Citation Nr: 1014841 Decision Date: 04/19/10 Archive Date: 04/30/10 DOCKET NO. 06-38 177 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUE Entitlement to service connection for arthritis of multiple joints. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARINGS ON APPEAL The Veteran and a witness ATTORNEY FOR THE BOARD C. Bosely, Associate Counsel INTRODUCTION The Veteran had active service from January 1949 to October 1952. This matter originally came before the Board of Veterans' Appeals (Board) on appeal from an August 2005 rating determination of the Cleveland, Ohio, Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared at a hearing at the RO before a local hearing officer in April 2006. He also appeared at a Travel Board hearing before the undersigned Acting Veterans Law Judge at the RO in July 2007. A transcript of both hearings has been associated with the claims file. In July 2009, the Veteran submitted new medical evidence directly to the Board without a waiver of RO jurisdiction. In November 2009, the Board again remanded the issue on appeal to the RO for additional evidentiary development. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2009). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT 1. The Veteran had significant cold weather exposure in the Republic of Korea during active service in the Korean Conflict. 2. The weight of the competent evidence demonstrates that the Veteran's currently disability manifested by arthritis of the hands, cervical spine, and thoracolumbar spine, is not related to any incident during his service, to include cold weather exposure. CONCLUSION OF LAW The Veteran does not have a current disability manifested by arthritis of the hands, cervical spine, and thoracolumbar spine, due to disease or injury that was incurred in or aggravated by active service, to include cold weather exposure. 38 U.S.C.A. §§ 1101, 1110, 1154, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Duties to Notify and Assist VA's duties to notify and assist claimants in substantiating a claim for VA benefits are found at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 and 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a); see also 73 Fed. Reg. 23,353- 23,356 (April 30, 2008) (concerning revisions to 38 C.F.R. § 3.159). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical evidence or lay evidence that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). In accordance with 38 C.F.R. § 3.159(b)(1), proper notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. Notice should be provided to a claimant before the initial unfavorable decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004). Here, the RO sent the Veteran a letter in May 2005 fulfilling the requirements of 38 C.F.R. § 3.159(b). The RO also sent a letter in March 2006 advising the Veteran of the five Dingess elements, to specifically include that a disability rating and an effective date for the award of benefits are assigned in cases where service connection is warranted. See Dingess/Hartman, 19 Vet. App. at 484. Accordingly, VA has fulfilled its duty to notify. VA has also fulfilled its duty to assist in obtaining the identified and available evidence needed to substantiate the claims adjudicated in this decision. First, all reported VA and private treatment records have been obtained, and there is no indication of additional pertinent treatment for which records have not been obtained. See Golz v. Shinseki, 590 F.3d 1317, 1323 (Fed. Cir. 2010) (clarifying that VA's duty to assist applies only to records relevant to a Veteran's present claim). Second, the Veteran was afforded VA examinations in June 2008 and December 2009 to determine whether his claimed arthritis is due to the circumstances of his active service. The Board finds that the VA examinations (when considered with subsequent addendums) are adequate because, as shown below, they were based upon consideration of the Veteran's pertinent medical history, including his cold weather exposure in Korea, plus his lay assertions and current complaints. Additionally, the VA examinations describe his disability in detail sufficient to allow the Board to make a fully informed determination. Barr v. Nicholson, 21 Vet. App. 303 (2007) (citing Ardison v. Brown, 6 Vet. App. 405, 407 (1994)). Finally, the Veteran has been afforded a hearing before a Veterans Law Judge in which he presented oral argument in support of his claim. For these reasons, there is no indication of any VA error in notifying or assisting the Veteran that reasonably affects the fairness of this adjudication. Also, VA's duty to assist is met. Thus, it is not prejudicial for the Board to proceed with appellate review. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). The Board also finds that there was substantial compliance with the November 2009 Board remand directives. A remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand order. Stegall v. West, 11 Vet. App. 268 (1998). Nonetheless, it is only substantial compliance, rather than strict compliance, with the terms of a remand that is required. See D'Aries v. Peake, 22 Vet. App. 97, 104-05 (2008) (finding substantial compliance where an opinion was provided by a neurologist as opposed to an internal medicine specialist requested by the Board); Dyment v. West, 13 Vet. App. 141 (1999). In particular, the Board directed the AMC/RO to schedule the Veteran for a VA examination to determine whether he has arthritis that is at least as likely as not related to his cold weather exposure during the Korean Conflict. This was accomplished by the AMC/RO in December 2009. As there has been substantial compliance with all directed action, further remand is not necessary. See Stegall v. West, 11 Vet. App. 268 (1998); see also D'Aries v. Peake, 22 Vet. App. 97, 104- 05 (2008) (finding substantial compliance where an opinion was provided by a neurologist as opposed to an internal medicine specialist requested by the Board). II. Analysis The Veteran is contending that service connection is warranted for arthritis of multiple joints, including the low back, neck, and right ankle. With regard to the scope of his claim, the Board points out that he is currently service-connected for residuals of cold weather injury of the (1) arthritis and neuropathy of the left foot, (2) arthritis and neuropathy of the right foot, and (3) neuropathy of the left hand, and (4) neuropathy of the right hand. The record shows that the Veteran has also been diagnosed with osteoporosis, but he has not indicated in his correspondence that he is seeking service connection for this disorder. Accordingly, the scope of the present claim does not encompass these disabilities. The Board points out that the Veteran is not presently service-connected for arthritis of the bilateral hands. Therefore, the scope of the present claim is found to encompass this disorder. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). 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; 38 C.F.R. § 3.303(a). Service connection generally requires credible and competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet .App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498 (1995). Also, certain chronic diseases, including arthritis, may be presumed to have been incurred during service if manifested to a compensable degree within one year of separation from active service. 38 U.S.C.A. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In the case of a veteran who engaged in combat with the enemy during a period of war, lay evidence of in-service incurrence or aggravation of a disease or injury shall be accepted if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the lack of official record of such incurrence or aggravation. 38 U.S.C.A. § 1154(b); Collette v. Brown, 82 F.3d 389, 392-94 (Fed. Cir. 1996); Libertine v. Brown, 9 Vet. App. 521, 524 (1996). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Board's duty is to assess the credibility and weight of the evidence. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (BVA has a duty to assess). Here, based upon careful and independent review, the Board finds that the preponderance of the evidence is against the Veteran's claim. The Veteran contends that he has a current disability manifested by arthritis that is due to cold weather exposure during service in Korea during the Korean Conflict. His official service department records confirm that he participated in "[o]perations against enemy forces south and central Korea," from July 6, 1951 to June 3, 1952, which, the Board points out, was during the Korean Conflict. For his service, the Veteran received numerous medals including the Navy Occupation Service Medal, Korean Service Medal with four Bronze Stars, the U.N. Service Medal, and a Combat Action Ribbon. The record on appeal also includes an April 2005 "buddy statement" from a Veteran who wrote that he joined the Veteran's unit in Korea in January 1952. The buddy further wrote that cold weather was their "worst enem[y]" in Korea. In fact, they were cold throughout the winter where temperatures dropped to as low as 47 degrees below zero. Hands, ears, feet, and faces were almost always frozen, except that their feet would become damp when walking to their bunker. They would then have to lie in the bunker with wet feet for 12 hours. Afterwards, their feet and toes would look gray. The "buddy statement" then goes on to detail how the buddy lost touch with the Veteran after May/June 1952, until approximately 1998-99, when they re-connected. In short, the record shows that the Veteran was involved in combat with the enemy during his service in Korea. Also, the lay statements of record are competent and credible evidence demonstrating the circumstances of the Veteran's service in Korea, including exposure to extreme cold weather. Nonetheless, service connection is not warranted unless the evidence also establishes that the Veteran has a current disability that resulted from his in-service cold weather exposure. See Davidson, 581 F.3d at 1316. On this issue, the preponderance of the evidence is against the Veteran's claim. First, service treatment records (STR) does not show that he was treated for frostbite and any other complaints related to cold weather exposure during service. According to a (post- service) March 2006 VA psychiatry treatment note, the Veteran complained of having had frostbite in Korea. In contrast, he reported to a June 2008 VA examiner that he did not remember having actual frostbite, frostnip, or frozen feet or symptoms during service. The Board points out that the STR are consistent with his assertions to the June 2008 VA examiner. He testified at an April 2006 Decision Review Officer (DRO) hearing that he did not undergo a discharge examination. Nonetheless, the STR contain a September 1952 separation examination report showing that a clinical evaluation of all systems (with the exception of several tattoos) was "normal." Second, the weight of the evidence shows that the