Citation Nr: 21015645 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 16-02 205 DATE: March 18, 2021 ORDER Service connection for muscle and joint pain and bone mass loss, to include as due to an undiagnosed illness, is denied. FINDINGS OF FACT 1. The Veteran did not serve in the Southwest Asia theater of operations during the Persian Gulf War. 2. The preponderance of the evidence shows that the Veteran’s claimed muscle and joint pain and bone mass loss (diagnosed as bilateral shoulder arthritis) did not have its onset in service, or within the first post-service year, and is not otherwise etiologically related to service, to include any anthrax vaccinations received in service. CONCLUSION OF LAW The criteria for service connection for muscle and joint pain and bone mass loss, to include as due to an undiagnosed illness, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the Navy from November 1997 to July 2002. This matter was before the Board in May 2019 and June 2020 when it was remanded for additional development. The Veteran had a hearing before the Board in January 2019. On February 3, 2021, the Veteran was advised by letter that the Veterans Law Judge (VLJ) who conducted the 2019 Board hearing was no longer available to participate in the appeal, and of his right to have another hearing before a different VLJ if he requested such a hearing within 30 days. The Veteran has not responded to this letter and so the Board will proceed without scheduling another hearing. Service Connection The Veteran contends that he has muscle tenderness, bone mass loss, and joint pain in the shoulders, as a result of taking Anthrax vaccinations in service. See December 2010 Correspondence, December 2013 Notice of Disagreement (NOD), December 2015 VA Form 9. Alternatively, he maintains that this disability is due to Gulf War service. See December 2013 NOD. Finally, he has stated that he has experienced chronic shoulder pain since carrying fuel hoses in service. See September 2014 Decision Review Officer (DRO) Hearing Transcript. 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). Certain chronic diseases, such as degenerative joint disease, are subject to presumptive service connection if they manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d). VA regulations also provide that compensation will be paid for disability due to undiagnosed illness and medically unexplained chronic multisymptom illnesses to a Persian Gulf War veteran who exhibits objective indications of a qualifying chronic disability if that disability became manifest either during active service in the Southwest Asia theater of operations, or to a degree of 10 percent or more not later than December 31, 2021, and by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 C.F.R. § 3.317(a)(1). After considering all information including the lay and medical evidence of record in a case with respect to benefits under laws administered by the Secretary, when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The benefit of the doubt rule is inapplicable when the evidence preponderates against the claim. Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). At the outset, the Board finds that the Veteran did not serve in the Southwest Asia theater of operations during the Persian Gulf War. See Military Personnel Record. Therefore, presumptive service connection under special provisions of 38 C.F.R. § 3.317 pertaining to “Persian Gulf veterans” is not applicable. After reviewing the claims file, the Board concludes that, while the Veteran has a diagnosis of bilateral shoulder arthritis, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, illness, or disease, to include any anthrax vaccinations. Service treatment records (STRs) show that the Veteran received anthrax immunizations on at least four occasions in 1999. STRs are negative for complaints or findings related to muscle tenderness, bone mass loss, and joint pain in the shoulders. An August 2001 Separation Report of Medical History shows that the Veteran denied any history of arthritis, rheumatism, bursitis, painful or trick shoulder or elbow, or bone, joint, or other deformity. An August 2001 Separation Report of Medical Assessment does not show complaints or findings related to muscle tenderness, bone mass loss, or joint pain in the shoulders. There is no evidence or allegation that the Veteran’s arthritis was treated or diagnosed within one year of separation of service. A November 2002 VA General Medical Examination report notes no complaints related to the shoulders. Examination of the extremities was normal with the exception of the left knee (for which the Veteran is now service connected). The first post-service of shoulder complaints or findings is a March 2009 VA treatment record that notes bilateral shoulder arthralgia. January 2013 VA X-ray studies revealed narrowing at the inferior aspect of the acromioclavicular (AC) joint of the left shoulder. No bone loss was shown. An October 2013 Shoulder and Arm Conditions Disability Benefits Questionnaire (DBQ) notes the Veteran’s complaints of joint and muscle pain in his shoulders since service. He did not recall any shoulder injury in service. Examination revealed crepitus, less movement than normal and pain on movement in both shoulders. December 2019 VA X-ray studies revealed degenerative changes of the AC joints of both shoulders. Several VA medical opinions were obtained in this case. A December 2019 VA Shoulder and Arm Conditions DBQ notes the Veteran’s report of injuring his shoulders in service when dragging fuel hoses across the flight deck in 1999. Later, the Veteran reported that his shoulder pain began after receiving anthrax vaccinations in 1999 and 2000. Currently, he complained of cracking and stiffness in both shoulders, with flare-ups of pain. The examiner noted findings of arthritis in both shoulders. A December 2019 VA Muscle Injuries DBQ notes the Veteran’s report of researching the Anthrax vaccination, which he stated caused muscle loss. He reported “knots” in his arms after receiving the vaccinations. The examiner stated that these “knots” were a common, acute reaction to vaccinations; the Veteran’s symptoms resolved, and he no longer had “knots” at the injection sites. A December 2019 VA Medical Opinion DBQ notes the examiner’s opinion that the Veteran did not have an undiagnosed illness of the joints or muscles. Moreover, a June 2020 VA Medical Opinion DBQ shows that the examiner reviewed the claims file and opined that the Veteran’s bilateral shoulder arthritis was less likely than not related to, incurred in, or caused by his military service. The examiner explained that there was no evidence of in-service injury, and the Veteran denied shoulder problems on separation examination in August 2001. The first complaint was not until several years later. The examiner also listed several risk factors for arthritis, to include genetics and age. Additional evidence includes an Anthrax Vaccine Information Sheet received in January 2012, which lists possible risks from the vaccine, including allergic reaction, muscle aches, and lumps. The sheet also states that there is “no evidence that anthrax vaccine causes longterm health problems.” While the Veteran believes his shoulder disability began in service, arthritis is not readily apparent to lay observation and he is not competent to provide a diagnosis or nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships, pathology and the interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the medical opinions of the VA examiners. In light of the probative negative medical nexus opinions provided by the VA examiners as noted above, the lack of medical evidence showing that onset of the claimed shoulder disability was in service, within one year of separation from service, or related to service, service connection is not warranted. (Continued on the next page)   Because the preponderance of the evidence is against this service connection claim, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Fletcher, Kathleen 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.