Citation Nr: 0810739 Decision Date: 04/01/08 Archive Date: 04/14/08 DOCKET NO. 00-00 895 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to service connection for pneumonia with high fever to include as due to undiagnosed illness. 2. Entitlement to service connection for fatigue to include as due to undiagnosed illness. 3. Entitlement to service connection for crawling sensation in right lower extremity to include as due to undiagnosed illness. 4. Entitlement to service connection for bilateral knee chondromalacia to include as due to undiagnosed illness. 5. Entitlement to service connection for a right wrist condition to include as due to undiagnosed illness. 6. Entitlement to service connection Achilles tendinitis to include as due to undiagnosed illness. REPRESENTATION Appellant represented by: Texas Veterans Commission ATTORNEY FOR THE BOARD Mark Vichich, Associate Counsel INTRODUCTION The veteran served on active duty from August 1980 to May 1986, and from March 1987 to July 1991. The veteran served in Southwest Asia during Operations Desert Storm and Desert Shield from August 1990 to March 1991. This matter comes before the Board of Veterans' Appeals (Board) following Board remands of November 2000, November 2003, February 2005, and June 2006. This matter was originally on appeal from a February 1999 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. In correspondence dated in October 2000, the veteran requested an RO hearing. The RO provided the veteran with such a hearing, as evidenced by a transcript in the file, dated in March 2001. In a letter dated in June 2001, the RO asked the veteran whether he wished to have a Board hearing. The veteran failed to respond to this correspondence and the Board, therefore, concludes there are no outstanding hearing requests. FINDINGS OF FACT 1. The veteran has been notified of the evidence necessary to substantiate his claim, and all relevant evidence necessary for an equitable disposition of this appeal has been obtained. 2. The evidence does not show that the veteran incurred pneumonia in service and the competent medical evidence does not show the veteran currently has chronic residuals of pneumonia or high fever. 3. The competent medical evidence does not show that the veteran suffers from chronic fatigue syndrome; the veteran's reported fatigue is a manifestation of his service-connected PTSD. 4. The veteran's crawling sensation in right lower extremity is attributable to a known clinical diagnosis of restless leg syndrome; the competent medical evidence does not show that the restless leg syndrome had its onset during active duty service or is related to an event in service. 5. The veteran's joint pain of the knees is attributable to a known clinical diagnosis of bilateral chondromalacia; the competent medical evidence does not show that the chondromalacia had its onset during active duty service or is related to an event in service. 6. The veteran's preexisting residuals of a right wrist fracture underwent no increase in severity during service. 7. The tenderness of the right wrist detected on examination in December 1998 was attributed to known clinical diagnoses and the competent medical evidence does not relate those diagnoses to an incident of the veteran's active duty service. 8. There are currently no objective indications of a right wrist disability. 9. The veteran's ankle pain is attributable to a known clinical diagnosis of Achilles tendinitis; the competent medical evidence does not relate this disorder to the veteran's active duty service. CONCLUSIONS OF LAW 1. Pneumonia with high fever, including as due to an undiagnosed illness, was not incurred or aggravated during active service. 38 U.S.C.A. §§ 1110, 1117, 1131 (West 2002 & Supp. 2007); 38 C.F.R §§ 3.303, 3.317 (2007). 2. Fatigue, including as due to an undiagnosed illness, was not incurred or aggravated during active service. 38 U.S.C.A. §§ 1110, 1117, 1131 (West 2002 & Supp. 2007); 38 C.F.R §§ 3.303, 3.317 (2007). 3. Crawling sensation in right lower extremity, including as due to an undiagnosed illness, was not incurred or aggravated during active service. 38 U.S.C.A. §§ 1110, 1117, 1131 (West 2002 & Supp. 2007); 38 C.F.R §§ 3.303, 3.317 (2007). 4. Bilateral knee chondromalacia, including as due to an undiagnosed illness, was not incurred or aggravated during active service. 38 U.S.C.A. §§ 1110, 1117, 1131 (West 2002 & Supp. 2007); 38 C.F.R §§ 3.303, 3.317 (2007). 5. A right wrist condition, including as due to an undiagnosed illness, was not incurred or aggravated during active service. 38 U.S.C.A. §§ 1110, 1117, 1131 (West 2002 & Supp. 2007); 38 C.F.R §§ 3.303, 3.317 (2007). 6. Achilles tendinitis, including as due to an undiagnosed illness, was not incurred or aggravated during active service. 38 U.S.C.A. §§ 1110, 1117, 1131 (West 2002 & Supp. 2007); 38 C.F.R §§ 3.303, 3.317 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Veterans Claims Assistance Act of 2000 and Board Remands The Veterans Claims Assistance Act of 2000 (VCAA) imposes obligations on VA with respect to its duty to notify and assist a claimant in developing a claim. 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2007); 38 C.F.R. § 3.159 (2007). Under the VCAA, upon receipt of a complete or substantially complete application for benefits, VA is required to notify the veteran and his representative, if any, of any information and medical or lay evidence necessary to substantiate the claim. The United States Court of Appeals for Veterans Claims (hereinafter the Court) has held that these notice requirements apply to all five elements of a service connection claim, which include: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VA law and regulations also indicate that part of notifying a claimant of what is needed to substantiate a claim includes notification as to what information and evidence VA will seek to provide and what evidence the claimant is expected to provide. Further, VA must ask the claimant to provide any evidence in her or his possession that pertains to the claim. 38 U.S.C.A. § 5103 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.159(a)-(c) (2007). VCAA notice must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112, 120 (2004). The veteran was provided with notice in correspondences dated in March 2004 and June 2006. In both letters the Appeals Management Center (AMC) advised the veteran of what the evidence must show to establish entitlement to service- connected compensation benefits, what duty VA had in obtaining relevant evidence, and what duty the veteran had in obtaining relevant evidence. In both letters the AMC requested that the veteran send any evidence in his possession that pertained to the claims. In the June 2006 correspondence, the AMC informed the veteran of what the evidence needed to show to establish entitlement to service connection for an undiagnosed illness. The AMC also informed the veteran that when service connection is granted, a disability rating and effective date of the award is assigned. The AMC also explained how the disability rating and effective date are determined. The Board finds that in issuing this letter, the RO has satisfied the requirements of Dingess/Hartman and the Board remand of June 2006. Finally, the Board also finds that the RO has satisfied VA's duty to assist, including as directed in the Board's remands. The RO has obtained the veteran's service medical records, VA Medical Center (VAMC) treatment records, and all private medical records that the veteran requested. The veteran was provided with VA examinations in December 1998 and May 2005. A report of the May 2005 VA examination indicates that the examiner addressed the criteria pertaining to disabilities claimed as due to undiagnosed illness as requested by the Board in the remand of February 2005. VA also obtained a medical opinion in response to the Board's June 2006 remand. This opinion, dated in March 2007, has been associated with the claims file. The veteran has not made the RO or the Board aware of any other evidence relevant to his appeal and no further development is required to comply with the duty to assist the veteran in developing the facts pertinent to his claims. Accordingly, the Board will proceed with appellate review. II. Legal Criteria Service connection will be granted if it is shown that a veteran has a disability resulting from an injury or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in active military service. 38 U.S.C.A. § 1110, 1131 (West 2002 & Supp. 2007); 38 C.F.R. § 3.303 (2007). Service connection may also 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) (2007). "Generally, to prove service connection, a claimant must submit (1) medical evidence of a current disability, (2) medical evidence, or in certain circumstances lay testimony, of in-service incurrence or aggravation of an injury or disease, and (3) medical evidence of a nexus between the current disability and the in-service disease or injury." Pond v. West, 12 Vet. App. 341, 346 (1999). Where the determinative issue involves a medical diagnosis, competent medical evidence is required. This burden typically cannot be met by lay testimony because lay persons are not competent to offer medical opinions. Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). A pre-existing injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C.A. § 1153 (West 2002); 38 C.F.R. § 3.306(a) (2007). Service connection may also be established for a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active military, naval, or air service in the Southwest Asia Theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2011. 38 U.S.C.A. § 1117(a)(1) (West 2002); 38 C.F.R. § 3.317(a) (2007). A "Persian Gulf veteran" is one who served in the Southwest Asia Theater of operations during the Persian Gulf War. See 38 C.F.R. § 3.317 (2007). A "qualifying chronic disability" includes: (A) an undiagnosed illness, (B) the following medically unexplained chronic multi symptom illnesses: chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome, as well as any other illness that the Secretary of VA determines is a medically unexplained chronic multi-symptom illness; or (C) any diagnosed illness that the Secretary determines, in regulations, warrants a presumption of service connection. 38 U.S.C.A. §1117(a)(2) (West 2002); 38 C.F.R. § 3.317(a)(2)(i) (2007). Objective indications of a chronic disability include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. Disabilities that have existed for 6 months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. Signs or symptoms which may be manifestations of undiagnosed illness or medically unexplained chronic multisymptom illness include, but are not limited to: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs and symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; (13) menstrual disorders. 38 C.F.R. § 3.317(a)(3)-(6) (2007). Compensation may be paid under 38 C.F.R. § 3.317 for disability which cannot, based on the facts of the particular veteran's case, be attributed to any known clinical diagnosis. The fact that the signs or symptoms exhibited by the veteran could conceivably be attributed to a known clinical diagnosis under other circumstances not presented in the particular veteran's case does not preclude compensation under § 3.317. VAOPGCPREC 8-98. Entitlement to service-connected benefits is specifically limited to cases where there is a current disability. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (providing that in the absence of proof of a present disability there can be no valid claim). III. Evidence and Analysis Pneumonia The veteran has claimed that he was hospitalized with either a high fever or pneumonia in service and that he currently suffers from residuals of one of these conditions. In his claim for compensation benefits, dated in February 1998, the veteran claimed he was exposed to burning oil, smoke, and fumes from oil fires while in the Gulf Region, causing high fever, extreme fatigue, a crawling sensation in his right leg, and severe joint pain. In his substantive appeal, dated in November 1999, he claimed he experienced three to five episodes of the flu each year as a result of his pneumonia while in the military. The veteran's service medical records included a Southwest Asia Demobilization/Redeployment Medical Evaluation dated in May 1991, showing that the veteran reported he had incurred rule out pneumonia while serving in the Southwest Asia region. There are no treatment records confirming this. The service medical records did include a radiology report, dated in May 1991, in which the radiologist reported that a chest x-ray revealed a nodule density on the right suprahilar region, which was related to the vessel-on-end or a granuloma. Post-service medical evidence include two VA examination reports. In a VA general medical examination report, dated in December 1998, Dr. J.S. stated that upon reviewing the claims file, he was unable for find records confirming hospitalization for pneumonia. Dr. J.S. did, however, note the May 1991 radiology report confirming that the veteran had a nodule density. Dr. J.S. did not specify the significance of this, if any. On physical examination, Dr. J.S. reported the veteran appeared to be in good health. Respirations were 12 per minute with no dyspnea noted. Lungs were clear without wheezes, rhonchi, or rales. Dr. J.S. concluded that this was a normal examination for a person of this age, with the exception of the sad expression on the veteran's face. In the May 2005 VA examination report, W.A., Physician Assistant, Certified (PA-C), reported that the veteran was unsure whether he ever had pneumonia, but claimed to have suffered from a high fever in service requiring hospitalization for two weeks. The veteran denied chronic cough, chest pain or shortness of breath, or hemoptysis. The veteran's weight had also remained stable over the past year. On examination, W.A. found lungs to be clear to auscultation without rales, rhonchi, wheezing, or rubs, and resonant to percussion. W.A. diagnosed pneumonia by history, no sequelae. W.A. also confirmed that he had reviewed the claims file. The Board finds no basis to grant service connection for pneumonia and/or high fever, including as due to an undiagnosed illness. First, the medical evidence fails to show a current diagnosis of either pneumonia or chronic fever or that the veteran currently suffers from chronic residuals of any previous episodes of these diseases. Both VA examiners based their opinions on a review of the claims file, history reported by the veteran, and current examination findings. For these reasons, the Board finds these opinions to be both reliable and probative. The Board declines to give any weight to the veteran's opinion that he currently suffers from residuals of either pneumonia or fever. As a layperson, he has no professional expertise. Lay assertions regarding medical matters such as diagnosis or etiology of a disability have no probative value because laypersons are not competent to offer medical opinions. Where a claim involves issues of medical fact, such as causation or diagnosis, competent medical evidence is required. Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). There being no competent medical evidence contrary to the VA examination reports of record, they are controlling. There is no current chronic disability and thus, no basis to grant service connection for these diseases or residuals thereof. Id. Second, the evidence also fails to support granting service connection based on the presence of a current qualifying chronic disability for Persian Gulf veterans (i.e. an undiagnosed illness). Although the veteran has described three to five episodes of flu annually, the lack of objective findings on examination and the lack of medical records documenting these illnesses weigh against the veteran's claim. Moreover, the medical evidence was negative for, and the veteran has denied the presence of, other objective signs such as chronic cough, chest pain, or shortness of breath. For reasons explained above, the opinions from Dr. J.S. and W.A., PA-C, are both reliable and probative and outweigh any evidence to the contrary. There being no credible evidence of a chronic qualifying disability, the Board may not grant service connection for such a disability. 38 U.S.C.A. §1117(a)(2) (West 2002); 38 C.F.R. § 3.317(a)(2)(i) (2007). Fatigue According to a transcript of the veteran's RO hearing in March 2001, he testified that his fatigue began approximately three years after his discharge. The veteran had been told it was due to his job and a medication he was taking. The veteran claimed he only slept between four and six hours nightly. In a VA general medical examination report, dated in December 1998, Dr. J.S. noted that he and the veteran had discussed the veteran's chronic fatigue very thoroughly. Dr. J.S. noted that the veteran worked the night shift and had done so since 1993. Dr. J.S. also noted that the veteran slept for three hours when he came home from work in the morning and then later slept four hours before going to work. The veteran did not exercise and reported taking sleep medicine. Dr. J.S. concluded that the veteran's schedule could be a major cause of his fatigue. In the December 1998 VA neurological examination report, Dr. H.M. reported that the veteran complained of chronic fatigue that began two to three years after leaving the military. According to the report, the veteran attributed the problem to his work schedule, which began at 1:00 A.M. and ended at 9:30 A.M. Dr. M.H. discussed neurologic examination findings and concluded the veteran's subjective feeling of chronic fatigue could be related to his PTSD, but was probably related to his work schedule. In the May 2005 VA examination report, W.A., Physician Assistant, Certified (PA-C), assessed fatigue, more likely than not due to the veteran's depression and PTSD. In the report, W.A. discussed the veteran's complaints of constant fatigue and his night shift at work. W.A. also discussed the veteran's history of depression and PTSD. W.A.'s assessment was fatigue, more likely than not due to the veteran's depression and PTSD. W.A. also assessed chronic fatigue syndrome, but referred to the other VA examination report for further explanation. In a May 2005 VA orthopedic examination report, Dr. N.C. discussed the veteran's complaints of fatigue. The doctor concluded that the veteran did not meet the criteria for chronic fatigue syndrome. In his report, the doctor noted that there was no history or diagnosis of chronic fatigue syndrome and that the veteran took no medications for it. Dr. N.C. concluded that the veteran's fatigue was most likely related to his PTSD because he presented with insomnia, fatigue, and depression related to his psychological problems. The Board does not find that service connection for chronic fatigue syndrome is warranted because the evidence fails to show the veteran meets the criteria for this disability. Although W.A.'s assessment was "chronic fatigue syndrome," the Board finds this assessment to be less probative than that found in Dr. N.C.'s report because W.A. referred to that report for further explanation. It is apparent that W.A. was deferring to Dr. N.C. for a definitive conclusion on this issue. Regarding Dr. N.C.'s statement relating the veteran's fatigue to his depression, the Board finds that it does not support his claim. This statement does not establish that the veteran's fatigue is a separate disability; instead, Dr. N.C.'s statement only confirms that the veteran experiences fatigue as a symptom of his service-connected PTSD. As the fatigue is considered a manifestation of the service- connected PTSD, VA is prohibited from assigning a separate evaluation for it. See 38 C.F.R. § 4.14 (2007) (providing that the evaluation of the same manifestation under different diagnoses is to be avoided). The Board has no basis to grant service connection for chronic fatigue syndrome, including as due to an undiagnosed illness. Crawling Sensation, Right Lower Leg According to a transcript of the veteran's RO hearing in March 2001, he testified that his crawling sensation began two to three years after his discharge. The veteran claimed he had been treated with medication for the symptoms, but that there was no diagnosis. The veteran also submitted a statement dated in January 2005 in which he reported he had been treated for crawling sensation of the right leg a VAMC Beaumont and Houston. The veteran reported he took Calcet, Sulindac, and Omeprazole for this condition. The veteran's service medical records were negative for complaints of tingling in the right leg. The earliest records of such a complaint is found in a VA progress note, dated in November 1996. According to that note, the veteran told a social worker he had various symptoms-such as aching joints and tingling in the arms and legs-that he felt were related to his Gulf War experience. The medical evidence also included several VA examination reports. In a December 1998 VA neurological examination report, Dr. H.M. reported that the veteran began experiencing a sensation in the right leg four years earlier. The sensation occurred either when he was standing up or laying down trying to fall asleep. On examination, Dr. H.M. found muscle tone and strength to be normal in all four extremities. Sensory examination was intact to all tested modalities, including pinprick, light touch, proprioception, vibration, and temperature. Deep tendon reflexes were physiologic and symmetric. Gait was normal with adequate tiptoe, heel, and tandem walking. The doctor concluded that the examination was completely normal and did not reveal any sensory deficits in the right lower extremity. The doctor found no evidence on examination of any peripheral nerve dysfunction and determined that the etiology of the complaint was unclear. In the May 2005 VA examination report, W.A., Physician Assistant, Certified (PA-C), discussed the veteran's complaints of a crawling sensation in the leg intermittently, two to three times a month, lasting two hours. Examination findings, including neurologic examination, were unremarkable. W.A. diagnosed restless leg syndrome right leg. In a VA opinion report, dated in March 2007, C.D., PA-C, advised that he had reviewed the veteran's claims file, including the May 2005 VA examination report prepared by W.A., PA-C and service medical records. After noting that he had reviewed the veteran's service medical records, including on deployment and reenlistment, C.D. noted that in 1991 the veteran complained of sleeping difficulties, depression, and nervousness, but that there was no diagnosis of restless leg syndrome or documentation of complaints of "creepy crawling" feelings. Therefore, C.D. concluded, it was less likely as not that this problem occurred in service. Given the current diagnosis of restless legs syndrome, C.D. felt that it was less likely than not that the veteran's restless leg syndrome was an undiagnosed illness due to exposure during the Gulf War. C.D. cited Harrison's 15th Edition Principles of Internal Medicine, which stated, according to C.D., that restless legs syndrome was a common chronic disorder that often had a familial basis with evidence of an autosomal dominant inheritance. The claim for tingling in the right leg cannot be granted as due to an undiagnosed illness because the medical evidence attributes the veteran's crawling sensation to a known clinical diagnosis: restless legs syndrome. Service connection cannot be granted for restless legs syndrome on a direct basis because the competent medical evidence does not relate this condition to any incident of the veteran's active duty service. In making this conclusion, the Board weighs heavily the absence of any complaints for the disorder in the veteran's service medical records and the negative opinion from C.D. C.D.'s opinion is particularly probative because he reviewed the claims file and all pertinent evidence and supported his conclusion with reasons supported by the records. Bilateral Knees The veteran's claim for a bilateral knee disability must be denied because his knee pain has been attributed to a known clinical diagnosis and the competent medical evidence does not relate that disorder to an event in the veteran's active duty service. The pertinent evidence is found in VA examination reports, dated in December 1998 and May 2005. In the December 1998 VA joints examination report, Dr. C.G. reported that the veteran complained of bilateral knee pain that increased with activity. On examination, the veteran had zero to 140 degrees of motion bilaterally with no locking, no anterior or posterior drawer, and no McMurray's. There was no medial or lateral joint line tenderness and there was no effusion bilaterally. The veteran did have crepitation of the patellofemoral joint bilaterally. Dr. C.G. determined that the veteran had chondromalacia of the patella of the bilateral knees, which appeared to be mild to moderately symptomatic depending on activity level. VA radiology report, dated in December 1998, Dr. S.S. noted that x-rays of the bilateral knees showed no abnormalities. According to the May 2005 VA examination report, the veteran reported pain in the left knee, but denied pain in the right. The veteran reported no injury to the knees. Prolonged walking and cold weather aggravated the knee pain. On examination, Dr. N.C. found the knees to have full range of motion (zero to 140 degrees) with minimal crepitus. The veteran exhibited no evidence of pain on motion. X-rays of both knees revealed no acute fracture or dislocation, but did show slight narrowing in the medial compartment bilaterally. Dr. N.C. diagnosed bilateral knee chondromalacia with minimal to moderate residuals and minimal to mild degenerative joint disease. The onset of the bilateral chondromalacia patella, Dr. N.C. stated, was less likely related to the in-service disease or injury. The claim for joint pain of the knees cannot be granted as due to an undiagnosed illness because the medical evidence attributes this pain to known clinical diagnoses: chondromalacia patella and degenerative joint disease. Service connection cannot be granted for these diagnosed conditions for two reasons. First, the veteran's service medical records are negative for treatment of a knee injury and the veteran has not alleged an in-service knee injury. Thus, there is no evidence of an in-service knee injury. Second, there is no medical evidence of a nexus between the current disability and any event of the veteran's military service. Right Wrist At the veteran's RO hearing, he testified that he fractured his right wrist prior to entering service, but that he continued to experience problems with his right wrist during service. The veteran's service medical records are negative for treatment, complaints, or a diagnosis of a right wrist disorder. At his hearing, the veteran acknowledged that he received no treatment for a right wrist condition in service. The medical evidence pertaining to a right wrist condition is found in VA joints examination reports, dated in December 1998 and May 2005. In the December 1998 examination report, Dr. C.G. noted that the veteran fractured his right wrist in 1974 after falling from a truck. On examination of the right wrist, Dr. C.G. found flexion to be to 85 degrees, extension to 75 degrees, ulnar deviation to 40 degrees, and radial deviation to 20 degrees. The veteran was tender over the extensor tendons of the wrist. X-rays of the right wrist demonstrated no fractures, dislocations, or subluxations with movement. Dr. C.G. concluded the veteran had an old fracture that appeared to be well healed and nontender on examination. He did have some evidence of synovitis and tendinitis of the extensor tendons of the wrist that appeared to be mildly symptomatic according to the doctor. In the May 2005 VA examination report, Dr. N.C. noted that the veteran had history of right wrist fracture in 1974 prior to joining service, but denied current pain, redness, swelling, locking, or fatigability in the right wrist. The veteran also denied migratory joint pain. On examination of the wrists, extension was from zero to 70 degrees, flexion was from zero to 80 degrees, radial deviation was from zero to 20 degrees, and ulnar deviation was from zero to 45 degrees bilaterally. There was no evidence of pain, stiffness, lack of endurance, weakness, or incoordination on movement. Dr. N.C. diagnosed right wrist fracture with no residuals. The Board finds no basis to grant service connection for a right wrist condition. First, the evidence does not show that any residuals of the veteran's pre-service right wrist increased in severity during such service. The absence of any complaints in service for a right wrist condition weighs heavily against the veteran's claim. The only evidence pertaining to the veteran's condition in service are his statements at his RO hearing. The veteran, however, provided no examples of what sort of right wrist problems he had in service or otherwise allege that his right wrist disorder had increased in severity. The absence of treatment for a right wrist condition after service also weighs against the veteran's claim. The evidence also fails to show objective indications of a qualifying chronic disability of the right wrist. The only right wrist abnormality detected on examination was tenderness, and this was attributed to known clinical diagnoses of synovitis and tendinitis of the extensor tendons. Moreover, the more recent examination report was negative for any objective signs of a right wrist abnormality. This report provides no support for the veteran's claim because entitlement to service-connected benefits requires there to be a current disability. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Achilles Tendinitis The veteran's service medical records included a record of emergency care, dated in June 1984. According to that document, the veteran presented with left ankle pain after sustaining an injury. X-rays were negative for a fracture. On examination, the veteran was found to have a swollen left ankle and the assessment was a sprained left ankle. The service medical records were negative for additional treatment of any abnormalities of the left ankle. In a VA joints examination report, dated in December 1998, Dr. C.G. reported that the veteran complained of pain in the left ankle and that he had been diagnosed with left Achilles tendinitis four years earlier. Examination of the left ankle demonstrated dorsiflexion to 20 degrees, plantar flexion to 60 degrees, inversion of 40 degrees, and eversion of 20 degrees. There was no anterior drawer. Radiographs of the left ankle demonstrated no fractures, dislocations or subluxations; joint spaces were well maintained. Dr. C.G. concluded that the veteran had Achilles tendinitis in the left ankle that appeared to be mild to moderately symptomatic, depending on the activity level. A VA progress note, dated in December 1994, confirmed that the veteran had been diagnosed with left ankle tendinitis; no other information is ascertainable from this document. In a VA examination report, dated in May 2005, Dr. N.C. noted the veteran's history of left ankle pain in 1984 and diagnosis of left ankle Achilles tendinitis in 1994. At present, the veteran denied pain, redness, swelling, locking, or fatigability in the left ankle. On examination of the ankles, Dr. N.C. found no evidence of swelling, crepitus, or tenderness. Dr. N.C. also found no evidence of tenderness in the Achilles tendon. Bilateral ankle dorsiflexion was from zero to 20 degrees, plantar flexion was from zero to 45 degrees, with no evidence of pain, tenderness, or weakness. Both ankles were adequately aligned, with no varus or valgus. Dr. N.C. diagnosed history of left Achilles tendinitis, onset in 1994, with minimal residuals. The tendinitis was less likely related to any in service injury or disease according to the doctor. The claim for ankle pain cannot be granted as due to an undiagnosed illness because the medical evidence attributes the veteran's ankle pain to a known clinical diagnosis; namely, Achilles tendinitis. Service connection cannot be granted for Achilles tendinitis because the competent medical evidence does not relate this condition to the veteran's active duty service, but instead, shows that it had its first onset after the veteran's discharge. Dr. N.C.'s opinion is credible because he based it on a review of the veteran's objective medical history as found in his records, current examination findings, and subjective history as reported by the veteran. There is no medical evidence contradicting Dr. N.C.'s opinion. IV. Doctrine of Reasonable Doubt In reaching these decisions, the Board has considered the doctrine of reasonable doubt. However, because the preponderance of the evidence is against the veteran's claims, the doctrine is not for application. 38 U.S.C.A. § 5107(b) (West 2002). Accordingly, the Board must deny each claim on appeal. ORDER 1. Service connection for pneumonia with high fever to include as due to undiagnosed illness is denied. 2. Service connection for fatigue to include as due to undiagnosed illness is denied. 3. Service connection for crawling sensation in right lower extremity to include as due to undiagnosed illness is denied. 4. Service connection for bilateral knee chondromalacia to include as due to undiagnosed illness is denied. 5. Service connection for a right wrist condition to include as due to undiagnosed illness is denied. 6. Service connection for Achilles tendinitis to include as due to undiagnosed illness, is denied. ____________________________________________ John E. Ormond, Jr. Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs