling from her middle finger to her shoulder since 2013 in July 2018 and August 2018. See September 2019 Medical Treatment Record - Government Facility.

The Board further notes that the Veteran reported that she began experiencing right hand pain while cooking approximately nine or ten years after she was discharged from active duty in May 2019, and that the Veteran's husband indicated the he noticed that the Veteran was having difficulties with pain in her hands, fingers, and wrists in or around 2010. See May 2019 VA Form 21-4138 Statement in Support of Claim; May 2019 Buddy/Lay Statement. In addition, during her February 2020 VA examination, the Veteran reported that she began experiencing locking in some of her fingers in or around 2009, and she continued to report that her symptoms, to include pain and stiffness in her hands, manifested in 2009 during her April 2022 VA examination. See February 2020 C&P examination; April 2022 C&P examination

The Board further notes that the Veteran stated that her symptoms, to include soreness in her hands, were caused by the amount of time she spent on the computer, rather than to her active service, in October 2016. See September 2019 Medical Treatment Record - Government Facility. Thus, the Board finds the Veteran to be an inaccurate historian as to the onset and continuity of her left middle finger and right hand symptoms. See Gardin v. Shinseki, 613 F.3d 1374, 1379 (Fed. Cir. 2010) (stating that the Board acted appropriately in its fact-finding role in its determination that lay statements of record were not credible because they are in direct contradiction to the medical evidence of record). In this regard, contemporaneous evidence may have greater probative value than history as reported by the Veteran at a later date. Curry v. Brown, 7 Vet. App. 59, 68 (1994). For the reasons cited above, the Board cannot credit the Veteran's reports that she began to experience symptoms related to her left middle finger and right hand disabilities during or shortly after service or that she has continued to experience such symptoms since service.

In addition, the Board acknowledges and has considered the Veteran's statements indicating that her diagnosed left middle finger and right hand disabilities were caused by wear and tear from performing repetitive movements and lifting heavy objects in her MOS as a cook. However, the question of whether such a relationship exists is a complex medical issue that is far beyond the purview of a lay person.

Thus, the Board concludes that the Veteran's lay assertions are outweighed by the medical evidence of record, to include the May 2024 and July 2024 VA medical opinions and the cumulative medical
Veteran's reports that she began to experience symptoms related to her left middle finger and right hand disabilities during or shortly after service or that she has continued to experience such symptoms since service.

Thus, the Board concludes that the Veteran's lay assertions are outweighed by the medical evidence of record, to include the May 2024 and July 2024 VA medical opinions and the cumulative medical evidence of record. As noted above, the examiners have the training, knowledge, and expertise on which they relied to form their opinions and provided persuasive rationales. Importantly, there are no competent medical opinions to the contrary.

Lastly, the Board acknowledges that the medical opinions of record have not addressed whether the Veteran's diagnosed left middle finger and right hand disabilities were caused or aggravated by her service-connected left and right thumb disabilities. However, the Board finds no such medical opinions were required because the evidence does not indicate that her diagnosed left middle finger disability or right hand disability may be associated with her service-connected left and right thumb disabilities. Thus, the Board finds that a remand to obtain medical opinions to address whether the Veteran's left middle finger disability and right hand disability are etiologically related to her service-connected left and right thumb disabilities are not warranted as the claims do not meet the low threshold requirements of McLendon, and therefore VA's duty to provide an examination has not been triggered. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); see also Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010) (explaining that something more than conclusory, generalized statements is needed to trigger VA's duty to assist); Duenas v. Principi, 18 Vet. App. 512, 517 (2004).

Based on the foregoing, the Board finds that the third Shedden requirements have not been met. Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit-of-the-doubt doctrine is inapplicable where, as here, the evidence is persuasively against the claims for service connection for a left middle finger disability and a right hand disability, to include a right middle finger disability. The claims are denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 999 F.3d 1391, 1394 (Fed. Cir. 2021).

3. Entitlement to service connection for a left arm disability manifested by pain from the left arm to the shoulder is denied.

The Veteran states that her left arm disability manifested while she was doing pullups and working out during basic training and indicated that her symptoms continued to worsen over time. See February 2024 C&P examination. She further stated that her left arm disability may have been caused by wear and tear from performing repetitive movements and lifting heavy objects in her MOS as a cook. In this regard, she explained that she was required to stand for eight to twelve hours per day, up to seven days per week, and to perform repetitive tasks, including repeatedly lifting heavy objects, twisting, stirring, and turning, while she was serving on active duty. See May 2019 Hearing Transcript, pages 6-11, 14, 23-25, 39-40; March 2016 VA Form 9.

The Veteran's STRs are silent for any findings or diagnoses related to her left arm disability manifested by pain from her left arm to her shoulder. See April 2014 STR - Medical.

A review of the post-service treatment records shows that the Veteran reported that she experienced left hand numbness which radiated a little past her elbow in November 2014. However, she also explained that her symptoms occurred approximately one month prior, resolved with sleep, and indicated that she had not experienced any other occurrences of such symptoms. The assessment included upper extremity numbness. See September 2023 CAPRI.

In her September 2015 NOD, the Veteran reported that she did not seek treatment for her claimed disabilities in service because her symptoms did not manifest until approximately nine or ten years after she was discharged from active duty. In this regard, she explained that her MOS required her to lift heavy objects, twist, stir, and turn, while her post-service work involved performing office work at a desk with limited
numbness which radiated a little past her elbow in November 2014. However, she also explained that her symptoms occurred approximately one month prior, resolved with sleep, and indicated that she had not experienced any other occurrences of such symptoms. The assessment included upper extremity numbness. See September 2023 CAPRI.

In September 2016, the Veteran sought treatment for upper back pain and a "pinch" in her left neck and shoulder area. She further explained that her symptoms manifested the preceding Friday. See September 2019 Medical Treatment Record - Government Facility. In addition, a September 2016 mental health consultation shows that the Veteran's medical history included chronic arm pain. See September 2019 CAPRI.

A November 2016 physician note shows that the Veteran reported arthritis and pain in her shoulders. The examiner diagnosed arthritis and shoulder pain. See April 2023 CAPRI.

In March 2017, the Veteran endorsed bilateral elbow numbness and hand pain. She further explained that her symptoms started five years prior and indicated that they became aggravated when she used her hands for work. Nerve conduction studies and EMG testing performed at that time revealed electrodiagnostic evidence of moderate bilateral carpal tunnel syndrome and mild left cubital tunnel syndrome (ulnar nerve). She was subsequently diagnosed with bilateral carpal tunnel syndrome and left upper limb cubital tunnel syndrome, to include a lesion of the ulnar nerve. See May 2019 Medical Treatment Record - Government Facility; September 2019 Medical Treatment Record - Non-Government Facility.

Thereafter, an August 2017 EMG and nerve conduction history report shows that the Veteran endorsed forearm and shoulder pain and indicated that her symptoms had been present for five years. She further stated that she was unemployed but noted that she previously worked as a cook and in an office for 13 years and 5 years, respectively. See September 2019 Medical Treatment Record - Non-Government Facility.

In July 2018 and August 2018, the Veteran reported that she had been experiencing pain, numbness, and tingling from her middle finger to her shoulder since 2013 and noted that she previously worked as a cook while she was serving on active duty. See September 2019 Medical Treatment Record - Government Facility.

An August 2018 left hand EMG study showed decreased conduction velocity proximal to the elbow indicating axonal loss that could be consistent with cubital tunnel syndrome. See May 2019 Medical Treatment Record - Government Facility.

During her May 2019 Board hearing, the Veteran testified that her upper body symptoms manifested when she was in her late 20s or early 30s and noted that she was discharged from active duty when she was 30 years old. In this regard, she acknowledged that she did not seek treatment for her disabilities until nine years after she was discharged from active duty but explained that she did not have any medical insurance and was not able to see a doctor. She further explained that she did not file a service connection claim when her symptoms manifested because she did not believe she was eligible for VA disability compensation because she never served in combat. In addition, the Veteran's husband indicated that he had been married to the Veteran for 19 years and testified that he had seen her conditions progressively worsen over the preceding 10 years. See May 2019 Hearing Transcript, pages 6-11, 14, 23-25, 39-40.

In February 2020, the Veteran underwent a VA examination for peripheral nerve conditions. The examiner, in pertinent part, noted that the Veteran had been diagnosed with cubital tunnel syndrome of the left elbow. During the examination, the Veteran endorsed bilateral wrist and left elbow pain, as well as pain that radiated down into her hands and up to her shoulders and reported that her symptoms manifested in or around 2009. However, she also stated that she believed that her problems originated in service and were caused by her MOS as a cook.

Following the examination, the examiner opined that it was less likely than not that the Veteran's diagnosed cubital tunnel syndrome was incurred in or caused by the Veteran's in-service wrist condition. In support of her opinion, the examiner stated that the Veteran's STRs did not show any documented complaints related to her elbows, forearms
had been diagnosed with cubital tunnel syndrome of the left elbow. During the examination, the Veteran endorsed bilateral wrist and left elbow pain, as well as pain that radiated down into her hands and up to her shoulders and reported that her symptoms manifested in or around 2009. However, she also stated that she believed that her problems originated in service and were caused by her MOS as a cook.

Following the examination, the examiner opined that it was less likely than not that the Veteran's diagnosed cubital tunnel syndrome was incurred in or caused by the Veteran's in-service wrist condition. In support of her opinion, the examiner stated that the Veteran's STRs did not show any documented complaints related to her elbows, forearms, wrists, or hands and emphasized that, by her own admission, such symptoms did not appear until 2009, approximately 10 years after she was discharged from active duty, and were not evaluated until 2015. She further emphasized that all of the Veteran's diagnoses, to include her cubital tunnel syndrome, were found to be mild at the time of actual diagnosis. Thus, the examiner found that it was less likely than not that the Veteran's cubital tunnel syndrome of the left elbow was incurred in or the result of any in-service injury or event. See February 2020 C&P examination.

The Veteran was afforded a VA examination for shoulder and arm conditions in November 2020. During the examination, the Veteran reported that she had been experiencing episodic pain that radiated into her bilateral shoulders since 2009. However, the examiner found that the Veteran did not have a current diagnosis associated with her claimed left arm disability manifested by pain from the left arm to the shoulder. In this regard, he explained that no objective evidence of a bilateral shoulder disability was found on examination, and as such, that no diagnosis was warranted at that time.

After performing an examination and reviewing the evidence of record, the examiner opined that it was less likely than not that the Veteran's claimed left arm disability was incurred in or caused by the claimed in-service injury, event, or illness. In support of his opinion, the examiner stated that the evidence of record did not support finding that the Veteran had a condition affecting her left shoulder and reiterated that no objective evidence of a left arm disability was found on examination. As such, the examiner found that it was less likely than not that the Veteran's left arm disability was incurred in or caused by her in-service duties, complaints, or injuries. See November 2020 C&P examination.

VA obtained an addendum medical opinion in November 2020. After reviewing the evidence of record, the examiner found that the Veteran's reports of bilateral shoulder and left arm pain were not supported by any objective evidence that she had any shoulder or arm diagnoses or pathology at that time. In this regard, he acknowledged that the Veteran's work as a cook involved repetitious motion at times. However, he stated that pain was not considered to be an objective diagnosis and indicated that he would anticipate objective support of the Veteran's reported shoulder pathology if such was related to her active service. See November 2020 C&P examination.

VA obtained an addendum medical opinion in April 2022. After reviewing the evidence of record, the examiner opined that it was less likely than not that the Veteran's claimed left arm disability was incurred in or caused by the claimed in-service injury, event, or illness. In support of his opinion, the examiner explained that the medical evidence of record was insufficient to find that the Veteran's left arm disability, to include left shoulder pain, was related to her post-service complaints of bilateral knee pain. In this regard, the examiner stated at there was no medical explanation relating the Veteran's claimed left arm disability to her diagnosed bilateral knee disabilities. See April 2022 C&P examination.

The Veteran underwent a VA examination for shoulder and arm conditions in November 2023. The examiner diagnosed left shoulder strain. During the examination, the Veteran reported that she began experiencing left shoulder pain while doing pullups and working out during basic training and indicated that her symptoms had continued to worsen over time.

