Citation Nr: 20021475 Decision Date: 03/25/20 Archive Date: 03/25/20 DOCKET NO. 14-09 921 DATE: March 25, 2020 ORDER Service connection for a joint disorder, to include sprains/strains, arthritis, and pain, is denied. FINDING OF FACT A chronic joint disorder was not shown in service, joint arthritis was not diagnosed within one year of service discharge, and the weight of the evidence fails to establish that the Veteran’s current joint disorder is etiologically related to her active service or due to or aggravated by medications used to treat her service-connected asthma. CONCLUSION OF LAW The criteria for service connection for a joint disorder have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from January 1975 to January 1978. In connection with this appeal, the Veteran testified at a hearing before the undersigned in December 2016. A transcript of that hearing is of record. In September 2015, the RO granted a total disability rating based on individual unemployability as a result of service-connected disabilities (TDIU), effective June 1, 2012. The Board thereafter remanded that issue in light of caselaw suggesting that the matter of entitlement to a TDIU prior to that date might still be on appeal. The AOJ issued a supplemental statement of the case on that matter. However, on further review of the record the Board notes that the Veteran has not in fact suggested that the effective date assigned in any way does not constitute a full grant of her appeal. She has not argued for an earlier effective date. Given these circumstances, the Board finds that the matter of entitlement to a TDIU was in fact resolved by the September 2015 rating decision. That issue is no longer before the Board. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 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). Service connection may also be established under 38 C.F.R. § 3.303(b), where a condition in service is noted but is not, in fact, chronic, or where a diagnosis of chronicity may be legitimately questioned. The continuity of symptomatology provision of 38 C.F.R. § 3.303(b) has been interpreted as an alternative to service connection only for the specific chronic diseases listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 718 F.3d 1331 (Fed. Cir. 2013). Service connection may also be established with certain chronic diseases based upon a legal presumption by showing that the disorder manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from 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, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disability which is aggravated by a service-connected disability. In order to prevail on the issue of secondary service connection, the record must show (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509 (1998). The Veteran filed a service connection claim for pain in her back, wrists, fingers, hips, ankles, and toes, which was denied by April 2012 and June 2013 rating decisions. The Veteran asserts that she has a joint disorder due to medications used to treat her asthma. At the December 2016 Board hearing, she testified that her joint pain started around 2010. She testified that her physician told her that her joint pian was due to the side effects of Prednisone for her asthma. The Veteran’s STRs show that at her August 1974 entrance physical and her November 1977 physical, she had normal examinations. At her November 1977 separation examination, she specifically denied having any arthritis, rheumatism, bursitis, bone, joint or other deformity, painful or trick shoulder or elbow, recurrent back pain, trick or locked knee, or foot trouble. Her STRs do not show any complaints, treatment, or diagnosis for a joint disorder. The Veteran’s medical records show that she has been diagnosed with lumbar spine arthritis, bilateral shoulder arthritis, bilateral wrist arthritis, bilateral hand arthritis, bilateral ankle sprains, and bilateral foot disorders beginning in 2010, which is over three decades after the Veteran’s separation from active service. In December 2011, the Veteran was afforded a VA examination. She reported that her ankles give out and hurt intermittently. She also reported throbbing in her big toes. After reviewing the Veteran’s claims file, interviewing the Veteran, and conducting an examination, the examiner diagnosed the Veteran with bilateral ankle sprain/strain, metatarsalgia, and Tailor’s bunion. The examiner opined that the Veteran’s ankle and foot disorders were less likely as not due to her osteoporosis. In January 2012, the Veteran was afforded a VA examination. She reported that she started having back pain in 1979 without an acute injury. She reported a gradual onset of left hip pain, bilateral wrist pain, and bilateral hand pain. After reviewing the Veteran’s claims file, interviewing the Veteran, and conducting an examination, the examiner diagnosed the Veteran with a lumbar spine strain, a left hip strain, a bilateral wrist strain, and a bilateral hand strain. The examiner opined that the Veteran’s lumbar spine disorder, left hip disorder, bilateral wrist disorder, and bilateral hand disorder were at least as likely as not due to the Veteran’s osteoporosis. In November 2012, a VA examiner reviewed the Veteran’s claims file. The examiner reported that a September 2012 DEXA bone scan did not demonstrate osteoporosis. The examiner opined that the Veteran’s lumbar spine disorder, left hip disorder, bilateral wrist disorder, bilateral hand disorder, were not due to or aggravated by osteoporosis. The examiner reported that osteoporosis was a loss of calcium in the bone and affected the quality and strength of that bone specifically, which increased the risk of bone fracture and not soft tissue strain. The examiner reported that strain injuries were a musculoskeletal injury to soft tissue including muscles, ligaments and tendons, and were not bone fractures. The examiner reported that strain injuries were not caused or aggravated by osteoporosis. A March 2013 VA examiner reviewed the Veteran’s claims file and opined that the Veteran’s bilateral foot and ankle disorders were less likely than not due to the Veteran’s Prednisone therapy as there was no causative link. A March 2013 VA examiner reviewed the Veteran’s claims file. The examiner opined that the Veteran’s lumbar spine disorder, left hip disorder, bilateral wrist disorder, and bilateral hand disorder were less likely than not due to or the result of the Veteran’s Prednisone therapy. The examiner reported that the Veteran’s disorders were caused by arthritis in these joints and Prednisone did not cause arthritis. The examiner reported that long-term Prednisone caused osteoporosis, but the Veteran had no evidence of osteoporosis. In May 2013, a VA examiner reviewed the Veteran’s claim and affirmed the March 2013 VA examination opinions. In July 2018, a VA examiner reviewed the Veteran’s claims file. The examiner opined that the Veteran’s bilateral ankle disorder and bilateral foot disorder were less likely than not caused or aggravated by osteopenia or medication used to treat the Veteran’s asthma. In July 2018, the Veteran was afforded a VA examination. After reviewing the Veteran’s claims file, interviewing the Veteran, and conducting an examination, the examiner diagnosed the Veteran with lumbar spine arthritis, bilateral shoulder arthritis, bilateral wrist arthritis, and bilateral hand arthritis. The examiner reported that the Veteran did not have left hip arthritis. The examiner opined that the Veteran’s lumbar spine arthritis, bilateral shoulder arthritis, bilateral wrist arthritis, and bilateral hand arthritis were not caused or aggravated by osteopenia as osteopenia was not a risk factor for strains or arthritis. The examiner reported that these conditions were separate and did not overlap. After weighing all the evidence, the Board finds great probative value in the March 2013, May 2013, and July 2018 VA examiners’ opinions. These negative opinions are sufficient to satisfy the statutory requirements of producing an adequate statement of reasons and bases where the expert has fairly considered material evidence which appears to support the Veteran’s position. Wray v. Brown, 7 Vet. App. 488, at 492-93 (1995). The Veteran has not submitted any medical evidence supporting her assertion that her joint disorder was due to or the result of her active service or caused or aggravated by medications used to treat her service-connected asthma. VA obtained medical opinions in an effort to support the Veteran in establishing her claim. The March 2013, May 2013, and July 2018 VA examiners opined that the Veteran’s joint disorder was less likely than not due to or aggravated by medications used to treat her service-connected asthma. Therefore, after weighing all the evidence, the Board finds great probative value in the March 2013, May 2013, and July 2018 VA examiners’ opinions. Thus, the evidence fails to establish service connection for the Veteran’s joint disorder either on a direct or secondary basis. Consideration has been given to the Veteran’s personal assertion that her joint disorder was due to medications used to treat her service-connected asthma. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issues in this case, the etiology of arthritis and strains/sprains, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Arthritis and sprains/strains are not the type of conditions that is readily amenable to mere lay diagnosis or probative comment regarding its etiology, as the evidence shows that physical examinations that include objective medical tests are needed to properly assess and diagnose the disorder. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). That is, although the Board readily acknowledges that Veteran is competent to report perceived symptoms of joint pain, she has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that he has received any special training or acquired any medical expertise in evaluating orthopedic or respiratory disorders. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). Accordingly, the Veteran’s assertions do not constitute competent medical evidence. The Veteran has not offered any medical opinion of record that refutes the March 2013, May 2013, and July 2018 VA examiner’s opinions. As such, the VA examiner’s opinions are given great weight. (Continued on the next page)   Accordingly, as the criteria for service connection for a joint disorder have not been met, the Veteran’s claim is denied. Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Berryman, 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.