MEDIAN NERVE PARALYSIS

ROBERT C. SCHARNBERGER · 2026 · Case ID: 26003118

DENIED

Summary

The veteran, who served in the U.S. Army with multiple periods of service between August 1985 and August 2007, including deployments to Afghanistan and Uzbekistan, appeals the denial of service connection for bilateral arm and leg nerve disabilities, including carpal tunnel syndrome. The Board reviewed numerous VA medical examinations and private treatment notes. While the veteran received diagnoses such as bilateral carpal tunnel syndrome, peripheral neuropathy, and lumbar radiculopathy, VA examiners consistently opined that these conditions were not related to service or toxic exposures. Specifically, examiners noted that nerve entrapment and degenerative disc disease were the likely causes of the veteran's neurological symptoms, and that environmental toxic exposures do not cause physical compression of nerves. Medical literature reviewed did not support a causal link between the veteran's claimed exposures and these specific nerve conditions. The Board found the VA examiners' opinions to be the most probative, concluding that the evidence weighed against service connection for all claimed nerve disabilities. Therefore, the Board denied service connection for the left and right arm nerve disabilities, and the left and right leg nerve disabilities.

Rationale

VA examiners opined conditions were not related to service or toxic exposure.; Examiners associated disabilities with physical nerve compression and degenerative spine issues.; Medical literature did not support a causal link to toxic exposures.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

09-50 407

Full Decision Text

Citation Nr: 26003118
Decision Date: 03/09/26 Archive Date: 03/09/26

DOCKET NO. 09-50 407
DATE: March 9, 2026

ORDER

Entitlement to service connection for a left arm nerve disability, to include carpal tunnel syndrome, is denied.

Entitlement to service connection for a right arm nerve disability, to include carpal tunnel syndrome, is denied.

Entitlement to service connection for a left leg nerve disability is denied.

Entitlement to service connection for a right leg nerve disability is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that left arm nerve disability, to include carpal tunnel syndrome, began during active service or is otherwise related to an in-service injury or disease, to include exposure to toxins.

2. The evidence of record persuasively weighs against finding that right arm nerve disability, to include carpal tunnel syndrome, began during active service or is otherwise related to an in-service injury or disease, to include exposure to toxins.

3. The evidence of record persuasively weighs against finding that left leg nerve disability began during active service or is otherwise related to an in-service injury or disease, to include exposure to toxins.

4. The evidence of record persuasively weighs against finding that right leg nerve disability began during active service or is otherwise related to an in-service injury or disease, to include exposure to toxins.

CONCLUSIONS OF LAW

1. The criteria for service connection for left arm nerve disability, to include carpal tunnel syndrome, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for service connection for right arm nerve disability, to include carpal tunnel syndrome, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

3. The criteria for service connection for left leg nerve disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

4. The criteria for service connection for right leg nerve disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty with the United States Army from August 1985 to August 1989, from November 2001 to July 2002, from April 2007 to August 2007, with additional periods of active duty for training (ACDUTRA), inactive duty for training (INACDUTRA), and service with the Reserves and National Guard.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2007 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this matter in August 2014, October 2017, September 2020, July 2022, and September 2023, for additional development. The matter is now returned to the Board for further appellate review. The Board finds there has been substantial compliance with the remand directives for the claim decided herein. Stegall v. West, 11 Vet. App. 268 (1998).

Service Connection

1. Entitlement to service connection for a left arm nerve disability, to include carpal tunnel syndrome.

2. Entitlement to service connection for a right arm nerve disability, to include carpal tunnel syndrome.

3. Entitlement to service connection for a left leg nerve disability.

4. Entitlement to service connection for a right leg nerve disability.

The Veteran seeks entitlement to service connection for left and right arm nerve disabilities, and left and right leg nerve disabilities.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection on a direct incurrence basis 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
4. Entitlement to service connection for a right leg nerve disability.

The Veteran seeks entitlement to service connection for left and right arm nerve disabilities, and left and right leg nerve disabilities.

For Veterans with 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases may be presumed to have been incurred in service if they manifest to a compensable degree within a certain timeframe from service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309.

Certain medical conditions are eligible for service connection on a presumptive basis due to a Veteran's participation in TERA in the Persian Gulf during Gulf War service, meaning that additional evidence of a nexus is not required. 38 U.S.C. §§ 1117-1120; 38 C.F.R. §§ 3.317, 3.320. Although the claimed neurological disabilities are not a presumptive conditions of Gulf War exposures, a Veteran may nonetheless establish service connection on a direct basis with sufficient proof of a causal link between his claimed disability and TERA. See 38 U.S.C. § 1113(b); 38 C.F.R. §§ 3.303(d), 3.320; Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

Service connection may be granted to any Persian Gulf Veteran suffering from a chronic disability resulting from an undiagnosed illness or combination of undiagnosed illnesses which became manifest either during active duty in the Southwest Asia Theater of operations during the Persian Gulf War, or to a degree of 10 percent or more within a presumptive period following service in the Southwest Asian Theater of operations during the Persian Gulf War.

In this case, the Veteran's DD Form 214 reflects service in Afghanistan subsequent to 1990.

There are three types of "qualifying chronic disabilities" for the purposes of 38 C.F.R. § 3.317: (1) an undiagnosed illness; (2) a medically unexplained chronic multi-symptom illness defined by a cluster of signs or symptoms (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome); or (3) a diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection. Disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a six-month period will be considered chronic. The six-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. 38 C.F.R. § 3.317(a)(4).

An "undiagnosed illness" is defined as a condition that by history, physical examination, and laboratory tests cannot be attributed to a known clinical diagnosis. 38 C.F.R. § 3.317(a)(1)(ii). In the case of claims based on undiagnosed illness, there is no requirement that there be competent evidence of a nexus between the claimed illness and service. See Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004).

A "medically unexplained chronic multi-symptom illness" means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii). There are currently no diagnosed illnesses with known pathophysiology or etiology that have been determined by the Secretary to warrant a presumption of service connection under 38 C.F.R. § 3.317 as a medically unexplained chronic multi-symptom illness.

Objective indications of a chronic disability include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and
is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii). There are currently no diagnosed illnesses with known pathophysiology or etiology that have been determined by the Secretary to warrant a presumption of service connection under 38 C.F.R. § 3.317 as a medically unexplained chronic multi-symptom illness.

Objective indications of a chronic disability include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Signs or symptoms that may be manifestations of undiagnosed illness or medically unexplained chronic multi-symptom illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders. 38 C.F.R. § 3.317(b).

The Board finds that entitlement to service connection is not warranted.

Service treatment records show that the Veteran had normal deep tendon reflexes, muscle strengths, knee rises, toe rises, knee extension, and heel-shin slide on examination in December 2003. However, the Veteran had a reduced grip at that time. A medical prescreen in November 2005 did not identify any disabilities. On medical examination in January 2006 the Veteran was noted to have a normal neurological examination, spine examination, upper extremity examination, and lower extremity examination. A medical history from the same month does not identify a disability other than hearing loss.

In October 2007 the Veteran had absent reflexes in the upper and lower extremities except for 1+ bilateral patellar reflexes. Thereafter, in November 2007 it was noted rule-out peripheral neuropathy.

In December 2007 nerve conduction studies of the right lower extremity, including proximal conductions as measured by F-response and H-reflex latencies, were normal. Needle electrode examination of the right lower extremity, including paraspinals, was also normal. Interpreted as no electrodiagnostic evidence for a right lower extremity radiculopathy, mononeuropathy or large fiber peripheral polyneuropathy.

Upon neurological evaluation in August 2012, September 2012, and November 2012, the Achilles and Patellar reflexes were normal brisk and symmetrical bilaterally. Epicritic sensation including sharp-dull, light touch, proprioception, 2-point discrimination and protective threshold were intact and without focal motor or sensory deficit in the bilateral lower extremities. There were downgoing toes and a negative clonus bilaterally. There was normal muscle mass appreciated to both the lower extremities and feet bilaterally. The Veteran could heel and toe walk with ease as well as arise from a seated position. Percussion of the tarsal tunnel and porta pedis was negative for Tinnel's or Valleix sign bilaterally.

