Citation Nr: 1318496 Decision Date: 06/06/13 Archive Date: 06/11/13 DOCKET NO. 09-11 983 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUES 1. Entitlement to service connection for a right hip disability. 2. Entitlement to service connection for arthritis of multiple joints. 3. Entitlement to service connection for bilateral shin splints. 4. Entitlement to an effective date earlier than September 12 2006, for service-connected fibromyalgia. 5. Entitlement to an effective date earlier than September 12, 2006, for service-connected lumbar strain. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD James A. DeFrank, Counsel INTRODUCTION The Veteran served on active duty from September 1978 to August 1983. This matter comes before the Board of Veterans' Appeals (Board) on appeal from February 2007 and September 2012 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. In a January 2012 decision, the Board remanded these issues for additional development. The issues of entitlement to an effective date earlier than September 12 2006 for service-connected fibromyalgia and entitlement to an effective date earlier than September 12 2006 for a service-connected lumbar strain, are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. Arthritis of the right hip is not shown to be etiologically related to a disease, injury, or event in service, nor is it shown to have manifested within 1 year of discharge from service. 2. The preponderance of the evidence is against finding that the Veteran has arthritis of the multiple joints separate from and in addition to her osteoarthritis of bilateral hip that manifested in service or is otherwise related to a disease, injury, or event in service. 3. There is no current diagnosis of shin splints. CONCLUSIONS OF LAW 1. Arthritis of the right hip was not incurred in or aggravated by active service, and may not be presumed to have been incurred in or aggravated by active service. See 38 U.S.C.A. §§ 1110, 1112, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309 (2012). 2. Arthritis of multiple joints was not incurred in or aggravated by active service, and may not be presumed to have been incurred in or aggravated by active service. See 38 U.S.C.A. §§ 1110, 1112, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309 (2012). 3. A bilateral shin splint disability was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. § 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 (VCAA) 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 (West 2002) and 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). See also 73 Fed. Reg. 23,353-23,356 (April 30, 2008) (concerning revisions to 38 C.F.R. § 3.159). In this appeal, the RO provided notice to the Veteran in a November 2006 letter prior to the date of the issuance of the appealed February 2007 rating decision. The November 2006 letter explained what information and evidence was needed to substantiate a claim for service connection, as well as what information and evidence must be submitted by the Veteran, and what information and evidence would be obtained by VA. The letter also provided the Veteran with information pertaining to the assignment of disability ratings and effective dates, as well as the type of evidence that impacts those determinations, consistent with Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VA has also fulfilled its duty to assist in obtaining the identified and available evidence needed to substantiate the claims adjudicated in this decision. The RO has either obtained, or made sufficient efforts to obtain, records corresponding to all treatment for the claimed disorders described by the Veteran. Additionally, VA examinations and medical opinions were obtained in February 2012. The Board finds that the examination was thorough and adequate on which to base a decision in that they were based on physical examination, interview of the Veteran, and a review of her claims file. Overall, there is no evidence of any VA error in notifying or assisting the Veteran that reasonably affects the fairness of this adjudication. Service Connection Laws and Regulations Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). If certain diseases, such as arthritis, become manifest to a degree of 10 percent within one year of separation from active service, then it is presumed to have been incurred during active service, even though there is no evidence of such disease during service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. An alternative method of establishing the second and third elements of service connection for those disabilities identified as a "chronic condition" under 38 C.F.R. § 3.309(a) is through a demonstration of continuity of symptomatology. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). A claimant can establish continuity of symptomatology with competent evidence showing: (1) that a condition was "noted" during service; (2) post-service continuity of the same symptomatology; and (3) a nexus between a current disability and the post-service symptomatology. 38 C.F.R. § 3.303(b). Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In relevant part, 38 U.S.C.A. § 1154(a) requires that the VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim to disability or death benefits. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a 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." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed.Cir.2007). In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Id. at 1376-77; see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, supra (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted"). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107(b). The Board has reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Factual Background The Veteran contends that she has a right hip disability, arthritis of multiple joints and bilateral shin splint disabilities that were incurred during her military service. Specifically, in a January 2007 statement, the Veteran noted that she had received treatment in service as early as in basic training. She stated that she endured extreme conditions during field exercises and that she concurrently held many positions during her time in Germany. She indicated that she had suffered with chronic pain since she left the Army. Service treatment records reflect that in January 1978, the Veteran complained of bilateral shin pain. Physical examination revealed slight swelling. The impression was probable mild shin splints. In November 1978 the Veteran reported pain and swelling in her right knee. Physical examination revealed crepitation and swelling in the right knee and crepitation in the left knee without swelling. The Veteran was placed on profile for seven days. An April 1980 radiology report indicates that there was an old fracture at L4, but no displacement. In July 1981 the Veteran complained of pain in both legs of six months' duration. She noted that she ran two and a half miles five days per week, sometimes in boots. Shin splints were assessed. The provider noted that the Veteran was apparently angry when she left, and intimated that she would like to get out of the Army before her legs were "wrecked." The Veteran reported having low back pain in February 1983. She indicated that she had done some heavy lifting two months previously. Low back sprain was assessed. At that time, physical examination also revealed tenderness in the right hip, and bursitis was assessed. In March 1983 the Veteran complained of extreme low back pain, upper back pain, and knee pain. She stated that she had been thrown while horseback riding two years previously and had experienced pain since that time, to include in her right hip. The provider noted that the Veteran had been seen on numerous occasions for problems with no definite diagnosis. Physical examination revealed tenderness over the lumbosacral region, radiculitis in the right leg, and a positive straight leg raise at 40 degrees on the right. The assessment was low back pain with questionable sciatica. On follow-up in April 1983, the provider noted chronic low back pain. VA treatment records show that in June 1985 the Veteran complained of chronic back pain. In August 1985 she reported low back pain of four years' duration. The plan was to conduct an X-ray study and EMG study. The EMG was normal; the report of an X-ray study is not of record. On VA examination in September 1997, the Veteran presented with complaints of a history of a lumbar strain and arthralgia of the right hip. She reported hip pain since 1980 as a result of a lifting and falling. On examination, there were no positive findings. The Veteran had a normal range of motion of the hips. A private record dated in September 1998 notes that the Veteran had ill-defined body aches which were probably myofascial pain syndrome. Degenerative disc disease of the back was noted. The provider noted in October 1999 that the Veteran continued to have generalized body aches and pains. Low back syndrome was assessed, as well as generalized myalgias and arthralgias. In November 2001 a private provider noted that the Veteran had seen a rheumatologist and that she had fibromyalgia. Low back and right hip pain was noted in a July 2004 record. The Veteran reported that her right hip pain had bothered her for the past 20 years. In a November 2006 letter a private physician noted that the Veteran had been "plagued for many years by diffuse myalgias and arthralgias". The Veteran reported that during her time in the Army she was required to spend up to 6 months at a time under adverse conditions with poor nutrition and shelter. The physician noted that this "does appear to have contributed to her arthritic complaints". Per the January 2012 remand instructions, the Veteran underwent a VA examination in February 2012. The examiner noted that the Veteran suffered a hip/thigh contusion while in service in March 1980. The Veteran denied trauma at the time but reported that she sustained an injury to her low back due to running in her combat boots during the military. An interior facet fracture of L4 was noted on the March 1980 treatment note. The examiner also noted that in February 1983 she was seen for hip bursitis and in March 1983, she presented with reports of a right hip injury sustained after falling off of a horse. At the time, she was diagnosed with a hip contusion and low back pain. The examiner indicated that on examination in 1987, no back or hip condition was found and all issues were deemed resolved at the time. Since then, the Veteran has reported that she has had increased bilateral hip pain. She also had a hip arthrogram showing a labral tear. Additionally, the Veteran presented with generalized musculoskeletal pain in all the joints of the upper and lower extremities. She indicated that she had a diagnosis of fibromyalgia. The Veteran had a diagnosis of osteoarthritis of the right hip which was diagnosed in February 2011. A February 2011 MRI of the pelvis revealed a possible degenerate tear of the anterosuperior right acetabular labrum. The examiner noted that the Veteran had mild osteoarthritis of both hips and MRI evidence of a labral tear of the right hip. The examiner indicated that the labral tear may be caused by the degenerative arthritis in the right hip. The arthritis present was likely slowly progressing with time. The examiner opined that he did not find any significant injuries in the Veteran's service record to suggest that the Veteran's current hip condition was related to her military service. The examiner concluded that it was less likely than not that the Veteran's bilateral hip condition was caused by her military service. The examiner additionally noted that he did not believe that the Veteran's hip condition was related to her lumbar condition. The VA examiner also noted that the Veteran had a diagnosis of fibromyalgia which resulted in pain of the bilateral shoulders, hips, elbows, knees, wrists, ankles, hands/fingers and feet/toes. The examiner again noted that the Veteran had osteoarthritis of the hips but indicated that there has been no other x-ray confirmation which has diagnosed osteoarthritis of another joint. Regarding the Veteran's claimed bilateral shin splint disability, the examiner noted that the Veteran had a diagnosis of shin splints in November 1978. The examiner however concluded that in review of the Veteran's claims file, x-rays and the examination, there was no evidence of shin splints or any other knee or lower leg condition. In February 2012, the Veteran also underwent a VA arthritis/rheumatology consultation that was scheduled in regard to her claim of service connection for fibromyalgia. The treating physician noted that the Veteran had been diagnosed with fibromyalgia. The Veteran presented with complaints that she "hurt all over" as she had pain "everywhere in my bones". It was noted that over the years she had been treated for her chronic pain associated with fibromyalgia. Her range of symptoms included joint pain in the wrists, feet, hips, low back, shin splints, generalized pain, pain in the balls of her feet and tingling in her toes and fingertips. Her past medical history noted osteoarthritis of the thoracolumbar spine and feet. The diagnosis was a long history of fibromyalgia with active symptoms dating back to her service. It was noted that the Veteran currently had widespread musculoskeletal pain that was attributed to her fibromyalgia. Analysis Having carefully reviewed the record, the Board concludes that service connection is not warranted for the claimed arthritis of the right hip, arthritis of multiple joints and bilateral shin splint disabilities. A. Right hip With regard to establishing service connection for arthritis of the right hip on a presumptive basis under 38 U.S.C.A. §1112, the Board notes that there is no medical evidence of record indicating that the Veteran had a diagnosis of osteoarthritis of the right hip to a compensable degree within one year of discharge from active duty. Notably, the February 2012 VA examiner noted that the Veteran was initially diagnosed with osteoarthritis of the right hip in February 2011. The Veteran's September 1997 VA examination also noted no positive findings on examination of the right hip. Therefore, service connection for arthritis of the right hip cannot be granted on a presumptive basis under 38 U.S.C.A. § 1112. With regard to establishing service connection on a direct basis, regulations provide that service connection may be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. 3.303(d) (2012). There is a current diagnosis of degenerative joint disease of the right hip, the first element of service connection is satisfied. However, a veteran seeking disability benefits must establish not only the existence of a disability, but also an etiological connection between his military service and the disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); D'Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000); Hibbard v. West, 13 Vet. App. 546, 548 (2000). The Board notes that the Veteran's service treatment records demonstrate complaints of right hip pain. Notably, in February 1983, a physical examination revealed tenderness in the right hip, and bursitis was assessed. In March 1983 the Veteran stated that she had been thrown while horseback riding two years previously and had experienced pain since that time, to include in her right hip. The service treatment records however, were negative for any or diagnoses of any chronic right hip disorder as the right hip complaints were medically addressed in service, and appear to have been of an acute and transitory nature. While the Veteran had in-service