Citation Nr: 21024595 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 11-16 903 DATE: April 23, 2021 ORDER Entitlement to service connection for a left ankle disability is denied. Entitlement to service connection for a right ankle disability is denied. Entitlement to service connection for a left-hand disability is denied. Entitlement to service connection for a right-hand disability is denied. Entitlement to service connection for a left shoulder disability is denied. Entitlement to service connection for a right shoulder disability is denied. Entitlement to service connection for a left elbow disability is denied. FINDING OF FACT The preponderance of the evidence shows that bilateral ankle, hand, shoulder, and left elbow disabilities were not present in service or until many years thereafter, they are not related to service or to an incident of service origin, they are not caused or aggravated by a service-connected disability, and they are not an undiagnosed illness, a diagnosable but medically unexplained chronic multisymptom illnesses of unknown etiology, or a diagnosable chronic multisymptom illness with a partially explained etiology. CONCLUSION OF LAW The criteria for service connection for bilateral ankle, hand, shoulder, and left elbow disabilities have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117, 1131, 1154(b), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service with the United States Army from November 1988 to April 1994. His service included service in South West Asia from October 1990 to March 1991. In December 2015, the Veteran and his wife testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the claims file. In an August 2016 decision, the Board reopened the claim of service connection for a bilateral ankle disability and thereafter denied service connection for bilateral ankle, hand, shoulder, and left elbow disabilities. The Veteran appealed the August 2016 Board decision to the United States Court of Appeals for Veterans Claims (Court). In a November 2017 memorandum decision from Judge Bartley, the Court vacated and remanded the Board’s August 2016 decision to the extent that it denied service connection for bilateral ankle, hand, and left elbow disabilities. In August 2018 the Board remanded the claims of service connection for bilateral ankle, hand, and left elbow disabilities to address the concerns raised by the Court decision as well as remanded claims for increased ratings for left knee and right elbow disabilities as well as an application to reopen a claim of service connection for a back disability for the regional office (RO) to issue a statement of the case (SOC). In October 2020, the Board again remanded the claims of service connection for bilateral ankle, hand, and left elbow disabilities to fully address all issues. As to the remanded claims for increased ratings for left knee and right elbow disabilities as well as the application to reopen a claim of service connection for a back disability, these issues have not again been certified to the Board because the Veteran is waiting on the hearing he had requested in connection with these claims. See VA Form 9, Appeal to Board of Veterans’ Appeals, received in May 2019 and August 2019. Therefore, the Board finds that it cannot take any further action as to these claims at this time. The Concerns Raised by the Court and Post-Remand Compliance As to the post-remand development, the Board finds that it substantially complied with the Reman and the concerns raised by the Court it its’ decision. See 38 U.S.C. § 5103; Barr v. Nicholson, 21 Vet. App. 303 (2007); Stegall v. West, 11 Vet. App. 268 (1998); D’Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict compliance with the terms of a remand request, is required); Dyment v. West, 13 Vet. App. 141, 146-47 (holding that there was no Stegall violation when the examiner made the ultimate determination required by the Board’s remand, because such determination more than substantially complied with the Board’s remand order). The Board has reached this conclusion because while the appeal was in remand status all identified and available VA and private treatment records were obtained and associated with the record. Id. The Board has also reached this conclusion because the post-remand record shows that in January 2021 the RO obtained new opinions as the diagnoses and etiology of the Veteran’s bilateral ankle, hand, shoulder, and left elbow disabilities based on all theories of entitlement (i.e., direct and secondary service connection as well as an undiagnosed illness) which opinions are supported by citation to the service treatment records, the post-service medical records, the appellant’s competent and credible lay claims regarding observable symptomatology, and controlling medical literature and the opinions are supported by medical reasoning. See Guerrieri v. Brown, 4 Vet. App. 467, 473 (1993) (“the probative value of medical opinion evidence is based on the medical expert’s personal examination of the patient, the physician’s knowledge and skill in analyzing the data, and the medical conclusion the physician reaches.... As is true with any piece of evidence, the credibility and weight to be attached to these opinions [are] within the province of the [Board as] adjudicators...”); Wray v. Brown, 7 Vet. App. 488, 493 (1995) (holding that the adoption of an expert medical opinion may satisfy the Board’s statutory requirement of an adequate statement of reasons and bases if the expert fairly considered the material evidence seemingly supporting the veteran’s position); Also see El–Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013) (holding that, when multiple theories of entitlement are at issue, the Board must ensure that the medical opinions of record directly address all theories reasonably raised by the record). In reaching this conclusion, the Board has not overlooked the fact that the Court decision directed it to consider whether X-ray imaging is necessary to determine whether the Veteran has degenerative joint disease in his ankles, hands, shoulders, and left elbow, as claimed. In this regard, and as discussed in more detail below, the Board is finding that the most probative evidence of record know shows that the Veteran has current post-service disabilities as required by 38 C.F.R. § 3.303 and defined by McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), even though the diagnoses are not all degenerative joint disease. Therefore, the Board finds that X-ray imaging is not necessary to adjudicate any of the claims. See Guerrieri, supra. It is important for the Veteran to understand that the Board does not normally order diagnostic testing such as x-rays or MRIs, as they tend to provide evidence that neither supports, or refutes, a Veteran’s claim. Whether a Veteran has degenerative joint disease is not, in most cases, the critical issue. The key issue is whether the disability is related to military service more than 20 years ago. An x-ray study in 2021 will no provide such evidence. Therefore, the Board finds that further delay by remanding these issues to provide the Veteran with new VA examination or to try to obtain additional medical record is not required. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). Lastly, the Court decision directed the Board to consider if service connection is warranted for any of the Veteran’s disability when considering 38 U.S.C. § 1117 and 38 C.F.R. § 3.317. In this regard, and as discussed in more detail below, the Board is specifically considering this theory of entitlement. Therefore, nothing more needs to be said as to this point at this time. The Service Connection Claims The Veteran claims that he is entitled to service connection for bilateral ankle, hand, shoulder, and left elbow disabilities because, in substance, they are due to his military service. Specifically, during his December 2015 hearing the Veteran testified that during service he was a paratrooper and he sustained injuries to his ankles, hands, shoulders, and left elbow during landings. He estimated that he had made as many as 28 jumps during service. The Veteran’s spouse testified that she has been married to him for 28 years and that she has observed his pain in the claimed joints. As noted above, the Court also direct the Board to consider if his disabilities are due to exposure to toxins serving in South West Asia from October 1990 to March 1991. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection if the disability is one that is listed in 38 C.F.R. § 3.309. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, service connection may also be granted on the basis of a post-service initial diagnosis of a disease, where the physician relates the current condition to the period of service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(d). Other specifically enumerated disorders, including arthritis, will be presumed to have been incurred in service if they manifested to a compensable degree within the first year following separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. In this regard, to establish service connection for the claimed disorders, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection may also be established on a secondary basis for a disability proximately due to or aggravated by a service-connected disease or injury. See 38 C.F.R. § 3.310; see also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). To establish secondary service connection, a Veteran must show: (1) the existence of a present disability; (2) the existence of a service-connected disability; and (3) a causal relationship between the present disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Ward v. Wilkie, 31 Vet. App. 233 (2019). The requirement of a current disability is “satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim.” See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Court in Joyner v. McDonald, 766 F.3d 1393, 1395 (Fed. Cir. 2014) held, in part, that the Board needs to always consider 38 U.S.C. § 1117 and 38 C.F.R. § 3.317 in cases like the current appeal in which Veterans have served in the Persian Gulf since August 2, 1990. Therefore, the Board finds that it is also required to consider 38 U.S.C. § 1117 and 38 C.F.R. § 3.317. See 38 C.F.R. § 3.117 (d)(1) and (2) (a “Persian Gulf veteran” is defined as “a veteran who served on active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War. The “Southwest Asia theater of operations” includes Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations). In this regard, service connection may be warranted for a Persian Gulf Veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active military, naval or air service in the Southwest Asia theater of operations during the Persian Gulf War, or that became manifest to a degree of 10 percent or more not later than December 31, 2021. 38 C.F.R. § 3.317(a)(1). For purposes of 38 C.F.R. § 3.317, there are three types of qualifying chronic disabilities: (1) an undiagnosed illness; (2) a medically unexplained chronic multi symptom illness; and (3) a diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection. An “undiagnosed illness” is defined as a condition that by history, physical examination and laboratory tests cannot be attributed to a known clinical diagnosis. In the case of claims based on undiagnosed illness under 38 U.S.C. § 1117; 38 C.F.R. § 3.317, unlike those for “direct service connection,” there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez, 19 Vet. App. at 8-9. Further, lay persons are competent to report objective signs of illness. Id. To determine whether the undiagnosed illness is manifested to a degree of 10 percent or more the condition must be rated by analogy to a disease or injury in which the functions affected, anatomical location or symptomatology are similar. See 38 C.F.R. § 3.317(a)(5); see also Stankevich v. Nicholson, 19 Vet. App. 470 (2006). A medically unexplained chronic multisymptom illnesses is one defined by a cluster of signs or symptoms and specifically includes chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders (excluding structural gastrointestinal diseases), as well as any other illness that the Secretary determines meets the criteria in paragraph (a)(2)(ii) of this section for a medically unexplained chronic multisymptom illness. A “medically unexplained chronic multisymptom illness” means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities.” Chronic multisymptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii). Functional gastrointestinal disorders are a group of conditions characterized by chronic or recurrent symptoms that are unexplained by any structural, endoscopic, laboratory, or other objective signs of injury or disease and may be related to any part of the gastrointestinal tract. Specific functional gastrointestinal disorders include, but are not limited to, irritable bowel syndrome, functional dyspepsia, functional vomiting, functional constipation, functional bloating, functional abdominal pain syndrome, and functional dysphagia. These disorders are commonly characterized by symptoms including abdominal pain, substernal burning or pain, nausea, vomiting, altered bowel habits (including diarrhea, constipation), indigestion, bloating, postprandial fullness, and painful or difficult swallowing. Diagnosis of specific functional gastrointestinal disorders is made in accordance with established medical principles, which generally require symptom onset at least 6 months prior to diagnosis and the presence of symptoms sufficient to diagnose the specific disorder at least 3 months prior to diagnosis. 38 C.F.R. § 3.317 (a)(2)(i)(B)(3). In evaluating the evidence, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Owens v. Brown, 7 Vet. App. 429, 433 (1995). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). As to a current disability, the post-service record shows the Veteran being diagnosed with left and right ankle strain, left and right hand arthritis, left and right shoulder arthritis, and left elbow arthritis. See, e.g., VA examination dated in January 2021. Next, the Board notes that service treatment records showed that in January 1989 the Veteran was treated for left ankle strain. The impression was Grade I mild inversion sprain. He was given a profile (light duty) preventing him from running for seven days. In March 1989, service treatment records show the Veteran was treated for symptoms following twisting his right ankle while playing basketball. The impression was mild right ankle sprain. In March 1990, service treatment records show the Veteran was treated for a left shoulder injury. On examination, he had full range of motion. An X-ray was within normal limits. The assessment was soft tissue injury. He was provided with a profile (light duty) and Motrin. Similarly, at the February 1994 separation examination the Veteran reported a history of bilateral ankle symptoms with a history of “twisting them a lot [sic]” and a history of swollen or painful joints, cramps in his legs, and painful or trick shoulder. Likewise, the Veteran’s DD 214 shows he earned the Parachutist Badge. The Board concedes the fact that this is difficult duty, sometimes leading to injuries that are not reported in some cases. The Board also finds that the Veteran is competent to report on the events he experiences while on active duty as well as manifestations of his disability, such as pain, instability, and swelling. See Davidson, supra. However, as to the ankles, the Board notes that when seen in January 1989 the left ankle sprain was opined to be mild, in March 1989 it was opined that the sprain was mild, and in March 1990 it was opined that the left shoulder X-ray were within normal limits with normal range of motion. Furthermore, the subsequent and earlier service treatment records, including the February 1994 separation examination, are otherwise negative for injuries, history, complaints, treatment for symptoms, and/or a diagnosis of bilateral ankle and left shoulder disabilities except for the history reported at the separation examination. Moreover, all the service treatment records, including the February 1994 separation examination, are negative for injuries, history, complaints, treatment for symptoms, and/or a diagnosis of bilateral hand, right shoulder, and left elbow disabilities, even though they documented problems with the right elbow, including due to bad landings while earning his Parachutist Badge. Clearly this indicates the Veteran’s willingness to report problems associated with jumps in service. In fact, while at the February 1994 separation examination the Veteran reported a history of bilateral ankle pain due “twisting them a lot” as well as a history of swollen or painful joints, cramps in his legs, and painful or trick shoulder he also specifically denied having a history of broken bones, arthritis, or bursitis and on examination it was opined that his upper and lower extremities were normal but for a problem unrelated to the current appeal. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (VA may only consider independent medical evidence to support its findings and is not permitted to base decisions on its own unsubstantiated medical conclusions). Accordingly, the Board finds, as the February 1994 separation examiner found, that the Veteran’s bilateral ankle and left shoulder injury and symptoms were transient in nature and resolved by the time he separated from service. See Owens, supra. Therefore, the Board finds that the most probative evidence of record shows that the Veteran did not sustain a disease or injury while on active duty that caused his current bilateral ankle, hand, shoulder, and left elbow disabilities despite the ankle and left shoulder injuries and symptoms seen on a few occasions while on active duty and his earning the Parachutist Badge. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). In this regard, the Board finds that the detailed service record, which documents the Veteran’s complaints, diagnoses, or treatment for a number of other problems, the opinions that the Veteran’s ankle sprains were mild, and the negative left shoulder X-ray, weights against his current claims. See Owens, supra. Overall, the Board must find the service records provide unusually highly probative evidence against these claims. They are very detailed. Similarly, the post-service record does not show the Veteran being diagnosed with arthritis in the ankles, hands, shoulders, and left elbow in the first post-service year. Therefore, the Board finds that the presumptions found at 38 C.F.R. § 3.309(a) do not help the Veteran establish service connection for bilateral ankle, hand, shoulder, and left elbow disabilities. See 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. § 3.307. More importantly, the record does not show that the Veteran had a continued problem with bilateral ankle, hand, shoulder, and left elbow disabilities in and since service. In fact, as noted above, the February 1994 separation examiner opined that his upper and lower extremities were normal despite the ankle and left shoulder problems seen on active duty, the history of bilateral ankle pain due “twisting them a lot,” swollen or painful joints, cramps in his legs, and painful or trick shoulder reported at the February 1994 examination, and the Veteran having earned the Parachutist Badge; providing highly probative evidence against the claims. Likewise, and more importantly, the post-service is negative for any complaints, diagnoses, or treatment for bilateral ankle, hand, shoulder, and/or left elbow disabilities until, at the earliest, until 1999; five years after his 1994 separation from active duty. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(b); Also see VA treatment record dated in July 1999, February 2000, May 2011, and April 2012. In this regard, the Board finds it significant that while the Veteran was afforded a VA general examination in May 1994 (i.e., only one month after his separations from service), and reported having bilateral ankle as well as left shoulder problems at this time, neither the Veteran nor the examiner noted a history of bilateral hand, right shoulder, or left elbow disabilities. Moreover, after the examination, the examiner’s diagnoses only included a history of left shoulder dislocation (i.e., the examiner did not diagnose bilateral ankle, hand, shoulder, and left elbow disabilities). The Board finds this particularly negative evidence against these claims. This fact would seem to support the findings of the examiner in service who provided evidence against the claims, as noted above. Given this record, the Board finds that the service medical records and the post-service medical evidence provides highly probative evidence, overall, against these claims. Therefore, the Board finds that the most probative evidence of record shows that the Veteran did not have a continued problem with bilateral ankle, hand, shoulder and left elbow disabilities in and since service despite the documented ankle and left shoulder injuries and symptoms seen on a few occasions while on active duty and his earing the Parachutist Badge. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(b). For the reasons noted above, the Board finds that the post-service medical records provide highly probative evidence against these claims. The Board also finds that the preponderance of the evidence shows that the Veteran’s current bilateral ankle, hand, shoulder, and left elbow disabilities are not due to his military service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(d); also see Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992) (establishing service connection requires finding a relationship between a current disability and events in service or an injury or disease incurred therein). In this regard, an April 2012 VA treatment record included the opinion that the Veteran had degenerative joint disease of the elbows secondary to parachute jumping while he was in the Army. However, the Board finds this opinion lacks probative value because it is not supported by any rationale. See Bloom v. West, 13 Vet. App. 185, 187 (1999) (a medical opinion without supporting clinical data or other rationale does not provide the required degree of medical certainty to be credible). On the other hand, the January 2021 VA examiner opined that the Veteran’s bilateral ankle, hand, shoulder, and left elbow disabilities are not due to his military service. Moreover, the Board finds these opinions the most competent and credible medical opinions of record because they are provided after a review of the record on appeal and an examination of the Veteran as well as because they are supported by citation to evidence found in the record and controlling medical literature as well as because they are supported by medical reasoning and, as to