Citation Nr: 21023994 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 20-02 021 DATE: April 21, 2021 ORDER Entitlement to service connection for residuals of rheumatic fever is denied. Entitlement to service connection for right knee disability, including secondary to inservice rheumatic fever, is denied. Entitlement to service connection for left knee disability, including secondary to inservice rheumatic fever, is denied. Entitlement to service connection for right hip disability, including secondary to inservice rheumatic fever, is denied. Entitlement to service connection for left hip disability, including secondary to inservice rheumatic fever, is denied. Entitlement to service connection for degenerative arthritis of the spine, including secondary to inservice rheumatic fever, is denied. REMANDED Entitlement to service connection for bilateral hearing loss is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has any current residuals of rheumatic fever. 2. The Veteran’s osteoarthritis of the knees were 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, including his inservice rheumatic fever. 3. The Veteran’s degenerative joint disease of the hips were 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, including his inservice rheumatic fever. 4. The Veteran’s degenerative arthritis of the lumbar spine 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, including his inservice rheumatic fever. CONCLUSIONS OF LAW 1. The criteria for service connection for residuals of rheumatic fever are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for right knee disability, including secondary to inservice rheumatic fever, are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for left knee disability, including secondary to inservice rheumatic fever, are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for right hip disability, including secondary to inservice rheumatic fever, are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for left hip disability, including secondary to inservice rheumatic fever, are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 6. The criteria for service connection for degenerative arthritis of the spine, including secondary to inservice rheumatic fever, are not 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 in the United States Marine Corps from January 1953 to January 1957 and from April 1957 to April 1963. For his meritorious service, the Veteran was awarded (among other decorations) a National Defense Service Medal and Good Conduct Medal. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In March 2021, the Veteran testified at a video conference hearing held before the undersigned Veterans Law Judge. A transcript of this hearing has been added to the record. Service Connection 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, including arthritis, 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). 1. Entitlement to service connection for residuals of rheumatic fever. The Veteran is seeking service connection for residuals of rheumatic fever. A review of his service treatment records confirms that he was diagnosed with and treated for rheumatic fever during his service. The remaining 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, including his inservice rheumatic fever. Based upon a longitudinal review of the record, the Board concludes that the Veteran does not have a current diagnosis of any rheumatic fever residual 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). In November 2017, the Veteran underwent a VA examination for infectious diseases. The November 2017 VA examiner evaluated the Veteran and determined that the Veteran’s rheumatic fever was inactive, and that he does not have any current symptoms or residuals attributable to this disease. In rendering this opinion, the examiner considered the evidence of record, including the Veteran’s statements, prior to forming this opinion. The examiner also physically examined the Veteran and supported the conclusions provided with a sufficient rationale. Despite receiving consistent medical care for the past several years, the Veteran’s post service treatment records do not contain a diagnosis of any rheumatic fever residuals. A January 2019 treatment report noted that there was no link between the Veteran’s current chronic heart failure and atrial fibrillation and his remote rheumatic fever. In an addendum to the report, the VA physician stated that while the Veteran may have a history of rheumatic fever, there is no echocardiographic evidence to suggest cardiac involvement from it. The VA physician noted that the Veteran’s heart condition was primarily related to RV dysfunction, poorly controlled obstructive sleep apnea, and a history of heart failure with preserved ejection fraction, but not rheumatic heart disease. A May 2019 VA treatment report commented that the Veteran’s pulmonary hypertension was not caused by his history of rheumatic heart disease. While the Veteran believes he has residuals of his in-service rheumatic fever, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). In support of his claim, the Veteran has submitted numerous articles concerning rheumatic fever and its potential to generate serious long-term health effects, such as rheumatoid heart disease, rheumatic arthritis, and other rheumatic diseases. These articles, however, do not discuss the Veteran’s particular circumstances or the disabilities for which he is currently being treated, which does not include any current diagnosis of a rheumatic fever related disability. Consequently, the Board gives more probative weight to the competent medical evidence. 2. Entitlement to service connection for right knee disability, including secondary to inservice rheumatic fever. 3. Entitlement to service connection for left knee disability, including secondary to inservice rheumatic fever. 4. Entitlement to service connection for right hip disability, including secondary to inservice rheumatic fever. 5. Entitlement to service connection for left hip disability, including secondary to inservice rheumatic fever. 6. Entitlement to service connection for degenerative arthritis of the spine, including secondary to inservice rheumatic fever. The Veteran contends that he has bilateral knee, bilateral hip, and lumbar spine disabilities as a result of his inservice rheumatic fever. The Veteran is currently shown to have diagnoses of osteoarthritis of the knees, degenerative joint disease of the hips, and degenerative arthritis of the spine. Arthritis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, these disabilities were not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and were not noted in service with attributable continuity of symptomatology. The Veteran’s April 1963 separation examination listed his lower extremities and spine as normal. Post service treatment records are also silent as to any treatment for these conditions for more than forty years, decades outside of the applicable presumptive period. While the Veteran is competent to report having experienced symptoms of knee, hip, and back pain during service and consistently thereafter, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of his current disabilities as the Veteran has not demonstrated the necessary medical expertise. The issue is medically complex, as it requires interpretation of complicated diagnostic medical testing. Jandreau, 492 F.3d at 1377. The Board also finds the Veteran’s reports of continuity of symptomatology not credible. The Veteran’s reports are internally inconsistent with reports in contemporaneous treatment records, which show that he experienced symptoms of a much shorter duration, and decades outside of the presumptive period. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). A July 2016 VA treatment report noted the Veteran’s complaints of hip pain for the past four days. A March 2019 statement from the Veteran indicated that he changed care providers in 2018 because he, “had started experiencing health problems and symptoms with a lot of pain in my body and joints like when I was in the Marine Corps.” Thus, the complaints of joint pain were not ongoing since service. Service connection for these conditions may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s knee, hip, and lumbar spine disabilities and an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. The November 2017 VA examination for infectious diseases noted that the Veteran had been treated for rheumatic fever during his military service. The VA examiner concluded, however, that the Veteran’s rheumatic fever was now inactive, and that the Veteran did not have symptoms or residuals attributable to this disease. In rendering this opinion, the VA examiner physically examined the Veteran and considered the evidence of record, including the Veteran’s statements. The examiner and also supported the opinion provided with a sufficient rationale. The November 2017 VA examiner opined that the Veteran’s degenerative arthritis of the spine is not at least as likely as not related to an in-service injury, event, or disease, including his inservice rheumatic fever. The rationale provided was that rheumatic fever refers to an inflammatory process that can affect the heart, joints, skin, and brain. It typically develops two to four weeks after a streptococcal throat infection. The joints involved are predominantly the smaller joints of the hands, fingers, and ankles; and the Veteran’s current spine disability is age related, related to degenerative arthritis changes, and less likely than not related to a previous history of rheumatic fever. While the Veteran believes his knee, hip, and spine disabilities are related to his inservice rheumatic fever, he is not competent to provide a nexus opinion in this case. These issues are medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Consequently, the Board gives more probative weight to the competent medical evidence. REASONS FOR REMAND 1. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran contends that he has bilateral hearing loss attributable to his inservice noise exposure. He contends that he was exposed to acoustic trauma during service from gunfire, artillery, explosions, aircraft and equipment operations. He further claims that he has had hearing problems ever since. The Board finds the November 2017 VA examination for hearing loss to be inadequate. Specifically, the VA examiner failed to address or consider the Veteran’s reported history of hearing loss, which the Veteran is competent to report. Moreover, the VA examiner failed to address or consider the Veteran’s post service noise exposure, if any. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination for hearing loss. The examiner must review the claims file. The examiner should obtain a full history of the Veteran’s current hearing loss from the Veteran, including his inservice and post service noise exposure. Thereafter, the examiner must provide an opinion as to whether the Veteran’s current hearing loss is at least as likely as not related to his military service. Provide a rationale to support the opinion. In providing the requested opinion, consider the Veteran’s description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board W. Yates, 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.