Citation Nr: 21031724 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 16-42 651 DATE: May 24, 2021 ORDER Entitlement to service connection for residuals of Lyme disease, to include arthritis, is denied. FINDING OF FACT The Veteran contracted Lyme disease in connection with his active duty service, but there is no currently diagnosed residual thereof. CONCLUSION OF LAW The criteria for service connection for residuals of Lyme disease, to include Lyme arthritis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran was a member of the Army National Guard with periods of active service from January 1985 to April 1985 and from May 2004 to February 2005. This matter come before the Board of Veterans' Appeals (Board) on appeal from an April 2016 rating decision by a Regional Office (RO) of the United States Department of Veterans Affairs. In a December 2018 decision, the Board found that previously denied claims of service connection for Lyme disease must be reconsidered based on receipt of additional relevant service department records. 38 C.F.R. § 3.156(c). The issue was then remanded by the Board in December 2018 for additional development, to include securing any outstanding treatment records and providing a VA examination. VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326(a). These duties have been satisfied in this case. Appropriate notice was provided in the Fully Developed Claim Form filed by the Veteran in November 2015. The RO associated the Veteran's service and VA private outpatient treatment records with the claims file. All released or submitted private treatment records have been associated with the claims file. No other relevant records have been identified and are outstanding. Appropriate and necessary examinations were afforded the Veteran, and are adequate for evaluation, as they include needed findings to permit application of the rating schedule and identification of current disability. As such, VA has satisfied its duet to assist with the procurement of relevant records. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). Neither the Veteran nor his representative have raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection on a direct basis, the record requires competent evidence showing: (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, 1167 (Fed. Cir. 2004). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). A layperson is generally not capable of opining on matters requiring medical knowledge. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran is seeking service connection for residuals of Lyme disease, which he asserts he contracted due to a tick bite or bites incurred during periods of training. The Veteran's service treatment records (STRs) include a December 1989 Statement of Medical Examination and Duty Status which notes the Veteran suffered a tick bite in July 1989, incurred in the line of duty, leading to Lyme arthritis "now resolved." He suffered additional tick bites during inactive duty training in March 1990, August 1992 and August 1996. An in-service injury, a Lyme disease infection, is established. However, there is no evidence of a current residual disability related to such. The requirement that a current disability be present is satisfied when a claimant has a disability at the time a claim for VA disability is filed or during the pendency of that claim, even though the disability resolves prior to adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319 (2007). VA treatment records are negative for treatment for and/or a diagnosis of Lyme disease or Lyme arthritis. The Veteran underwent a VA shoulder and arm examination in October 2019. The VA examiner noted that the Veteran did not have any diagnosis associated with Lyme arthritis. The Veteran reported that after sustaining a tick bite while serving in the National Guard on active duty, he tested positive for Lyme disease and experienced right shoulder pain which continued to bother him. The VA examiner acknowledged the December 2009 statement of medical examination and duty status acknowledging the line of duty injury for diagnosis of tick bite leading to Lyme arthritis included in the Veteran's medical records. Thereafter, the Veteran was treated for ongoing right shoulder pain for which he was evaluated by radiological imaging, treated with nonsteroidal anti-inflammatories which is corroborated by his medical records. Subjective complaints included ongoing right shoulder pain and restriction of range of motion of the right shoulder. The Veteran did to report experiencing flare-ups of the right shoulder. Range of motion of the right and left shoulders was normal. No pain, no additional functional loss on range of motion, and no additional contributing factors of disability were present. Muscle strength was normal. No ankylosis or rotator cuff conditions were present. X-rays taken of the right shoulder reveals no acute fracture, alignment was anatomic, joint spaces were preserved and soft tissues were unremarkable. The Veteran underwent a VA infectious diseases examination in October 2019. The VA examiner noted the Veteran's diagnosis of Lyme disease in 1989 leading to Lyme arthritis. The VA examiner noted that the Veteran was subsequently treated for right shoulder pain. Subjective complaints included ongoing pain in right shoulder, restriction of range of movement of right shoulder. The VA examiner noted that cessation of treatment for active disease occurred in 1989 and the condition became inactive in 1989. The Veteran had no other physical findings, complications, conditions, signs or symptoms related to Lyme disease. The VA examiner noted that the Veteran was diagnosed with Lyme disease during military service that was treated in August 1989 with antibiotics and received a diagnosis of Lyme arthritis, however there is no evidence of treatment with prolonged antibiotics (usually 4 weeks) for treatment of Lyme arthritis. The VA examiner noted the Veteran's claim of residual condition of Lyme arthritis, right shoulder, however the Veteran's symptoms were subjective with no objective findings; and stated that there is no evidence of ongoing symptoms and chronicity of care. The VA examiner also noted that the Veteran was last evaluated for and received physical therapy for shoulder pain in 2004 and at that time the diagnosis was bilateral shoulder tendinitis (unrelated to diagnosis of Lyme disease). There was no evidence of primary care notes, rheumatological evaluations, documenting diagnosis of ongoing right shoulder pain or diagnoses of Lyme arthritis right shoulder. The VA examiner stated that "in addition, a review of medical literature clearly shows that late Lyme disease occurs months to a few years after the onset of infection. Even in the absence of anti-inflammatory therapy, "antibiotic-refractory arthritis" may persist for several months to several years, but will EVENTUALLY resolve spontaneously. Almost no patients have persistent symptoms extending past five years. This is not consistent with Veterans [sic] diagnosis of Lyme arthritis which was approximately 30 years ago. Therefore, veteran does not have a diagnosis of Lyme arthritis incurred due to the tick bite during military service in 1989." In other words, while the Lyme disease infection did occur and was related to service, any residual effects of that infection, including flare-ups of musculoskeletal complaints, resolved long before the current appeal period, and caused no lasting damage. The Veteran now presents only subjective reports of symptoms, unsupported by physical findings. In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Further, even if the complaints of pain are considered a current disability under Saunders v. Wilkie, 886 F. 3d (Fed. Cir. 2018), the preponderance of the medical evidence relates such to non-service incidents, and not to Lyme disease. Accordingly, service connection for residuals of Lyme disease, to include Lyme arthritis, is not warranted. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Margaret M. Lunger 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.