BVA9502714 DOCKET NO. 93-05 526 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Cheyenne, Wyoming THE ISSUE Entitlement to service connection for residuals of a left wrist injury. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD A. S. Nemeth, Associate Counsel INTRODUCTION The veteran's active service extended from October 1973 to October 1988. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 1990 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Cheyenne, Wyoming, which denied service connection for residuals of a left wrist injury. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that the RO erred in denying service connection for the residuals of an inservice left wrist injury. The veteran claims that he injured his wrist during service when he jumped off a counter on which he had been sitting, slipped on a recently mopped floor, and landed on his wrist. He further contends that his wrist condition is manifested by limitation of motion and pain on use. 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 evidence is against the grant of service connection for the residuals of a left wrist injury. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained. 2. The left wrist injuries documented in service resulted in acute and temporary symptoms, but no chronic pathology was identified in service or thereafter. 3. There is no objective evidence of a disorder of the veteran's left wrist, which can be attributed to his military service. CONCLUSION OF LAW A left wrist disability was not incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. §§ 3.303, 4.40 and 4.45 (f) (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). That is, the veteran has presented a claim which is plausible. All relevant facts have been properly developed. No further assistance to the veteran is required to comply with the duty to assist as mandated by 38 U.S.C.A. § 5107(a). The veteran contends that the RO erred in denying service connection for the residuals of an inservice left wrist injury. The veteran claims that he injured his wrist during service when he jumped off a counter on which he had been sitting, slipped on a recently mopped floor, and landed on his wrist. He further contends that his wrist condition is manifested by limitation of motion and pain on use. The law provides that service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). For the showing of a chronic disorder in service, there is a required combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time as distinguished from merely isolated findings. 38 C.F.R. § 3.303 (1993). Service medical records (SMR) show that the veteran first injured his left wrist in service in 1977. He injured it again in 1978. No fractures or dislocations were identified in X-rays taken on both occasions. SMRs dated in April 1978 show full range of motion in the left wrist, tenderness over the carpal region, and no fracture. The veteran was diagnosed to have a contusion. SMRs dated August 1978 show that the veteran had again injured his left wrist six days prior to that date and that he presented with dorsal tenderness of the left wrist. A diagnosis of strain was made and a fracture was ruled out. SMRs from 1979 through 1981 show the veteran seeking treatment for a painful left wrist, some swelling was noted as was some limitation in the range of motion at various examinations. Pain was the constant complaint. A running diagnosis was tendonitis, although one SMR did rule out tendonitis. SMRs from 1982 showed a concern about a possible obstruction in the wrist, however, there are no records showing that such an obstruction was ever found. An SMR dated March 1983 reports the veteran's contention that a tomogram was previously performed which showed a fracture in his left wrist. However, the physician noted that such a tomogram was not in the medical record at that time. A Physical Profile Board proceeding in March 1983, changed the veteran's permanent physical profile to reflect arthritis in the left wrist and restricted the veteran's duty so as not to include pushups or overhead ladder work. An x-ray of the left wrist in May 1985 showed no evidence of fractures or dislocation. Ulnar minus variants was found but no other significant abnormalities were noted. A Physical Evaluation Board proceeding dated May 1985, found the veteran to have "pain, left wrist, chronic with slight decreased range of motion to dorsiflexion. There is no nerve or artery involved." The April 1985 examination upon which the above diagnosis was based, showed the veteran's left hand to be normal, except that the range of motion was slightly less than normal. The findings were as follows: dorsiflexion 70 degrees on the left versus 80 degrees on the right; palmar flexion of 60 degrees bilaterally, radial deviation of 20 degrees bilaterally, ulnar deviation 50 degrees bilaterally; no swelling, redness or effusion was seen, however, there was some tenderness over the lunate region dorsally; grip strength was 95 pounds with the left hand and 110 pounds with the right. X-rays and a bone scan showed a normal wrist. The veteran's separation examination in August 1988 listed arthritis of the left wrist as one of his conditions, but it did not appear that X-rays of the wrist were taken in connection with the examination. The veteran underwent a VA examination in January 1990. The examining physician reported normal range of motion in the wrists bilaterally. Pain was not noted. X-rays of the left wrist showed normal joint spaces, as well as no evidence of a fracture or dislocation. The examiner noted that the veteran had told him that while stationed in Germany and Fort Polk, Louisiana, he underwent a CT Scan of the left wrist and was told that he had arthritis by no other pathology was identified. As a result of the VA examination, the veteran was diagnosed to have "pain with left wrist, etiology unknown, no evidence of abnormality based on x-ray or physical examination today." A report from the veteran's private physician, C. R. Allen, M.D., dated in September 1991 notes that the veteran's left wrist showed full extension with a decrease in flexion to approximately 60 degrees. The physician noted that the veteran complained of pain with these motions. No palpable crepitations were found and x-rays of the left wrist were normal. The diagnosis was "[p]ain and limited motion, left wrist. Status post soft tissue injury occurred at time of dislocation of the wrist with possible early degenerative arthritis of the wrist." The veteran's service representative correctly discussed the consideration of functional disability due to pain. According to various decisions by the U.S. Court of Veterans Appeals, the application of 38 C.F.R. § § 4.40 and 4.45(f) (1993) is to be considered when the record contains frequent references by the veteran to pain affecting his body. See Voyles v. Brown, 5 Vet.App. 451 (1993); Quarles v. Derwinski, 3 Vet.App. 129 (1992); Schafrath v Derwinski, 1 Vet.App. 589 (1991); Hatlestad v. Derwinski, 1 Vet.App. 164 (1991); see also Douglas v. Derwinski, 2 Vet.App. 435 (1992) (en banc). 38 C.F.R. § 4.40 (1993) states that "functional loss... may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant...." It also states that "a part which becomes painful on use must be regarded as seriously disabled." The key term when discussing functional disability due to pain, is "supported by adequate pathology." Both the VA and private physician examination reports show essentially a normal wrist. Only the private physician reported a slight decrease in the range of motion. However, no etiology has been found that would cause the reported pain and therefore, the veteran's left wrist pain is not shown to be supported by adequate pathology. Service connection cannot be awarded on the basis of 38 C.F.R. §§ 4.40 and 4.45(f) (1993). It is noted that arthritis was reported at one time in service, but that report is not shown to have been based on x-ray findings, because all the x-ray reports in service of the veteran's left wrist were interpreted as normal. The veteran has referred to a left wrist fracture in service. However, neither a fracture nor a dislocation was ever reported while the veteran was in service. The VA must consider all of the evidence of record when deciding a claim for service connection. If the evidence supports the veteran's claim, then the claim will be allowed. Likewise, if the evidence is in equipoise, that is, equally balanced, the benefit of the doubt will apply to the veteran and the claim will be allowed. 38 U.S.C.A. § 5107(b) (West 1991); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). The veteran has been given numerous examinations and treatments and there has been no positive finding regarding the etiology of the veteran's left wrist pain. A VA examiner found a normal wrist as did the private physician. Further, the private physician's diagnosis of "status post soft tissue injury at the time of dislocation..." cannot be fully supported because there is no evidence, either in the SMRs or from subsequent examinations, that the veteran ever dislocated his left wrist. The Court has held that the Board is not required to accept doctors opinions rendered many years after service that necessarily relied upon the uncorroborated history as reported by the veteran. Black v. Brown, 5 Vet.App. 177 (1993). Accordingly, the private physician's diagnosis must be discounted to the extent that it was based on an unsubstantiated dislocation of the left wrist as reported by the veteran. Additionally, there is no objective evidence of current left wrist pathology. Service connection may be granted for a disease or disability incurred in service. In this case the evidence fails to show the existence of an actual disability for VA compensation purposes. No pathology has been attached or associated to the reported pain. The Board has considered the benefit of the doubt under 38 U.S.C.A. § 5107, however, the evidence is not in equipoise. The record, as it now stands, does not support a grant of service-connection for residuals of a left wrist injury. ORDER Service connection for residuals of a left wrist injury is denied. JOAQUIN AGUAYO-PERELES 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.