Citation Nr: 21076390 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 17-09 897 DATE: December 23, 2021 ORDER Entitlement to service connection for a left lower rib condition manifested by pain is denied. FINDING OF FACT The preponderance of the evidence is against finding that a left lower rib disability began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a left lower rib disability are not met. 38 U.S.C. §§ 1110, 1117, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 2010 to February 2014. This matter comes before the Board of Veterans Appeals (Board) from rating decisions by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The Veteran testified before the undersigned in November 2019 Board hearing. A transcript of the hearing is of record. This matter was previously remanded in February 2020 and August 2021. On remand and in a January 2021 rating decision, the AOJ granted service connection for carpal tunnel syndrome of the right upper extremity (claimed as a right elbow condition). In October 2021, the AOJ granted service connection for left hip strain, limited flexion and left hip strain limited abduction. As these are considered full grants of benefits as to this issue, those claims are no longer before the Board. 1. Service connection for a left lower rib disability The Veteran contends that he has a left lower rib disability, and it is related to his service. Specifically, that that his current rib pain is related to an in-service gym injury in March 2013. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.304. In addition, service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection may be established for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. In evaluating a claim, the Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1335 (2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159 (a); Layno v. Brown, 6 Vet. App. 465, 470 (1994) (providing that a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis if (1) the medical issue is within the competence of a layperson, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). If the evidence is competent, the Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007) (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this regard, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 51112 (1995). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The Veteran's service treatment records indicate that the Veteran sprained his ribs in March 2013. The Veteran's provider noted that the history and examination of the Veteran was consistent with a rib sprain with no signs or symptoms of a fracture or dislocation. In May 2013, service treatment records note that the Veteran had difficulty breathing. The Veteran reported that he broke a rib three months prior. The provider diagnosed the Veteran with anxiety. In the Veteran's November 2013 separation examination, the Veteran reported that his rib popped out. The examiner noted that the Veteran injured his rib while working out and was provided ice. The Veteran's post-service treatment records do not indicate any pain in his ribs, treatment, or diagnosis of a rib disability. The Veteran underwent a VA examination in December 2014. The Veteran reported that his rib popped out while squatting. The Veteran stated he sought care and the rib had spontaneously resolved. The Veteran noted he had an x-ray that did not show anything to include a fracture. The examiner did not find a diagnosis of a left rib disability. The examiner opined that the Veteran's rib condition is less likely as not caused by or a result of his service. The examiner reasoned that service treatment records indicated a minor contusion in March 2013 with a follow up in May and normal x-rays. The examiner noted that the contusion to the chest wall was resolved in 2013. The examiner concluded that the Veteran's current examination did not show a diagnosable or a compensable condition. The Veteran underwent a VA contract examination in December 2020. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned the Veteran's current findings are subjective, with no objective findings since 2013. In April 2021, the VA contract examiner provided an addendum medical opinion. The examiner stated that while the Veteran is competent to attest to matters of which he had first-hand knowledge, including observable symptomatology, treatment records do not support chronicity of symptoms. The examiner noted that there was left rib pain on active duty, x-ray rib pain, and as of 2019 no musculoskeletal pain in the ribs condition had been diagnosed. The examiner stated that "surely if complaints were as troubling as noted in the disability benefits questionnaire and remand, the Veteran would have reported them, yet there are none and no chronicity is established." In October 2021, the Veteran underwent another VA examination. The examiner diagnosed the Veteran with left lower rib contusion. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that the Veteran's service treatment indicates the Veteran was seen for left sided rib pain that begin while doing a leg press at the gym. The examiner noted that the history and examination was consistent with a rib sprain. The examiner noted the Veteran's November 2013 separation examination documented the left rib injury. The examiner stated are no medical records with complaints of left rib pain, treatment, or diagnosis after service. The examiner stated October 2014 and December 2020 examinations found no objective finding for ongoing complaints of left rib pain. The examiner explained that the Veteran had an acute left rib injury in service which was healed since there were no further medical records with the Veteran complaining of the left rib injury after service. The examiner stated the evidence of record, the Veteran's testimony, and the examination she conducted provides sufficient evidence to establish a clinical correlation or causal nexus between the Veteran's claim left rib injury and his left rib injury in service. In November 2021, the October 2021 VA examiner clarified her pervious opinion, by correcting her statement that there was sufficient evidence to establish a clinical correlation or causal nexus between the Veteran's claim left rib injury and his left rib injury in service, by explaining that there was "insufficient evidence." In November 2019, the Veteran testified in a Board hearing. The Veteran stated that while in service, he was working out and he injured his left lower rib. The Veteran stated that he went to sick call and was told that he had probably popped the rib out of place. The Veteran stated that after a few days he felt his rib pop back in. The Veteran stated he continued to have pain from that injury. The Veteran stated that he did not seek any treatment for his injury because he felt it was his own fault. The Board acknowledges that lay assertions may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms subject to lay observation. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Veteran is competent to report what he thinks is rib pain. While the Veteran is competent to report having experienced pain symptoms since service, his statements are not credible. Notably, the evidence in the record indicates that the Veteran has described a more severe rib injury than the contemporaneous records document. The March 2013 service treatment record that first documented the injury noted that that there was no signs or symptoms of fracture or dislocation. Yet, the Veteran consistently reported to treatment providers and VA examiners that he had either broken a rib or dislocated his rib when it "popped" out. Further, there is no objective evidence of post-service residuals of any rib strain or even any functional impairment at all due to any purported residuals of injury despite the Veteran reporting ongoing pain in that area. Given the above, the Board assigns low probative value to the Veteran's statements regarding the symptoms of rib pain continuing since his March 2013 injury. The Board finds that the October 2021 VA medical opinion with accompanying November 2021 addendum clarification to be probative. The medical professional that provided the medical opinion is competent to provide an opinion on this matter. The examiner determined that the Veteran's in-service rib injury was acute and not related to his current rib issue. The examiner had knowledge of the Veteran's medical history and examined the Veteran and the other records, considered the lay statements, and provided conclusions in medical documents based on sufficient facts and data. Therefore, this opinion is entitled to significant weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Consequently, the Board gives more probative weight to the VA opinion. The Board finds that the Veteran has reported current pain in the area of the left lower rib. The Veteran had a left rib injury in March 2013. However, the Board finds that his current pain is not etiologically related to his in-service rib injury because the October 2021 VA examiner found the March 2013 left rib injury was acute. Accordingly, the claim must be denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert, supra. S. L. Kennedy Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Robert Batten 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.