Citation Nr: 18158216 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 17-49 459 DATE: December 14, 2018 ORDER Entitlement to service connection for a left-shoulder disability, to include as secondary to Lyme disease, is denied. Entitlement to service connection for a right-shoulder disability, to include as secondary to Lyme disease, is denied. Entitlement to service connection for a left-wrist disability, to include as secondary to Lyme disease, is denied. Entitlement to service connection for a right-hand disability, to include as secondary to Lyme disease, is denied. Entitlement to service connection for a left-hand disability, to include as secondary to Lyme disease, is denied. Entitlement to service connection for a right-knee disability, to include as secondary to Lyme disease, is denied. Entitlement to service connection for a right-ankle disability, to include as secondary to Lyme disease, is denied. REMANDED Entitlement to service connection for irritable bowel syndrome (IBS) is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has a current diagnosis of a left-shoulder disability. 2. The preponderance of the evidence is against finding that the Veteran has a current diagnosis of a right-shoulder disability. 3. The preponderance of the evidence is against finding that the Veteran has a current diagnosis of a left-wrist disability. 4. The preponderance of the evidence is against finding that the Veteran has a current diagnosis of a right-hand disability. 5. The preponderance of the evidence is against finding that the Veteran has a current diagnosis of a left-hand disability. 6. The preponderance of the evidence is against finding that the Veteran has a current diagnosis of a right-knee disability. 7. The preponderance of the evidence is against finding that the Veteran has a current diagnosis of a right-ankle disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a left-shoulder disability have not been met. 38 U.S.C. §§ 1110, 1131, 1132, 5103A, 5107; 38 C.F.R. § 3.102, 3.159, 3.303, 3.304. 2. The criteria for entitlement to service connection for a right-shoulder disability have not been met. 38 U.S.C. §§ 1110, 1131, 1132, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 3. The criteria for entitlement to service connection for a left-wrist disability have not been met. 38 U.S.C. §§ 1110, 1131, 1132, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 4. The criteria for entitlement to service connection for a left-hand disability have not been met. 38 U.S.C. §§ 1110, 1131, 1132, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 5. The criteria for entitlement to service connection for a right-hand disability have not been met. 38 U.S.C. §§ 1110, 1131, 1132, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 6. The criteria for entitlement to service connection for a right-knee disability have not been met. 38 U.S.C. §§ 1110, 1131, 1132, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 7. The criteria for entitlement to service connection for a right-ankle disability have not been met. 38 U.S.C. §§ 1110, 1131, 1132, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service Connection Service connection may be granted for disability caused by disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish service connection for a claimed disability, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in service incurrence or aggravation of a disease or injury; and (3) evidence, generally medical, of a causal relationship between the claimed in service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247 (1999). Service connection may also be granted for any disease initially diagnosed after service, when the evidence establishes that the disease was incurred in service. 38 U.S.C. § 1113 (b); 38 C.F.R. § 3.303 (d) (2017); Cosman v. Principi, 3 Vet. App. 503 (1992). The disease entity for which service connection is sought must be chronic rather than acute and transitory in nature. For the showing of chronic disease in service, a combination of manifestations must exist sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic. Furthermore, service incurrence will be presumed for certain chronic diseases if manifest to a compensable degree within the year after active service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. A disability that is proximately due to or the result of a service connected disease or injury shall be service connected. When service connection is established for a secondary disability, the secondary disability shall be considered a part of the original disability. 38 C.F.R. § 3.310 (a). Secondary service connection may also be established for a non-service connected disability, which is aggravated by a service-connected disability. In such an instance, the Veteran is compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310 (b) Allen v. Brown, 7 Vet. App. 439 (1995). 1. Entitlement to service connection for a left shoulder disability, to include as secondary to Lyme disease 2. Entitlement to service connection for a right shoulder disability, to include as secondary to Lyme disease 3. Entitlement to service connection for a left wrist disability, to include as secondary to Lyme disease 4. Entitlement to service connection for a left-hand disability, to include as secondary to Lyme disease 5. Entitlement to service connection for a right-hand disability, to include as secondary to Lyme disease 6. Entitlement to service connection for a right knee disability, to include as secondary to Lyme disease 7. Entitlement to service connection for a right ankle disability, to include as secondary to Lyme disease The Veteran contends that he has a left shoulder, right shoulder, left wrist, left hand, right hand, right knee and right ankle disability, secondary to his service-connected Lyme disease. However, upon review of the record, the Board finds that service connection for these disabilities is not warranted. Service treatment records (STR) are silent for complaints, treatment and diagnoses of the left shoulder, left wrist, left hand, right hand, right knee and right ankle. Although STR show a November 2006 complaint of right shoulder pain, the pain was attributed to a right shoulder strain caused by a collision while playing football. Post-service treatment records complaints of pain in multiple joints. In September 2014, the Veteran denied arthralgia and decreased range of motion. In October 2014, the Veteran was treated for delayed onset of shoulder pain caused by a motor vehicle accident that had occurred that day. In September 2011, the Veteran’s screening test for Lyme disease was positive. At that time, the Veteran’s only complaint was mild fatigue; he denied myalgias and arthralgias. Service-connection is in effect for Lyme disease, rated as noncompensable. At a July 2015 VA examination, the Veteran reported that his joint pain started in “2012 or 2013” in his bilateral wrist and shoulders when he worked out, and in his knees when he ran. He also reported that he began to have pain in his fingers. Upon review of the Veteran and his file, the VA examiner determined that the Veteran’s joints complaints do not meet the criteria for the diagnosis of current Lyme disease, which includes recurrent brief attacks of objective swelling in joints and sometimes followed by chronic arthritis in joints. During a July 2016 VA examination, the Veteran reported multiple joint pain in his knees, ankles, wrists, hands and shoulders. He indicated that during flare ups, they symptoms in his wrists, ankles, knees, hands and shoulders worsen. The VA examiner examined the Veteran and determined that the Veteran had Lyme disease with residual arthralgia. However, diagnostic testing of the joints indicated that the Veteran did not have a diagnosed disability for VA purposes. Range of motion testing for all joints was normal. Localized tenderness or pain on palpation was noted in the right wrist; right knee; right shoulder; and right hand. Regarding the right and left wrist, no pain was noted, even with weight bearing, and there was no evidence of crepitus. No functional loss was noted, even after repetitive-use testing. Regarding the right and left knee, pain was noted upon flexion of the right knee and no pain was noted in the left knee. The Veteran indicated that weakness and pain occur with repeated use over time. There was no instability, history of recurrent subluxation, lateral instability or effusion noted for either knee. Regarding the right and left shoulder, pain was noted on flexion and abduction of the right shoulder; no pain in the left shoulder. There was no evidence of pain with weight bearing or crepitus in either shoulder. He indicated that weakness and pain occur with repeated use over time. Regarding the right and left hand, there was no evidence of pain in on use of either hand. Muscle strength testing was normal in both hands; there was no muscle atrophy in either hand and there was no ankylosis of any joint of either hand. There was also no evidence of pain when the hands were used in non-weight bearing. A July 2017 VA examiner opined that a right-hand and left-hand disability was less likely than not incurred in or caused by service as there was no pathology to render a diagnosis for the Veteran’s right and left-hand. Similarly, the July 2017 VA examiner opined that a right shoulder disability was less likely than not incurred in or caused by service as evidence shows that right shoulder pain began after the 2014 motor vehicle accident. Upon review of the evidence, the Board finds that the evidence does not show that the Veteran is currently diagnosed with disabilities manifested by a right shoulder, left shoulder, left wrist, right ankle, right knee, right hand or left-hand disabilities; therefore, service connection is not warranted for any of these joints. The Board is cognizant that record includes documented pain, to include under the finding of arthralgia. Although it is clear that the Veteran experiences pain in his right shoulder, left shoulder, left wrist, right ankle, right knee, right hand and left hand, pain without functional loss is not a disability. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Notably, testing shows that the range of motion of the right shoulder, left shoulder, left wrist, right ankle, right knee, right hand and left hand are all normal. The preponderance of the evidence weighs against a finding that the Veteran has functional impairments of these joints. Regarding Lyme disease, the Board notes that the issue before it are ones for service connection. As a rating issue, non-active Lyme disease is to be rated as arthritis under the appropriate system. 38 C.F.R. § 4.88b, DC 6319. Here, again, though, there is not functional impairment. As the preponderance of the evidence is against the claim for service connection for a disability manifested by a right-shoulder, left-shoulder, left-wrist, right-ankle, right-knee, right-hand and/or left-hand disability, the claims must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND Entitlement to service connection for irritable bowel syndrome (IBS) is remanded. Remand is required to obtain a medical opinion regarding the etiology of the Veteran’s IBS. Although a medical opinion was obtained in July 2015, another opinion is necessary as the VA examiner determined that the Veteran did not have a current diagnosis of IBS. However, a March 2016 VA treatment note shows that the Veteran is diagnosed with constipation-predominant IBS treated with medication. Therefore, a VA opinion is required regarding its etiology. The matter is REMANDED for the following action: 1. Obtain updated VA treatment records.   2. Then, schedule the Veteran for a VA examination for an opinion on whether IBS is as likely as not (50 percent or greater probability) incurred in or aggravated by active service, to include the bowel complaints noted upon the Veteran’s separation report of medical history. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Hemphill, Associate Counsel