Entitlement to service connection for a left elbow disability is denied.

Citation Nr: 26001447 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 18-51 683 DATE: January 30, 2026 ORDER Entitlement to service connection for a left elbow disability is denied. FINDING OF FACT The evidence of record persuasively weighs against finding the Veteran's left elbow disability is etiologically related to service. CONCLUSION OF LAW The criteria for service connection for a left elbow disability are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1999 to October 2001. The Veteran had additional periods of active duty for training and inactive duty training with the National Guard with a confirmed period of active duty for training from August 25, 1992, to October 7, 1992 (basic training) and a confirmed period of active duty for training from November 10, 1994, to March 15, 1995. This appeal comes before the Board of Veterans' Appeals (Board) from a January 2024 Order of the United States Court of Appeals for Veterans' Claims (Veterans Court or CAVC). The appeal originated from a November 2016 rating decision of the Department of Veterans Affairs (VA). In March 2021, the Veteran presented testimony at a Board hearing, chaired via videoconference by the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. In a February 2023 decision, the Board denied the claim of entitlement to service connection for a left elbow disability. The Veteran appealed that decision to the CAVC. In a January 2024 Order, pursuant to a Joint Motion for Remand (JMR), the Board decision was remanded for additional development. Pursuant to this Order, in May 2024, the Board remanded this claim for additional evidentiary development including obtaining additional records and a VA examination and medical opinion. This matter was last before the Board in May 2025, at which time the claim was remanded again to request service treatment records (STRs) for the verified period of active duty for training from August 25, 1992, to October 7, 1992. In line with the May 2025 Board remand, the RO requested STRs in June 2025. See VA 21-3101 Request for Information. In response, the RO was advised that all available STRs were previously uploaded into VBMS. See July 2025 Response to VA 21-3101. This was followed by a formal request being submitted to the National Guard for STRs, as well as letters sent to the Veteran notifying him of such requests. See July 2025 Correspondence. Another request for these records was submitted to the National Guard in August 2025. In September 2025, the Deputy Chief of Staff advised no further records were found. In light of the foregoing, the Board finds reasonable efforts were made to obtain STRs and further requests would be futile. See 38 C.F.R. § 3.159(c)(2). Accordingly, there has been substantial compliance with the Board's May 2025 remand directive. See Stegall v. West, 11 Vet. App. 268, 271 (1998). A Supplemental Statement of the Case (SSOC) issued in October 2025, denying service connection for a left elbow disorder. By letter dated November 2025, the Veteran was informed his appeal was being returned to the Board. Service Connection Entitlement to service connection on a direct basis requires (1) evidence of current nonservice-connected disability; (2) evidence of in-service incurrence or aggravation of disease or injury; and (3) evidence of a nexus between the in-service disease or injury and the current nonservice-connected disability. 38 C.F.R. § 3.303(a); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Saunders v. Wilkie, 886 F.3d 1356 (2018). A lay person is competent to report symptoms and experiences observable by their senses; however, usually, they are not competent to prove a matter requiring medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 470 (1994). After the evidence has been assembled, it is the Board's responsibility to evaluate the entire record. 38 U.S.C. § 7104(a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall resolve all reasonable doubt in favor of the claimant. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 C.F.R. § 3.102. This standard does not require the evidence to be exactly equal; rather, it includes "scenarios where the evidence is not in equipoise but nevertheless is in approximate balance. Put differently, if the positive and negative evidence is in approximate balance (which includes but is not limited to equipoise), the claimant receives the benefit of the doubt." Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Entitlement to service connection for a left elbow disability. The Veteran seeks service connection for a left elbow disability. Turning to the evidence, service treatment records are silent for left elbow complaints. However, the Veteran did treat in service for a painful "right" elbow in September 2001. The Veteran also treated for a number of other musculoskeletal complaints in service. See e.g., February 1999 (sore right shoulder for two days); May 1999 (sore right medial tibia pain for two to three weeks); November 1999 (back pain for three days); January 1999 (right ankle sprain); July 2000 (left leg pain and left fibula fracture); September 2000 (left ankle pain).; September 2001 (Veteran reported pain in "right" elbow for two days after throwing a football, assessed with medial epicondylitis). Post service, in April 2003, the Veteran denied arthralgia or joint swelling. See Primary Care Note. In March 2004, he complained of muscle and joint pain in his knees and elbows with no diagnosis at the time. In June 2016, the Veteran reported he had a motor vehicle accident in 2012 with rods being placed in his legs bilaterally at the tibia and femur, and that he sustained a head injury at the time. During this visit, he also reported breaking his left leg in service in 2000. It wasn't until August 2018 that the Veteran related a history of elbow pain to service to his medical providers. See Primary Care Initial Evaluation Note (the Veteran reported he thought his ankle, knee, shoulder and elbow pain was from jumping school in service, indicating he did not complain while doing it because he just wanted to finish school). He also complained of general joint pain for the last 17 years. The clinician noted the Veteran was very physically active, lifting for work while going up and down stairs and working out at least three times a week. In March 2021, the Veteran submitted 40 pages of medical articles with a synopsis of the articles that parachuting is the leading cause of "lower" extremity fractures and injuries in the Army. The majority of articles submitted were focused on lower extremity injuries and the development of osteoarthritis. See e.g. Injury Prevention: Just the Facts, Parachuting Injuries (injuries to the lower extremities, low back and head are most common); A Study of Typical Parachute Injuries Occurring in Two Hundred and Fifty Thousand Jumps at Parachute School (statistically, any parachutist has only a one percent chance of injury in anyone parachute descent and this figure is decreasing, typical parachute injuries include strain of right rectus muscle, shoulder AC joint injuries and fracture of the fibula); Fatigue Fractures (discussing treated insufficiency fractures, thirteen in the tibia, one in femur and one in pubic bone); Arthritis and the Military (arthritis is top cause of disability among veterans and one of major reasons discharged from service); Degenerative Joint Disease in Paratroopers (osteoarthritis, degenerative joint disease, is one of the oldest and most common forms of arthritis found in paratroopers caused by abnormal wearing of cartilage); Osteoarthritis More Common in Service Members Presents Challenge for Military (military troops more likely to develop osteoarthritis than civilians, especially for those serving in the Army). Two of the articles submitted by the Veteran discussed upper extremity injuries in more detail. See Military Parachuting Injuries: A Literature Review (most injuries occur to ankle with progressively lower proportion affecting the leg, back, arm shoulder and chest. If elbows not protected while landing, the point of the elbow may strike the ground causing transmission of impact to the shoulder girdle, which may cause humerus fracture, shoulder dislocation of fractured clavicle); Traumatic Injury Patterns Associated with Static Line Parachuting (of 110 patient charts reviewed, lower extremity injuries made up 65 percent, head injuries 22 percent, 22 percent neck or back injuries and 19 percent upper extremity injuries; of the 19 percent, 5 percent were arm fractures; 3 percent had fractures, 2 percent shoulder dislocation and 11 percent musculoskeletal without fractures or dislocation). Also in March 2021, the Veteran's representative asserted at the Board hearing that the rigors of service to include marches with 80 to 120 pound rucksacks, crawling on elbows and hard parachute landings took a toll on the Veteran's elbows. The Veteran testified that he hyperextended his elbows in airborne training on an apparatus called the sling load trainer, hanging in the air swinging back and forth and practicing his parachute landing falls, and that he hurt his elbows when he hit the ground on parachute jumps. The Veteran attended an in person VA examination in January 2025. The Veteran reported injuring his elbows during flight school in 1998, increasing in pain and severity since this time. Following a physical examination, lateral epicondylitis of the left elbow was diagnosed, and medical epicondylitis of the right elbow. The corresponding VA medical opinions found a nexus for the Veteran's right elbow condition noting treatment in service, but with regard to the left side, opined that: The claimed condition is less likely than not (likelihood is less than approximately balanced or nearly equal) incurred in or caused by the claimed in-service injury, event, or illness. Rationale is Veteran has claimed left elbow condition as being directly related to military service. Based on review of the available evidence, it is less likely than not that the claimed condition is due to service as there is a lack of substantiating evidence supporting a nexus between the current diagnosis of left lateral epicondylitis and military service. Without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. A second in person VA examination took place in October 2025. A history was taken from the Veteran and physical examination performed with the same diagnosis of left lateral epicondylitis and a negative nexus opinion as follows: The claimed condition is less likely than not (likelihood is less than approximately balanced or nearly equal) incurred in or caused by the claimed in-service injury, event, or illness. Rationale is STR is silent regarding inservice complaint, evaluation, diagnosis, or treatment for a left elbow condition, therefore the claimed condition is less likely than not (likelihood is less than approximately balanced or nearly equal) incurred in or caused by the claimed in-service injury, event, or illness. A January 2025 rating decision granted service connection for the Veteran's "right" elbow disability. The Board has reviewed the evidence of record in conjunction with the applicable laws and regulations and finds that service connection for a left elbow disability is not warranted. The Board finds that the first element of direct service connection, a current disability has been established. Both of the January 2025 VA medical examinations diagnosed left lateral epicondylitis. The Board next addresses whether the evidence establishes an event, injury or disease in service relative to the left elbow has been demonstrated. As outlined previously, STRs reflect the Veteran treated for musculoskeletal complaints, to include "right" elbow pain, in service. He also complained of right shoulder pain, right leg pain, back pain, and bilateral ankle pain. The Board has considered the Veteran's assertions, to include those made at hearing regarding the rigors of service, airborne training school and the parachute jumps themselves. While the absence of evidence may generally not be relied on as substantive negative evidence, in some instances, silence in a record where a notation of a particular fact would normally be expected may be considered. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (explaining that where there is a lack of notation of medical condition or symptoms where such notation would normally be expected, the Board may consider this as evidence that the conditions or symptoms did not exist). Here, the Board finds that the prevalence of other musculoskeletal treatment in service without mention of left elbow complaints weighs against finding an in service event. The Board has also considered the Veteran's lay assertions of his left elbow pain increasing in severity since service. Initially, the Board notes that there is not an arthritis diagnosis of record relative to the left elbow. The Veteran's diagnosed lateral epicondylitis is not an enumerated chronic disease under 38 C.F.R. § 3.309(a). Thus, presumptions applicable to chronic diseases are not for application. The Board also observes the significant time that has elapsed between the allegation of left elbow injuries in service and the Veteran seeking treatment. Post service, in March 2004 the Veteran complained the Veteran complained of pain in his knees and elbows without further details regarding onset or origin of pain, and no diagnoses were rendered. It was not until August 2018, over two years after the filing of this claim, that the Veteran complained of general joint pain for the last 17 years, to include bilateral elbow pain he related to jumping school. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006) (noting that the Board may consider lay statements to be of diminished probative value based on the significant time delay between observation and report of those observations). While the Veteran may believe his left elbow disability is related to service, he is not competent to render a nexus opinion in this matter. See Jandreau 492 F.3d at 1376-77 and n.4 (recognizing that the competence of a layperson to offer evidence on a medical issue is limited to where doing so does not require reliance on specialized medical knowledge or expertise). Here, the Board finds the collective medical evidence to include the STRs, post service treatment records and the January 2025 VA medical opinions to be of greater probative value than the Veteran's lay assertions. See Harvey v. Brown, 6 Vet. App. 390, 394 (1994) (Board decision properly assigned more probative value to a private hospital record that included lay history that was made for treatment purposes than to subsequent statements made for compensation purposes). Further, the majority of the medical articles submitted by the Veteran are not relevant to this claim as they pertain to a diagnosis not rendered for the left elbow (osteoarthritis) or focus on the prevalence of other musculoskeletal injuries. The only medical article to mention elbows explicitly does so in the context of explaining how shoulder injuries occur. The other medical article referencing upper extremity injuries focuses primarily on fractures of the arm or hand, or shoulder dislocations. Elbow injuries are not discussed in this article. Thus, the Board finds the medical articles submitted are of limited relevance and entitled to little probative value. Based on the foregoing, the evidence of record is persuasively against the claim. Lynch, 21 F.4th at 776. Accordingly, service connection for a left elbow disability is denied. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Long, Kindra F. 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.