MEDIAN NERVE PARALYSIS

CORY M. PICTON · 2026 · Case ID: A26034454

MIXED

Summary

The veteran, who served in the United States Air Force from March 1993 to March 1997 and October 1999 to July 2014, appeals the denial of service connection for several conditions, including left wrist, left elbow, left arm disabilities, and hyperlipidemia. The veteran also sought service connection for right wrist carpal tunnel syndrome. The veteran claimed these conditions stemmed from overuse and repetitive motions during her service in health care administration. The Board granted service connection for carpal tunnel syndrome, right wrist, finding it to be an organic disease of the nervous system and at least as likely as not related to service, resolving doubt in the veteran's favor. The Board denied service connection for left wrist, left elbow, and left arm disabilities, citing a lack of current diagnosis or functional impairment, and giving more weight to VA examinations that showed normal findings and were silent regarding these conditions. The hyperlipidemia claim was denied as it is a laboratory finding and not a disability for VA compensation purposes, lacking evidence of impairment to earning capacity. The Board remanded claims for right thumb, right lateral epicondylitis, and right arm disabilities, finding a duty to assist error occurred as no medical opinion was obtained to link these conditions to the granted service connection for right wrist carpal tunnel syndrome.

Rationale

Current diagnosis of carpal tunnel syndrome, right wrist; Organic disease of the nervous system; In-service treatment for wrist pain and possible early carpal tunnel syndrome; Post-service treatment for carpal tunnel syndrome; Credible and consistent lay testimony; Benefit of the doubt resolved in veteran's favor

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

200902-107799

Full Decision Text

Citation Nr: A26034454
Decision Date: 04/14/26 Archive Date: 04/14/26

DOCKET NO. 200902-107799
DATE: April 14, 2026

ORDER

Entitlement to service connection for carpal tunnel syndrome, right wrist, is granted.

Entitlement to service connection for left wrist disability is denied.

Entitlement to service connection for left elbow disability is denied.

Entitlement to service connection for left arm disability is denied.

Entitlement to service connection for hyperlipidemia is denied.

REMANDED

Entitlement to service connection for right thumb disability, including secondary to carpal tunnel syndrome, right wrist, is remanded.

Entitlement to service connection for right, lateral epicondylitis, including secondary to carpal tunnel syndrome, right wrist, is remanded.

Entitlement to service connection for right arm disability, including secondary to service-connected carpal tunnel syndrome, right wrist, is remanded.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, her carpal tunnel syndrome, right wrist, is at least as likely as not related to her military service.

2. The evidence of record persuasively weighs against finding that the Veteran has had a left wrist disability at any time during or approximate to the pendency of the claim.

3. The evidence of record persuasively weighs against finding that the Veteran has had a left elbow disability at any time during or approximate to the pendency of the claim.

4. The evidence of record persuasively weighs against finding that the Veteran has had a left arm disability at any time during or approximate to the pendency of the claim.

5. Hyperlipidemia is a laboratory finding and does not constitute a disability for Department of the Veterans Affairs (VA) compensation purposes; the evidence of record persuasively weighs against finding that the Veteran has had a medically diagnosed disability manifested by hyperlipidemia at any time during or approximate to the pendency of the claim.

CONCLUSIONS OF LAW

1. The criteria for service connection for carpal tunnel syndrome, right wrist, are 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 left wrist disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for left elbow disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for left arm disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for entitlement to service connection for hyperlipidemia are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303; 61 Fed. Reg. 20440, 20445 (May 7, 1996).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from March 1993 to March 1997 and from October 1999 to July 2014. For her meritorious service, the Veteran was awarded (among other decorations) an Air Force Achievement Medal, Air Force Outstanding Unit Award, and National Defense Service Medal,

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2019 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).

In her September 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on April 23, 2024. Therefore, the Board may only consider the evidence of record at the time of the September 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or her representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a).
Veterans' Appeals (Board) on appeal from a September 2019 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).

In her September 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on April 23, 2024. Therefore, the Board may only consider the evidence of record at the time of the September 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or her representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the Veteran's claims seeking service connection for right thumb, elbow, and arm disabilities, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Claims for Service Connection

Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a chronic condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed.Cir.2013) (holding that only conditions listed as chronic diseases in § 3.309(a) may be considered for service connection under 38 C.F.R. § 3.303(b). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d).

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

Moreover, where a veteran served continuously for 90 days or more during active service, and arthritis and/or other organic diseases of the nervous system become manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309.

Service connection may also be established for disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). Further, a disability that is aggravated by a service-connected disability may be service connected to the degree that the aggravation is shown. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310.

The proper standard an aggravation inquiry for service-connected disease or injury is not whether there was permanent worsening but rather any increase in disability. Ward v. Wilkie, 31 Vet. App. 233, 237-38 (2019).

Medical evidence is generally required to establish a medical diagnosis or to address questions of medical causation; lay assertions of medical status do not constitute competent medical evidence for these purposes. Lay assertions, however, may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence).

A Persian Gulf veteran is defined as a veteran who served on active military, naval or air service in the Southwest Asia theater of operations during the Persian Gulf War. 38 C.F.R. § 3.317(e)(1). The Southwest Asia theater of operations refers to Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. Id. § 3.317(e)(2). The period of the Persian Gulf War is from August 2, 1990, through the present. See 38 C.F.R. § 3.2(i). Additionally, for veterans diagnosed with an infectious disease as defined in 38 C.F.R. § 3.317(c)(2), the qualifying period of service also includes active military, naval, air, or space service in Afghanistan on or after September 19, 2001. 38 C.F.R. § 3.317(c)(3)(ii).

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, was enacted on August 10, 2022. Section 405 of the PACT Act reduces the threshold for establishing eligibility when considering presumptive service connection for Persian Gulf War veterans. Presumptive conditions under 38 C.F.R. § 3.317(a) and (b) may now manifest to any degree at any time. There is no longer a requirement for chronic disability to manifest to a degree of 10 percent or more prior to December 31, 2026. The end date is no longer applicable and will be removed in a forthcoming regulation.

Additionally, the PACT Act expanded the definition of a Persian Gulf veteran to include those who served in the countries of Afghanistan, Israel, Egypt, Turkey, Syria, and Jordan, along with those who served in the Southwest Asia theater of operations as defined in 38 C.F.R. § 3.317(e).

Finally, pursuant to the PACT Act, exposure to burn pits and other toxins (BPOT) is presumed for "covered veterans," i.e., those who served in specific locations on or after specific dates. 38 U.S.C. § 1119. Any veteran who, on or after August 2, 1990, performed active military, naval, air, or space service while assigned to a duty station in and/or airspace above Bahrain; Iraq; Kuwait; Oman; Qatar; Saudi Arabia; Somalia; the United Arab Emirates; the neutral zone between Iraq and Saudi Arabia; the Gulf of Aden; the Gulf of Oman; the Persian Gulf; the Arabian Sea; or the Red Sea will be presumed BPOT exposed, as will any veteran who, on or after September 11, 2001, performed active military, naval, air, or space service while assigned to a duty station in and/or airspace above Afghanistan; Djibouti; Egypt; Jordan; Lebanon; Syria; Yemen; or Uzbekistan. 38 U.S.C. § 1119; VBA Letter 20-22-10 at 7, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (Dec. 22, 2022). Certain diseases will be presumed related to service for veterans with in-service toxic exposure, including BPOT exposure. 38 U.S.C. § 1120.

In August 2019, the Veteran filed her present claims seeking service connection for bilateral wrist, elbow, and arm disabilities; hyperlipidemia; and right thumb disability. She attributes these conditions to injury caused by overuse and repetitive motions required to complete her inservice duties in health care administration.

The Veteran had active service in Kuwait from August 2004 to December 2004 and UAE from May 2007 to September 2007, and is thus considered a Persian Gulf veteran. 38 C.F.R. § 3.317(e). Moreover, her BPOT exposure is presumed. 38 U.S.C. § 1119.

The Veteran has participation in a toxic exposure risk activity (TERA). See 38 U.S.C. § 1119. Although VA has an obligation to obtain medical opinions for any service connection claim which cannot be granted where there is evidence of a TERA and of a disability, VA has identified several exceptions to this general obligation where there is no indication of an association between the disability and the TERA. See 38 U.S.C. § 1168(b). Specifically, a TERA opinion is not required for disabilities resulting from physical trauma; mental disorders; disabilities that have not been shown to have any positive association with herbicide exposure; and disabilities that manifested during service or with a clear etiology that is not associated with toxic exposure. See VBA Letter 20-22-10 at 10-13, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (Dec. 22, 2022). In this case, the Veteran's claimed disabilities are related to inservice injury, which is an exception to this requirement. Thus, an exception to the TERA opinion requirements applies, and remand for an examination is not warranted on this basis.

1. Entitlement to service connection for carpal tunnel syndrome, right wrist.

The Veteran has a current diagnosis of carpal tunnel syndrome, right wrist, as evidenced by her September 2019 VA examination for peripheral nerves. Carpal tunnel syndrome is considered an organic disease of the nervous system. Therefore, it is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331.

A January 2002 inservice treatment report noted the Veteran's complaints of forearm pain when typing for the past three to four months. The report concluded with diagnoses of wrist pain and possible early carpal tunnel syndrome. She was told to use NSAIDs, rest when possible, and use wrist braces as needed.

Post service treatment records indicate that the Veteran underwent a right carpal tunnel and trigger finger release in January 2018, with continued treatment for right carpal tunnel syndrome.

At her April 2024 Board hearing, the Veteran and her spouse testified that she continued to have right wrist and forearm pain ever since this condition began during her military service. The Veteran is competent to report having experienced symptoms of pain in her wrist and forearm. Statements from the Veteran and her spouse are credible and entitled to probative weight, as they are internally consistent with other evidence of record.

Resolving all doubt in the
and possible early carpal tunnel syndrome. She was told to use NSAIDs, rest when possible, and use wrist braces as needed.

Post service treatment records indicate that the Veteran underwent a right carpal tunnel and trigger finger release in January 2018, with continued treatment for right carpal tunnel syndrome.

Resolving all doubt in the Veteran's favor, the Board concludes that service connection for her carpal tunnel syndrome, right wrist, is warranted.

2. Entitlement to service connection for left wrist disability.

The Veteran contends that she has a current left wrist disability, manifested by pain in her left wrist and forearm, related to her military service. She attributes this condition to her inservice duties requiring extensive typing and repetitive motions involving both hands.

The Board concludes that the Veteran does not have a current left wrist disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

In support of her claim, the Veteran has reported complaints of left wrist pain, which she treats with Ibuprofen. She also reported using a wrist brace for this condition. A review of the record, however, does not reveal any current diagnosis of a left wrist disability. Moreover, the Veteran's complaints of pain alone does not reach the level of a functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (Fed. Cir. 2018).

The September 2019 VA examination for peripheral nerves was silent as to any findings of constant or intermittent pain, paresthesias, or numbness in the left upper extremity. Muscle strength testing of the left wrist revealed 5/5 strength in flexion and extension; and grip strength and pinch was also 5/5. Moreover, the Veteran's left upper extremity nerve groups were all deemed normal

The September 2019 VA examination for hands and fingers noted that motion in the Veteran's left hand was normal, and that she was able to perform repetitive use testing without any additional functional loss or range of motion. The report also noted that pain, weakness, fatigability, or incoordination did not significantly limit the Veteran's functional ability with repeated use over time.

The September 2019 VA examination for neck conditions was silent as to any findings of a left wrist disability. Physical examination revealed 5/5 strength in left wrist flexion and extension. It also revealed 5/5 strength in left finger flexion and abduction. Sensory and reflex examinations were normal throughout the left upper extremity, and no radicular neuropathy abnormalities.

A review of the Veteran's post service treatment reports are also silent as to diagnosis of or treatment for a left wrist disability.

While the Veteran and her husband believe that there is a current diagnosis of left wrist disability, they are not competent to provide a diagnosis in this case. The issue is medically complex, as it requires the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). Consequently, the Board gives more probative weight to the competent medical evidence of record that was silent as to any current left wrist disability, along with normal findings throughout.

Furthermore, while the Board has considered the Veteran's assertions as to the presence of a left wrist disability, she, as a lay person, does not have the requisite training and experience necessary to diagnose such conditions. Specifically, diagnosis of a left wrist disability requires the administration and interpretation of diagnostic and clinical testing. Thus, such matter may not be competently addressed by lay statements. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Accordingly, the Veteran's assertions as to the presence of left wrist disability are not competent and, consequently, are
she, as a lay person, does not have the requisite training and experience necessary to diagnose such conditions. Specifically, diagnosis of a left wrist disability requires the administration and interpretation of diagnostic and clinical testing. Thus, such matter may not be competently addressed by lay statements. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Accordingly, the Veteran's assertions as to the presence of left wrist disability are not competent and, consequently, are afforded no probative weight.

Therefore, based upon the foregoing, the Board finds that at no time during the pendency of the claim is the Veteran shown to have a left wrist disability. The record does not contain a recent diagnosis of such disability during the course of this appeal. Consequently, service connection for this condition is not warranted. See Brammer, supra.

In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative evidence is against the Veteran's claim for service connection for left wrist disability, that doctrine is not applicable in the instant appeal and her claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

3. Entitlement to service connection for left elbow disability.

The Veteran contends that she has a current left elbow disability related to her military service. She attributes this condition to her inservice duties requiring extensive typing and repetitive motions involving both hands.

The Board concludes that the Veteran does not have a current left elbow disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky, 26 Vet. App. at 294; McClain, 21 Vet. App. at 321. Although competent to report symptoms of elbow pain and reduced motion, she has not done so in this matter. She has not reported left elbow symptoms, the severity of which reach the level of a functional impairment of earning capacity. See Saunders, 886 F.3d at 1367-69.

The Veteran underwent a VA examination for elbow and forearm conditions in September 2019. The VA examiner noted that the Veteran's claims file had been reviewed, and the report noted the Veteran's contentions, as well as physical examination findings. The Veteran reported having a history of right elbow pain. No left elbow complaints were indicated. Physical examination of the left elbow revealed a normal range of motion, without any pain. There was no pain on weight bearing, no tenderness or pain on palpation, no localized tenderness, and no crepitus. The VA examiner noted that repeated use over time would not result in pain, weakness, fatigability, or incoordination significantly limiting her functional ability. Muscle strength testing revealed 5/5 strength for left elbow flexion and extension, with no muscle atrophy. The report also noted that there was no functional impairment of the left upper extremity; and that this condition would not result in any functional impairment.

The September 2019 VA examination for peripheral nerves was silent as to any findings of constant or intermittent pain, paresthesias, or numbness in the left upper extremity. The Veteran's left upper extremity nerve groups were all deemed normal

The September 2019 VA examination for hands and fingers noted that motion of the Veteran's left hand was normal, and that she was able to perform repetitive use testing without any additional functional loss or range of motion. The report also noted that pain, weakness, fatigability, or incoordination did not significantly limit the Veteran's functional ability with repeated use over time.

The September 2019 VA examination for neck conditions was silent as to any findings of a left elbow disability. Physical examination revealed 5/5 strength in left elbow flexion and extension. Sensory and reflex examinations were normal throughout the left upper extremity, and no radicular neuropathy abnormalities were indicated.

A review of the Veteran's post service treatment reports was silent as to treatment for or diagnosis of a left elbow disability.

While the Veteran claims that she has a current left elbow disability, she is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires the ability to interpret complicated diagnostic medical testing. Jandreau, 492 F.3d at 1376-77. Consequently, the Board gives more probative weight to the competent medical evidence of record that was silent as to any current left elbow disability, and listed normal
in left elbow flexion and extension. Sensory and reflex examinations were normal throughout the left upper extremity, and no radicular neuropathy abnormalities were indicated.

A review of the Veteran's post service treatment reports was silent as to treatment for or diagnosis of a left elbow disability.

While the Veteran claims that she has a current left elbow disability, she is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires the ability to interpret complicated diagnostic medical testing. Jandreau, 492 F.3d at 1376-77. Consequently, the Board gives more probative weight to the competent medical evidence of record that was silent as to any current left elbow disability, and listed normal findings throughout. Therefore, based upon the foregoing, the Board finds that at no time during the pendency of the claim is the Veteran shown to have a left elbow disability, and the record does not contain a recent diagnosis of such disability during the course of this appeal. Consequently, service connection for this condition is not warranted. See Brammer, supra.

In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative evidence is against the Veteran's claim for service connection for left elbow disability, that doctrine is not applicable in the instant appeal and her claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

4. Entitlement to service connection for left arm disability.

The Veteran contends that she has a current left arm disability related to her military service. She attributes this condition to her inservice duties requiring extensive typing and repetitive motions involving both hands.

The Board concludes that the Veteran does not have a current left arm disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky, 26 Vet. App. at 294; McClain, 21 Vet. App. at 321.

The Veteran underwent a VA examination for elbow and forearm conditions in September 2019. The VA examiner noted that the Veteran's claims file had been reviewed, and the report noted the Veteran's contentions, as well as physical examination findings. Physical examination of the left elbow revealed a normal range of motion, without any pain. There was no pain on weight bearing, no tenderness or pain on palpation, no localized tenderness, and no crepitus. The VA examiner noted that repeated use over time would not result in pain, weakness, fatigability, or incoordination significantly limiting her functional ability. Muscle strength testing revealed 5/5 strength for left elbow flexion and extension, with no muscle atrophy. The report also noted that there was no functional impairment of the left upper extremity.

The September 2019 VA examination for hands and fingers noted that the motion in the Veteran's left hand was normal, and that the Veteran was able to perform repetitive use testing without any additional functional loss or range of motion. The report also noted that pain, weakness, fatigability, or incoordination did not significantly limit the Veteran's functional ability with repeated use over time.

The September 2019 VA examination for neck conditions was silent as to any findings of a left arm disability. Physical examination revealed 5/5 strength in left elbow flexion and extension; and left wrist flexion and extension. Sensory and reflex examinations were normal throughout the left upper extremity, and there were no radicular neuropathy abnormalities of the left upper extremity.

A review of the Veteran's post service treatment reports was silent as to diagnosis of or treatment for a left arm disability.

While the Board has considered the Veteran's assertions as to the presence of a left arm disability, she, as a lay person, does not have the requisite training and experience necessary to diagnose such conditions. Accordingly, the Veteran's assertions as to the presence of left arm disability, without any functional impairment of earning capacity shown or even alleged, are afforded no probative weight.

Therefore, based upon the foregoing, the Board finds that at no time during the pendency of the claim is the Veteran shown to have left arm disability, and the record does not contain a recent diagnosis of such disability during the course of this appeal. Consequently, service connection for this condition is not warranted. See Brammer, supra.

In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative
lay person, does not have the requisite training and experience necessary to diagnose such conditions. Accordingly, the Veteran's assertions as to the presence of left arm disability, without any functional impairment of earning capacity shown or even alleged, are afforded no probative weight.

In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative evidence is against the Veteran's claim for service connection for left arm disability, that doctrine is not applicable in the instant appeal and her claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

5. Entitlement to service connection for hyperlipidemia.

The Veteran is seeking entitlement to service connection for hyperlipidemia.

