Citation Nr: 21074037 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 15-46 869 DATE: December 14, 2021 ORDER Entitlement to service connection for muscle and joint pain in arms, to include fibromyalgia, due to Gulf War environmental hazards is denied. Entitlement to service connection for muscle and joint pain in legs, to include fibromyalgia, due to Gulf War environmental hazards is denied. FINDINGS OF FACT 1. The Veteran does not have a current undiagnosed illness, or chronic multi-symptom illness, for which no etiology can be established. 2. The Veteran's muscle and joint pain of the arms and legs is not related to his service. CONCLUSIONS OF LAW 1. The criteria for service connection for muscle and joint pain of the arms have not been met. 38 U.S.C. §§ 1110, 1117, 1131, 5107; 38 C.F.R. §§ 3.303, 3.317. 2. The criteria for service connection for muscle and joint pain of the legs have not been met. 38 U.S.C. §§ 1110, 1117, 1131, 5107; 38 C.F.R. §§ 3.303, 3.317. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had qualifying service from February 1980 to February 1984 and from January 2008 to September 2008, including Southwest Asia service in Iraq from January 2008 to May 2008. In June 2019, the Veteran testified at a Board videoconference hearing before the undersigned Veterans law Judge. The matter was remanded by the Board in September 2019 for further development. At the time of the prior remand, the matter of whether service connection was warranted for an undiagnosed respiratory disability was before the Board. Following the remand development, in July 2020, service connection was awarded for an undiagnosed respiratory disability. This matter is, therefore, no longer before the Board. Service Connection Service connection may be granted for a present disability that resulted from an injury or disease incurred in or aggravated by active service. See 38 U.S.C. § 1110, 1131, 1153; 38 C.F.R. § 3.303 (a), 3.306 (a). Generally, a veteran must establish: "(1) evidence 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." See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be established for a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability resulting from undiagnosed illness that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021 and cannot be attributed to any known clinical diagnosis by history, physical examination, or laboratory tests. 38 U.S.C. § 1117; 38 C.F.R. § 3.317 (a)(1). A qualifying chronic disability means a chronic disability resulting from any of the following (or any combination of the following): (A) An undiagnosed illness; (B) A medically unexplained chronic multi-symptom illness that is defined by a cluster of signs or symptoms, such as chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disabilities (excluding structural gastrointestinal diseases). 38 C.F.R. § 3.317 (a)(2)(i). The term medically unexplained chronic multi-symptom illness means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology are not considered medically unexplained. 38 C.F.R. § 3.317 (a)(2)(ii). Service connection for Muscle and Joint Pain in Arms and Legs The Veteran has claimed entitlement to joint pain in the arms and legs due to Gulf War environmental hazards. The Veteran stated the joint pain in his arms and legs began during his deployment to Iraq in 2008. He stated he has treated it with over-the-counter pain relievers and anti-inflammatories ever since. During the June 2019 Board hearing, the Veteran contended that his joint pain in his legs and arms could be fibromyalgia. K.A., who employed the Veteran on his farm since 2000, stated he observed a decline in his health since 2009. He noticed the Veteran moved more slowly and was stiff a lot of days. He noticed the Veteran had pain in the hands when working with tools. R.P. also provided a statement indicating he witnessed the Veteran experiencing pain, walking slowly, bent over, and had trouble getting into trucks or tractors in 2020. The Veteran's spouse stated she has witnessed his physical decline. She stated he can hardly stand up straight or walk without pain. The December 2007 pre-deployment health assessment showed no pertinent, arm or leg joint pain abnormalities. In the April 2008 and June 2009 PDHRAs regarding the deployment from January 2008 to May 2008 in Iraq, the Veteran was concerned about trouble breathing, swollen, stiff, or painful joints, exposure to sand/dust, smoke from burning trash or feces and burn pit, and vehicle or truck exhaust fumes; the Veteran went to sick call for trouble breathing, generally feeling week, fever, and muscle aches. The Veteran underwent a VA arm and shoulder, hands and finger, and knee and leg examinations in December 2019. The Veteran stated he reported widespread joint pain when he finished his deployment in 2008. He recalls having joint pain "all over" and not in any particular location. It has been present intermittently ever since but has been getting worse. He stated the worst pain is in his hands. He can have a sharp stabbing pain at rest, or if he tries to do something like open a jar. He feels like he has reduced grip strength. He notices pain in his feet as well. He injured his achilles during service and says he has pains in his toes, feet, and arches since Iraq as well. He endorses pain in other joints as well - knees, hips, etc. The examiner noted that he has a peripheral neuropathy (meralgia paresthetica) and takes gabapentin for this. He also has a lumbar condition (arthritis and DDD). There was no objective evidence to support any bilateral knee diagnosis. Bilateral arthritis was noted in the hands and wrists. There were no findings related to the shoulders and arms other than reduced range of motion in both shoulders. The examiner stated this finding is likely unrelated to this claim. The examiner explained that the Veteran is already service connected for right shoulder degenerative arthritis and the records show that he has complained of left shoulder in the past. A left shoulder MRI in 2017 showed a possible partial thickness rotator cuff tear, rotator cuff tendinosis, AC joint arthritis, and concern for impingement syndrome. A left shoulder x-ray in 2017 showed degenerative changes. Since he has known pathology of both shoulders, the findings related to reduced shoulder range of motion would be attributable to those conditions. Since this claim is for more of a widespread muscle and joint condition (especially in the hands and feet), the specific shoulder conditions listed above do not explain his symptoms reported in this claim. The examiner stated the only clear diagnosis was bilateral hand and wrist arthritis. This was found on imaging in 2019 and was fairly mild but was seen in several locations. This degree of arthritis is not atypical for a 59-year-old male. This arthritis is less likely than not due to any environmental exposure but is more likely due primarily to age-related wear and tear. The December 2019 VA examiner provided an addendum opinion in August 2020 regarding the Veteran's legs and knees. The examiner explained that the Veteran did not have any significant complaints of leg or knee pain at the December 2019 examination that I completed. There were also no abnormal findings in the knees/legs on physical exam. Regardless, his earlier complaints of any leg/knee pain are unlikely related to any Gulf War exposure or to any undiagnosed illness. Joint pains, especially in the knees, are much more likely mechanical in nature (due to wear and tear and/or acute injury). The Veteran underwent a VA shoulder and arm examination in October 2020 which showed the Veteran did not have any current shoulder or arm diagnosis. In October 2020, the Veteran received a VA Gulf War examination. In the examination, the VA examiner noted there were no diagnosed illnesses for which no etiology was established, nor were there any signs or symptoms that may represent an undiagnosed illness or diagnosed medically unexplained chronic multisymptom illness. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317 (a)(1). The examiner stated the Veteran's diffuse muscle aches are more likely a statin issue than a neuro/myopathic process given the Veteran's history. The Veteran underwent a VA fibromyalgia examination in October 2020. The Veteran stated he had sharp pains in joints with limited use of hands. No findings, signs or symptoms attributable to fibromyalgia were found upon examination. The examiner stated the Veteran's diffuse muscle aches are more likely a statin issue than a neuro/myopathic process given the Veteran's history. Further, the Veteran does not have tender points on examination to suggest fibromyalgia. The Board finds VA examiner's opinion regarding fibromyalgia to be supported by a well-reasoned rationale. This constitutes highly probative evidence against the claim. While the Veteran's medical treatment records and examination do establish certain types of current muscle and joint pain, the probative evidence of record does not establish a nexus between the Veteran's claimed disabilities and his period of service. The Veteran has not provided any information or evidence indicating that either VA or private medical treatment providers have determined the claimed disabilities are related to the Veteran's period of service. See 38 C.F.R. § 3.309. The December 2019 VA examiner explained the Veteran had mild wrist and hand arthritis, not atypical for his age and there was no evidence of a knee diagnosis. Further, the December 2019 examiner explained the Veteran's shoulder issues were unrelated to this claim. The October 2020 VA examiner explained the Veteran's diffuse muscle aches are more likely a statin issue than a neuro/myopathic process. The Board finds that the December 2019 and October 2020 VA examiners' opinions are due significant probative value. The VA examiners provided the opinions based on an accurate understanding of the Veteran's medical history, on the examiner's own knowledge and expertise, and on an examination of the Veteran. Furthermore, the VA examiner provided rationale that explains the conclusions and gives insight into the medical aspects of the Veteran's claims. See Nieves- Rodriguez, 22 Vet. App. at 295. The only evidence indicating an association between the current claims and active duty are the Veteran's own assertions. It is well established that a layperson without medical training is not qualified to render a medical opinion regarding the diagnosis or etiology of certain disorders and disabilities. See 38 C.F.R. § 3.159 (a)(1). In certain instances, lay testimony may be competent to establish medical etiology or nexus. See Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007). However, as the origin or cause of muscle and joint pain of the arms and legs is not a simple question that can be determined based on personal observation by a lay person, the Veteran's lay testimony and the buddy statements are not competent to establish medical etiology or nexus. Id. As such, the Board finds the question of whether the Veteran's current muscle and joint pain of the arms and legs had its onset during active duty does not lie within the range of common experience or common knowledge but requires special experience or special knowledge. It is not shown that the Veteran is otherwise qualified through specialized education, training, or experience to offer a medical opinion as to the etiology of the muscle and joint pain of the arms and legs. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). The Board has also considered whether the Veteran is entitled to service connection for muscle and joints pain of the arms and legs as a "chronic disease." See 38 C.F.R. § 3.303 (b). Arthritis is included in the list of "chronic" diseases under 38 C.F.R. § 3.309 (a). The Board notes that the Veteran was diagnosed with arthritis in the hand and wrist in 2019, over 19 years after his separation from service. However, the Veteran has not argued, and the record does not show, that he was diagnosed with arthritis or any other "chronic" disease listed under 38 C.F.R. § 3.309 (a) during service or within one year of separation from service. Therefore, service connection is not warranted on a presumptive basis under the provisions of 38 C.F.R. §§ 3.303 (b), 3.307, and 3.309. In light of the above, the preponderance of the evidence is against the claims and the benefit-of-the-doubt doctrine is not for application. The claims therefore must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. St. Laurent, 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.