Citation Nr: 0710945 Decision Date: 04/13/07 Archive Date: 04/25/07 DOCKET NO. 04-00 162 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUE Entitlement to service connection for bilateral carpal tunnel syndrome. REPRESENTATION Veteran represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Catherine Cykowski, Associate Counsel INTRODUCTION The veteran had active service from August 1971 to August 1975. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2003 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. FINDING OF FACT Bilateral carpal tunnel syndrome was not shown during service or for many years after service and is not otherwise related to service. CONCLUSION OF LAW Bilateral carpal tunnel syndrome was not incurred during active duty service. 38 U.S.C.A. §§ 1110, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.303 (2006). REASONS AND BASES FOR FINDING AND CONCLUSION On November 9, 2000, the Veterans Claims Assistance Act of 2000 (VCAA), codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002), became law. Regulations implementing the VCAA were then published at 66 Fed. Reg. 45,620, 45,630-32 (August 29, 2001) and are now codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326 (2006). The VCAA and its implementing regulations are applicable to this appeal. The duty to notify under the VCAA requires VA to notify the claimant and the claimant's representative, if any, of the information and medical or lay evidence that is necessary to substantiate the claim. In Pelegrini v. Principi (Pelegrini II), 18 Vet. App. 112, 119-20 (2004), the Court specifically held that the VCAA requires VA to provide notice that informs the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim, (2) that VA will seek to provide, and (3) that the claimant is expected to provide. In what can be considered a fourth element of the requisite notice, the Court further held that, under 38 C.F.R. § 3.159(b), VA must request the claimant to provide any evidence in his possession that pertains to the claim. Id. at 120-21. The Court has indicated that notice under the VCAA must be given prior to an initial unfavorable decision by the agency of original jurisdiction. Id. The VCAA and its implementing regulations provide that VA will assist a claimant in obtaining evidence necessary to substantiate a claim. Under these provisions, VA is required to obtain service medical records and relevant VA healthcare records and must make reasonable efforts to help the veteran obtain other relevant medical records. The duty to assist also requires VA to provide the claimant with a medical examination or a medical opinion when such an examination or opinion is necessary to make a decision on a claim. 38 U.S.C.A. § 5103A(d) (West 2002); 38 C.F.R § 3.159 (2006). The Court has mandated that VA ensure strict compliance with the provisions of the VCAA. Quartuccio v. Principi, 16 Vet. App. at 183 (2002). In this case, as explained below, VA has strictly complied with the VCAA by providing the veteran adequate notice and assistance with regard to the claims on appeal. Accordingly, the veteran is not prejudiced by the Board's decision to proceed with the disposition of this appeal. Bernard v. Brown, 4 Vet. App. 384, 392-94 (1993). During the pendency of this appeal, on March 3, 2006, the Court issued a decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), which held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: 1) veteran status; 2) existence of a disability; 3) a connection between the veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. The Court held that upon receipt of an application for a service-connection claim, 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim as reasonably contemplated by the application. Dingess/Hartman at 488. Additionally, this notice must include notice that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. A. Duty to Notify A February 2003 letter to the veteran advised him of the evidence necessary to substantiate a service connection claim. This letter also informed the veteran of VA's duty to assist in the development of his claim and stated what evidence VA would be responsible for obtaining and what evidence VA would assist him in obtaining. The veteran was advised to submit any relevant evidence in his possession. The Board finds that the duty to notify has been satisfied. All the VCAA requires is that the duty to notify is satisfied, and that appellants be given the opportunity to submit information and evidence in support of their claims. Once this has been accomplished, all due process concerns have been satisfied. See Bernard v. Brown, 4 Vet. App. 384 (1993); Sutton v. Brown, 9 Vet. App. 553 (1996). B. Duty to Assist The duty to assist has been satisfied in this case. The RO has obtained the relevant evidence, including service medical records, and post-service VA outpatient records. The veteran has not identified any outstanding evidence that is relevant to this claim. The Board notes that the veteran was not afforded a VA examination. However, no examination was required in this case. Under § 3.159(c)(4), VA is required to provide an examination when it is necessary to make a decision on a claim. The Court has held that an examination is required when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, a VA examination is not necessary to decide the claim, as there is no indication that the veteran's bilateral carpal tunnel syndrome is associated with service. II. Analysis of Claim The veteran asserts that he has carpal tunnel syndrome as a result of his service duties as a pavement maintenance specialist and aircraft loadmaster. Applicable law provides that service connection will be granted if it is shown that the veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in active service. 38 U.S.C.A. §§ 1110. That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, to prevail on a claim of service connection on the merits, there must be medical evidence of (1) current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in- service disease or injury and the present disease or injury. Hickson v. West, 12 Vet. App. 247 (1999); see also Pond v. West, 12 Vet App. 341, 346 (1999). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim must be denied. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The veteran served on active duty from August 1971 to August 1975. Service medical records show that no hand conditions were noted during the August 1971 enlistment examination. Records show that the veteran was seen in July 1975 for complaints of pain in the fourth finger of his right hand and was diagnosed with a finger infection. The report of the separation examination shows normal findings, with no hand disabilities noted. The post-service evidence includes VA outpatient medical records dated from 1995 to 2006. These records show that the veteran was seen on several occasions in 2001 with complaints of right forearm pain and numbness over both hands. The veteran was seen in March 2002 for an evaluation of right forearm and wrist discomfort and left finger numbness. In June 2002, VA outpatient records show that the veteran complained of bilateral hand numbness, left greater than right, of six months in duration. A diagnosis of bilateral carpal tunnel syndrome was rendered, and the veteran underwent left carpal tunnel release surgery in July 2002. The VA medical records in evidence do not contain any medical opinions relating bilateral carpal tunnel to the veteran's service, and there are no other medical opinions of record relating the veteran's carpal tunnel syndrome to service. The Board concludes that there is a preponderance of the evidence against the veteran's claim for service connection for bilateral carpal tunnel syndrome. Aside from a finger infection that resolved during service, there were no complaints or findings of hand disabilities during service. A diagnosis of carpal tunnel syndrome is first shown many years after service, and there is no medical evidence linking bilateral carpal tunnel syndrome to service. In reaching this determination, the Board has considered the benefit-of- the-doubt doctrine. However, as there is a preponderance of the evidence against the claim, the benefit-of-the doubt doctrine is not applicable. 38 U.S.C.A. § 5107(b). ORDER Service connection for bilateral carpal tunnel syndrome is denied. ____________________________________________ M. G. MAZZUCCHELLI Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs