Citation Nr: 21032841 Decision Date: 05/28/21 Archive Date: 05/28/21 DOCKET NO. 18-34 463 DATE: May 28, 2021 ORDER Service connection for a right knee disability (other than sciatic nerve pain) is denied. Service connection for a left knee disability (other than sciatic nerve pain) is denied. Service connection for a right leg disability (other than sciatic nerve pain) is denied. Service connection for a left leg disability (other than sciatic nerve pain) is denied. Service connection for a left hand disability is denied. FINDINGS OF FACT 1. The Veteran does not have a separately diagnosed right knee disability (other than sciatic nerve pain). 2. The Veteran does not have a separately diagnosed left knee disability (other than sciatic nerve pain). 3. The Veteran does not have a separately diagnosed right leg disability (other than sciatic nerve pain). 4. The Veteran does not have a separately diagnosed left leg disability (other than sciatic nerve pain). 5. The Veteran does not have a left hand disability. CONCLUSIONS OF LAW 1. The criteria for service connection for a right knee disability (other than sciatic nerve pain) have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a left knee disability (other than sciatic nerve pain) have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a right leg disability (other than sciatic nerve pain) have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for a left leg disability (other than sciatic nerve pain) have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for a left hand disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303 REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1965 to June 1967. In addition, he retired from service in the National Guard. The case is on appeal from an October 2014 rating decision. In June 2019, the Veteran testified at a Board hearing. In December 2019, the Board remanded the issues of service connection for a back and right shoulder disorder, as well as right and left knee, leg, ankle, and hand disorders. The Board notes that although all of the remanded issues are included in the list of issues on appeal in the April 2021 submission by the Veteran's representative, by a rating decision in February 2021, the RO granted service connection for a back and right shoulder disability, as well as right and left ankle disabilities, and a right hand disability, as well sciatic nerve pain of the right and left lower extremity. The awards represent a full grant of the benefits sought with respect to those issues. As such, the remaining issues on appeal are as reflected on the title page. The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: "(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." Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Active service includes periods of active duty for training (ACDUTRA) when service connection may be granted for disabilities resulting from a disease or injury incurred in or aggravated while performing ACDUTRA. 38 U.S.C. § 101(22), (24); 38 C.F.R. § 3.6(a), (c). Active service also includes periods of inactive duty training (INACDUTRA) when service connection may be granted for disabilities resulting from an injury incurred in or aggravated while performing INACDUTRA. 38 U.S.C. § 101(23), (24); 38 C.F.R. § 3.6(a), (d). 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(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Analysis 1. Service connection for a right knee disorder. 2. Service connection for a left knee disorder. 3. Service connection for a right leg disorder. 4. Service connection for a left leg disorder. The Veteran asserts that he has right and left knee and leg conditions due to the combined effect of numerous parachute landings during service. The Veteran was awarded a parachute badge during active duty, and National Guard records reflect he performed multiple parachute jumps with an airborne unit. As noted above, while on remand, service connection was granted for a back disability and associated sciatic nerve pain of the right and left lower extremity due to injuries sustained as a result of multiple parachute jumps during active duty and/or National Guard service. The Veteran's active duty service treatment records (STRs) are negative for complaints or diagnosis of a chronic right or left knee or leg condition. The May 1967 separation examination report shows that the lower extremities were normal and assigned a profile a profile of "1." See Odiorne v. Principi, 3 Vet. App. 456, 457 (1992) (observing that the 'PULHES' profile reflects the overall physical and psychiatric condition of the Veteran on a scale of 1 (high level of fitness) to 4 (a medical condition or physical defect which is below the level of medical fitness for retention in the military service)). He denied having or having had a knee condition; swollen or painful joints; arthritis or rheumatism; bone, joint, or other deformity; and lameness. See November 2016 Military Personnel Record. In addition, pursuant to the Board's 2019 remand, the Veteran was afforded a VA examination in January 2021. The opinion reflects the Veteran's history of knee strain and leg cramps, as reflected in Reserve/National Guard records, including in August 1978, 1988, February 1990, and December 1994. See January 2020 STRs. However, the examiner reported no evidence of chronicity of symptoms or treatment during or within the year after separation. Moreover, range of motion of both knees was noted to be normal. The examiner concluded that the Veteran's symptoms of shooting pain originating from his lumbar spine and traveling to his posterior knees and legs causing numbness and a tingling sensation in his posterior right and left knees and legs were manifestations of his service-connected back disability and associated sciatic nerve pain rather than separate diagnosable disorders. See also July 2018 & December 2020 CAPRI documents. The Board notes that although the report of examination reflects pain on extension of the right and left knee caused functional loss, as noted, the Veteran's lower extremity symptoms are shown to be manifestations of his service-connected back disability and associated sciatic nerve pain of the lower extremities rather than separate and distinct disabilities. The evidence, including records obtained pursuant to the Board's December 2019 remand, see January 2020 Military Personnel Record & STRs, does not show that the Veteran has or has had relevant symptoms, separate and apart from those already associated with his service-connected back and/or sciatic nerve pain of the lower extremities or that result in any distinct functional impairment in earning capacity at any time during the period on appeal. See Saunders, 886 F.3d at 1367-68 (finding that the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability."); see also Wait v. Wilkie, 33 Vet. App. 8, 15-16 (2020) (holding that a symptom must be shown to impair earning capacity to constitute a disability). Service connection may only be granted for a current disability; when a claimed condition is not shown, there may be no grant of service connection. "In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board notes that although a July 2018 letter from a VA clinician indicates that the Veteran had ongoing treatment for multiple medical problems related to service, there was no reference to a knee or leg disorder. A bare transcription of lay history, unenhanced by additional comment by the transcriber, does not become competent medical evidence merely because the transcriber is a health care professional. LeShore v. Brown, 8 Vet. App. 406, 409 (1995). The Board notes although examination reports in June 1988, February 1990, and December 1994 reflect leg cramps and/or swollen joints, as above, the September 2014 VA examination report does not reflect a current diagnosis or any functional impairment in earning capacity with respect to the right or left knee or leg. Further, in October 2014, no myalgias or arthralgias of the musculoskeletal system were reported and normal range of motion was noted. See February 2020 Medical Treatment Record Non-Government Facility. Additionally, the assessment in August 2017 was lumbosacral dysfunction with tenderness to palpation of the bilateral sacroiliac joint and gluteal area, and no gross weakness of the bilateral lower extremities was reported. See July 2018 CAPRI documents. The Board notes that the lumbar spine and sacroiliac joints are considered as one anatomical segment for rating purposes. 38 C.F.R. § 4.66. Further, VA treatment records in July 2018 reflect electrodiagnostic study of the bilateral lower extremities was normal. The Board notes that a January 2021 VA back examination report reflects that prolonged standing was precluded due to the Veteran's lumbar spine arthritis with bilateral lower extremity radiculopathy. In addition, and although the Veteran is competent to report his symptoms, a determination as to whether the Veteran has a bilateral knee or leg disorder separate from his service-connected back disability and associated sciatic nerve pain of the lower extremities is a complex matter requiring related medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (holding that a lay person is not considered competent to testify regarding medically complex issues). As the Veteran has no known or reported medical expertise, his opinions as to diagnosis lack probative value, and an opinion by a qualified medical professional is required to decide the claims. In that regard, the opinions rendered by January 2021 VA examiner constitutes such competent medical evidence. Further, as the opinions are unequivocally stated, consistent with the record, and supported by cited evidence of record, the Board finds that these medical opinions are probative evidence against the Veteran's claims. That is, the medical evidence outweighs the Veteran's report of a continuity of symptomatology and his lay opinion on the matter, even if such a theory is intuitively plausible to a lay person. As the preponderance of the evidence is against the claims of service connection for right and left knee and leg disorders (other than sciatic nerve pain), there is no doubt to be resolved. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Therefore, service connection for right and left knee disorders or right and left leg disorders (other than sciatic nerve pain) is not warranted. 5. Service connection for a left hand disorder. The Veteran seeks service connection for a left hand condition. He maintains that left hand symptoms, including pain and swelling, are related to service. At the Board hearing in June 2019, the Veteran asserted that symptoms of pain and swelling are a result of repetitive parachute packing during service and/or injury. He noted having packed about a million parachutes. As reflected above, while on remand, service connection was granted for the Veteran's right hand condition as a result of an in injury sustained on a parachute landing that required surgery. However, the evidence does not show an injury to the left hand. The May 1967 separation examination report shows that the upper extremities were normal and assigned a profile a profile of "1." See Odiorne, 3 Vet. App. at 457. He denied having or having had swollen joints; arthritis or rheumatism; bone, joint, or other deformity; and lameness. See November 2016 Military Personnel Record. Pursuant to the Board's December 2019 remand, the Veteran was afforded a VA examination in January 2021. The examiner reported that the Veteran's left hand is normal. Range of motion testing of the left hand and fingers was normal, including on passive range of motion testing. No pain was reported, including when used in non-weight bearing. Sensation was normal and good hand grip and strength were noted. Moreover, no functional impairment in earning capacity was reported. See Saunders, 886 F.3d at 1356; Wait, 33 Vet. App. at 15-16. Further, a rash was noted on the right hand not the left. Additionally, and although the Veteran's wife stated that the Veteran's VA doctor advised that the Veteran has severe arthritis and nerve damage in his hands, see June 2019 Board hearing transcript, the VA examiner reported that the Veteran did not have weakened movements due to muscle or peripheral nerves injury of the left hand. In addition, x-ray examination of the left hand was normal. See also September 2014 VA examination report. As noted above, service connection may only be granted for a current disability; when a claimed condition is not shown, there may be no grant of service connection. See Brammer, 3 Vet. App. at 225. The Board notes that although a July 2018 letter from a VA clinician indicates that the Veteran had ongoing treatment for multiple medical problems related to service, there was no reference to a left hand disorder. See LeShore, 8 Vet. App. at 409. The evidence, including records obtained pursuant to the Board's December 2019 remand, including service records, see January 2020 Military Personnel Record & STRs, does not show that the Veteran has or has had left hand symptoms that result in any functional impairment in earning capacity at any time during the period on appeal. See Saunders, 886 F.3d at 1367-68; Wait, 33 Vet. App. at 15-16. As noted above, although the Veteran is competent to report his symptoms, a determination as to whether he has a left hand disorder is a complex matter requiring related medical expertise. See Jandreau, 492 F.3d at 1372. As the Veteran has no known or reported medical expertise, his opinion as to diagnosis lacks probative value, and an opinion by a qualified medical professional is required to decide the claim. In that regard, the opinion rendered by January 2021 VA examiner constitutes such competent medical evidence. Further, as the opinion is unequivocally stated, consistent with the record, and supported by cited evidence of record, the Board finds that the medical opinion is probative evidence against the Veteran's claim. A left hand disorder or As the preponderance of the evidence is against the claim of service connection for a left hand disorder, there is no doubt to be resolved. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Therefore, service connection for a left hand disorder is not warranted. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Taylor 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.