Citation Nr: A21018768 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 200807-92444 DATE: November 23, 2021 ORDER Service connection for psoriatic arthritis of the right foot is granted. Service connection for psoriatic arthritis of the left foot is granted. Service connection for psoriatic arthritis of the left ankle is granted. Service connection for psoriatic arthritis of the left knee is granted. Service connection for psoriatic arthritis of the right shoulder is granted. Service connection for psoriatic arthritis of the left shoulder is granted. Service connection for psoriatic arthritis of the right elbow is granted. Service connection for psoriatic arthritis of the left elbow is granted. Service connection for psoriatic arthritis of the right wrist is granted. Service connection for psoriatic arthritis of the left wrist is granted. Service connection for psoriatic arthritis of the right hand is granted. Service connection for psoriatic arthritis of the left hand is granted. FINDING OF FACT Resolving all reasonable doubt in his favor, the Veteran's psoriatic arthritis developed due to his service-connected psoriasis. CONCLUSIONS OF LAW 1. The criteria for service connection for psoriatic arthritis of the right foot have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for psoriatic arthritis of the left foot have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for psoriatic arthritis of the left ankle have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for psoriatic arthritis of the left knee have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for psoriatic arthritis of the right shoulder have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for psoriatic arthritis of the left shoulder have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for psoriatic arthritis of the right elbow have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for psoriatic arthritis of the left elbow have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for service connection for psoriatic arthritis of the right wrist have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 10. The criteria for service connection for psoriatic arthritis of the left wrist have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 11. The criteria for service connection for psoriatic arthritis of the right hand have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 12. The criteria for service connection for psoriatic arthritis of the left hand have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from January 2003 to January 2008. These matters come before the Board of Veterans' Appeals (Board) from a July 2020 rating decision issued by a Department of Veterans Affairs (VA) Regional Office under the modernized appeals system known as the Appeals Modernization Act. In August 2020, the Veteran timely appealed such rating decision to the Board by submitting a Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182) in which he elected the hearing lane. Consequently, the Board's review is limited to the evidence of record at the time of the issuance of the rating decision on July 31, 2020, and any evidence submitted within 90 days of his hearing before the Board, which took place before the undersigned on May 24, 2021. 38 C.F.R. § 20.303. A transcript of that hearing has been associated with the record. The Board notes that, while the Veteran's claims for service connection were previously denied in a prior rating decision, the July 2020 rating decision considered such issue on the merits. Thus, as the agency of original jurisdiction implicitly found that new and relevant evidence had been received so as to warrant readjudication of such claims and the Board is bound by such favorable finding, the Veteran's claims are reviewed on a de novo basis below. 38 C.F.R. §§ 3.104 (c), 20.801. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Establishing secondary service connection requires evidence of a current disability (for which secondary service connection is sought), a service-connected disability; and evidence that the current disability was either caused or aggravated by the service-connected disability. 38 C.F.R. § 3.310 (a); see also Allen v. Brown, 7 Vet. App. 439 (1995). When there is an approximate balance of positive and negative evidence regarding the merits of an issue, the benefit of the doubt shall be given to the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Veteran asserts that his diagnosed psoriatic arthritis developed as a result of his service-connected psoriasis. Thus, he contends, service connection is warranted. The Board notes that the Veteran does not contend, and the evidence does not show, that such disabilities had their onset in service, or are otherwise directly or presumptively related to any aspect of his military service. See Robinson v. Shinseki, 557 F.3d 1355, 1361 (2008) (claims which have no support in the record need not be considered by the Board as the Board is not obligated to considered "all possible" substantive theories of recovery. Where a fully developed record is presented to the Board with no evidentiary support for a particular theory of recovery, there is no reason for the Board to address or consider such a theory). The question before the Board is whether the Veteran's psoriatic arthritis developed as a result of his service-connected psoriasis. There are two medical reports of record which were obtained to address this question. In July 2020, the Veteran underwent a VA examination. At that time, the examiner concluded that the Veteran did not have a diagnosis of psoriatic arthritis in any of the claimed joints. Thus, she explained, no opinion or rationale regarding a nexus to service was warranted. At the May 2021 hearing, the Veteran submitted an April 2021 medical opinion from his treating rheumatologist, Dr. A.O. In that opinion, the doctor explained that the Veteran's psoriatic arthritis began as the plaque and inverse psoriasis which was first diagnosed in 2005 (and, the Board notes, for which service connection was granted in a June 2010 rating decision). Following many years of successful treatment, the condition flared in 2016 and manifested in the onset of joint arthritis in the bilateral hands, wrists, elbows, shoulders, ankles and feet, as well as the left knee. Dr. A.O. explained in detail how she diagnosed the condition in the Veteran, and how it was related to his service-connected psoriasis. The Board affords little probative weight to the July 2020 VA examination report, as it found no disorder present and, thus, lacked any discussion of a link to service. On the other hand, the Board affords great probative weight to Dr. A.O.'s detailed medical opinion, describing the onset of the Veteran's psoriatic arthritis and its direct relationship to the Veteran's psoriasis. Thus, the Board finds that the evidence is in relative equipoise as to whether the Veteran's psoriatic arthritis has been formally diagnosed and is related to his military service, to include a service-connected disability. (Continued on the next page) Accordingly, the Board resolves all doubt in favor of the Veteran and finds that there is a nexus between the diagnosed disability and service connected psoriasis; thus, service connection for psoriatic arthritis is warranted on a secondary basis. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. The claims are granted. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jeremy J. Olsen, 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.