TENDINITIS

PAULETTE VANCE BURTON · 2026 · Case ID: 26005103

DENIED

Summary

The veteran, who served in the United States Army from November 1988 to June 1992, appeals the denial of service connection for bilateral elbow disabilities, a right wrist disability, and bilateral knee disabilities. The veteran is a Persian Gulf Veteran presumed to have been exposed to toxins in service. The Board previously remanded the case for additional development, specifically requesting medical opinions on the etiology and pathophysiology of the claimed disabilities and their relation to service. The agency of original jurisdiction obtained initial opinions that did not fully comply with the remand, followed by an addendum opinion in October 2024. The Board found this addendum substantially complied with the remand directives. The VA examiner opined that the claimed disabilities were less likely than not caused by service, citing the lack of contemporaneous medical evidence, the timing of diagnoses decades after discharge, and the fully understood etiology of conditions like meniscus tears and degenerative arthritis. For the right wrist disability, the examiner noted the absence of in-service complaints and a 2023 diagnosis of a sprain, concluding it was less likely than not service-related. For the bilateral elbow disabilities, the examiner noted the absence of in-service elbow complaints and a 2023 diagnosis of tendinitis, deeming it unlikely to be related to service given the 30-year gap between service and diagnosis. The Board found no medical records or opinions supporting the veteran's claims and noted that the veteran's post-service statements regarding symptom onset were less credible due to inconsistencies with his post-service examination findings. The Board concluded the evidence was not evenly balanced, the weight of the evidence was against the claims, and therefore denied service connection for all five conditions.

Rationale

No in-service complaints or diagnosis of elbow issues.; Diagnosis of bilateral triceps tendinitis in 2023, over 30 years post-service.; Etiology and pathophysiology of tendinitis are fully understood (overuse/trauma).; Pain onset reported in 2021, six to seven months prior to 2023 evaluation.; Unlikely to be etiologically related to service.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

17-39 720A

Full Decision Text

Citation Nr: 26005103
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 17-39 720A
DATE: April 30, 2026

ORDER

Service connection for a left elbow disability, to include as a qualifying chronic disability under 38 C.F.R. § 3.317 is denied.

Service connection for a right elbow disability, to include as a qualifying chronic disability under 38 C.F.R. § 3.317 is denied.

Service connection for a right wrist disability, to include as a qualifying chronic disability under 38 C.F.R. § 3.317 is denied.

Service connection for a left knee disability, to include as a qualifying chronic disability under 38 C.F.R. § 3.317 is denied.

Service connection for a right knee disability, to include as a qualifying chronic disability under 38 C.F.R. § 3.317 is denied.

FINDINGS OF FACT

1. The Veteran's left elbow disability was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease, to include presumptive toxic exposure during service.

2. The Veteran's right elbow disability was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease, to include presumptive toxic exposure during service.

3. The Veteran's right wrist disability was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease, to include presumptive toxic exposure during service.

4. The Veteran's left knee disability was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease, to include presumptive toxic exposure during service.

5. The Veteran's right knee disability was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease, to include presumptive toxic exposure during service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for left elbow disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1117, 1118, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.317 (2021).

2. The criteria for entitlement to service connection for right elbow disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1117, 1118, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.317 (2021).

3. The criteria for entitlement to service connection for right wrist disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1117, 1118, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.317 (2021).

4. The criteria for entitlement to service connection for left knee disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1117, 1118, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.317 (2021).

5. The criteria for entitlement to service connection for right knee disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1117, 1118, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.
, 1112, 1113, 1117, 1118, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.317 (2021).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service in the United States Army from November 1988 to June 1992. He is a Persian Gulf Veteran and presumed to have been exposed to toxins in service.

These issues were previously before the Board. Most recently in December 2023, the Board remanded the appeal to the agency of original jurisdiction (AOJ) for additional development. Specifically, the Board directed the AOJ to obtain medical opinions on whether the etiologies and pathophysiologies were inconclusive, partially understood, or fully understood; and then whether they were at least as likely as not caused by the Veteran's service.

The AOJ initially obtained medical opinions in January 2024 that did not explicitly follow the remand directives. The examiner opined on the nature of the Veteran's current disabilities and how they were less likely than not caused by the Veteran's service based on the lack of contemporaneous medical evidence, and diagnosis of the disabilities decades after discharge.

In October 2024, the AOJ obtained an addendum medical opinion discussing the etiologies and pathophysiologies of the Veteran's disabilities. Thus, the Board finds that the RO substantially complied with the remand directives and no further action is necessary in this regard. Stegall v. West, 11 Vet. App. 268 (1998).

Following evidentiary development, the VA Appeals Management Center (AMC) continued the previous denials in a supplemental statement of the case (SSOC) issued in October 2024. The Veteran's VA claims file has been returned to the Board for further appellate proceedings.

Service Connection

Service connection may be granted for a disability resulting from personal injury suffered or disease contracted in the line of duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. Service connection may also be granted for a 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).

In addition, certain chronic diseases may be presumed to have been incurred during service if the disorder becomes manifest to a compensable degree within one year of separation from active duty. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. The option of establishing service connection through a demonstration of continuity of symptomatology rather than through a finding of nexus is specifically limited to the chronic disabilities listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (rejecting the argument that continuity of symptomatology in § 3.303(b) has any role other than to afford an alternative route to service connection for specific chronic diseases).

Service connection may be established for a Persian Gulf Veteran who exhibits objective indications of chronic disability that cannot be attributed to any known clinical diagnosis, but instead results from an undiagnosed illness that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021. 38 C.F.R. § 3.317(a)(1)(i) (2017). A "Persian Gulf Veteran" is one who served in the Southwest Asia theater of operations during the Persian Gulf War. Id.

Objective indications of a chronic disability include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. Disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. The
Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021. 38 C.F.R. § 3.317(a)(1)(i) (2017). A "Persian Gulf Veteran" is one who served in the Southwest Asia theater of operations during the Persian Gulf War. Id.

Objective indications of a chronic disability include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. Disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. The 6-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. A disability referred to in this section shall be considered service-connected for the purposes of all laws in the United States. 38 C.F.R. § 3.317(a)(2)-(5).

Effective March 1, 2002, the law affecting compensation for disabilities occurring in Persian Gulf War Veterans was amended. 38 U.S.C. §§ 1117, 1118. These changes revised the term "chronic disability" to "qualifying chronic disability," and involved an expanded definition of "qualifying chronic disability" to include: (a) an undiagnosed illness, (b) a medically unexplained chronic multi-symptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs or symptoms, or (c) any diagnosed illness that the Secretary determines, in regulations, warrants a presumption of service connection. 38 U.S.C. § 1117(a)(2)(B); 38 C.F.R. § 3.317. The term "medically unexplained chronic multisymptom illness" means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. 38 C.F.R. § 3.317(a)(2)(ii). Chronic multisymptom illnesses of partially understood etiology and pathophysiology, such as diabetes and multiple sclerosis, will not be considered medically unexplained. Id.

With claims based on undiagnosed illness, the Veteran is not required to provide competent evidence linking a current disability to an event during service. Gutierrez v. Principi, 19 Vet. App. 1 (2004). Signs or symptoms that may be a manifestation of an undiagnosed illness or a chronic multi-symptom illness include: fatigue, unexplained rashes or other dermatological signs or symptoms, headache, muscle pain, joint pain, neurological signs and symptoms, neuropsychological signs or symptoms, signs or symptoms involving the upper or lower respiratory system, sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. 38 U.S.C. § 1117(g); 38 C.F.R. § 3.317(b).

Section 1117(a) of Title 38 of the United States Code authorizes service connection on a presumptive basis only for disability arising in Persian Gulf Veterans due to "undiagnosed illness" and may not be construed to authorize presumptive service connection for any diagnosed illness, regardless of whether the diagnosis may be characterized as poorly defined. VAOPGCPREC 8-98 (Aug. 3, 1998). Compensation may be paid under 38 C.F.R. § 3.317 for disability which cannot, based on the facts of the particular Veteran's case, be attributed to any known clinical diagnosis. The fact that the signs or symptoms exhibited by the Veteran could conceivably be attributed to a known clinical diagnosis under other circumstances not presented in the particular Veteran's case does not preclude compensation under § 3.317. Id.

Finally, service connection may be established if the evidence of record shows that a chronic disorder has been caused or aggravated by an already service-connected disability. 38 C.F.R. § 3.310 (2017); Allen v. Brown, 7 Vet. App. 439 (1995).

The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107(b). Under that provision, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. Id; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). "It is in recognition of our debt to our veterans that society has [determined that,] [b]y tradition and by statute, the benefit of the doubt belongs to the veteran." Gilbert, 1 Vet. App. At 54.

1. Service connection for a left elbow disability, to include as a qualifying chronic disability under 38 C.F.R. § 3.317

2. Service connection for a right elbow disability, to include as a qualifying chronic disability under 38 C.F.R. § 3.317

3. Service connection for a right wrist disability, to include as a qualifying chronic disability under 38 C.F.R. § 3.317

4. Service connection for a left knee disability, to include as a qualifying chronic disability under 38 C.F.R. § 3.317

5. Service connection for a right knee disability, to include as a qualifying chronic disability under 38 C.F.R. § 3.317

As discussed in the prior December 2023 Board remand, there is no medical record of the Veteran's having complained of, receiving treatment for, or diagnosed as having bilateral elbow disabilities, right wrist disability, and/or bilateral knee disabilities.

