Citation Nr: 21011237 Decision Date: 03/01/21 Archive Date: 03/01/21 DOCKET NO. 15-06 500 DATE: March 1, 2021 ORDER Entitlement to service connection for a bilateral elbow disability is denied. Entitlement to service connection for a right ankle disability is denied. Entitlement to service connection for a bilateral shoulder disability is denied. Entitlement to service connection for a bilateral hand disability is denied. Entitlement to service connection for a neck disability is denied. Entitlement to service connection for a bilateral knee disability, to include residuals of left and right meniscal tears, is denied. FINDINGS OF FACT 1. The Veteran has not had a right or left elbow disability during the appeal period. 2. The Veteran has not had a right ankle disability during the appeal period. 3. The Veteran’s current bilateral shoulder disabilities were not incurred during, and are not otherwise related to, the Veteran’s period of active service. 4. The Veteran’s current bilateral hand disabilities were not incurred during, and are not otherwise related to, the Veteran’s period of active service. 5. The Veteran’s current neck disability was not incurred during, and is not otherwise related to, the Veteran’s period of active service. 6. The Veteran’s current bilateral knee disabilities, to include residuals of left and right meniscal tears, were not incurred during, and are not otherwise related to, the Veteran’s period of active service. CONCLUSIONS OF LAW 1. The criteria for service connection for a bilateral elbow disability have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 2. The criteria for service connection for a right ankle disability have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 3. The criteria for service connection for a bilateral shoulder disability have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 4. The criteria for service connection for a bilateral hand disability have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 5. The criteria for service connection for a neck disability have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 6. The criteria for service connection for a bilateral knee disability, to residuals of include left and right meniscal tears, have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from September 1982 to August 1986. In July 2018, the Veteran testified before the undersigned at a Travel Board hearing. A transcript of the hearing is associated with the record. In November 2018, the Veteran’s claim was by the Board for additional development. Review of the completed development reveals that, at the very least, substantial compliance with the remand directives was obtained. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). The issues of entitlement to service connection for a left ankle disability and residuals of an injury to the ring finger, left hand were remanded by the Board in November 2018. The Agency of Original Jurisdiction (AOJ) granted service connection for left ankle sprain and residual scar, ring finger injury, left hand in an August 2020 rating decision. These issues, having been granted in full, are no longer for appellate review. Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). Service Connection, Generally Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity for certain diseases. 38 C.F.R. §§ 3.303 (a), (b), 3.309(a); see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection for the claimed disorder, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical, or in certain circumstances, lay evidence of a nexus between the claimed in-service disease or injury and the current disability. See 38 C.F.R. § 3.303 (2017); see also Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247, 253 (1999); Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a “competent” source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). The third step of this inquiry requires the Board to weigh the probative value of the evidence in light of the entire record. A layperson is competent to report on the onset and continuity of current symptomatology based on personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if the layperson: (1) is competent to identify the medical condition, (2) is reporting a contemporaneous medical diagnosis, or (3) is describing symptoms that support a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, at 1376-77 (Fed. Cir. 2007). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. See Caluza v. Brown, 7 Vet. App. 498 (1995). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. In March 2013, the Veteran filed a claim for service connection for a bilateral elbow disability, a right ankle disability, a bilateral shoulder disability, a bilateral hand disability, a neck disability, and a bilateral knee disability. In July 2018, the Veteran provided testimony at a Board hearing regarding why he believed his reported disabilities were related to his period of active service. The Veteran reported that while he was in service he performed duties as a welder. He stated that this was a physically demanding Military Occupational Specialty that placed a lot of wear and tear on his body, particularly his joints. “We serviced all types of jobs, anything that was metal related, anything that was to be fabricated, any size of equipment, stationary and nonstationary such as tanks, AMTRACKS. We built armory. We went on contact teams. We carried equipment out in field when they were in the field. If it was broken, we would go in the field and repair.” Hearing Testimony, pp.3. He also reported a great deal of strain on his hands and neck in relation to his duties. “A lot of times we would have to climb ladders to ten to fifteen feet off the ground and make armories. To secure armories…we would have to lean backwards and hang on with one hand and try to weld with other, or vice versa. Or, we had our welding cables, we would have to wrap around, and hold with one hand and try to weld with the other.” He also reported repeatedly snapping his helmet down with his neck because his hand would be unavailable. Hearing Testimony, pp. 9-11. 1. Entitlement to service connection for a bilateral elbow disability 2. Entitlement to service connection for right ankle disability Unfortunately, the Board finds that service connection for a bilateral elbow disability and a right ankle disability is not warranted. Particularly, the Board finds that the evidence of record weighs against a finding that the Veteran has had a diagnosis of a right ankle disability or a right or left elbow disability during the appeal period; accordingly, service connection for a right ankle disability and a bilateral elbow disability must be denied. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). First, the Board notes that service treatment records are silent for treatment of a right ankle or elbow disability during his period of service. The Veteran’s examination prior to separation from service in July 1986 does not report any right ankle or elbow disability and documents normal evaluations of the Veteran’s upper and lower extremities. The only evidence in support of either a right ankle disability or a bilateral elbow disability is the lay statements provided by the Veteran in his initial claim, his lay statements during his 2018 Board hearing, and the Veteran’s reports during his 2019 VA examinations. With regard to the right ankle, the Board notes that he stated during his hearing that he has been diagnosed with peroneal tendonitis. The Board, however, finds these statements to be outweighed by the normal findings of the 2019 VA examinations and the Veteran’s treatment records that do not demonstrate reports of functional impairment of the right ankle or either elbow. The Board notes that in Saunders v. Wilkie, the Federal Circuit held that pain alone, even without an underlying pathology or diagnosis, can constitute a disability under VA law where such pain results in functional impairment. See Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Here, however, none of the medical evidence of record has demonstrated functional impairment related to the Veteran’s reports of right ankle or elbow pain. Upon examination, the Veteran’s right ankle and bilateral elbows were reported to have full range of motion and the 2019 examiner specifically denied that the Veteran’s complaints of pain in the right ankle or bilateral elbows resulted in functional impairment. Moreover, with regard to the Veteran’s bilateral elbows the examiner noted that the Veteran denied any functional impairment. The Veteran’s VA treatment records do not report any history of right or left elbow pain that results in functional impairment. While VA treatment records report a history of right ankle pain, they do not report that the Veteran has functional limitations due to his ankle pain. Accordingly, the Board finds that the evidence of record does not support that the Veteran has had a right ankle disability or bilateral elbow disability during the appeal period, even considering the Veteran’s reports of pain. As the weight of the evidence of record does not support that the Veteran has had a right ankle disability or a disability of either elbow during the appeal period, service connection for a right knee disability must be denied. In the absence of proof of a present disability, there can be no valid claim. See Brammer, 3 Vet. App. at 225. As the preponderance of the evidence is against the Veteran’s claims, the benefit-of- the-doubt doctrine is not applicable. 38 U.S.C. § 5107 (b); see also Gilbert, 1 Vet. App. at 55 (1990). 3. Entitlement to service connection for a bilateral shoulder disability The Veteran has also asserted that service connection is warranted for a bilateral shoulder disability. As noted above, during the July 2018 hearing, the Veteran reported wear and tear in service due to his duties as a welder. The Veteran reported strain from climbing ladders and securing armories. Hearing Testimony, pp. 9. The Veteran’s service treatment records are silent for any treatment for his left or right shoulders. The Veteran’s examination prior to separation from service in July 1986 does not report any shoulder disability and documents normal evaluations of the Veteran’s upper extremities. In November 2019, the Veteran was provided a VA examination related to his claim for service connection for a bilateral shoulder condition. The examiner noted that the Veteran reported bilateral shoulder pain related to carrying heavy cables while in service. The examiner did not diagnose the Veteran with a shoulder disability and did not report limitation of range of motion. The examiner, however, noted that the Veteran’s symptoms of pain result in functional limitation, specifically that he uses care at work when doing overhead activities and that flare ups can be caused by climbing or lifting his arms. As such, the Board finds that a bilateral shoulder disability is present during the appeal period. See Saunders, 886 F.3d at 1361. Unfortunately, the weight of the competent medical evidence of record does not indicate a link between any current shoulder disability and the Veteran’s period of active service. The Board notes that the November 2019 examiner opined that the Veteran’s current bilateral shoulder disabilities were less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner provided a thorough rationale that is supported by the evidence of record, including consideration of the lay statements provided by the Veteran, available medical records, and a physical examination of the Veteran. The examiner noted that there is no medical documentation of record during or after service to support a link between any current shoulder condition and the Veteran’s period of service. As such, the Board finds the November 2019 VA medical opinion to be highly probative evidence weighing against a relationship to between any current bilateral shoulder disability and the Veteran’s active service. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). To the extent the Veteran has asserted that any current shoulder disability was related to, or caused by, any incident of his period of service, the Board finds that an opinion regarding the development of these conditions many years after service is of a complex medical nature that is beyond the scope of a lay opinion. See Jandreau, at 1376-77. Further, none of the medical evidence of record provides a nexus between any current shoulder disability and the Veteran’s period of active service. Moreover, the Veteran’s treatment records from the Reno VA Medical Center (VAMC) do not report recurrent complaints of a bilateral shoulder disability or treatment for such a condition. In summary, the Board finds that the preponderance of the evidence weighs against a finding that any current bilateral shoulder disability began during, or is otherwise due to, the Veteran’s period of active service. Consequently, the benefit-of-the-doubt rule does not apply, and the claims must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 4. Entitlement to service connection for a bilateral hand disability The Veteran has also asserted that service connection is warranted for a bilateral hand disability. As noted above, during the July 2018 hearing, the Veteran reported wear and tear in service due to his duties as a welder. The Veteran reported strain from climbing ladders and securing armories. The Veteran stated that they would need to wrap cables around their hands and try to weld with the other. He stated that, after a period, his hands would go numb or start to hurt. Hearing Testimony, pp. 9-10. The Veteran’s service treatment records are silent for any treatment for his left or right hands. The Veteran’s examination prior to separation from service in July 1986 does not report any hand disability and documents normal evaluations of the Veteran’s upper extremities. In November 2019, the Veteran was provided a VA examination related to his claim for service connection for a bilateral hand condition. The examiner noted that the Veteran reported right hand pain as a residual of his military welding job in service. The examiner did not diagnose the Veteran with a hand disability; however, the examiner noted abnormal range of motion of the right and left hand. Additionally, the examiner noted the Veteran’s reports of flare ups with repetitive use of his hands. As such, the Board finds that a bilateral hand disability is present during the appeal period. See Saunders, 886 F.3d at 1361. Unfortunately, the weight of the competent medical evidence of record does not indicate a link between any current hand disability and the Veteran’s period of active service. The Board notes that the November 2019 examiner opined that the Veteran’s current bilateral hand disabilities were less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner provided a rationale that is supported by the evidence of record, including consideration of the lay statements provided by the Veteran, available medical records, and a physical examination of the Veteran. As such, the Board finds the November 2019 VA medical opinion to be highly probative evidence weighing against a relationship to between any current hand disability and the Veteran’s active service. See Nieves-Rodriguez, 22 Vet. App. at 304. To the extent the Veteran has asserted that any current hand disability was related to, or caused by, any incident of his period of service, the Board finds that an opinion regarding the development of these conditions many years after service is of a complex medical nature that is beyond the scope of a lay opinion. See Jandreau, at 1376-77. Further, none of the medical evidence of record provides a nexus between any current hand disability and the Veteran’s period of active service. Moreover, the Veterans treatment records from the Reno VAMC do not report recurrent complaints of a recurrent left- or right-hand disability or treatment for such a condition. In summary, the Board finds that the preponderance of the evidence weighs against a finding that any current bilateral hand disability began during, or is otherwise due to, the Veteran’s period of active service. Consequently, the benefit-of-the-doubt rule does not apply, and the claims must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 5. Entitlement to service connection for a neck disability The Veteran has also asserted that service connection is warranted for a neck disability. As noted above, during the July 2018 hearing, the Veteran reported wear and tear in service due to his duties as a welder. The Veteran reported stiffness and soreness due to different types of angles he had positioned himself in order to complete jobs. He also stated that he would snap his neck to lower his helmet because his hands would be unavailable. Hearing Testimony, pp. 11. The Veteran’s service treatment records are silent for any complaints of neck pain or treatment for his neck. The Veteran’s examination prior to separation from service in July 1986 does not report any neck disability and documents normal evaluations of the Veteran’s head, face, neck and scalp. In November 2019, the Veteran was provided a VA examination related to his claim for service connection a neck condition. The examiner noted that the Veteran reported a history of neck pain from the weight of wearing a welding helmet. The examiner did not diagnose the Veteran with a neck disability. The examiner, however, noted abnormal range of motion of the cervical spine and noted the Veteran’s reports of flare ups with overuse. As such, the Board finds that a neck disability is present during the appeal period. See Saunders, 886 F.3d at 1361. Unfortunately, the weight of the competent medical evidence of record does not indicate a link between any current neck disability and the Veteran’s period of active service. The Board notes that the November 2019 examiner opined that the Veteran’s current neck disability was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner provided a thorough rationale that is supported by the evidence of record, including consideration of the lay statements provided by the Veteran, available medical records, and a physical examination of the Veteran. The examiner noted that there is no medical documentation of record during or after service to support a link between any current neck condition and the Veteran’s period of service. As such, the Board finds the November 2019 VA medical opinion to be highly probative evidence weighing against a relationship to between any current neck disability and the Veteran’s active service. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). To the extent the Veteran has asserted that any current neck disability was related to, or caused by, any incident of his period of service, the Board finds that an opinion regarding the development of such a condition many years after service is of a complex medical nature that is beyond the scope of a lay opinion. See Jandreau, at 1376-77. Further, none of the medical evidence of record provides a nexus between any current neck disability and the Veteran’s period of active service. Moreover, the Veteran’s treatment records from the Reno VAMC do not report recurrent complaints of a neck disability or treatment for such a condition. In summary, the Board finds that the preponderance of the evidence weighs against a finding that any current neck disability began during, or is otherwise due to, the Veteran’s period of active service. Consequently, the benefit-of-the-doubt rule does not apply, and the claims must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 6. Entitlement to service connection for a bilateral knee disability The Veteran has also asserted that service connection is warranted for a bilateral knee disability. As noted above, during the July 2018 hearing, the Veteran reported wear and tear in service due to his duties as a welder. The Veteran reported strain from climbing ladders and securing armories. Hearing Testimony, pp. 16-17. The Veteran’s service treatment records are silent for any treatment for his left or right knees. The Veteran’s examination prior to separation from service in July 1986 does not report any knee disability and documents normal evaluations of the Veteran’s lower extremities. In November 2019, the Veteran was provided a VA examination related to his claim for service connection for a bilateral knee condition. The examiner noted that the Veteran stated that he noted knee pain from squatting in small areas in tanks during service, but that he was never seen in service for his knees. The examiner also noted the Veteran’s reports that he underwent knee surgeries in 2015 due to injuries at work. The Veteran was diagnosed with the residuals of meniscal tears of both knees. Unfortunately, the weight of the competent medical evidence of record does not indicate a link between any current knee disability and the Veteran’s period of active service. The Board notes that the November 2019 examiner opined that the Veteran’s current bilateral knee disabilities were less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner provided a thorough rationale that is supported by the evidence of record, including consideration of the lay statements provided by the Veteran, available medical records, and a physical examination of the Veteran. As such, the Board finds the November 2019 VA medical opinion to be highly probative evidence weighing against a relationship to between any current hand disability and the Veteran’s active service. See Nieves-Rodriguez, 22 Vet. App. at 304. To the extent the Veteran has asserted that any current knee disability was related to, or caused by, any incident of his period of service, the Board finds that an opinion regarding the development of these conditions many years after service is of a complex medical nature that is beyond the scope of a lay opinion. See Jandreau, at 1376-77. The Board notes that the Veteran stated that a physician informed him that he had wear and tear to his knees that was attributed to his active service. Hearing Testimony, pp. 16-17. While the Veteran is competent to report what a physician has informed him regarding his knee conditions, the Board finds this opinion related during the Veteran’s 2018 Board hearing to be less probative than the opinion provided by the 2019 VA examiner. The Board notes that this opinion did not state that any current knee diagnosis was at least as likely as not due to any incident of his period of active service. The examiner also reportedly indicated that the Veteran’s work for the railroad subsequent to service also had an impact on his current knee diagnoses and it’s unclear to what extent both experiences were thought to have contributed to any current diagnosis. Additionally, the Board finds that the rationale provided by the 2019 VA examiner more extensively discussed the Veteran’s history and why they came to the conclusion that the Veteran’s current diagnoses were less likely than not a result of any incident of the Veteran’s period of service. As such, the Board finds the opinion provided by the 2019 VA examiner is afforded more probative weight than the opinion relayed by the Veteran during his 2018 hearing. See Nieves-Rodriguez. Lastly, the Veteran’s treatment records from the Reno VAMC do not provide evidence of a nexus between any current knee disability and the Veteran’s period of active service. In summary, the Board finds that the preponderance of the evidence weighs against a finding that any current bilateral knee disability began during, or is otherwise due to, the Veteran’s period of active service. Consequently, the benefit-of-the-doubt rule does not apply, and the claims must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Duties to Notify and Assist The VCAA, codified in part at 38 U.S.C. §§ 5103, 5103A, and implemented in part at 38 C.F.R. § 3.159, amended VA’s duties to notify and to assist a claimant in developing information and evidence necessary to substantiate a claim. As noted above, the Board finds that, at the very least, substantial compliance with the November 2018 Board remand directives was obtained. Stegall, 11 Vet. App. 268 (1998); Dyment, 13 Vet. App. 141, 146-47 (1999). Particularly, to the extent that the Veteran has identified and the November 2018 remand requested that records related to the Veteran’s treatment with Reno Orthopedic and his chiropractor be obtained, the Board notes that a letter was sent to the Veteran in August 2019 requesting that he complete the necessary authorizations to obtain these records from private health care providers. Since the 2019 letter, the Veteran has not provided VA with authorizations to obtain records from these providers. The duty to assist in the development and the adjudication of a claim is not a one-way street. As such, to the extent that VA has obtained any relevant records identified by the Veteran and has been given proper authorizations to obtain those records, the Board finds that the duty to assist has been met. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991); see also Stegall. Additionally, the Board notes that the Veteran 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.”) Based upon the foregoing, the duties to notify and assist the Veteran have been met, and no further action is necessary to assist the Veteran in substantiating these claims. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P.M. Johnson, 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.