Citation Nr: 22018508 Decision Date: 03/29/22 Archive Date: 03/29/22 DOCKET NO. 17-58 023 DATE: March 29, 2022 ORDER Entitlement to service connection for fibromyalgia, to include as secondary to service-connected disabilities, is denied. FINDING OF FACT The evidence of record persuasively weighs against finding that the Veteran has had fibromyalgia at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for fibromyalgia 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 served on active duty in the United States Army from July 1976 to August 1978. These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The remanded this matter for further development in April 2019. The Board finds that there has been substantial compliance with the January 2017 remand directives and that the matters are now properly before the Board. See, Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board notes that service connection for costochondritis was granted in a May 2020 rating decision. As such, that matter is no longer in appellate status. 1. Entitlement to service connection for fibromyalgia, to include as secondary to service-connected disabilities. The Veteran contends that he has fibromyalgia that is related to his active-duty service or is secondary to his service-connected disabilities. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of fibromyalgia and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). February 2016 VA treatment record notes the Veteran was referred for multiple joint pains and Achilles' tendinosis. The Veteran reported that his symptoms first started with his lumbar spine in the 1970s after parachute jumping. He then stated that in 2005v he was a truck driver and had L4/L5 disc herniation and now has right hip pain with radiation down the right leg. Bilateral knee osteoarthritis was also noted. Upon examination, "[s]uspect fibromyalgia" with diffuse point tenderness was noted. Here, the Board finds that the use of the term "suspect" renders the assessment of fibromyalgia as vague and not conclusive. See generally, Tirpak v. Derwinski, 2 Vet. App. 609, 610 (1992) (doctor's letter stating probability in terms of "may or may not" was speculative); Bostain v. West, 11 Vet. App. 124, 127-28 (1998), quoting Obert v. Brown, 5 Vet. App. 30, 33 (1993), (a medical opinion expressed in terms of "may" also implies "may or may not" and is too speculative to establish a causal relationship). As such, this opinion is of no probative value. The Veteran was afforded a contract VA fibromyalgia examination in May 2017. It was noted that the Veteran reported being diagnosed with fibromyalgia 6 months prior, but the examiner noted that "there is limited documentation that can confirm this diagnosis." The examiner further noted that one diagnosing criteria for fibromyalgia is that there is no other disorder that could explain the symptoms, then noted that the Veteran has thoracolumbar spine degenerative joint disease with degenerative disc disease to account for the diffuse back pain, as well as bilateral knee degenerative joint disease that can account for his knee pains. The examiner then noted that fibromyalgia is not from an autoimmune, inflammation, joint, or muscle disorder. It was then noted that the Veteran had no symptoms of fibromyalgia or no tender points for pain. The examiner then concluded that the Veteran does not have a current diagnosis of fibromyalgia. In his June 2017 Notice of Disagreement (NOD), the Veteran asserted that fibromyalgia is caused by trauma, such as "breaking [his] back" in service. In support of this assertion, the Veteran submitted an article with his NOD that states "[a] large number of fibromyalgia patients do seem to have suffered from serious injury or muscle trauma". The Veteran added a handwritten assertion that his service-connected lower back injury caused his fibromyalgia. In a January 2019 correspondence, the Veteran asserted that his fibromyalgia "metastasized" from his cervical and lumbar spine disabilities. The Veteran was afforded a VA fibromyalgia examination in November 2019. The VA examiner noted that the Veteran does not meet the criteria for fibromyalgia, noting that Up TO Date stated that fibromyalgia should be suspected in patients with chronic pain of at least 3 months duration without another identified cause. The examiner stated that although a VA rheumatologist diagnosed fibromyalgia in 2017, the examination was "perfunctory" and did not address or mention the underlying conditions of degenerative disease affecting both the cervical and lumbar spines. The examiner then noted that the Veteran's symptoms, radiographic findings, and the examination were more consistent with degenerative disease that with fibromyalgia. Specifically, the examiner noted limited range of motion, marked asymmetry of symptoms, and lacking tender points in areas not affected by degenerative disease. The examiner found that the Veteran does not meet the third criteria for fibromyalgia, as there is another disorder that explains his symptoms. Here, the Board finds that both the May 2017 and November 2019 VA opinions contain clear conclusions with supporting data and well-reasoned rationales. Nieves-Rodrigues v. Peake, 22 Vet. App. (2008). As such, the Board finds these opinions to be significantly probative. The Board acknowledges the article submitted by the Veteran notes that some people with fibromyalgia have suffered trauma. The Court has held that a medical article or treatise "can provide important support when combined with an opinion of a medical professional" if the medical article or treatise evidence discusses generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least "plausible causality" based upon objective facts rather than on an unsubstantiated lay medical opinion. Mattern v. West, 12 Vet. App. 222, 228 (1999). See also, Sacks v. West, 11 Vet. App. 314 (1998); Wallin v. West, 11 Vet. App. 509 (1998). In short, articles and treatises tend to be general in nature and tend not to relate to the specific facts in a given veteran's claim. In the present case, the article submitted by the Veteran falls into this general category. Ultimately, the article provides general information and does not relate specifically to the facts and circumstances surrounding the case of this Veteran. Thus, this evidence holds less probative weight than the other evidence of record in this case. While the Veteran believes he has a current diagnosis of fibromyalgia, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education, knowledge of the interaction between multiple organ systems in the body, and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for fibromyalgia is warranted. Rather, the evidence persuasively weighs against finding that the Veteran has a current diagnosis of fibromyalgia. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application as to this claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Keeley, Brian 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.