Citation Nr: 21010315 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 18-36 102 DATE: February 24, 2021 ORDER Entitlement to service connection for fibromyalgia is denied. FINDING OF FACT The Veteran does not have a confirmed diagnosis of fibromyalgia and her joint and lower extremities pains have been attributed to other etiologies for which she is already service connected. CONCLUSION OF LAW The criteria for service connection for fibromyalgia have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1999 to December 2001. In November 2018, the Board remanded the claim for further development. Entitlement to service connection for fibromyalgia Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). To establish service connection on a direct basis, the record must contain: (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, 1167 (Fed. Cir. 2004). A layperson is competent to report on the onset and continuity of his or her current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). Analysis The Veteran contends that she has fibromyalgia that is related to service. The Veteran’s service treatment records (STRs) do not document a diagnosis for fibromyalgia. However, the STRs document complaints, treatments, and diagnoses for patellofemoral syndrome, bilateral knees; tibial stress syndrome; and chronic leg, shin, and ankle pain. During her March 1999 Enlistment Exam, the Veteran’s lower extremities, feet, spine, and other musculoskeletal systems were clinically normal. In May 1999, the Veteran was seen for left leg pain. She stated that she had a 10-day history of left anterior thigh, posterior calf, and knee pain. She was diagnosed with generalized left leg exercised-induced myalgias. In August 1999, the Veteran was seen for shooting pains in her left leg. The pains shot from her ankle to her hip. In February 2000, the Veteran was seen for left lower leg pains. She was diagnosed with left leg shin splints. In May 2000, she was seen for pain in her left anterior calf. She was diagnosed with bilateral anterior leg pain. In April 2001, the Veteran was diagnosed with patellofemoral syndrome, mild, bilateral knees and tibial stress syndrome. The Board notes that the Veteran was seen on multiple other occasions for leg pain. During her December 2001 Report of Medical Examination, Separation physical, the Veteran’s lower extremities, spine and other musculoskeletal systems were clinically normal. However, the Veteran noted that she had painful and swollen ankles and knees and a bilateral leg disorder. In September 2016, the Veteran’s private physician referred her to a rheumatologist. The referring physician stated that the Veteran complained of aches and pains all over her body, to include in her arms and legs. The referring physician also stated that the Veteran reported tingling in her arms, hands, and calves. The rheumatologist noted multiple tender points in the exact location for fibromyalgia. The rheumatologist diagnosed the Veteran with fibromyalgia. The Board notes that this evidence was not of record until 2020. In October 2019, the Veteran was afforded a VA examination to determine the nature and etiology of her disorder. The Veteran stated that her fibromyalgia symptoms began in 1999. She denied injury or trauma to her bilateral lower extremities. She described gradual onset of symptoms, to include right and left lower extremity pain. Initially, she believed the pain was related to the routine physical demands of basic training. However, due to unresolved symptoms, she completed multiple medical evaluations where multiple diagnoses were considered. But, ultimately, she was diagnosed with retropatellar pain syndrome or patellofemoral pain syndrome (RPPS) with tibial stress reactions. The examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. Based on the physical exam, as well as a thorough review of the Veteran’s claims file, the examiner was unable to confirm a current chronic diagnosis of fibromyalgia. The examiner stated that the Veteran’s reported symptoms of fibromyalgia were subjective only. The objective exam was normal, i.e., there was no objective physical evidence of a chronic condition of fibromyalgia. Additionally, based on a thorough review of available records, the examiner concluded that the Veteran did not meet diagnostic criteria for a diagnosis of fibromyalgia, as there was no clinically significant pathology to render a diagnosis. With regard to the solitary fibromyalgia diagnosis noted in the Veteran’s claims file, listed as an “Active problem” at a PCM visit dated February 2018, the examiner stated that after a thorough review of the claims file, she was unable to locate sufficient documentation of a rationale for this diagnosis. The examiner stated that the VA records did not address formal 1990 or 2019 Fibromyalgia Diagnostic Criteria and did not document the presence of symptomatology warranting a formal diagnosis. The examiner noted that formal, and final, diagnosis of RPPS with mild tibial stress changes given during service is unrelated to fibromyalgia. According to Mayo Clinic, RPPS is pain at the front of the knee, around the kneecap (patella). RPPS has been associated with overuse, trauma to the kneecap, and surgery. Regarding shin splints, the term refers to pain along the shin bone (tibia), i.e., the large bone in the front of the lower leg. The examiner stated that shin splints are common in runners, dancers, and military recruits. Shin splints are caused by repetitive stress on the shinbone and the connective tissues that attach the muscles to the bone. Based on the above information, the examiner stated that a nexus could not be established. The Board notes that the Veteran’s STRs document complaints, treatments, and diagnosis for knee, ankle, hip, and leg pain. She was diagnosed with, among other things, shin splints; exercised-induced myalgias syndrome; patellofemoral syndrome, bilateral knees; and tibial stress syndrome. However, she was not diagnosed with fibromyalgia. Additionally, the VA examiner was unable to confirm a current chronic diagnosis of fibromyalgia. The examiner stated that the Veteran’s reported symptoms of fibromyalgia were subjective only. The objective exam was normal. The examiner further stated that formal and final diagnosis of RPPS with mild tibial stress changes given during service is unrelated to fibromyalgia. The Board notes that at the time of the October 2019 VA examination, the Veteran’s private medical records which showed a fibromyalgia diagnosis was not of record. However, the medical evidence of record does not show that the Veteran’s condition (claimed as fibromyalgia) is attributed to any unknown clinical diagnosis. Instead, all the symptomatology and impairment caused by the Veteran’s joint pains (claimed as fibromyalgia) are specifically contemplated by the schedular rating criteria in effect for her service-connected trochanteric pain syndrome (left hip condition), bilateral knee patellofemoral syndrome with shin splints, degenerative joint disease/degenerative disc disease of the lumbosacral spine, and bilateral lower extremity radiculopathy. The schedular rating criteria in effect for these disorders specifically provide for disability ratings based on a combination of history, symptoms, and clinical findings, to include pains. See DCs 5243 regarding spine conditions, as well as DC 8520 regarding radicular symptoms, and 5261 regarding knee conditions, and 5252 regarding trochanteric pain syndrome. As such, the Board concludes that there is no probative medical evidence that indicates the Veteran has a current fibromyalgia diagnosis. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). Regarding the September 2016 rheumatology consult, the rheumatologist diagnosed the Veteran with fibromyalgia. However, as mentioned above, the Veteran’s knee and leg pain and tingling in her lower extremities have already been diagnosed and attributed to her service-connected bilateral knee patellofemoral syndrome with shin splints and/or bilateral lower extremity radiculopathy. See 38 C.F.R. § 4.14. The Board acknowledges the Veteran and her representative’s statements that the Veteran suffers from fibromyalgia that is related to service. The Board notes that although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, a diagnosis and nexus between the diagnosis and active service is outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). For these reasons, the Board finds that a preponderance of the evidence is against the claim for service connection for fibromyalgia, and the appeal is denied. Because the preponderance of the evidence is against the Veteran’s appeal, the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Moore 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.