MEDIAN NERVE PARALYSIS

Summary

The Veteran, who served from October 2011 to February 2015, including active duty for training (ACDUTRA) in Afghanistan from July 2013 to February 2014, appeals the denial of service connection for a right wrist condition and obstructive sleep apnea (OSA). The Board granted service connection for the right wrist condition, diagnosed as carpal tunnel syndrome, finding it had its onset during ACDUTRA in 2017. The Board noted treatment records from a civilian hospital and a Statement of Medical Examination and Duty Status from July 21, 2017, which diagnosed carpal tunnel syndrome and noted the injury occurred on that date, establishing service connection. The Board found no prejudice in not providing a VA examination for this granted issue. The claim for OSA was remanded. The Veteran reported symptoms of snoring, disrupted sleep, and daytime fatigue starting after her return from Afghanistan in 2014, with a diagnosis of OSA in May 2019. Lay statements from the Veteran and her husband corroborated these symptoms and suggested a link to service. However, the Board found these lay statements, while competent to report symptoms, were not competent to opine on the medical etiology of OSA. The Board also noted the Veteran's service in Afghanistan involved toxic risk exposure (TERA), including fire pay and hazardous duty pay, and remanded the OSA claim for a TERA memorandum and a new VA examination. The examiner is to consider all exposures, the lay statements, and provide an opinion on the onset and etiology of OSA, specifically whether it began in service or is related to toxic exposures.

Rationale

Current right wrist disorder diagnosed as carpal tunnel syndrome.; Treatment records from civilian hospital and Statement of Medical Examination and Duty Status dated July 21, 2017, indicate injury on that date.; Disorder had onset during ACDUTRA in 2017.

Full Decision Text

Citation Nr: A26040130
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 201001-111975
DATE: April 29, 2026

ORDER

Service connection for right wrist disorder, diagnosed as carpal tunnel syndrome, is granted.

REMANDED

Entitlement to service connection for obstructive sleep apnea (OSA) is remanded.

FINDING OF FACT

The evidence demonstrates that the Veteran's right wrist disorder had its onset during a period of active duty for training (ACDUTRA).

CONCLUSION OF LAW

The criteria for service connection for right wrist disorder are 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 from October 2011 to February 2015, with additional periods of ACDUTRA in the National Guard.

This case comes before the Board of Veterans' Appeals (Board) from a November 2019 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), hereinafter the Agency of Original Jurisdiction (AOJ), which, in pertinent part denied service connection for a right wrist condition and OSA. In October 2020, the Veteran submitted a timely Board Appeal: Notice of Disagreement (NOD), VA Form 10182, identifying issues decided in that decision, and electing the Hearing docket.  A hearing with a Veterans Law Judge was held on November 8, 2024; a transcript of the hearing is of record. 

Because the Veteran elected the Hearing docket, the Board may only consider the evidence of record at the time of the notification of the AOJ decision on appeal (November 29, 2019), as well as any evidence submitted by the Veteran at the hearing and within 90 days of the hearing (November 8, 2024 through February 6, 2025). 38 C.F.R. § 20.302. The Board cannot consider (1) evidence submitted during the period after the AOJ promulgated and issued the decision on appeal and before the hearing was held (November 30, 2019 through November 7, 2024), or (2) evidence submitted more than 90 days after the hearing was held (on or after February 7, 2025). 38 C.F.R. § 20.302. If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision. 38 C.F.R. § 20.300.

With regard to the remanded OSA claim, any evidence that is not considered by the Board at this time will be considered by the AOJ upon readjudication of this claim.

Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty from active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence 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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that which is pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

In the context of Reserve or National Guard service, the term "active military, naval, or air service" includes active duty, any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty. 38 U.S.C. § 101(21), (24); see also 38 C.F.R. § 3.6. Diseases or injuries incurred or aggravated while performing ACDUTRA are eligible for service connection. 38 U.S.C. §§ 101(24), 106, 1110, 1131. In other words, when a claim is based on a period of Reserve or National Guard service, it must be shown that the individual concerned became disabled (or died) as a result of a disease or injury incurred or aggravated in the
 and any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty. 38 U.S.C. § 101(21), (24); see also 38 C.F.R. § 3.6. Diseases or injuries incurred or aggravated while performing ACDUTRA are eligible for service connection. 38 U.S.C. §§ 101(24), 106, 1110, 1131. In other words, when a claim is based on a period of Reserve or National Guard service, it must be shown that the individual concerned became disabled (or died) as a result of a disease or injury incurred or aggravated in the line of duty on Reserve ACDUTRA/INACDUTRA or during Federalized National Guard service.

Claims based on a period of ACDUTRA or INACDUTRA are not entitled to the presumptions outlined in 38 C.F.R. § 3.307 and § 3.309. Smith v. Shinseki, 24 Vet. App. 40 (2010). However, if such service becomes active service, the presumptions may apply.

The Veteran contends that her right wrist disorder began during a period of ACDUTRA for the National Guard in 2017. She states that her military occupational specialty (MOS) was Cook, and after cooking three meals a day for over 3,000 people, she noticed her wrist was hurting accompanied by prolonged numbness. She stated she was sent to the medics in the National Guard for this issue and then to a civilian hospital where she was diagnosed with a right wrist disorder. See November 2024 Board Hearing Transcript.

To begin, the Veteran has a current right wrist disorder. In this regard, the AOJ made the favorable finding that there was "Treatment for wrist pain found in Alexandria VA treatment records dated May 30, 2018." See November 2019 Rating Decision. Additionally, the Veteran was diagnosed with right wrist carpal tunnel syndrome in December 2019. See CAPRI Records. As such, the first element of service connection is met.

Next, the Veteran's military personnel records (MPRs) show she was ordered to ACDUTRA for the period from July 8, 2017 to July 22, 2017. See June 13, 2017 MPRs (submitted to VA in January 2025). Additionally, the Veteran's DD-214 for her prior active duty service shows her MOS was Food Service Specialist, which aligns with the Veteran's statements of her duties on ACDUTRA.

Finally, a memorandum for Rapides Regional Medical Center dated July 21, 2017 shows the Veteran was authorized for emergency civilian medical treatment for injuries/illnesses incurred or aggravated by military duty. Medical records from Rapides Regional Medical Center on that same date show an emergency department visit in which the Veteran was diagnosed with carpal tunnel syndrome. Lastly, a Statement of Medical Examination and Duty Status dated July 21, 2017 shows the Veteran suffered an injury on July 21, 2017 at 1300 hours, was treated at Rapides Regional Medical Center, that the disability may result in permanent and total disability, and the details of the incident were noted as right wrist carpal tunnel syndrome. See July 21, 2017 Memorandum, Emergency Department Record, and Statement of Medical Examination and Duty Status (submitted to VA in January 2025).

Accordingly, with this evidence, the Board finds the Veteran's right wrist disorder had its onset during a period of ACDUTRA. As such, service connection for right wrist disorder, diagnosed as right wrist carpal tunnel syndrome, is warranted. See 38 C.F.R. § 3.303.

The Board notes that the Veteran was never afforded a VA examination or medical opinion for this disorder; however, the Board finds there is no prejudice to the Veteran in not providing such at this time as this constitutes a full grant of the benefits sought on appeal for this issue. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997).

REASONS FOR REMAND

The Veteran contends that her symptoms of snoring, moving around while sleeping, and waking up feeling less rested began when she got back from Afghanistan in 2014. See November 2024 Board Hearing Transcript.  The Veteran was diagnosed with OSA in a May 2019 sleep study. See May 2019 Private Treatment Records.

A lay statement authored by J.C.M.G., the Veteran's husband at the time of her deployment to Afghanistan, details the Veteran's symptoms when she came back from Afghanistan in 2014. He stated that she often had trouble sleeping, would snore loudly, and there would
, 114 F.3d 1156 (Fed. Cir. 1997).

REASONS FOR REMAND

The Veteran contends that her symptoms of snoring, moving around while sleeping, and waking up feeling less rested began when she got back from Afghanistan in 2014. See November 2024 Board Hearing Transcript.  The Veteran was diagnosed with OSA in a May 2019 sleep study. See May 2019 Private Treatment Records.

