Citation Nr: 1321497 Decision Date: 07/03/13 Archive Date: 07/12/13 DOCKET NO. 05-22 954 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to service connection for arthralgia/arthropathy. 2. Entitlement to service connection for a left arm disability. 3. Entitlement to service connection for tendonitis. 4. Entitlement to service connection for a bilateral ankle disability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD J. N. Moats, Counsel INTRODUCTION The Veteran served on active duty from June 1995 to March 1996. This matter comes to the Board of Veterans' Appeals (Board) on appeal from September 2004 and October 2010 rating decisions by the Regional Office (RO) of the Department of Veterans Affairs (VA) in Montgomery, Alabama. The September 2004 rating decision denied service connection for a bilateral ankle disability. The Veteran presented testimony at a Board hearing in March 2010 with respect to this issue. A transcript of the hearing is associated with the Veteran's claims folder. Subsequently, the Board remanded this issue for further development in August 2010. In an October 2010 rating decision, the RO denied the remaining issues on appeal, which the Veteran appealed. However, in his substantive appeal, the Veteran did not request a Board hearing with respect to these issues. In October 2012, the Board remanded these issues as well as the issue of service connection for bilateral ankle disability for further development. The Veteran submitted additional evidence in May 2013. However, this evidence consisted of copies of his service treatment records that were already associated with the claims file and considered by the RO. As these records are duplicative, waiver of RO consideration of this evidence is not necessary. 38 C.F.R. § 20.1304(c). Moreover, earlier in May 2013, the Veteran signed a statement waiving RO consideration of any future evidence submitted. The Veteran's Virtual VA electronic record has also been reviewed and considered in conjunction with the current claim. In July 2012, the Veteran filed a statement requesting review of all of his disabilities. He also included applications for automobile or other conveyance and adaptive equipment and specially adapted housing or special home adaptation grant. It does not appear that these matters have been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over them, and they are referred to the AOJ for appropriate action. The issues of entitlement to service connection for tendonitis and a bilateral ankle disability 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. The Veteran does not currently have a multi-joint disability described as arthralgia/arthropathy for purposes of service connection. 2. Service connection for status post fractured left clavicle has been established. 3. The Veteran does not have a separate and distinct left arm disability from his already service-connected status post fractures left clavicle that is causally or etiologically related to any disease, injury, or incident in service, and any arthritis did not manifest within one year of the Veteran's discharge from service. CONCLUSIONS OF LAW 1. The criteria for service connection for arthralgia/arthropathy have not been met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1116, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2012). 2. The criteria for service connection for a left arm disability, separate and distinct from the already service-connected status post fractured left clavicle, have not been met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1116, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VA's Duties to Notify and Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012). Proper notice from VA must inform the claimant of any information and medical or lay 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. 38 C.F.R. § 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183 (2002). In addition, the notice requirements of the VCAA apply to all elements of a service-connection claim, including: (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). Further, this notice must include information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. at 486. VCAA notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). Where complete notice is not timely accomplished, such error may be cured by issuance of a fully compliant notice, followed by readjudication of the claim. See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); see also Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (the issuance of a fully compliant VCAA notification followed by readjudication of the claim, such as a statement of the case or supplemental statement of the case, is sufficient to cure a timing defect). With respect to the issues being decided herein, the Veteran was sent a letter in March 2010 that fully addressed all notice elements and was sent prior to the initial RO decision in this matter. The letter provided information as to what evidence was required to substantiate the claims and of the division of responsibilities between VA and a claimant in developing an appeal. Moreover, the letter informed the Veteran of what type of information and evidence was needed to establish a disability rating and effective date. Accordingly, no further development is required with respect to the duty to notify. Next, VA has a duty to assist the Veteran in the development of the claim. This duty includes assisting him in the procurement of service treatment records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the