complaints of right hip pain, there are no clinical findings or diagnoses of a right hip disability until many years after service as the first diagnosis of a right hip disability is the February 2011 diagnosis of right hip osteoarthritis. While the Veteran reported right hip pain prior to this diagnosis, the Board notes that pain is not analogous to disability. See Sanchez-Benitez v. West, 13 Vet. App. 282 (1999), appeal dismissed in part, and vacated and remanded in part sub nom. Sanchez-Benitez v. Principi, 259 F.3d 1356 (Fed. Cir. 2001) (holding that pain alone without a diagnosed or identifiable underlying malady or condition did not constitute a disability for which service connection may be granted). To the extent that the Veteran is asserting a continuity of symptomatology since service, the Board acknowledges that a layperson is competent to testify in regard to the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Caldwell v. Derwinski, 1 Vet. App. 466 (1991). Furthermore, lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (finding that the Board's categorical statement that "a valid medical opinion" was required to establish nexus, and that a layperson was "not competent" to provide testimony as to nexus because she was a layperson, conflicts with Jandreau). However, in this case, it must also be considered that service connection has been awarded for fibromyalgia. Diagnostic Code 5025 defines fibromyalgia as widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud's-like symptoms. A Note to Diagnostic Code 5025 provides that widespread pain means pain in both the left and right sides of the body, that is both above and below the waist, and that affects both the axial skeleton (i.e., cervical spine, anterior chest, thoracic spine, or low back) and the extremities. Given that fibromyalgia is manifested by widespread musculoskeletal pain, the Board finds that the question regarding the potential relationship between the Veteran's claimed continuous symptoms and her current right hip arthritis is unusually complex in nature. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). As such, the Board ascribes far more weight to the conclusions of the VA examiner who concluded that the Veteran's current right hip disability was not related to service. See Jandreau, 492 F.3d at 1377. The Board has considered the November 2006 letter, a private physician, which indicated that the Veteran reported adverse conditions during her military service that did "appear to have contributed to her arthritic complaints". The Board may favor the opinion of one competent medical professional over that of another so long as an adequate statement of reasons and bases is provided. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). An evaluation of the probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the examiner's knowledge and skill in analyzing the data, and the medical conclusion reached. The credibility and weight to be attached to such opinions are within the province of the Board as adjudicators. Guerrieri v. Brown, 4 Vet. App. 467 (1993). Greater weight may be placed on one physician's opinion over another depending on factors such as reasoning employed by the physicians and whether or not and the extent to which they reviewed prior clinical records and other evidence. Gabrielson v. Brown, 7 Vet. App. 36 (1994). The probative value of a medical opinion is generally based on the scope of the examination or review, as well as the relative merits of the expert's qualifications and analytical findings, and the probative weight of a medical opinion may be reduced if the examiner fails to explain the basis for an opinion. Sklar v. Brown, 5 Vet. App. 140 (1993). In this instance, the Board finds that the February 2012 VA examiner's opinion to be the most probative. Regarding the November 2006 private physician's opinion that the Veteran's reported adverse conditions during her military service "appear to have contributed to her arthritic complaints", the Board notes that such a qualifying statement supports the conclusion that the physician's opinion that "appears" that military service contributed to the disorder is no more than mere speculation. An examiner's opinion that a current disorder "could be" related to, or that there "may be" some relationship with, symptomatology in service makes the opinion of the examiner too speculative in nature and of little probative value. See Bostain v. West, 11 Vet. App. 124, 127-28, quoting Obert v. Brown, 5 Vet. App. 30, 33 (1993) (a medical opinion expressed in terms of "may" also implies "may or may not" and is too speculative to establish a causal relationship). See also Warren v. Brown, 6 Vet. App. 4, 6 (1993) (a doctor's statement framed in terms such as "could have been" is not probative). Additionally, no rationale was provided for this opinion and he did not provide any specific evidentiary or medical basis for the opinion. The Board notes that, in assessing evidence such as medical opinions, the failure of the physician to provide a basis for his opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). In contrast, the February 2012 VA examiner provided an unequivocal and detailed medical opinion supported by a pertinent