Citation Nr: 21010011 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 15-08 102 DATE: February 23, 2021 ORDER Entitlement to service connection for rheumatoid arthritis of the right hand to include as secondary to the lumbosacral strain is denied. Entitlement to service connection for rheumatoid arthritis of the left hand to include as secondary to the lumbosacral strain is denied. Entitlement to service connection for rheumatoid arthritis of the right ankle to include as secondary to the lumbosacral strain is denied. Entitlement to service connection for rheumatoid arthritis of the left ankle to include as secondary to the lumbosacral strain is denied. FINDINGS OF FACT 1. The Veteran’s rheumatoid arthritis of the right hand is not secondary to service-connected lumbosacral strain not otherwise related to an in-service injury or disease. 2. The Veteran’s rheumatoid arthritis of the left hand is not secondary to service-connected lumbosacral strain not otherwise related to an in-service injury or disease. 3. The Veteran’s rheumatoid arthritis of the right ankle is not secondary to service-connected lumbosacral strain not otherwise related to an in-service injury or disease. 4. The Veteran’s rheumatoid arthritis of the left ankle is not secondary to service-connected lumbosacral strain not otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for rheumatoid arthritis of the right hand due to service or due to the lumbosacral strain are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2020). 2. The criteria for service connection for rheumatoid arthritis of the left hand due to service or due to the lumbosacral strain are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2020). 3. The criteria for service connection for rheumatoid arthritis of the right ankle due to service or due to the lumbosacral strain are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2020). 4. The criteria for service connection for rheumatoid arthritis of the left ankle due to service or due to the lumbosacral strain are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Army from January 1973 to November 1978. In June 2020, the Board of Veterans’ Appeals remanded the Veteran’s claims for entitlement to service connection for the bilateral hands and ankles. In the remand, the Board notified the Veteran that the assigned representative, Dr. Vivian Anderson, was not an accredited agent per VA regulations. See 38 C.F.R. § 14.629. In August 2020, the Regional Office sent a letter informing you that your chosen representative was not accredited and provided the appropriate form in order to name a new representative. No form has since been returned. Our records indicate that Dr. Vivian Anderson continues to not be accredited to represent claimants before VA. The Board therefore cannot recognize her as the Veteran’s representative. Given the Board has duly notified the Veteran of the accreditation status of Dr. Vivian Anderson and provided the information necessary to name an accredited representative, the Board finds that the duty to assist the Veteran in obtaining representation has been fulfilled. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence 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 between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (noting that nexus may be demonstrated by a showing of continuity of symptomatology where the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a)). Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra. 1. & 2. Entitlement to service connection for rheumatoid arthritis of the bilateral hands to include as secondary to the lumbosacral strain 3. & 4. Entitlement to service connection for rheumatoid arthritis of the bilateral ankles to include as secondary to the lumbosacral strain The Veteran seeks service connection for rheumatoid arthritis of the bilateral hands and ankles. Due to the similar nature of the claims, they have been discussed together, herein. The private medical records show the Veteran has been treated for rheumatoid arthritis of the bilateral hands and ankles in September 2012 and continued to have a current diagnosis. See Private progress notes dated September 5, 2012 and November 2020 VA examination. Thus, the first element of service connection is established. In regard to the second element of service connection, the Veteran’s service treatment records (STRs) do not show any complaints, treatment, or diagnoses for bilateral hand or ankle pain. Further, the STRs do not show the Veteran had any injuries to the hands or ankles. In November 2014, the Veteran testified before a Decision Review Officer that his hands and ankles began hurting him while he was in the field in the 13B Infantry Division. In April 2020, the Veteran testified before the Board that his hands ached during service and his ankles started hurting after service. He stated that he was told his hand and ankle pain was due to spreading rheumatoid arthritis. Accordingly, affording the Veteran the benefit of the doubt, the Board finds the second element of service connection is also established for the Veteran’s claims for rheumatoid arthritis of the bilateral hands and feet. However, the preponderance of the evidence is against finding the Veteran’s bilateral hand and ankle rheumatoid arthritis is directly related to service. In November 2020, a VA examiner opined the Veteran’s currently diagnosed conditions of the bilateral hands and ankles is rheumatoid arthritis. The examiner noted that during service the Veteran’s hand and ankle pain were acute only and noted that the STRs do not contain complaints of chronic ankle or hand pain. Symptoms of recurrent joint pains were noted in 1994 at which point the Veteran was diagnosed with rheumatoid arthritis in May 1994, 16 years after service. The examiner found that there was no evidence that veteran’s onset of rheumatoid arthritis occurred during active duty or was caused by service. The examiner further noted that rheumatoid arthritis is an autoimmune disease in which the body’s immune system attacks its own healthy cells. The examiner opined it is less likely than not that the Veteran’s bilateral rheumatoid arthritis of the hands and ankles is related to active duty service. Great probative weight is given to the November 2020 VA examiner’s opinion because it is well-reasoned, based upon an examination of the Veteran with consideration of his lay statements and a thorough review of the claims file. In February 2015, the Veteran’s treating rheumatologist, Dr. A.M., submitted a statement that it is possible that the Veteran’s rheumatoid arthritis was aggravated by his military service. This opinion is afforded little probative weight. The physician has not given an affirmative opinion, rather the opinion is speculative, conclusory in nature, and lacks an adequate rationale. The Board finds the Veteran’s rheumatoid arthritis of the bilateral hands and ankles is not directly related to his military service. The most probative medical evidence of record regarding the nexus element demonstrates that the Veteran’s rheumatoid arthritis is not related to is military service. See November 2020 VA examiner’s report. The question remains if the Veteran’s currently diagnosed rheumatoid arthritis of the bilateral hands and ankles is secondary to one of the Veteran’s service-connected disabilities to include his lumbosacral strain. Following the June 2020 Board remand, the Veteran was afforded a VA examination in November 2020. The examiner opined that the Veteran’s bilateral hand and ankle rheumatoid arthritis was less likely than not related to or aggravated by the service-connected lumbar strain. The examiner noted that the conditions of rheumatoid arthritis are entirely separate entities than the lumbar strain and unrelated to it. The examiner noted that a review of the medical literature failed to demonstrate a causal relationship. The examiner found that the Veteran’s rheumatoid arthritis is an autoimmune disease whereas the Veteran’s lumbar strain is a muscular condition caused by wear and tear. The examiner concluded the conditions have no relation to one another and a nexus has not been established. The examiner further noted that the Veteran’s rheumatoid arthritis of the bilateral hands and ankles was not aggravated beyond its natural progression as a result of the Veteran’s service-connected lumbar spine condition. The Board has carefully considered the Veteran’s statements that he has had chronic hand and ankle pain since service. However, there is no persuasive medical evidence or persuasive credible lay evidence that the Veteran’s claimed disorders manifested to a compensable degree within a year of his separation of service or had its onset in service and continued ever since service. Therefore, service connection based on presumptive service connection for a chronic disease or based on a theory of continuity of symptomatology is not warranted. Indeed, to the extent the Veteran has experienced bilateral hand and ankle pain over the years, the Veteran’s theory that his symptoms are a continuing disease process that had its onset in service as opposed to symptoms due to post-service events has been rendered unfounded by the medical expert evidence. The opinion from the November 2020 VA examiner was that bilateral hand and ankle rheumatoid arthritis was less likely than not related to service. The Board finds this opinion highly probative as it is supported by an explanation based on a review of relevant medical evidence, and examination of the Veteran, and specialized medical knowledge. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). As such, the Board finds that service connection is not warranted as due continuity of symptoms since service. Accordingly, the Board finds that the weight of the evidence is against finding the Veteran’s rheumatoid arthritis of the bilateral hands and ankles is related to his active service or a service-connected disability. 38 U.S.C. § 1131; 38 C.F.R. § 3.303, 3.310. As the preponderance of the evidence is against the claim, further application of the benefit-of-the-doubt doctrine is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Board is grateful for the Veteran’s honorable service, and this decision is not meant to detract in any way from the Veteran’s service. Unfortunately, however, for the reasons and bases discussed above, the competent and probative evidence of record preponderates against a finding that the Veteran’s rheumatoid arthritis of the bilateral hands and ankles is service connected. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Laura C. Owens 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.