Citation Nr: 18148465 Decision Date: 11/07/18 Archive Date: 11/07/18 DOCKET NO. 16-27 481A DATE: November 7, 2018 ORDER Service connection for gout is denied. Service connection for a left knee disorder is denied. Service connection for a right knee disorder is denied. Service connection for a right ankle disorder is denied. Service connection for an eye disorder is denied. REMANDED Service connection for sinusitis is remanded. FINDING OF FACT The weight of the evidence is against a finding that the Veteran’s gout, left knee symptoms, right knee symptoms, right ankle disorder, and/or eye disorder are due to or the result of his active service. CONCLUSIONS OF LAW 1. The criteria for service connection for gout have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. 2. The criteria for service connection for a left knee disorder have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. 3. The criteria for service connection for a right knee disorder have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. 4. The criteria for service connection for a right ankle disorder have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. 5. The criteria for service connection for an eye disorder have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran had active service in the Air Force from June 1971 to March 1975. 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 military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be established under 38 C.F.R. § 3.303(b), where a condition in service is noted but is not, in fact, chronic, or where a diagnosis of chronicity may be legitimately questioned. The continuity of symptomatology provision of 38 C.F.R. § 3.303(b) has been interpreted as an alternative to service connection only for the specific chronic diseases listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 718 F.3d 1331 (Fed. Cir. 2013). Service connection may also be established with certain chronic diseases based upon a legal presumption by showing that the disorder manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from service. Such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Gout and Bilateral Knee Disorders The Veteran filed his service connection claim for gout and bilateral knee disorders in September 2013, which was denied in an April 2014 rating decision. He asserts that his gout and bilateral knee disorders are due to his active service. The Veteran’s service treatment records (STRs) do not show any complaints, symptoms, treatment, or diagnosis for gout and/or bilateral knee disorders. At his February 1975 separation physical he was found to have normal lower extremities and feet. In addition, he denied having any feet or knee symptoms. The Veteran’s STRs from his reserve service show that in November 1975, he continued to have normal examinations of his lower extremities and feet. He continued to deny having any feet or knee symptoms. After his separation from service, the medical records do not show any complaints, treatment, or diagnoses for gout and/or knee symptoms until 2013, almost four decades after his separation from active service. Significantly, a March 2013 VA treatment record shows a history of gout and a September 2013 VA treatment record shows an impression of arthralgia of the knees. There is also no competent medical opinion of record which even suggests that the Veteran’s current gout or bilateral knee complaints might be related to his service. Initially, the Board notes that, while the Veteran has been diagnosed with arthralgia of the knees, arthralgia is not a disability for VA compensation purposes. By way of reference, arthralgia is defined as pain in a joint. See Dorland’s Illustrated Medical Dictionary 152 (31st Ed. 2007). “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.” Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999). Without a current diagnosis, service connection cannot be granted. See Brammer v. Derwinski, 3 Vet. App. 233, 225 (1992) (noting that service connection presupposes a current diagnosis of the claimed disability); see also Chelte v. Brown, 10 Vet. App. 268 (1997) (observing that a “current disability” means a disability shown by competent medical evidence to exist at the time of the award of service connection). Even if the Veteran has been diagnosed with a disability of the knees for VA compensation purposes, consideration has been given to the Veteran’s allegation that his gout and bilateral knee symptoms are due to his active service. He is clearly competent to report symptoms of gout and knee disorders, such as pain. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). However, while the Veteran may describe feet and knee symptoms, he lacks the medical training or qualification either to diagnose a foot/knee disorder or to relate it to any in-service injury or disease. Id. The Board notes that no feet or knee problems were noted during his active service. In addition, gout or knee disabilities were not diagnosed within one year of separation from service. The record contains no evidence of treatment for gout or bilateral knee disorders in service, the medical evidence does not document any gout or bilateral knee symptoms for the year following his separation from service, and, as such, the Veteran is not entitled to presumptive service connection for gout or bilateral knee disorders. Therefore, presumptive service connection has not been triggered. While no medical opinion of record was obtained to specifically address the etiology of the Veteran’s gout or bilateral knee disorders, the Veteran’s claims file is void of any competent evidence even suggesting that his gout of bilateral knee disorders either began during or were otherwise caused by his active service. Accordingly, the criteria for service connection have not been met for gout or bilateral knee disorders. That is, the evidence does not show that gout and/or a knee disorder was diagnosed in service or within a year of service and the weight of the evidence is against a finding that his current gout and/or bilateral knee symptoms have existed continuously since service. Therefore, the claims are denied. Right Ankle Disorder and Eye Disorder The Veteran filed his service connection claims for a right ankle disorder and an eye disorder in January 2015, which were denied in a May 2015 rating decision. He asserts that he his right ankle disorder and eye disorder are due to his active service. Specifically, he reported injuring his right ankle in service. In addition, he reported having battery acid in his eyes during service. The Veteran’s STRs show he was treated for right ankle complaints in October 1972 and was diagnosed with a bruised Achille’s tendon. He reported feeling better a few days later. In December 1973, he reported getting battery acid in his eyes. His eyes were irrigated. Three days later he had no eye complaints. At his February 1975 separation physical, he had a normal examination of his lower extremities, feet, and eyes. He retained 20/20 vision. He did not report any ankle or eye symptoms. The Veteran’s STRs from his reserve service show that in November 1975, he continued to have normal examinations of his lower extremities, feet, and eyes. He also continued to have 20/20 vision. In May 2015, the Veteran was afforded a VA examination for his right ankle. The Veteran reported having intermittent heel pain since injuring his right ankle in service. After reviewing the Veteran’s claims file, interviewing the Veteran, and conducting an examination, the examiner opined that the Veteran’s right ankle disorder was less likely than not due to his active service. The examiner reported that the Veteran’s STRs contained one acute complaint of right ankle pain that resolved three days later. The examiner reported that no other notes were found to indicate any ongoing symptoms resulting from this acute and apparently self-limiting injury. The examiner concluded that there was no evidence of a chronic condition during his active service. In November 2017, the Veteran was afforded a VA examination for his eyes. The Veteran reported that a car battery blew up in his face. He also reported getting metal in his eye during his service. The examiner reviewed the Veteran’s claims file, interviewed the Veteran, and conducted an examination. The examiner reported that the Veteran had age-related cataracts, presbyopia, hyperopia, and astigmatism that were consistent with what would be expected in a person of the Veteran’s age regardless of service. The examiner opined that the Veteran’s cataracts, presbyopia, hyperopia, and astigmatism were not incurred or caused by his active service. Initially, the Board notes that the Veteran’s presbyopia, hyperopia and astigmatism are considered refractive errors. See VBA Manual M21-1, IV.ii.2.B.6.c. (last accessed February 1, 2018). Refractive errors of the eyes are congenital or developmental defects and not disease or injury for VA compensation purposes. See 38 C.F.R. §§ 3.303(c), 4.9. Service connection is only possible in such cases when there is evidence of additional disability due to aggravation during service of the congenital defect by superimposed disease or injury. See Monroe v. Brown, 4 Vet. App. 513, 514-15 (1993); Carpenter v. Brown, 8 Vet. App. 240, 245 (1995). In other words, absent a superimposed disease or injury, service connection may not be granted for refractive error of the eyes, including hyperopia, astigmatism, and presbyopia, even if visual acuity decreased in service. Also, as described, the record contains no diagnosis of a chronic right ankle disorder or cataracts either in service or within one year after service, which would preclude service connection on the basis of continuity of symptomology or on any presumptive basis. The Veteran has not argued to the contrary. There is also no medical evidence linking the Veteran’s current right ankle disorder or cataracts to his active service, and he has not submitted any medical opinion that even suggests a relationship between his right ankle disorder or cataracts and his active service. See Shedden, 381 F.3d 1163, 1167. Thus, there is no basis for service connection on a direct or presumptive basis. Consideration has been given to the Veteran’s personal assertion that his right ankle disorder and cataracts are due to his active service. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issues in this case, the etiology of joint and eye disorders, the fall outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d 1372, 1377 n.4. These disorders are not the type of conditions that are readily amenable to mere lay diagnosis or probative comment regarding their etiology, as the evidence shows that physical examinations that include objective medical tests and medical knowledge/expertise are needed to properly assess and diagnose the disorders. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau, 492 F.3d 1372, 1377; and Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). That is, although the Board readily acknowledges that the Veteran is competent to report perceived symptoms, he has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that he has received any special training or acquired any medical expertise. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). Accordingly, the Veteran’s assertions do not constitute competent medical evidence. The criteria for service connection for a right ankle disorder and an eye disorder have not been met, and the Veteran’s claims are denied. REASONS FOR REMAND Regarding the Veteran’s service connection claim for sinusitis, the Veteran asserts that his sinusitis is due to his active service. His STRs show that in April 1973, he was treated for possible sinusitis. Post-service VA medical records show an impression of chronic sinusitis as early as October 2015. No medical opinion has yet been obtained regarding this issue. Given the in-service treatment for possible sinusitis, the current diagnosis of chronic sinusitis, and the Veteran’s contention that his current sinusitis is related to his military service, a medical opinion is necessary to adjudicate this claim. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of any sinusitis. The examiner then should opine whether it is at least as likely as not (50 percent or greater) that any current sinusitis began during or was otherwise caused by the Veteran’s active service. The examiner should specifically consider the April 1973 STR showing possible sinusitis as well as the post-service VA treatment records showing chronic sinusitis as early as October 2015. (Continued on the next page)   2. Readjudicate the claim. APRIL MADDOX Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Berryman, Counsel