Veteran currently does not have arthritis of any system that is a long-term effect of his in-service cold weather exposure. See, e.g., VA Adjudication Procedure Manual (M21-1), Part VI, § 11.20(a). The pertinent post-service evidence shows that the Veteran is diagnosed with arthritis of multiple joints. He was diagnosed with osteoarthritis at the lower cervical spine and L5-S1 in January 2002. Subsequent testing, including an April 2005 VA computed tomography (CT) scan, confirmed the diagnosis. During a January 2008 VA rheumatology consultation, the Veteran was also diagnosed with right thumb pain secondary to 1st carpal metacarpal (CMC) joint osteoarthritis. A follow-up VA rheumatology note from January 2009 shows a diagnosis of osteoarthritis of the bilateral hands and wrists, mainly affecting function at the right CMC joint. In short, the Veteran has been diagnosed with arthritis of the cervical spine, thoracolumbar spine, and bilateral hands and wrists. (Although a private June 2004 treatment note reports a diagnosis of "degenerative knee and hip problems," this clinical diagnosis has not been confirmed by X-ray.) With regard to the relationship between the arthritis of these joints and the Veteran's active service, the record contains some evidence tending to weigh against his present claim and some evidence tending to support the claim. Under such circumstances, the Board's duty is to the probative value of the medical evidence. See Hayes, 5 Vet. App. at 69. The opinions of a medical professional are medical conclusions that the Board cannot ignore or disregard, but the Board is not obligated to accept any physician's opinion. See Willis v. Derwinski, 1 Vet. App. 66, 70 (1991); Hayes v. Brown, 5 Vet. App. 60, 69 (1993). In fact, the Board may favor one medical opinion over another if it offers an adequate statement of reasons or bases. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). In determining the probative value to be assigned to a medical opinion, the Board must consider three factors. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case. A review of the claims file is not required, since a medical professional can also become aware of the relevant medical history by having treated a veteran for a long period of time or through a factually accurate medical history reported by a veteran. See id. at 303-304. Although being fully and accurately informed of the relevant medical history is necessary, the most probative value of a medical opinion comes from its reasoning. Accordingly, the second inquiry in determining the probative value of a medical opinion is whether the medical expert provided a fully articulated opinion. See id. A medical opinion that is equivocal in nature or expressed in speculative language, does not provide the degree of certainty required for medical nexus evidence. See Stegman v. Derwinski, 3 Vet. App. 228, 230 (1992); Bostain v. West, 11 Vet. App. 124, 127-28 (1998); Obert v. Brown, 5 Vet. App. 30, 33 (1993). The third and final factor in determining the probative value of an opinion involves consideration of whether an opinion is supported by a reasoned analysis. A medical opinion containing only data and conclusions is not entitled to any weight. In fact, a review of the claims file does not substitute for a lack of a reasoned analysis. See Nieves- Rodriguez, 22 Vet. App. at 304. Therefore, a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. See Miller v. West, 11 Vet. App. 345, 348 (1998). In short, a medical opinion will be considered probative if it includes clear conclusions and supporting data with a reasoned analysis connecting the data and conclusions. A medical opinion that is a factually accurate, fully articulated, and based on sound reasoning carries significant weight. See Nieves-Rodriguez, 22 Vet. App. at 304. Here, the evidence weighing against the claim consists of two VA examinations. First, the Veteran underwent a VA examination in June 2008. The examiner reviewed the Veteran's claims file and noted his history of service in Korea with exposure to temperatures as low 47 degrees below zero. The Veteran did not remember having actual frostbite/frostnip/frozen feet or symptoms during service. He also denied such current symptoms of cold sensitization, Raynaud's phenomenon, hand numbness, and other symptoms (except for the feet). In a January 2009 addendum, the June 2008 VA examiner reported that the Veteran shows signs of osteoarthritis of the spine. In support, the VA examiner cited a September 2005 X-ray revealing findings of moderate degenerative changes of the lumbar spine. With regard to the etiology of the disorder, the VA examiner indicated that the record does not confirm any event affecting the lumbosacral spine during the Veteran's active service. Accordingly, the VA examiner opined, it is not as likely as not that the degenerative changes of the Veteran's lumbosacral spine are a result of a cold injury. In support, she explained that review of the literature shows no connection between degenerative changes of the spine and exposure, long or short, to cold. Moreover, according to the VA examiner, degenerative changes of the spine are common among older people and more than 80 percent of males over the age of 55 show signs and/or symptoms of osteoarthritis. There are numerous risk factors for development of this problem, but, the examiner noted, cold injury is not on the list. The Board finds that the VA examiner's January 2009 addendum opinion is highly probative with