Citation Nr: 21022785 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 16-45 375 DATE: April 19, 2021 ORDER Service connection for a right knee condition is denied. Service connection for a left knee condition is denied. Service connection for a low back condition is denied. Service connection for gastritis is denied. Service connection for gastroesophageal reflux disease (GERD) is denied. Service connection for a skin condition is denied. Service connection for a thyroid condition is denied. FINDINGS OF FACT 1. A preponderance of the evidence is against a finding that the right knee condition was shown to be related to or caused by active service. 2. A preponderance of the evidence is against a finding that the left knee condition was shown to be related to or caused by active service. 3. A preponderance of the evidence is against a finding that the low back condition was shown to be related to or caused by active service. 4. There is no competent evidence that the Veteran has been diagnosed with gastritis. 5. There is no competent evidence that the Veteran has been diagnosed with GERD or an esophageal condition. 6. A preponderance of the evidence is against a finding that the skin condition was shown to be related to or caused by active service. 7. A preponderance of the evidence is against a finding that the thyroid condition was shown to be related to or caused by active service. CONCLUSIONS OF LAW 1. The criteria have not been met for service connection for a right knee condition. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. § §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria have not been met for service connection for a left knee condition. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. § §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria have not been met for service connection for a low back condition. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. § §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria have not been met for service connection for gastritis. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. § §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria have not been met for service connection for GERD. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. § §§ 3.102, 3.303, 3.307, 3.309. 6. The criteria have not been met for service connection for a skin condition. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. § §§ 3.102, 3.303, 3.307, 3.309. 7. The criteria have not been met for service connection for a thyroid condition. 38 U.S.C. §§ 1101, 1131, 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 October 1984 to August 1997. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a December 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In May 2019, the Veteran testified before the undersigned Veterans Law Judge (VLJ) via videoconference. This case was previously before the Board in September 2019 when it was remanded for additional development. The Board finds that there has been substantial compliance with its prior remand directives. See Stegall v. West, 11. Vet. App. 268 (1998). During the period of the appeal, in an August 2020 Rating Decision, the RO granted service connection for sleep apnea. Therefore, that claim for service connection has been resolved and is no longer before the Board on appeal. See generally Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997); Barrera v. Gober, 122 F.3d 1030 (Fed. Cir. 1997). Service Connection Legal Criteria Service connection may be granted for a disability resulting from disease or injury incurred or aggravated during active military service. 38 U.S.C. §§ 1101, 1131. Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, 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 (Fed. Cir. 2004). Certain disabilities, including arthritis, are presumed to be serviced connected if they manifest to a compensable degree within one year following service. 38 C.F.R. §§ 3.303, 3.307, 3.309. 1. Service connection for a right knee condition is denied. 2. Service connection for a left knee condition is denied. 3. Service connection for a low back condition is denied. As there is considerable overlap in the applicable evidence for the Veteran’s claims, the Board will discuss them together. Factual Background In a February 2020 VA examination report, the Veteran was diagnosed with bilateral degenerative arthritis of the knees. He reported that his knee pain was caused by a lot of running during active service. The Veteran stated that his knee pain worsened in 2002. The VA examiner opined that it was less likely than not that the Veteran’s bilateral knee conditions were incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that the Veteran’s records and separation examination were silent for ongoing treatment for a knee condition. Post-active duty records were also silent for ongoing treatment until 2014, when the Veteran was seen for knee pain in a compensation and pension examination. In 2016, x-rays showed mild tricompartmental osteoarthritis. The examiner’s medical opinion was that the bilateral knee osteoarthritis was most likely a natural progression of aging. In an August 2020 addendum opinion, the VA examiner opined that it was less likely than not that the Veteran’s back and knee conditions were caused by or a result of his previous military service. According to the examiner, the Veteran’s service treatment records (STRs) were silent for knee or back conditions. The examiner acknowledged the Veteran’s reports that he had knee and back pain during active duty. The examiner noted that these statements regarding pain in the Veteran’s knees and back were provided in a 2019 videoconference. However, according to the VA examiner, the Veteran’s statements were in contrast to statements provided in his active duty records, including statements made during several examinations during active service. As noted by the VA examiner, the Veteran was examined during service on several occasions, did not report knee or back pain, and indicated that his health was “good to excellent.” Furthermore, there was no evidence of chronic knee or back conditions until recently. The VA examiner noted that the non-governmental records did not show reports of knee or back pain, or evidence of ongoing treatment. The Veteran’s current diagnoses of mild arthritis of the lumbar spine and bilateral knees were based on x-rays from 2016. At that time, the 2016 VA examiner opined that the Veteran’s arthritis of the knees and back was more likely from a combination of advancing age and obesity, rather than from active duty. In the August 2020 addendum opinion, the VA examiner concluded that, although the Veteran may recall some knee and back pains during active duty, his own personal statements in from his active duty records did not support his statements from 2019. At his Board hearing, the Veteran testified that “you were taught not to go to medical, suck it up, and keep going, right?” The examiner opined that, while this statement may be factually correct, the post-active duty records did not reflect ongoing treatment for the knees or back after separation from service until recently. The lack of evidence for treatment or chronicity in the active duty and post-active duty records further supported that the Veteran’s current knee and back conditions were most likely from advancing age and obesity. Analysis The Board has not overlooked the Veteran’s statements regarding his bilateral knee and low back arthritis. While the Veteran is competent (qualified) to report observable arthritis symptoms, he does not have the specialized medical training or credentials to provide a medically qualified opinion about the cause of his bilateral knee and back arthritis or whether they were related to active service, because these complex medical issues have multiple potential causes that are not capable of lay observation. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board finds that the February 2020 and August 2020 VA examination opinions (finding no connection between the Veteran’s knee and back disabilities to active service) to be the most probative evidence of record, because the examiners reviewed the claims file and provided detailed and well-supported rationales. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Based on the above analysis, the preponderance of the evidence is against the claims. The benefit-of-the-doubt rule does not apply, and service connection for knee and back conditions must be denied. 4. Service connection for gastritis is denied. 5. Service connection for GERD is denied. As there is considerable overlap in the applicable evidence for the Veteran’s claims, the Board will discuss them together. Factual Background In a February 2020 VA examination report, the examiner noted that the Veteran had never been diagnosed with any stomach or duodenum conditions. The Veteran reported that “I take Pepto-Bismol as long as I’ve been in the Corps. I take it once a week to help me with my bowel movement.” He noted no other issues. The VA examiner reported that the Veteran had no symptoms of a stomach, esophageal, or duodenal disorder. The only symptom described by the Veteran was a history of constipation, corresponding with periods of hypothyroidism. According to the VA examiner, the Veteran’s bowel movements were regular. The VA examiner opined that it was less likely than not that the Veteran’s claimed gastritis and GERD were incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that the Veteran did not have a diagnosis of a stomach or esophageal disorder. According to the examiner, the Veteran offered no medical records of a stomach or esophageal disorder since active service. The examiner noted that in 2017, the Veteran was found to have a small colonic ulcer at a routine colonoscopy, which was felt to be due to nonsteroidal anti-inflammatory drugs (NSAIDs) and caused no symptoms. The Veteran’s reported symptoms were of mild, diet-controlled, constipation, only. The examiner noted that this was not a stomach or esophageal disorder. Analysis The Board has not overlooked the Veteran’s lay statements regarding his claimed gastritis or GERD. The Veteran is competent (qualified) to report on observable factual matters of which he had firsthand knowledge; and the Board finds that the reports concerning his symptoms are credible and accurate. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). However, there is no basis for concluding that a lay person is competent to discern whether any given symptoms constitute a diagnosis of gastritis or GERD, or any other esophageal condition, or are related to service, in the absence of specialized medical training, which in this case has not been established. 38 U.S.C. § 1153(a); 38 C.F.R. §§ 3.303(a), 3.159(a); Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). Because of this, the objective medical findings and opinions provided by the February 2020 VA examiner have been accorded greater probative weight in determining that service connection is not warranted. There is no competent medical evidence showing a diagnosis of gastritis, GERD, or any esophageal condition during the appeal period. The most fundamental requirement for any claim for service connection, on either a direct or secondary basis, is that the Veteran must first establish he or she has the condition claimed. See Degmetich v. Brown, 8 Vet. App. 208 (1995); 104 F.3d 1328 (1997); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In other words, the evidence must show that, at some point during the appeal period, the Veteran has the disabilities for which benefits are being claimed. See McClain v. Nicholson, 21 Vet. App. 319 (2007). Based on the above analysis, the preponderance of the evidence is against the claims. The benefit-of-the-doubt rule does not apply, and service connection for gastritis and GERD must be denied. [CONTINUED ON NEXT PAGE]   6. Service connection for a skin condition is denied. Factual Background In a February 2020 VA examination report, the Veteran was diagnosed with hyperpigmentation. The Veteran reported that when he served in Kuwait, he would get itching on his elbows and the back of his neck. He noted that he occasionally would get itching on these spots still. The Veteran reported that this recurs yearly and lasts 1-2 weeks. He stated that starting in 2019, he began to have itching on his chest and nipples, but he had not sought treatment yet. The Veteran reported that his last flare-up was 3 days before the examination. He noted that the itching increases when he sweats. The VA examiner noted that previously, the Veteran had pityriasis rosacea, which resolved completely in 1987 and no longer required treatment. The examiner also noted that there was evidence of hyperpigmentation over both elbows. The VA examiner opined that it was less likely than not that the Veteran’s claimed skin condition was incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that although the Veteran’s diagnosis of hyperpigmentation could be seen post-inflammatory, one would not expect it to occur post-pityriases rosacea, the only skin condition supported in the Veteran’s medical records. According to the examiner, hyperpigmentation is also common, especially in darker skinned individuals, from prolonged “leaning.” It is also more common in obese people. The VA examiner found no evidence of any chronic skin condition or rash either in the Veterans STRs, his VA records, or in the few private records. The VA examiner reported that the Veteran’s rash, described as being on his nipples, could not be diagnosed properly without being seen during the examination, or by one of the Veteran’s medical providers at the time of an outbreak. However, according to the examiner, there was no likelihood that it was related to the Veteran’s in-service pityriasis rosacea because the distribution and pattern of recurrence would be “highly atypical.” The examiner concluded by noting that it was likely that the Veteran had some dry skin at times on his nipples and perhaps on his elbows, unrelated to his active service. Analysis The Board has not overlooked the Veteran’s statements regarding his skin condition. While the Veteran is competent (qualified) to report observable skin and rash symptoms, he does not have the training or credentials to provide a competent opinion as to the cause of his hyperpigmentation or whether it was related to active service because these are complex medical questions involving multiple possible causes that are not distinguishable by lay observation. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board finds that the February 2020 VA examination opinion (finding no connection between the Veteran’s skin conditions to active service) to be the most probative evidence of record, because the examiner reviewed the claims file and provided a detailed rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Based on the above analysis, the preponderance of the evidence is against the claim. The benefit-of-the-doubt rule does not apply, and service connection for a skin condition must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 7. Service connection for a thyroid condition is denied. In a February 2020 VA examination report, the Veteran was diagnosed with hypothyroidism and thyroiditis. The Veteran reported that he thought he had a thyroid disorder during active service because he started gaining weight while in the military. He noted that his medical problems started getting “worse and worse and worse.” The VA examiner opined that it was less likely than not that the Veteran’s thyroid condition was incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that the Veteran did not have a current diagnosis of hyperthyroidism. The Veteran had had hyperthyroidism in 2003, six years after leaving service. At the time of the February 2020 VA examination, the Veteran was diagnosed with hypothyroidism due to treatment of his previous hyperthyroidism. According to the VA examiner, the Veteran’s currently diagnosed hypothyroidism is not a result of service, because the previously diagnosed hyperthyroidism was not a result of service. The Veteran stated that he believed his thyroid condition began in service because he had considerable weight gain in service. However, according to the VA examiner, this rationale was “illogical.” The Veteran’s initial thyroid condition was HYPER (likely thyroiditis) which would have caused unexplained weight LOSS. His weight GAIN due to his thyroid condition would occur only after treatment with I131, which destroys thyroid tissue and usually results in hypothyroidism. The Veteran’s I131 treatment was clearly administered well after service, by his history around 2005 (8 years after service). According to the examiner, if the Veteran’s hyperthyroidism, the original condition, began in service, he should have experienced unexplained weight LOSS in service, the opposite of what he described and of what is supported in the STRs. Further evidence against the Veteran having hyperthyroidism in service was his normal pulse rate of 68 on his separation examination. According to the VA examiner, a person’s pulse is very sensitive to their thyroid status, and a pulse rate of 68 is a normal pulse. The Veteran’s separation weight was 235lbs, stable since 1996 (while he was trying to lose weight). According to the provided records, the Veteran’s thyroid diagnosis was first made in 2003, six years after leaving service. Analysis The Board has not overlooked the Veteran’s statements regarding his thyroid condition. While the Veteran is competent (qualified) to report observable symptoms, he does not have the training or credentials to provide a qualified medical opinion about the cause of his thyroid condition or whether it was related to active service. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board finds that the February 2020 VA opinion (finding no connection between the Veteran’s thyroid condition to active service) to be the most probative evidence of record, because the examiner reviewed the claims file and provided a detailed rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Based on the above analysis, the preponderance of the evidence is against the claim. The benefit-of-the-doubt rule does not apply, and service connection for a thyroid condition must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Abrams, 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.