Citation Nr: 21024625 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 13-32 777 DATE: April 23, 2021 ORDER Entitlement to service connection for a joint disorder is denied. FINDING OF FACT The evidence is not sufficient to establish that the Veteran’s joint disorder is related to his military service or that it is a residual effect of dengue fever. CONCLUSION OF LAW The criteria for service connection for a joint disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Air Force from January1962 to January 1966. This matter returns to the Board of Veterans’ Appeals (Board) from a previous Board remand in February 2021 (Board Remand) to obtain an addendum medical opinion related to the Veteran’s claim for service connection for a joint disorder. This matter originally comes before the Board on the Veteran’s appeal of a March 2012 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO), which is the agency of original jurisdiction (AOJ). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c); 38 U.S.C. § 7107(a)(2). Service Connection Generally, service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. To establish a right to compensation for a present disability, a Veteran must show: (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-the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 38 F.3d 1163, 1167 (Fed. Cir. 2004)). The absence of any one element will result in denial of service connection. Service connection for certain chronic diseases specifically identified in VA regulations may also be established on a presumptive basis by showing that the disease manifested to a compensable degree during service or within one year from the date of separation from active service. 38 C.F.R. §§ 3.307(a)(3), 3.309 (a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Arthritis is a disease for which these provisions apply. 38 C.F.R. § 3.309(a). 1. Entitlement to service connection for a joint disorder is denied The Veteran seeks entitlement to service connection for a joint disorder which he claims stems from his time in the Air Force, including that he contracted dengue fever while he was stationed in Puerto Rico. In a February 2021 Remand, the Board requested the AOJ to obtain a medical opinion whether the Veteran has a current joint disorder, and if so, it’s nature and etiology, and whether any identified joint disorder(s) may be associated with an in-service injury, event, or disease, including the illness the Veteran has described during his period of active service, claimed as dengue fever. VA provided the Veteran a VA examination in March 2021, which did entail an in-person examination of the Veteran, as well as the examiner’s review of his file. The VA examiner determined that the Veteran has a current diagnosis of non-traumatic or gout related multi-joint arthritis in two or more joints. The conditions noted included degenerative joint disease of the right knee, diagnosed in 2015; degenerative arthritis of the lumbar spine, diagnosed in 2014; and degenerative joint disease of the bilateral feet, diagnosed in 2012. However, the VA examiner stated that the Veteran does not have a current diagnosis of any systemic joint disorder. The examiner noted the Veteran’s description of his in-service incident, based on his statements in the file and the in-person interview, that while in Puerto Rico he had nausea and a high fever up to 105 degrees, with pain over all his body and with blood from nose and mouth, for which he was hospitalized. He also experienced abdominal pains for more than a year. However, he states he was never told for sure that he had dengue fever, but only heard there was dengue fever in the area. He states that he now has pain in “every joint from his head to his toes.” The examiner noted that there was no confirmation shown in his service medical records of the Veteran having dengue fever. The Veteran denied all other significant medical or surgical history. Further, the VA examiner noted that the Veteran had been followed and treated by the VA over many years with many blood tests and some x-rays performed with no evidence shown to support a systemic joint disorder related to an exposure event, to include exposure to dengue fever. The VA examiner stated that it is rare to actually get dengue fever, as well as to have any sequela of this disorder since it is self-limiting, indicating that most citations reviewed did not document sequela of dengue fever. However, a single article indicated some evidence that on rare occasions fatigue and depression can be residual. The VA examiner pointed out that these are not present in this Veteran’s claim. Thus, the VA examiner opined that it is less likely than so (less than 50 percent likely) the Veteran’s joint disorder incurred in or was caused by the claimed in-service injury, event, or illness. The Veteran’s military service treatment records (STRs) do not indicate any complaints of, treatment for, or diagnosis of dengue fever, or chronic joint disorder. The Veteran’s December 1965 separation physical records, including his report of medical history completed by the Veteran himself, denies any problems with swollen or painful joints, arthritis or rheumatism, or bone, joint, or other deformity. Foot trouble indicated at that time was related to a left foot bunion. Stomach trouble reported in 1965 was noted to have responded to treatment with no recurrence, complications, or sequalae. The Veteran provided his own and “buddy” statements from D.M. who served with the Veteran. They both described the Veteran’s illness with high fever which lead to him being hospitalized and losing significant weight. The Veteran claimed that he might have had dengue fever but admitted that he was never actually diagnosed with or that he was ever told he had dengue fever, only that he heard it was in the area. The Board finds both the Veteran and D.M., to be competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed or experienced, and which are within the realm of his or her personal knowledge. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159 (a). However, without specialized medical training a lay witness is not competent to either diagnose or make a nexus opinion concerning most medical conditions. Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Veteran did not identify or provide copies of medical records which show that his joint disorder manifested to a compensable degree within one year of his separation for the military in 1966, or any medical opinion letters that provide a positive nexus between his current joint disorder and his military service. Based on the evidence of record, the Board finds that the evidence is insufficient to support the Veteran’s claim that his current joint disorder was incurred in, or is related to his military service, including based on the claim that his joint disorder is the result of his having suffered from dengue fever while in service. There is a lack of evidence which competently substantiates the Veteran’s claim that actually had dengue fever in service and admits himself that he was never actually given that diagnosis. Further, the medical literature reviewed and cited by the VA examiner indicates the joint disorders are not a known residual of dengue fever. There is no evidence that his joint disorder manifested as a chronic condition during his service or manifested to a compensable degree within one year of his separation from military service. 38 C.F.R. §§ 3.307(a)(3), 3.309 (a). In reviewing the entirety of the record, the Board finds that the VA examiner’s opinion is competent and adequate. It is based upon a full review of the record and the Veteran’s history. A rationale is provided that is consistent with the evidence in the claims file. As such, it is the most probative evidence of record and is certainly given more weight than the Veteran’s lay assertions. As the Veteran is a layperson, his opinion is given less weight than that of a medical professional. In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). The Veteran’s claim for entitlement to service connection for a joint disorder is denied. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Bannach, 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.