BVA9417813 DOCKET NO. 93-04 031 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUE Entitlement to service connection for rheumatoid arthritis. REPRESENTATION Appellant represented by: California Department of Veterans Affairs WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD L. B. Wirt, Associate Counsel INTRODUCTION The veteran served on active duty from November 1945 to October 1948, and from June 1949 to July 1966. This appeal arises from a February 1991 rating decision of the Department of Veterans Affairs (VA) Los Angeles, California, Regional Office (RO), which denied the veteran entitlement to service connection for rheumatoid arthritis. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he was diagnosed as having rheumatoid arthritis in service and that he continues to suffer from the disease. 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 preponderance of the evidence is in favor of the grant of entitlement to service connection for rheumatoid arthritis. FINDING OF FACT Chronic rheumatoid arthritis was properly identified and diagnosed in service, and the veteran continues to suffer from the disease. CONCLUSION OF LAW Chronic rheumatoid arthritis was incurred in service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. §§ 3.303, 3.309 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board notes that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). The Board is also satisfied that all relevant facts have been properly developed and that no further assistance to the veteran is required to comply with the statutory duty to assist mandated by 38 U.S.C.A. § 5107(a). The veteran has appealed a denial of service connection for rheumatoid arthritis. Service connection may be established for disabilities resulting from personal injury or disease incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). The veteran's service medical records show that he complained of intermittent swelling and pain in his right wrist and ankle in May 1966. Physical examination was negative, and the veteran was told to return to the clinic in three days. He returned the next day complaining of severe pain in his right wrist. The wrist was noted as tender with no erythema or swelling, and the fingers were noted as stiff. The impression was arthritis, and the veteran was started on aspirin therapy. A latex fixation test yielded a strong reaction. In July 1966, the veteran presented complaining of right shoulder pain. His arthritis was noted as somewhat worse, and the veteran was instructed in 10 gram aspirin therapy every 4 hours. A week later, minimal improvement was noted, and the examiner set out a specific aspirin schedule (15 per day total, taken two or three at a time every four hours). The final entry in the veteran's medical records, dated July 25, 1966, indicates that he was doing fairly well at that time, but continued to have flare-ups, particularly in his right wrist. Definite proximal interphalangeal joint swelling was noted, with increased heat and tenderness in the right fourth and index fingers. The wrist was also noted to be tender. The diagnosis was rheumatoid arthritis. The examiner noted that the veteran was advised as to filing a disability claim upon his impending retirement, and was instructed to continue with the aspirin therapy. The veteran testified at his hearing that he continued to take large doses of aspirin after he retired. Hr'g Tr. at 2 (June 29, 1992). He testified that over the years he did not have a need to seek further medical treatment for his rheumatoid arthritis, because aspirin is readily available without a prescription and regular doses enabled him to function fairly well. Id. at 2, 7. He testified that he eventually did talk to two physician's assistants at George Air Force Base, California, about his condition, on a friendship-type basis. Id. at 5. One of these persons, Chris Lynch, P.A., submitted a letter dated in July 1992 on behalf of the veteran, stating that he treated the veteran from approximately 1983 to 1988, for a variety of minor medical problems. The letter further stated that at some point during that period he switched the veteran from aspirin to ibuprofen for his rheumatoid arthritis, as he was uncomfortable with the large amount of aspirin the veteran was taking. The veteran underwent a carotid endarterectomy in May 1988. His contemporaneous medical records reflect his history of rheumatoid arthritis, and laboratory tests results were positive for the disease. The veteran's physician, Kanagaratnam Sivalingam, M.D., submitted a letter dated in August 1990, noting that the veteran's regular aspirin doses were reduced at that time to just one per day because of his carotid occlusive disease, and that he was started on Feldene instead. Dr. Sivalingam stated that the veteran's rheumatoid arthritis became significantly worse as a result, and that he was referred to rheumatologist Martin Berry, M.D., after two other drugs also failed to adequately control his symptoms. Records from Dr. Berry indicate that despite various treatments, the veteran's rheumatoid arthritis has continued to progress. The veteran's rheumatoid arthritis was also confirmed at his April 1990 VA examination. The examiner noted that the veteran had deformity of his hands and wrists, as well as limitation of motion due to pain and tenderness. Straight leg raising and fabere sign were positive in the back and hips. Swelling of his ankles was also noted. The serology report indicated that the veteran's rheumatoid factor test was reactive. X-rays of his right wrist, right hand, left wrist, left hand, right knee, left knee and right ankle revealed degenerative changes or findings consistent with rheumatoid arthritis. 38 C.F.R. § 3.303(b) provides that in the case of any disease shown as chronic in service, thus permitting a finding of service connection, any later manifestations of the disease, however remote, are service connected unless clearly attributable to intercurrent causes. In order to show the existence of a chronic disease in service, a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity is required. Id. When chronicity is not shown in service, then continuity of symptomatology after discharge is required to support the claim; when the identity of the disease is established, a showing of continuity is not required. Id. Arthritis is designated as a chronic disease at 38 C.F.R. § 3.309(a). The Board finds that chronic rheumatoid arthritis was sufficiently and clearly diagnosed in the veteran's medical records, and that he continues to suffer from this condition. Therefore, service connection for rheumatoid arthritis is warranted. ORDER Entitlement to service connection for rheumatoid arthritis is granted. NANCY I. PHILLIPS 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.