Citation Nr: 1007111	
Decision Date: 02/25/10    Archive Date: 03/05/10

DOCKET NO.  01-05 519	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Montgomery, 
Alabama


THE ISSUE

Entitlement to service connection for additional claimed 
residuals of a July 1999 lightning strike, i.e., eye or 
visual impairment and cardiovascular disability to include of 
the carotid artery in the neck and hypertension. 



REPRESENTATION

Appellant represented by:	The American Legion



WITNESS AT HEARING ON APPEAL

Appellant




ATTORNEY FOR THE BOARD

A. A. Booher, Counsel


INTRODUCTION

The Veteran had active duty for training (ACDUTRA) from 
January 1992 to May 1992.  She also additional periods of 
service in the Reserve, with ACDUTRA at various times 
including November 2001 to October 2002, and February 2005 to 
February 2006.  Her periods of ACDUTRA in the Army Reserve 
included service in July 1999. 

This matter comes to the Board of Veterans' Appeals (Board) 
on appeal from a July 2000 rating decision by the above 
Department of Veterans Affairs (VA) Regional Office (RO).  

In June 2002, the Veteran presented testimony at a Travel 
Board hearing before the undersigned Veterans Law Judge.  A 
transcript of this hearing is of record.

At the time the case was previously before the Board, the 
issue was phrased as "Entitlement to service connection for 
the residuals of a lightening strike, claimed as left hand 
problems, neck problems, a carotid artery problem in the 
neck, a left foot disorder, eyesight problems, a problem with 
the left shoulder scapular joint, and headaches".  The Board 
remanded the case in June 2003 for specified development.

In action by the VARO in March 2005, service connection was 
granted for the following: "pain syndrome with associated 
proximal muscle weakness, left upper extremity (claimed as 
decreased motor skills in left hand and hemiparesis, 
residuals of lightning strike)", for which as 30 percent 
rating was assigned, effective October 4, 1999; "pain 
syndrome with associated proximal muscle weakness in left 
lower extremities (claimed as plantar flexion muscle of the 
left foot, residuals of lightning strike)", for which a 10 
percent rating was assigned from October 4, 1999; and 
"migraine headaches (claimed as migraine headaches due to 
residuals of lightning strike)", for which a 10 percent 
rating was assigned from October 4, 1999.

A VA Form 21-6789 is in the file dated March 7, 2005, to the 
effect that rating action had been deferred, pending medical 
opinions, on the remaining issues of entitlement to service 
connection for residuals of a lightning strike to include 
disabilities claimed as involving "neck problems, carotid 
artery, eyesight and left shoulder scapular joint".  A 
subsequent addendum was to the effect that the disability 
claimed as "left scapular joint" had been included in the 
earlier grants of service connection and was no longer in a 
deferred status.

Additional VA examinations were undertaken and are of record; 
VA clinical records are also in the file.  After the results 
of VA examinations showed pulmonary hypertension, the Veteran 
raised that as a collateral claim.  The RO denied the claim 
of service connection for hypertension in April 2007.  In 
action dated in June 2007, service connection was denied for 
"eyesight problems, residuals of lightning strike", and 
"carotid artery problems in neck, residuals of lightning 
strike".   

Because of the nature of the ongoing claim, e.g., entitlement 
to current residuals of a lightning strike, the Board haqs 
construed the current appellate issue to include disability 
of a cardiovascular nature, to include the carotid artery in 
the neck and hypertension.  

In November 2007, the Board again remanded the case for 
development.  Pertinent portions thereof will be set forth 
below.  

During the course of the current appeal, gastroesophageal 
acid reflux disorder has been raised as an issue, but is not 
part of the current appellate review.




The Veteran most recently submitted additional evidence to 
the Appeals Management Center, which forwarded it to the 
Board, along with comments in response to the most recent 
SSOC, in December 2009.  This packet was attached to her file 
on January 20, 2010, and has been considered herein.

In addition to all the foregoing, the Board notes that a "DD 
Form 214-Automated" is of record, showing that the Veteran 
was ordered to active duty in support of Operation Enduring 
Freedom from April 2007 to April 2008.  The present claim and 
appeal, which involve only claimed residuals of the 1999 
lightning incident, do not encompass any aspects of that 
recent service.


FINDING OF FACT

The aggregate evidence preponderates against a finding that 
the Veteran has additional residuals of a 1999 lightning 
strike to include eye or visual impairment and cardiovascular 
disability to include of the carotid artery in the neck and 
hypertension, any chronic heart problems including 
hypertension are not otherwise attributable to service on any 
premise, and none of the claimed disorders is shown to be due 
to, the result of, or aggravated by any service-connected 
disability.


CONCLUSION OF LAW

Additional claimed residuals of a lightning strike to include 
eye or visual impairment, and cardiovascular disability to 
include of the carotid artery in the neck and hypertension, 
were not incurred in or aggravated by service, are not 
secondary to any service-connected disability, and may not be 
presumed to be associated with service on any premise.  38 
U.S.C.A. §§ 101, 106, 1101, 1131, 1137 (West 2002 and Supp. 
2009); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310 
(2009).



REASONS AND BASES FOR FINDING AND CONCLUSION

I.  Duty to Notify and Duty to Assist

The Veterans Claims Assistance Act of 2000 (VCAA) enhanced 
VA's duty to notify and assist claimants in substantiating 
their claims for VA benefits, as codified in pertinent part 
at 38 U.S.C.A. §§ 5103, 5103A, 5107, 5126 (West 2002 & Supp. 
2009); 38 C.F.R. §§ 3.102, 3.159, 3.326(a) (2009).   

Upon receipt of a complete or substantially complete 
application for benefits, VA is required to notify the 
claimant and her representative, if any, of any information, 
and any medical or lay evidence, that is necessary to 
substantiate the claim, and this correspondence was sent to 
her initially after her claim and on subsequent occasions.  
38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. 
Principi, 16 Vet. App. 183 (2002).  

Proper notice from VA must inform the claimant of any 
information and evidence not of record (1) that is necessary 
to substantiate the claim; (2) that VA will seek to provide; 
and (3) that the claimant is expected to provide.  38 C.F.R. 
§ 3.159(b)(1) (2009).  This notice must be provided prior to 
an initial unfavorable decision on a claim by the RO.  
Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); 
Pelegrini v. Principi, 18 Vet. App. 112 (2004). 

The U.S. Supreme Court has held that an error in VCAA notice 
should not be presumed prejudicial, and that the burden of 
showing harmful error rests with the party raising the issue, 
to be determined on a case-by-case basis.  Shinseki v. 
Sanders, 129 S. Ct. 1696 (2009).  In this case, the appellant 
has not demonstrated any prejudicial or harmful error in VCAA 
notice.

The Board finds that the RO has satisfied the duty to notify 
and assist under the VCAA.  The contents of the 
correspondence of record complied with the requirements of 38 
U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) regarding VA's 
duty to notify.  Further, the Veteran was advised of the 
opportunities to submit additional evidence, after which 
additional information was obtained and entered into the 
record.  As a result, the purpose behind the notice 
requirement has been satisfied because she has been afforded 
a meaningful opportunity to participate effectively in the 
processing of the claim.  She has indicated that he has no 
other information or evidence to substantiate the claim.

In addition, it appears that all obtainable evidence 
identified by the Veteran relative to the claim has been 
obtained and associated with the claims file, and that she 
has not identified any other pertinent evidence, not already 
of record, which would need to be obtained for a fair 
disposition of the current appeal, nor has she suggested in 
any way that there is any prejudice due to a lack of proper 
VA notice or assistance.

The Veteran has demonstrated actual knowledge of, and has 
acted on, the information and evidence necessary to 
substantiate the pending claim.  See, e.g., Dalton v. 
Nicholson, 21 Vet. App. 23, 30 (2007) (Court was convinced 
that the appellant and representative had demonstrated actual 
knowledge of the information and evidence necessary to 
establish the claim).  Moreover, she has not demonstrated any 
prejudicial or harmful error in VCAA notices provided.

Accordingly, the Board finds that VA has satisfied its duty 
to assist the Veteran in apprising her as to the evidence 
needed, and in obtaining evidence pertinent to her claim 
under the VCAA.  

II.  Applicable Legal Criteria

Service connection may be granted for disability resulting 
from personal injury suffered or disease contracted during 
active military service, or for aggravation of a pre-existing 
injury suffered, or disease contracted, during such service.  
38 U.S.C.A. § 1131 (West 2002 & Supp. 2009); 38 C.F.R. §§ 
3.303(a), 3.304 (2009).  Where there is a chronic disease 
shown as such in service, subsequent manifestations of the 
same chronic disease at any later date, however remote, may 
be service connected, unless clearly attributable to 
intercurrent causes.  When a condition noted during service 
is not shown to be chronic, or the fact of chronicity in 
service is not adequately supported, then a showing of 
continuity of symptomatology after discharge is required to 
support the claim.  38 C.F.R. § 3.303(b).  

Active military, naval, or air service includes any period of 
active duty for training (ACDUTRA) during which the 
individual concerned was disabled from a disease or injury 
incurred or aggravated in the line of duty, and any period of 
inactive duty training (INACDUTRA) during which the 
individual concerned was disabled from an injury incurred or 
aggravated in the line of duty.  38 U.S.C.A. § 101(24).  That 
is to say, when a claim is based on a period of ACDUTRA, 
there must be evidence that the individual concerned died or 
became disabled during the period of ACDUTRA as a result of a 
disease or injury incurred or aggravated in the line of duty.  
In the absence of such evidence, the period of ACDUTRA would 
not qualify as "active military, naval, or air service" and 
the claimant would not achieve Veteran status for purposes of 
that claim.  See 38 U.S.C.A. § 101(2)-(24); Mercado-Martinez 
v. West, 11 Vet. App. at 415, 419 (1998).

ACDUTRA includes full-time duty with the Army National Guard 
of any State under sections 316, 502, 503, 504, or 505 of 
title 32, U.S.C.A., or the prior corresponding provisions of 
law.  See 38 U.S.C.A. § 101(22)(C); 38 C.F.R. § 3.6(c) 
(2008).  INACDUTRA includes service with the Army National 
Guard of any State (other than full-time duty) under section 
316, 502, 503, 504, or 505 of title 32, or the prior 
corresponding provisions of law.  National Guard service 
generally includes periods of ACDUTRA and/or INACDUTRA.  
Basically, this refers to the two weeks of annual training 
that each National Guardsman must perform each year and, in 
most cases, an initial period of six months for basic 
training.  It also includes periods, as in this case, of 
activation for a given stated limited program or operation.

Presumptive periods do not generally apply to ACDUTRA or 
INACDUTRA.  See Biggins v. Derwinski, 1 Vet. App. 474, 477-78 
(1991).  Therefore, consideration of 38 U.S.C.A. §§ 1111 and 
1131 (presumption of soundness), 3.306 (presumption of 
aggravation of a chronic pre-existing disease), and 38 C.F.R. 
§§ 3.307 and 3.309 (presumption of service incurrence for 
certain diseases first manifested after separation) for the 
periods of ACDUTRA or INACDUTRA is not appropriate (although 
the citations above include both these and those which also 
reflect the Veteran's other period of active service).

Service connection may also be granted for any disease 
diagnosed after discharge, when all of the evidence 
establishes that the disease was incurred in service.  38 
C.F.R. § 3.303(d).  Such evidence must be medical unless it 
relates to a condition as to which, under the Court case law, 
lay observation is competent.  Savage v. Gober, 10 Vet. App. 
488, 498 (1997).  

The Court has held that, in order to prevail on the issue of 
service connection, there must be (1) medical evidence of a 
current disability; (2) medical, or in certain circumstances, 
lay evidence of incurrence or aggravation of a disease or 
injury in service; and (3) medical evidence of a nexus 
between the claimed in-service injury or disease and the 
current disability.  Hickson v. West, 12 Vet. App. 247, 252 
(1999).

In addition, the law provides that, where a Veteran served 
ninety days or more of active military service, and certain 
chronic diseases, including cardiovascular-renal disease, 
become manifest to a degree of 10 percent or more within one 
year after the date of separation from such service, such 
disease shall be presumed to have been incurred in service, 
even though there is no evidence of such disease during the 
period of service.  38 U.S.C.A. § 1101, 1112, 1113, 1137; 38 
C.F.R. § 3.307, 3.309(a).

