Citation Nr: 22015986 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 09-03 061 DATE: March 21, 2022 ORDER Entitlement to service connection for arthralgias, to include arthritis, (other than thoracolumbar spine, cervical strain, left elbow, left shoulder, and left hip) is granted. FINDING OF FACT The Veteran has arthralgias, to include arthritis, that are related to an in-service injury, event, or disease. CONCLUSION OF LAW The criteria for service connection for arthralgias, to include arthritis, have been satisfied. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from January 1968 to November 1971, and from March 1973 to September 1973. The Veteran passed away in January 2021. The Appellant, his surviving spouse, was recognized as the substitute claimant in March 2021. This matter is on appeal to the Board of Veterans Appeals (Board) from a May 2008 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In December 2011, October 2013, May 2017, June 2018, and June 2020, the Board remanded the matter to the Agency of Original Jurisdiction (AOJ) for additional development, and it has since returned for further appellate review. The Board notes that the Veteran filed a claim of entitlement to service connection for "arthritis" with no further specification. As explained in the June 2018 and June 2020 Board remands, the issue was recharacterized to broadly encompass the Veteran's reported symptoms. See Saunders v. Wilkie, 886 F. 3d 1356, 1363 (Fed. Cir. 2018) (pain alone can constitute a "disability" under 38 U.S.C. § 1110 because pain can cause functional impairment); see also, Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009) (in determining the scope of a claim, the Board must consider the claimant's description of the claim, symptoms described, and the information submitted or developed in support of the claim). Accordingly, the issue is expanded as indicated on the title page. In the June 2020 remand, the Board directed the AOJ to obtain any outstanding treatment records, and to schedule the Veteran for a VA examination to determine the nature and etiology of his arthralgias, arthritis, and/or any disability of the joints. The Board finds that there was substantial compliance with the remand directives as adequate attempts were made to obtain any outstanding treatment records, and the Veteran was afforded VA examinations consistent with instructions from the Board. See Stegall v. West, 11 Vet. App. 268 (1998). 1. Service Connection for Arthralgia, to include Arthritis The Veteran had asserted that his arthritis began during active service. See June 2008 Notice of Disagreement. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an 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. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). VA has established certain rules and presumptions for chronic diseases, such as arthritis. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). With chronic diseases shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless attributable to intercurrent causes. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. § 3.303(b). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). The Board concludes that the Veteran had a current disability that began during active service or otherwise is related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Turning to the evidence, the Veteran presented for VA examinations in July 2017 where he was diagnosed with osteoarthritis of the right hip, osteoarthritis of both hands, osteoarthritis of both knees, degenerative joint disease (DJD) of the right shoulder, DJD of the bilateral wrists, DJD of the right elbow, and DJD of the right ankle. See also August 2019, October 2020 VA Examinations. He was also diagnosed with unspecified polyarthritis. See April 2021 VA Medical Opinion. Thus, the question becomes whether the current disability is related to service. Service treatment records (STR) show that in July 1969, the Veteran sustained injuries from a motor vehicle accident (MVA) including multiple contusions over the forehead, face, left leg, and bilateral arms. STRs document complaints of pain on motion of the knees and pain in the right shoulder. An October 1969 STR reflects complaint of pain in the right trapezius, diagnosed as muscle spasm. March 1970 and August 1970 STRs indicate continued complaint for right trapezius pain. In October 1976, the Veteran sustained a left knee injury from another MVA. A December 1976 STR shows complaint of pain in joints. A May 1978 STR note chronic right shoulder pain since the July 1969 MVA. A December 1979 STR shows complaint of pain in the joints, specifically the right hip and right elbow, diagnosed as joint problems associated with degenerative joint disease secondary to MVA, with possible muscle strain and possible tendon strain. In December 1987, the Veteran experienced a slip and fall in which he landed on his left arm. An August 1990 STR shows complaint of right hip pain, and the examiner noted that the Veteran had developed myalgia of the feet and right hip during practice sessions. He was diagnosed with right hip bursitis. An August 1992 STR note a history of arthritis, and indicate a diagnosis of polyarthritis. In a December 1992 STR, the Veteran complained of having multi joint pain, and was diagnosed with polyarthritis. During another December 1992 STR, there were complaints of migrating joint pain, specifically in the elbows, shoulders, hips, knees, and ankles. The examiner diagnosed the Veteran with joint pain secondary to degenerative joint disease and habitus. A May 1993 STR reflects degenerative joint disease. A July 1993 STR reflects a history of arthritis and painful joints. The Veteran was afforded VA examinations in July 2017 and August 2019 where accompanying medical opinions were provided. However, these medical opinions have been deemed inadequate and thus, will not be addressed in this decision. See June 2018, June 2020 Board Remand. Consistent with the June 2020 Board remand, medical opinions were provided by examiners in October 2020 relating to the claim on appeal. The examiner opined that the right elbow condition was not related to service as the condition was not reported during treatments after the May 1969 MVA, and a 1973 physical examination did not show reports for right elbow condition. With the right knee, the examiner noted that while the right knee was injured during the MVA, the condition appears to have resolved as it was not mentioned in his reenlistment physical in 1973. The examiner further noted that there was no documentation of a left knee injury during service. The examiner opined that the right shoulder, right hip, and ankle conditions were not related to service as the records after the MVA did not mention any of the conditions. The Board finds these opinions inadequate as the rationales provided did not consider all of the evidence of record. Thus, the opinions are given no probative weight. Another addendum VA medical opinion as obtained in April 2021. The examiner stated the Veteran's STR document repeated complaints over many years of diffuse joint pain treated with anti-inflammatory medications but not medically explained or diagnosed definitely. The examiner noted that while the Veteran was involved in a 1969 MVA, his complaints of joint pains were noted many years later and continued through separation from service and for the remainder of his life. His STR shows on-going symptoms of discomfort in many of the joints in his upper and lower extremities. The examiner noted that there was no recorded pattern as to the onset or progression of his symptoms. The Veteran was able to perform his military duties and obligations because of self-treatment and conservative medical treatment. The examiner explained that despite many failed attempts to define precisely what exactly was causing his symptoms of diffuse joint pain, the fact is that the Veteran repeatedly sought help for his joint pains. The examiner stated that it is plausible that something other than psychosomatic illness was at play. Given the above, the examiner opined that it is likely that the Veteran had a diagnosis of unspecified polyarthritis, and that his symptoms of polyarthritis after his release from service were related to his active duty service. The Board finds this opinion highly probative as it was made by a medical professional with consideration of the specific facts in this case. The opinion is also supported by other evidence of record, such as the Veteran's STRs. As the remaining medical opinions have been deemed inadequate, there is no medical opinion or competent and credible evidence in significant conflict with the VA medical opinion. Upon review of the record, the Board finds the most persuasive evidence of record support a finding that the Veteran's current disability is related to an in-service injury, event, or disease. In that regard, the Board assigns greater probative weight to the medical evidence of record, to include the April 2021 opinion rendered by a trained medical professional based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for arthralgia, to include arthritis, is warranted. The claim is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Mathew 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.