MEDIAN NERVE PARALYSIS

Summary

The Veteran, who served in the United States Marine Corps from October 1995 to December 1998, appeals the denial of service connection for right carpal tunnel syndrome with median nerve neuropathy. The Veteran claims this condition is secondary to his service-connected limitation of motion of the left wrist. The Board reviewed the evidence of record at the time of the April 2025 agency of original jurisdiction decision. Several VA medical opinions were obtained, all of which indicated that the Veteran's right carpal tunnel syndrome was less likely than not related to his military service. However, a private medical opinion from Dr. D.B. in December 2024 concluded that it was at least as likely as not that the condition was caused by the Veteran's service-connected left hand and wrist injury. Dr. D.B. provided a detailed rationale linking the left wrist injury to compensatory overuse of the right hand, leading to carpal tunnel syndrome. The Board found both the private opinion and the VA opinions to be competent and well-researched. After considering the evidence and affording the Veteran the benefit of the doubt, the Board determined the evidence was in approximate balance regarding the secondary service connection claim. Consequently, service connection for right carpal tunnel syndrome as secondary to the service-connected left wrist limitation of motion was granted.

Rationale

Private medical opinion found condition at least as likely as not caused by service-connected left wrist injury.; VA opinions found condition less likely than not related to service.; Evidence found to be in approximate balance, with doubt resolved in Veteran's favor.

Full Decision Text

Citation Nr: A26039418
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 250714-564844
DATE: April 28, 2026

ORDER

Entitlement to service connection for right carpal tunnel syndrome with median nerve neuropathy is granted.

FINDING OF FACT

Resolving any reasonable doubt in the Veteran's favor, the Veteran's right carpal tunnel syndrome with median nerve neuropathy is caused or aggravated by his service-connected limitation of motion of left wrist.

CONCLUSION OF LAW

The criteria for service connection for right carpal tunnel syndrome with median nerve neuropathy as secondary to limitation of motion of left wrist are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served in the United States Marine Corps from October 1995 to December 1998.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 2025 rating decision issued by a Department of Veterans Affairs (VA) Regional Office, the agency of original jurisdiction (AOJ).

In January 2025, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of service connection for a right-hand disability most recently addressed in a December 2024 rating decision. In April 2025, the AOJ issued the supplemental claim decision on appeal. Although the April 2025 decision did not discuss whether new and relevant evidence was received, because the decision readjudicated the merits of the claim, there was an implicit finding that new and relevant evidence was received by the AOJ. Thus, the Board is bound by the AOJ's implicit favorable finding that new and relevant evidence was received and has characterized such issue accordingly. 38 C.F.R. § 3.104(c). Accordingly, a discussion as to whether new and relevant evidence has been received sufficient to readjudicate the claim is not required herein.

In the July 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the April 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 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 service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.  Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability.  Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may also be established by credible lay evidence and medical evidence provided by the Veteran or otherwise. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).

Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury.  38 C.F.R. § 3.310.

To meet the criteria for secondary service connection, a veteran must prove that there is (1) a current disability that is not already service-connected; and (2) at least one service-connected disability; and (3) evidence that the non-service connected disability is either proximately due to or the result of a service-connected disability, or aggravated (increased in severity) beyond its natural progress by a service connected disability. See 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995).


 also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury.  38 C.F.R. § 3.310.

To meet the criteria for secondary service connection, a veteran must prove that there is (1) a current disability that is not already service-connected; and (2) at least one service-connected disability; and (3) evidence that the non-service connected disability is either proximately due to or the result of a service-connected disability, or aggravated (increased in severity) beyond its natural progress by a service connected disability. See 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995).

1. Entitlement to service connection for right carpal tunnel syndrome with median nerve neuropathy. 

The Veteran contends that his right carpal tunnel syndrome is secondary to his service-connected limitation of motion of left wrist. See September 2025 Appellate Brief.