Service connection may also be granted for disability which 
is proximately due to or the result of service-connected 
disability.  38 C.F.R. § 3.310(a); see Allen v. Brown, 7 Vet. 
App. 439 (1995) (en banc).  An increase in severity of a non-
service-connected disorder that is proximately due to or the 
result of a service-connected disability, and not due to the 
natural progress of the non-service-connected condition, will 
be service connected.  Aggravation will be established by 
determining the baseline level of severity of the non-
service-connected condition and deducting that baseline 
level, as well as any increase due to the natural progress of 
the disease, from the current level.  38 C.F.R. § 3.310(b).


During the pendency of this claim and appeal, an amendment 
was made to the provisions of 38 C.F.R. § 3.310.  See 71 Fed. 
Reg. 52,744-47 (Sept. 7, 2006).  The amendment sets a 
standard by which a claim based on aggravation of a non-
service-connected disability by a service-connected one is 
judged.  Although VA has indicated that the purpose of the 
regulation was merely to apply the Court's ruling in Allen, 
supra, it was made clear in the comments to the regulation 
that the changes were intended to place a burden on the 
claimant to establish a pre-aggravation baseline level of 
disability for the non-service-connected disability before an 
award of secondary service connection may be made.  This had 
not been VA's practice, which suggests that the recent change 
amounts to a substantive change.  The present case predates 
the regulatory change.  Consequently, the Board will apply 
the older version of 38 C.F.R. § 3.310, which is more 
favorable to the claimant because it does not require the 
establishment of a baseline before an award of service 
connection may be made.

When all the evidence is assembled, VA is responsible for 
determining whether the evidence supports the claim or is in 
relative equipoise, with the Veteran prevailing in either 
event, or whether a preponderance of the evidence is against 
a claim, in which case, the claim is denied.  Gilbert v. 
Derwinski, 1 Vet. App. 61 (1991).

It is also noted that in this as in any other case, it 
remains the duty of the Board as the fact finder to determine 
credibility in any number of contexts, whether it has to do 
with testimony or other lay or other evidence.  See Culver v. 
Derwinski, 3 Vet. App. 292, 297 (1992).  In general, lay 
individuals may not render medical conclusions, see Espiritu 
v. Derwinski, 2 Vet. App. 492 (1992); however , a lay 
statement may be made which relays the visible symptoms of a 
disease or disability or the facts of observed situations or 
circumstances, see Caldwell v, Derwinski, 1 Vet. App. 466, 
469 (1991), after which a decision must be made as to the 
credibility thereof in the context of probative medical 
evidence, see Rowell v. Principi, 4 Vet. App. 9, 19 (1993).  
The Court has held that "where the determinative issue 
involves medical causation or a medical diagnosis, competent 
medical evidence is required."  Grottveit v. Brown, 5 Vet. 
App. 91, 93 (1993).  The Court calls upon the Board to make 
judgments as to the credibility of various medical opinions.  
In determining whether documents submitted by a Veteran are 
credible, the Board may consider internal consistency, facial 
plausibility, and consistency with other evidence submitted 
on behalf of the claimant.  Caluza v. Brown, 7 Vet. App. 498, 
511 (1995); see also Pond v. West, 12 Vet. App. 341, 345 
(1999)

In any event, the Board has the clear duty to assess the 
credibility and weight to be given the evidence.  The Board 
is not competent to supplement the record with its own 
unsubstantiated medical conclusions.  Colvin v. Derwinski, 1 
Vet. App. 171, 175 (1991); however, following the point at 
which it is determined that all relevant evidence has been 
obtained, it is the Board's principal responsibility to 
assess the credibility, and therefore the probative value of 
proffered evidence of record in its whole.  Owens v. Brown, 7 
Vet. App. 429, 433 (1995); Elkins v. Gober, 229 F. 3d 1369 
(Fed. Cir. 2000). 

The Federal Circuit has recognized the Board's "authority to 
discount the weight and probity of evidence in light of its 
own inherent characteristics and its relationship to other 
items of evidence."  Madden v. Gober, 125 F.3d 1477, 1481 
(Fed. Cir. 1997).  

The Board has an obligation to provide adequate reasons and 
bases supporting this decision, but there is no requirement 
that every item of evidence submitted by the appellant or 
obtained on his behalf be discussed in detail.  The Board's 
analysis below will focus specifically on what evidence is 
needed to substantiate the claim and what the evidence in the 
claims file shows, or fails to show, with respect to the 
claim.  See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. 
Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 
(2000).