More importantly, in an August 1992 VA examination that took place two months after his discharge in June 1992, the Veteran and the examiner noted that his "only" trauma or surgical history was in June 1991 when he was hit in the right eye and had a cut on his left shoulder. No complaints or abnormalities were reported nor observed in his elbows, right wrist, or knees.

Thus, the Board finds that the only remaining issue at question is whether the Veteran's disabilities could be considered as (a) an undiagnosed illness, (b) a medically unexplained chronic multi-symptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs or symptoms, or (c) any diagnosed illness that the Secretary determines, in regulations, warrants a presumption of service connection. 38 U.S.C. § 1117(a)(2)(B); 38 C.F.R. § 3.317.

After reviewing the evidence of record, the Board finds that the Veteran's disabilities are not among those considered in 38 C.F.R. § 3.317, and that his disabilities are not caused by his service.

In January 2024, a VA examiner opined that the Veteran's disabilities were less likely than not caused by his service based on the date of diagnoses, nature of the disabilities, and the lack of contemporaneous medical evidence during service.

In an October 2024 addendum opinion, the January 2024 VA examiner opined that the claimed bilateral knee disabilities were less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner noted that the Veteran was diagnosed with a right meniscus tear in 2006, left meniscus tear in 2014 and left knee degenerative arthritis in 2023. Both the etiology and pathophysiology of a torn meniscus and degenerative arthritis are fully understood, occurring due to overuse or trauma. The examiner noted that the Veteran's in-service medical records are silent for complaints of trauma or injury to the knees, and as the file is silent for any complaints to the knees during service and was evaluated for left knee pain in 2023. He stated in 2023 that he "was squatting and heard a pop," supporting that his knee conditions did not occur during active service.

Regarding the right wrist disability, the examiner noted that the service treatment records were silent for reports of wrist issues during service and at separation. The examiner added that the Veteran was diagnosed with a chronic right wrist sprain during 2023, over 30 years after separation and that both
arthritis are fully understood, occurring due to overuse or trauma. The examiner noted that the Veteran's in-service medical records are silent for complaints of trauma or injury to the knees, and as the file is silent for any complaints to the knees during service and was evaluated for left knee pain in 2023. He stated in 2023 that he "was squatting and heard a pop," supporting that his knee conditions did not occur during active service.

Regarding the right wrist disability, the examiner noted that the service treatment records were silent for reports of wrist issues during service and at separation. The examiner added that the Veteran was diagnosed with a chronic right wrist sprain during 2023, over 30 years after separation and that both the etiology and pathophysiology of sprained joints are fully understood. As sprains occur due to overuse or injury, and as the Veteran was evaluated for right wrist pain in 2021 and had stated that the pain started six to seven months ago, the examiner opined that it was less likely than not that the Veteran's right wrist disability was caused by his service.

Turning to the claimed bilateral elbow disabilities the examiner noted that the Veteran was diagnosed with bilateral triceps tendinitis at the 2023 VA examination. Again, both the etiology and pathophysiology of tendinitis are fully understood, with tendinitis caused by overuse or trauma. Service treatment records were silent for complaints of elbow issues during service or at separation, and the Veteran was evaluated for right elbow pain in 2021, and at that time he again stated that the pain started six to seven months ago. Given the length of time between separation and diagnosis, which is over 30 years, the examiner opined that it is unlikely that Veteran's current bilateral elbow conditions are etiologically related to service.

There are no medical records nor medical opinions supporting the Veteran's contentions.

It is also well established that internal inconsistency, bias, facial plausibility, and consistency with other evidence submitted on behalf of the Veteran may be considered. Caluza v. Brown, 7 Vet. App. 498, 511-12, aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curium) (table); Madden v. Gober, 125 Fed. Cir. 1477, 1481 (Fed. Cir. 1997) (holding that the Board has the "authority to discount the weight and probative value of evidence in light of its inherent characteristics in its relationship to other items of evidence"). Given the Veteran's own report of no complaints and/or disabilities in August 1992, only months after discharge, the Board finds that any statements made thereafter regarding onset of his symptoms to be less credible and less probative.

Therefore, the evidence in this case is not so evenly balanced as to allow application of the benefit-of-the-doubt rule as required by law and VA regulations. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 54. The weight of the competent and credible evidence is against the Veteran's claims, and as such entitlement to service connection for a left elbow disability, right elbow disability, right wrist disability, left knee disability, and right knee disability are denied.

Paulette Vance Burton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board H. Yun

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.

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