Citation Nr: 0007588 Decision Date: 03/21/00 Archive Date: 03/28/00 DOCKET NO. 98-05 325A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUES 1. Entitlement to service connection for right carpal tunnel syndrome. 2. Entitlement to service connection for a low back disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD B. N. Booher, Associate Counsel INTRODUCTION The veteran had active service from October 1988 through December 1996 with a period of prior active service in excess of two years. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 1997 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio which denied the benefits sought on appeal. FINDINGS OF FACT 1. There is no competent medical evidence of record linking the veteran's currently diagnosed carpal tunnel syndrome to her period of active service. 2. There is no competent medical evidence of record linking the veteran's currently diagnosed low back disorder to her period of active service, or to any low back disorder shown during service. CONCLUSIONS OF LAW 1. The veteran's claim for service connection for carpal tunnel syndrome is not well grounded. 38 U.S.C.A. § 5107 (West 1991). 2. The veteran's claim for service connection for a low back disorder is not well grounded. 38 U.S.C.A. § 5107 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran and her representative allege that she is entitled to service connection for right carpal tunnel syndrome and a low back disorder. The VA may pay compensation for "disability resulting from personal injury or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in the active military, naval or air service." 38 U.S.C.A. § 1110 (West 1991). However, the threshold question that must be answered in this case is whether the veteran has presented well-grounded claims for service connection. A well grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. In this regard, the veteran has "the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded." 38 U.S.C.A. § 5107(a) (West 1991); Grivois v. Brown, 6 Vet. App. 136, 140 (1994); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). If the evidence presented by the veteran fails to meet this threshold level of sufficiency, no further legal analysis need be made as to the merits of the claim. Boeck v. Brown, 6 Vet. App. 14, 17 (1993). For a claim to be well grounded, there must be (1) a medical diagnosis of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service disease or injury and the current disability. Where the determinative issue involves medical causation, competent medical evidence to the effect that the claim is plausible is required. See Epps v. Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997). For disorders subject to presumptive service connection, the nexus requirement may be satisfied by evidence of manifestation of the disease to the required extent within the prescribed time period, if any. See Traut v. Brown, 6 Vet. App. 495, 497 (1994); Goodsell v. Brown, 5 Vet. App. 36, 43 (1993). A claimant may also establish a well-grounded claim for service connection under the chronicity provision of 38 C.F.R. § 3.303(b)(1999), which is applicable where the evidence, regardless of its date, shows that a veteran had a chronic condition in service or during an applicable presumption period, and that same condition currently exists. Such evidence must be medical unless the condition at issue is one which, under case law, lay observation is considered competent to prove its existence. If the chronicity provision is not applicable, a claim still may be well- grounded pursuant to the same regulation if the evidence shows that the condition was observed during service or any applicable presumption period and continuity of symptomatology was demonstrated thereafter, and includes competent evidence relating the current condition to that symptomatology. Savage v. Gober, 10 Vet. App. 488, 495-98 (1997). Right carpal tunnel syndrome Service medical records show that the veteran was seen for complaints of right wrist pain in October 1993. A clear diagnosis was not given. The physician's diagnosis was to rule out carpal tunnel syndrome and tendinitis of the right wrist. The veteran was seen for similar complaints in November 1993 and given the same diagnosis. In November 1994, the veteran sustained a trauma to her right arm. She was advised to take Motrin, provided with an ace wrap and a diagnosis was not given. In December 1994, the veteran was diagnosed with right wrist pain. A subsequent December 1994 treatment record reveals that the veteran was diagnosed with post-traumatic ganglion cyst on the right wrist. A periodic February 1995 examination reflects that the veteran had a history of a ganglion cyst on the right wrist, and there was no notation regarding carpal tunnel syndrome. After separation from service, the veteran was afforded three VA examinations. The first examination conducted in April 1997 was limited, due to the veteran's pregnancy. The veteran did not present with complaints of carpal tunnel syndrome and she was not diagnosed with the same. An August 1997 VA examination report shows that the veteran complained of soreness in her right wrist and numbness and pain that radiated into her hand and elbow. The veteran gave a history of a right ganglion cyst that had resolved. In connection with this examination, the veteran was referred for a peripheral nerve disease evaluation in September 1997. This evaluation revealed pain in the right wrist of a non- neurological nature. The examiner indicated that based on results of electrodiagnostic studies of the right wrist, there was no evidence of carpal tunnel syndrome, or dysfunction of the peripheral nerves. An addendum to the August/September 1997 VA examination report does not discuss carpal tunnel syndrome. A November 1998 VA examination report indicates that the