The Veteran was afforded a VA examination in December 2015. The Veteran was noted to have mild ulnar nerve irritation. However, the Veteran was not diagnosed with any peripheral nerve disability.

The Veteran was afforded another VA examination in February 2017. The Veteran was not diagnosed with any peripheral neuropathy.

In February 2018 and February 2019, the Veteran denied upper or lower extremity pain, swelling, or claudication.

The Veteran was afforded another VA examination in October 2019. The Veteran was not found to have a peripheral nerve condition or peripheral neuropathy. Examination was within normal limits and records were reported to be silent for any formal diagnosis of peripheral neuropathy or any electromyography (EMG) / nerve conduction velocity (NCV) test results.

In a February 2020 private treatment note, nerve conduction studies and needle electromyography in the right upper extremity were consistent with mild right carpal tunnel syndrome. It was found to be probable and borderline early left carpal tunnel syndrome suggested by nerve conduction studies in the left upper extremity. There was no evidence of ulnar compression neuropathy, significant polyneuropathy involving the upper extremities or right upper extremity radiculopathy.

not found to have a peripheral nerve condition or peripheral neuropathy. Examination was within normal limits and records were reported to be silent for any formal diagnosis of peripheral neuropathy or any electromyography (EMG) / nerve conduction velocity (NCV) test results.

In July 2020 the Veteran underwent non-VA testing. The Veteran was noted to have lower extremity paresthesia. Needle EMG of selected muscles of the bilateral lower extremities, including the lumbosacral paraspinal, did not reveal abnormal spontaneous activity in any of the tested muscles. The impression was sensory polyneuropathy of axonal type, chronic lumbar radiculitis mainly at the L4-L5 level, and the peripheral neuropathy may in part be related to known toxic exposures during military service.

In a treatment note dated in February 2021 it was reported that despite clinical suspicion, no significant entrapment neuropathy (e.g. carpal tunnel syndrome (CTS)) was found.

In June 2020, November 2020, and August 2021, it was reported that peripheral neuropathy may partly be related to exposure to malaria drug.

The Veteran was afforded another VA examination in June 2021. The Veteran was diagnosed with bilateral median compression neuropathy at the carpal tunnel; sensory polyneuropathy of the lower extremities; and L4-5 radiculitis. The examiner noted that the Veteran's active current nerve condition diagnosed by EMG, carpal tunnel syndrome, and polyneuropathy of the lower extremity, were not found on previous EMGs of either 2007 or 2016. It was reported that it was unknown why the doctor wrote that it could be a toxic exposure, but it was probably because the Veteran was claiming that and reports that its going through congress now, as he handed me literature about toxins, and was vocal to the examiner about his exposure to "over 400 chemicals." It was conceded that as of 2020, he had compression neuropathy at the wrists, not found in the 2007 and 2016 EMGs, and new onset of polyneuropathy of the legs, also not found on previous EMG.

The Veteran submitted a VA disability benefit questionnaire (DBQ) completed in December 2021. The Veteran was diagnosed with bilateral carpal tunnel syndrome and bilateral ulnar nerve compression. However, no medical nexus opinion was provided.

The Veteran was afforded a VA examination in February 2023. The Veteran was diagnosed with peripheral neuropathy of the bilateral upper and lower extremities.

Medical opinions were provided. The examiner found that it was less likely than not that the Veteran arm and leg nerve disabilities were caused by toxic risk exposure, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic combined effect of all toxic exposure risk activities of the Veteran.

The examiner reported that the prior medical opinions and treatment notes were reviewed. The Veteran had bilateral upper extremity CTS diagnosed in 2020. Although the latest EMG nerve conduction testing of Veteran's upper extremities was negative for any CTS. The examiner noted that CTS is a compressive peripheral mononeuropathy at the wrists. The examiner reported that environmental toxic exposures would not and could not cause a physical compression of a single nerve, the median nerve, at the wrists. This was also stated in a peripheral nerve disability medical opinion dated in December 2022.