After performing an examination and reviewing the evidence of record, the examiner opined that it was less likely than not that the Veteran's diagnosed left arm disability was incurred in or caused by the claimed in-service injury, event, or illness. In support of her opinion, the examiner noted that the Veteran's STRs did not show any complaints related to her left arm disability in service. In this regard, she acknowledged that the physical demands of the Veteran's MOS, to include repetitive heavy lifting, cutting, stirring, and using large pots, could have led to or caused unwarranted strain and repetitive injuries, to include shoulder strain. However, the examiner found that the
training and indicated that her symptoms had continued to worsen over time.

After performing an examination and reviewing the evidence of record, the examiner opined that it was less likely than not that the Veteran's diagnosed left arm disability was incurred in or caused by the claimed in-service injury, event, or illness. In support of her opinion, the examiner noted that the Veteran's STRs did not show any complaints related to her left arm disability in service. In this regard, she acknowledged that the physical demands of the Veteran's MOS, to include repetitive heavy lifting, cutting, stirring, and using large pots, could have led to or caused unwarranted strain and repetitive injuries, to include shoulder strain. However, the examiner found that the Veteran's MOS would not have caused her left arm disability to manifest approximately 17 years after service. In this regard, she noted that the Veteran left service in 1999 and that she first sought treatment her left arm disability symptoms in or around 2016 or 2017. See February 2024 C&P examination.

VA obtained an addendum medical opinion in May 2024. After reviewing the evidence of record, the examiner opined that it was less likely than not that the Veteran's diagnosed left arm disability was etiologically related to her active service. In support of her opinion, the examiner acknowledged that acute injuries, to include fracture or strain, could lead to chronic issues over time but found that it was not likely that the Veteran's diagnosed left arm disability was related to her active service. In this regard, the examiner reiterated that no left arm injuries were documented in the Veteran's STRs and that her post-service treatment records indicated that she initially sought treatment for her claimed disabilities in or around 2016 or 2017, approximately 16 or 17 years after she was discharged from active duty.

After a review of the evidence of record, the Board finds that service connection for the Veteran's left arm disability, to include a disability manifested by pain from the left arm to the shoulder, is not warranted.

As an initial matter, the Board recognizes that the evidence of record shows that the Veteran has been diagnosed with bilateral carpal tunnel syndrome. However, the Veteran's claim for entitlement to service connection for a bilateral wrist disorder was denied in a September 2021 Board decision, which explicitly found that the Veteran's bilateral carpal tunnel syndrome did not manifest until many years after service and was not related to service. See September 2021 BVA Decision. Accordingly, the Board finds that the Veteran's diagnosed carpal tunnel syndrome is not relevant for the purposes of establishing service connection for the Veteran's diagnosed left arm disability and that the issue of entitlement to service connection for a wrist disability, to include carpal tunnel syndrome, is not currently before the Board, and as such, will not be addressed herein.

Here, the Board finds the November 2023 VA medical opinion, considered in connection with the May 2024 VA examiner's opinion, to be the most probative evidence of record as such considered all pertinent evidence, to include the Veteran's statements and his relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the opinions include clear conclusions with supporting data, as well as reasoned medical explanations connecting the two. Nieves-Rodriguez, 22 Vet. App. at 304; Stefl, 21 Vet. App. at 124.

In this regard, the
tunnel syndrome, is not currently before the Board, and as such, will not be addressed herein.

In this regard, the Board recognizes that the November 2023 and May 2024 VA examiners incorrectly identified the first post-service treatment record addressing the Veteran's claimed left arm disability as being dated in or around 2016 or 2017 versus a November 2014 date. However, the Board finds that the omission is harmless as it does not change the examiner's rationale, which the Board finds to be well-supported by the evidence of record.

In reaching the above conclusions, the Board acknowledges and has considered the Veteran's reports that her left arm disability manifested in service or shortly thereafter and that she has continued to experience related symptoms since that time. See, e.g., May 2019 Hearing Transcript, pages 6-11, 14, 23-25, 39-40. However, the Board finds that the Veteran has provided inconsistent, and in some instances directly contradictory, statements regarding the onset and continuity of her symptoms.

In this regard, the Board notes that the Veteran testified that her upper body symptoms manifested when she was in her late 20s or early 30s, or during or shortly after she was discharged from active duty, during her May 2019 Board hearing. See May 2019 Hearing Transcript, pages 6-11, 14, 23-25, 39-40. In addition, the Veteran reported that she began experiencing left shoulder pain while doing pullups and working out during basic training during her November 2023 VA examination. See February 2024 C&P examination.

