Citation Nr: 21072097 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 18-48 718 DATE: December 2, 2021 ORDER Entitlement to service connection for lymphedema of the right arm and hand is denied. REMANDED Issue of entitlement to service connection for right hip bursitis (also claimed as pain) is remanded. Issue of entitlement to service connection for L4 compression fracture (claimed as back pain) is remanded. Issue of entitlement to service connection for a left knee condition is remanded. Issue of entitlement to service connection for left hip pain is remanded. Issue of entitlement to service connection for a right knee condition is remanded. Issue of entitlement to service connection for a left foot condition is remanded. Issue of entitlement to service connection for a right foot condition is remanded. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran's lymphedema of the right arm and hand was incurred in or caused by service. CONCLUSION OF LAW The criteria for entitlement to service connection for lymphedema of the right arm and hand are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1974 to June 1978. The Veteran has reserve service from February 1978 to June 2000, with unverified periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). This appeal to the Board of Veterans' Appeals (Board) arose from a September 2016 rating decision issued by the Department of Veterans Affairs (VA). See September 2017 Notice of Disagreement (NOD); August 2018 Statement of the Case (SOC); October 2018 Substantive Appeal (VA Form 9). The Veteran testified before the undersigned Veterans Law Judge in a May 2021 hearing. See May 2021 Hearing transcript. The Board notes that the Veteran did not appeal the prior May 2015 rating decision, but new and material evidence was received within the one-year appeal period and rendered that rating decision non final. See 38 C.F.R. § 3.156(b). As there is no prior finally adjudicated decision on the above claims, a request to reopen is not an issue in this case. The Board also recognizes that additional medical evidence was received after the last adjudication by the agency of original jurisdiction (AOJ). This evidence is about treatment for the Veteran's back condition and not relevant to whether the Veteran's right upper extremity pain or lymphedema was incurred in or caused by service. Entitlement to service connection for lymphedema of the right arm and hand. The Veteran asserts entitlement to service connection for lymphedema, also claimed as right-sided upper extremity pain, due to frequent use of her right hand to lift heavy loads during service. See September 2017 NOD; May 2021 Hearing Transcript. She testified to having pain and tingling in her right upper extremity during service that she believes resulted in her lymphedema later on. See May 2021 Hearing Transcript. The term "active military, naval, or air service" includes active duty, and any period of active duty for training during which the individual concerned was disabled or died from a disease or injury incurred in or aggravated in the line of duty. 38 U.S.C. § 101(24); 38 C.F.R. § 3.6(a). Service connection is warranted where the evidence of record establishes that an injury or disease resulting in disability was incurred in the line of duty in the active military, naval, or air service or, if preexisting such service, was aggravated thereby. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. Service connection is established when there is competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). After careful and thorough review of the evidence, the Board finds that the preponderance of the evidence is against finding that the Veteran's lymphedema of the right arm and hand, also claimed as right upper extremity pain, was incurred in or caused by service. The evidence supports that the Veteran has had a history of right upper extremity lymphedema, status post mastectomy. May 2004 Military Health System records; August 2016 VA treatment evidence. However, the medical evidence is against finding that it was incurred in or due to service. Service treatment records during the Veteran's period of active duty shows no complaint or treatment for lymphedema or right upper extremity pain. A June 1982 Report of Medical History for the her reserve service after separation shows that the Veteran reported no problems with a painful shoulder, nor having a bone, joint, or other deformity. Rather, the Veteran's treatment provider remarked that the Veteran's right upper extremity lymphedema is related to her right breast cancer and treatment, which was diagnosed and treated in 2003, more than 20 years after her period of active duty. August 2016 VA treatment evidence. This evidence is highly probative and against finding that the Veteran's lymphedema of the right arm and hand was incurred in or caused by service. The Board considered the Veteran's testimony about having right upper extremity pain during service, and that she believes it resulted in her current lymphedema condition. In weighing and balancing the veracity of the Veteran's statements, the Board finds that the statements of the Veteran made on her June 1982 Report of Medical History to be more probative than her statements many years later. In addition, the cause of any right upper extremity pain that she did experience would fall outside of the realm of knowledge of a lay person as it is a medically complex issue. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran's testimony about her right upper extremity pain during service and the cause of her current lymphedema condition is, thus, less probative than the medical evidence and her reported medical history given shortly after her period of active duty. The Board also considered whether the evidence supports finding her right upper extremity pain or lymphedema was due to a disease or injury incurred in or aggravated during a period of ACDUTRA, or due to or aggravated by an injury during INACDUTRA. As noted above, the medical evidence supports that the Veteran's lymphedema condition is due to her breast cancer, which is not a disease or injury incurred in or caused by the Veteran's service. Moreover, the Veteran did not testify that the condition was incurred in or aggravated by a period of ACDUTRA or INACDUTRA. See May 2021 Hearing Transcript. The Board, thus, finds that the Veteran's lymphedema of the right arm and hand was not incurred in or caused by a period of ACDUTRA or INACDUTRA. The Board finds that the preponderance of the probative evidence is against finding that the Veteran's lymphedema of the right arm and hand, also claimed as right upper extremity pain, was incurred in or due to service. Accordingly, entitlement to service connection for lymphedema of the right arm and hand is not warranted. REASONS FOR REMAND 1. Issue of entitlement to service connection for right hip bursitis (also claimed as pain) is remanded. 2. Issue of entitlement to service connection for L4 compression fracture (claimed as back pain) is remanded. 3. Issue of entitlement to service connection for a left knee condition is remanded. 4. Issue of entitlement to service connection for left hip pain is remanded. 5. Issue of entitlement to service connection for a right knee condition is remanded. 6. Issue of entitlement to service connection for a left foot condition is remanded. 7. Issue of entitlement to service connection for a right foot condition is remanded. The Board cannot make a fully informed decision on the issues of entitlement to service connection for right hip bursitis/pain, L4 compression fracture/back pain, a left knee condition, left hip pain, a right knee condition, a left foot condition, and a right foot condition because an evaluation from a VA examiner is needed. The evidence shows that the Veteran has diagnoses for right hip arthritis and replacement, bilateral knee arthritis, and degenerative spondylolisthesis at L4-L4. December 2012 Private treatment evidence; February 2014 VA Examination. The evidence also shows that the Veteran has a history of a bunionectomy. March 1992 Military Health System records; August 2016 VA Form 21-4138. Service treatment records show that the has complained of a leg problem that feels like "if she has water on the knees." December 1974 Service treatment records. The Veteran had also complained of back pain. December 1976 Service treatment records. The Veteran asserts that her bunions were due to using steel-toe boots during service. May 2021 Hearing Transcript. There is currently no opinion from VA examiner about whether any of the above asserted conditions were incurred in or caused by service. The Board finds that the Veteran should be afforded VA examinations to identify the Veteran's current foot, knee, hip, and back conditions; and whether any of the identified conditions have a medical link to service. The matters are REMANDED for the following action: 1. Attempt to identify the Veteran's periods of ACDUTRA and INADUTRA during her reserve service. 2. Schedule the Veteran for VA examinations by appropriate medical professional(s) to determine the nature and cause of any current foot, knee, hip, and back conditions. The medical professional(s) should respond to the following: (a) Identify the Veteran's current foot, knee, hip, and back conditions, to include evidence of arthritis or residuals of a bunionectomy. (b) For each identified condition, is it at least as likely as not (a 50 percent or greater probability) that the condition began in (or is otherwise related to) the Veteran's period of active duty from January 1974 to June 1978? The medical professional(s) should also consider if the identified conditions were incurred or aggravated by aa disease or injury during a period of ACDUTRA, or by an injury during INACDUTRA. The medical professional(s) should consider and discuss the Veteran's lay testimony and assertions regarding any pertinent complaints and symptoms, including that she believes her bunion was due to using steel-toe boots during service. A detailed explanation (rationale) is requested, including citing to supporting clinical data (and/or medical literature), as appropriate. (c) For each disability deemed to be unrelated to service, the examiner should, if possible, identify the cause considered more likely and explained why that is so. (Continued on next page) 3. Readjudicate the claims. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Lin 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.