The examiner further reported that the Veteran was diagnosed with lumbar radiculopathy, right and left lower extremities. The Veteran had an EMG nerve conduction test of the lower extremities in July 2020 that reflected chronic lumbar radiculitis L4-L5, and a sensory polyneuropathy of the axonal type of the lower extremities. The examiner explained that lumbar radiculopathy is caused by nerve compression in the lumbar spine. The lumbar radiculitis was caused by the Veteran's back pathology, nerve compression at the L4-L5, sciatic nerve, also diagnosed in a private back disability exam of December 2021 from degenerative disc disease. The examiner found that environmental toxic exposures would not and could not cause physical compression of a single spinal nerve at the lumbar spine.

Regarding the sensory polyneuropathy of the lower extremities found on EMG in July 202
0 that reflected chronic lumbar radiculitis L4-L5, and a sensory polyneuropathy of the axonal type of the lower extremities. The examiner explained that lumbar radiculopathy is caused by nerve compression in the lumbar spine. The lumbar radiculitis was caused by the Veteran's back pathology, nerve compression at the L4-L5, sciatic nerve, also diagnosed in a private back disability exam of December 2021 from degenerative disc disease. The examiner found that environmental toxic exposures would not and could not cause physical compression of a single spinal nerve at the lumbar spine.

Regarding the sensory polyneuropathy of the lower extremities found on EMG in July 2020, the examiner found that this had never been diagnosed by physical examination. This was a nerve test only. The examiner noted that there have never been any positive physical examination findings to render a peripheral polyneuropathy of the lower extremity diagnosis.

The examiner noted that the Veteran was exposed in Afghanistan for 1 to 2 months in 2001 and Uzbekistan 2001 to 2002 per medical records. His military occupational specialty was water purification and he guarded ammunition bunkers. The Veteran reported exposure to depleted uranium, exposure to nerve gas, mustard gas, and multiple chemicals

In a VA opinion dated in May 2023 the examiner found that the claimed condition was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

The Veteran had diagnoses of bilateral carpal tunnel syndrome, bilateral ulnar nerve compression, bilateral lower extremity lumbar radiculopathy, and bilateral lower extremity lumbar radiculopathy. The examiner found that review of the medical literature did not demonstrate a definitive causal relationship between the claimed condition and toxic exposure risk activities experienced by the Veteran. There was insufficient evidence to support the claim. The claimed condition was less likely than not caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. Additionally, there were no literature reports that link mefloquine exposure to the development of carpal tunnel syndrome.

In another May 2023 VA opinion it was found that the Veteran had a left upper extremity peripheral neuropathy not due to mefloquine prophylaxis. There have been isolated case reports of peripheral neuropathy in the available literature, however the onset in those cases were shortly after exposure and/or associated with large doses for front-load prophylaxis or treatment. The examiner explained that this was not consistent with the Veteran's case, as the compensation and pension examination from 2015 was normal. The Veteran's peripheral neuropathy was neither due to mefloquine exposure nor any toxic exposure risk activities experienced by the Veteran as literature has not established Southwest Asia and other qualifying location exposure to the primary development of peripheral neuropathy.

Multiple VA medical opinions were obtained in December 2024.

These medical opinions identified the Veteran's CTS and ulnar entrapment, bilateral CTA and bilateral ulnar nerve compression, left and right arm nerve disabilities, bilateral lower extremity lumbar radiculopathy, bilateral lower extremity lumbar radiculopathy and peripheral neuropathy, and sciatica.

The examiner opined that the evidence did not show that these disabilities had their onset in service. Specifically, the examiner stated that the Veteran had bilateral upper extremity numbness in 2001; however, an NCV/SMG in 2007 was negative. In addition, an EMG in 2016 was identified that was concerning for early onset of mild bilateral compression around the elbows. But a repeat test in 2020 did not show irregularities of the upper extremities other than mild CTS.

The examiner further noted that the EMG of the lower extremities in 2020 did find bilateral radiculitis of the L4-5 that accounted for the Veteran's buttock pain and axonal polyneuropathy in the lower extremities. Thereafter, sensory polyneuropathy of the lower extremities was noted in a February 2023 examination report.

The lower extremity radiculopathy was therefore found to be caused by compression of lumbar spine nerves by degenerative disc disease/bulging discs. The examiner reported that degenerative disc disease / bulging disc will usually cause compression of the spinal nerves resulting to radiculopathy. It was explained that a common cause of radiculopathy is narrowing of the space where nerve roots exit the spine, which can be a result of stenosis, bone spurs, disc herniation
4-5 that accounted for the Veteran's buttock pain and axonal polyneuropathy in the lower extremities. Thereafter, sensory polyneuropathy of the lower extremities was noted in a February 2023 examination report.

