MEDIAN NERVE PARALYSIS

Summary

The Veteran, who served in the United States Marine Corps from January 1968 to August 1972 as an Amphibian Tractor Crewman (MOS 1833), appeals the denial of service connection for bilateral carpal tunnel syndrome. The Veteran contends that his duties, which involved frequent, repetitive, and forceful heavy lifting, caused or contributed to his current diagnosis. He points to MOS-specific physical standards requiring significant lifting and carrying. The Board reviewed the evidence of record, including a May 2025 VA examination, which confirmed the diagnosis of bilateral carpal tunnel syndrome, with symptoms first documented in 2008, many years after service. The VA examiner opined that the condition was less likely related to service due to a lack of in-service findings, normal separation examinations, and a significant time gap between service and the first documented symptoms. The Board found this opinion probative and consistent with the evidence, noting that service treatment records were silent for relevant symptoms and the separation examination was normal. While acknowledging the Veteran's belief about his MOS duties, the Board found no specific in-service injury or disease related to carpal tunnel syndrome. The Veteran's lay statements regarding symptom onset in 2015 were noted, but even this was many years after service. The Board concluded that the evidence persuasively weighs against an in-service origin or relation. Therefore, service connection for bilateral carpal tunnel syndrome is denied.

Rationale

Persuasive evidence weighs against in-service injury or disease.; No relevant findings in service treatment records.; Normal separation examination findings.; Substantial gap between service separation and first documented symptoms.

Full Decision Text

Citation Nr: A26039615
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 260415-648030
DATE: April 28, 2026

ORDER

Entitlement to service connection for bilateral carpal tunnel syndrome is denied.

FINDING OF FACT

The evidence of record persuasively weighs against finding that bilateral carpal tunnel syndrome began during active service, or is otherwise related to an in-service injury or disease.

CONCLUSION OF LAW

The criteria for service connection of bilateral carpal tunnel syndrome were not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service in the United States Marine Corps from January 1968 to August 1972 with a military occupation specialty (MOS) of Amphibian Tractor Crewman (1833). His awards and decorations include National Defense Service Medal, Good Conduct Medal (2d Award), and Rifle Sharpshooter Badge.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2025 supplemental review rating decision issued by the Agency of Original Jurisdiction (AOJ), a Department of Veterans Affairs (VA) Regional Office (RO).

In an April 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the direct review docket and waived his right to switch dockets. 38 C.F.R. § 20.202(c)(2). Hence, the Board will issue a decision without delay. In so doing, the Board may only consider evidence of record at the time of the June 2025 AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after that cannot be considered. 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, he 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 evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision.

Procedural History

On June 1, 2023, the Veteran submitted an initial claim seeking entitlement to service connection for bilateral upper extremity radiculopathy and carpal tunnel syndrome. See VA Form 21-526EZ, rec'd. Jun. 1, 2023; VA Form 21-4138, rec'd. Jun. 16, 2023. On December 6, 2023, the AOJ issued a decision, which denied the claim based on the evidence of record at the time.

Within one year of its issuance, the Veteran filed a supplemental claim, requesting readjudication of the issue most recently addressed in the December 2023 decision. See VA Form 20-0995, rec'd. Feb. 13, 2024. Then, on June 4, 2024, the AOJ issued a supplemental claim decision. Applying an inappropriate legal standard, it found that the evidence submitted was not new and "material" and declined to "reopen" the claim. Rating Decision Notification Letter, dated Jun. 4, 2024.

Within one year of its issuance, the Veteran filed a request for higher-level review of the June 2024 supplemental claim decision. See VA Form 20-0996, rec'd. Mar. 11, 2025. On April 24, 2025, the AOJ issued a higher-level review decision, which considered the evidence of record at the time of the prior June 2024 supplemental claim decision and identified a duty to assist error. Consequently, the matter was returned to the rating activity and placed in the supplemental review lane for more development. To that end, a new VA medical examination and direct nexus opinion were obtained to address the Veteran's contentions more fully.

After development was completed, the AOJ issued the supplemental review rating decision on appeal. This time, applying the appropriate legal standard, it found that new and "relevant" evidence had been received to "readjudicate" the claim. But it denied the claim based on the evidence of record at the time. See Rating Decision Notification Letter, dated Jun. 12, 2025. As demonstrated above, the initial claim has been continuously pursued from June 1, 2023, the date VA received it. 38 C.F.R.
 to the rating activity and placed in the supplemental review lane for more development. To that end, a new VA medical examination and direct nexus opinion were obtained to address the Veteran's contentions more fully.

After development was completed, the AOJ issued the supplemental review rating decision on appeal. This time, applying the appropriate legal standard, it found that new and "relevant" evidence had been received to "readjudicate" the claim. But it denied the claim based on the evidence of record at the time. See Rating Decision Notification Letter, dated Jun. 12, 2025. As demonstrated above, the initial claim has been continuously pursued from June 1, 2023, the date VA received it. 38 C.F.R. §§ 3.400, 3.2500.