appellant. See Bernard v. Brown, 4 Vet. App. 384 (1993). In this regard, the claims file contains the Veteran's service treatment records, post-service reports of VA treatment, Social Security Administration (SSA) records and VA examinations reports. The record shows that the RO has requested all identified private treatment records and either received such records or negative responses from the providers. Virtual VA includes additional VA treatment records dated through April 2013 that were considered by the RO in the most recent supplemental statement of the case issued in May 2013. Furthermore, the Veteran's statements in support of the claims decided herein are of record. The Board has carefully reviewed such statements and concludes that no available additional outstanding evidence has been identified. The Board has also perused the medical records for references to additional treatment reports not of record, but has found nothing to suggest that there is any outstanding evidence with respect to the Veteran's claim. The Board observes that in Bryant v. Shinseki, 23 Vet. App. 488 (2010), the United States Court of Appeals for Veterans Claims (Court) held that 38 C.F.R. 3.103(c)(2) (2012) requires that any Veterans Law Judge who chairs a hearing fulfill two duties to comply with the VCAA. These duties consist of (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. Bryant, 23 Vet. App. at 488. Although the Veteran did testify at a Board hearing in March 2010, the hearing did not address the issues being decided herein and he did not request a hearing with respect to these issues. Thus, no further analysis with respect to Bryant is necessary at this time. For the above reasons, no further notice or assistance to the appellant is required to fulfill VA's duty to assist the appellant in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd, 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). Finally, the Board finds that there was substantial compliance with the October 2012 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 (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 in October 2012 directed the AOJ to obtain additional VA treatment records and to schedule the Veteran for a VA examination. As noted above, additional VA treatment records were associated with the Veteran's Virtual VA record and the Veteran was afforded a VA examination in April 2013. As the April 2013 VA examination was prepared by a competent clinician who considered the Veteran's claims file and medical history in the report and provided an etiological opinion, complete with rationale, the Board finds that the is adequate to adjudicate the Veteran's claims decided herein. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007); Ardison v. Brown, 6 Vet. App. 405, 407 (1994); Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Accordingly, the Board finds that there has been substantial compliance with the prior Board remand directives and, therefore, no further remand is necessary. See Stegall, supra; D'Aries, 22 Vet. App. at 104 (2008). Analysis 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 may also be granted for any disease 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). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. 38 U.S.C.A. § 1112; 38 C.F.R. § 3.304. See also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. Additionally, for Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, such as arthritis, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki 708 F.3d 1331 (Fed. Cir. 2013). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Arthralgia/Arthropathy The Veteran is seeking service connection for arthralgia/arthropathy of multiple joints. Service treatment records failed to contain any findings attributed to arthralgia/arthropathy. Shortly after his discharge from service, the Veteran filed a claim in October 1996 for residuals of left clavicle fracture and he was afforded a VA examination in November 1996. There was no mention of multi-site joint pain in either the claim or at the examination. Post service VA treatment records showed that a November 2001 physical evaluation showed full range of motion and 2+ reflexes as well 5/5 strength throughout. However, VA treatment records reflect that approximately in August 2003, the Veteran complained of multi-joint pain. An assessment during this period also showed a history of degenerative joint disease. He reported arthralgia in early 2004; and that in February 2004, the Veteran was assessed with arthropathy of the left shoulder. In June 2004, the Veteran was afforded a VA joint examination with respect to his left shoulder, ankles and knees. The examiner diagnosed previous clavicle fracture, bilateral knee patella spur (patellofemoral syndrome) and bilateral ankle strain. However, no other joints were addressed. A June 2004 treatment record showed an evaluation of arthropathy of the left shoulder region and degenerative joint disease of the bilateral knees and ankles. Interestingly, another June 2004 VA treatment record gave an assessment of questionable malingering. SSA records showed the Veteran was considered disabled since November 2004 primarily due to his psychiatric disabilities. In November 2006, the Veteran was afforded another VA examination with respect to his left shoulder, ankles and knees. The examiner diagnosed left shoulder clavicular fracture, bilateral knee strain and bilateral ankle sprain. However, again, no other joints were addressed. Subsequent March 2007 treatment records showed that the Veteran