LUMBOSACRAL OR CERVICAL STRAIN

Summary

The Veteran, an Air Force Veteran who served from March 2003 to October 2007, April 2020 to August 2020, and February 2021 to June 2021, including service in Iraq, appeals the denial of service connection for a left thumb strain, claimed as tendonitis. The Veteran reported left thumb pain starting in 2023, attributing it to repetitive typing and workouts during service. The Board reviewed two VA examinations. The October 2024 examination diagnosed a left thumb strain, with the examiner finding it less likely than not caused by toxic exposure or service, citing mechanical factors like repetitive use as the cause. The February 2025 examination also found the condition less likely than not incurred in or caused by service, noting no evidence of an in-service event and that texting was a more common cause than keyboard use for De Quervain's tenosynovitis. The Board found these opinions persuasive due to their review of the record and rationale, outweighing the Veteran's less credible, inconsistent lay statements which did not align with contemporaneous medical evidence. Service connection for the left thumb strain was denied due to lack of nexus. The Board also remanded the claim for a right hand or finger disability, as the Veteran reported right wrist pain in service and submitted a claim for right hand issues, but had not yet received a VA examination for this condition. The remand directs a VA examination to determine the nature and etiology of the right hand condition and assess its service connection.

Rationale

Lack of nexus to service; Negative VA opinions; Inconsistent lay statements

Full Decision Text

Citation Nr: A26038131
Decision Date: 04/23/26	Archive Date: 04/23/26

DOCKET NO. 250328-532838
DATE: April 23, 2026

ORDER

Entitlement to service connection for a left thumb strain (claimed as left hand/fingers tendonitis) is denied.

REMANDED

Entitlement to service connection for a right hand or finger disability (tendinosis in hand or fingers, right) is remanded.

FINDING OF FACT

The evidence of record persuasively weighs against finding that a left thumb strain began during active service or is otherwise related to the Veteran's toxic exposures.

CONCLUSION OF LAW

The criteria for service connection for a left thumb strain are not 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 in the Air Force from March 2003 to October 2007, from April 2020 to August 2020, and from February 2021 to June 2021, including service in Iraq.  The Board recognizes the Veteran's service to our country, and the sacrifices it necessarily entailed.

This case comes before the Board of Veterans' Appeals (Board) on appeal from an October 2024 rating decision issued by the Agency of Original Jurisdiction (AOJ), Department of Veterans Affairs (VA) Regional Office (RO), which denied entitlement to service connection for the above claims.  The Veteran requested higher level review in October 2024.  In January 2025 and March 2025 higher level rating decisions, the AOJ again denied service connection.  

On August 23, 2017, the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55, 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA), was enacted.  This law creates a framework for Veterans dissatisfied with VA's decision on their claim to seek review.  The Veteran timely appealed the rating decision to the Board by requesting Direct Review under the AMA.  See VA Form 10182 Notice of Disagreement, March 2025.  Accordingly, the Board's current review is limited to the evidence of record at the time of the March 2025 rating decision, as the AOJ ordered additional development following the October 2024 denials.

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 a disability resulting from a disease or injury incurred in or aggravated by active service.  See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  "To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"- the so-called "nexus" requirement."  Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

A Veteran can provide competent reports of factual matters of which he or she has first-hand knowledge, such as experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy.  See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005).  Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a lay person is competent to identify the medical condition (noting that sometimes the lay person will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.  See Jandre
 as experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy.  See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005).  Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a lay person is competent to identify the medical condition (noting that sometimes the lay person will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.  See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007).  Similarly, laypersons are competent to diagnose and provide nexus opinions to some extent, notably where the diagnosis or opinion is not of a complex nature.  Id., see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

Entitlement to service connection for a left thumb strain (claimed as left hand/fingers tendonitis) is denied.

Regarding her left hand and fingers, the Veteran has stated,

My hands have bothered me for some time but I just assumed it was from a lot of use of them with constant typing I did a lot of computer work and I believe the constant use of using the keyboard made it worse.  I also believe it got worse during a lot of the workouts[.] I was seen by the VA doc in February and was told by the occupational therapist that I have developed arthritis in my thumb.

See VA 21-526EZ, Fully Developed Claim (Compensation), April 2024. 

The Veteran reported right wrist issues during service.  See STR - Reserve STR, November 2022. 

After leaving active duty service in 2021, the Veteran did not report any left hand or finger issues until January 2024 when the Veteran reported left thumb pain.  See CAPRI, October 2024.  

The Veteran was first afforded a VA hand and fingers examination in October 2024.  A left thumb strain was diagnosed in 2024.  The condition onset in 2023 with pain and weakness opening jars which the Veteran claimed was due to repetitive use of the hand during service.  See C&P Exam, October 2024. 

In the opinion section of the examination, the examiner found 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 examiner stated,

Toxic exposure is unlikely to be a direct cause of thumb strain since strains are due to mechanical factors involving muscles, tendons, and ligaments.  Causes of thumb strain are repetitive use, sudden force, overuse and poor ergonomics.  The diagnosed left thumb strain is 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.  See C&P Exam, October 2024.

The Board notes that only the Veteran's left hand and fingers were assessed during the October 2024 VA examination, and not the Veteran's right hand or fingers.  Id. 

Following the October 2024 VA examination, the Veteran was afforded a second VA opinion for her left hand and fingers in February 2025.  The examiner found the claimed condition was less likely than not (likelihood is less than approximately balanced or nearly equal) incurred in or caused by the claimed in-service injury, event, or illness.  The examiner stated, 

Claimant has been diagnosed with De Quervain's tenosynovitis as the etiology of his L thumb pain.  The tendons involved in de Quervain's tenosynovitis are the abductor pollicis longus (APL) and extensor pollicis brevis (EPB).  These tendons run through the first extensor compartment of the wrist. De Quervain's tenosynovitis affects the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB).  These are two of the main tendons to the thumb that assist with bringing the thumb out away from the index finger (APL) and straightening the joints of the thumb (EPB).  Texting on an cell phone is known to cause this because of use of thumbs.  Typing on a keyboard as claimed by this
's tenosynovitis are the abductor pollicis longus (APL) and extensor pollicis brevis (EPB).  These tendons run through the first extensor compartment of the wrist. De Quervain's tenosynovitis affects the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB).  These are two of the main tendons to the thumb that assist with bringing the thumb out away from the index finger (APL) and straightening the joints of the thumb (EPB).  Texting on an cell phone is known to cause this because of use of thumbs.  Typing on a keyboard as claimed by this claimant as cause of his de Quervain's tenosynovitis /thumb strain can occur but is not a common cause for the simple reason than the[re] are less key strokes on a keyboard that are struck with thumbs that stress these ligaments.  There is also no evidence pain in this area resulting from of any event ,injury or activity on active duty making it less likely than not that claimants dx is caused by his MOS..  Based on the available evidence , it is not possible to support a statement that there is an equal or nearly equal likelihood that thumb condition was incurred on active duty. 

The examiner cited medical literature in making their assessment.  See C&P Exam, February 2025. 

When assessing the probative value of a medical opinion, the access to claims files and the thoroughness and detail of the opinion must be considered.  The opinion is considered probative if it is definitive and supported by detailed rationale.  See Prejean v. West, 13 Vet. App. 444, 448-49 (2000).

To this end, the Board finds that the October 2024 and February 2025 VA opinions were based on a review of the record, including the Veteran's statements, medical history, and clinical findings.  The examiners explained the reasons for their conclusions based on an accurate characterization of the evidence of record.  Significantly, the VA examiners explicitly considered the assertions of the Veteran concerning the onset and progression of her left thumb symptoms and service treatment records in rendering the negative nexus opinions.  The VA opinions sufficiently inform the Board of the clinician's judgment on the relevant medical questions and the "essential rationale" for their opinions.  Monzingo v. Shinseki, 26 Vet. App. 97, 105-07 (2012) (the fact that the rationale provided by an examiner "did not explicitly lay out the examiner's journey from the facts to a conclusion," did not render the examination inadequate); Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012) (noting that VA examiners do not have a reasons or bases requirement).  Where a medical opinion is lacking in detail, "the Board is permitted to draw inferences based on the overall report so long as the inference does not result in a medical determination."  Id. at 294.  Moreover, medical reports must be read as a whole and in the context of the evidence of record.  Id.

The Board therefore places significant weight on the cumulative findings expressed in the October 2024 and February 2025 VA medical opinions.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) ("It is the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion"); see also Bloom v. West, 12 Vet. App. 185, 187 (1999) (the probative value of a physician's statement is dependent, in part, upon the extent to which it reflects "clinical data or other rationale to support his opinion").  Significantly, after reviewing the Veteran's medical history, the VA examiners concluded that the Veteran's left thumb condition was not etiologically related to her military service to include her reports of in-service typing on a computer.  Accordingly, the Board finds that the competent medical evidence demonstrating the absence of nexus between the claimed disability and the Veteran's active duty service outweighs any medical evidence suggestive of a nexus.

