Citation Nr: 20006737 Decision Date: 01/28/20 Archive Date: 01/27/20 DOCKET NO. 19-12 347 DATE: January 28, 2020 ORDER Entitlement to service connection for a right elbow condition, claimed as epicondylitis, is granted. FINDING OF FACT The evidence of record shows that the Veteran’s right elbow condition manifested during active service. CONCLUSION OF LAW The criteria for service connection for a right elbow condition, claimed as epicondylitis, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from March 1991 to July 1997 and again from March 2003 to October 2004. This case is on appeal before the Board of Veterans’ Appeals (Board) from a September 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Reno, Nevada. As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5103, 5103A; 38 C.F.R. §§ 3.159, 3.326(a). The Board herein grants in full the benefit sought on appeal. Accordingly, assuming, without deciding, that any error was committed with respect to either the duty to notify or the duty to assist, such error was harmless and will not be discussed. The Veteran seeks service connection for a right elbow condition, claimed as epicondylitis. He asserts that this disability manifested during his second period of active duty between March 2003 and October 2004. See September 2017 notice of disagreement. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Regulations provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). In order to prevail on the issue of service connection, generally, there must be (1) medical evidence of a current disability; (2) medical evidence, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) competent evidence of a nexus between an in-service injury or disease and the current disability. Hickson v. West, 12 Vet. App. 247, 253 (1999); Barr v. Nicholson, 21 Vet. App. 303 (2007); Pond v. West, 12 Vet. App. 341, 346 (1999). In rendering a decision on appeal, the Board must analyze the credibility and probative value of all medical and lay evidence of record, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. 38 U.S.C. § 1154(a); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board must resolve reasonable doubt in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). The Veteran’s service treatment records contain numerous references to right elbow pain and epicondylitis. A progress note from December 2003 indicates that his right elbow pain started after he began to work as a mechanic; he was subsequently placed on restricted duty. An April 2004 medical examiner opined that the Veteran’s right elbow disability was incurred in the line of duty, finding “no reason not” to reach this conclusion. He was later diagnosed with epicondylitis, which is reflected in his August 2004 separation examination. In October 2004, less than one month after discharge, the X-rays of the Veteran’s elbows were conducted at a VA facility. Although the attending physician noted his history of epicondylitis, imaging revealed no evidence of fracture. Additionally, the mineralization pattern of the visualized osseous structures was normal in both elbows. No destructive or sclerotic lesions were seen. Joint effusion was also absent and the soft tissue structures were normal in appearance. The final impression was a negative examination of the bilateral elbows. There are no further references to epicondylitis until October 2013. That month, the Veteran sought treatment at a VA facility for complaints of joint pain. He claimed that he had been experiencing these symptoms since his second period of active duty. The attending physician confirmed a diagnosis of bilateral epicondylitis. A VA progress note from July 2016 states that the Veteran had a long history of joint pain, which was attributed to physical work as a mechanic. Recent VA medical records reflect continuing complaints of right elbow pain and soreness. After careful consideration of the claims file, the Board finds that the evidence of record is in relative equipoise as to whether the Veteran’s right elbow condition is related to his military service. The evidence associated with the claims file clearly establishes that the Veteran suffered from epicondylitis in his right elbow during service. Indeed, his service treatment records reflect near-continuous complaints of right elbow pain from December 2003 onward. The Board also points out that the April 2004 military examiner is the only medical professional on file to have issued an opinion regarding the nature and etiology of the Veteran’s right elbow condition. Since the impairment manifested during a period of active duty, the military examiner found “no reason not” to believe that it was therefore incurred in the line of duty. Despite the overwhelming evidence of epicondylitis in the Veteran’s right elbow during service, the RO denied his claim for service connection. The basis of this determination was the fact that there is no documented evidence of right elbow pain or limitations between 2004 and 2013. As such, the RO found nothing to link the Veteran’s current complaints to his in-service epicondylitis. See April 2019 Statement of the Case. However, the Board recognizes that epicondylitis symptoms do not manifest constantly. Rather, they may increase or decrease in severity depending on how often and in what way the affected joint is used. Therefore, a mere lack of reported symptoms is not dispositive evidence that the Veteran has not suffered from epicondylitis in his right elbow since service. The Board thus concludes that there is approximately equal evidence for and against the Veteran’s claim. Since the evidence of record is in relative equipoise as to whether the Veteran’s right elbow condition has existed since service, the benefit of the doubt rule applies. Gilbert, 1 Vet. App. at 58. Accordingly, the Veteran’s claim for service connection for a right elbow condition, claimed as epicondylitis, is granted. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals MJS, Attorney for the Board Department of Veterans Affairs 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.