Citation Nr: 21042615 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 16-41 318 DATE: July 13, 2021 ORDER Service connection for a cervical (neck) spine disability is denied. Service connection for a disability manifesting as headaches is denied. Service connection for a right shoulder disability is denied. Service connection for a left knee disability is denied. Service connection for a right knee disability is denied. Service connection for a degenerative disease (arthritis) of the lumbar spine is granted. Service connection for a left hand disability is denied. Service connection for a right hand disability is denied. Service connection for a left hip disability is denied. Service connection for a right hip disability is denied. Service connection for a left ankle disability is denied. Service connection for a right ankle disability is denied. Service connection for a left foot disability is denied. Service connection for a right foot disability is denied. FINDINGS OF FACT 1. The weight of the evidence is against a finding that the Veteran has a current cervical spine disability or that any current symptoms reach the level of a functional impairment of earning capacity; to the extent that they do, the weight of the evidence is against a finding that they are related to service. 2. The weight of the evidence is against a finding that the Veteran has a current headache disability or that any current symptoms reach the level of a functional impairment of earning capacity; to the extent that they do, the weight of the evidence is against a finding that they are related to service. 3. The weight of the evidence is against a finding that any current right shoulder disability was incurred in service or is related to service. 4. The weight of the evidence is against a finding that the Veteran has a current left knee disability that is related to service. 5. The weight of the evidence is against a finding that the Veteran has a current right knee disability that is related to service. 6. The competent evidence shows that the Veteran's current lumbar spine disability, to include arthritis, was incurred in service and continued chronic since then. 7. The weight of the evidence is against a finding that the Veteran has a current left hand disability that is related to service. 8. The weight of the evidence is against a finding that the Veteran has a current right hand disability that is related to service. 9. The weight of the evidence is against a finding that any current left hip disability was incurred in service or is related to service. 10. The weight of the evidence is against a finding that any current right hip disability was incurred in service or is related to service. 11. The weight of the evidence is against a finding that the Veteran has a current left ankle disability that is related to service. 12. The weight of the evidence is against a finding that the Veteran has a current right ankle disability that is related to service. 13. The weight of the evidence is against a finding that the Veteran has a current left foot disability that is related to service. 14. The weight of the evidence is against a finding that the Veteran has a current right foot disability that is related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for a cervical spine disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a disability manifesting as headaches are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a right shoulder disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for a right knee disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for degenerative disease (arthritis) of the lumbar spine are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309. 7. The criteria for service connection for a left hand disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for a right hand disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for service connection for a left hip disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 10. The criteria for service connection for a right hip disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 11. The criteria for service connection for a left ankle disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 12. The criteria for service connection for a right ankle disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 13. The criteria for service connection for a left foot disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 14. The criteria for service connection for a right foot disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1976 to October 1984. This matter comes before the Board of Veterans' Appeals (Board) from a May 2013 rating decision. 1. Service connection for a cervical spine disability is denied. 2. Service connection for a disability manifesting as headaches is denied. The Veteran seeks service connection for a disability described as neck pain and headaches, as a result of a garage door coming down on his head, in 1980 or 1981. 10/09/2012, VA 21-526EZ, Fully Developed Claim. VA treatment records show treatment since September 2011. The Board has reviewed these records but found no indication that the Veteran has a current cervical spine disability or a disability manifesting as headaches. Similarly, service treatment records, which show treatment for other types of injures, are silent for a neck or head injury, or an injury sustained in the manner described by the Veteran. Additionally, there is no argument or indication that any current cervical spine symptoms or headaches reach the level of a functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (Fed. Cir. 2018). Insofar as the Veteran believes that he has a cervical spine or headaches disability that is related to service, the Board notes that he is not competent to either provide a diagnosis or establish a causal nexus. The issue is medically complex, as it requires specialized medical education, to include of the orthopedics and/or neurological factors and body systems. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). As such, the Board finds that the Veteran is not competent to provide a diagnosis or evidence of nexus on these matters and that any statements from him in this regard lack weight. The Board gives more probative weight to the competent medical evidence. In sum, the weight of the evidence is against a finding that the Veteran has a current neck disability or disability manifesting as headaches. Similarly, there is no indication that his symptoms have reached the level of a functional impairment of earning capacity. Furthermore, there is no evidence suggesting that any such functional impairment, were it to exist, is related to an injury in service. The only evidence submitted by the Veteran is the statement that he injured his head in service during a garage door accident. While this statement can be competent and can tend to establish an injury in service, it does not indicate a nexus between any current symptoms and service. In view of this, the Board finds that VA's duty to provide a VA examination has not been triggered. As the preponderance of the evidence weighs against a finding that the Veteran has a current disability due to service, these service connection issue are denied. Finally, the Veteran should be aware that he is free to submit a supplemental claim for these issues (or any other issues being denied in the present decision) at any time in the future, provided that he submits new and relevant evidence. See 38 C.F.R. § 3.2501; see also 38 C.F.R. § 3.2500(h) (regarding effective dates for continuously pursued claims and supplemental claims). 3. Service connection for a right shoulder disability is denied. VA treatment records shows consistent complaints of pain in the right shoulder. 06/11/2016, CAPRI, at 166. Subsequent, VA treatment notes reference a diagnosis of osteoarthritis, site unspecified. Id. at 57, 125. As such, the evidence tends to show a current disability There is, however, no argument or indication that the Veteran's right shoulder disability, to include any potential arthritis, is related to service. Service treatment records, to include the separation examination, are silent for a shoulder injury, and the Veteran has not submitted any evidence in support of his claim. 38 U.S.C. § 5107(a). In fact, there is no indication that the Veteran has actively claimed service connection for a right shoulder disability. Rather, it appears that the Agency of Original Jurisdiction (AOJ) found the issue to have been raised by VA treatment records. In this regard, the evidence does not tend to show an in-service event, injury, or disease. The Veteran's representative contends in a February 2021 brief that a new VA examination is warranted for additional x-rays to determine the severity of his condition and for an etiological opinion. As described above, the Board has already found competent evidence of a current disability and the level of severity is not at issue because the right shoulder is not service-connected. Further, as an in-service event is not of record another VA examination is not indicated. As the preponderance of the evidence weighs against a finding that any current disability was incurred in service or is related to service, the Board finds that VA's duty to provide a VA examination has not been triggered. For that same reason, this service connection is denied. 4. Service connection for a left knee disability is denied. 5. Service connection for a right knee disability is denied. Service treatment records show complaints of a sore left knee in January 1977, treatment for a mild left knee sprain in April 1983 and complaints of left knee pain (diagnosed as mild muscle strain) in April 1984. 01/10/2013, STR-Medical, at 11, 38, and 49. In contrast, the separation examination is silent for knee abnormalities. Id. at 104-105 At an April 2013 VA examination, the Veteran complained of pain in both knees, but later contradicted himself by saying that he really does not have pain in the knees. Rather, he stated that he was worried about variations in his knee reflexes. He described his knees as occasionally cranky, unable to bend or straighten. In the diagnosis section, the VA examiner recorded an in-service diagnosis, namely, a "mild muscle strain [of the] left knee with no physical findings at the time" from Apri 1984. There is, however, no indication that the VA examiner found a current diagnosis. Rather, in her opinion, the examiner stated that the Veteran only had one current diagnosis overall, the one for his lumbar spine (addressed below). 4/24/2013 VA examination, at 71. VA treatment records show treatment since September 2011. The Board has reviewed these records but found no indication that the Veteran has a diagnosed knee disability. Additionally, there is no argument or indication that any current knee symptoms reach the level of a functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (Fed. Cir. 2018). In support, the 2013 VA examination report reflects no pain or tenderness on palpation, muscles strength of 5/5, no instability, and no functional impact on his ability to work. This competent evidence tends to weigh against a finding of an impairment of earning capacity. Insofar as the Veteran believes that he has a knee disability that is related to service, the Board notes that he is not competent to either provide a diagnosis or establish a causal nexus. The issue is medically complex, as it requires specialized medical education, to include knowledge of the knee and related orthopedics. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). As such, the Board finds that the Veteran is not competent to provide a diagnosis or evidence of nexus in regarding to the knee and that any statements from him in this regard lack weight. The Board gives more probative weight to the competent medical evidence. As mentioned, a VA examiner concluded that the Veteran does not have a current knee disability. The Board finds that this opinion is adequate under the circumstances of the present case, in which the Veteran has not submitted any evidence in support of his claim. 38 U.S.C. § 5107(a). Furthermore, the VA opinion shows adequate consideration of, and is consistent with, the relevant evidence of record so it is given weight. In sum, the weight of the evidence is against a finding that the Veteran has a current knee disability. Similarly, there is no indication that his symptoms have reached the level of a functional impairment of earning capacity. Furthermore, there is no evidence suggesting that any such functional impairment, were it to exist, is related to an injury in service. The Veteran has not submitted any evidence in support of his claim. In fact, there is no indication that the Veteran has actively claimed service connection for a knee disability. Rather, it appears that the AOJ found the issue to have been raised by service treatment records. As the preponderance of the evidence weighs against a finding that the Veteran has a current disability due to service, service connection for left and right knees is denied. 6. Service connection for a lumbar spine disability is granted. An April 2013 VA examination shows a diagnosis of mild to moderate degenerative disease of the lumbar spine and document arthritis per a 2013 x-ray. Therefore, the competent medical evidence establishes a current disability. So, the question for the Board is whether this current lumbar disability is at least as likely as not related to service. Service treatment records show complaints of low and mid back pain in October 1982 and November 1983. 01/10/2013, STR-Medical, at 6, 7 & 33. In contrast, the separation examination is silent regarding a back abnormality. Id. at 104-105. However, the weight of the service treatment records show document in-service complaints of pain and treatment regarding the lumbar spine so the second service connection element is also established. At the April 2013 VA examination, the Veteran suggested that his back pain started at some point in the 1980s but could not recall any details. Regarding his inability to recall details, he mentioned that he spent most of the 1980s with severe alcohol abuse symptoms and could not really remember. He acknowledged that he had never seen a doctor for his back pain. It was noted that the back issue had been gradual in its development, with no specific injuries or radicular symptoms. The April 2013 VA examiner opined that the Veteran's current lumbar spine disability is less likely than not related to service. The examiner's rationale was that "the medical record does not find any conditions not self-limited, nor evidence of chronicity to indicate [the current disability] began in service." In this regard, the examiner noted that the Veteran's service treatment records showed multiple self-limiting conditions, but without follow-up or subsequent medical record to establish chronicity. 04/24/2013, VA examination, at 71. The Veteran's representative, in a February 2021 brief, contends a nexus is established due to the Veteran's consistent reports of back pain and the chronic nature of arthritis. The Board recognizes the Veteran's statement at the 2013 examination that his back pain began in the 1980s and that service treatment records, as described above, tend to support this statement. The Veteran also reported at the examination not seen a doctor for his back pain, but that it has been gradual in developing. The Veteran is competent and credible to report the onset and gradual increase in back pain. In light of the current documented arthritis per x-ray, and the chronic nature of this disease, the Board resolves doubt in favor of the Veteran on this material issue and finds continuous lumbar symptomatology from service. As such, service connection is warranted for degenerative disease (arthritis) of the lumbar spine. 7. Service connection for a left hand disability is denied. 8. Service connection for a right hand disability is denied. Service treatment records show treatment for a rash to the wrist and palm of hand (side unspecified) in October 1977, for a laceration to the fifth digit of the left hand in January 1978, and for blunt trauma to the left thumb (diagnosed as soft tissue injury). 01/10/2013, STR-Medical, at 23, 30, 35-36. In contrast, the separation examination is silent for hand abnormalities. Id. at 104-105 At an April 2013 VA examination, the Veteran complained of join pain in both hands, with pain worst in the palms (right worse than the left). In the diagnosis section, the VA examiner recorded two in-service diagnoses: (1) the laceration to the fifth digit of the left hand and (2) the rash on hand and wrist noted in 1977. There is, however, no indication that the VA examiner found a current diagnosis. Rather, in her opinion, the examiner stated that the Veteran only had one current diagnosis overall, the one for his lumbar spine. 4/24/2013 VA examination, at 71. VA treatment records show treatment since September 2011. The Board has reviewed these records but found no indication that the Veteran has a diagnosed had disability. Additionally, there is no argument or indication that any current hand symptoms reach the level of a functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (Fed. Cir. 2018). In support, the 2013 VA examination report reflects no functional impact from the Veteran's hand on his ability to work. Such evidence tends to weigh against an impairment of earning capacity. Insofar as the Veteran believes that he has a knee disability that is related to service, the Board notes that he is not competent to either provide a diagnosis or establish a causal nexus. The issue is medically complex, as it requires specialized medical education, to include of the hands and the processes related to lacerations and/or trauma. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). As such, the Board finds that the Veteran is not competent to provide a diagnosis or evidence of nexus of the hands and that any statements from him in this regard lack weight. The Board gives more probative weight to the competent medical evidence. As mentioned, a VA examiner concluded that the Veteran does not have a current hand disability. The Board finds that this opinion is adequate under the circumstances of the present case, in which the Veteran has not submitted any evidence in favor of his claim. Furthermore, the VA opinion shows adequate consideration of, and is consistent with, the relevant evidence of record. In sum, the weight of the evidence is against a finding that the Veteran has a current hand disability. Similarly, there is no indication that his symptoms have reached the level of a functional impairment of earning capacity. Furthermore, there is no evidence suggesting that any such functional impairment, were it to exist, is related to an injury in service. The Veteran has not submitted any evidence in support of his claim. In fact, there is no indication that the Veteran has actively claimed service connection for a hand disability. Rather, it appears that the AOJ found the issue to have been raised by service treatment records. As the preponderance of the evidence weighs against a finding that that the Veteran has a current disability due to service, the Veteran's claim of service connection of the left and right hands is denied. 9. Service connection for a left hip disability is denied. 10. Service connection for a right hip disability is denied. VA treatment records shows complaints of pain in the hip (side unspecified), in November 2012. 06/11/2016, CAPRI, at 166. Subsequent, VA treatment notes reference a diagnosis of osteoarthritis, site unspecified. Id. at 57, 125. In light of this competent evidence, the Board will resolve doubt in favor of the Veteran on this material issue and find a current disability has been established. There is, however, no argument or indication that any current hip disability, to include any potential arthritis, is related to service. Service treatment records, to include the separation examination, are silent for a hip injury, and the Veteran has not submitted any evidence in support of his claim. In fact, there is no indication that the Veteran has actively claimed service connection for a hip disability. Rather, it appears that the AOJ found the issue to have been raised by VA treatment records. Similar to the right shoulder issue, the Veteran's representative contends in a February 2021 brief that a new VA examination is warranted for additional x-rays to determine the severity of his condition and for an etiological opinion of the right hip. As described above, the Board has already found competent evidence of a current right hip disability and the level of severity is not at issue because the right hip is not service-connected. Further, as an in-service event is not of record another VA examination is not indicated. So, the Board finds that VA's duty to provide a VA examination has not been triggered. As the preponderance of the evidence weighs against a finding that any current disability was incurred in service or is related to service, the Veteran's claim of service connection for left and right hips is denied. 11. Service connection for a left ankle disability is denied. 12. Service connection for a right ankle disability is denied. Service treatment records show treatment for a right ankle injury in February 1978 and a left ankle injury in April 1983. 01/10/2013, STR-Medical, at 10-11 & 31. They also show complaints of painful popping in the left ankle in March 1980. Id. at 15. In contrast, the separation examination is silent for ankle abnormalities. Id. at 104-105 At an April 2013 VA examination, the Veteran complained of pain in multiple joints, to include the ankles. Regarding the ankles, he stated that the right ankle bothers him "quite a bit" but denied any issue with the left ankle. The VA examiner, however, concluded that the Veteran did not have a current diagnosis for his ankles. VA treatment records show treatment since September 2011. The Board has reviewed these records but found no indication that the Veteran has a diagnosed ankle disability. Additionally, there is no argument or indication that any current ankle symptoms reach the level of a functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (Fed. Cir. 2018). The 2013 VA examination report reflects that the Veteran did not have flare-ups and had normal plantar flexion and dorsiflexion (extension) of the both ankles without localized tenderness or pain on palpation. Additionally, it reflects no functional impact on the Veteran's ability to work due to his ankles. This competent evidence tends to weigh against a finding of impairment of earning capacity. Insofar as the Veteran believes that he has an ankle disability that is related to service, the Board notes that he is not competent to either provide a diagnosis or establish a causal nexus. The issue is medically complex, as it requires specialized medical education, to include of the ankles and orthopedics. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). As such, the Board finds that the Veteran is not competent to provide a diagnosis or evidence of nexus regarding the ankles and that any statements from him in this regard lack weight. The Board gives more probative weight to the competent medical evidence. As mentioned, a VA examiner concluded that the Veteran does not have a current ankle disability. The Board finds that this opinion is adequate under the circumstances of the present case, in which the Veteran has not submitted any evidence in favor of his claim. Furthermore, the VA opinion shows adequate consideration of, and is consistent with, the relevant evidence of record. In sum, the weight of the evidence is against a finding that the Veteran has a current ankle disability. Similarly, there is no indication that his symptoms have reached the level of a functional impairment of earning capacity. Furthermore, there is no evidence suggesting that any such functional impairment, were it to exist, is related to an injury in service. The Veteran has not submitted any evidence in support of his claim. 38 U.S.C. § 5107(a). In fact, there is no indication that the Veteran has actively claimed service connection for an ankle disability. Rather, it appears that the AOJ found the issue to have been raised by service treatment records. As the preponderance of the evidence weighs against a finding that the Veteran has a current disability due to service, the issues of service connection for left and right ankles is denied. 13. Service connection for a left foot disability is denied. 14. Service connection for a right foot disability is denied. Service treatment records show treatment for a soft tissue trauma to the left foot in April 1981, a laceration to the right foot in October 1981, bilateral athlete's foot and pain in the left great toe (diagnosed as tinea pedis and subungual hematoma) in July 1982, and a blood blister to the side of the right foot (diagnosed as tinea pedis and skin fissure crack on foot) in December 1983. 01/10/2013, STR-Medical, at 19, 27-28, 39, 42, 69 & 87. In contrast, the separation examination is silent for foot or skin abnormalities. Id. at 104-05. At an April 2013 VA examination, the Veteran stated that he had athlete's foot in service and that he had it for many years, until he eventually used an over-the-counter cream and the symptoms cleared up in a week, with no recurrence ever since. In the diagnosis section, the VA examiner recorded two in-service diagnoses: (1) right foot 1.5 cm laceration without residuals from October 1981 and (2) left foot bruise/athlete's foot from April 1981 and December 1983. There is, however, no indication that the examiner found a current diagnosis. Rather, in her opinion, the examiner stated that the Veteran only had one current diagnosis overall, the one for his lumbar spine. 4/24/2013 VA examination, at 71. VA treatment records show treatment since September 2011. The Board has reviewed these records but found no indication that the Veteran has a currently diagnosed foot disability. Additionally, there is no argument or indication that any current foot symptoms reach the level of a functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (Fed. Cir. 2018). The 2013 VA examination report reflects that examiner marked no to various foot disabilities, specific and general, and listed no other pertinent physical findings. Additionally, it reflects no functional impact on the Veteran's ability to work due to his feet. This competent evidence tends to weigh against a finding of impairment of earning capacity. Insofar as the Veteran believes that he has a foot disability that is related to service, the Board notes that he is not competent to either provide a diagnosis or establish a causal nexus. The issue is medically complex, as it requires specialized medical education, to include of the feet and orthopedics. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). As such, the Board finds that the Veteran is not competent to provide a diagnosis or evidence of nexus and that any statements from him in this regard lack weight. The Board gives more probative weight to the competent medical evidence. As mentioned, a VA examiner concluded that the Veteran does not have a current foot disability. The Board finds that this opinion is adequate under the circumstances of the present case, in which the Veteran has not submitted any evidence in favor of his claim. Furthermore, the VA opinion shows adequate consideration of, and is consistent with, the relevant evidence of record. In sum, the weight of the evidence is against a finding that the Veteran has a current foot disability. Similarly, there is no indication that his symptoms have reached the level of a functional impairment of earning capacity. Furthermore, there is no evidence suggesting that any such functional impairment, were it to exist, is related to an injury in service. The Veteran has not submitted any evidence in support of his claim. 38 U.S.C. § 5107(a). In fact, there is no indication that the Veteran has actively claimed service connection for a foot disability. Rather, it appears that the AOJ found the issue to have been raised by service treatment records. (Continued on the next page) As the preponderance of the evidence weighs against a finding that the Veteran has a current disability due to service, the issues of service connection for left and right feet is denied. Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. López, 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.