Citation Nr: 20007597 Decision Date: 01/29/20 Archive Date: 01/29/20 DOCKET NO. 19-16 709 DATE: January 29, 2020 ORDER The claim of entitlement to a left ankle disorder is denied. The claim of entitlement to a left wrist disorder is denied. The claim of entitlement to a left hand/fingers disorder is denied. REMANDED The claim of entitlement to service connection for a left knee disorder is remanded. FINDINGS OF FACT 1. A left ankle disorder has not been present during the period of the claim. 2. A left hand/fingers disorder has not been present during the period of the claim. 3. The Veteran’s left wrist disorder did not originate in service and is not otherwise etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for a left ankle disorder have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 2. The criteria for establishing entitlement to service connection for a left hand/fingers disorder have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 3. The criteria for establishing entitlement to service connection for a left wrist disorder have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active service with the United States Navy from August 2000 to August 2004. Duties to Notify and Assist Neither the Veteran nor his representative has raised any specific issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Burden of Proof Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. 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. § 5107 (2012); 38 C.F.R. §§ 3.102, 4.3 (2018); see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. 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; 38 C.F.R. § 3.303. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease, injury, or event and the present disability. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (finding service connection presupposes a current diagnosis of the condition claimed). The requirement that a current disability be present is satisfied, “when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim... even though the disability resolves prior to the Secretary’s adjudication of the claim.” McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). 1. Entitlement to service connection for a left ankle disorder. Please see discussion in paragraph 3. 2. Entitlement to service connection for a left hand/fingers disorder. Please see discussion in paragraph 3. 3. Entitlement to service connection for a left wrist disorder. The Veteran asserts that his claimed left ankle, left hand/fingers, and left wrist disorders were caused by in-service anthrax vaccinations. A review of the Veteran’s service treatment records does not show any treatment or complaints related to the left ankle, left wrist, or left hand/fingers. There is evidence of anthrax vaccinations. The Veteran underwent VA orthopedic examinations in August 2018. The VA examiners conducted thorough examinations, which included range of motion testing and muscle strength testing. The tests demonstrated no limitation of motion of the left ankle, left wrist, or left hand/fingers. There was pain on range of motion testing of the left wrist, but it did not cause functional loss. There were also no abnormalities in muscle strength for the left ankle and left hand/fingers. The examination report included a diagnosis of chronic left wrist sprain. The examiners also determined that there was no left ankle or left hand/fingers diagnosis. The examiner opined that the Veteran’s left wrist disorder was less likely than not incurred in or caused by service. The rationale was that medical literature failed to show that the anthrax vaccine caused wrist disorders. They also had different pathophysiological processes unrelated to each other. Based on the above, the Board finds that the preponderance of the evidence demonstrates that the Veteran has not had a diagnosis of a left ankle disorder or a left hand/fingers disorder at any point during the period of the claim. The Board acknowledges the holding in Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), however, the evidence does not demonstrate that any claimed pain from the Veteran’s left ankle or left hand/fingers resulted in functional impairment. Accordingly, the Board finds that the weight of the evidence does not establish a diagnosis of a left ankle disorder or a left hand/fingers disorder at any time during the period on appeal. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In addition, the Board finds that the preponderance of the evidence is against service connection for a left wrist disorder. Significantly, there is no competent medical evidence in the record that links his left wrist disorder to military service. In this regard, the only competent medical opinion of record addressing the etiology of his left wrist disorder was provided by the August 2018 VA examiner. The Board affords significant probative value to the VA medical opinion as it was supported by adequate rationale and a thorough review of the evidence. There is no medical opinion of record to contradict the VA examiner’s opinion and the Veteran has not submitted competent medical evidence relating his left wrist disorder to service. To the extent that the Veteran contends that his left wrist disorder is related to service, the Board finds that such an opinion is more suited to the realm of medical, rather than lay, expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). There is no indication that the Veteran has had any specialized education, training, or experience in determining the etiology of wrist disorders. Accordingly, the Board finds that the requirement for a nexus has not been met. In reaching the above conclusion, the Board has considered the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claims, that doctrine does not apply, and service connection must be denied. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). REASONS FOR REMAND The claim of entitlement to service connection for a left knee disorder is remanded. The Veteran asserts that he developed a left knee disorder as a result of in-service anthrax vaccinations. An April 2017 VA treatment record noted left knee pain associated with chondromalacia. His left knee pain interfered with his activities of daily living and required the use of prosthetic equipment and pain medication. July 2018 VA treatment records showed that the Veteran complained of knee pain mainly during extension movements. He reported moderate difficulty performing simple activities. The Veteran underwent a VA examination in August 2018. The examiner found that there was no left knee diagnosis or functional impairment. The examiner provided an opinion against the claim. The rationale was that there was no left knee diagnosis or clinical findings, therefore, the claimed condition was less likely related to the anthrax vaccinations. In Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the Federal Circuit held that pain, even in the absence of a presently-diagnosed condition, can be viewed as a “disability” when there is evidence of functional impairment. In light of Saunders and the above-mentioned VA treatment records, a remand is required to obtain another medical opinion that addresses whether the Veteran’s pain is related to service and causes functional impairment. The matters are REMANDED for the following action: 1. The RO or the AMC should undertake appropriate development to obtain any outstanding records pertinent to the Veteran’s claim. If the RO or AMC deems the records do not exist or that any additional attempts to obtain these records would be futile, the record should be annotated to reflect such and the Veteran should be notified in accordance with 38 C.F.R. § 3.159 (e). 2. Then, the RO or the AMC should afford the Veteran a VA examination by a physician with sufficient expertise, to determine the nature and etiology of his claimed left knee condition. All pertinent evidence of record must be made available to and reviewed by the examiner. All necessary tests and studies should be performed. The examiner should identify all diagnoses of the left knee then answer the following: (a) If there is no diagnosis associated with the Veteran’s left knee pain, the examiner should note whether the Veteran’s left knee condition caused functional impairment. (b) Whether it is at least as likely as not (50 percent probability or greater) that the left knee pain or left knee disorder was incurred in, was caused by, or is otherwise etiologically related to the Veteran’s military service, to include his in-service, to include anthrax vaccinations. Have the examining physician/specialist provide information to demonstrate that they are qualified to offer the above requested opinion (such as a curriculum vitae or similar demonstrable documentation). This information is to be associated with the Veteran’s claims file. The rationale for all opinions expressed should also be provided. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. 3. Then, the RO or the AMC should readjudicate the issue on appeal. If the benefit sought on appeal is not granted to the appellant’s satisfaction, the appellant and her representative should be furnished an appropriate supplemental statement of the case and be afforded the requisite opportunity to respond. Thereafter, the case should be returned to the Board for further appellate action. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. N. Nolley, Associate Counsel 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.