THUMB IMPAIRMENT OF

Summary

The veteran, who served in the U.S. Navy from March 1998 to January 2002, appeals the denial of service connection for a left thumb injury. The veteran claims to have injured his left thumb during service when a car hood fell on his hands, although he initially focused on a right-hand injury. The Board acknowledged a current diagnosis of left thumb extensor pollicis longus (EPL) disruption with degenerative joint disease, satisfying the first element of service connection. However, the Board found the evidence weighed against a service connection. The veteran's service treatment records mentioned an injury to his right hand's second and third fingers, with no record of left thumb injury or treatment. VA treatment records from 2019 indicated the veteran sought care for his left thumb, reporting a delayed awareness of the injury's extent. The VA examiner diagnosed left thumb EPL disruption and DJD, but could not link it to service, noting the in-service injury involved the right hand and that the left thumb was not treated or noted on separation exams. The Board found the VA examiner's opinion probative due to thorough record review and analysis. The veteran testified at a Board hearing about the left thumb injury, but the Board found his lay testimony, while competent, lacked the medical expertise to establish etiology and noted the significant delay in seeking treatment. Consequently, the Board denied service connection for the left thumb injury.

Rationale

No in-service treatment or mention of left thumb injury in service treatment records.; VA examiner opined less likely than not related to service.; Significant delay in seeking treatment for the left thumb injury.

Full Decision Text

Citation Nr: A26036588
Decision Date: 04/20/26	Archive Date: 04/20/26

DOCKET NO. 210428-155980
DATE: April 20, 2026

ORDER

Entitlement to service connection for left thumb injury is denied.

FINDING OF FACT

The competent evidence of record is against a finding that the Veteran's left thumb condition had its onset in or is otherwise due to service. 

CONCLUSION OF LAW

The criteria for service connection for left hand thumb injury have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty with the U.S. Navy from March 1998 to January 2002.

In February 2021, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a February 2020 decision.  In April 2021, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior February 2020 decision.  

In the April 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.  A Board hearing was held on December 16, 2024.  Therefore, the Board may only consider the evidence of record at the time of the February 2020 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing.  38 C.F.R. § 20.302(a).  If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

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

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 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).

1. Left hand thumb injury.

The Veteran contends that he injured his left thumb in an accident during service.   

The favorable finding from both the February 2020 and April 2021 Rating Decisions include confirmation of a current diagnosis of left thumb extensor pollicis longus (EPL) disruption with degenerative joint disease, first carpometacarpal (CMC) joint.  As such, the first element of service connection has been met. 

The Board concludes that, while the Veteran has a diagnosis of left thumb disability, the evidence of record persuasively weighs against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease.  

The Veteran's service treatment records show the Veteran injured his second and third fingers when the hood of a car fell on his right hand.  There was no mention of an injury to his left thumb or hand. 

VA treatment records show the Veteran sought treatment for his left hand/thumb in September 2019.  He reported a history of trauma to both hands approximately 15 years ago.  At the time, he was focused on the right-hand injury and did not notice until months later that he was unable to extend the tip of his left thumb.  The examiner diagnosed boutonniere deformity of the left thumb.
 finding that it began during active service, or is otherwise related to an in-service injury, event, or disease.  

The Veteran's service treatment records show the Veteran injured his second and third fingers when the hood of a car fell on his right hand.  There was no mention of an injury to his left thumb or hand. 

VA treatment records show the Veteran sought treatment for his left hand/thumb in September 2019.  He reported a history of trauma to both hands approximately 15 years ago.  At the time, he was focused on the right-hand injury and did not notice until months later that he was unable to extend the tip of his left thumb.  The examiner diagnosed boutonniere deformity of the left thumb.  

The Veteran was afforded a VA examination in January 2020, and the examiner diagnosed him with left thumb EPL disruption with DJD first CMC joint.  The Veteran reported conducting maintenance on a tractor during service when the hood fell onto his hands.  He had a fracture of the end of the right 5th finger and a crush injury to the base of the left thumb.  He was treated with a splint to the right 5th finger but no treatment for the left.  He says that he did not pay much attention to the left thumb but noticed that he could not extend the end of it.  He recently sought treatment and was told that he had ruptured the EPL tendon of the left thumb.  He was scheduled to have a tendon graft procedure and will have 8 weeks of PT following the procedure.  

Ultimately, the examiner opined that the Veteran's left thumb disability was less likely as not related to an in-service injury, event, or disease.  He was seen in February 1999 after a hood of a vehicle fell onto his right hand.  He had superficial lacerations that did not require sutures.  He was diagnosed with contusions of the second and third fingers of the right hand.  There is no evidence that the left hand was injured or treated.  He was able to return to full unrestricted duty.  There is no record for any treatment of a right- or left-hand disability in the remainder of his service treatment records.  His separation exam did not reveal any hand disability or limitation.  His annual certificates of medical condition did not list any physical defects.  He does have evidence of a left thumb deformity due to a rupture of the EPL tendon, but the examiner was unable to relate his left thumb condition to his in-service right-hand contusion or any other injury in his active-duty service.  There is no record of injury to the left thumb, and it was not reported on his separation exam or annual medical certificates.  

 The Board finds the opinion probative because the examiner conducted a physical examination, thoroughly reviewed the record, and provided a well thought out analysis in support of the opinion.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (noting that the probative value of a medical opinion derives from the factually accurate, fully articulated, sound reasoning for the conclusion).

During the December 2024 Board hearing, the Veteran testified that during service he injured both hands when the car hood fell.  Most of the impact fell on his left hand/thumb because it was top and prevented the hood from fully closing onto his hands.  After pulling his hands out, he realized his left thumb was cut open at the tip.  He sought treatment and the bleeding was stopped, he was patched up and given a splint.  More extensive treatment or care, such as x-rays, were not conducted.  He was placed on light duty for some time.  He did not have any symptoms in the left hand/thumb except for some numbness.  He did not realize the extent of the problem until he joined the Reserves and found that he was unable to extend his left thumb.  He did not seek treatment at VA until 2016.   

Although the Veteran believes the claimed left thumb injury is related to the reported in-service injury, and he is competent to report an injury to the left hand/thumb and symptoms such as pain or limited motion since, he lacks the medical expertise to provide a diagnosis or determine the etiology of his current disability.  See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  Moreover, the Veteran did not seek care for over 15 years after the alleged injury, making it less likely that his current disability was caused by service. 

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for left hand/thumb disability, is not warranted.  Rather, the evidence persuasively weighs against this claim.  The benefit of doubt is therefore not for application as to this
 to the left hand/thumb and symptoms such as pain or limited motion since, he lacks the medical expertise to provide a diagnosis or determine the etiology of his current disability.  See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  Moreover, the Veteran did not seek care for over 15 years after the alleged injury, making it less likely that his current disability was caused by service. 

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for left hand/thumb disability, is not warranted.  Rather, the evidence persuasively weighs against this claim.  The benefit of doubt is therefore not for application as to this service connection claim.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). 

 

David Robertson

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Price Umaru, Antonette

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.