However, the Veteran also reported that her symptoms, to include left hand numbness which radiated a little past her elbow, occurred approximately one month prior, resolved with sleep, and denied any other occurrences thereof, when she initially sought treatment for such in November 2014. See September 2023 CAPRI. In addition, the Veteran explained that she did not seek treatment for her claimed disabilities in service because her symptoms did not manifest until approximately nine or ten years after she was discharged from active duty in her September 2015 NOD. See September 2015 NOD. The Board further notes that the Veteran reported that her symptoms manifested the preceding Friday when she sought treatment for a "pinch" in her left neck and shoulder area in September 2016 and subsequently stated that she had been experiencing bilateral elbow numbness and forearm and shoulder pain for five years in November 2016 and August 2017, indicating that her symptoms manifested in or around 2011 or 2012. See September 2019 Medical Treatment Record - Government Facility.

In addition, the Veteran reported that she had been experiencing pain, numbness, and tingling from her middle finger to her shoulder since 2013 in July 2018 and August 2018. See September 2019 Medical Treatment Record - Government Facility. The Board further notes that the Veteran reported that her left arm disability symptoms, to include pain which radiated down into her hands and up to her shoulders, manifested in or around 2009 during her February 2020 VA examination, and that she subsequently stated that she had been experiencing episodic pain that radiated into her bilateral shoulders since 2009 during her November 2020 VA examination. See February 2020 C&P examination; November 2020 C&P examination.

Thus, the Board finds the Veteran to be an inaccurate historian as to the onset and continuity of her left arm disability symptoms. See Gardin, 613 F.3d at 1379. In this regard, contemporaneous evidence may have greater probative value than history as reported by the Veteran at a later date. Curry, 7 Vet. App. at 68. For the reasons cited above, the Board cannot credit the Veteran's reports that she began to experience symptoms related to her left arm disability during or shortly after service or that she has continued to experience such symptoms since service.

In addition, the Board acknowledges and has considered the Veteran's statements indicating that her diagnosed left arm disability was caused by wear and tear from performing repetitive movements and lifting heavy objects in her MOS as
as to the onset and continuity of her left arm disability symptoms. See Gardin, 613 F.3d at 1379. In this regard, contemporaneous evidence may have greater probative value than history as reported by the Veteran at a later date. Curry, 7 Vet. App. at 68. For the reasons cited above, the Board cannot credit the Veteran's reports that she began to experience symptoms related to her left arm disability during or shortly after service or that she has continued to experience such symptoms since service.

In addition, the Board acknowledges and has considered the Veteran's statements indicating that her diagnosed left arm disability was caused by wear and tear from performing repetitive movements and lifting heavy objects in her MOS as a cook. However, the question of whether such a relationship exists is a complex medical issue that is far beyond the purview of a lay person.

Thus, the Board concludes that the Veteran's lay assertions are outweighed by the medical evidence of record, to include the November 2023 and May 2024 VA medical opinions and the cumulative medical evidence of record. As noted above, the examiners have the training, knowledge, and expertise on which they relied to form their opinions and provided persuasive rationales. Importantly, there are no competent medical opinions to the contrary.

Lastly, the Board acknowledges that the medical opinions of record have not addressed whether the Veteran's left cubital tunnel syndrome is etiologically related to her active service. However, the Board finds no such medical opinions were required because the evidence does not indicate that her diagnosed left cubital tunnel syndrome may be associated therewith. Thus, the Board finds that a remand to obtain medical opinions to address the nature and etiology of the Veteran's diagnosed cubital tunnel syndrome is not warranted as the claim does not meet the low threshold requirements of McLendon, and therefore VA's duty to provide an examination has not been triggered. See McLendon, 20 Vet. App. at 81; see also Waters, 601 F.3d at 1278; Duenas, 18 Vet. App. at 517.

Based on the foregoing, the Board finds that the third Shedden requirement has not been met. Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit-of-the-doubt doctrine is inapplicable where, as here, the evidence is persuasively against the claim for service connection for a left arm disability manifested by pain from the left arm to the shoulder. The claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, 999 F.3d at 1394.

