Citation Nr: 18152516 Decision Date: 11/23/18 Archive Date: 11/23/18 DOCKET NO. 16-32 530 DATE: November 23, 2018 ORDER Entitlement to service connection for a right shoulder disability is granted. Entitlement to service connection for a right wrist disability is granted. Entitlement to service connection for a left wrist disability is granted. Entitlement to service connection for a lumbar spine disability is granted. Entitlement to service connection for a left hip disability is granted. Entitlement to service connection for a right hip disability is granted. Entitlement to service connection for a left knee disability is granted. Entitlement to service connection for a right ankle disability is granted. Entitlement to service connection for a left ankle disability is granted. Entitlement to service connection for a right foot disability is denied. FINDINGS OF FACT 1. The Veteran maintains that he has weekly moderate right shoulder pain that hurts with heavy lifting. While the post-service evidence of record has not provided a specific diagnosis for the Veteran’s right shoulder pain, a VA examiner could not conclusively rule out that the pain has causes some functional limitation, and relates the recurrent right shoulder pain to military service. 2. The Veteran asserts that he has severe weekly bilateral wrist pain. While the post-service evidence of record has not provided a specific diagnosis for the Veteran’s complaints of bilateral wrist pain, a VA examiner cannot conclusively rule out that the pain has caused some functional limitation, notably in his ability to move his hands and wrists, and relates the recurrent bilateral wrist pain to military service. 3. The Veteran maintains that he has low back pain. While the post-service evidence of record has not provided a specific diagnosis for the Veteran’s complaints of lumbar spine pain, a VA examiner noted that he has the factors of pain, weakness, fatigability and/or incoordination during flare-ups of the lumbar spine and relates the recurrent lumbar spine pain to military service. 4. The Veteran maintains that he has severe ongoing daily bilateral hip pain. While the post-service evidence of record has not provided a specific diagnosis for the Veteran’s complaints of bilateral hip pain, a VA examiner could not conclusively rule out that the pain has causes some functional limitation, and relates the recurrent bilateral hip pain to military service. 5. The Veteran relates that he has left knee, pain, weakness and decreased range of motion. While the post-service evidence of record has not provided a specific diagnosis for the Veteran’s complaints of left knee pain, a VA examiner cannot conclusively rule out that the pain has caused difficulty walking with prolonged periods of time and relates the left knee pain to military service. 6. The Veteran maintains that he has severe ongoing daily bilateral ankle pain. While the post-service evidence of record has not provided a specific diagnosis for the Veteran’s complaints of bilateral ankle pain, a VA examiner could not conclusively rule out that the pain has causes some functional limitation of the ankles, and relates the recurrent bilateral ankle pain to military service. 7. The Veteran has not had a diagnosed right foot disability during the appeal period or within proximity thereto. CONCLUSIONS OF LAW 1. The criteria for service connection for a right shoulder disability (manifested by pain and functional impairment) have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). 2. The criteria for service connection for a right wrist disability (manifested by pain and functional impairment) have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). 3. The criteria for service connection for a left wrist disability (manifested by pain and functional impairment) have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). 4. The criteria for service connection for a low back disability (manifested by pain and functional impairment) have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). 5. The criteria for service connection for a right hip disability (manifested by pain and functional impairment) have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). 6. The criteria for service connection for a left hip disability (manifested by pain and functional impairment) have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). 7. The criteria for service connection for a left knee disability (manifested by pain and functional impairment) have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). 8. The criteria for service connection for a right ankle disability (manifested by pain and functional impairment) have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). 9. The criteria for service connection for a left ankle disability (manifested by pain and functional impairment) have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). 10. The criteria for service connection for a right foot disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018); 38 C.F.R. § 3.303 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Army from January 1993 to January 2001, and from November 2004 to November 2005. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision. While the Veteran’s claims were previously denied by a rating decision in October 2014, 38 C.F.R. § 3.156 (c) is applicable to this appeal as relevant official service department records existed and had not been associated with the claims file when VA first decided the claim. Specifically, since the time of the October 2014 rating decision, additional service treatment records were added to the claims file. As such, 38 C.F.R. § 3.156 (c) requires VA to reconsider the claims, rather than conducting an inquiry into whether new and material evidence had been received. Id. The Veteran seeks service connection for right shoulder; bilateral wrist; low back; bilateral hip; left knee; bilateral ankle; and, right foot disabilities. After a brief discussion of the laws and regulations governing service connection, the Board will analyze the merits of the claims. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (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 - the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially 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) (2018). In addition, service connection for certain chronic diseases, such as arthritis, may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumptive 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. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Additionally, for certain chronic diseases with potential onset during service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309 (2017); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Board notes that May 2014 VA examination reports disclose that the Veteran has complained of chronic and, at times, severe, right shoulder; bilateral wrist; low back; bilateral hip; left knee; and bilateral ankle pains. (See May 2014 Shoulder and Arm; Wrist; Thoracolumbar Spine; Knee and Lower Leg; and Ankle Disability Benefits Questionnaires (DBQs)). As the Veteran has complained of right shoulder; bilateral wrist; low back; bilateral hip; left knee; and bilateral ankle pains pain that cause functional limitations, notably, pain with heavy lifting; difficulty moving his hands and wrists and walking, current disabilities have been shown. See Saunders, supra. This case held that a finding that pain, even in the absence of a presently-diagnosed condition, can constitute a disability for VA purposes if it causes functional impairment. In addition, the record supports a finding that the Veteran has experienced recurrent right shoulder; bilateral wrist; bilateral ankle and hip; low back and left knee pains after he had received treatment on several occasions during military service. Service treatment records (STRs) reveal treatment for right shoulder pain in April 1993 and 1994; left wrist pain in December 1997 and January 1998 with an assessment of improved Dequervain’s [disease] of both wrists in February 1998; several complaints of right and left ankle pain and left Achilles tendonitis, with an assessment of possible sprain in June 1995 and retrocalcaneal bursitis of the left ankle in April 2000; recurrent complaints of left knee pain in November 1993 (three times); January and November 1994; and December 1998; and diagnosis and assessment of left hip flexion strain and soft tissue injury of the paravertebral [muscle]. Additionally, VA opinions, authored in April 2015, state that the Veteran’s right shoulder; bilateral wrist, bilateral ankle; left knee, low back and bilateral hip pains are related to his in-service complaints of pain. (See April 2015 VA opinions). Accordingly, service connection for right shoulder; right and left wrist; right and left ankles; left knee; low back; and, left and right hips disabilities (manifested by pain and functional impairment) is warranted. Saunders, supra. Regarding the Veteran’s right foot disorder, the Veteran asserts that he experiences a right foot disorder that is related to his periods of active service. After a review of the record, the Board finds that the preponderance of the evidence of record is against an award of service connection for a right foot disorder because there is no competent, credible, and probative evidence that would establish that the Veteran experiences a right foot disorder that is etiologically related to his periods of military service. Regarding the first element of service connection (i.e. a current disability), importantly, the Veteran’s STRs and post-service medical records do not show any subjective complaints referable to the right foot and/or a diagnosis of a disorder, or any residuals of a right foot disability. As such, the evidence of record does not disclose that the Veteran had or has a chronic right foot disorder either in active service or after it. In the absence of proof of a present disorder (and, if so, of a nexus between that disorder and the active military service), there can be no valid claims for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). This principle has been repeatedly reaffirmed by the Federal Circuit, which has stated that “a Veteran seeking disability benefits must establish... the existence of a disability [and] a connection between the Veteran’s service and the disability.” Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). The Board has considered whether the Veteran experienced a right foot disorder at any time during the pendency of this appeal. Service connection may be granted if there is a disability at some point during the claim even if it later resolves or becomes asymptomatic. McClain v. Nicholson, 21 Vet. App. 319 (2007). In this case, there is no evidence of a right foot disorder at any time during the pendency of this appeal. The Veteran also has not identified or submitted any competent evidence, to include a diagnosis of the disorder, or a medical nexus, relating his claimed right foot disorder to a period of active service. The Board has considered the Veteran’s lay statements in support of his claim. In statements, the Veteran related that he believed that he had a right foot disorder that was related to his periods of military service. Although laypersons are competent to provide opinions on some medical issues, as to the specific issues in this case, diagnosing a right foot disorder, this issue falls outside the realm of common knowledge of a layperson. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). As a layperson, the Veteran has not been shown to possess the medical expertise to diagnose a right foot disorder and its etiology. The Veteran claims file does not contain any medical examinations diagnosing him with a right foot disorder, or linking his self-reported symptoms to a period military service. In sum, there is no evidence, medical or otherwise, to support the Veteran’s statements. Thus, as previously stated, the medical evidence of record is only against the Veteran’s claim for service connection for a right foot disorder. Finally, the Board is cognizant of the recent holding in Saunders which stated that where pain causes functional impairment, a disability for VA compensation purposes exists, even if there is no underlying diagnosis. Saunders, supra. In sum, pain alone resulting in functional impairment is in fact a disability, and should not be summarily discounted as a bar to benefits based on a finding of no current diagnosis. However, the Veteran does not claim, nor do his medical records show, that he experiences any functional impairment due to his right foot pain. As such, Saunders is not applicable with respect to this claim. Accordingly, service connection for a right foot disorder is not warranted because the Veteran has not satisfied the first requirement of service connection, i.e., a current diagnosis of a disability. See 38 C.F.R. § 3.303; Brammer, 3 Vet. App. at 225. In reaching the above conclusion, the Board has considered the benefit-of- the-doubt doctrine. However, as the preponderance of the evidence of record is against the claim of entitlement to service connection for a right foot disorder, that doctrine does not apply. 38 U.S.C. § 5107 (b). The claim of entitlement to service connection for a right foot disorder is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Carole Kammel, Counsel