Citation Nr: 21006893 Decision Date: 02/05/21 Archive Date: 02/05/21 DOCKET NO. 15-10 363 DATE: February 5, 2021 ORDER Service connection for arthritis is denied. FINDING OF FACT The Veteran’s arthritis did not manifest within one year of separation, it was not incurred in or otherwise related to service, and it is not proximately due to or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for service connection for arthritis have not been met. 38 U.S.C. §§ 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1968 to March 1970. This case returns to the Board of Veterans’ Appeals (Board) after remands to the agency of original jurisdiction (AOJ) in July 2018 and June 2020. The AOJ substantially complied with the Board’s remand instructions, and the case is ready for further review. Stegall v. West, 11 Vet. App. 268, 271 (1998). On remand, the AOJ granted service connection for monoclonal gammopathy of undetermined significance (MGUS) (claimed as multiple myeloma). See October 2020 rating decision. That issue is no longer before the Board. Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997). Service Connection for Arthritis The Veteran asserts that his chronic joint pain is secondary to service-connected cutaneous T-cell lymphoma (a type of non-Hodgkin’s lymphoma), or to MGUS. Alternatively, he attributes the disability to herbicide agent exposure in Vietnam. After careful review, the Board finds that service connection for arthritis is not warranted. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection generally requires evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (“nexus”) between the current disability and the disease or injury incurred or aggravated during service. Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013). Secondary service connection may be granted when a disability is proximately due to or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 447-48 (1995). Presumptive service connection may be established for certain chronic diseases, including arthritis, which manifest to a compensable degree within one year of separation from active service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). When a disease is not shown to be chronic during service or within the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. 38 C.F.R. § 3.303(b); Walker, 708 F.3d at 1338. Presumptive service connection is also available for certain diseases associated with exposure to Agent Orange or other herbicide agents. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e). VA regulations provide that veterans who served in the Republic of Vietnam between January 9, 1962 and May 7, 1975 are presumed to have been exposed to herbicide agents. 38 C.F.R. §§ 3.307(a)(6). Only the specific diseases listed under 38 C.F.R. § 3.309(e) are subject to presumptive service connection on this basis. Nevertheless, a claimant may establish service connection for an unlisted disability on a direct basis by showing proof of causation through competent evidence. Combee v. Brown, 34 F.3d 1039, 1042 (1994). First, the Board finds that the Veteran is not entitled to service connection on either a direct or a presumptive basis. The Veteran does not contend that he developed joint pain during service or within one year of separation. Nor does he contend that his arthritis is related to any injuries in service. His medical records do not suggest otherwise. Service treatment records do not document joint pain, arthritis, or any other relevant diagnoses or findings. While they show treatment for issues like chronic lumbosacral strain, a right foot muscle strain, and a right leg contusion, there is no indication in the record that the Veteran’s current disability may be associated with these in-service injuries. VA treatment records show initial diagnoses for rheumatoid arthritis, gouty arthropathy, and osteoarthritis in 2009 or 2010. See e.g. July 2010 rheumatology note. It is unclear when the Veteran began experiencing symptoms. He did not provide any testimony about their onset at his May 2018 hearing. VA disability benefits questionnaires from April 2019 indicate that the date of onset is unknown. In any case, there is no evidence that arthritis manifested within the one-year presumptive period, and service connection is therefore not available under 38 C.F.R. § 3.309(a). The Veteran has suggested that his arthritis is due to herbicide agent exposure. Military records confirm that he served in Vietnam, so he is presumed to have been exposed to herbicides. However, because arthritis is not one of the diseases listed under 38 C.F.R. § 3.309(e), presumptive service connection is not available on this basis. Additionally, the Veteran has not identified or submitted any evidence indicating that his arthritis may be associated with herbicide agent exposure. The Board finds none in the record. Direct service connection is not warranted here either. Next, the Board finds that the record does not support service connection on a secondary basis. After the April 2019 VA examination, the examiner determined it is less likely than not that the Veteran’s arthritis is proximately due to or aggravated by his service-connected T-cell lymphoma. With respect to proximate causation, the 2019 examiner stated that current medical literature notes autoimmune inflammatory conditions, like rheumatoid arthritis, as a specific risk factor for developing lymphomas. However, he reasoned, “the reverse … does not seem to be valid.” The examiner found no evidence in the current literature that T-cell lymphoma is an underlying etiology for rheumatoid arthritis, gout, or inflammatory arthropathies. Additionally, the examiner noted that the Veteran’s arthritis diagnoses predate the T-cell lymphoma diagnosis, which occurred in approximately 2014. The 2019 examiner also wrote that recent hematology/oncology records indicated the Veteran’s rheumatoid arthritis and gout are under good control without flares or anemia. Based on these records, the examiner determined that T-cell lymphoma is not aggravating his rheumatoid arthritis, gout, or inflammatory polyarthritis. Overall, the 2019 examiner’s opinion is well-reasoned, consistent with the available medical records, and supported by relevant medical literature. The Board finds it probative. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (an opinion is probative when it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data). In November 2020, a second VA examiner determined it is less likely than not that the Veteran’s arthritis is proximately due to or aggravated by either his service-connected T-cell lymphoma or MGUS. Like the first examiner, the 2020 examiner explained that rheumatoid arthritis can increase the risk of certain types of cancers, including lymphomas. However, lymphomas and MGUS have not been shown to cause rheumatoid arthritis. The 2020 examiner found no evidence of aggravation, noting that the Veteran’s rheumatoid arthritis has followed the natural progression of the condition. The Board finds the 2020 examiner’s opinion probative as well. Nieves-Rodriguez, 22 Vet. App. at 304. There is no competent evidence on file that contradicts the VA examiners’ opinions. The Veteran expressed his belief that his chronic joint pain is the result of T-cell lymphoma at the 2018 hearing. He did not explain the basis for this belief, or offer any other testimony regarding causation or aggravation. The Board finds that the Veteran, as a layperson, lacks the medical expertise necessary to competently link his arthritis symptoms to his service-connected cancer without additional evidence. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Thus, his unsupported lay belief is not sufficient to establish secondary service connection. In sum, the preponderance of evidence is against service connection for arthritis on any basis. As such, the benefit-of-the-doubt rule is not applicable in this instance. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The appeal must be denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D.Z. Wall, 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.