Citation Nr: 20003362 Decision Date: 01/14/20 Archive Date: 01/14/20 DOCKET NO. 12-00 711 DATE: January 14, 2020 ORDER Entitlement to service connection for bone loss is denied. Entitlement to service connection for residuals of rabies is denied. FINDINGS OF FACT RESIDUALS OF RABIES 1. The preponderance of the evidence is against finding that osteopenia of the right hip began during active service or is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence is against finding that that the Veteran’s claimed residuals of rabies originated in service or for many years thereafter and is related to an incident during active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for bone loss have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for residuals of rabies have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from January 1969 to August 1970, with service in the Republic of Vietnam from June 1969 to August 1970. This matter comes to the Board of Veterans’ Appeals (Board) from January 2011 and August 2013 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned in July 2017. This case was previously remanded in September 2017 for additional development. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). 1. Entitlement to service connection for bone loss The Veteran contends that service connection is warranted for bone density loss, and it is due to either his exposure to Agent Orange while in Vietnam, or a rabid dog bite, an injury that occurred while in service. See Board Hearing Transcript, p. 16. The Veteran was initially denied service connection for bone loss in an August 2013 rating decision, as it was shown that service treatment records did not contain complaints, treatment or diagnosis for any bone loss condition. In the September 2013 Notice of Disagreement, the Veteran contended that he felt he had bone loss due to his exposure, to Agent Orange. The October 2016 Statement of the Case found that service connection could not be established because bone loss is not a condition that has been associated with exposure to Agent Orange herbicides. The official diagnosis of the Veteran’s bone loss disability was provided in a private examination report from July 2012 which found osteopenia of the right hip, with mild increased fracture risk. See July 2012 Medical Treatment Records – Non-Government Facility. At his Board hearing, the Veteran attributed the bone loss to either Agent Orange exposure, or to the rabid dog bite that he claims also resulted in separate residual disabilities. The Veteran stated that doctors could not come with the cause the broad array of the Veteran’s symptomology required expert medical opinion for clarity. As a result, the September 2017 Board decision remanded the claim for bone loss service connection, to afford the Veteran a VA examination to determine the etiology of his bone density loss. See BVA Decision. The Veteran was provided VA examinations in June 2019 and September 2019, which determined the manifestations of the in-service rabid dog bite, service treatment for rabies, and the bone loss claim. The VA examiner provided a negative nexus opinion and opined that the osteopenia of the right hip is not caused by or related to the rabid dog bite or Agent Orange exposure during service. See September 2019 VA Bones Examination. The examiner reviewed the Veteran’s entire medical history and concluded that the bones condition is due to underlying Vitamin D deficiency; the service records also indicate that there was indeed a rabid dog bite in service, but the Veteran did not develop rabies, thus osteopenia could not be due to any rabies in the Veteran as he did not develop rabies. The Board concludes that while the Veteran has a diagnosis of right hip osteopenia, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. The Veteran’s service treatment records are silent for any in-service injury, event, or disease during active service. No lay or medical evidence of record shows a nexus between the bone loss disability and the rabid dog bite that occurred in service. While the Veteran believes his osteopenia is related to active service, the Board reiterates that the preponderance of the evidence weighs against findings that the disability started in service or is related to any in-service event or injury. Therefore, entitlement to service connection for bone loss is not warranted. 2. Entitlement to service connection for residuals of rabies The Veteran contends that service connection is warranted for residuals of rabies, and it is due to a rabid dog bite, an injury that occurred while in service. See Board Hearing Transcript, p. 16. The Veteran asserts that he has experienced residuals of generalized pain, fatigue, burning, itching, tingling, numbness in lower extremities, limitation of motion in the feet and legs, sleep disorders, difficulty swallowing and breathing taking the form of choking spells, gastrointestinal problems and nervous disorder as a result of the rabid dog bite and subsequent rabies treatment in service. See April 2010 Correspondence; see also Board Hearing Transcript at 10. The Veteran was initially denied service connection for residuals of rabies in a January 2011 rating decision, where it was shown that the Veteran was treated in service for exposure to rabies in January 1970 following a bite from a dog that was found to be rabid. The records show he was given rabies shots immediately, and the treatment records did not show any diagnosis of rabies in service. The treatment records also showed the Veteran experienced an allergic reaction to the rabies shots diagnosed as serum sickness, for which he was given 10 shots of a vaccine with Benadryl and aspirin. No additional treatment or complaints associated with the rabid dog bite incident, or exposure to rabies were shown following the final booster on January 29, 1970. The STRs show that on the Veteran’s separation examination in August 1970, no permanent residuals or complaints associated with rabies exposure and treatment thereof were noted or found. Due to the lack of a medical relationship between the claimed residual symptoms and the in-service dog bite and rabies exposure treatment, the RO denied the claim. The rationale provided also mentioned that the claim is not considered “chronic,” another reason for service connection denials. The Veteran argued in his January 2012 Form 9 that his claim denied due to a misinterpretation of his symptoms, that the symptomology occurred solely because of the rabid dog bite and not Agent Orange. The Veteran also argued that the delay in his treatment of rabies exposure while in service due to obtaining the dog’s head medical evidence, rabies diagnosis, the type of treatment available at the time and location, the allergic reaction to the horse serum treatment, and the long term results to his health from nerve damage and general health issues warranted service connection. At his July 2017 Board Hearing, the Veteran provided statements that the adverse health effects he suffered due to not getting the vaccine or the rabies shots early enough included psychiatric impairment, for which he is service-connected, malaria, which is also service-connected, and a weakened immune system, which has led to a number of different health problems. The Veteran stated he would like to report for VA examination to determine the etiology of his various immune system issues and related residuals and the relationship with the in-service dog bite. Subsequently, this claim was remanded in the September 2017 BVA Decision to afford the Veteran a VA examination. The Veteran was provided VA examinations in June 2019 and September 2019, which determined the manifestations of the in-service rabid dog bite, service treatment for rabies, and the bone loss claim. After VA examinations were provided for chronic fatigue syndrome, peripheral nerves conditions, muscle injuries, infectious diseases, esophageal conditions, intestinal conditions, respiratory conditions, the VA examiner opined, in sum, that the Veteran did not contract rabies as noted in the STRs and private medical records; the treatment he received in service were to prevent the transmission of rabies and he was never diagnosed with rabies, therefore there were no residuals from the condition. The examiners found no evidence of chronic fatigue syndrome in June 2019, as well as in September 2019. As to the reported residual symptoms, the examiner stated that there were no diagnoses for fatigue, dizziness, gastrointestinal problems, itching, and any sleep disorders. The Veteran did have intervertebral disc disease of the cervical spine, lumbar radiculopathy which caused tingling/numbness in the lower extremities and limitation of motion in the feet and legs and mild laryngitis that caused the difficulty swallowing and breathing taking the form of choking spells. The examiner provided further rationales as to his negative nexus opinions. See September 2019 Medical Opinions DBQ. The intervertebral disc disease of cervical and lumbar spine with bilateral radiculopathy was not related to the inservice rabid dog bite because September 2014 private medical records showed these conditions were most likely due to age related changes and the aggravation of the conditions were more likely due to normal pathophysiology of the conditions itself due to normal aging. The mild laryngitis onset predated the rabid dog bite as it was reported in 1969, before the dog bite incident, and was not aggravated due to the dog bite; rather the severity of the condition has more likely to do with a natural progression of the disease. The etiology of the reported residuals was determined to not have been caused by or related to the inservice bite by a rabid dog or the inservice treatment for rabies. The examiner reiterated that the treatment that the Veteran received in service consisted of rabies vaccinations which were to prevent the transmission of rabies and were not considered treatment for active disease; the examiner concluded that there was no rabies diagnosis, and therefore no residuals stemmed from a rabies condition. Accordingly, the preponderance of the evidence does not support a finding that the Veteran’s residuals symptomology was incurred in or otherwise related to the Veteran’s active service dog bite incident. The Veteran provided letters from September 2019 and October 2019, where he claims it is as likely as not that his medical claims and conditions are a result of rabies exposure from the inservice incident, and the delayed treatment from the incident. The Veteran mentions the allergic reaction that occurred in response to the treatment and opined that it could have been due to the late administration of the serum, masked by or acerbated by the Veteran’s malaria, and long-term misdiagnosis and treatment has followed resulting in the on-going continued chronic medical problems he has. He claims the VA doctors have been reckless in dealing his health problems, and have provided biased opinions in favoring the VA. The Veteran in this case is not competent to provide a nexus opinion regarding these issues. The issue is medically complex, as it requires knowledge of disease processes, the effects of several disabilities and interpretation of complicated medical documentation. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the medical evidence of record, discussed above. In reaching the conclusions above, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against the claim for service connection for residuals of rabies, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b). Therefore, the Veteran’s claim for service connection for residuals of rabies is denied. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Zarar Ahmed, Attorney Advisor The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.