Citation Nr: 21021341 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 16-08 011 DATE: April 12, 2021 ORDER Service connection for dermatitis of the hands is granted. Service connection for a bilateral eye disability is denied. Service connection for a left shoulder disability is denied. Service connection for a right shoulder disability is denied. Service connection for a right elbow disability is denied. FINDINGS OF FACT 1. The Veteran’s dermatitis of the hands began in service. 2. No bilateral eye disability began in service or is related to service in any other way. 3. No left shoulder disability began in service or is related to service in any other way. 4. No right shoulder disability began in service or is related to service in any other way. 5. No right elbow disability began in service or is related to service in any other way. CONCLUSIONS OF LAW 1. The criteria for service connection for dermatitis of the hands are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. 2. The criteria for service connection for a bilateral eye disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. The criteria for service connection for a left shoulder disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 4. The criteria for service connection for a right shoulder disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 5. The criteria for service connection for a right elbow disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1989 to August 1994. This appeal is before the Board of Veterans’ Appeals (Board) from a November 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office. The matters on appeal were remanded by the Board in November 2018 and September 2020. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection requires: (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); see also Caluza v. Brown, 7 Vet. App. 498 (1995). In addition, for certain chronic diseases, such as arthritis and organic diseases of the nervous system, a presumption of service connection arises if the disease is manifested to a degree of 10 percent within one year following discharge from service. 38 C.F.R. §§ 3.307, 3.309(a). When a chronic disease is not shown within one year after service, under 38 C.F.R. § 3.303(b) 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. When the fact of chronicity in service is not adequately supported, a showing of continuity after discharge is required to support a claim for such diseases; however, such continuity of symptomatology may only support a claim for those chronic diseases listed under 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 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. 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. 1. Service connection for dermatitis of the hands is granted. As reflected in his November 2014 notice of disagreement and February 2016 substantive appeal, the Veteran asserts that that he has dermatitis of the hands that comes and goes, which he believes is due to chemicals associated with his in-service duties repairing vehicles and equipment. On May 2014 VA examination, the Veteran was diagnosed with non-specific dermatitis, and he reported symptoms since 1992, which started in his fingers and hand while working on tanks, and had stayed the same. The diagnosis was non-specific dermatitis. On September 2019 VA examination, the Veteran reported that, around 1993, he started out with small bumps between the fingers on hands, and that his condition was productive of itching. Despite several attempts by VA to obtain an adequate medical opinion addressing the etiology of the Veteran’s hand dermatitis, one has not been obtained. Pursuant to the Board’s September 2020 remand instructions, a VA opinion was obtained in September 2020. The examiner provided an opinion explaining why contact with chemicals associated with the repair of equipment on tracked and wheeled vehicles during service was unlikely to be the cause of any current dermatitis. However, the examiner did not, either directly or indirectly, address the Veteran’s reports of onset of symptoms beginning in 1993. Based on the current evidence, and resolving reasonable doubt in the Veteran’s favor, the Board finds that his dermatitis of the hands began in service. While no dermatitis was documented in the medical record prior to his service-connection claim, given the description by the Veteran of his condition of bumps and itching that comes and goes, the continuing existence of his condition despite any documentation is plausible. There is also no competent and adequate medical evidence against the Veteran’s claim. Accordingly, service connection for dermatitis of the hands is granted. 2. Service connection for a bilateral eye disability is denied. As reflected in his November 2014 notice of disagreement and February 2016 substantive appeal, the Veteran asserts he experiences vision problems, including spots in vision, which he believes are due to his experience in service of shock waves from tank firing. On VA examination in May 2014, the Veteran reported that the onset of his vision spots was 1992. The examiner diagnosed ischemic optic atrophy/neuropathy, noting abnormal examination of the optic disc, but no pathology to render a diagnosis for the Veteran’s asserted vision spots. On September 2019 VA examination, the Veteran was diagnosed with ocular hypertension, anisometropia, blepharitis, syneresis, vitreal floaters, astigmatism, and presbyopia. On that examination, however, the examiner determined that the Veteran did not have ischemic optic atrophy/neuropathy, as cup-to-disc ratio of each eye was 0.7, the optic nerve appeared to have good perfusion, acuity was excellent with minor corrective lenses, and visual field was only slightly constricted nasally, which was due to anatomical features. The examiner explained that individuals with ischemic optic neuropathy (ION) normally do not have 20/15 acuity and visual field as manifested in the Veteran. The examiner added that the Veteran had a large cup/disc ratio, and his tissue rims were healthy with good perfusion. In an April 2020 addendum, relevant records relating to ocular health were reviewed, another VA examiner explained that ischemic optic atrophy (neuropathy), or ION, was when blood does not flow properly to the eye’s optic nerve, eventually causing lasting damage to this nerve. With ION there is sudden loss of vision in one or both eyes. If blood flow to the optic nerve is reduced vision will darken for a few seconds or minutes then return to normal, which is called a transient ischemic attack (TIA). The examiner could not locate any records that documented a frank diagnosis of ION. In September 2020, another VA examiner, an ophthalmologist, opined that none of the Veteran’s eye disorders were related to service. The examiner found that the records showed that the ocular hypertension, blepharitis, syneresis (vitreous degeneration) and refractive errors were less likely than not due to the shock wave from tank firing asserted by the Veteran. The ocular hypertension was most likely developmental or age-related; the blepharitis was most likely due to skin conditions such as rosacea or chronic environmental irritants; the vitreous degeneration was most likely related to normal aging of the vitreous of the eyes; and the refractive errors were most likely developmental. The examiner noted that, as visual acuity on that exam was 20/15, it is less likely than not that the Veteran had a diagnosis of ION, as these are ischemic events to the nerve of the eye that most likely result in long-lasting severe reduction in visual acuity. In this case, the Veteran’s service connection claim for bilateral eye disability must be denied. While the Veteran has been diagnosed with current ocular hypertension, blepharitis, syneresis, vitreal floaters, and some refractive visual errors, none have been related to service by the medical evidence; rather, the September 2020 ophthalmologist related each to different etiologies, based on the record. While the May 2014 VA examiner diagnosed ION, a preponderance of the evidence reflects that the Veteran does not have this disorder. The only explanation given for this diagnosis in the November 2014 examination report was a finding of an abnormal examination of the optic disc, with no further specificity. Subsequently, three different VA examining eye specialists, including the September 2020 ophthalmologist, each opined did not have ION, for essentially the same reasons: the Veteran did not manifest the signs and of ION, including significant damage to the eyes and severe, long-lasting visual impairment. In any event, no such disorder has ever been related by any medical professional—including the May 2014 examiner—to service. The Board notes the Veteran’s assertions of visual problems since service. Neither the service treatment records, nor the post-service medical records, contain any notation of any eye or vision problems in service or in the almost 20 years after the Veteran’s discharge from service and prior to his service connection claim; the Veteran, moreover, does not assert that he ever reported any such problems. However, service treatment records reflect that the Veteran was treated for complaints of sore throat and genito-urinary complaints, and received treatment post-service, beginning by at least February 2007, for medical complaints such as back pain. Particularly considering this, a chronic, disabling vision problem, beginning in service, and continuing for 20 years after, likely would have been reported or noted in a medical record. The Board thus cannot find such assertions of the Veteran credible. Moreover, again, the probative medical evidence of record relates the Veteran’s current eye disorders to nonservice etiologies. Therefore, a preponderance of the evidence is against a finding that an eye disability began during service or is related to service in any other way. Accordingly, service connection for a bilateral eye disability must be denied. 3. Service connection for a left shoulder disability is denied. 4. Service connection for a right shoulder disability is denied. 5. Service connection for a right elbow disability is denied. As reflected in his November 2014 notice of disagreement and February 2016 substantive appeal, the Veteran asserts that his shoulder and elbow pain is due to a number of his in-service duties including shock from tank firing, working on tanks, and making mechanical repairs. He asserts that he had pain in service that he treated with over the counter medication, but that the pain never went away and got worse with time. Private treatment records beginning in February 2007 reflect a complaint of left shoulder pain in April 2012, and no further shoulder or elbow treatment. On May 2014 VA examination, the Veteran reported shoulder pain, which began in 1993 with sharp pain and muscle fatigue, and which had gotten worse. Examination of the Veteran was normal, and there was no arthritis or other significant findings on X-ray. The examiner determined that there was no pathology to render a diagnosis. Regarding his elbow, the Veteran reported that pain began in 1993 with hyperextension and had gotten worse over the years. On examination, there was pain on palpation of the right elbow and no abnormality on X-ray, and a diagnosis of medial epicondylitis was indicated. On September 2019 VA examination, the Veteran reported that his pain began in 1993 and 1994 from working on contact teams and riding in tracked vehicles, and after time his shoulders became stiffer with increasing soreness. Examination was again normal, X-rays were again negative, but a diagnosis of bilateral shoulder strain was indicated. Regarding the right elbow, the Veteran reported that symptoms began in service working on tracked vehicles, with numbness in the hands and popping in the elbows. Examination of the right elbow was completely normal, with X-rays again negative, and the impression was negative left elbow. In September 2020, a physician again reviewed the entire record, and opined that no shoulder or right elbow disability was related to service, and specifically to a shock wave from a tank firing and repair of equipment on tracked and wheeled vehicles during service. The examiner explained that there was no information or evidence to suggest that a chronic shoulder or elbow condition during service was a result of, or associated with, any such events; and records showed he had worked 19-hour days for 21 years as a federal corrections officer – a job that very likely was physically demanding. According to the VA physician, it is not presumptive to assume that if the in-service duties and events described by the Veteran had caused shoulder or elbow problems, some complaints would be noted in the record. It was highly likely the claimed shoulder and elbow problems were incurred after the service. The evidence in this case weighs against the Veteran’s service connection claims for shoulder or elbow disability. The September 2020 VA examiner’s opinion is probative. The examiner considered the entire record, including the Veteran’s more than 20-year work history post service, to determine that his shoulder and elbow problems likely did not begin in, or result from, service. While the examiner considered the lack of any documented evidence of shoulder or elbow problems in service or until many years later, the examiner explained why this was relevant, as one would have expected to see such documentation had the Veteran’s joint problems existed since service; the examiner indicated that, particularly given the Veteran’s physically demanding job for 21 years, at least some complaints of chronic joint issues of the type described by the Veteran would very likely have been noted, had they persisted, as asserted by the Veteran. Moreover, there is no contrary medical opinion or other competent medical evidence linking any current shoulder or elbow problems to service. The Board recognizes the Veteran’s contentions as reflected in the November 2014 notice of disagreement and February 2016 substantive appeal, which recount that in service, he was not one to complain by way of going to sick call; and was always able to treat with asprin or ibuprofen even though his joint pain did not go away but actually got worse. However, service treatment records show only that the Veteran sought treatment for medical issues unrelated to his claims before the Board, such as a sore throat and genito-urinary complaints. Moreover, the Veteran received treatment post-service, beginning by at least February 2007, for medical complaints such as back pain. Private records dated February 2007 to October 2013 reflect treatment for various complaints, including continuing treatment for low back pain; the earliest notation of left shoulder pain in these records was in April 2012, and there are no notations of right shoulder pain or elbow pain. Had the Veteran had chronic shoulder and elbow pain and functional problems in service and for over 17 years after his discharge, it is very likely that he would have reported such problems earlier than April 2012, particularly considering his ongoing complaints of other orthopedic problems, such as back pain, as early as February 2007. The Board thus cannot find assertions of elbow and shoulder pain and problems continuing since service to be credible. Therefore, a preponderance of the evidence is against a finding that a shoulder or right elbow disability began in service or is related to service in any other way. Accordingly, service connection for a right and left shoulder disability, and an elbow disability, must be denied. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Andrew Mack, 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.