Citation Nr: 21032718 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 11-31 340 DATE: May 27, 2021 ORDER Service connection for a disability characterized by general joint pain is denied FINDING OF FACT The Veteran does not have a separate current disability characterized by general joint pain CONCLUSION OF LAW The criteria for service connection for a disability characterized by general joint pain have not been met. 38 U.S.C. §§ 1101, 1105, 1110, 1113, 1131, 1137, 5103, 5103A, 5.107; 38 C.F.R. §§ 3.1, 3.102, 3.301, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service in the United States Navy from July 1959 to September 1963 and from December 1963 to January 1978. This case has a lengthy procedural history, which has been documented in prior Board Remand decisions. Most recently, in February 2021, the Board remanded this matter for additional evidentiary development of which there has been substantial compliance. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection The Veteran asserts that he suffers from a separate disability characterized by general joint pain was incurred in, aggravated by, or otherwise attributed to, service. In order to establish service connection on a direct basis, the record must contain competent evidence of: (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. 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). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F. 3d 1039, 1043 (Fed. Cir. 1994). 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. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). If the evidence is competent, the Board must then determine if the evidence is credible. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this regard, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511 (1995). Certain chronic diseases, including osteoarthritis, will be presumed related to service if they were shown as chronic in service (or within a presumptive period) and there are subsequent manifestations of the same chronic diseases; or if they manifested to a compensable degree within a presumptive period following separation from service (in this case, one year); or if they were noted in service, with continuity of symptomatology since service. See 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Evidence and Analysis In an August 1973 service treatment record (STR), the Veteran complained of right knee pain and redness. A clinician indicated that x-ray imaging was normal; however, the Veteran reported that right knee pain persisted when he played baseball. In a September 1976 STR, the Veteran complained of hand pain and inflammation. A clinician prescribed a 7-day course of aspirin and Butazolidin. In an undated (presumably 1978) retirement Report of Medical History, the Veteran indicated that he had swollen or painful joints. In an undated (again, presumably 1978) retirement Report of Medical Examination, a clinician reported normal clinician evaluations of the Veteran's upper extremities; feet; lower extremities; and spine including other aspects of the musculoskeletal system. In a November 1995 VA treatment record, a clinician indicated that the Veteran had a history of acromioclavicular (AC) arthritis. X-ray imaging disclosed "early post-traumatic osteolysis or other arthritic change." In November 2000, the Veteran received a referral to an orthopedic surgeon and underwent arthroscopic surgery. This provider provided a post-operative diagnosis of internal derangement of the left shoulder, tear of rotator cuff and SLAP lesion, type-1, with repair of the rotator cuff and coracoacromial ligament resection. In a March 2002, a clinician indicated a diagnosis of adhesive capsulitis of the left shoulder with radicular neuralgia affecting the left upper extremity. Additionally, the clinician reported a subsequent diagnosis of cervicobrachial radicular neuralgia affecting the left upper extremity. In an interpretive report of an April 2016 computed tomography (CT) scan of the Veteran's left shoulder, a private clinician opined that the scan was indicative of "typical age-appropriate AC joint changes." In a lay statement of the same month, the Veteran conveyed that he experienced trouble with his back and shoulder prior to 1992. However, the Veteran no longer possessed the medical records which documented his complaints and treatment. In November 2020, a VA clinician provided an addendum opinion pursuant to the Board's October 2020 remand directives. The clinician reviewed the entirety of the evidence of record, to include the Veteran's lay accounts. Upon scrutiny of this evidence, the clinician indicated that while it is possible that the Veteran's initial (claimed) injury in 1968 could have led to arthritic changes in the AC joint, considering the Veteran's age, 1995 x-ray imaging findings of mild degeneration (early post traumatic osteolysis or other arthritic change) is not consistent with a traumatic injury. Consequently, the clinician opined that the 1995 imaging finding of mild degeneration made it less likely than not that the in-service injury in 1968 was the cause of the Veteran's arthritis. Here, the clinician added that most radiologists interpret post-traumatic arthritis as more significant than mild degeneration. Moreover, to the extent the Veteran's current disability could be related to residuals of the November 2000 surgery, the clinician explained that the imaging indicated that it was less likely than not the rotator cuff condition was related to the Veteran's service. Opining as to whether any diagnosed general joint pain/arthralgia condition was at least as likely as not related to service. The November 2020 clinician indicated that the Veteran's current shoulder disorder was less likely than not related to any event which occurred over three decades ago. As a rationale for this negative nexus opinion, the clinician reported that there is no record of any other additional injury "event" in the medical evidence. Consequently, the 1995 x-ray imaging finding was at least as likely as not indicative of some "other injury event" which occurred closer to 1995. Upon a March 2021 VA medical opinion (responsive to the Board's February 2021 remand directives), a clinician, after reviewing the entire record of evidence, indicated that the Veteran currently does not have a separate diagnosable disorder which manifests in general joint pain/arthralgia. As a rationale for this negative opinion as to a separate diagnosable disorder, the clinician reported that the Veteran had undergone examinations in October 1962, September 1963, December 1963, September 1969, March 1973, and the separation exam of 1978, which were negative for all complaints except knee complaints. The March 2020 VA opinion, as noted above, is clear, thorough, and precise. The noted STR reveals hand pain secondary to inflammation. (The Board observes that the clinician's report contains an error to the date of this STR, reported as March 1972 instead of September 1976. This error is not prejudicial to the Veteran's interests as it refers to the selfsame 7-day delimited course of treatment; therefore, the Board finds this error harmless.) The Veteran took ASA (aspirin) and Butazolidin for 7 days; the evidence shows that this prescription pertained to the hand pain only and was in effect for 7 days. Upon completion of the 7-day course of medication, the Veteran's hand pain subsided. The clinician noted that ASA and Butazolidin were prescribed at that time as anti-inflammatory agentsboth to suppress hand inflammation and control hand pain. "In no way," does this evidence suggest that ASA was a part of any systemic treatment plan. Consequently, no clinical inference can be rendered to the effect that there was a nascent arthritic diagnosis (to be provided). The Veteran believes that a separate condition characterized by joint pain was incurred in, aggravated by, or otherwise attributable to, service. The Board recognizes the Veteran's belief in this separate condition. Indeed, the Veteran is competent to report discernable symptoms such as joint pain. Nevertheless, as a lay person, this Veteran lacks the highly specialized medical training to render a diagnosis of a separate condition characterized by general joint pain or, if applicable, to render an etiological opinion as to any separate condition. See Jandreau, 492 F. 3d 1372. As such, this lay evidence does not constitute competent medical evidence. Neither the Veteran nor his representative have submitted competent medical evidence to support the Veteran's assertions. See 38 U.S.C. § 5107(a); Cromer v. Nicholson, 455 F. 3d 1346 (Fed. Cir. 2006); 38 C.F.R. § 3.159(a)(1). The Board assigns significant probative weight to the March 2021 VA clinician's opinion. This medical professional performed a comprehensive review of the evidence of record. Moreover, the clinician provided an evidence-based and medical knowledge-informed rationale for the negative conclusion reached as to the "absence" of a separate diagnosable disorder which manifests in general joint pain/arthralgia. As already discussed, in the absence of proof of a present disability there can be no valid claim. Brammer, 3 Vet. App. 223. The weight of extant evidence is against a finding that the Veteran has a current separate diagnosable disorder which manifests in general joint pain. Without a current disability, service connection cannot be established on either a direct or a presumptive basis. Id. The preponderance of evidence is the Veteran's service connection claim. As such, the benefit of doubt doctrine is not for application in this case. See 38 U.S.C. §§ 5107 Katherine Kiemle Buckley Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. J. Komins, 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.