Citation Nr: 21070254 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 16-40 290 DATE: November 23, 2021 ORDER Entitlement to service connection for mixed connective tissue disease, claimed as due to exposure to contaminated water at Fort McClellan, Alabama, is denied. REMANDED Entitlement to service connection for a right hip disability, claimed as secondary to service-connected left hip disability, is remanded. FINDING OF FACT The Veteran does not have a current diagnosis of mixed connective tissue disease, and the evidence weighs against a finding of a current disability at any time relevant to the period under appeal. CONCLUSION OF LAW The criteria for service connection for mixed connective tissue disease have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1981 to October 1984. These matters come before the Board of Veterans' Appeals (Board) on appeal from July 2014 and August 2015 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). In a November 2018 decision, the Board, in pertinent part, denied service connection for mixed connective tissue disease and remanded the claim for service connection for a right hip disability for further development. The Veteran appealed the denial to the United States Court of Appeals for Veterans Claims (Court). In an August 2019 Order, the Court granted a Joint Motion for Partial Remand (JMPR) that vacated the portion of the Board decision that denied service connection for mixed connective tissue disease. In October 2020, the Board remanded the claims for service connection for mixed connective tissue disease and right hip disability for further development. Service Connection for Mixed Connective Tissue Disease The Veteran seeks entitlement to service connection for mixed connective tissue disease. Specifically, she asserts that the condition was caused by her active duty service, to include exposure to contaminated water while stationed at Fort McClellan, Alabama. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. In order to establish service connection on a direct basis, the record must contain: (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). After considering all of the evidence of record, to include that set forth below, the Board concludes that the Veteran does not have a current diagnosis for mixed connective tissue disease and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Veteran's service treatment records (STRs) do not reveal any diagnosis, treatment, or complaints of mixed connective tissue disease. The Veteran underwent a VA examination in April 2021, in which the examiner indicated that there were no findings, signs, and/or symptoms to support a diagnosis of mixed connective tissue disease. The examiner noted that the Veteran was referred to VA rheumatology in January 2009 for an unclear diagnosis of fibromyalgia and/or mixed connective tissue disease. The January 2009 treatment records indicate that the Veteran's serologies were all essentially negative and that her current symptoms were more consistent with fibromyalgia than active inflammatory disease. A subsequent March 2009 rheumatology note indicates that all serological work-ups were negative for mixed connective tissue disease; a diagnosis of fibromyalgia was noted. Further testing was done in July 2009 for possible mixed connective tissue disease or other diagnoses besides fibromyalgia, which were negative. At that time, treatment for other possibilities besides fibromyalgia was discontinued. After August 2011, the only diagnosis remained fibromyalgia. During the examination, the examiner noted that the Veteran reported ongoing symptoms of fibromyalgia without new or additional symptoms to support any additional diagnoses, to include mixed connective tissue disease or undifferentiated connective tissue disease. The examiner indicated that the Veteran confirmed that her symptoms had been essentially stable since onset in the 1980s. The examiner noted that although various doctors from 2009 used different terms and/or diagnoses, or combination of diagnoses, the Veteran's condition has not changed in regard to her symptoms, as she was seen by VA rheumatology and dermatology over the years from 2009 to about 2012 and the only active diagnosis is fibromyalgia. The examiner further noted that recent records confirm that there is no change, and no need for resumption of the prior treatment for possible mixed connective tissue disease that she had been on in the 2000s, and no new symptoms or other signs of mixed connective tissue disease. Thus, he concluded that her diagnosis remains fibromyalgia. The existence of a current disability is the cornerstone of a claim for service connection and VA disability compensation. 38 U.S.C. § 1110; Degmetich v. Brown, 104 F.3d 1328, 1332 (Fed. Cir. 1997). Evidence must show that the Veteran currently has the disability for which benefits are being claimed. Here, the Veteran has not been diagnosed with mixed connective tissue disease at any point during the appeal period. The Board recognizes that the Veteran's VA treatment records note diagnosis of mixed connective tissue disease in 2004, 2005, and 2006. However, the April 2021 VA examination report demonstrates that subsequent treatment records indicate that the diagnosis of mixed connective tissue disease was ruled out and her reported symptoms were attributed to her service-connected fibromyalgia. Moreover, the VA examiner specifically reviewed the evidence of record and conducted an examination of the Veteran and concluded that the Veteran has not meet the criteria for a diagnosis of mixed connective tissue disease during the appellate period. While the Veteran's application for service connection illustrates that she believes she has a current disability for VA purposes, she is not competent to provide a diagnosis in this case. The issue is medically complex as it requires the ability to interpret diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board affords more probative weight to the April 2021 VA medical opinion, as the examiner based his opinion on a review of the claims file and consideration of the Veteran's statements. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (noting that most of the probative value of a medical opinion comes from its reasoning). The Board does not question the Veteran's sincerity in her belief that service connection is warranted for mixed connective tissue disease. However, without evidence of a current disability or symptoms causing functional impairment of earning capacity, the preponderance of the evidence is against the claim. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). As such, service connection is denied. REASONS FOR REMAND Service Connection for Right Hip Disability The Veteran seeks service connection for a right hip disability. Specifically, she asserts that her right hip disability is secondary to her service-connected left hip disability. She has not claimed that her right hip was injured in service; rather, she contends that her right hip disability is due to gait changes resulting from her service-connected left hip disability. Pursuant to the Board's October 2020 remand directives, the Veteran underwent a VA examination in April 2021, in which she was diagnosed with right sacroiliac (SI) joint degenerative joint disease. The examiner noted that the Veteran's medical records indicate that she began having problems in the SI joint area since 1984-1985; however, multiple imagining studies from that time were negative. The examiner indicated that a doctor in 1986 noted marked tenderness of the SI joint, which continues to be present. The examiner opined that the Veteran's right SI joint degenerative joint disease was less likely than not caused by or aggravated beyond its natural progression by her service-connected left hip disability. The examiner reasoned, in part, that there is no evidence of altered gait or biomechanics when this condition started in the 1980s and per the Veteran's reported history this condition has been present to a similar degree since it began over 30 years ago. The Board notes that a December 1984 VA examination reveals that the Veteran reported limping on occasion, especially in cold weather. A September 1986 medical record notes that the Veteran had a slight antalgic gait, favoring her left lower extremity. A January 1987 examination notes that the Veteran favored her left leg considerably and walked with a rather marked limp. Thus, the Board finds that the April 2021 VA examiner's conclusion that the record was silent for an altered gait in the 1980s was based on an inaccurate factual premise, and as such, is inadequate. See Reonal v. Brown, 5 Vet. 458, 461 (1993) (medical opinions based on an incomplete or inaccurate factual premise are not probative). Accordingly, as there is no adequate medical opinion on which to adjudicate the matter, the Board finds that remand is necessary to obtain an adequate medical opinion. The matter is REMANDED for the following action: 1. Obtain any updated VA treatment records. 2. Thereafter, obtain an addendum medical opinion by an appropriate medical examiner to determine the nature and etiology of the Veteran's right hip disability. If the examiner determines that another physical examination is necessary, such an examination should be scheduled. Following a review of the claims file, the examiner is asked to address the following: a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's right hip disability was caused by her service-connected left hip disability, to specifically include as a result of altered gait mechanics? Please explain why or why not. b) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's right hip disability was aggravated by her service-connected left hip disability, to specifically include as a result of altered gait mechanics? Please explain why or why not. The Board points the examiner to the December 1984 VA examination revealing the Veteran limped on occasion; the September 1986 medical record noting that the Veteran had a slight antalgic gait favoring her left lower extremity; and the January 1987 examination noting that the Veteran favored her left leg considerably and walked with a rather marked limp. If the examiner finds that the disability was aggravated by the service-connected disability, the examiner must identify the baseline level of the disability that existed before aggravation by the service-connected disability occurred. A complete rationale must be provided for all opinions expressed. If the examiner is unable to provide an opinion without resort to speculation, an explanation as to why this is so should be provided and any additional evidence that would be necessary before an opinion could be rendered should be identified. Jenna Brant Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Robinson, 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.