The examiner also explained that the upper and lower extremity nerve disabilities would be more likely due to degenerative joint conditions and that the etiology and pathophysiology of each condition was understood in the context of the Veteran's specific circumstances as noted in EMG and imaging.

It was explained that CTS occurred when the median nerve, which runs through the carpal tunnel in the wrist, becomes compressed. This was usually caused by inflammation of the nearby tendons and tissues. Further, ulnar nerve entrapment was the most common ulnar nerve problem and occurred when something puts pressure on your ulnar nerve in your elbow or wrist. Nerve entrapment was described as a type of nerve compression syndrome.

Lumbar radiculopathy, also known as sciatica, was reported to be a condition that occurs when a nerve in the lower back is irritated or compressed. This can cause pain, numbness, tingling, weakness, or reflex loss that radiates down the legs.

The examiner reported that peripheral neuropathy occurred when the nerves outside of the spinal cord and brain are damaged, which can lead to a variety of symptoms. The pathophysiology of peripheral neuropathy can be caused by a number of mechanisms, including axonal degeneration, demyelinating neuropathy, distal axonopathy, and myelopathy.

The examiner continued to discuss TERA exposure. The examiner specifically identified the reported claimed exposures to burn pits, airborne hazards, ionizing radiation, VOCs, SVOCs, treated water, depleted uranium, asbestos, nerve, muscle, fumes, mustard gas, mefloquine for malaria prevention, and windstorms. The examiner found that the disabilities were less likely than not caused by, due to active-duty service after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic combined effect of all toxic exposure risk activities of the Veteran. The examiner identified and discussed the Veteran's TERA memorandum and discussed the available literature.

In explaining this finding, the examiner again discussed the nerve entrapment, compression, and breakdown of the spine issues that were the cause of the disabilities. The examiner further commented that the literature did not support the contentions.

The Board finds that entitlement to service connection for left arm, right arm, left leg, and right leg nerve disabilities is not warranted. During the course of the appeal the Veteran has been afforded numerous VA medical examinations. While the Veteran has been diagnosed variously with CTS, upper extremity neuropathy, radiculopathy of the lower extremities, and sciatica, the examiners have opined that these disabilities are not related to the Veteran's active service, did not arise in service, and are not associated with any toxic exposure in service. The examiners have indicated that neurological testing showed that the disabilities did not arise in service. The examiners have identified that the disabilities were diagnosed, have known etiologies, and the disabilities have been described in depth. The disabilities were associated with ulnar nerve compression and degenerative back disability. More specifically, the examiners have associated the Veteran's CTS and upper extremity neurological disabilities and lower extremity neurological disabilities with physical nerve compression and did not associate these conditions with the Veteran's active service or exposure to any TERA as described in detail above. In rendering these opinions, the examiners contemplated the Veteran's exposures in-service and considered the medical literature. Rather, the examiner repeatedly opined that the disabilities were specifically associated with nerve entrapment and the Veteran's degenerative spine disability. The Board finds the opinions of the VA examiners to be most probative. Lastly, the Board notes that the Veteran is not in receipt of service-connected disability benefits for any back disability. Therefore, consideration of the lower extremity disabilities as secondary to the low back is not warranted. As such, the claims of entitlement to service connection for left and right upper extremity and left and right lower extremity nerve disabilities are denied.

ROBERT C. SCHARNBERGER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Robert J. Burriesci, Counsel

The Board's
opined that the disabilities were specifically associated with nerve entrapment and the Veteran's degenerative spine disability. The Board finds the opinions of the VA examiners to be most probative. Lastly, the Board notes that the Veteran is not in receipt of service-connected disability benefits for any back disability. Therefore, consideration of the lower extremity disabilities as secondary to the low back is not warranted. As such, the claims of entitlement to service connection for left and right upper extremity and left and right lower extremity nerve disabilities are denied.

ROBERT C. SCHARNBERGER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Robert J. Burriesci, 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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