III.  Pertinent Factual Background and Analysis

To simplify the current decision and clarify both the issues 
at hand and the circumstances leading to this point in the 
appeal, the following quotation is excerpted from pp. 4-6 of 
the Board's November 2007 Remand:

The essence of the still pending appellate claim 
relates to entitlement to service connection for 
residuals of the 1999 lightning strike.  It has 
been fully conceded that the Veteran was 
subjected to such a lightning strike (or was in 
such close proximity thereto as to be tantamount 
to the same thing) and, as noted above, she has 
already been granted service connection for 
certain residuals.  The remaining issue is 
simply whether she does or does not have 
additional residuals.  

At the time of the rating action which granted 
service connection for stated residuals, it was 
specifically noted that action could not be 
taken on the issue shown as remaining on the 
first page of the present decision, pending 
appropriate medical opinions in that regard.  
She was to have been so informed; it is unclear 
the extent to which she has or has not been 
informed or understands that requirement.

Since then, the Veteran has been seen for a 
number of both outpatient visits and VA 
examinations.  It has been said that she did not 
appear for a specific VA examination in March 
2007, but it is unclear whether she understood 
that she was to so report.  This confusion may 
have arisen out of the fact that, in the 
interim, it had been determined that she also 
has hypertension; and was seen, as documented in 
VA records in the file, both before and since 
the purported failure to report.  

The Board's (prior) remand asked for additional 
records from a private neurologist.  An attempt 
was made to obtain his additional records, but 
the correspondence was returned as 
undeliverable.  It is unclear why this occurred, 
e.g., has the physician died, left the area, 
moved, etc.

The Board also notes that whether the Veteran 
did or did not report for other examinations, 
findings of specialized testing including a 
cerebrovascular Duplex Scan in September 2004, 
are of record reflecting that she had been 
observed to have mild stenosis of 49-59 percent 
involving the intracranial internal carotid 
artery.  There is no opinion as to whether this 
is or is not due to the lightning strike, or 
whether it may have been impacted in any way 
thereby.  

Since that time she has been found to have 
pulmonary hypertension, results having come from 
specialized testing including on the carotid 
artery.  We note there is no medical expert 
opinion of record as to whether that is also due 
to the lightning strike, the abnormal carotid 
artery findings, and/or other already service-
connected disabilities.

The Court has held that a remand by the Board 
confers on the Veteran, as a matter of law, the 
right to compliance with the remand orders.  
Stegall v. West, 11 Vet. App. 268, 271 (1998).  
The remand has not been completely effectuated 
with regard to the Veteran's remaining claimed 
disabilities.  And, with due process 
requirements of VCAA not having been fulfilled, 
an additional remand is mandated.

Accordingly, the case is REMANDED for the 
following action:

1.  The appellant has the right to submit 
additional evidence and argument on the 
matter or matters the Board has remanded.  
Kutscherousky v. West, 12 Vet. App. 369 
(1999).

a.  The additional records for any care the 
Veteran may have received for the herein 
claimed disabilities since the lightning 
strike, including but not limited to Dr. 
Fraught, should be obtained.  A concerted 
effort should be made by the RO to obtain 
information so as to track down these 
records, and the Veteran should provide 
whatever information she may have in that 
regard, to facilitate VA assistance in 
obtaining them.

b.  Up-to-date VA records for all 
examinations, care and evaluations should 
be attached to the claims file.

2.  The Veteran should then be re-examined by 
a VA ophthalmologist and cardiovascular 
specialist to determine the nature of all 
additional residuals of the lightning strike.  

a.  Specifically, opinions should be 
reached as to whether the Veteran has any 
eye disability or visual impairment and/or 
cardiovascular disability, to include of 
the carotid artery in the neck and/or 
hypertension, and whether it is at least as 
likely as not that any such disorder is due 
to the lightning strike injury she 
sustained in service; or is due to any 
service-connected disability.

b.  Note:  The term "at least as likely as 
not" does not mean merely within the realm 
of medical possibility, but rather that the 
weight of medical evidence both for and 
against a conclusion is so evenly divided 
that it is as medically sound to find in 
favor of causation as it is to find against 
it.

