Citation Nr: 18147253 Decision Date: 11/02/18 Archive Date: 11/02/18 DOCKET NO. 16-19 394 DATE: November 2, 2018 ORDER Entitlement to service connection for muscle and joint pain, to include as due to an undiagnosed illness or medically unexplained chronic multi-symptom illness, is denied. FINDINGS OF FACT 1. The Veteran served in the Southwest Asia Theater of operations during the Persian Gulf War Era. 2. The Veteran's claimed chronic muscle and joint pain is not shown to be a chronic qualifying disability, and is not shown to be etiologically related to his service. CONCLUSION OF LAW The criteria for service connection for muscle and joint pain have not been met. 38 U.S.C. §§ 1110, 1117, 1130, 1154, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.317 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from November 2001 to May 2003 and from August 2006 to August 2008, including service in the Southwest Asia Theater of Operations. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran also initiated appeals of the RO’s June 2013 denial of entitlement to service connection for shortness of breath and for a right shoulder disability, but he did not perfect an appeal of these issues when he filed his substantive appeal (VA Form 9) in April 2016. 38 C.F.R. 20.200. He additionally initiated an appeal of the RO’s June 2013 denial of entitlement to service connection for headaches, but the RO subsequently granted this claim in April 2016. Accordingly, this matter is no longer on appeal. See AB. Brown, 6 Vet. App. 35, 38 (1993). Service Connection – Chronic Muscle and Joint Pain Aside from the Veteran’s complaints of leg pain in October 2006 and February 2007 which were diagnosed as shin splints, his service treatment records are devoid of complaints and treatment for muscle and joint pain. Indeed, he denied having joint pain on a July 2008 post-deployment assessment form. At a May 2013 VA examination, the Veteran reported that the onset of these symptoms, which primarily affected his legs and knees, was in 2008. He described the symptoms as intermittent pain. He also noted that he did not seek treatment for those symptoms during service or after service. He attributed the symptoms to his exposure to environmental hazards while serving in the Persian Gulf. Despite the Veteran’s assertions, there are no objective signs or symptoms of a qualifying chronic disability manifested by muscle and/or joint pain. In this regard, a VA examiner diagnosed the Veteran in May 2013 as having bilateral patellofemoral syndrome. That diagnosis does not meet the criteria for a qualifying chronic disability since it is a known diagnosis. Also, there were no other pertinent findings at the May 2013 VA examination and the May 2013 VA examiner reported that the Veteran had a normal muscle examination. In terms of non-medical indicators of an undiagnosed illness or medically unexplained chronic multi-symptom illness, such indicators include evidence of time lost from work, the veteran having sought treatment for his symptoms, and changes in the veteran's appearance, physical abilities, and mental or emotional attitude. Joyner v. McDonald, 766 F.3d 1393, 1395 (Fed. Cir. 2014); 38 C.F.R. § 3.317 (a)(1) and (3). As noted, the Veteran reported in May 2013 that he had not sought medical treatment for his symptoms. Accordingly, service connection for the claimed muscle and joint pain disability on a presumptive basis (as an undiagnosed illness/medically unexplained chronic multi-symptom illness under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317) is not warranted. Regarding service connection for a disability manifested by muscle and joint pain on a direct basis, the weight of evidence is against the claim. As noted, the May 2013 VA examiner diagnosed the Veteran as having bilateral patellofemoral syndrome. He went on to opine that the claimed muscle and joint pain was less likely than not (less than 50% probability) incurred in or caused by the claimed inservice event of injury. He explained that based on clinical experience and rationale, the Veteran’s “muscle and joint pain (knee)” was not established as a chronic condition while on active duty and there is no evidence of treatment for the condition within a reasonable period of time after active duty. The Board acknowledges the Veteran's statements regarding his belief that his post-service symptoms of muscle and joint pain, particularly in the lower extremities, are due to exposure to hazards while serving in the Persian Gulf. While he is competent to report his symptoms, he is not shown to have the medical expertise to determine the nature and etiology of his symptoms, to include whether they are due to exposure to environmental hazards in Southwest Asia. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). On those points, the May 2013 medical opinion is more probative. The Board has also considered the Veteran’s assertions in his April 2016 substantive appeal that the May 2013 examination report is inadequate because the examination had been conducted while he was incarcerated and he had been physically restrained for parts of the examination. However, the examination report contains adequate findings with respect to the Veteran’s muscle and joints, and there is nothing to suggest that the findings are inaccurate. Also, the Board does not agree with the Veteran’s representative’s argument in August 2018 that the May 2013 examination report is too old for rating purposes. The May 2013 VA examiner had the available evidence before him at the time he rendered his etiological opinion, to include the Veteran’s service treatment records, reported date of onset of symptoms, and available post-service medical and lay evidence. There is no indication of the existence of pertinent evidence dated after May 2013 that has not yet been obtained. 38 U.S.C. 5103A. Moreover, the practice of affording a veteran a new and contemporaneous examination based on stale findings generally arises in claims for increased ratings. See Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992). (CONTINUED ON NEXT PAGE) In light of the foregoing, the Board concludes that the preponderance of the evidence is against the claim of entitlement to service connection muscle and joint pain, to include as due to an undiagnosed illness or medically unexplained chronic multi-symptom illness. Accordingly, the appeal in this matter is denied. 38 U.S.C. § 5107 (b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Shawkey, Counsel