Citation Nr: 18144268 Decision Date: 10/25/18 Archive Date: 10/24/18 DOCKET NO. 14-40 948A DATE: October 25, 2018 ORDER Entitlement to service connection for rheumatic fever is denied. Entitlement to service connection for an ear condition, to include as secondary to rheumatic fever is denied. Entitlement to service connection for bilateral eye condition, to include as secondary to rheumatic fever is denied. Entitlement to a disability rating of 10 percent, but no higher, for service-connected chronic tonsillitis is granted. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of rheumatic fever or residuals 2. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of an ear condition. 3. The Veteran’s bilateral eye conditions are neither proximately due to nor aggravated by rheumatic fever, and are not otherwise related to an in-service injury, event, or disease. 4. The Veteran’s service-connected chronic tonsillitis manifested by symptoms equivalent to hoarseness with inflammation of cords or mucous. CONCLUSIONS OF LAW 1. The criteria for service connection for ear condition are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for rheumatic fever are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for bilateral eye condition are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 4. Entitlement to the criteria for a rating of 10 percent, but no higher, for chronic tonsillitis have not been met. 38 U.S.C. §§ 1155, 5107 (2015); 38 C.F.R. § 4.3, 4.7, 4.97, Diagnostic Code (DC) 6599-6516 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1959 to January 1961 in the United States Army. Service Connection 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 service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 1. Entitlement to service connection for an ear condition, to include as secondary to rheumatic fever is denied. The Veteran contends that he has an ear condition that is secondary to his in-service rheumatic fever. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of an ear condition and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The April 2013 VA examiner evaluated the Veteran and fond that, the Veteran denied any ear complaint and he did not have a diagnosis of any ear condition. Further, despite VA treatment from March 2012 to June 2018, VA treatment records do not contain a diagnosis of any ear condition. Additionally, the Veteran has characterized his ear condition claim as stemming from his in-service diagnosis of rheumatic fever. However, as discussed below the rheumatic fever is not entitled to service connection and therefore the Veteran is not entitled to a grant of secondary service connection for any disability on this basis.   2. Entitlement to service connection for rheumatic fever is denied. The Veteran contends that his in-service diagnosed rheumatic fever is entitled to service connection. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease, specifically rheumatic fever. The Board concludes that the Veteran does not have a current active diagnosis of rheumatic fever or any residuals attributable to his in-service rheumatic fever and has not had such at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The April 2013 VA examiner evaluated the Veteran and determined that, while he was diagnosed and treated for rheumatic fever during active duty, he did not have any currently active diagnosis of rheumatic fever or residuals attributable to rheumatic fever. Further, despite treatment from March 2012 to June 2018, VA treatment records do not contain a diagnosis of any rheumatic fever or associated residuals. The Board is cognizant of the fact that the Veteran was treated for rheumatic fever while on active duty service and service connection has been granted for rheumatic heart disease. However, the STRs also indicate that the condition was acute and treated successfully. While the Veteran believes his rheumatic fever warrants service connection he does not have a current diagnosis of rheumatic fever or associated residuals and he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. 3. Entitlement to service connection for bilateral eye condition, to include as secondary to rheumatic fever. The Veteran contends that he has a bilateral eye condition that is caused or aggravated by rheumatic fever diagnosed in-service. As noted above the Veteran has maintained a claim of entitlement to service connection for rheumatic fever and has therefore sought service connection on a secondary basis to that condition. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or is aggravated by service-connected disability. As stated above the Board has found that rheumatic fever is not entitled to service connection and therefore the Veteran is precluded from seeking service connection for bilateral eye condition on a secondary basis to rheumatic fever. The Veteran has not claimed that any bilateral eye condition is secondary to a currently service-connected disability. Service connection may also be granted on a direct basis, but the preponderance of the evidence is also against finding that the Veteran’s bilateral eye condition is related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). However, the April 2013 VA examiner, an optometrist, opined that the Veteran’s bilateral eye condition is not at least as likely as not related to an in-service injury, event, or disease, including in-service rheumatic fever. The rationale was that the Veteran’s diagnosed eye conditions are only age related ocular changes. The VA examiner further opined that the cataracts, the primary diagnosed eye condition, specifically were not related to in-service rheumatic fever because the left eye cataract is age related and the right eye cataract was removed, therefore etiology was impossible to determine. While the Veteran believes his bilateral eye condition is related to an in-service injury, event, or disease, including rheumatic fever, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the opinion of the April 2013 VA examiner. 4. Entitlement to a disability rating of 10 percent, but no higher, for service-connected chronic tonsillitis Disability evaluations are determined by the application of the Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can practicably be determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual disorders in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1. When a question arises as to which of two ratings applies under a particular DC, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. Otherwise, the lower rating will be assigned. Id. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). VA regulations provide that when an unlisted condition is encountered, it is permissible to rate under a closely related disease or injury in which the functions affected, anatomical localization, and symptomatology are closely analogous. 38 C.F.R. § 4.20. As such, the Veteran’s chronic tonsillitis has been rated as most equivalent to chronic laryngitis, pursuant to 38 C.F.R. § 4.97, DC 6516. In rating by analogy not every element is required to be shown; requiring such would make rating by analogy pointless. See Wilkins v. McDonald, 2015 U.S. App Vet Claims Lexis 1729. Any reasonable doubt regarding the degree of disability is resolved in favor of the claimant. 38 C.F.R. § 4.3. Under DC 6516, chronic laryngitis manifested by hoarseness with inflammation of cords or mucous membrane is rated as 10 percent disabling. Chronic laryngitis manifest by hoarseness, with thickening or nodules of cords, polyps, submucous infiltration or pre-malignant changes on biopsy warrants a 30 percent rating. The Veteran underwent a VA examination in January 2016 for his service-connected chronic tonsillitis. The VA examiner assessed the Veteran’s condition as chronic laryngitis finding that the condition manifests with hoarseness, however the VA examiner did not indicate the frequency. The Board finds that, affording the Veteran the benefit of the doubt, his chronic tonsillitis more closely approximates the criteria for a 10 percent rating for the period on appeal. Symptoms of hoarseness are clearly demonstrated on the Veteran’s October 2016 VA examination and while these symptoms are not noted on the April 2013 VA examination the Board notes that this appears likely due to the examiner’s failure to assess the condition as analogous to the criteria for chronic laryngitis. While there is no objective evidence of inflammation of cords or mucous membrane the Board finds that this evidence is not necessary due to the rating by analogy. 38 C.F.R. § 4.20. The Veteran is not, however, entitled to a rating more than 10 percent as there is no evidence of chronic laryngitis manifest by hoarseness, with thickening or nodules of cords, polyps, submucous infiltration or pre-malignant changes on biopsy. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P.S. McLeod