all but the elbow, these opinions are not contradicted by any other medical evidence of record. See Owens, supra; Guerrieri v. Brown, 4 Vet. App. 467, 473 (1993) (“the probative value of medical opinion evidence is based on the medical expert’s personal examination of the patient, the physician’s knowledge and skill in analyzing the data, and the medical conclusion the physician reaches.... As is true with any piece of evidence, the credibility and weight to be attached to these opinions [are] within the province of the [Board as] adjudicators...”); Colvin, supra. Therefore, the Board finds that the most probative evidence of record shows that the Veteran’s bilateral ankle, hand, shoulder, and left elbow disabilities are not due to his military service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(d); also see Rabideau, supra. The key question in this case is not if the Veteran injured himself in service, or if the Veteran currently has the problems cited above. The key issue is whether the Veteran’s military service, and any injury he had in that service, was at least as likely as not (a 50% or greater chance) the cause of the current problems. The fact that he may, or may not, have injured his hand, or elbow, or any body part in service does not always provide the basis to find that his current problem is the result of that injury from about 25 years ago. Sometimes, in some cases, the best evidence provides evidence against such claims. In this case, the Board finds that there is now significant evidence in this record, in both the service and post-service, that provides highly probative evidence against these claims that clearly outweigh all evidence that supports these claims. The Board next finds that the preponderance of the evidence shows that the Veteran’s bilateral ankle, hand, shoulder, and left elbow disabilities are not caused or aggravated by an already service-connected disability. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310; Also see Allen, supra; Wallin, supra; Ward, supra. In this regard, the January 2021 VA examiner opined that the Veteran’s bilateral ankle, hand, shoulder, and left elbow disabilities are not caused or aggravated by a service-connected disability. Moreover, the Board finds these opinions the most competent and credible medical opinions of record because they are provided after a review of the record on appeal and an examination of the Veteran as well as because they are supported by citation to evidence found in the record and controlling medical literature and because they are supported by medical reasoning and not contradicted by any other medical evidence of record. See Owens, supra; Guerrieri, supra; Colvin, supra. Therefore, the Board finds that the most probative evidence of record shows that the Veteran’s bilateral ankle, hand, shoulder, and left elbow disabilities are not secondary to an already service-connected disability. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310; Also see Allen, supra; Wallin, supra; Ward, supra. Lastly, the Board notes that given the Veteran’s documented service in South West Asia from October 1990 to March 1991 the laws and regulations governing undiagnosed illnesses are applicable to the current claim. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317. However, the January 2021 VA examiner diagnosed the Veteran with known bilateral ankle, hand, shoulder, and left elbow disabilities (i.e., left and right ankle strain, left and right hand arthritis, left and right shoulder arthritis, and left elbow arthritis). Moreover, the January 2021 VA examiners specifically opined had known etiologies and are not due to exposure to toxins serving in South West Asia during the Gulf War. Additionally, the Board finds these medical opinions the most probative evidence of record because they are provided after a review of the record on appeal and an examination of the Veteran as well as because they are supported by citation to evidence found in the record and controlling medical literature and because they are supported by medical reasoning and not contradicted by any other medical evidence of record. See Owens, supra, Colvin, supra. With each remand of the case, the Board obtains more evidence against these claims that it cannot ignore. Therefore, the Board finds that the January 2021 VA examiners opinions show that the Veteran’s bilateral ankle, hand, shoulder, and left elbow disabilities are not an undiagnosed illness, a diagnosable but medically unexplained chronic multisymptom illnesses of unknown etiology, or a diagnosable chronic multisymptom illness with a partially explained etiology. See 38 U.S.C. §§ 1110, 1117, 1131; Owens, supra, Colvin, supra. In addition, the Board finds that neither the Veteran or his spouse are competent to provide the missing direct and secondary nexus opinions or diagnosis of an undiagnosed illness because they do not have the required medical expertise to provide answers to these complex medical questions (i.e., what caused his current bilateral ankle, hand, shoulder, and left elbow disabilities). See Davidson, supra. It is vital for the Veteran to again understand that the Board has taken his concerns seriously (it was the bases of the Board’s remand), however, there is now overwhelming medical evidence against these claims from the VA examiners that the Board cannot ignore. Therefore, the Board finds that the claims of service connection for bilateral ankle, hand, shoulder, and left elbow disabilities are denied. 38 U.S.C. §§ 1110, 1117, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310, 3.317. John J. Crowley Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N.T. Werner, 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.