The clinical record does not show, and the Veteran has not claimed that her hyperlipidemia (high cholesterol) is a symptom of a specific disability. An elevated cholesterol level alone represents a laboratory finding. Hyperlipidemia, dyslipidemia, or high cholesterol is not a disability for which VA disability compensation may be granted. 61 Fed. Reg. 20440, 20445 (May 7, 1996). Therefore, service connection for high cholesterol must be denied.

VA post service treatment records show that the Veteran has high cholesterol, also known as hyperlipidemia. While it may reflect a possible underlying disability, there is no showing of a current medically diagnosed disability manifested by high cholesterol. The term "disability" as used for VA purposes refers to impairment of earning capacity. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). There is no evidence of record suggesting the Veteran's high cholesterol reading causes any impairment of earning capacity.

Statements by the Veteran to the effect that she has high cholesterol do not constitute competent evidence of a current disability productive of impairment in earning capacity.

In the absence of a current medically diagnosed disability manifested by high cholesterol, there is no basis for service connection. As the persuasive evidence of record is against the claim, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 49.

REASONS FOR REMAND

1. Entitlement to service connection for right thumb disability, including secondary to carpal tunnel syndrome, right wrist, is remanded.

2. Entitlement to service connection for right, lateral epicondylitis, including secondary to carpal tunnel syndrome, right wrist, is remanded.

3. Entitlement to service connection for right arm disability, including secondary to service-connected carpal tunnel syndrome, right wrist, is remanded.

The issues of entitlement to service connection for right thumb disability; right, lateral epicondylitis; and right arm disability are being remanded to correct a duty to assist error that occurred prior to the September 2019 rating decision on appeal.

As noted above, the Board has determined that service connection is warranted for carpal tunnel syndrome, right wrist. The Board also finds that there is evidence of record suggesting a possible link between the Veteran's right thumb, right elbow, and right arm disabilities, and her carpal tunnel syndrome, right wrist.

An October 2017 VA treatment report noted the Veteran's complaints of tingling right thumb and forearm ever since her carpal tunnel surgery in January 2018. The report concluded with an assessment of pain in the right thumb for the past month. A January 2019 VA treatment report noted the Veteran's complaints of tingling sensation in the right thumb and forearm since carpal tunnel surgery in January 2018. A March 2019 VA treatment report noted the Veteran's complaints of pain in her right elbow and up into the right arm. The report concluded with an impression of lateral epicondylitis of the right elbow. An October 2019 VA treatment report noted the Veteran's complaints of pain with resisted extension of the right arm and lateral epicondyle.

Although provided with VA examinations of the wrist, elbow, forearms, peripheral nerves, and neck, the AOJ did not obtain any medical opinion addressing whether the Veteran's right thumb, right elbow, and right arm disabilities were caused or aggravated by her carpal tunnel syndrome, right wrist, on a secondary basis.

Under these circumstances, the Board finds that a medical opinion is required to
2019 VA treatment report noted the Veteran's complaints of pain in her right elbow and up into the right arm. The report concluded with an impression of lateral epicondylitis of the right elbow. An October 2019 VA treatment report noted the Veteran's complaints of pain with resisted extension of the right arm and lateral epicondyle.

Under these circumstances, the Board finds that a medical opinion is required to determine whether these conditions were caused or aggravated by her service-connected disabilities.

The matters are REMANDED for the following action:

Obtain addendum medical opinions from an appropriate clinician regarding whether the Veteran's right thumb disability, right lateral epicondylitis, and/or right arm disability is at least as likely as not related to, caused by, and/or aggravated by her service-connected carpal tunnel syndrome, right wrist; and cervical spine degenerative disc disease.

The examiner must review the claims file. If the VA examiner concludes a new medical examination is necessary to make this determination, it should be conducted.

Each opinion should contain a complete rationale for the opinion provided, to include discussion of any pertinent studies or medical literature, as well as pertinent evidence on file, including the severity of the Veteran's carpal tunnel syndrome, right wrist, and its resulting physical limitations on her activities.

Cory M. Picton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Yates, William M.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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