Citation Nr: 21074286 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 17-66 915 DATE: December 14, 2021 ORDER Service connection for a right elbow disorder is denied. FINDING OF FACT The Veteran's pre-existing right elbow disorder was not aggravated during service. CONCLUSION OF LAW The criteria for service connection for a right elbow disorder are not met. 38 U.S.C. §§ 1110, 1153, 5107; 38 C.F.R. § 3.102, 3.303, 3.306. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1996 to August 2000. The case is on appeal from a July 2016 rating decision. In July 2021, the Veteran testified at a Board hearing. Later that month, the Board remanded claims of service connection for a low back disorder and a right elbow disorder for additional development. Thereafter, in an August 2021 rating decision, the RO granted service connection for degenerative arthritis of the thoracolumbar spine effective February 3, 2016. As the low back claim has been granted in full, it is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Service connection for a right elbow disorder. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: "(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." Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). A veteran is presumed to be in sound condition when he entered into military service, except for conditions noted on the entrance examination. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). If a preexisting disability is noted upon entry into service, service connection may still be granted based on in-service aggravation of that disability. 38 U.S.C. § 1153; 38 C.F.R. § 3.306; see Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). A preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. See 38 U.S.C. § 1153; 38 C.F.R. § 3.306. Analysis The Veteran is seeking service connection for a right elbow disorder. In a December 2017 VA Form 9, he reported aggravating a pre-existing right elbow injury during service. During the July 2021 Board hearing, the Veteran reported that he frequently experiences losing muscle grip in his right hand related to a right elbow condition. He also reported that he does not seek treatment for this condition and self-medicates with over the counter medication. The Veteran's service personnel records (SPRs) show that he served as an aviation structural mechanic. His service treatment records (STRs) show that his right upper extremity was noted as abnormal during a January 1996 enlistment examination. In a November 1996 report of medical history, the Veteran noted that he broke his right arm when he was 10 years old. In September 1998, the Veteran was treated for right elbow pain due to twisting while playing baseball 45 days earlier. The treatment provider noted a right elbow injury at 12 years old. The treatment provider assessed him with "overuse/tendonitis". In February 1999, the Veteran was treated for right elbow trauma that occurred while playing basketball. He reported hyperextending the elbow followed by hearing a crack followed by a pop when he bent it back. The injury was assessed as hyperextension of the elbow. In July 1999, he was treated for chronic right elbow pain on activity. The treatment provider listed a provisional diagnosis of status post right elbow trauma with loss of range of motion and persistent pain. A March 2000 x-ray was found to show an old dislocation of the right elbow and a cubital varus. A March 2000 separation examination was marked abnormal for his upper extremities. The examiner noted a right upper extremity deformity. Pursuant to the July 2021 Board remand, the Veteran was afforded a VA examination for this claim in August 2021. The Veteran reported injuring his right elbow prior to service and claimed that he aggravated the condition due to his work during service. He also reported being placed on a permanent profile during service for no pushups. The Veteran further reported that the condition has remained the same since outset, with symptoms of constant upper elbow and forearm pain, sometimes locking up, and intermittent loss of grip strength in the right hand since the injury. The Veteran denied receiving treatment for the condition since service because he has learned to deal with pain because it has been present for so long. The examiner reported diagnoses of cubitus varus right upper extremity and osteopenia, posterior olecranon. The examiner also reported the current symptoms consist of elbow and forearm pain, sometimes locking up with flexion or extension, and intermittent loss of grip strength. The examiner concluded that the condition clearly and unmistakably existed prior to service and was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. The examiner explained that the Veteran's in-service symptoms were typical of the pre-existing condition and that the current symptoms are the same as the symptoms prior to service. The Board finds that the Veteran's right elbow disorder was noted at his entrance into service and that it did not increase in severity during service beyond any temporary flare-up. In this regard, the August 2021 VA examiner's opinion is clear and unequivocal and is based on the relevant information, including the Veteran's statements, STRs, and post-service records. Moreover, his explanation is logical and follows from the facts and information given. See Monzingo v. Shinseki, 26 Vet. App. 97, 105-06 (2012); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The examiner explained that the condition started prior to service as indicated by the Veteran's entrance examination. The examiner also explained that the condition was not aggravated during service because the in-service right elbow symptoms resulting in the need for treatment were typical for the condition rather than an indication of an abnormal progression of the disorder. In addition, the examiner's conclusion is supported by the examination report that shows the Veteran's account of right elbow symptoms since onset of the condition to be the same as his present right elbow symptoms. See Monzingo, 26 Vet. App.at 106 ("the medical report must be read as a whole"); see also Acevedo v. Shinseki, 25 Vet. App. 286, 293-94 (2012) (a VA examination report "must be read as a whole, and the Board is permitted to draw inferences based on the overall report so long as the inference does not result in a medical determination"). Even though the examiner used a standard typically used for rebutting the presumption of soundness, this is a higher evidentiary standard than standard aggravation. Thus, the opinion is probative to the question at hand. Therefore, the examiner's finding that the preexisting right elbow was clearly and unmistakably not aggravated beyond its natural progression during service is highly persuasive and probative evidence. While the Veteran believes that he has a right elbow disorder aggravated by service, this is a complex medical question outside the competence of a non-medical expert to determine whether such a cause-and-effect relationship exists in this particular case. As a lay person, the Veteran has not established the competence needed to rebut the expert medical opinion of record. As such, the Veteran's opinion is not adequate to rebut the examiner's opinion as to the nature and etiology of the claimed condition. The evidence shows that the right elbow disorder clearly and unmistakably existed prior to service and clearly and unmistakably did not increase in severity beyond its natural progression during service. Thus, the pre-existing condition was not aggravated. Accordingly, the preponderance of the evidence is against the claim. Therefore, the benefit-of-the-doubt doctrine is not applicable, and service connection for a right elbow disorder, including on the basis of service aggravation, is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Jimerfield 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.