4. Entitlement to service connection for an upper back disability manifested by pain from the upper back to the right shoulder blade is denied.

The Veteran states that her upper back disability manifested during basic training and indicated that her symptoms continued to worsen over time and increased to the point that they began affecting her everyday life in or around 2004. See February 2024 C&P examination. She further stated that her upper back disability may have been caused by wear and tear from performing repetitive movements and lifting heavy objects in her MOS as a cook. In this regard, she explained that she was required to stand for eight to twelve hours per day, up to seven days per week, and to perform repetitive tasks, including repeatedly lifting heavy objects, twisting, stirring, and turning, while she was serving on active duty. See May 2019 Hearing Transcript, pages 6-11, 14, 23-25, 39-40; March 2016 VA Form 9.

A review of the STRs shows an April 1991 enlistment report of medical examination which notes the Veteran's neck and upper extremities to be normal. In March 1993, the Veteran reported a history of back and neck problems and explained that she was involved in a motor vehicle accident when she was 19 years old. In this regard, she reported that she received chiropractic care for two years and indicated that her symptoms were limited to intermittent central back pain at that time. However, the Veteran's neck and upper extremities were subsequently noted to be normal on her October 1994 and June 1997 retention reports of medical examination. See April 2014 STR -Medical. Thus, the Veteran's STRs are silent for any findings or diagnoses related to her claimed upper back disability.

A review of the post-service evidence shows that the Veteran endorsed upper back pain and pain on the right side of her shoulder blade area in April 2014. See April 2014 VA Form 21-526EZ, Fully Developed Claim (Compensation).

In her September 2015
received chiropractic care for two years and indicated that her symptoms were limited to intermittent central back pain at that time. However, the Veteran's neck and upper extremities were subsequently noted to be normal on her October 1994 and June 1997 retention reports of medical examination. See April 2014 STR -Medical. Thus, the Veteran's STRs are silent for any findings or diagnoses related to her claimed upper back disability.

In June 2016, the Veteran endorsed upper back and shoulder pain. However, she also indicated that she "woke up feeling good" on the day she made the report. See September 2019 CAPRI.

A November 2016 physician note shows that the Veteran endorsed arthritis and pain in her shoulders. The examiner diagnosed arthritis and shoulder pain. See April 2023 CAPRI.

The Veteran underwent a VA examination for neck conditions in November 2020. During the examination, the Veteran reported that she began experiencing aching pain and stiffness in her neck in or around 2009. However, the examiner found that the Veteran did not have, and had never been diagnosed with, a cervical spine disability. In this regard, he explained that no objective evidence of a cervical spine disability was found on examination, and as such, indicated that no diagnosis was warranted at that time.

After performing an examination and reviewing the evidence of record, the examiner opined that it was less likely than not that the Veteran's claimed upper back disability was incurred in or caused by the claimed in-service injury, event, or illness. In support of his opinion, the examiner stated that the evidence of record did not support finding that the Veteran had an upper back disability, to include a disability manifested by pain from the upper back to the right shoulder, and reiterated that no objective evidence of such was found on examination. Thus, the examiner found that it was less likely than not that the Veteran's claimed upper back/right shoulder blade disability was incurred in or caused by her in-service duties, complaints, or injuries. See November 2020 C&P examination.

VA obtained an addendum medical opinion in November 2020. After reviewing the evidence of record, the examiner acknowledged that the Veteran's work as a cook involved repetitious motion at times but found that her reports of bilateral shoulder and upper back pain were not supported by any objective evidence to show that she had a shoulder or upper back diagnosis or pathology at that time. In this regard, the examiner stated that pain was not considered to be an objective diagnosis. He further noted that he would anticipate objective support of the Veteran's reported shoulder pathology if such was related to her active service. See November 2020 C&P examination.

An April 2021 telephone encounter note shows that the Veteran had been diagnosed with muscle spasms of the head and/or neck. See August 2023 CAPRI.

VA obtained an addendum medical
the examiner acknowledged that the Veteran's work as a cook involved repetitious motion at times but found that her reports of bilateral shoulder and upper back pain were not supported by any objective evidence to show that she had a shoulder or upper back diagnosis or pathology at that time. In this regard, the examiner stated that pain was not considered to be an objective diagnosis. He further noted that he would anticipate objective support of the Veteran's reported shoulder pathology if such was related to her active service. See November 2020 C&P examination.