rationale based upon a review of the Veteran's claims file and an examination of the Veteran, when concluding that the Veteran's claimed right hip disability was not related to the Veteran's service. Significantly, unlike the other physicians, the examiner noted that the Veteran's arthritis present was likely slowly progressing with time. The examiner also noted that he did not find any significant injuries in the Veteran's service record to suggest that the Veteran's current hip condition was related to her military service. For these reasons the Board finds the February 2012 VA examiner's assessment to be the most probative. Given that the most probative opinion is against a finding of a relationship between a right hip disability and service, the Board finds that service connection is not warranted. B. Arthritis of Multiple Joints and Shin Splints While the Veteran contends that she has arthritis of multiple joints and shin splints as a result of her service, the Board finds that service connection is not warranted as the Veteran has not been shown to have a current arthritis of multiple joints or shin splints disability. The Veteran's service treatment records demonstrate complaints of multiple joint pain and shin pain as well as a diagnosis of shin splints. However, the Veteran's current treatment records do not provide a diagnosis of arthritis of the multiple joints or shin splints. Notably, the February 2012 VA examiner noted that the Veteran presented with generalized musculoskeletal pain in all the joints of the upper and lower extremities. The examiner also noted that the Veteran had a diagnosis of fibromyalgia which resulted in pain of the bilateral shoulders, hips, elbows, knees, wrists, ankles, hands/fingers and feet/toes. However, the examiner determined that while the Veteran had osteoarthritis of the hips, that there had been no other x-ray confirmation which has diagnosed osteoarthritis of another joint. As detailed above, the Veteran's osteoarthritis of her hips has been addressed in a separate claim for service connection. Similarly, the examiner noted that while the Veteran also had a past medical history that included bilateral shin splints, after a review of the Veteran's claims file, x-rays and the examination, he determined that there was no evidence of shin splints or any other knee or lower leg condition. As noted above, the VA treatment records have demonstrated that the Veteran has been assessed with multiple joint pain. However, the Board again notes that mere pain, alone, without a diagnosed or identifiable underlying malady or condition does not in and of itself constitute a disability for which service connection may be granted. See Sanchez-Benitez , supra. Additionally, regarding the arthralgia complaints, arthralgia is defined as "pain in a joint." DORLAND'S ILLUSTRATED MEDICAL DICTIONARY, 152 (31st ed. 2007). In light of such definition, the Board finds that the notation of arthralgia is not competent evidence of a back disability. See Sanchez-Benitez, supra. The Board also notes that the February 2012 VA arthritis consultation noted that the Veteran's range of symptoms included joint pain in the wrists, feet, hips, low back, shin splints, generalized pain, pain in the balls of her feet and tingling in her toes and fingertips. It was also noted that her past medical history noted osteoarthritis of the thoracolumbar spine and feet. However, under the rating schedule, osteoarthritis must be demonstrated by X-ray examination. 38 C.F.R. §4.71a, Diagnostic Code 5003 (2012). The claims file contains no X-ray examinations which demonstrated osteoarthritis of the Veteran's feet and the February 2012 VA examiner again specifically determined that while the Veteran had osteoarthritis of the hips, that there had been no other x-ray confirmation which has diagnosed osteoarthritis of another joint. Regarding the range of symptoms which included shin splints, the Board notes that despite listing these symptoms, the February 2012 VA arthritis consultation did not provide a diagnosis regarding the Veteran's shins. Rather, the consultation merely diagnosed the Veteran with a long history of fibromyalgia with active symptoms dating back to her service while also noting that the Veteran currently had widespread musculoskeletal pain that was attributed to her fibromyalgia. Conversely, the February 2012 VA examiner specifically determined that the Veteran did not have a current diagnosis of bilateral shin splints. Accordingly, the medical evidence of record does not support a current diagnosis of the claimed arthritis of multiple joints or bilateral shin splints disability. Hence, whereas here, the competent evidence establishes that the Veteran does not have the disability for which service connection is sought, there can be no valid claim for service connection. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In the instant appeal, the claim for service connection for arthritis of multiple joints and bilateral shin splints must be denied because the first criterion for the grant of service connection-competent evidence of the disability for which service connection is sought-is not met. The Board does note that a diagnosis of arthritis of the left hip was confirmed on VA examination. However, that same VA examiner opined that he did not find any significant injuries in the Veteran's service record to suggest that the Veteran's current left hip condition was related to her military service. As discussed, the examiner concluded that it was less likely than not that the Veteran's bilateral hip condition was caused by her military service, or related to her lumbar condition. Thus, service connection for left hip arthritis is also not warranted. The Board again parenthetically notes that the Veteran has been granted service connection for fibromyalgia at the maximum rating of 40 percent. The Board also notes that the February 2012 arthritis consultation was a Fibromyalgia Benefits Questionnaire to specifically address the Veteran's fibromyalgia symptoms. As noted by the VA physician, the Veteran's complaints of multiple joint pain, to include shin pain, were all attributed to her fibromyalgia disability as the physician again noted that the Veteran currently had widespread musculoskeletal pain that was attributed to her fibromyalgia. Diagnostic Code 5025 defines fibromyalgia as widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud's-like symptoms. A Note to Diagnostic Code 5025 provides that widespread pain means pain in both the left and right sides of the body, that is both above and below the waist, and that affects both the axial skeleton (i.e., cervical spine, anterior chest, thoracic spine, or low back) and the extremities. Accordingly, the Board finds that the Veteran's complaints of musculoskeletal pain claimed as arthritis of multiple joints and bilateral shin splints have been encompassed by the criteria used to rate her service-connected fibromyalgia. In this regard, the rating schedule accounts for widespread musculoskeletal pain and tender points. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994) (the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition). As the preponderance of the evidence is against the claims, the benefit of the doubt rule is inapplicable. 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102 (2012). ORDER Entitlement to service connection for a right hip disability is denied. Entitlement to service connection for arthritis of multiple joints is denied. Entitlement to service connection for bilateral shin splints is denied. REMAND The Board finds that more development is necessary prior to final adjudication of the claims remaining on appeal. One of the matters the Board must address is which issue or issues are properly before it at this time. Under the provisions of 38 U.S.C.A. § 7105(a), an appeal to the Board must be initiated by a notice of disagreement and completed by a substantive appeal after a statement of the case is furnished to the veteran. In essence, the following sequence is required: There must be a decision by the RO, the veteran must express timely disagreement with the decision, VA must respond by explaining the basis of the decision to the veteran, and finally the veteran, after receiving adequate notice of the basis of the decision, must complete the process by stating his argument in a timely- filed substantive appeal. See 38 C.F.R. §§ 20.200, 20.201, 20.202, and 20.203. In a September 2012 rating decision, the RO granted service connection for fibromyalgia at a 40 percent disability rating and a lumbar strain at 10 percent disability rating, effective September 12, 2006. In a December 2012 letter, the Veteran indicated that he disagreed with the September 2012 decision as he felt that his effective date for the ratings should be in 1987 when he first applied for his claims. While the Veteran expressed disagreement with the September 2012 rating decision, it appears that no subsequent statement of the case was ever issued. Under Manlincon v. West, 12 Vet. App. 238, 240 (1999), the Board must instruct the RO that the issues of entitlement to an effective date earlier than September 12 2006, for service-connected fibromyalgia and a service-connected lumbar strain remain pending in appellate status (see 38 C.F.R. § 3.160(c)) and requires further action. See 38 U.S.C.A. § 7105; 38 C.F.R. § 19.26. In this regard, it is noteworthy that these claims are not before the Board at this time and will only be before the Board if the Veteran files a timely substantive appeal. The Board's actions regarding these issues are taken to fulfill the requirements of the Court in Manlincon. Accordingly, the case is REMANDED for the following action: The RO should issue a statement of the case to the Veteran addressing the matters of entitlement to an effective date earlier than September 12 2006, for service-connected fibromyalgia and entitlement to an effective date earlier than September 12 2006 for a service-connected lumbar strain, including citation to all relevant law and regulation pertinent to this claim. The Veteran must be advised of the time limit for filing a substantive appeal. 38 C.F.R. § 20.302(b). Then, only if the appeal is timely perfected, these issues are to be returned to the Board for further appellate consideration, if otherwise in order. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ MICHAEL LANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs