Citation Nr: 18159757 Decision Date: 12/19/18 Archive Date: 12/19/18 DOCKET NO. 16-61 961 DATE: December 19, 2018 ORDER Entitlement to service connection for a whole body arthritis is denied. Entitlement to service connection for a left hip disability is denied. FINDINGS OF FACT 1. The weight of the evidence does not establish a current diagnosis of systemic arthritis, whole body arthritis, or osteoarthritis. 2. A left hip disability was not manifested in active service, is not related to disease or injury or other event in active service, and first manifested many years after active service. CONCLUSIONS OF LAW 1. The criteria for service connection for whole body arthritis to include osteoarthritis are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). 2. The criteria for service connection for a left hip disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from July 1998 to August 2002. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a June 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. The Veteran did not perfect an appeal of the issue of service connection for bilateral hearing loss and this issue is not currently before the Board for appellate review. 1. Service Connection In order to establish service connection, the facts, as shown by evidence, must demonstrate that a disease or injury resulting in current disability was incurred during service or, if pre-existing active service, was aggravated therein. 38 U.S.C. §§ 1110, 1131. Service connection may also be granted for a disability initially diagnosed after service when all of the evidence shows it to have been incurred in service. 38 C.F.R. § 3.303 (d) (2018). 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). Where a veteran served ninety days or more of active service, and certain chronic diseases, such as arthritis become manifest to a degree of 10 percent or more within one year after the date of separation from such 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; 38 C.F.R. §§ 3.307, 3.309(a). 38 C.F.R. § 3.303 (b) applies to the “chronic diseases” under 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Once the evidence has been assembled, it is the Board’s responsibility to evaluate the evidence. 38 U.S.C. § 7104(a). The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.102, 4.3. 2. Entitlement to service connection for whole body arthritis and a left hip disability is denied. The Veteran asserts that he has whole body arthritis and a left hip disability that are related to active service. In an August 2015 statement, the Veteran stated that he was an airborne ranger and he had quite a few jumps which have worn his joints down. He stated that along with the airborne operations, the heavy rucks and long marches added to the permanent damage to his whole body. The Veteran indicated that he had heavier than normal rucks. He stated that he is in pain every day. He indicated that he had osteoarthritis and he had surgery in the left hip. The September 2016 VA examination report indicates that the Veteran reported that beginning in 2002, he experienced a gradual onset and progressive pain all over with the knees, hands, and hips being the worst. He stated that from 1998 to 2002, he served on multiple airborne operations. He indicated that his symptoms were not noticeable while on active duty, rather they started after discharge. He stated that Osgood-Schlatter Disease (knee pain) was diagnosed when he was on active duty in 2002. The Veteran noted that his hand pain made grasping difficult, and he began to experience increasing symptoms of hip pain over past five years. The Veteran reported that all conditions have progressed including constant pain; pain with grasping heavy objects and freezing joints in both hands; dull, aching pain on front aspect of the knees; and pain in both hips, left worse than the right. He stated that he has been treated with Parafin wax and non-steroidal anti-inflammatory drugs. The Board finds that the weight of the competent and credible evidence establishes that the Veteran does not have a current diagnosis of whole body arthritis or systemic arthritis. The record in this case is negative for any indication, other than the Veteran’s own general assertion, that he has a current diagnosis of systemic or whole body arthritis. Private medical records from a primary care clinic dated in August 2013 indicate that the Veteran wanted to establish care for joint pain. The Veteran reported no significant past medical history except for several years of joint pain in the knees, shoulders, neck, elbows, and wrists. He has no significant past medical history except for several years of joint pain in his knees, shoulders, neck, elbows, and wrists. It was noted that the Veteran has been very active physically his whole life; he was a paratrooper in the army and had over 100 jumps, he currently teaches martial arts and does the classes with his students, and he has been in multiple motorcycle accidents. It was further noted that Osgood-Schlatter syndrome was diagnosed in the military. The impression was osteoarthritis. The examiner indicated that due to the negative Erythrocyte Sedimentation Rate and Rheumatoid factor, as well as crepitus and history of abuse to the joints, it was most likely osteoarthritis. The Veteran was afforded a VA non-degenerative arthritis (including inflammatory, autoimmune, crystalline, and infectious arthritis) and dysbaric osteonecrosis examination in September 2016. The Veteran’s virtual file was reviewed, his lay statements were considered, and the Veteran underwent physical examination. The VA examiner concluded that the Veteran did not have a current diagnosis of the claimed condition of whole body arthritis. The Veteran did not have a diagnosis of gout, Rheumatoid arthritis, Gonorrheal arthritis, Pneumococcic arthritis, Typhoid arthritis, Syphilitic arthritis, Streptococcic arthritis, Dysbaric osteonecrosis (Caisson Disease of Bone), or other inflammatory, autoimmune, crystalline, or infectious arthritis. The VA examination report indicates that the Veteran had pain in the knees. He did not have any joint abnormalities attributable to the arthritis condition. He did not have systemic involvement other than joints. The VA examiner noted that there were no abnormal test findings due to any conditions. The Board finds the September 2016 VA medical findings and opinion to have great evidentiary weight as the opinion reflects a comprehensive, accurate, and reasoned review of the entire evidentiary record. The VA examiner reviewed the claims folder and the Veteran’s medical history including the service treatment records, considered the Veteran’s report of symptoms and onset of the claimed disorder, and examined the Veteran before rendering the medical opinion. Factors for assessing the probative value of a medical opinion are the examiner’s access to the claims file and the thoroughness and detail of the opinion. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Prejean v. West, 13 Vet. App. 444, 448-9 (2000). The medical opinion is based on sufficient facts and data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The VA examiner has the skill and expertise to analyze the medical evidence and render an opinion as to the etiology of arthritis. See Black v. Brown, 10 Vet. App. 279, 284 (1997). The Board acknowledges that the Veteran is competent to report observable symptoms. However, as a layperson, he is not competent to provide a medical diagnosis for a systemic disease such as arthritis. The Veteran is not shown to possess the type of medical expertise that would be necessary to render a medical diagnosis. See Kahana v. Shinseki, 24 Vet. App. 428, 435 2011). The Veteran has not provided any medical evidence to support his general contentions that he has systemic arthritis or whole body arthritis. Despite the Veteran’s contentions, systemic arthritis or whole body arthritis is not currently shown. The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F. 3d 1328 (1997) (holding that section 1110 of the statute requires the existence of a present disability for VA compensation purposes); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). In light of the evidence of record, the Board finds that the preponderance of the evidence is against a finding of any current systemic arthritis or whole body arthritis. Accordingly, as the Veteran has not been shown to have this disorder, service connection for such is not warranted. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In reaching this decision, the Board considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for systemic arthritis or whole body arthritis, and that doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Service connection is denied. The Board finds that while there is evidence of current diagnoses of a left hip disability, the preponderance of the evidence weighs against finding that this disability began during service or is otherwise related to an injury, event, or disease in active service. There is competent and credible evidence of a current diagnosis of a left hip disability. Private medical records dated in April 2014 show a diagnosis of left acetabular labral tear with acetabular cartilage injury and femoral acetabular impingement with a Cam lesion. The Veteran underwent a left hip surgical dislocation with greater trochanteric osteotomy and fixation; left open femoral head and neck osteoplasty; and left labral debridement. A May 2014 x-ray report indicates that the Veteran was status post greater trochanteric osteotomy with two fixation screws. There was no radiologic evidence of complication. The left hip joint was within normal limits and the x-ray revealed the prior osteoplasty of the femoral head/neck junction. The September 2016 VA examination report indicates that the left hip diagnosis was status post left hip surgery with residual decreased range of motion of the left hip. The VA examiner opined that the Veteran’s claimed left hip condition was less likely as not (50 percent or greater probability) incurred in or caused by the parachute jumps during service. The VA examiner noted that there is no mention of left hip pain during the Veteran’s active duty service, and the Veteran did not experience symptoms until 12 years after he left the service. The VA examiner further noted that while the Veteran is rather young to be having hip issues as described, the cause of the hip pain could have been due to other reasons during the 12 years after he left service. The service treatment records do not show treatment or diagnosis of a left hip disability. The June 2002 separation exam report of medical history indicates that the Veteran responded “yes” when asked if he had swollen and painful joints, bone or joint deformity, and broken bones. He denied having arthritis or rheumatism. The examiner noted that the Veteran was referring to the painful and swollen joints after long runs, and the bone or joint deformity was the Osgood Schlatter’s disease of the left knee. Physical examination of the lower extremities was normal. The Veteran separated from active service in August 2002. The record shows that the left acetabular labral tear with acetabular cartilage injury and femoral acetabular impingement with a Cam lesion was first diagnosed in 2014, 12 years after separation from service. With respect to negative evidence, the fact that there were no records of any complaints, treatment, or diagnosis of the claimed disability for many years after service separation weighs against the claim. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Veteran has made general assertions that service connection is warranted for the current left hip disability and the current disability is related to active service. However, as noted above, the Veteran, as a layperson, does not have the medical expertise to opine as to the etiology of an orthopedic disability or relate a disability to a specific injury. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Thus, the Veteran’s assertion that the current left hip disability is related to active service is not a competent medical opinion and is not afforded significant probative weight. As such, the medical findings and opinion of the VA examiner warrants greater probative weight than the Veteran’s lay contentions. The Veteran has not identified or produced competent evidence that related this disorder to active service. There is no competent evidence to establish a nexus between the left hip disability and any documented event or injury of active service. Accordingly, on this record, the evidence is found to preponderate against the claim for service connection for a left hip disability. Therefore, service connection is denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Lastly, the Board has also considered whether service connection is warranted for osteoarthritis. In the December 2016 VA Form 9, the Veteran asserted that osteoarthritis was diagnosed in 2013. Osteoarthritis was not diagnosed in active service. The June 2002 separation examination of the lower and upper extremities, hands, feet, and spine was normal. As noted above, the private medical records show a diagnosis of osteoarthritis in 2013. Private medical records from a primary care clinic dated in August 2013 indicate that the Veteran wanted to establish care for joint pain. The Veteran reported no significant past medical history except for several years of joint pain in the knees, shoulders, neck, elbows, and wrists. It was noted that the Veteran has been very active physically his whole life; he was a paratrooper in the army and had over 100 jumps, he currently teaches martial arts and does the classes with his students, and he has been in multiple motorcycle accidents. It was further noted that Osgood-Schlatter syndrome was diagnosed in the military. The impression was osteoarthritis. The examiner indicated that due to the negative Erythrocyte Sedimentation Rate and Rheumatoid factor, as well as crepitus and history of abuse to the joints, it was most likely osteoarthritis. An April 2016 VA treatment record show an assessment of traumatic arthropathy, multiple sites, stable. However, the Board finds that the weight of the competent and credible evidence establishes that the Veteran does not have a current diagnosis of osteoarthritis. The 2013 diagnosis of osteoarthritis is not supported by x-ray evidence. The May 2014 x-ray examination of the left hip indicates that the left hip joint was within normal limits; the x-ray report does not document osteoarthritis. The September 2016 VA examination of the hip, knees, legs, hands and fingers did not detect osteoarthritis in these joints. The left hip diagnosis was status post left hip surgery with residual decreased range of motion of the left hip. The knee and leg diagnosis was left knee Osgood-Schlatter’s disease. There was no hand or finger diagnosis. The September 2016 VA systemic arthritis examination report indicates that the Veteran did not have any joint abnormalities attributable to the arthritis condition, he did not have systemic involvement other than joints, and there were no abnormal test findings due to any conditions. The record shows a diagnosis of Osgood-Schlatter’s disease of the left knee in active service. The Board notes that the Veteran filed a separate claim for service connection for a bilateral knee disability in March 2015. The June 2015 rating decision denied this claim. The Veteran did not perfect an appeal. Accordingly, on this record, the evidence is found to preponderate against the claim for service connection for whole body arthritis, osteoarthritis, and a left hip disability. Therefore, service connection is denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. THOMAS H. O'SHAY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C.L. Krasinski, Counsel