Under the AMA, the Board is bound by favorable findings of the AOJ in the absence of evidence of clear and unmistakable error. See 38 C.F.R. § 3.104. In the April 2025 rating decision, the AOJ found that the Veteran had a current diagnosed disability of right carpal tunnel syndrome, that he had been granted service connection for limitation of motion of left wrist, and conceded in-service toxic exposure risk activities.  Further it concluded that the Veteran had sufficient service to meet the minimum requirements for presumptive service connection from October 16, 1995, to December 31, 1998. As such, the Veteran's claim turns on whether his right carpal tunnel syndrome is either proximately due to or the result of a service-connected disability, or aggravated (increased in severity) beyond its natural progress by a service-connected disability.

VA medical opinions were obtained regarding the etiology of the Veteran's right carpal tunnel syndrome in July 2023, August 2024, November 2024, and March 2025.  All of these opinions indicate that it was less likely than not that the Veteran's right carpal tunnel syndrome was related to his military service.  The July 2023, August 2024, and March 2025 VA medical opinions focused solely on a direct theory of entitlement. The November 2024 VA medical opinion addressed solely whether the Veteran's toxic exposure risk activities (TERAs) may have caused his right carpal tunnel syndrome. 

The only opinion of record that addresses a secondary theory of entitlement is the December 2024 private medical opinion from Dr. D.B. The December 2024 private medical opinion indicates that it is at least as likely as not that the Veteran's right carpal tunnel syndrome is caused by the Veteran's service-connected left hand and wrist injury.  The rationale, in relevant parts, stated "...Mr. Gambino sustained an injury to his left hand, resulting in numbness and flexor tendon damage. This injury significantly limited the use of his left hand, compelling him to rely more on his right hand for daily activities. As a consequence of this increased reliance, Mr. Gambino developed carpal tunnel syndrome (CTS) in his right hand. The pathophysiological link between Mr. Gambino's left hand and wrist injury and the subsequent development of CTS in his right hand can be traced back to the compensatory overuse of his right hand. Initially, the injury to his left hand, which resulted in numbness and flexor tendon damage, significantly impaired its functionality. This forced Mr. Gambino to rely heavily on his right hand for most daily activities, including tasks that require strength and precision. The increased demand on his right hand led to repetitive stress and strain on the median nerve, which runs through the carpal tunnel in the wrist. Over time, this repetitive strain can cause inflammation and swelling within the carpal tunnel, compressing the median nerve and leading to the symptoms associated with CTS, such as numbness, tingling, and weakness. The development of CTS in Mr. Gambino's right hand is a classic example of how compensatory overuse can lead to secondary musculoskeletal disorders. The median nerve compression in CTS is exacerbated by repetitive hand movements and prolonged wrist flexion or extension, which are common when one hand is overburdened due to the dysfunction of the other. The reliance on his right hand for tasks that would typically be shared between both hands increased the mechanical load on the wrist, accelerating the onset of CTS..."

The Veteran's claims file includes a positive nexus opinion, as well as negative nexus opinions regarding the etiology of the Veteran's right carpal tunnel syndrome condition. Both the private medical provider and the VA examiners are competent to provide a medical opinion and are qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. 
 can lead to secondary musculoskeletal disorders. The median nerve compression in CTS is exacerbated by repetitive hand movements and prolonged wrist flexion or extension, which are common when one hand is overburdened due to the dysfunction of the other. The reliance on his right hand for tasks that would typically be shared between both hands increased the mechanical load on the wrist, accelerating the onset of CTS..."

The Veteran's claims file includes a positive nexus opinion, as well as negative nexus opinions regarding the etiology of the Veteran's right carpal tunnel syndrome condition. Both the private medical provider and the VA examiners are competent to provide a medical opinion and are qualified through education, training, or experience to offer medical diagnoses, statements, or opinions.  See 38 C.F.R. § 3.159(a)(1).  Each opinion is extensive and generally well researched. Thus, after affording the Veteran the benefit of the doubt, the Board finds that the evidence is at least in approximate balance as to whether the Veteran's right carpal tunnel syndrome is secondary to his service-connected limitation of motion of left wrist.

Accordingly, after resolving all reasonable doubts in favor of the Veteran, the Board finds that the evidence is in approximate balance and entitlement to service connection for right carpal tunnel syndrome is secondary to his service-connected limitation of motion of left wrist is warranted.  38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).

 

 

D. SMART

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Poston, 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.