12-17 589
12-17 589
| Board of Vet. App. | Feb 2, 2017Background
- Veteran served active duty Jan–Jul 1988 and Nov 1990–Aug 1991, including Southwest Asia (Gulf War); reserve service also 1987–1991. Appeal from Jan 2010 RO rating decision; Board remanded in May 2015 and obtained VA exams in Oct 2015 and July 2016.
- Claims: service connection for bilateral knee disability, bilateral foot disability, skin disability (multiple lipomas), and gastrointestinal disability (including possible IBS).
- Relevant medical record: service treatment records show limited foot stress reaction in 1988 and no documented lipomas or knee problems during service; later records note knee pain (patellar tendonitis diagnosed Oct 2015), pes planus (diagnosed July 2016), and multiple benign lipomas (diagnosed 2015–2016). X‑rays negative for arthritis/osseous abnormality.
- VA examinations in Oct 2015 and July 2016 reviewed records, examined the Veteran, and provided nexus opinions finding the knee tendonitis, pes planus, and lipomas less likely than not related to service; July 2016 found no current knee disability.
- Board concluded the preponderance of the evidence is against service connection for knees, feet, and skin (denied); remanded the gastrointestinal claim for a complete IBS workup and new opinion.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Service connection — bilateral knees | Veteran contends knee injury/pain began in service (jumped off trailer) and persisted; private physician supports possible service acquisition | VA records show no knee diagnosis in service; VA exams found either no current knee disability or that tendonitis is not related to service | Denied — preponderance against nexus; no current diagnosable chronic knee disability attributable to service |
| Service connection — bilateral feet | Veteran alleges stress fractures/overuse in basic training caused long‑term foot problems (pes planus) | Service records lack pes planus; VA exams diagnosed pes planus but opined less likely than not related to service | Denied — pes planus not shown to be related to service |
| Service connection — skin (lipomas) | Veteran reports lumps appearing around 1991 and shortly after discharge | Service exams in 1991 were normal; VA exams characterize lipomas as benign and possibly familial, not linked to Gulf exposures | Denied — preponderance against nexus to service |
| Service connection — gastrointestinal (IBS) | Veteran claims GI symptoms possibly related to Gulf service | VA 2016 examiner could not complete opinion without full IBS workup | Remanded — obtain complete GI workup and opinion addressing IBS, chronic multisymptom illness criteria, and nexus to service |
Key Cases Cited
- Barr v. Nicholson, 21 Vet. App. 303 (2007) (VA exam adequacy and reasoning requirements)
- Stegall v. West, 11 Vet. App. 268 (1998) (AOJ compliance with Board remand directives)
- McLain v. Nicholson, 21 Vet. App. 319 (2007) (diagnosis during pendency can satisfy current disability requirement)
- Shedden v. Principi, 381 F.3d 1163 (2004) (elements for direct service connection)
- Brammer v. Derwinski, 3 Vet. App. 223 (1992) (no service connection without proof of present disability)
- Buchanan v. Nicholson, 451 F.3d 1331 (2006) (lay evidence admissible; weight considerations)
- Maxson v. West, 12 Vet. App. 453 (1999) (negative inference from absence of treatment over extended period)
- Jandreau v. Nicholson, 492 F.3d 1372 (2007) (competence of lay evidence for medical matters)
- Gilbert v. Derwinski, 1 Vet. App. 49 (1990) (benefit of the doubt rule and burden of proof)
- McClendon v. Nicholson, 20 Vet. App. 79 (2006) (requirement for adequate medical examinations)