An April 2021 telephone encounter note shows that the Veteran had been diagnosed with muscle spasms of the head and/or neck. See August 2023 CAPRI.

VA obtained an addendum medical opinion in April 2022. After reviewing the evidence of record, the examiner opined that it was less likely than not that the Veteran's claimed upper back disability manifested by pain from the upper back to the right shoulder blade was incurred in or caused by the claimed in-service injury, event, or illness. In support of his opinion, the examiner found that it would be speculative, at best, to find that the Veteran had an upper back disability and/or that such was related to her active service. In this regard, he stated that there were no objective findings or evidence to support a diagnosis and emphasized that there did not appear to be any loss of function other than the Veteran's subjective reports of perceived pain, to support a diagnosis. See April 2022 C&P examination.

In July 2022, the Veteran reported that she had been experiencing left neck pain for more than one month. See September 2023 CAPRI.

The Veteran underwent VA examinations for back conditions and neck conditions in November 2023. The examiners, in pertinent part, diagnosed thoracic strain/spasm, cervical strain, intervertebral disc syndrome (IVDS), and bilateral upper extremity radiculopathy. During the examinations, the Veteran reported that she began experiencing back, neck, and shoulder pain, during basic training, and indicated that her symptoms continued to worsen as she repeatedly lifted heavy pots and pans, rucked, and stood on concrete floors while she was serving on active duty. She further explained that her symptoms worsened to the point that her neck and shoulder pain began affecting her everyday life in or around 2004.

After performing an examination and reviewing the evidence of record, the examiner opined that it was less likely than not that the Veteran's diagnosed upper back disability was incurred in or caused by the claimed in-service injury, event, or illness. In this regard, she acknowledged that the physical demands of the Veteran's MOS, to include repetitive heavy lifting, cutting, stirring, and using large pots, could have led to or caused unwarranted strain and repetitive injuries. However, the examiner emphasized that the Veteran's STRs did not show any complaints related to her upper back disability in service and noted that she first sought treatment for cervical spine and right shoulder symptoms in or around 2016 or 2017. In this regard, the examiner found that wear and tear from the Veteran's MOS would not have caused a disability to manifest approximately 17 years after she was discharged from active duty. See February 2024 C&P examination.

VA obtained an addendum medical opinion in May 2024. After reviewing the evidence of record, the examiner acknowledged that acute injuries, to include fracture or strain, could lead to chronic issues over time but found that it was not likely that the Veteran's diagnosed upper back disability was related to her active service. In this regard, the examiner reiterated that no injuries related to the Veteran's diagnosed upper back disability were documented in the Veteran's STRs and that her post-service treatment records indicated that she initially sought treatment for her claimed disabilities in or around 2016 or 2017, approximately 16 or 17 years after she was discharged from active duty.

The examiner further explained that repetitive use could lead to issues, but stated that they would normally manifest less than 17 years after service. In this regard, she noted that carpal tunnel syndrome, and symptoms related thereto, could take between 6 months and 2 years to manifest depending on activity but emphasized that the absence of any complaints in service or for 16 years thereafter made it less likely that the Veteran's symptoms were related to her active service. She further stated that human bodies often have a stress response following a car accident and noted that the response and release of endorphins and adrenaline could give an individual a boost of energy and hide symptoms of even severe injuries. However, although she stated that it was normal for many symptoms to be delayed or to show up days or weeks after an accident, the examiner emphasized that such situations would not commonly hide symptoms for 15 or 16 years. To the
tunnel syndrome, and symptoms related thereto, could take between 6 months and 2 years to manifest depending on activity but emphasized that the absence of any complaints in service or for 16 years thereafter made it less likely that the Veteran's symptoms were related to her active service. She further stated that human bodies often have a stress response following a car accident and noted that the response and release of endorphins and adrenaline could give an individual a boost of energy and hide symptoms of even severe injuries. However, although she stated that it was normal for many symptoms to be delayed or to show up days or weeks after an accident, the examiner emphasized that such situations would not commonly hide symptoms for 15 or 16 years. To the contrary, the examiner stated that the Veteran's reported in-service injuries, to include her repetitive use injuries, should have been noticed within the first few years after service. Thus, as the Veteran initially sought treatment for her claimed disability approximately 17 years after she was discharged from active duty, the examiner found that there was nothing in medical research to establish a nexus between the Veteran's diagnosed upper back disability and her active service. See May 2024 C&P examination.

