BVA9501357 DOCKET NO. 93-04 013 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma THE ISSUES 1. Entitlement to service connection for left carpal tunnel syndrome. 2. Entitlement to an increased (compensable) evaluation for polyarthritis of the hands and feet. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD Christopher Maynard, Associate Counsel INTRODUCTION The veteran had active service from May 1989 to June 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 1991 rating decision which, in part, granted service connection for polyarthritis of the hands and feet and denied service connection for left carpal tunnel syndrome. A personal hearing was conducted in March 1992. At the personal hearing, the veteran described various problems he was having with his left hand which he attributed to left carpal tunnel syndrome. The Board notes that Dupuytren's contracture of the little finger of the left hand was diagnosed on VA examination in April 1992. However, the issue of entitlement to service connection for Dupuytren's contracture of the little finger of the left hand has not been developed or certified for appellate review and cannot be addressed in this decision. Accordingly, this matter is referred to the RO for appropriate action. CONTENTIONS OF APPELLANT ON APPEAL The veteran asserts, in essence, that he had no problems with his left hand when he entered service but was treated on a number of occasions during service for problems with both hands which he believes to be due to carpal tunnel syndrome. The veteran also reports pain and occasional swelling in his feet. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the veteran has not met the initial burden of submitting sufficient evidence to justify a belief by a fail and impartial individual that the claim of service connection for left carpal tunnel syndrome is well grounded. The evidence favors the grant of an increased rating to 10 percent for polyarthritis of the hands and feet. FINDINGS OF FACT 1. No competent evidence has been submitted to show that the veteran currently has left carpal tunnel syndrome which is due to disease or injury in service. 2. The veteran's polyarthritis of the hands and feet is manifested principally by complaints of pain and X-ray evidence of arthritis of the feet without limitation of motion or other functional impairment of the hands or feet. CONCLUSIONS OF LAW 1. The veteran has not submitted evidence of a well-grounded claim of service for left carpal tunnel syndrome. 38 U.S.C.A. §§ 1131, 5107, 7104 (West 1991); 38 C.F.R. §§ 3.102, 3.303 (1993). 2. The criteria for an increased rating to 10 percent for polyarthritis of the hands and feet are met. 38 U.S.C.A. § § 1155, 5107, 7104 (West 1991); 38 C.F.R. § § 4.3, 4.7, 4.71a, 5003-5010 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. With regard to the issue of entitlement to service connection for left carpal tunnel syndrome, the threshold question to be answered is whether the veteran has presented evidence of a well- grounded claim; that is, a claim which is plausible. A plausible claim is one which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet.App. 78 (1990). If the veteran has not presented a well-grounded claim, his appeal must fail and there is no further duty to assist him in the development of his claim. § 5107. The claim must be accompanied by evidence; a mere allegation will not suffice. Tirpak v. Derwinski, 2 Vet.App. 609, 611 (1992). The sufficiency of the evidence necessary to meet the statutory burden that a claim is well grounded depends upon the nature of the claim. The veteran's statements alone are not sufficient to establish a well-grounded claim in cases involving questions of medical diagnosis or causation. Grottveit v. Brown, 5 Vet.App. 91 (1993). The veteran's entrance examination in April 1989 showed, in part, mild contracture of the second interphalangeal joint of the fifth finger of the left hand and swelling in the finger with extension limited to 45 degrees. There was good function in the left hand and the disability was not considered disabling. The veteran was evaluated on a number of occasions during service for complaints of pain, stiffness and numbness, primarily in the fifth fingers of both hands. Although a number of diagnoses were considered, including Dupuytren's contracture secondary to history of alcohol abuse and carpal tunnel syndrome, subsequent diagnostic and clinical studies did not result in a diagnosis of carpal tunnel syndrome. Electromyogram testing in December 1989 and September 1990 also did not result in findings of left carpal tunnel syndrome. The final diagnoses on a medical evaluation report dated in February 1991 included polyarthritis and Dupuytren's contracture, clinically. When examined by VA in August 1991, the veteran had full range of motion of all of the