A lay statement authored by J.C.M.G., the Veteran's husband at the time of her deployment to Afghanistan, details the Veteran's symptoms when she came back from Afghanistan in 2014. He stated that she often had trouble sleeping, would snore loudly, and there would be moments when she would stop breathing and make hiccup sounds during her sleep. He stated he also observed the Veteran waking up in the middle of the night gasping for air and visibly distressed, and that she seemed extremely fatigued during the day despite appearing to get enough sleep at night. He stated her condition worsened over time, the symptoms of her later diagnosed sleep apnea were ongoing for a long time, and that they were linked to service.  The Board acknowledges these lay statements from the Veteran and J.C.M.G., and notes that they are competent to report on the observable symptoms of which they have first-hand knowledge. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); see also Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). However, the Board notes they are not competent to provide an opinion on the etiology of the Veteran's OSA because such an opinion requires specialized medical expertise which falls outside the realm of the common knowledge of a layperson. See 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); see also Jones v. West, 12 Vet. App. 383, 385 (1999) (where the determinative issue is one of medical causation or a diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue). Thus, the Board finds it cannot grant service connection at this time with the evidence of record.

In this regard, the Board notes that the record indicates the Veteran experienced toxic risk exposure during her military service, but has not been evaluated for it. Specifically, the Veteran is a Persian Gulf Veteran, was awarded the Afghanistan Campaign Medal with Campaign Star, and received fire pay, imminent danger pay, and/or hazardous duty pay for service in Afghanistan from July 2013 to February 2014. See DD-214 and 38 U.S.C. §§ 1117 and 1119 Memorandums. Thus, VA should provide a toxic risk exposure activity (TERA) Memorandum for this Veteran because there is another statutory or regulatory duty to ascertain exposures and to provide medical opinions on this basis in this case. See Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act); 38 U.S.C. § 1168, 38 C.F.R. § 20.802.

The matters are REMANDED for the following action:

1. Properly develop this case under 38 U.S.C. § 1168 for any and all toxic exposure risk activities (TERAs) pertinent to this Veteran. In this regard, VA should provide a TERA Memorandum for this Veteran pursuant to the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act), documenting all potential toxic exposures during her period of service.

2. Then, schedule the Veteran for a VA examination from an appropriate examiner for her OSA. The claims file, including a copy of this remand, should be reviewed in conjunction with this examination. All tests deemed appropriate should be accomplished and the results reported in detail.  

During the examination, the examiner should obtain a detailed medical history regarding onset and medical course of any OSA symptoms, including the lay statements in the record already indicating onset and snoring/sleep issues during service.

After examination and review of the claims file, the examiner should state whether the Veteran's OSA began in service, within one year of discharge therefrom, or is otherwise the result of military service, to include any toxic exposures the Veteran had during military service. In this regard, the examiner is asked to consider total potential exposure through all applicable military deployments and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

In addressing the above, the examiner must address: (i) any TERA memorandums, (ii) any ILER memor
 should obtain a detailed medical history regarding onset and medical course of any OSA symptoms, including the lay statements in the record already indicating onset and snoring/sleep issues during service.

After examination and review of the claims file, the examiner should state whether the Veteran's OSA began in service, within one year of discharge therefrom, or is otherwise the result of military service, to include any toxic exposures the Veteran had during military service. In this regard, the examiner is asked to consider total potential exposure through all applicable military deployments and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

In addressing the above, the examiner must address: (i) any TERA memorandums, (ii) any ILER memorandums, (iii) the Veteran's and J.C.M.G.'s lay statements concerning symptoms after her return from Afghanistan, and (iii) any other relevant lay statements of record to include any statements regarding onset of symptomatology and any continuity since onset. Specifically, the examiner should state whether the Veteran's claimed symptoms onset during service are initial manifestations of the Veteran's later diagnosed OSA.

All findings should be reported in detail and all opinions must be accompanied by a clear rationale.

 

 

MARTIN B. PETERS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Garfield, Jeannine F.

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.