After a review of the evidence of record, the Board finds that service connection is not warranted for the Veteran's upper back disability manifested by pain from the upper back to the right shoulder blade.

In this regard, the Board finds the November 2023 VA medical opinion, considered in connection with the May 2024 VA examiner's opinion, to be the most probative evidence of record as such considered all pertinent evidence, to include the Veteran's statements and his relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the opinions include clear conclusions with supporting data, as well as reasoned medical explanations connecting the two. Nieves-Rodriguez, 22 Vet. App. at 304; Stefl, 21 Vet. App. at 124.

In reaching the above conclusions, the Board acknowledges and has considered the Veteran's reports that her upper back disability manifested in service or shortly thereafter and that she has continued to experience related symptoms since that time. See, e.g., May 2019 Hearing Transcript, pages 6-11, 14, 23-25, 39-40. However, the Board finds that the Veteran has provided inconsistent, and in some instances directly contradictory, statements regarding the onset and continuity of her symptoms.

In this regard, the Board notes that the Veteran testified that her upper body symptoms manifested when she was in her late 20s or early 30s, or during or shortly after she was discharged from active duty, during her May 2019 Board hearing. See May 2019 Hearing Transcript, pages 6-11, 14, 23-25, 39-40. In addition, the Veteran reported that her upper back pain manifested during basic training and indicated that her symptoms continued to worsen in service due to wear and tear from activities required by her MOS during her November 2023 VA examination. See February 2024 C&P examination.

However, the Veteran also reported that her symptoms did not manifest until approximately nine or ten years after she was discharged from active duty in her September 2015 NOD. See September 2015 NOD. The Board further notes that the Veteran reported that her upper back disability symptoms, to include neck pain and stiffness, manifested in or around 2009 during her November 2020 VA examination, and that she subsequently indicated that she had been experiencing left neck pain for more than one month, but did not state that her symptoms manifested in or shortly after service, in July 2022. See November 2020 C&P examination; September 2023 CAPRI.

In addition, although the Veteran reported upper back pain and pain on the right side of her shoulder blade area on her April 2014 VA Form 21-526EZ, a review of the medical evidence of record shows that she initially sought treatment for upper back pain in September 2016, approximately 17 years after she was discharged from active duty. See April 2023 CAPRI. Thus, the Board finds the Veteran to be an inaccurate historian as to the onset and continuity of her left arm disability symptoms. See Gardin, 613 F.3d at 1379. In this regard, contemporaneous evidence may have greater probative value than history as reported by the Veteran at a later date. Curry, 7 Vet. App. at 68. For the reasons cited above, the Board cannot credit the Veteran's reports that she began to experience symptoms related to her left arm disability during or shortly after service or that she has continued to experience such symptoms since service.

In reaching the above
approximately 17 years after she was discharged from active duty. See April 2023 CAPRI. Thus, the Board finds the Veteran to be an inaccurate historian as to the onset and continuity of her left arm disability symptoms. See Gardin, 613 F.3d at 1379. In this regard, contemporaneous evidence may have greater probative value than history as reported by the Veteran at a later date. Curry, 7 Vet. App. at 68. For the reasons cited above, the Board cannot credit the Veteran's reports that she began to experience symptoms related to her left arm disability during or shortly after service or that she has continued to experience such symptoms since service.

In reaching the above conclusions, the Board acknowledges and has considered the Veteran's statements indicating that her diagnosed upper back disability manifested in service and was caused by wear and tear from performing repetitive movements and lifting heavy objects in her MOS as a cook. However, the question of whether such a relationship exists is a complex medical issue that is far beyond the purview of a lay person.

Based on the foregoing, the Board finds that the third Shedden requirement has not been met. Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit-of-the-doubt doctrine is inapplicable where, as here, the evidence is persuasively against the claim for service connection for an upper back disability manifested by pain from the upper back to the right shoulder blade. The claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, 999 F.3d at 1394.

S. HENEKS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board K. Justis, 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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