In its role as factfinder, the Board is obligated to determine whether lay evidence is credible.  See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (2006).  In doing so, the Board may properly consider facts such as internal inconsistency of statements, facial plausibility, and consistency with other evidence.  See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown,
 to include her reports of in-service typing on a computer.  Accordingly, the Board finds that the competent medical evidence demonstrating the absence of nexus between the claimed disability and the Veteran's active duty service outweighs any medical evidence suggestive of a nexus.

In its role as factfinder, the Board is obligated to determine whether lay evidence is credible.  See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (2006).  In doing so, the Board may properly consider facts such as internal inconsistency of statements, facial plausibility, and consistency with other evidence.  See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996); Macarubbo v. Gober, 10 Vet. App. 388 (1997).  To the extent the Veteran contends that her current left thumb disability is related to her service and that she has experienced symptoms since, such statements are notably inconsistent with the remainder of the record, including in-service and post service medical evidence as documented in medical histories.  The Veteran did not complain of any left thumb symptoms following her service until 2023, and there is no evidence of treatment associated with a left thumb disability until 2024, more than one year after she left service.  As such, the recent recounting by the Veteran is less credible than the contemporaneous evidence.

Based on the lack of treatment for her left thumb disability after service, in addition to the October 2024 and February 2025 VA examiner's negative nexus opinions, the Board finds the contemporaneous medical evidence of record to be more probative and establishes a lack of continuity of symptomatology.  As such, the Board finds that the probative evidence of record does not establish a medical nexus.

Viewing the record as a whole, the Board concludes that the evidence persuasively favors against service connection for a left thumb disability.  The evidence is not in approximate balance and the benefit-of-the-doubt rule does not apply.  See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).  Therefore, the claim is denied.

REASONS FOR REMAND

Entitlement to service connection for a right hand or finger disability (tendinosis in hand or fingers, right) is remanded.

Regarding her right hand and fingers, the Veteran stated, 

During my military service I spent a great portion of time doing computer work, exercising that required using my hands, weapons training etc.  I used to always have achy hands but just assumed it was from them being overworked.  Over the years I began to notice my hands becoming weak and not able to do certain things or open items.  

See VA 21-526EZ, Fully Developed Claim (Compensation), August 2024. 

The Veteran's service treatment records showed right wrist pain with right wrist weakness in March 2007.  See STR - Reserve STR, November 2022.  

While the Veteran was afforded a VA examination for her left hand and fingers, to date, the Veteran has not been afforded a VA examination to determine the nature and etiology of her claimed right hand and fingers condition.  VA's duty to assist includes providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on the claim.  McLendon v. Nicholson, 20 Vet. App. 79 (2006).  The failure to obtain a VA examination or medical opinion constitutes a pre-decisional duty to assist error.  Therefore, a remand is necessary to afford the Veteran a VA examination to address the nature and etiology of her claimed right hand and fingers condition.  

The matters are REMANDED for the following action:

1.  Schedule the Veteran for a VA examination by an appropriately qualified examiner to determine the nature and etiology of her claimed right hand and fingers condition.  Access to the Veteran's electronic claims file, which shall include a copy of this Remand, must be made available to the examiner for review, and be reviewed, in connection with the examination.  

Elicit from the Veteran and the record the history of all signs and symptoms associated with the claimed right hand and fingers in service and since separation from service.

2.  After a complete review of the claims file, the examiner is asked to respond to the following:

(a)  Whether it is at least as likely as not (i.e., the likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's claimed right hand and fingers condition originated during or was otherwise etiologically related to her active service?

In providing
 Access to the Veteran's electronic claims file, which shall include a copy of this Remand, must be made available to the examiner for review, and be reviewed, in connection with the examination.  

Elicit from the Veteran and the record the history of all signs and symptoms associated with the claimed right hand and fingers in service and since separation from service.

2.  After a complete review of the claims file, the examiner is asked to respond to the following:

(a)  Whether it is at least as likely as not (i.e., the likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's claimed right hand and fingers condition originated during or was otherwise etiologically related to her active service?

In providing his or her opinions, the examiner must address all of the Veteran's service treatment records, military personnel records, and all of the Veteran's medical records.  The examiner must provide a complete rationale for each opinion provided.  

Then, readjudicate the case.

 

 

Frederic P. Gallun

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Axelrad, E

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.