Citation Nr: 21009464 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 14-34 715A DATE: February 22, 2021 ORDER Entitlement to service connection for a bilateral wrist disorder is denied. Entitlement to service connection for a right knee disorder, to include as secondary to service-connected left knee and/or low back disabilities is denied. Entitlement to service connection for a condition manifested by facial swelling is denied. Entitlement to service connection for a condition manifested by total body numbness and tingling is denied. FINDINGS OF FACT 1. The Veteran’s bilateral wrist tendonitis did not have its onset in service and is not etiologically related to any aspect of service. 2. The Veteran’s right knee condition did not have its onset in service, is not etiologically related to any aspect of service, and was not caused or aggravated beyond its normal course of progression by any service-connected disability. 3. The Veteran does not have a current diagnosis of any chronic condition manifested by facial swelling. 4. The Veteran does not have a current diagnosis of any chronic condition manifested by total body numbness and tingling. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a bilateral wrist disorder have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 2. The criteria for entitlement to service connection for a right knee disorder, to include as secondary to service-connected left knee and/or low back disabilities have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 3. The criteria for entitlement to service connection for a condition manifested by facial swelling have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 4. The criteria for entitlement to service connection for a condition manifested by total body numbness and tingling have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty April 2008 to April 2012. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge in May 2018. The transcript is of record. These matters were previously before the Board in October 2018, at which time they were remanded for development. They have been returned to the Board for appellate review. The Board finds that there was substantial compliance with its remand orders. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999); Stegall v. West, 11 Vet. App. 268, 271 (1998). The claimant has not raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004)). The absence of any one element will result in denial of service connection. Coburn v. Nicholson, 19 Vet. App. 247, 431 (2006). Service connection may be granted for any disease initially 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). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including other organic diseases of the nervous system (which includes sensorineural hearing loss and tinnitus), are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. §§ 3.303 (b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310 (2018). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). 1. Entitlement to service connection for a bilateral wrist disorder The Veteran carries current diagnoses of bilateral tendonitis in both wrists, thus, the current disability requirement outlined above has been met. She avers that her wrist conditions relate to service, specifically, that her wrist tendonitis is related to heavy lifting she was required to perform while on active duty. The Veteran has been afforded several VA examinations in connection with her claim in this matter. The first, in June 2017, confirmed her wrist diagnosis, but the examiner concluded that the Veteran’s tendonitis was unrelated to service, noting the absence of any wrist-related complaints in service treatment records, adding that “[w]rist tendonitis caused by heavy lifting or other repetitive activities would have caused manifestations at the time,” and that it was “unlikely that this injury would not become evidence until years later.” A second VA examiner, with whom the Veteran met in September 2019, agreed that the Veteran’s bilateral tendonitis was less likely than not service related, noting that a November 2011 examination was silent for any wrist-related complaints. The Board notes that these medical opinions, which are based on in-person examinations of the Veteran and thorough reviews of the medical file, are essentially uncontroverted by the objective evidence of record. They are based on accurate history of the conditions and are supported by adequate rationales. The Veteran’s service records are indeed silent for wrist-related complaints or injury, and no treating or examining provider has ever indicated any etiological relationship between a current wrist condition and service. While the Board has considered with sympathy the Veteran’s lay statements, it cannot afford probative weight to his assertions with respect to the etiology of her wrist conditions in this case. While she is competent to report her experiences and symptoms since service, the Veteran is not competent to provide a nexus opinion regarding the nature and etiology of her tendonitis. Jandreau v. Nicholson, 492 F. 3d 1372 (2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). The Veteran’s reports of her symptoms are relevant, competent, and credible; however, the question of the etiology of her bilateral wrist tendonitis is limited to the purview of someone with medical knowledge and training, such as the VA medical examiners in this case. In sum, the evidence does not show that it is at least as likely as not that the Veteran’s diagnosed wrist conditions are related to active service. The probative value of the Veteran’s assertions is outweighed by the probative value of the thorough and reasoned opinions of the VA medical experts. As the preponderance of the evidence is against the claims, service connection for disorders of the bilateral wrists must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for a right knee disorder, to include as secondary to service-connected left knee and/or low back disabilities The Veteran asserts that she has a right knee disability caused by her service-connected left knee and/or low back disabilities. The Board notes that the Veteran has not claimed, and the evidence does not reflect, that any current right knee condition is directly related to service. To be clear, service records are silent for any notation of right knee-related complaints or injury, separation examination records show no indication of right knee problems, and a right knee diagnosis was not furnished within a year of separation from service. Moreover, a February 2013 VA General Medical Examination, conducted within one year of her separation from service, which included examination of the Veteran’s knees, found no right knee disorder present at that time. Accordingly, service connection on a direct basis is not warranted. On a secondary basis, the Veteran has claimed that she is beset by a current right knee disorder, and that that condition has been caused or aggravated beyond its normal course of progression by a service-connected left knee and/or lower back condition. To explore the Veteran’s theory of entitlement, she was afforded a VA examination in September 2019. The examiner furnished a diagnosis of patellofemoral pain syndrome, but indicated that condition bore no etiological relationship to any service-connected disability. With respect to the left knee and the low back, the examiner explained that neither condition caused a limp or other gait alteration that might affect the Veteran’s right knee, nor did either disability create any biomechanical condition that might be expected to affect the right knee. This assessment is uncontroverted by the objective medical evidence of record. No treating or examining provider has ever linked the Veteran’s right knee symptoms to a service-connected disability, including of the low back or left knee. Moreover, the September 2019 VA examiner’s assessment is in accord with the evidence, and is based on an in-person examination and thorough review of the medical file. The Board therefore affords it great probative weight. In sum, while the Board is sympathetic to the Veteran’s sincerely held belief that her right knee condition is related to her service-connected disabilities of the low back and left knee, the objective evidence does not support that view, and the Veteran is not competent to provide a nexus opinion regarding her right knee condition in this matter. Jandreau v. Nicholson, 492 F. 3d 1372 (2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). The Veteran’s reports of her symptoms are relevant, competent, and credible; however, the question of the etiology of her right knee condition is limited to the purview of someone with medical knowledge and training, such as the VA medical examiner in this case. In sum, the evidence does not show that it is at least as likely as not that the Veteran’s diagnosed right knee condition is related to active service, or that it has been caused or aggravated by a low back or left knee disability. The probative value of the Veteran’s assertions is outweighed by the probative value of the thorough and reasoned opinions of the VA medical expert. As the preponderance of the evidence is against the claims, service connection for a right knee condition must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to service connection for a condition manifested by facial swelling and for a condition manifested by total body numbness and tingling In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223 (1992); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998) (service connection may not be granted unless a current disability exists.) The Court has consistently held that, under the law, a “determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service.” Watson v. Brown, 4 Vet. App. 309 (1993). This principle has been repeatedly reaffirmed by the Federal Circuit, which has stated that “a veteran seeking disability benefits must establish...the existence of a disability [and] a connection between the veteran’s service and the disability.” Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000). In this case, the Veteran has never been explicitly diagnosed with conditions associated with facial swelling, or total body tingling and numbness. Moreover, at a September 2019 VA examination, she acknowledged she did not have current facial swelling or total body numbness or tingling. The Veteran indicated that she had an episode of facial swelling and numbness at the jaw in 2011, and that she has had a couple of episodes since, but the record does not reflect any chronic disability associated with these symptoms, and no such condition was found on examination. With respect to tingling and numbness, examination of the Veteran’s peripheral nerves reflected no symptoms, normal reflex and sensory testing, and no trophic changes. These findings are consistent with the medical evidence of record, which neither shows any diagnosis or chronic condition to which either symptom might be attributable, nor is there evidence of treatment sought or received for repeated bouts of either facial swelling or tingling and numbness of the total body. In light of the lack of evidence of any current disability related to facial swelling or total body numbness and tingling in the record, the Board finds that the Veteran has no current disabilities, and as such, the preponderance of the evidence is against her claims of entitlement to service connection for facial swelling and total body tingling and numbness. As a result, the claims must be denied. Because the preponderance of the evidence is against the claims, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102 GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Z. Sahraie, 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.