Citation Nr: 21065879 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 16-42 426 DATE: October 27, 2021 ORDER Entitlement to service connection for rheumatoid arthritis is granted. FINDING OF FACT The evidence is at least in relative equipoise for finding that the Veteran's rheumatoid arthritis is due to her service. CONCLUSION OF LAW The criteria for service connection for rheumatoid arthritis have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1997 to September 2001, and October 2009 to March 2010. This matter comes before the Board of Veteran's Appeals (Board) on appeal of an April 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In September 2021, the Veteran participated in a hearing before the undersigned veterans law judge. A transcript has been associated with the record. 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. § 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 (Fed. Cir. 2004). Additionally, service connection can also be established through application of a statutory presumption for chronic diseases, including organic diseases of the nervous system, such as hearing loss and tinnitus, when manifested to a compensable degree within a year of separation from service. 38 C.F.R. §§ 3.307, 3.309. If a chronic disease is not manifested to a compensable degree within a year of separation of service, then, generally, a showing of "continuity of symptoms" after service is required for service connection. 38 C.F.R. § 3.303(b). The Veteran has a current diagnosis of rheumatoid arthritis. This diagnosis was noted in 2013 during a VA medical fitness evaluation that noted the Veteran had a diagnosis of rheumatoid arthritis in 2010. The Veteran has consistently stated that her symptoms began while she was in active service. The Veteran was given a VA examination in April 2015. The examiner opined against service connection for the Veteran's rheumatoid arthritis. While the Board cannot ignore or disregard the VA examiner's medical conclusions [Willis v. Derwinski, 1 Vet. App. 66 (1991)], the Board is free to assess medical evidence and is not compelled to accept a medical opinion. Wilson v. Derwinski, 2 Vet. App. 614 (1992). Here, the 2015 VA examiner found that the Veteran's rheumatoid arthritis was not related to service due to the Veteran's symptoms being well controlled with medication. Additionally, the examiner noted that the Veteran's STRs, including immediate post-service medical records are silent for RA. However, the Board notes that a lack of evidence cannot be corroborating to conclude that there is no relationship between the Veteran's current disability and his military service. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). Additionally, the severity of the Veteran's disability does not reflect the etiology of the disability. Lastly, the examiner did not address the Veteran's claims of continuity of symptoms since service. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Board must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion." See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); see also Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that "a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to a doctor's opinion"). In September 2015, the Veteran submitted a private medical opinion. The physician noted that while the Veteran was on active duty military at the onset of her symptoms in the fall of 1020. Specifically, she was seen in the Eglin Air Force Emergency Room on October 5, 2010 for bilateral wrist pain and swelling. She was diagnosed with tendinitis. In retrospect, this was likely her initial presentation of rheumatoid arthritis. She was subsequently seen on tow more occasions with similar symptoms of pain, swelling, and stiffness symmetrically. A rheumatoid factor was noted to be positive on her evaluation in the Spring of 2012. The physician concluded that he suspects that the initial presentation at the Eglin ER on October 5, 2010 was related ot RA rather than tendonitis. In November 2019, the Veteran submitted a buddy statement from a coworker of the Veteran during her military service. The coworker remembers the Veteran complaining of wrist pain on a monthly basis. The Veteran submitted a private nexus statement in November 2019. The physician noted that he reviewed the service tenement records as well as treatment records since separation from active service. She stated that the Veteran's rheumatoid arthritis had its onset during her active service. The examiner explained that the Veteran presented with rheumatoid arthritis in 2008-2010. The Veteran was diagnosed with tendonitis, but that early rheumatoid arthritis patients may present with symptoms of tendonitis that waxes and wanes. The examiner further stated that it was her professional opinion that if the Veteran had been referred to a Rheumatologist at the time, the Veteran would have been properly diagnosed with rheumatoid arthritis. The Board finds that the evidence is at least in relative equipoise. The lay and medical statements submitted by the Veteran undermines the examiner's opinion that the Veteran's rheumatoid arthritis is not related to military service. As the Veteran has shown a continuity of symptomatology since service, which is supported by the current diagnosis of rheumatoid arthritis and the Veteran's positive nexus opinions by medical professionals, the Board concludes that service connection for rheumatoid arthritis is warranted. A. J. Spector Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lent, Edward 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.