Citation Nr: 20044590 Decision Date: 07/02/20 Archive Date: 07/02/20 DOCKET NO. 13-14 330 DATE: July 2, 2020 ORDER Entitlement to service connection for a bilateral elbow disability is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s bilateral elbow disability was incurred in, caused by, or is otherwise etiologically related to his military service, or that it was caused by or aggravated by any of his service-connected disabilities. CONCLUSION OF LAW The criteria for entitlement to service connection for a bilateral elbow disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from August 1972 to January 1973, from May 1974 to July 1976, and from May 1985 to December 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Portland, Oregon. The matter was previously before in March 2017, at which time the Board remanded the claim to the RO to obtain an additional medical opinion ascertaining the nature and etiology of the Veteran’s claimed bilateral elbow disability as well as an opinion addressing whether such a disability was either caused by or aggravated by any of the Veteran’s service-connected disabilities. The matter was returned to the Board in August 2019, at which time the Board remanded the claim again in order to procure an adequate medical opinion clarifying whether any of the Veteran’s service-connected disabilities, to include his diabetes mellitus and peripheral neuropathy of the upper extremities, aggravated his elbow condition beyond its natural progression. The Board finds that there has been substantial compliance with its remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss every piece of evidence of record in detail. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Thus, the Board will summarize the relevant evidence as appropriate and the Board’s analysis will focus specifically on what the evidence shows, or fails to show, as to the claims. Entitlement to service connection for a bilateral elbow disability Service connection is warranted if it is shown that a veteran has a disability resulting from an injury incurred or a disease contracted in active duty service or for aggravation of a pre-existing injury or disease in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing direct service connection generally requires competent evidence of: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Alternatively, a veteran can receive compensation via secondary service connection, which can be established when a disability is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. To be awarded secondary service connection, there must be evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). 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; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Here, the Veteran contends that his service-connected disabilities have caused or aggravated his bilateral elbow disability. See, e.g., Hearing Transcript at 11. He notes that his elbow condition results in pain and a compromised range of motion. See, e.g., Notice of Disagreement, dated April 26, 2010. The Veteran is service connected for, in pertinent part, diabetes mellitus, peripheral neuropathy of the right and left upper extremities, and tendinitis and mild degenerative arthritis of the right and left wrists. A review of the record indicates that the Veteran has current diagnoses of osteoarthritis and degenerative arthritis of both the right elbow and the left elbow. See VA examination dated April 5, 2017. Although the Veteran has not alleged that his bilateral elbow disability was caused by, or is otherwise etiologically related to, his military service, VA obtained a nexus opinion regarding direct service connection. In April 2017, a VA examiner opined that the Veteran’s elbow disability was less likely than not incurred in, or caused by, the Veteran’s active duty service. See VA examination dated April 5, 2017. In so finding, the examiner reasoned that the Veteran’s elbow condition is degenerative in nature and not related to any physical trauma the Veteran may have sustained. The examiner also found no evidence of causation of the condition by the Veteran’s military service or a continuity of symptomatology since the time of the Veteran’s military service. Concerning entitlement to service connection on a secondary basis, the April 2017 examiner opined that the Veteran’s bilateral elbow condition is less likely than not proximately due to or the result of his service-connected disabilities. The examiner noted that the bilateral nature of the elbow condition is not due to “a chronic mechanical deficiency or insult” but is instead more likely caused by the aging process. In a March 2019 addendum medical opinion, the examiner further specified that the Veteran’s elbow disabilities were less likely than not caused by or aggravated beyond their natural progression by his service-connected bilateral wrist disabilities. Pursuant to the Board’s August 2019 remand, the agency of original jurisdiction (AOJ) obtained an additional medical opinion addressing whether any of the Veteran’s other service-connected disabilities, to include the Veteran’s diabetes mellitus and bilateral peripheral neuropathy of the upper extremities, caused or aggravated his bilateral elbow condition. In December 2019, a clinician determined that the Veteran’s bilateral elbow condition was less likely than not caused by or aggravated by any of the Veteran’s service-connected disabilities. The clinician reasoned that, while the Veteran’s diabetes mellitus and peripheral neuropathy of the upper extremities decrease sensation and strength of the arms, they do not affect the elbow joints or cause limitation of motion of the elbows. The clinician also noted that the Veteran’s service-connected disabilities have not aggravated his bilateral elbow disability, as the elbow joints experience degenerative mechanical functionality attributable to aging. The Board acknowledges the insightful lay statements provided by the Veteran and various family members concerning the repercussions of the Veteran’s bilateral elbow disability on his everyday life; and, the Board thanks those individuals for their efforts to assist in the adjudication of the Veteran’s claim. Lay persons are competent to report observable symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, opining the etiology of the Veteran’s condition in this case requires specialized medical knowledge, training, or experience that the individuals are not shown to have. See, e.g., Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). Thus, concerning the etiology of the Veteran’s disability, the Board finds the medical opinions to be the most probative evidence of record. Finally, the Board notes that the Veteran has expressed his disagreement with the denial of his claim for service connection for a bilateral elbow disability based, at least in part, on VA’s failure to provide him with a new medical examination for the disability. Notably, the last physical examination the Veteran was afforded for the condition was conducted approximately 3 years ago. However, the duty to assist does not require that a claim be remanded solely due to the passage of time since an otherwise adequate VA examination was conducted. See Palczewski v. Nicholson, 21 Vet. App. 174, 182 (2007) (stating that the mere passage of time, as opposed to evidence or allegation of a worsening disability, does not warrant the provision of a new medical examination). Furthermore, the record does not provide evidence supporting that a material change in the nature of the Veteran’s elbow disability has occurred, such that the validity of the negative nexus opinions of record might be called into question. Accordingly, the preponderance of the evidence demonstrates that entitlement to service connection for a bilateral elbow disability is not warranted. Because the preponderance of the evidence is against the claim, the “benefit-of-the-doubt” doctrine is not applicable; and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Tolbert, 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.