digits of the left hand with adequate grip strength and no pain on gripping. Left carpal tunnel syndrome was not diagnosed. Similarly, while there was some restricted range of motion of the left wrist and little finger and X-ray studies showed a little flexion of the proximal and distal interphalangeal joints of the little finger when examined by VA in April 1992, left carpal tunnel syndrome was not diagnosed. Rather, the diagnoses included Dupuytren's contracture of the little finger of the left hand. The Board notes that the veteran testified at a personal hearing in March 1992, to recurring problems with his left hand since service but has never been diagnosed with carpal tunnel syndrome. Although the veteran believes that his problems with his left hand are due to carpal tunnel syndrome, he has presented no cognizable or competent evidence to support his assertions. The medical evidence of record does not show left carpal tunnel syndrome in service or at present. Therefore, in the absence of any competent evidence showing the existence of left carpal tunnel syndrome at present, the Board finds that a well-grounded claim has not been presented. Brammer v. Derwinski, 3 Vet.App. 223 (1992). II With regard to the claim of an increased rating for polyarthritis of the hands and feet, Board finds that the veteran's claim is well grounded within the meaning of § 5107, and is satisfied that all relevant facts pertinent to this issue have been properly developed in accordance with this law. As noted above, service connection for polyarthritis of the hands and feet was granted by rating action dated in November 1991, and a noncompensable evaluation assigned, based on a showing of aggravation of the preexisting disorder during service. When examined by VA in August 1991, the veteran complained of chronic pain in his hands and feet. On examination there was evidence of contractures of the joints of the middle, ring and little fingers of the right hand (which is separately rated under the service connected right carpal tunnel syndrome) and grip strength was normal in the left hand without evidence of pain on gripping. X-ray examination of both hands was essentially normal with no evidence of arthritis. There was no evidence of swelling or other abnormalities of the feet and the veteran had full range of motion in both feet. X-ray studies of the feet showed minimal degenerative changes, bilaterally. Similar findings were noted on VA examination in April 1992. At that time, the veteran could walk on his toes and heels and on the inside/outside of his feet. X-ray studies of the hands and feet were essentially normal except for some evidence of a little flexion of the proximal and distal interphalangeal joints of the fifth finger of both hands. Otherwise, the structures were negative. The veteran is currently assigned a noncompensable evaluation for polyarthritis of the hands and feet under the provisions of Diagnostic Code (DC) 5003. That provision of the Code provides that degenerative arthritis established by X-ray evidence will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When the limitation of motion of the specific joint or joints involved is noncompensable, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under DC 5003. In the absence of limitation of motion, with X-ray involvement of two or more major joints or two or more minor joints, a 10 percent rating is applicable. A 20 percent evaluation is provided when there are occasional incapacitating exacerbations. In the instant case, there is no X-ray evidence of arthritis of either hand; thus, a compensable evaluation for polyarthritis of the hands is not warranted. Although the most recent VA X-ray report (April 1992) showed no evidence of arthritis, the August 1991 VA X-ray studies did indicate minimal arthritis of the feet. Neither VA examination report showed any evidence of limitation of motion of the feet nor has the veteran reported occasional incapacitating exacerbations due to the arthritis of the feet. Therefore, the Board finds that the medical evidence of record supports the grant of an increased rating to 10 percent for arthritis of the feet , based upon multiple joint involvement without limitation of motion under DC 5003. There is no evidence to support an increased rating for the hands or for an overall rating higher than 10 percent for polyarthritis of the hands and feet. ORDER As a well-grounded claim of service connection for left carpal tunnel syndrome has not been present, the appeal is dismissed. The RO should take all indicated adjudicatory action consistent with this decision. An increased rating to 10 percent for polyarthritis of the hands and feet is granted, subject to VA laws and regulations concerning payment of monetary benefits. BARBARA B. COPELAND Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.