regard to the issue of the etiology of the Veteran's lumbar spine arthritis. First, the VA examiner accurately reviewed the pertinent history, including the Veteran's exposure to extreme weather in Korea, plus his post-service symptomatology. In fact, the VA examiner cited a September 2005 VA treatment records showing diagnosis of lumbar spine arthritis. This demonstrates that the VA examiner was fully aware of the pertinent factual premises of the Veteran's case. Second, the VA examiner fully and unequivocally articulated her opinion. She found that it is not as likely as not that the Veteran's lumbosacral spin arthritis is the result of a cold injury. Finally, the VA examiner provided a reasoned analysis for her conclusion, by citing medical literature showing no connection between cold injuries and degenerative changes of the spine. Instead, she reasoned, degenerative disease of the spine is common among older people, especially males over 55. The Board also finds the June 2008 VA examiner's opinion highly probative because the VA examiner otherwise found support to conclude that the Veteran has current disorders of the bilateral feet and hands that are likely related to his in-service cold weather exposure. The VA examiner's careful distinction between the disorders of the hands and feet and the spine shows that the VA examiner thoroughly considered the circumstances of the Veteran's service and the relationship between his service and these current disabilities. In other words, the June 2008 VA examiner's opinion (including the January 2009 addendum) is factually accurate, fully articulated, and based on sound reasoning. Therefore, it carries significant weight with regard to the issue of the likely etiology of the Veteran's degenerative arthritis of the lumbosacral spine. See Nieves-Rodriguez, 22 Vet. App. at 304. Also weighing against his claim, the Veteran underwent a second VA examination in December 2009. The VA examiner, who is an orthopedist, reviewed the pertinent medical history by noting the Veteran's four-year history of neck and back pain. The VA examiner also noted that X-rays showed osteoarthritis of the spine. (Attachments to the December 2009 VA examiner's report consist of X-rays showing no significant bony abnormality of the bilateral knees and hips.) The VA examiner further noted the Veteran's current complaints, which included needing a cane to get around and having pain on motion of the neck and back. With regard to the etiology of the osteoarthritis of the spine, the VA examiner opined that it is not likely related to a service injury, but a natural occurring phenomenon. In an addendum, the December 2009 VA examiner noted that the Veteran also has arthritis of the hands. The VA examiner also documented the Veteran's complaints of hip pain and knee pain, which, according to the examiner, the Veteran had had for a "long number of years." The VA examiner noted that this was from a "natural occurring degenerative arthritis." On physical examination, the VA examiner found that both hands showed some Heberden's nodes over the distal interphalangeal (DIP) joints with pain and tenderness over the metacarpophalangeal joint (MCP) joints of both thumbs. Range of motion testing revealed pain on motion of the hips, knees, and hands, increased by repetitive use. Based on the results of the examination, the VA examiner diagnosed arthritis of the hands and strain of the hips and knee. With regard to the etiology of the disorders, the VA examiner explained that a review of the record and the examination showed that "there is no relationship to call it systemic arthritis." Rather, the VA examiner observed, this is more likely a natural occurring phenomenon, and not likely related to old injury. The Board finds that the December 2009 VA examiner's opinion, including the December 2009 addendum, is highly probative with regard to the issue of the nature and likely etiology of the Veteran's arthritis. First, the VA examiner reviewed the Veteran's claims file and current complaints, which supports a conclusion that he was aware of the pertinent factual premises of the case. Moreover, the VA examiner clearly stated his conclusions that the Veteran's arthritis is a "natural occurring degenerative arthritis," rather than "systemic arthritis," and is "not likely related to [a] service injury." The VA examiner explained that he based his conclusion on the clinical examination and a record review. In other words, the December 2009 VA examiner's opinion is fully articulated and based on sound reasoning. Therefore, it is highly probative with regard to the issue of the nature and likely etiology of the Veteran's current arthritis. See Nieves-Rodriguez, 22 Vet. App. at 304. Tending to support the Veteran's claim, the record contains an article by Dr. J. Johnson entitled "Cold Injury." The article explains that cold injuries may cause such disorder as arthritis; osteoporosis; joint pain and stiffness; numbness and odd sensations in the feet; and peripheral neuropathy. Also, according to the article, many soldiers either have forgotten or did not know at the time that they had frozen feet or other non-freezing injuries. The article goes on to indicate that these disorders may be asymptomatic for many years. Because Veterans may not know they had non- freezing cold injuries and because the symptoms developed over long years, it is often not easy to connect residuals of cold injuries based on later symptoms. This article is competent evidence showing that