Citation Nr: 20041678 Decision Date: 06/18/20 Archive Date: 06/18/20 DOCKET NO. 18-19 448 DATE: June 18, 2020 ORDER Entitlement to service connection for rheumatic fever is denied. Entitlement to service connection for rhinitis (also claimed as hay fever) is denied. FINDINGS OF FACT 1. The Veteran’s pre-existing rheumatic fever was not aggravated by his active military service, nor is it etiologically related to his active military service. 2. The Veteran’s pre-existing rhinitis (also claimed as hay fever) was not aggravated by his active military service, nor is it etiologically related to his active military service CONCLUSIONS OF LAW 1. The criteria for service connection for rheumatic fever have not been met. 38 U.S.C. §§ 1110, 1131, 1153; 38 C.F.R. § 3.303. 2. The criteria for service connection for rhinitis (also claimed as hay fever) have not been met. 38 U.S.C. §§ 1110, 1131, 1153; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the United States Marine Corps from November 1959 to March 1962. In March 2019, the Board remanded the issue on appeal for further development, and the case has since been returned to the Board. The Board finds that the agency of original jurisdiction (AOJ) has substantially complied with the remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Generally, in order to establish service connection for the claimed disability, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The requirement of a current disability 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.” See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). A preexisting disease will be presumed to have been aggravated by military service when there is an increase in disability during such service, unless there is a specific finding that the increase is due to the natural progress of the disease. See 38 U.S.C. §1153; 38 C.F.R. §3.306(a). In deciding an aggravation claim, the Board must determine, after having found the presence of a preexisting condition, whether there has been any measurable worsening of the disability during service and whether such worsening constitutes an increase in disability. See Browder v. Brown, 5 Vet. App. 268, 271 (1993); Hensley v. Brown, 5 Vet. App. 155, 163 (1993). If the presumption of aggravation under § 1153 arises, clear and unmistakable evidence (obvious or manifest) is required to rebut this presumption. See 38 C.F.R. § 3.306 (b). Entitlement to service connection for rheumatic fever The Veteran contends that his rheumatic fever was aggravated by his military service. In addition, he contends that it is the result of strep throat while in service. Service treatment records (STRs) indicate that the Veteran’s rheumatic fever was preexisting. Specifically, his entrance examination notes a history of rheumatic fever. Therefore, the remaining question before the Board is whether there was a measurable worsening of rheumatic fever during service and whether such worsening constitutes an increase. Notably, the Veteran’s separation examination in 1962 does not mention any complaints or diagnosis of rheumatic fever. In October 2019, as directed by the March 2019 Board remand, a VA Infectious Diseases Disability Benefits Questionnaire (DBQ) was provided. The examiner diagnosed rheumatic fever. Further, he opined that: There is no objective medical evidence to support this veteran’s pre-existing rheumatic fever was aggravated permanently, beyond normal progression, by in service subjective symptoms, objective diagnosis, and/or treatment to include the treatment for a sore throat in February 1962. Also, as there was no aggravation of the pre-existing rheumatic fever in service this veteran’s multiple current cardiac conditions would not be related to said aggravation. VA treatment records indicate a diagnosis of rheumatic fever but no discussion regarding possible aggravation. Having carefully considered the evidence of record, the Board finds that the preponderance of the evidence is against the Veteran’s claim of service connection for rheumatic fever. In this regard, there is no evidence that the Veteran’s pre-existing rheumatic fever was aggravated permanently, beyond normal progression by his active service. Further, the Board finds the October 2019 opinion the most probative of record because it is based on a more complete and accurate medical history and provided an explanation that contained clear conclusions and supporting data. Further, while the Veteran contends that his rheumatic fever was aggravated during his active military service, he is not competent to opine on a complex question such as aggravation of pre-existing rheumatic fever. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Simply stated, the Veteran’s service treatment records (showing no chronic disability at separation from service) and post-service treatment records (showing no competent medical evidence linking the asserted disability to service) outweigh the Veteran’s contentions. A basis upon which to grant the Veteran’s service connection claim for rheumatic fever has not been established, therefore, the claim must be denied. As the preponderance of the evidence is against the service connection claim, the benefit-of-the-doubt doctrine is not helpful to the Veteran. See generally Gilbert, 1 Vet.App. at 49. Entitlement to service connection for rhinitis (also claimed as hay fever) The Veteran contends that his rhinitis was aggravated by his military service. Service treatment records (STRs) indicate that the Veteran’s rhinitis was preexisting. Specifically, his entrance examination notes a history of hay fever. Therefore, the remaining question before the Board is whether there was a measurable worsening of rhinitis during service and whether such worsening constitutes an increase. Notably, the Veteran’s separation examination in 1962 does not mention any complaints or diagnosis of rhinitis or hay fever. In November 2015, the Veteran attended a VA Sinusitis Rhinitis and Other Conditions of the Nose, Throat, Larynx and Pharynx DBQ examination. The examiner diagnosed allergic rhinitis and opined that there is no objective medical evidence this preservice condition was permanently aggravated by military service or events which occurred on active duty. No rationale was provided in support of this opinion. In October 2019, the Veteran attended another VA a VA Sinusitis Rhinitis and Other Conditions of the Nose, Throat, Larynx and Pharynx DBQ examination. The examiner diagnosed allergic rhinitis and opined: There is no physiologic mechanism by which treating hay fever (rhinitis) with Chlor-Trimeton Syrup and aspirin 5/19/1961 would cause a permanent aggravation of the hay fever (rhinitis) being treated beyond normal progression. There is no objective medical evidence this preservice condition was permanently aggravated, beyond normal progression, by military service or events which occurred on active duty. There is no objective medical evidence this preservice condition was permanently aggravated, beyond normal progression, by subjective complaints, objective diagnosis, and/or treatment which occurred on active duty Having carefully considered the evidence of record, the Board finds that the preponderance of the evidence is against the Veteran’s claim of service connection for rhinitis. In this regard, there is no evidence that the Veteran’s pre-existing rhinitis was aggravated permanently, beyond normal progression by his active service. Further, the Board finds the October 2019 opinion the most probative of record because it is based on a more complete and accurate medical history and provided an explanation that contained clear conclusions and supporting data. Further, while the Veteran contends that his rhinitis (claimed as hay fever), was aggravated during his active military service, he is not competent to opine on a complex question such as aggravation of pre-existing rhinitis. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir.. Simply stated, the Veteran’s service treatment records (showing no chronic disability at separation from service) and post-service treatment records (showing no competent medical evidence linking the asserted disability to service) outweigh the Veteran’s contentions. A basis upon which to grant the Veteran’s service connection claim for rhinitis has not been established, therefore, the claim must be denied. As the preponderance of the evidence is against the service connection claim, the benefit-of-the-doubt doctrine is not helpful to the Veteran. See generally Gilbert, 1 Vet.App. at 49. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R.A. Elliott II, 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.