UNITED STAT ES COURT OF AP P EALS FOR VETERANS CLAIMS

N O
. 03-2159
M I CH A EL A. S T A N KEV I CH , A PP EL L ANT ,

V
. R. J A M ES N I C HOL S ON , S EC RE T A RY O F V ET ER A N S A FF A I RS , A PPEL L EE
.

On Ap pe a l f ro m th e B oa

rd of Ve te ra ns ' Ap pe a ls
(Argued Nove mber 7, 2005 De cided January 3, 2006 )

Robert C. Rhodes of

Cha pin , So uth

Caro lin a , w a s o n th e br ie f f or the a pp e lla nt. Kerry J. Loring , w ithwh om Tim S. Mc Cla in , G e n e r a l Cou ns e l; R. Ra nd all Cam pb e ll , Assistant Gener al Counsel; and Carolyn F. W ashington , Deputy

Assistant Gener al Counsel, all of Washington, D.C., wer e on the br ief for the appe llee.
Be fore KASOL D, DAVI S, and SCHOEL EN, Judges

. KASOL D, Judge : Persian Gulf w ar ve tera n Michae l A. Stankevich appe als throug h counsel that part of a

n October 23, 2003, decision of the B oard of Veter ans' Appe al s (B o ar d ) that denie d entitlement to service connec tion for chr onic muscle a nd joint pains as manifestations of an

un dia g no se d il lne ss. F or

the re a so ns se t f

or th b e low , th a t pa

rt of the B oa

rd ' s d e c isi on

on a pp e a l w ill be modified in par

t, set aside in par

t, and the matter

rema nded for rea djudication.

I. BACKG ROUND Mr. Stankevich serve d in the U.S. A rmy from September 1987 to Septembe r 1991, including

ser vi ce in th e P ers ian G ulf wa r. Re c or d ( R.) a t 2. I n M ay 19 95 , h e fi le d a

c la im f or dis a bil ity compensation benefits on the basis of having "G ulf War Sy ndrome" and residuals there of. R. at 65. He c omp la ine d o f p a in t

hr ou g ho ut his bo dy , inc lud ing , inte r a lia , b oth his le ft and ri g ht s ho uld e rs , elbows, wrists, hands, hips, knees, lower leg s, and ankle s, as well as his ribs and uppe r and lowe r2

back. R. at 72-73. A VA nurse practitioner diagnose d Mr. S tankevich as having chronic g ener alized muscle strain that wa s "ve ry likely " due to his profession, which " consisted of be nding ove r and li ft in g t he hea ds of

c ars and tr uc ks , w or kin g a wr e nc h w hic h to ok

a lot of pr e ssu re and tor qu e to
remove nuts and bolts." R. 244-45. A VAphy sician noted that Mr. Stanke vich' s pain was "g ener alized achingwith exertions and relief w ith rest" a nd that the pain " does not l i m i t joint

moveme n t in an y p arti c u la r jo in t. " R. a t 2 4 8

- 4 9

. T h e p h y s ic ia n d e te r mi n e d th a t th e r e w e re " no po sit ive fi nd ing s and

the his tor y is g e ne ra lize d, bu t no la

bo rator y wo rk is f ound to e xpla in t

he c ours e of e ve nts c omi ngon

tw o y e ars a ft e r mil ita

ry se rv ic e . T he dia g no sis c ann ot b e ma de be y on d mu lti ple joint pain and fatig ue by

history of unknown e tiology ." R. at 249. Al tho ug h a VA re g ion a l of fi c e de nie d M r. Stank e vic h' s c la im o n th e ba sis that hi s d isa bil ity

was "de termined to r esult from a known clinical diag nosis of chronic , g ener alized musc le s train, which neither

occur red in nor w as ca

used or ag g ravated by service " (R. at 267), on appe al the B oard found that the " rec ord does not provide a convincing basis for e ither ac cepta nce or reje ction of either medical opinion in this case a s to the question of whethe r [Mr. Stanke vich' s] chronic muscle/joint pains are manifestations of a n undiag nosed illness." R. at 13. The Boa rd then stated: Howeve r, even if rea sonable doubt is resolved in the vetera n' s favor on this point , the veter an' s sy

mptoms are not shown to be ratable at 10 pe rce nt under a ny provision of the VA r ating schedule

. Since there is no code that a pplies specific ally

to ge nera liz ed mus c le /jo int pa ins , a

ratin g by ana log y wo uld be re qu ir e d, and

the on ly re a so na bly a na l o g o u s c o d e w o u l d a

p p e ar t o b e D i a g n o s t i c C o d e [( D C ) ] 5 0 0 3 p e rt a i n i n g to arthritis. 38 C.F.R. § 4

. 7 1 a, [Diagnostic] Code 5003 (2002). Unde r that code , rat i n gs ar e assig ned on the ba sis of limi tation of motion of the joints i n which the prese nce of

arthritis is shown by

X-ra y s. Where limitation of moti on is not shown, a 10 per cent r ating can be assig ned whe n there is X-ra y evidenc e of involvement of two or more major joints or minor joi nt gr oups. The vete ran doe s not have limitation of motion of any

j o int, and the B oard is unable to find that a provision requir ing X-ra y finding s alone as the basis for assig ning a rating is truly analo go u s fo r t he purpose of

assig ning a

rating to satisfy

the undiag nosed illness presumption. R. at 13-14. This appea l followed.3 II. AN AL YSI S A. Presumptive Service Connection Se rv ic e c onne c tio n ma

y be g ra nte d o n a pr e su mpt ive ba sis to a Per sia n Gul f wa r v e te ra n w ith a qual i fy i n g ch ro n i c d i s ab i l i t y re s u l t i n g fr o m an u n d i agn o s edi l l n es s t h at b ec am e m an i fe s tto a deg ree of 10% or

m o re n o l at er tha

n Dec ember

31, 2006. See 38 U. S.C. § 1 11 7( a ); 38 C.F .R. § 3.317(a) (1)( i) (2005). Aqualifying c hronic disability may result from an undiag nosed illness that cannot be attributed to any known clinical diag nosis by history , phy sical examination, or laboratory tests. See 38 U.S.C. § 1117(a) (2); 38 C.F.R. § 3.317(a) (2). For purposes of establishing a qualifying chronic disability , an undiag nosed illness may be manifested by muscle or joint pain. See 38 U. S.C. § 1117(g )(4) -(5) ; 38 C.F.R. § 3.317(b)(4) -(5) . To deter mine whether

the undiag nosed illness has manifested t o a d e g r e e o f 1 0 % o r mo r e , th e v e te r an ' s c o n d it io n mu s t b e r a te d an a lo g o u s ly to a disease or injury in which the func tions af fe ct ed, anatomical localization, or sy mptomatology

are simil ar. See 38 C.F.R. § 3.317(a) (5). B. B oard' s Selection of Diag nostic Code 5003 Although the Court review s the selec tion of a DC und e r th e a r b it r a r y - a n d

- c a pricious standar d of re view, se e Bu tts v . B ro wn , 5 Vet.App. 532, 539 (1993) (en banc) (selec tion of a DC is a question of application of law to fac ts and is subject to Cour t re view under the ar bitrary -and- capr icious standard) , the B oard is neve rtheless re quired to provide a n adequate statement of r easons or bases for its selec tion, see 38 U.S.C. § 7104(d)(1); Al lda yv . B ro wn , 7 Ve t.A

pp . 5 17 , 5 27 (1 99 5) ; Suttmann

v . B ro wn , 5 Ve t.A

pp . 1 27 , 1 33 (1 99 3) . In th is i ns tanc e , th e B oa rd fa ile d to a de qu a te ly e xpla in i ts selec tion of DC 5003 and, furthe r, i t s ap p lication of DC 5003 re ndere d its selection arbitra ry and capr icious. See 38 U.S.C. § 7261(a)(3) (A) ( Court shall hold unlawful decisions by the B oard that
are "a rbitrar y , capr icious, an abuse of discre tion, or otherwise not in ac corda nce w ith law")

. The B oard' s statement t hat " the only rea sonably

analog ous code w ould appea r to be Diag nostic Code 5003 perta ining to a rthritis," is the only

basis for its selec tion of DC 5003 for rating purposes. The Boa

rd provided no analy sis to support its conclusion and failed to e x plain why other DCs were not rea sonably analog ous. Although the Court cannot substitute its vi ew of the appropr iate DC for

that of the B oard, w e note that f ibromy alg ia, whic h i n v o l ves " widespre ad musculoskeletal pain a

nd tender points" an d i s s p ecif

ically named a s a condition for w hich4

presumptive ser

vice c onnection may

be g rante d, appea

rs to be at lea st as equally analogo u s as arthritis to Mr. Stankevich' s condition. See 3 8 U

. S

. C

. § 1 1 1 7 ( a ) ( 2 ) ( B ) ; 3 8 C .F .R. §§ 3. 31 7( a )( 2) (i )( B )( 2) , 4 .7 1a , D C 50 25 (2 00 5) ; see also Schafrath v. D erwinski , 1 Vet.App. 589, 59 3 ( 19 91 ) ( B oa

rd is re qu ir e d to con sid e r a ll e vid e nc e of re c or d a nd to c on sid e r, and

dis c us s in

its de c isi on , a ll p ote nti a lly

a pp lic a ble pr ov isi on s of law an d r e g ulatio n) . In a ny e ve nt, the B oa

rd mus t provide a n adequate statement of rea sons or bases for its sele ction of a DC. See Alldayand Suttman , both su pra . Moreove r, DC 5003 provides f or a 10% disab i lity

rating only

if there is x -ra

y evidenc e of arthritis. Althoug h the B oard note d that "a provision requiringx -ra

y finding s alone a s the basis for

a ssi g nin g a

ra tin g " wa s no t " tr

uly ana log ou s" fo r p ur

po se s o f s e c tio n 1 11 7, the B oa rd ne ve rt he le ss proce eded to a

pply it. R. at 13-14. The B oard f ound that M r. S tankevich ha d no limit ation of motion, and implicitly found no evidenc e of multipl e-joint arthr itis, by x -ra y or otherw ise, and on that basis deter

mined that Mr. Stankevich wa s not entitled to a 10% disability rating

. Id. Ab se nt a 10% disability

rating , Mr. Stankevich c ould not be g rante d presumptive ser vice c o n n ection under section 1117. The ve ry essenc e of a

n undiag nosed i llness is that there is no diag nosis. The function aff ecte d, anatomica l loc alization, or sy mptomatology

of an undia g nosed illness cannot be analog ous if the B oard a

pplies that rating criter ia to require objective e vidence of a diag nosed disability (her e,
x -ra y evidenc e of a

rthritis). See Gutierrez v. Princ ipi , 19 Vet.App. 1, 9 ( 2004) (" Objective me dical evidenc e i s n o t require d for a n awa rd of se rvice connec tion under sec tion 1117."). The Court conclude s that the Boa

rd' s manner of ap p l y i n g DC 5003 in this case – by requiringa diag nosis of arthritis in order to g rant a 10% di sability rating wher e a dia g nosis cannot be ha d – is arbitrar y and

c a p r i c i o u s b e c a

u s e t h e an a l o g y i s , a tb e s t , i l l u s o r y. C. T he Ev ide nc e Do e s N ot P re po nd e ra te Ag a ins t a F inding of

an Undiag nosed Condition The Sec reta

ry argues that the B oard ma de no dete rmination as to whether Mr. Stankevich ha d

an undiag nosed condition. Although the specific words expressing such a de termination wer e not used by the B oard, it neve rtheless a ssessed the e vidence and found no basis for acce pting or reje cting eith er o f t h e co nflicting medical opinions. As a matter of law, w hen the e vidence does not5

preponde rate one way or the other, it sits in relative e quipoise, see G ilbert v. Derwinski , 1 Vet.App. 49, 54 (1990) ( "a

veter an nee d only

demonstrate that there is an ' approximate balanc e of positi ve and neg ative evide nce' in order to prevail" ), and the benefit of t he doubt must go to the ve tera n, se e Or tiz

v . P rin c ipi

, 274 F.3d 1361, 1365 ( Fe d. C i r. 2 0 0 1 ) (" b enef it of the doubt rule may

be viewe d as shifting the ' risk of nonper suasion' onto the VA to prove that the veteran is not entitled to benef its"); Robin et t e v. B rown, 8 Vet.App. 69, 76 ( 1995) (" the unique evide ntiary burdens in the VA

a dju dic a tio n s y ste m . .
. pe rm it a me ri ts dis a llo wa nc e on ly wh e re the e vid e nc e pr e po nd e ra te s a g a ins t the c la im" ); Gi lbe rt , 1 Ve t.A pp . at 54 (" the pr e po nd e ra nc e of the e vid e nc e mus t be a g a ins t th e c la im fo r be ne fi ts t o b e de nie d" ); see also Padgett v. Nicholson , 19 Vet.App. 133, 146- 47 (2005) ( en banc ), withdraw n on other grounds , 19 Vet.App. 334 ( 2005). Ac cording ly , th e Bo ar d 's d ecision will be modified in part to explicitl y state the Boa rd' s finding that Mr. Stankevich' s muscle and joint pains

are manif e statio ns of

an und ia g no se d il lne ss.

III . C ON CL USI ON Upon consider ation of the for eg oing, that part of the B o a r d ' s decision addr essing whether Mr. Stank e vic h' s musc le and joi nt pa ins are manif e statio ns of an und ia g no se d illn e ss i s MO DI F I ED to include an expli cit statement of the Boa rd finding that Mr. Stankevich' s muscle and joint pains are manifestations of a

n undiag nosed illness. The rema inder of the Boa rd' s decision that denied se rvice

c on ne c tio n f

or c hr on ic mus c le and

joi nt p a ins , in c lud inga s ma nif e statio ns of

an und ia g no se d il lne ss, is SE T A SI DE . T he matte r o n a pp e a l is REM AN DE D for rea dju dic a tio n c on sis te nt w iththi s opinion. See 38 U.S.C. § 7252(a) . On re mand, Mr. Stankevich ma y prese nt additional evidence and argument in support of the m att ers r emande d, and the B oard must consider any evidenc e and argument so prese nted. See Kay v. Principi , 16 Vet.App. 529, 534 ( 2002). The Court e x pects that the B oard w ill provide expediti ous treatment of this matter on rema

nd. See 38 U.S.C. § 7112. MODI FI ED I

N PART, SET ASI DE I

N PART, and REMANDED.