Citation Nr: 21075854 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 17-16 625 DATE: December 21, 2021 ORDER Service connection for facioscapulohumeral muscular dystrophy (FSHD) is granted. FINDING OF FACT Resolving reasonable doubt in favor of the Veteran, his FSHD symptoms manifested during service. CONCLUSION OF LAW The criteria for service connection for FSHD are 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 November 1967 to November 1971. In June 2019, the Veteran appeared for a hearing before the Board. The hearing transcript is associated with the claims file. In October 2021, the Veteran was informed the Veterans Law Judge (VLJ) who conducted the hearing is no longer employed by the Board and advised of his right to another hearing held before a different VLJ. The letter advised if he did not respond within 30 days, the Board would proceed with adjudication. VA has not received a response, so the Board will proceed with adjudication based on the record. Service connection for FSHD The Veteran contends his FSHD symptoms manifested during service. The preponderance of the evidence shows FSHD is a congenital disease. See November 2020 VA medical opinion. Service connection may be granted for diseases, but not defects, of congenital, developmental or familial origin. See VAOPGCPREC 82-90 (July 18, 1990). The presumption of soundness applies to congenital diseases that are not noted at entry, as is the case here. See Quirin v. Shinseki, 22 Vet. App. 390 (2009). VA's Office of General Counsel has confirmed the existence of a congenital hereditary disease under 38 C.F.R. § 3.303(c) does not always rebut the presumption of soundness, and that service connection may be granted for congenital hereditary diseases which either first manifest during service or which preexist service and progressed at an abnormally high rate during service. See VAOPGCPREC 67-90; 55 Fed. Reg. 43, 253 (1990). The preponderance of the evidence shows the Veteran's FSHD, a congenital disease, first manifested during service. Service treatment records (STR) are absent for diagnosis of FSHD. A November 1980 letter from Dr. F.H. at Mayo Clinic stated he evaluated the Veteran and diagnosed FSHD of the slowly progressive type. The clinician noted he participated in high school athletics without problem, but began to notice weakness in his arms in 1968 or 1969. This slowly progressed, he did not pay attention to the symptoms until a volunteer fireman examination referred him to a neurologist due to noticing abnormality with the use of his arms. A January 2008 VA examination stated the Veteran had FSHD, which was diagnosed and symptoms since 1980s. A December 2008 private treatment visit noted an initial visit at Mayo Clinic for FSHD. The clinician noted the Veteran experienced weakness starting in 1968 or 1969. The clinician gave an impression of FSHD, clinical onset 1970. A March 2014 visit with Dr. N.P. at the Mayo Clinic noted the Veteran's FSHD symptoms became apparent while in military service with winging of his shoulder blades and difficulty abducting his arms. The clinician noted continued progressive weakness and atrophy. The clinician gave an impression of classical presentation of FSHD. In December 2015, the Veteran submitted a medical article from the Muscular Dystrophy Association (MDA) about FSHD, which stated most people with FSHD notice weakness in the shoulder blades as the first sign, specifically scapular winging. The Veteran submitted photos of himself in the Air Force showing scapular winging. A May 2016 private treatment letter by Dr. M.B. at Oregon Neurology Associates noted the Veteran was treated at the clinic for FSHD. The clinician stated this genetically based muscle disease typically had symptom onset prior to age 20, with clinical signs becoming apparent by late 20s. The clinician stated the most likely onset of the Veteran's symptoms began in the late 1960s. In June 2016, the Veteran submitted a different medical article from the MDA about FSHD, which stated people with FSHD often do not go to the doctor until their shoulder or leg muscles become involved. The article noted hearing loss sometimes occurs in FSHD, often it is minor and not noted unless careful testing happens to be done. The Veteran submitted his STR entrance and separation examinations showing worsening of his hearing during service. A June 2016 VA neurology treatment visit with Dr. M.S. noted the Veteran reported his symptoms began in service in the late 1960s. He stated prior to this, he was in high school, was an athlete, and did not note any symptoms. He stated in late 1960s, at age 19 to 20, he noticed difficulty lifting his arm. He was seen by Mayo Clinic and diagnosed with FSHD, which was genetically confirmed in 2007. The clinician assessed FSHD, first noticing symptoms in service, which is consistent with the usual age onset of the disease. A June 2016 letter from Dr. M.S. reiterated the Veteran reported FSHD symptoms beginning at age 18 to 19 while in service. The clinician stated more likely than not this onset is accurate because that age onset is typical for this disease. A June 2019 private treatment letter from Dr. T.B., a VA neuromuscular fellow, stated the Veteran was being treated in the neuromuscular clinic for FSHD. The clinician noted, as previously stated, the onset of his symptoms was at age 19 to 20. The clinician stated this disease is slowly progressive, because initial symptoms are often mild, it is not uncommon for patients to not seek medical attention until years later when the symptoms are more severe. A November 2020 VA treatment visit with Dr. O.M., another neuromuscular fellow, noted followup for genetically confirmed FSHD type 1, with continued slow progression of weakness. The clinician noted his reported onset around age 19 to 20 during service is consistent with FSHD presentation. The clinician noted, per review of medical literature, the classic form of FSHD is characterized by muscle weakness involving facial, scapular, upper arm, lower leg, and abdominal muscles with asymmetric involvement and age of symptomatic onset is usually in the second decade. By age 20, findings are seen in approximately 90 percent of affected patients, consistent with the patient's report of onset. In December 2020, the Veteran submitted a high school yearbook page and newspaper clipping showing he participated in football, wrestling, and the ski team in high school. Resolving reasonable doubt in favor of the Veteran, the Board finds the Veteran's FSHD symptoms manifested during service. The Veteran provided evidence of scapular winging during service, which medical opinions and medical articles confirmed is an early symptom of FSHD. The Veteran reported experiencing some difficulty lifting his arms during service. A June 2016 VA neurology medical opinion stated the Veteran reported FSHD symptoms beginning while in service, which more likely than not this onset is accurate because that age onset is typical for this disease. Numerous VA and private medical opinions have stated the Veteran's lay statements reporting the onset of his symptoms is consistent with the usual age of onset of FSHD. See May 2016, June 2019, and November 2020 medical opinions. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (finding that lay testimony is competent to establish the presence of observable symptomatology). This finding is consistent with, at his initial Mayo Clinic treatment visit in 1980, the Veteran reported he began to notice weakness in his arms in 1968 or 1969 during service. This 1980 treatment visit was decades prior to the Veteran filing a claim for service connection. See Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). This finding is consistent with the June 2019 neuromuscular fellow statement that FSHD is a slowly progressive disease and because initial symptoms are often mild, it is not uncommon for patients to not seek medical attention until years later when the symptoms are more severe. Resolving reasonable doubt in favor of the Veteran, the Veteran's FSHD manifested during service. Accordingly, service connection for FSHD is granted. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Winkler, 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.