again reported constant pain radiating in the left arm, ankles and knees as well as the back. The assessment was myofascial pain. In an August 2007 record, the assessment was again myofascial pain syndrome and the examiner also noted that the Veteran did not have degenerative joint disease. However, a January 2008 VA treatment record showed that on physical examination, his extremities and neurological system were unremarkable. However, the impression observed that the Veteran had a history of multi-system illness including degenerative joint disease, arthralgia, arthropathy, osteoarthritis and the like. Again, in June 2008, the Veteran reported having muscle spasms and body ache all over for about six months. A January 2009 record showed that the Veteran was still complaining of pains in the back, ankles, shoulder and knees. It was noted that the Veteran had a history of arthritis of the different joints. The problem list in pertinent part included degenerative joint disease, arthralgia, arthropathy involving the shoulder region, generalized osteoarthrosis, neck pain, knee pain, ankle pain and Achilles tendonitis. The Veteran was afforded a VA examination in November 2011 for his cervical spine, left shoulder/arm, knees and ankles. An addendum in May 2012 confirmed that the Veteran's claims file was reviewed in conjunction with the examination. However, again, no other joints were addressed. On remand, the Veteran was afforded another VA examination in April 2013 to specifically address the Veteran's claim for arthralgia/arthropathy. The claims file was reviewed. The Veteran reported pain the right shoulder, but denied any specific treatment. After examining the Veteran, the examiner found no impairment of the right shoulder. Moreover, although the Veteran reported generalized bilateral wrist, elbow and hip pain, the examiner also found no impairment with respect to these joints. Contemporaneous x-rays of the right shoulder, bilateral wrists and bilateral hips were all normal. In turn, the examiner determined that the claimed arthralgia/arthropathy was less likely than not incurred in or caused by the claimed in-service injury, event or illness. With respect to the right shoulder, bilateral elbows, bilateral wrists and bilateral hips, there was no specific impairment related to these joints on examination. The examiner also observed that subsequent lab testing was negative, including hepatitis profile, rheumatoid testing, and SED rate. Based on the above, the examiner determined that there was no evidence of underlying pathology to account for the Veteran's nonspecific, subjective symptoms. Moreover, the examiner was unable to create a link between the Veteran's subjective complaints and his previously military service or fall that resulted in a left clavicle fracture in 1995. The examiner provided that the Veteran's contention was not substantiated by any documentation and previously stated mechanism of injury (i.e. how would a fall to the left shoulder effect multiple joints on the right side of the body?). Initially, the Board observes that the Veteran is already service-connected for cervical strain, status post fractured left clavicle and bilateral knee patella spur and any claims associated with these disabilities are not currently before the Board. Moreover, any additional disabilities associated with the left arm are addressed below and any bilateral ankle disabilities are addressed in the Remand portion of this decision. Accordingly, this decision primarily addresses the remaining joints, specifically the right shoulder, bilateral elbows, bilateral wrists and bilateral hips. Based on a thorough review of the evidence, the Board finds that there is no evidence of a multi-joint disability described as arthralgia/arthropathy for which VA compensation may be awarded. Service treatment records are silent with respect to any objective findings of multi-join pain diagnosed as a chronic disability. There is also no evidence of arthritis of these joints within one year of discharge. Further, while VA treatment records showed various assessments of degenerative joint disease, arthropathy and osteoarthrosis, these assessments were either made in connection with the Veteran's left shoulder, knees or ankles or were primarily based on the Veteran's reported history as opposed to physical and x-ray evidence. Importantly, after thoroughly examining the Veteran and reviewing the claims file, the April 2013 VA examiner found that there was no objective evidence of any impairment of the right shoulder, hips, elbows and wrists. It was also noted that lab results were all negative. Again, contemporaneous x-rays of these joints were also negative. The Court has indicated that in the absence of proof of a present disability, there can be no valid claim for service connection; an appellant's belief that he or she is entitled to some sort of benefit simply because he or she had a disease or injury while on active service is mistaken, as Congress has specifically limited entitlement to service connection to cases where such incidents have resulted in a disability. Brammer v. Derwinski, 3 Vet. App. 223 (1992). The board observes that arthralgia simply refers to pain, which cannot be service connected in the absence of an underlying disability. Pain alone, without a diagnosed or identifiable underlying malady or condition does not in itself constitute a disability for which service connection may be granted. See Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999), aff'd sub nom. Sanchez-Benitez v. Principi, 259 F. 3d 1356 (Fed. Cir. 2001) The Board acknowledges that lay assertions may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C.A. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). Citing Buchanan and Jandreau, the Federal Circuit reiterated that it had previously and explicitly rejected the view that competent medical evidence is required when the determinative issue in a claim for benefits involves either medical etiology or a medical diagnosis. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). In the instant case, the Veteran is competent to report in-service injuries and describe pertinent symptomatology since service. While the Veteran can describe symptoms, he is not competent to diagnosis a chronic multi-joint disability. Given that lab work, x-rays and a thorough medical examination is necessary to diagnosis such a disability and determine the causation of any such disability, the Board finds that medical experience is required to diagnose and link any multi-joint disability to service in the instant case and that the Veteran has not shown that he has such experience. In this regard, the question of whether the Veteran suffers from a current chronic disability involving multiple joints involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, this case may not be competently addressed by lay evidence, and the Veteran's own opinion is nonprobative evidence. See Davidson, supra; Jandreau, supra; see also Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Moreover, any lay evidence of pertinent symptomatology since service cannot be used to establish service connection as the Veteran has not been diagnosed with one of the diseases, i.e. arthritis, listed at 38 C.F.R. § 3.309(a). See Walker, cited above. For these reasons, a preponderance of the evidence is against the Veteran's claim for service connection for arthralgia/arthropathy. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C.A. § 5107(b). Left Arm Disability The Veteran is also seeking service connection for a left arm disability. Service treatment records document that the Veteran fractured his left clavicle in September 1995 when he fell while playing football. A nerve conduction study done the following month for the left arm was negative. In December 1995, he was diagnosed with a left shoulder strain and again in January 1996, it was observed that he reinjured his shoulder in December 1995 lifting a tool box. He subsequently underwent physical therapy and was discharged in March 1996. After service, in November 1996, the Veteran was afforded a VA examination to address the severity of his left shoulder. Musculoskeletal abnormalities were observed on examination in association with the injury. However no neurological deficits were found. A contemporaneous x-ray showed old healed fracture midshaft left clavicle. After examining the Veteran, the examiner diagnosed residuals of fractured left clavicle with deformity, non-aligned. Subsequent VA treatment records showed continuing complaints of left shoulder pain and an assessment of arthralgia and status post fracture of left clavicle. A September 2000 record observed that the Veteran reported pain and radicular symptoms into the left arm. However, reflexes were intact, sensation was intact to light touch and strength was 5/5. Follow up treatment records continued to show complaints of left shoulder pian that was attributed to old clavicular fracture. The Veteran underwent another VA examination in December 2000. Again, sensory examination was grossly normal and strength was 5/5. The assessment was history of left clavicle fracture with ongoing discomfort and mildly decreased range of motion. A June 2004 VA examination again noted pain and range of motion restrictions of the left arm. Arm strength again was 5/5 and sensation was intact. The assessment was previous clavicular fracture with mild to moderate impairment. Another VA examination in November 2006 basically reported the same findings except left shoulder impingement was observed. Follow up x-rays continued to show healed fracture of the left clavicular, otherwise normal shoulder. Follow up treatment records continue to show reports of left shoulder/arm pain. As noted above, SSA records showed that the Veteran was receiving disability benefits for his psychiatric disabilities. An October 2011 VA examination also found no sensory deficits and clearly indicated that there was no radiculopathy associated with the Veteran's cervical spine disability. Deep tendon reflexes were also normal. A contemporaneous MRI showed an impression of healed clavicle fracture and small tear to the supraspinatus tendon. The examiner diagnosed left shoulder strain, status post left clavicle fracture and small tear to distal end of supraspinatus tendon. The examiner opined that the left shoulder and cervical disabilities were related to the left shoulder injury in service. However, in the October 2012 remand, the Board determined that another examination was needed because it was unclear based on the evidence of record whether the Veteran's symptoms were due to his already service-connected left shoulder disability or whether the Veteran had an additional disability of the left arm. The Veteran underwent another VA examination in April 2013. The Veteran reported injuring his left shoulder in service and reported constant pain. Functional impairment, including any restrictions on range of motion, was observed on physical examination. The Veteran reported problems driving for extended periods of time, but had no problems lifting. The examiner diagnosed left clavicle fracture (healed) and left shoulder tendonitis. The examiner determined that any additional left arm/shoulder disability was less likely than not incurred in or caused by the claimed in-service injury, event or illness. In proffering this opinion, the examiner observed that the Veteran's service treatment records showed that he was treated for a left clavicular fracture, but there was no evidence of treatment or diagnosis regarding his left shoulder joint while on active duty. The examiner continued that there was no evidence of chronic problems with the left shoulder joint (including tendons and ligaments) while on active duty. The examiner concluded that he was unable to create a link between the Veteran's current left shoulder condition and his service-connected left clavicular fracture (now healed) that occurred in 1995. Again, the Veteran is already service-connected for his left clavicular fracture and in the prior October 2012 decision, the Board determined that a rating in excess of 10 percent was not warranted under the rating criteria for limitation of motion of the arm as well any dislocation or nonunion of the clavicle. Accordingly, after considering the totality of the evidence of record, the Board finds that service connection for any separate left arm disability is not warranted as there is no competent evidence linking any separate disability to the injury in service, and no evidence of arthritis within one year of service. Importantly, after examining the Veteran and reviewing the claims file, the April 2013 VA examiner clearly found that any separate disability was not related to the injury in service and provided a detailed rationale for this opinion. Moreover, as discussed above, while the Veteran is competent to report in-service injuries and pertinent symptomatology since service, he is not competent to directly link any current disability to service as medical expertise is required. In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's own opinion is nonprobative evidence. See Davidson, supra; Jandreau, supra; see also Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). While the Veteran can report left shoulder pain, he is not competent to link that shoulder pain to a specific internal process as medical expertise is required. In other words, the Veteran cannot determine whether his current symptoms are attributed to his already service-connected left shoulder disability or to another distinct disability of the left arm. Moreover, the Board observes that the United States Court of Veterans Appeals (Court) had determined that the rating schedule may not be employed as a vehicle for compensating a claimant twice (or more) for the same symptomatology; such a result would overcompensate the claimant for the actual impairment of his earning capacity and would constitute pyramiding of disabilities, which is cautioned against in 38 C.F.R. § 4.14. Essentially, under the anti-pyramiding provision of 38 C.F.R. § 4.14, (2012), the evaluation of the "same disability" or the "same manifestation" under various diagnoses is to be avoided. The Court held, in Esteban v. Brown, 6 Vet. App. 259 (1994), that for purposes of determining whether the appellant is entitled to separate ratings for different problems or residuals of an injury, such that separate evaluations do not violate the prohibition against pyramiding, the critical element is that none of the symptomatology for any one of the conditions is duplicative of or overlapping with the symptomatology of the other two conditions. In the instant case, the medical evidence clearly shows that the Veteran's primary symptoms of pain and functional limitations are currently being compensated for his service-connected residuals of clavicular fracture. To award a separate rating based on the same symptomatology would be pyramiding. The Board recognizes that the Veteran has reported separate symptoms of numbness and tingling down the arm. However, no neurological deficits have been found on objective examination. Motor strength, reflexes and sensory examination have all been normal. Moreover, the April 2011 VA examiner clearly found no radiculopathy associated with the Veteran's cervical spine disability. In sum, there has been no objective findings of a separate neurological disability of the left arm. Again, in the absence of proof of a present disability, there can be no valid claim for service connection; an appellant's belief that he or she is entitled to some sort of benefit simply because he or she had a disease or injury while on active service is mistaken, as Congress has specifically limited entitlement to service connection to cases where such incidents have resulted in a disability. See Brammer v. Derwinski, 3 Vet. App. 223 (1992). Moreover, for the same reasons discussed above, the Veteran is not competent himself to diagnose a separate neurological disability as medical expertise is required. In conclusion, based on the analysis above, the Board finds that the preponderance of evidence is against the Veteran's claim for service connection for a separate left arm disability. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C.A. § 5107(b). ORDER Service connection for arthralgia/arthropathy, is denied. Service connection for left arm disability, is denied. REMAND The Veteran is also seeking service connection for tendonitis and a bilateral ankle disability. The Board will address these disabilities together as they are closely related to (and may even be one and the same). Although the Board regrets further delaying appellate review, based upon review of the record, the Board finds additional development is necessary. As directed in the October 2012 remand, the Veteran was afforded a VA examination in April 2013 to address the etiology of these disabilities. The examiner opined that the Veteran's disabilities were less likely as not caused by or a result of an event noted in service or aggravated by service-connected condition. It appears that the examiner's opinion primarily relied on the mistaken facts that there was no documentation in the service treatment records with respect to the ankle and no current diagnosis with respect to the ankles as well as no objective findings of Achilles tendonitis. However, a July 1995 treatment record showed complaints of ankle pain, which the VA examiner failed to address. Moreover, a June 2004 VA examination showed an assessment of bilateral ankle strain with mild impairment secondary to pain. A contemporaneous x-ray als0 showed that while the ankles were within normal limits, there was prominence of the OS trigonum. An assessment in the VA treatment records showed mild degenerative joint disease with crepitus of the ankles. Another July 2004 treatment record indicated that x-rays showed mild to moderate signs of osteoarthritis of the ankles. A November 2006 VA examination also showed an assessment of bilateral ankle sprain. Further, a January 2008 VA treatment record observed a history of Achilles tendinitis. A June 2009 treatment record listed Achilles tendonitis on the problem list. In sum, the Veteran has been diagnosed with various ankle disabilities throughout the course of the appeal. The Board observes that the requirement of a current disability is satisfied when the claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim, and that a claimant may be granted service connection even though the disability resolves prior to adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Thus, the VA examiner must address these previously diagnosed disabilities. The Court has held that a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Moreover, once VA undertakes the effort to provide an examination for a service connection claim, even if not statutorily obligated to do so, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided). Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Accordingly, given the deficiencies described above in the April 2013 VA examination report and in order to comply with the Board's prior remand, the Board finds that the claims file should be returned to the April 2013 VA examiner for an addendum opinion. If the same examiner is not available, then the Veteran should be afforded a new examination. See Stegall v. West, 11 Vet. App. 268 (1998). Lastly, the Veteran's Virtual VA electronic record includes VA treatment records dated from April 2013. As VA medical records are constructively of record and must be obtained, the AOJ should obtain VA treatment records dated from April 2013 to the present. See 38 C.F.R. § 3.159; Bell v. Derwinski, 2 Vet. App. 611 (1992). Accordingly, the case is REMANDED for the following action: 1. Associate all VA treatment records from April 2013 to present with the record. 2. After obtaining any outstanding treatment records, the claims file should be returned to the VA examiner who conducted the April 2013 VA examination. If the same examiner is not available, the Veteran should be scheduled for another appropriate VA examination with an orthopedist to determine the etiology of his bilateral ankle disorder. It is imperative that the claims file be made available to the examiner for review in connection with the examination, to specifically include these remand instructions. After reviewing the claims file, the examiner should offer an opinion as to the following: a) Whether at any point during the course of the appeal has the Veteran had a chronic left or right ankle disability, including Achilles tendonitis. In making this determination, the examiner should specifically address the prior treatment records showing various ankle disabilities, including chronic sprains, strains, arthritis and Achilles tendonitis. If so, the examiner should also respond to the following question with respect to any diagnosed disability. b) Whether it is at least as likely as not (a 50% or higher degree of probability) that any bilateral ankle disabilities are causally related to the Veteran's service. A detailed rationale for all opinions expressed should be provided. The examiner should specifically address the Veteran's service treatment records documenting ankle pain in service, lay evidence concerning symptoms in service that have continued to the present and medical evidence showing current ankle disabilities. 3. In the interest of avoiding future remand, the RO should then review the examination report to ensure that the above questions have been clearly answered and a rationale furnished for all opinions. If not, appropriate action should be taken to remedy any such deficiencies in the examination report. 4. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issues on appeal should be readjudicated based on the entirety of the evidence. If the issues remain denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. 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). [CONTINUED ON NEXT PAGE] 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). ______________________________________________ MARJORIE A. AUER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs