Citation Nr: 25005158 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 24-00 162 DATE: April 16, 2025 ORDER Service connection for costochondritis is granted. FINDINGS OF FACT 1. The evidence shows a diagnosis of costochondritis during the appeal period. 2. The Veteran participated in strenuous physical training exercises during service that led to a diagnosis of costochondritis. 3. The in-service strenuous physical training exercises caused the current costochondritis. CONCLUSION OF LAW Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for costochondritis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran, who is the appellant, had active service from April 2009 to August 2014, which included service in Southwest Asia. The instant case is on appeal to the Board of Veterans' Appeals (Board) from a January 2016 Department of Veterans Affairs (VA) Regional Office (RO) rating decision that denied service connection for costochondritis. The legacy system applies to this appeal. In a July 2024 private opinion, the private examiner wrote that the Veteran had not been provided with an adequate VA examination, as there were specific tests that should have been conducted to determine if costochondritis was present. As the instant decision is a full grant of the benefits sought on appeal, the Board does not need to further discuss the adequacy of the VA examination. Service Connection for Costochondritis is Granted. The Veteran appeals for service connection for costochondritis, contending that current costochondritis is etiologically related to in-service strenuous physical training exercises. Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. With any claim for service connection (under any theory of entitlement), it is necessary for a current disability to be present. See Brammer v. Derwinski, 3 Vet. App. 223 (1992); see also McClain v. Nicholson, 21 Vet. App. 319 (2007) (service connection may be warranted if there was a disability present at any point during the claim period, even if it is not currently present); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013) (when the record contains a recent diagnosis of disability immediately prior to a veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency). The evidence shows that, during the period on appeal, the Veteran was diagnosed with costochondritis, alternatively diagnosed as Tietze's Syndrome. See, e.g., December 2015 VA Treatment Record; June 2016 VA Treatment Record. While at a May 2024 VA examination the VA examiner did not find evidence of costochondritis, a current disability for VA compensation purposes exists when the diagnosis is present at any point during the period on appeal, even if it has resolved during the appeal period. See McClain, 21 Vet. App. at 319. For these reasons, the Board finds that the service connection requirement of a current disability of costochondritis has been met. After a review of the lay and medical evidence of record, the Board finds that the evidence is at least in relative equipoise on the question of whether the Veteran participated in strenuous physical training exercises during service, which would serve as an in-service "event" for VA compensation purposes. In an April 2024 lay statement, the Veteran wrote that service as a firefighter required a range of strenuous physical training exercises, which included raising and climbing ladders, dragging and pulling fire hoses, academic training including first aid response, fire ground search and rescue, driving the fire engine and familiarizing the crews with building lay outs, responding to any fire, medical, and/or HAZMAT emergencies. The physical training at a minimum consisted of 30 minutes of cardiovascular exercises, mainly running, push-ups, and sit-ups. The Veteran reported that he would run at least four times per week and would practice drags and carries with life-size mannequins around twice per month outside of an actual emergency. Given the Veteran's competent report of extensive physical training exercises during service, the Board will resolve reasonable doubt in favor of the Veteran to find that the Veteran experienced the "event" of strenuous physical training exercises during service. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Contemporaneous to the in-service event of strenuous physical training, costochondritis was diagnosed during service. See, e.g., December 2011 Private Treatment Record (finding the Veteran was seen with a history and physical examination that was consistent with right lower costochondritis and recommending rest with no strenuous activity for four to six weeks with a high dose of anti-inflammatory medication); January 2012 Service Treatment Record (documenting that the Veteran was seen for right costochondral pain while participating in physical training tests); May 2013 Service Treatment Record (documenting right costochondral pain). These in-service diagnoses provide an additional in-service incurrence for service connection purposes. The evidence is at least in relative equipoise on the question of whether the in-service strenuous physical training exercises caused the current costochondritis. A July 2024 private opinion provided a positive nexus opinion, opining that costochondritis developed and continues to recur because of strenuous physical activity related to required physical fitness tests and the occupation of a firefighter during service. See July 2024 Private Opinion. The July 2024 private examiner noted the in-service diagnoses of costochondritis, the Veteran's description of strenuous physical activities that he performed, which would have required use of the chest and back, and pertinent medical literature. The July 2024 private examiner wrote that medical literature documents that costochondritis can be precipitated by vigorous activity of the upper extremities, coughing, or strenuous activity. See July 2024 Private Opinion. The claims file includes two May 2024 VA negative nexus opinions. The opinions are based solely on the absence of a finding of costochondritis at the time of examination. Because the Board is finding as a fact there is a current diagnosis of costochondritis during the claims period (per McClain), the Board finds that the May 2024 VA opinions are of no probative value, as they are based on an inaccurate factual assumption that there is not a current disability - a factual assumption that is contrary to the facts as found by the Board in this case after weighing all lay and medical evidence. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that an opinion based upon an inaccurate factual premise has no probative value). The Board will resolve reasonable doubt in favor of the Veteran to find that the strenuous in-service physical training exercises caused the current costochondritis. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. As there is evidence of a current disability of costochondritis, the in-service "event" of strenuous in-service physical training exercises, and a nexus between the current costochondritis and the in-service strenuous physical training exercises, the criteria for direct service connection (38 C.F.R. § 3.303(a), (d)) have been met and the Board will grant the appeal. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Smith, Associate 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.