Benefit of the Doubt

VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a claimant prevailing in either event. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claimant is entitled to the benefit of the doubt when there is an "approximate" (i.e., nearly equal) balance of positive and negative evidence regarding any material determination. Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021). When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 3.102.

In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. 38 U.S.C. § 7104(a). Although it has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each, and every piece of evidence submitted by the Veteran or on his behalf. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Rather, the analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to it. Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000).

Entitlement to service connection for bilateral carpal tunnel syndrome is denied.

The Veteran contends that his bilateral carpal tunnel syndrome is related to service. He asserts that his duties required frequent, repetitive, and forceful heavy lifting from the ground and overhead, which placed daily stress on his wrists and upper extremities. He points to MOS-specific physical standards (as shown in NAVMC 3500.2B, Appendix G) including a 150-pound deadlift held at knuckle height for 30 seconds, a 150-pound clean and press from the ground to overhead with locked elbows, and a 50-meter casualty drag. He maintains that these physical demands caused or contributed to the damage underlying his current diagnosis. Accordingly, he maintains that his bilateral carpal tunnel syndrome was caused or aggravated by service, and that service connection is warranted throughout the claim period. See VA Form 10182, rec'd. Apr. 15, 2026.

The Board recognizes that the Veteran separately appealed the issue of entitlement to service connection for a neck disability (Docket No. E251009-596693). That appeal necessarily encompasses the issue of entitlement to service connection for any associated upper extremity radiculopathy. Accordingly, that issue is not before the Board in the current appeal stream. The issue is whether the Veteran's bilateral carpal tunnel syndrome began during service or is (at least as likely as not) related to an in-service injury or disease.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 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).

The Board concludes that, although the Veteran has a current diagnosis of bilateral carpal tunnel syndrome, the evidence of record persuasively weighs against finding that it began during active service, or is otherwise related to an in-service injury or disease.

In May 2025, a VA examination was obtained to determine the nature and etiology of the Veteran's carpal tunnel syndrome. A questionnaire was completed with an
 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).

The Board concludes that, although the Veteran has a current diagnosis of bilateral carpal tunnel syndrome, the evidence of record persuasively weighs against finding that it began during active service, or is otherwise related to an in-service injury or disease.

In May 2025, a VA examination was obtained to determine the nature and etiology of the Veteran's carpal tunnel syndrome. A questionnaire was completed with an in-person examination and records review. The examiner confirmed the diagnosis from as early as October 2008. The Veteran reported that it began in 2015 and worsened over time. It initially presented with tingling in both hands and wrists. While he had not received treatment, he reported continued tingling in the hands and wrists with impaired grip strength. Evaluation of the upper extremity nerves and radicular groups revealed bilateral involvement of radial and median nerves with moderate incomplete paralysis. See VA Peripheral Nerve DBQ, dated May 5, 2025.

The examiner opined that the Veteran's bilateral carpal tunnel syndrome was less likely related to service as there were no relevant findings during service, normal findings on entrance and separation examinations, and there was a substantial gap between separation from service and the first documented symptoms during a 2008 EMG. See VA Medical Opinion DBQ, dated May 27, 2025.

The Board finds this opinion probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

The examiner's opinion is consistent with the competent and credible medical evidence. For example, service treatment records are silent for complaints and treatment for relevant hand or wrist symptoms. At separation, a clinical evaluation of the Veteran's upper extremities was normal. See Report of Medical History, dated Jul. 14, 1972. At the same time, he denied ever having neuritis, swollen or painful joints, and the like. See id. Consequently, the Veteran was found physically qualified for discharge. Id. Post-service treatment records are silent for complaints of symptoms associated with carpal tunnel syndrome until 2008. As noted by the examiner, symptoms associated with carpal tunnel syndrome were not documented until many years after the Veteran's separation from service. 

The examiner's opinion is also more or less consistent with the Veteran's lay statements. As discussed, the Veteran reported that his bilateral carpal tunnel syndrome began in 2015. See VA Peripheral Nerve DBQ, dated May 5, 2025. 

To the extent that his assertion does not contradict the VA examiner's finding that he began to experience symptoms in 2008, the Board finds no reason to question the Veteran's credibility on this point. In either case, he did not begin to experience carpal tunnel-related symptoms until many years following his service. As such, the Board finds the Veteran's statement against his own pecuniary interest highly probative.

The Board acknowledges the physical duties associated with the Veteran's MOS. However, evidence describing the general physical demands of his MOS, by itself, does not establish that an in-service injury or disease occurred. Significantly, the Veteran does not assert and the evidence does not show that he incurred a specific hand or wrist injury or otherwise developed carpal tunnel syndrome during service commensurate with those activities. Rather, he conveys his belief that those duties caused or somehow aggravated his current bilateral carpal tunnel syndrome.

Although the Veteran believes that his carpal tunnel syndrome is related to specific physical standards associated with his MOS, the Board reiterates that the evidence of record persuasively weighs against finding that an in-service injury or disease occurred. Accordingly, entitlement to service connection for bilateral carpal tunnel syndrome is denied.

 

 

Cory M. Picton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Raymond P. Skinner III

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.