Citation Nr: 0001403 Decision Date: 01/18/00 Archive Date: 01/27/00 DOCKET NO. 96-38 802 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Indianapolis, Indiana THE ISSUE Entitlement to service connection for bilateral wrist disability. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Stephen L. Higgs, Associate Counsel INTRODUCTION The veteran served on active duty from November 1991 to February 1992. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision dated in February 1996 by the Department of Veterans Affairs (VA) Regional Office (RO) in Indianapolis, Indiana. In the November 1999 Appellant's Brief, the veteran's representative raised the issues of entitlement to service connection for an acquired psychiatric disorder and a right ankle disorder. These issues are referred to the RO for appropriate action. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The claim for service connection for bilateral wrist disability is not plausible. CONCLUSION OF LAW The claim for service connection for bilateral wrist disability is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION Factual Background Service medical records reveal that in December 1991 the veteran hyperextended the right thumb. Examination revealed a full range of motion of the thumb. Service medical records are otherwise silent or negative for disability of the wrists. A November 1992 VA examination report noted that the veteran had a history of amputation of the left middle finger with skin graft, loss of nail. No pathology or disability of the wrists was noted. During a VA examination in August 1995, the veteran gave a history having injured both of his hands during service. He complained of pain, numbness and paresthesia in both wrists. X-rays of the wrists were normal. The diagnosis was to rule out carpal tunnel syndrome. During a follow-up VA examination in September 1995, the veteran complained of pain and numbness in the hands over the past three years. He was referred for the purpose of ruling out carpal tunnel syndrome. The examiner noted that the veteran worked as a painter and used as hydraulic gun to paint. He was diagnosed by nerve conduction studies as having carpal tunnel syndrome of the right hand. Medical records of the State of Indiana dated in September 1995 reveal that the veteran complained of pain in the wrists since a 1991 inservice injury in which he fell forward and hyperflexed his hands on his forearms. The veteran stated his symptoms were triggered by exposure to vibration at work. The veteran was noted to have remained active with crafts, and to be working as a painter. He was noted to ride a motorcycle. There was no history or numbness or tingling except for some intermittent numbness of the entire left arm. The examiner's impression was that the veteran had no type of inflammatory arthritis. The veteran was treated for previously diagnosed right carpal tunnel syndrome. During a September 1996 psychiatric examination by the State of Indiana, the veteran was assessed as having bilateral carpal tunnel syndrome in the wrists. Analysis The threshold question that must be resolved with regard to a claim is whether the veteran has presented evidence of a well-grounded claim. See 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1991). A well-grounded claim is a plausible claim that is meritorious on its own or capable of substantiation. See Murphy, 1 Vet. App. at 81. An allegation of a disorder that is service connected is not sufficient; the veteran must submit medical evidence in support of a claim that would "justify a belief by a fair and impartial individual that the claim is plausible." See 38 U.S.C.A. § 5107(a); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). The quality and quantity of evidence required to meet this statutory burden of necessity will depend upon the issue presented by the claim. Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993). If the veteran has not presented a well-grounded claim, his appeal on the claim must fail and there is no duty to assist him further in the development of the claim. 38 U.S.C.A. § 5107(a). See Epps v. Gober, 126 F.3d 1464 (1997). In order for a claim for service connection to be well- grounded, there must be competent evidence of a current disability (a medical diagnosis); of incurrence or aggravation of a disease or injury in service (lay or medical evidence); and of a nexus between the in-service injury or disease and the current disability (medical evidence). Caluza v. Brown, 7 Vet. App. 498 (1995); 38 U.S.C.A. §§ 1110; 38 C.F.R. § 3.303. Where the determinant issue involves a question of medical diagnosis or medical causation, competent medical evidence to the effect that the claim is plausible or possible is required to establish a well-grounded claim. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Lay assertions of medical causation cannot constitute evidence to render a claim well- grounded under 38 U.S.C.A. § 5107(a); if no cognizable evidence is submitted to support a claim, the claim cannot be well-grounded. Id. Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty or for aggravation of a preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C.A. § 1110 (West 1991). Regulations also provide that service connection may 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). A disorder may be service connected if the evidence of record, regardless of its date, shows that the veteran had a chronic disorder in service or during an applicable presumptive period, and that the veteran still has such a disorder. 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488 (1997). Such evidence must be medical unless it relates to a disorder that may be competently demonstrated by lay observation. Savage. If the disorder is not chronic, it may still be service connected if the disorder is observed in service or an applicable presumptive period, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present disorder to that symptomatology. Id. In the present case, although there is medical evidence of record of post-service carpal tunnel syndrome, there is no medical "nexus" evidence relating this disability to a disease or injury incurred or aggravated during service. Epps; Caluza. Thus the claim must be denied as not well grounded. Id. The Board acknowledges the contention of the veteran's representative that an inservice thumb injury caused the veteran's carpal tunnel syndrome. The Board further acknowledges the veteran's contention that his bilateral wrist disability was caused by an inservice injury in which he fell and hyperflexed his hands on his forearms. However, these are matters of medical causation requiring medical expertise -- a physician's written opinion supporting such assertions would be required to well ground the veteran's claim. Grottveit. The veteran and his representative, as lay persons, are not competent to provide medical opinions, so that their assertions as to medical diagnosis or causation cannot constitute evidence of a well-grounded claim. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992). ORDER Entitlement to service connection for bilateral wrist disability is denied. RENÉE M. PELLETIER Member, Board of Veterans' Appeals