Citation Nr: 21022648 Decision Date: 04/16/21 Archive Date: 04/16/21 DOCKET NO. 18-28 223A DATE: April 16, 2021 ORDER Service connection for arthritis is denied. REMANDED Entitlement to an initial rating in excess of 10 percent for rhinitis is remanded. FINDINGS OF FACT The Veteran’s arthritis was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. CONCLUSIONS OF LAW The criteria for service connection for arthritis have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1962 to January 1965. This matter comes before the Board of Veterans’ Appeals (Board) from February 2015 and January 2019 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in September 2019 and June 2020. The Board finds there has been substantial compliance with the Board prior remand directives for the claim decided herein. Stegall v. West, 11 Vet. App. 268, 271 (1998). Additionally, the Board notes the RO granted service connection for degenerative arthritis of the spine (claimed as a low back disability and degenerative bone disease/disc herniations) in a December 2020 rating decision. This was a full grant of the benefit sought with regard to that issue. Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.800 (c). 1. Service connection for arthritis is denied. The Veteran seeks service connection for arthritis, previously claimed as osteoarthritis. The Veteran contends his arthritis is due to his daily in-service repelling and jumping. See, e.g., October 2013 VA Form 21-4138. For the reasons that follow, the Board finds entitlement to service connection is not warranted. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. To the extent the Veteran has alleged entitlement to service connection for a form of non-degenerative or generalized arthritis, the Board concludes that the Veteran does not have a current diagnosis of non-degenerative arthritis and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The November 2020 VA examiner evaluated the Veteran and determined that, while he has a diagnosis of degenerative arthritis, he did not have a diagnosis of non-degenerative arthritis, including inflammatory, autoimmune, crystalline, and/or infectious arthritis. Further, despite treatment since May 1975, VA and private treatment records do not contain a diagnosis of non-degenerative arthritis. To the extent the record reflects a diagnosis of arthritis of the left second finger, bilateral wrist pain, and bilateral wrist strain, the Board further concludes that the preponderance of the evidence weighs against finding that the Veteran’s current disabilities began during service or are otherwise related to an in-service injury, event, or disease. The Veteran’s service treatment records are silent for complaints of, treatment for, and/or a diagnosis related to arthritis. The Veteran’s January 1962 enlistment report of medical examination reflects a normal clinical evaluation. His January 1962 enlistment report of medical history indicates the Veteran denied a history of arthritis or rheumatism. March 1963, September 1963, and November 1964 reports of medical examination also reflect normal clinical evaluations. His November 1964 separation report of medical history also reflects the Veteran denied swollen or painful joints; arthritis or rheumatism; and bone joint, or other deformity. Post-service, a May 1975 VA treatment record indicates no right wrist abnormalities but a residual of a fracture at the lower end of the ulna. A May 1975 VA treatment record also notes a history of fracture above the right wrist in 1959 that is asymptomatic. A September 1986 private treatment record notes the Veteran injured his right hand in a mining accident where the ring finger was fractured. An October 2000 private treatment record notes a history of degenerative arthritis indicated as degenerative changes of the cervical spine. A June 2007 private treatment record notes the Veteran denied arthritis and joint pain. A June 2010 private treatment record notes generalized osteoarthritis of multiple sites. A private treatment record notes a February 2011 onset of generalized osteoarthritis. A January 2011 VA treatment record notes a fall and pain on right forearm and fingers. A January 2011 VA treatment record also notes x-ray findings of the wrists are negative for fracture or dislocation. An April 2011 VA treatment record notes the Veteran does not have advanced rheumatoid arthritis. A July 2012 private treatment record notes a history of osteoarthritis. The Veteran underwent a VA non-degenerative arthritis examination in December 2019. The examiner found the Veteran does not have a current diagnosis of non-degenerative arthritis. The examiner indicated the Veteran has evidence of degenerative arthritis with no diagnostic evidence of non-degenerative arthritis. During the examination, the Veteran reported joint pain primarily in bilateral hands and wrists. The Veteran reported a broken arm in 1959 but denied other injuries to his arms or hands. The examiner indicated the Veteran does not have a diagnosis of inflammatory, autoimmune, crystalline, or infectious arthritis. The examiner noted a diagnosis of degenerative arthritis of the spine and reports of worsening pain in bilateral hands and wrists with stiffness. The Board has previously found the December 2019 VA examiner’s opinion inadequate. The Veteran also underwent a VA hand and finger conditions examination in December 2019. The examiner noted a diagnosis of degenerative arthritis of the left hand. A December 2019 VA wrist examination noted subjective symptoms only with no objective evidence of a wrist condition. The December 2019 wrist examiner noted there was no diagnosis of a wrist condition. During the examination, the Veteran reported ongoing and worsening pain and stiffness of the bilateral wrists for years but was unable to recall timeframe of onset. In compliance with the Board’s prior remand directives, the Veteran underwent another VA non-degenerative arthritis examination in November 2020. The examiner indicated the Veteran does not have a current diagnosis of non-degenerative arthritis but does have a diagnosis of degenerative arthritis. The November 2020 VA examiner opined that the Veteran’s claimed condition was less likely than not incurred in or caused by service. The examiner noted that, during service, the Veteran claimed to have jumped and rappelled out of helicopters frequently over the course of years. The examiner noted that, over time, this mechanism would be expected to manifest in weightbearing joints such as back, hips, knee, and less likely affect wrists, hands, or fingers. The examiner indicated the Veteran’s claims file does not reflect an established diagnosis of arthritis of bilateral wrists; however, there is radiological evidence of arthritis of the left second finger. The examiner noted no history of injury to fingers, hands, or wrists while in service. The examiner concluded it is less likely than not that the Veteran’s bilateral wrist and hand/finger condition was incurred in or caused by his duties involving jumping and rappelling out of helicopters while in service. A November 2020 VA opinion also notes that, while he has a diagnosis of degenerative arthritis of the spine, he does not have a diagnosis of generalized arthritis of other joints including wrists and hands. The examiner noted that the Veteran had complaints of bilateral wrist pain in addition to neck and back pain but there was no radiological evidence or established diagnosis of arthritis in these joints. A November 2020 VA wrist examination notes a diagnosis of bilateral wrist strain. The examiner noted ongoing, progressively worsening bilateral wrist pain with normal wrist x-rays in December 2019. After a review of the evidentiary record, the Board finds the preponderance of the evidence weighs against finding entitlement to service connection for arthritis is warranted. The Veteran’s service treatment records are silent for a diagnosis of arthritis and/or wrist, hand, and finger complaints. Related diagnosis were not noted in service or within a year of discharge with continuity thereafter. The Veteran’s lay statements did not establish with any specificity chronicity in service or continuity of symptoms since separation from service. Accordingly, 38 C.F.R. § 3.303 (b) does not provide an avenue of service connection based on chronicity or continuity of symptomatology. Service connection for arthritis may also not be awarded as a chronic disease under 38 C.F.R. §§ 3.307, 3.309(a). Moreover, the Board finds the November 2020 VA examinations and opinions are probative evidence against the claim. The examiner has the appropriate training, expertise, and knowledge to evaluate the claimed disability. The examiner provided a cogent rationale for her finding and opinion. The claims file otherwise contains no competent opinions linking a current wrist, hand, or finger condition to service. The Veteran also asserts his current arthritis is related to service. However, to the extent that these statements are offered to establish a causal nexus, the probative value of these assertions is outweighed by the competent medical evidence of record. Although lay persons are competent to provide opinions on some medical issues, the specific issue in this case, the potential relationship between the Veteran’s currently diagnosed disabilities and his service, is complex in nature and falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). There is no indication that the Veteran possesses the medical knowledge to attribute his condition to events or injuries in service. Therefore, he is not competent to opine on this complex medical question and these lay assertions are insufficient evidence to establish etiology. Consequently, the Board places little weight on these statements and gives more probative weight to the medical evidence of record rendered by competent medical professionals with the clinical expertise and training to render medical opinions on the etiology of complex medical conditions, such as arthritis. To the extent the November 2020 VA examiner relied on an absence of evidence of a related condition during service or at separation to support their conclusion, the Board notes it has found the Veteran did not experience such a condition in service. The Veteran is competent to report his readily observable symptoms, but the Board notes the Veteran has not reported onset during service with continuity thereafter. Furthermore, on his separation report of medical history, he indicated “no” for any symptoms related to his currently diagnosed conditions. This is affirmative evidence contrary to his current assertions, and the Board finds it more probative given that the statement was made contemporaneous to service. Thus, the examiners’ statements that the Veteran did not complain of a related condition during service is factually consistent with the Board’s finding herein. Therefore, the Board finds the supporting rationale of the November 2020 VA opinion is consistent with the facts found and, when considered alongside the other competent medical evidence of record, is adequate to decide the claim. In sum, the evidence weighs against a nexus between the Veteran’s current condition and active military service. Accordingly, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Service connection is not warranted. REASONS FOR REMAND 1. Entitlement to an initial rating in excess of 10 percent for rhinitis is remanded. The Veteran contends entitlement to an initial rating in excess of 10 percent for his service-connected rhinitis. In June 2020, the Board remanded this matter for consideration of the findings of private physician T.W., including whether the Veteran’s current disabilitiy is equivalent to rhinitis with polyps. Unfortunately, the Board finds remand is necessary to ensure compliance with its prior remand directives. Stegall, 11 Vet. App. at 271. In addition to considering the June 2018, April 2019, and January 2020 letters submitted by T.W., a private treating physician, the June 2020 Board remand directives directed the examiner to address whether the Veteran’s allergic rhinitis is equivalent to rhinitis with polyps. In compliance with Board’s prior remand directives, the Veteran underwent a VA rhinitis examination in October 2020. During the examination, the examiner indicated the Veteran did not have nasal polyps; however, the associated November 2020 VA opinion indicated that the Veteran’s issues of rhinitis and polyps are interrelated. The examiner did not address whether the Veteran’s allergic rhinitis is equivalent to rhinitis with polyps. An addendum opinion must be obtained. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s service-connected allergic rhinitis. The examiner should consider the letters from T.W., a private treating physician, submitted in June 2018, April 2019, and January 2020, addressing the Veteran’s nasal conditions. The examiner should then address whether the Veteran’s allergic rhinitis is equivalent to rhinitis with polyps. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.Aoughsten, Associate 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.