there may be an increased risk of developing arthritis after a cold injury. The evidence, however, is not probative with regard to the present Veteran's claim because it does not specifically address the circumstances of his service or the relationship between his cold weather injury and his later development of arthritis. See Sacks v. West, 11 Vet. App. 314, 317 (1998); Mattern v. West, 12 Vet. App. 222, 228 (1999). Moreover, the article is not supported by any medical evidence of record addressing the specific circumstances of the Veteran's case. In short, the article is too general and inconclusive to outweigh the highly probative June 2008 and December 2009 VA examiners opinions. The Veteran submitted two other printed items in support of his claim. The first, an article entitled "Frostnip and Frostbite," provides no support for his claim because it simply explains the signs and symptoms of frostnip and frostbite and how to treat the conditions. This issue is not in dispute in the present claim. The Veteran additionally submitted a pamphlet explaining the VA claims process for cold injuries. Although the pamphlet states that arthritis is a common residual of a cold injury, the pamphlet does not cite the basis for this conclusion or indicate that it was written by a medical professional. Moreover, the Board points out, the article is elsewhere inaccurate. It states that VA has established a "presumption of incurred injury" for veterans exposed to cold weather during service. The section of the Code of Federal Regulations applying to veterans' claims does not, however, contain a presumption relating to cold weather injuries. See 38 C.F.R. § 3.300, et. al. For these reasons, these two items are not pertinent or probative evidence in the present claim. Also in support of his claim, the Veteran testified during a July 2007 Board hearing. He explained that he was exposed to temperatures as low as 47 degrees below zero, including during offensive action in September 1951. According to the Veteran, he essentially lived in a foxhole during this time, and as it was raining constantly, he had to everything, including eating and sleeping, covered in water. The Veteran also submitted a statement in October 2005, in which he expressed his opinion that he has neck, low back, and right ankle arthritis due to his combat experiences in Korea. The Board points out that the lay evidence of record also includes a November 2006 email from "BJ Cooper" to the Veteran. The email indicates that "[t]here is a very good chance that some of your ongoing health problems could be directly related to [c]old [i]njury." Although the lay evidence is credible and provides some support for the Veteran's claim, it is outweighed by the highly probative opinions of the June 2008 and December 2009 VA examiners. Most importantly, the relationship between a cold weather injury and the later development of arthritis is not capable of lay observation. It is also not otherwise the type of medical question for which lay evidence is competent evidence. To the contrary, it is a question requiring medical knowledge. Therefore, the lay opinions asserting that there is a relationship between the Veteran's cold weather exposure in Korea and the later development of his arthritis is not competent evidence in support of his claim. See Davidson, 581 F.3d at 1316; Jandreau , 492 F.3d at 1376- 77; see also Robinson v. Shinseki, 312 Fed. Appx. 336, 339 (Fed. Cir. 2009) (nonprecedential). The Veteran also testified during his July 2007 Board hearing that his physicians have told him that his arthritis may be related to his active service or that it may also be due to old age. Although this lay assertion is competent evidence, it carries little probative weight because the Veteran made clear that his physicians' opinions were equivocal in that they attributed his arthritis to his service or his age. Such an equivocal opinion does not provide the degree of certainty required for medical nexus evidence. See Stegman, 3 Vet. App. at 230. Otherwise, the Veteran has not asserted that he has had a continuity of symptomatology since service, and the record contains no contemporaneous descriptions of the Veteran's symptomatology supporting a later medical professional's diagnosis or etiology opinion. For these reasons, the lay evidence of record is found to have little probative value in support of the Veteran's claim. See Davidson, 581 F.3d at 1316; Jandreau , 492 F.3d at 1376-77. In conclusion, the record on appeal includes some evidence tending to support the Veteran's claim. The most probative evidence of record, however, consists of the June 2008 and December 2009 VA examiners' opinions, and this evidence weighs against his claim. Therefore, the preponderance of the evidence is against the Veteran's claim of service connection for arthritis of multiple joints, and the claim must be denied. In reaching this determination, the Board acknowledges that VA is statutorily required to resolve the benefit of the doubt in favor of the Veteran when there is an approximate balance of positive and negative evidence regarding the merits of an outstanding issue. That doctrine, however, is not applicable in this case because the preponderance of the evidence is against the his claim. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). ORDER Service connection for arthritis of multiple joints is denied. ____________________________________________ A. C. MACKENZIE Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs