Citation Nr: 21075723 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 16-63 143 DATE: December 21, 2021 ORDER Entitlement to service connection for reactive arthritis is denied. Entitlement to service connection for asthma is denied. REMANDED Entitlement to service connection for a digestive disorder is remanded. Entitlement to service connection for allergic rhinitis is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has had a clinical diagnosis of reactive arthritis at any time during the appeal. 2. The preponderance of the evidence is against finding that the Veteran has had a clinical diagnosis of asthma at any time during the appeal. CONCLUSIONS OF LAW 1. The criteria for service connection for reactive arthritis are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310, 3.317. 2. The criteria for service connection for asthma are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310, 3.317. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the Navy from July 1990 to July 1994. The matter was remanded in December 2018 and August 2020 for a VA examination. Examinations with opinions for reactive arthritis and asthma were obtained in September 2021. There has been substantial compliance with the Remand directives. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection for a disability requires evidence of: (1) a current disability; (2) a disease or injury in service; and (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). For veterans with service in the Southwest Asia theater of operations during the Persian Gulf War, service connection may be established under 38 U.S.C. § 1117; 38 C.F.R. § 3.317. Under this law and regulation, service connection may be warranted for a Persian Gulf veteran who exhibits objective indications of "a qualifying chronic disability" that became manifest during active military, naval or air 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. 38 C.F.R. § 3.317(a)(1). For purposes of 38 C.F.R. § 3.317, qualifying chronic disabilities include, among other things, a medically unexplained chronic multisymptom illness. 38 C.F.R. § 3.317(a)(2). 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a), (b). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). The Veteran contends that he has reactive arthritis due to a documented in-service urethral infection in 1991. See March 2016 Statement. He contends that he has asthma due to Southwest Asia service or secondary to obesity caused by his service-connected back disability. See February 2021 Correspondence. Service treatment records are silent for complaints, treatment, or diagnosis of reactive arthritis or asthma. Although the Veteran reported shortness of breath at separation in June 1994, this was attributed to smoking and lack of exercise, and the respiratory system was evaluated as normal at that time. He denied a history of arthritis. Post-service treatment records reflect his self-reported history of being diagnosed with asthma in 2002 and developing reactive arthritis in service. However, the records do not contain objective testing confirming a diagnosis of reactive arthritis or asthma. Notably, pulmonary function testing in July 2015 was negative for an impression of asthma, and the Veteran denied having asthma in February 2020. The Veteran's VA treatment records indicate that post-streptococcal reactive arthritis was added to the Veteran's active problems list in May 2016. However, numerous records call into the legitimacy of that diagnosis. For example, although a May 2015 treatment record noted that he may have had reactive arthritis, it was less likely given that his HLA-B27, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were all negative. Instead, it was more likely that the Veteran symptoms were attributable to his osteoarthritis and disc issues. A January 2017 VA treatment record noted that the Veteran had reactive arthritis in the remote past "by history," but there were no signs or symptoms presently. The treatment record also noted that the Veteran's prior diagnosis of reactive arthritis did not seem likely, and that it was more likely degenerative disease. A July 2015 VA treatment record noted that asthma should be consider if there were clinical symptoms; however, the treatment also noted that there was mild restriction due to the Veteran being overweight. A February 2020 VA treatment record noted that the Veteran denied asthma. The Veteran was afforded VA examinations in September 2021. The examiner noted the self-reported history of reactive arthritis and asthma but was unable to render any such diagnosis. With respect to reactive arthritis, the examiner noted his pertinent VA treatment records, including the record showing post-streptococcal reactive arthritis as an active problem. The examiner explained that the Veteran had normal serologic tests previously and that clinical presentation did not corroborate a diagnosis of reactive arthritis. The examiner indicated that he did not have acute phase reactants such as elevated ESR or CRP. The examiner noted that genetic predisposition to reactive arthritis through the prevalence of HLA-B27 at 30 to 50 percent was negative in the Veteran and that there was no evidence of inflammatory synovitis on examination. As to asthma, the examiner indicated that it was a disease with a clear and specific etiology. The examiner found no confirmed diagnosis in the record other than the Veteran's statement. While he reported using albuterol twice a day, the examiner noted that this was not prescribed for a confirmed diagnosis of asthma but rather dyspnea. Significantly, pulmonary function testing at the examination was normal. Service connection may only be granted for a current disability; when a claimed condition is not shown, there may be no grant of service connection. See 38 U.S.C. § 1131; Rabideau v. Derwinski, 2 Vet. App. 141 (1992). In the absence of proof of a present disability, there can be no valid claim for service connection. See Degmetich v. Brown, 104 F.3d 1328 (1997); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement that a current disability be present is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim, even if the disability resolves prior to the adjudication of the claim. See McClain v. Nicholson, 21 Vet. App. 319 (2007). The preponderance of the evidence is against finding that the Veteran has had a clinical diagnosis of reactive arthritis or asthma at any time during the appeal. Despite the indication by history, the pertinent medical evidence of record, to include his VA treatment records and the September 2021 VA examination reports do not confirm diagnoses of reactive arthritis and/or asthma based on objective testing. As for the claimed reactive arthritis, the evidence appears to show that the Veteran's claimed symptoms were more likely related to his already service-connected lumbar spine disease. The September 2021 examiner reviewed the pertinent evidence of record, including the medical evidence and his reported history; based on that information, the examiner concluded that the Veteran did not have clinical diagnoses for either disorder which he was claiming. The Board finds that the September 2021 VA medical opinion, along with the Veteran's VA treatment records discussed above, are the most probative evidence as to whether the Veteran has had a current disability at any point during the appeal period. Furthermore, as for any assertions by the Veteran that he suffers from reactive arthritis, the Board finds that such assertions lack probative weight in comparison to the medical evidence discussed above. The medical matter of the diagnosis of reactive arthritis is a matter within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). Although lay persons are competent to report symptoms or other matters within their personal knowledge, and to provide opinions on some medical matters (see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011)), here, the specific matter of the diagnosis of reactive arthritis is a complex medical matter that falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007) (providing that lay persons are not competent to diagnose cancer). The Veteran is not shown to have appropriate training and expertise to diagnose reactive arthritis. The Board emphasizes that Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C. § 1110. Thus, where, as here, the collective lay and medical evidence, or lack thereof, indicates that, fundamentally, the Veteran does not have a current disability for which service connection is sought, there can be no valid claim for service connection. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). See also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). The Board accordingly finds that service connection for reactive arthritis is not warranted. In reaching this decision, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim; as such, that doctrine is not applicable, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. REASONS FOR REMAND 1. Entitlement to service connection for a digestive disorder is remanded. The Veteran contends that he has a digestive disorder due to Southwest Asia service or obesity caused by his service-connected back disability. He was afforded a VA examination in July 2021 and diagnosed with gastroesophageal reflux disease (GERD). While an opinion was obtained in July 2021, it does not address a theory of service connection based on obesity. As such, an addendum is required. 2. Entitlement to service connection for allergic rhinitis is remanded. The Veteran contends that he has allergic rhinitis due to Southwest Asia service or obesity from his service-connected back disability. While he reported for an examination in July 2021, he declined assessment and therefore no findings were made or an opinion rendered. In August 2021, he indicated that he would be willing to comply if afforded another opportunity for an examination. Therefore, he should be afforded another examination to determine the nature and etiology of his claimed allergic rhinitis. The matters are REMANDED for the following action: 1. Request an addendum from the July 2021 stomach examiner. The examiner is asked to address the following: (a) Is it at least as likely as not that a stomach disorder had its onset in or is otherwise etiologically related to active service? (b) Notwithstanding the above, the reviewing clinician should also provide an opinion as to whether it is at least as likely as not that the Veteran's stomach disorder was caused or aggravated by a service-connected disability or disabilities. Specifically, the examiner should address whether it is at least as likely as not that obesity served as an "intermediate step" between the Veteran's service-connected disabilities and his stomach disorder by answering the following: (i) Is it at least as likely as not that the Veteran's service-connected disabilities caused the Veteran to become obese or aggravated his obesity? (ii) If so, was the obesity that resulted from or was aggravated by the service-connected disabilities a substantial factor in causing his current stomach disorder? (iii) Would the Veteran's current stomach disorder not have occurred, but for the obesity caused by or aggravated by the service-connected disabilities? All opinions should be supported by a medical explanation or rationale. If in the opinion of the reviewing clinician responses to the questions above cannot be answered without an in-person or virtual examination or interview, such should be scheduled. 2. Then, schedule the Veteran for an examination to determine the nature and etiology of his claimed allergic rhinitis. The examiner is asked to address the following: (a) Is it at least as likely as not that allergic rhinitis had its onset in or is otherwise related to active service? (b) Review the addendum provided by the July 2021 stomach examiner concerning the relationship between the Veteran's obesity and his service-connected back disability. If the examiner found that obesity was proximately caused or aggravated by the service-connected back disability, please address the following: (i) Was the obesity that resulted from or was aggravated by the service-connected disabilities a substantial factor in causing his current allergic rhinitis? (ii) Would the Veteran's current allergic rhinitis not have occurred, but for the obesity caused by or aggravated by the service-connected disabilities? All opinions should be supported by a medical explanation or rationale. (CONTINUED ON NEXT PAGE) 3. Thereafter, readjudicate the issues remaining on appeal. James Springer Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Alhinnawi 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.