veteran reported right wrist pain and weakness associated with some throbbing in her arms and tingling in her fingers. The veteran underwent an MRI and EMG of the right wrist. Based on the results of these tests, the veteran was diagnosed with carpal tunnel compression with no nerve damage. The examiner did not discuss the cause or etiology of the veteran's carpal tunnel syndrome. During a September 1998 hearing held before the RO in Cleveland, Ohio, the veteran testified that she first began experiencing pain in her right wrist in 1992. She received treatment for her wrist and was advised to take Motrin and to wear a brace. In 1994-1995 the veteran injured her wrist when lifting crates of equipment. Thereafter the veteran was diagnosed with a ganglion cyst, but she testified that she was not diagnosed with carpal tunnel syndrome during her period of active service. Low back disorder With regard to the veteran's claim for entitlement to service connection for a low back disorder, the veteran was initially treated for and diagnosed with mechanical low back pain in November 1988. She gave no history of trauma or injury. A February 1995 periodic examination report shows that the veteran indicated that she did not have problems with recurrent back pain. The veteran was later treated for low back pain in September 1995. In October 1996, it was noted that the veteran had possible mechanical low back pain with spasm. An April 1997 VA examination report is somewhat limited due to the veteran's pregnancy. However, at that time the veteran reported a gradual onset of dull back pain and difficulty with motion. Diagnosis was deferred until post- pregnancy examination in August 1997. In August 1997, the veteran presented with complaints of tightness and soreness in the low back and a mild loss of mobility with tightness and stiffness. She indicated that she did not have a history of back injury. The veteran was diagnosed with chronic low back strain with muscle spasm, and no obvious neurological deficit. In the addendum to the August 1997 VA examination report, it was indicated that the veteran had complete range of motion of the lumbar spine with muscle spasms by history. The examiner further indicated that it would not be uncommon for the veteran to experience intermittent spasms, but the examiner did not discuss possible causes of the veteran's low back pain. A November 1998 VA examination report reflects that the veteran reported pronounced low back pain due to lifting heavy boxes and participating in forced marches while carrying heavy rucksacks in the military. The veteran stated that her back pain was primarily located in the lumbar region on the left side of the spine and could be characterized as a 4 out of 10. She also indicated that she has occasional numbness in her left toes and tingling in her right hand. The veteran was diagnosed with degenerative joint disease of the lumbar spine at L4-S1 and normal cervical spine by x-ray. During a September 1998 hearing before the RO in Cleveland, Ohio, the veteran testified that her back pain started in 1991 when she was working as a food inspector/sanitation inspector with the military, which required routine heavy lifting of boxes weighing 60 to 75 pounds. The veteran also indicated that she injured her back when participating in forced marches during which she had to carry a rucksack. The veteran testified that she continues to have problems with her back and that she is currently seeking treatment for the same from a private physician. However, the veteran indicated that she is not currently taking any prescribed medication for her back. She also stated that she would attempt to obtain copies of her private medical records and have them associated with her claims file. The veteran testified that she has not been diagnosed with any type of back disorder since her discharge from service. Analysis While the veteran has submitted evidence to show that she has current diagnoses of right carpal tunnel syndrome and degenerative joint disease of the lumbar spine at L4-S1, she has not submitted any competent medical evidence linking carpal tunnel syndrome, or her current back disorder to her period of active service. While the veteran clearly believes that her disorders are related to her period of active service, the veteran, as a lay person is not competent to offer an opinion that requires medical expertise, such as the underlying cause of her carpal tunnel syndrome, or her low back disorder. See Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). In the absence of such competent medical evidence, the veteran has not submitted well-grounded claims for service connection and her claims must be denied on this basis. The veteran has indicated that she sought treatment for her low back disorder from a private physician. It does not appear that these treatment records have been associated with the claims file and the veteran has not indicated that these records would contain evidence which would well ground her claim. In any event, in the absence of evidence of a well- grounded claim there is no duty to assist the claimant in developing the facts pertinent to her claim. Epps v. Gober, 126 F.3d 1464 (1997). The Board is unaware of the existence of any relevant evidence, if obtained, that would serve to well ground either of the veteran's claims for service connection. Should the veteran obtain such evidence, she may request that the RO again consider her claims for service connection. See McKnight v. Gober, 131 F.3d 1483, 1485 (Fed. Cir. 1997) (per curiam). ORDER 1. Evidence of a well-grounded claim not having been submitted, service connection for right carpal tunnel syndrome is denied. 2. Evidence of a well-grounded claim not having been submitted, service connection for a low back disorder is denied. WARREN W. RICE, JR. Member, Board of Veterans' Appeals