12-30 901
12-30 901
Board of Vet. App.Apr 28, 2017Background
- Veteran served on active duty June 1992–July 1999 and filed for service connection for a right upper‑extremity neurological disorder (diagnosed as right ulnar nerve neuropathy in July 2012).
- Claim processed by the St. Petersburg RO; initial denial in June 2012; multiple remands (Jan 2014, Apr 2015, Aug 2016) and a September 2016 VA exam; October 2016 SSOC continued denial.
- Veteran asserts right ulnar neuropathy is secondary to his service‑connected cervical spine disability; he reported first right‑arm symptoms in March 2011 (about 12 years post‑discharge).
- Record lacks in‑service documentation of right upper‑extremity issues; service records show neck and left arm complaints but not right arm.
- VA medical examiner(s) opined (Sept 2015, Sept 2016 exam review) that ulnar neuropathy is unlikely to be caused or aggravated by cervical spine disease, citing typical etiologies (elbow compression, trauma).
- Board found VA satisfied notice and assistance duties, determined substantial compliance with remand directives, and concluded no reasonable possibility further records (two EMGs, vocational rehab records) would change outcome.
Issues
| Issue | Veteran's Argument | VA/Board's Argument | Held |
|---|---|---|---|
| Entitlement to service connection for right ulnar nerve neuropathy as secondary to service‑connected cervical spine disability | Right ulnar neuropathy is proximately due to or aggravated by cervical spine disability | Medical opinion and record show ulnar neuropathy etiologies unrelated to cervical spine; examiner found less likely than not causal/aggravating link | Denied — not proximately due to or aggravated by service‑connected cervical spine disability |
| Direct service connection for right ulnar nerve neuropathy | (Not expressly argued) Claim may be directly service‑connected | No in‑service complaints or diagnosis; first symptoms reported ~12 years after discharge; no continuity of symptomatology | Denied — not shown to be incurred in or aggravated by service and not presumed to be service‑connected |
| VA compliance with duty to assist and remand (Stegall) | Veteran implied need for EMG and rehab records requested on remand | Board: VA obtained necessary records, provided exams; missing EMG/rehab records would not likely change findings | Found substantial compliance with remand; no further development required |
| Application of benefit‑of‑the‑doubt doctrine | Benefit of doubt should apply if equilibrium of evidence exists | Board: negative and probative medical evidence outweighs lay assertions; no approximate balance | Benefit‑of‑the‑doubt not applied; claim denied |
Key Cases Cited
- Stegall v. West, 11 Vet. App. 268 (Board remand substantial compliance standard)
- Dyment v. West, 13 Vet. App. 141 (substantial vs. absolute compliance with remand)
- Kahana v. Shinseki, 24 Vet. App. 428 (Board must analyze credibility and explain rejection of favorable evidence)
- Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir.) (limits of lay competence for medical etiology)
- Holton v. Shinseki, 557 F.3d 1362 (establishing elements for service connection)
- Fagan v. Shinseki, 573 F.3d 1282 (Veteran bears burden of proof for nexus; benefit of doubt standard discussion)
- Walker v. Shinseki, 708 F.3d 1331 (burden elements for service connection)
- King v. Shinseki, 700 F.3d 1339 (weighing lay evidence against medical evidence)
- Gilbert v. Derwinski, 1 Vet. App. 49 (benefit‑of‑the‑doubt doctrine)