Citation Nr: A20007345 Decision Date: 04/30/20 Archive Date: 04/30/20 DOCKET NO. 200102-57426 DATE: April 30, 2020 ORDER New and relevant evidence having been submitted, the application to readjudicate the previously denied claim of service connection for right hip degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is granted, and the claim will be readjudicated. New and relevant evidence having been submitted, the application to readjudicate the previously denied claim of service connection for left hip degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is granted, and the claim will be readjudicated. New and relevant evidence having been submitted, the application to readjudicate the previously denied claim of service connection for left knee degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is granted, and the claim will be readjudicated. New and relevant evidence having been submitted, the application to readjudicate the previously denied claim of service connection for right ankle degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is granted, and the claim will be readjudicated. New and relevant evidence having been submitted, the application to readjudicate the previously denied claim of service connection for left ankle degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is granted, and the claim will be readjudicated. New and relevant evidence having been submitted, the application to readjudicate the previously denied claim of service connection for right hand little finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is granted, and the claim will be readjudicated. New and relevant evidence having been submitted, the application to readjudicate the previously denied claim of service connection for right hand long finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is granted, and the claim will be readjudicated. New and relevant evidence having been submitted, the application to readjudicate the previously denied claim of service connection for right hand ring finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is granted, and the claim will be readjudicated. New and relevant evidence having been submitted, the application to readjudicate the previously denied claim of service connection for right hand index finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is granted, and the claim will be readjudicated. New and relevant evidence having been submitted, the application to readjudicate the previously denied claim of service connection for right hand thumb degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is granted, and the claim will be readjudicated. Entitlement to service connection for right hip degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is denied. Entitlement to service connection for left hip degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is denied. Entitlement to service connection for left knee degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is denied. Entitlement to service connection for right ankle degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is denied. Entitlement to service connection for left ankle degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is denied. Entitlement to service connection for right hand little finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is denied. Entitlement to service connection for right hand long finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is denied. Entitlement to service connection for right hand ring finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is denied. Entitlement to service connection for right hand index finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is denied. Entitlement to service connection for right hand thumb degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) is denied. FINDINGS OF FACT 1. A May 2019 Board decision denied claims for service connection for right hip, left hip, left knee, right ankle, left ankle, right hand little finger, right hand long finger, right hand ring finger, right hand index finger, and right hand thumb degenerative arthritis, all as secondary to inflammatory arthritis (also claimed as gout and arthralgia). 2. In November 2019, the Veteran filed claims for service connection for right hip, left hip, left knee, right ankle, left ankle, right hand little finger, right hand long finger, right hand ring finger, right hand index finger, and right hand thumb degenerative arthritis under the Appeals Modernization Act. 3. New evidence was received after the May 2019 denial that is relevant to the issues of entitlement to service connection for right hip, left hip, left knee, right ankle, left ankle, right hand little finger, right hand long finger, right hand ring finger, right hand index finger, and right hand thumb degenerative arthritis. 4. A preponderance of the competent and credible evidence of record shows that the claimed right hip degenerative arthritis disability is not related to active service or other service connected disability. 5. A preponderance of the competent and credible evidence of record shows that the claimed left hip degenerative arthritis disability is not related to active service or other service connected disability. 6. A preponderance of the competent and credible evidence of record shows that the claimed left knee degenerative arthritis disability is not related to active service or other service connected disability. 7. A preponderance of the competent and credible evidence of record shows that the claimed right ankle degenerative arthritis disability is not related to active service or other service connected disability. 8. A preponderance of the competent and credible evidence of record shows that the claimed left ankle degenerative arthritis disability is not related to active service or other service connected disability. 9. A preponderance of the competent and credible evidence of record shows that the claimed right hand little finger degenerative arthritis disability is not related to active service or other service connected disability. 10. A preponderance of the competent and credible evidence of record shows that the claimed right hand long finger degenerative arthritis disability is not related to active service or other service connected disability. 11. A preponderance of the competent and credible evidence of record shows that the claimed right hand ring finger degenerative arthritis disability is not related to active service or other service connected disability. 12. A preponderance of the competent and credible evidence of record shows that the claimed right hand index finger degenerative arthritis disability is not related to active service or other service connected disability. 13. A preponderance of the competent and credible evidence of record shows that the claimed right hand thumb degenerative arthritis disability is not related to active service or other service connected disability. CONCLUSIONS OF LAW 1. The criteria for readjudicating the claim for service connection for right hip degenerative arthritis have been met. 84 Fed. Reg. 138, 169 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 3.156(d)). 2. The criteria for readjudicating the claim for service connection for left hip degenerative arthritis have been met. 84 Fed. Reg. 138, 169 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 3.156(d)). 3. The criteria for readjudicating the claim for service connection for left knee degenerative arthritis have been met. 84 Fed. Reg. 138, 169 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 3.156 (d)). 4. The criteria for readjudicating the claim for service connection for right ankle degenerative arthritis have been met. 84 Fed. Reg. 138, 169 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 3.156(d)). 5. The criteria for readjudicating the claim for service connection for left ankle degenerative arthritis have been met. 84 Fed. Reg. 138, 169 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 3.156(d)). 6. The criteria for readjudicating the claim for service connection for right hand little finger degenerative arthritis have been met. 84 Fed. Reg. 138, 169 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 3.156(d)). 7. The criteria for readjudicating the claim for service connection for right hand long finger degenerative arthritis have been met. 84 Fed. Reg. 138, 169 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 3.156(d)). 8. The criteria for readjudicating the claim for service connection for right hand ring finger degenerative arthritis have been met. 84 Fed. Reg. 138, 169 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 3.156(d)). 9. The criteria for readjudicating the claim for service connection for right hand index finger degenerative arthritis have been met. 84 Fed. Reg. 138, 169 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 3.156(d)). 10. The criteria for readjudicating the claim for service connection for right hand thumb degenerative arthritis have been met. 84 Fed. Reg. 138, 169 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 3.156(d)). 11. The criteria for service connection for right hip degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) have not been met. 38 U.S.C. §§ 1110, 1114, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. 12. The criteria for service connection for left hip degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) have not been met. 38 U.S.C. §§ 1110, 1114, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. 13. The criteria for service connection for left knee degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) have not been met. 38 U.S.C. §§ 1110, 1114, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. 14. The criteria for service connection for right ankle degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) have not been met. 38 U.S.C. §§ 1110, 1114, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. 15. The criteria for service connection for left ankle degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) have not been met. 38 U.S.C. §§ 1110, 1114, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. 16. The criteria for service connection for right hand little finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) have not been met. 38 U.S.C. §§ 1110, 1114, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. 17. The criteria for service connection for right hand long finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) have not been met. 38 U.S.C. §§ 1110, 1114, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. 18. The criteria for service connection for right hand ring finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) have not been met. 38 U.S.C. §§ 1110, 1114, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. 19. The criteria for service connection for right hand index finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) have not been met. 38 U.S.C. §§ 1110, 1114, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. 20. The criteria for service connection for right hand thumb degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) have not been met. 38 U.S.C. §§ 1110, 1114, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from May 1964 to May 1968. The Board notes that the rating decision on appeal was issued in December 2019. In that decision, the Agency of Original Jurisdiction (AOJ) found that new and relevant evidence was not submitted to warrant readjudicating the claims for service connection for right hip, left hip, left knee, right ankle, left ankle, right hand little finger, right hand long finger, right hand ring finger, right hand index finger, and right hand thumb degenerative arthritis, all as secondary to inflammatory arthritis (also claimed as gout and arthralgia). The Veteran timely appealed that rating decision to the Board and requested review of the evidence considered by the AOJ. New and Relevant Evidence 1. Whether new and relevant evidence has been received to readjudicate the previously denied claim of service connection for right hip degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) 2. Whether new and relevant evidence has been received to readjudicate the previously denied claim of service connection for left hip degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) 3. Whether new and relevant evidence has been received to readjudicate the previously denied claim of service connection for left knee degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) 4. Whether new and relevant evidence has been received to readjudicate the previously denied claim of service connection for right ankle degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) 5. Whether new and relevant evidence has been received to readjudicate the previously denied claim of service connection for left ankle degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) 6. Whether new and relevant evidence has been received to readjudicate the previously denied claim of service connection for right hand little finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) 7. Whether new and relevant evidence has been received to readjudicate the previously denied claim of service connection for right hand long finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) 8. Whether new and relevant evidence has been received to readjudicate the previously denied claim of service connection for right hand ring finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) 9. Whether new and relevant evidence has been received to readjudicate the previously denied claim of service connection for right hand index finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) 10. Whether new and relevant evidence has been received to readjudicate the previously denied claim of service connection for right hand thumb degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) VA will readjudicate a claim if new and relevant evidence is presented or secured. 84 Fed. Reg. 138, 169 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 3.156(d)). Relevant evidence is evidence that tends to prove or disprove a matter in issue. 84 Fed. Reg. 138, 172 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 3.2501(a)(1)). The Board notes that the task is to first decide whether new relevant evidence has been received, as opposed to whether or not the evidence actually substantiates the claim. Relevant evidence added to the record since the prior May 2019 decision includes an April 2019 letter from a private examiner and the report of a July 2019 VA examination. That evidence documents chronic bilateral ankle, left knee, bilateral hip, and right-hand pain. The Board finds the Veteran submitted new evidence after the May 2019 rating decision that is relevant to the claims. Based on that newly added evidence, the Board finds that new and relevant evidence has been added to the record that may prove or disprove the current disability element of the claims for service connection for right hip, left hip, left knee, right ankle, left ankle, right hand little finger, right hand long finger, right hand ring finger, right hand index finger, and right hand thumb degenerative arthritis. Readjudication of the claims is warranted. Service Connection Service connection may be established for disability caused by disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish service connection for a 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) evidence, generally medical, of a relationship between the claimed in service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247 (1999). Service connection may also be established for any disease initially diagnosed after service, when the evidence establishes that the disease was incurred in service. 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 503 (1992). The disease entity for which service connection is sought must be chronic rather than acute and transitory in nature. For the showing of chronic disease in service, a combination of manifestations must exist sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic. Arthritis is among the chronic diseases listed in 38 C.F.R. § 3.309(a), and service connection for arthritis may be established based on a continuity of symptomatology. Furthermore, service incurrence will be presumed for certain chronic diseases, including arthritis, if manifest to a compensable degree within the year after active service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. A disability that is proximately due to or the result of a service connected disease or injury shall be service connected. When service connection is established for a secondary disability, the secondary disability shall be considered a part of the original disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a non-service connected disability, which is aggravated by a service-connected disability. In that instance, the Veteran is compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 7 Vet. App. 439 (1995). 11. Entitlement to service connection for right hip degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) 12. Entitlement to service connection for left hip degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) 13. Entitlement to service connection for left knee degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) 14. Entitlement to service connection for right ankle degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) 15. Entitlement to service connection for left ankle degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) 16. Entitlement to service connection for right hand little finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) 17. Entitlement to service connection for right hand long finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) 18. Entitlement to service connection for right hand ring finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) 19. Entitlement to service connection for right hand index finger degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) 20. Entitlement to service connection for right hand thumb degenerative arthritis as secondary to inflammatory arthritis (also claimed as gout and arthralgia) The Veteran contends that bilateral ankle arthritis, bilateral hip arthritis, left knee degenerative arthritis, and right hand and fingers degenerative arthritis is related to active service. He alternatively asserts that the claimed disabilities are secondary to service-connected inflammatory arthritis. The service medical records do not show treatment or diagnoses of bilateral ankle arthritis, bilateral hip arthritis, left knee degenerative arthritis, or right hand or fingers arthritis. Post-service medical treatment records include a February 2014 VA Disability Benefits Questionnaire completed by the Veteran’s treating physician which noted the Veteran had no joints affected by service-connected inflammatory arthritis, nor did the Veteran have any joint limitation or joint deformities as a result of inflammatory arthritis. A February 2015 VA examination report recorded the Veteran’s complaints of bilateral ankle, hip, left knee, and right hand and finger pain which he believed was attributable to inflammatory arthritis. The examiner noted the joints affected according the Veteran and recorded the described limitation of movement as a flareup every two to three days which resulted in nonuse of the right hand. No etiologic opinion as to whether or not any claimed bilateral ankle arthritis, bilateral hip arthritis, left knee degenerative arthritis, and right hand and fingers degenerative arthritis was related to service was provided. An April 2015 VA examination report found that the Veteran had no joints affected by service-connected inflammatory arthritis, nor did the Veteran have any joint limitation or joint deformities as a result of inflammatory arthritis. On physical examination, the examiner noted no erythema, swelling, or increased warmth of any joints. The examiner opined that although the Veteran had a diagnosis of osteoarthritis of multiple joints, those diagnoses were not related to service-connected inflammatory arthritis. As rationale, the examiner stated that based on medical literature review, clinical experience, medical record review, and evaluation of the Veteran, the degenerative arthritis shown in the Veteran’s joints was not the same as or etiologically related to inflammatory arthritis, and there was no objective medical evidence for aggravation of degenerative arthritis by inflammatory arthritis. An August 2015 letter from Dr. F.W. shows current diagnoses of bilateral ankle arthritis, bilateral hip arthritis, left knee degenerative arthritis, and right hand and fingers degenerative arthritis. Dr. W. did not offer an etiology opinion. An April 2019 letter from Dr. K.C. indicates that the Veteran had gout and inflammatory arthritis. Dr. C. stated that the Veteran had joint pain, swelling, and inflammation throughout multiple joints during active duty to include the bilateral ankles, bilateral knee, bilateral bit toes, bilateral hips, and bilateral wrists. Dr. C. noted X-ray evidence during active duty of “punched out” lesions in the carpal bones of the right hand which were consistent with gout. Dr. C. stated that the documented onset of all the aforementioned joints should qualify for service connection, and the gout was as likely as not related to service. On VA examination in July 2019, the examiner diagnosed of a history of inflammatory arthritis. The Veteran reported having chronic ankle, left knee, right wrist, and right hand pain. The examiner stated that the Veteran did not have any joint limitation or joint deformities as a result of inflammatory arthritis. The examiner noted that the Veteran’s medical history was pertinent for degenerative joint disease. Based upon the evidence of record, the Board finds that bilateral ankle, hip, left knee, and right hand and finger arthritis did not manifest during active service, nor did any bilateral ankle, hip, left knee, and right hand and finger arthritis manifest within a year of separation from service. The service medical records do not show specific treatment or diagnoses of bilateral ankle, hip, left knee, and right hand and finger arthritis, and post-service medical treatment records do not establish diagnoses or treatment of the specific claimed conditions within one year of service separation. Although the service medical records note treatment for and complaints of inflammatory arthritis, which is currently service-connected, no specific joints were treated or diagnosed. Further, no objective medical evidence of record has positively opined that the claimed bilateral ankle, hip, left knee, and right hand and finger arthritis are related to active service, and the preponderance of the objective medical evidence of record does not establish that any of the claimed disabilities is a result of service-connected inflammatory arthritis. The Board has carefully considered the April 2019 letter from Dr. C. submitted by the Veteran. Service connection has previously been granted for inflammatory arthritis. While opining that the Veteran’s gout and inflammatory arthritis were as likely as not related to service, Dr. C. stated nothing about degenerative arthritis. Although the April 2019 letter from Dr. C. provides evidence of the Veteran’s symptoms, the letter does not show any a relationship between the Veteran’s service or service-connected disability and the disabilities for which he currently seeks service connection. The Board finds the opinion of the February 2014 and April 2015 VA examiners to be probative and persuasive. The examiners are shown to have reviewed of the evidence of record, including the contentions of the Veteran, and the evidence as to the Veteran’s history was adequately considered. Dalton v. Nicholson, 21 Vet. App. 23 (2007). Therefore, the Board finds that the preponderance of the evidence is against a finding that the claimed disabilities manifested during active service and also does not establish that the claimed disabilities manifested as a result of service or within one year of service. The preponderance of the evidence also does not demonstrate that the claimed disabilities were incurred secondary to a service-connected disability. The Veteran’s lay statements of record are competent insofar as they report symptomatology which is capable of lay observation. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, to the extent that the Veteran asserts a nexus between bilateral ankle, hip, left knee, and right hand and finger arthritis disabilities and service-connected inflammatory arthritis disability or service, the Board finds them to be less probative, as the Veteran is not shown to possess expert knowledge which would enable him to provide such an opinion as to medical etiology. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Veteran’s lay statements concerning a nexus between the claimed disabilities and the service-connected disability or service do not constitute competent medical evidence and are outweighed by the other evidence of record because of the medical knowledge and training of the examiners. The Board finds that the February 2014 and April 2015 VA examiners’ opinions are the most persuasive evidence in this case. The Board is appreciative of the Veteran’s faithful and honorable service to our country. However, because the preponderance of the evidence is against the claim, the claim must be denied. Accordingly, the Board concludes that the preponderance of evidence is against establishing service connection for bilateral ankle, hip, left knee, and right hand and finger arthritis on any theory of entitlement raised by the Veteran or the record. Thus, there is no reasonable doubt to be resolved in the Veteran’s favor, and the claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Layton, 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.