[End of quotation]

As a result of that November 2007 remand, additional 
extensive testing and evaluations were undertaken by VA in 
June, September, and October 2009, reports from all of which 
are in the file.  Each examiner, a specialist in the given 
area under review, reviewed the evidence of record including 
the circumstances of the lightning strike and symptom then 
and since.  

In assessing the Veteran's claim, the Board must reiterate 
that it has been fully recognized that she has residuals of a 
in-service lightning strike.  Specifically, service 
connection is already in effect for pain syndrome with 
associated proximal muscle weakness, left upper extremity 
(claimed as decreased motor skills in left hand and 
hemiparesis, residuals of lightning strike)", for which a 30 
percent rating is assigned; "pain syndrome with associated 
proximal muscle weakness in left lower extremities (claimed 
as plantar flexion muscle of the left foot, residuals of 
lightning strike)", for which a 10 percent rating is 
assigned; and "migraine headaches (claimed as migraine 
headaches due to residuals of lightning, rated as 10 percent 
disabling.

Thus, the only issue remaining is whether any of her 
additional complaints are also due to the incident in 1999.  
In that regard, a great deal of concentrated effort has been 
undertaken to obtain sufficient medical and other evidence to 
render a competent and qualified decision in that regard.  
Pursuant to the Board's remands, additional clinical records 
and a variety of pertinent medical expert assessments and 
opinions were obtained including up-to-date VA assessments 
and clinical evaluation reports.  In keeping with Gonzalez 
and Timberlake, supra, these have all been reviewed but will 
not be cited in detail.  The Board is satisfied that such 
adequate and supportive evidence is now of record for an 
equitable resolution of the remaining aspects of her claim.

Evidence recently received shows that the Veteran has some 
acute right eye complaints in July 2004, and symptoms 
including erythema.  Visual acuity was correctible to 20/20, 
bilaterally.  The most recent comprehensive VA 
ophthalmological assessment, in October 2009, was that she 
had had refractive error and had worn glasses since 
childhood.  She stated that now she was better able to see at 
night than during the day, and her left eye was weaker than 
the right.  In addition to her astigmatism, she had normal 
ocular anatomy.  The examiner concluded that it was unlikely 
that she had any ocular or visual disability relating to the 
prior lightning strike.  Otherwise, the Veteran has a virtual 
lifelong refractive error (for which she has long been using 
eyeglasses), which was not changed or aggravated in or as a 
result of anything in service.  She also has astigmatism.  
The Court has noted that medical authorities indicate that 
"although nearly all astigmatism is congenital (where 
heredity is the only known factor), it may also occur as a 
residual of trauma and scarring of the cornea, or even from 
the weight of the upper eyelid resting upon the eyeball . . . 
."  Browder v. Brown, 5 Vet. App. 268, 272 (1993).  In this 
case, the eye examiner opined that the astigmatism was not 
due to the lightning strike, and that the Veteran had no 
ocular or visual problem as a result thereof. 

As for her heart, the VA cardiovascular specialist found in 
June 2009 that the stenosis shown on the cerebrovascular 
duplex study is mild and without hemodynamic significance.  
Pulses were normal.  The Veteran again demonstrated small 
intracranial carotid arteries as shown on the 1999 studies, 
but these were a normal variant.  She had not been seen for 
elevated blood pressure or diagnosed with hypertension prior 
to 2000 (at a time when she was not on ACDUTRA and not within 
a year's time of active duty, if any) since which she had 
taken oral medication.  Her more recent reported palpitations 
and shortness of breath were felt to be due to sinus 
tachycardia, and she was advised to avoid caffeine.  Other 
testing was normal and she had no peripheral edema.  Symptoms 
of heart fluttering had been identified in summer 2002; 
hypertension was characterized in July 2004.  Various 
specialized testing was accomplished in November 2009 showing 
ECG findings of probable LVB but consistent with an infarct.  
Private evaluative studies in September and October 2009 
confirmed her hypertension which had been fairly well 
controlled with medication.  She reported that she has been 
told her hypertension is stress related or impacted, and the 
examiner stated that, while this may be entirely correct, it 
is irrelevant to the etiology of the disability in this case.

The cardiological examiner opined that it is less likely as 
not that the lightning strike was in any way responsible for 
her carotid artery condition.  That opinion was supported by 
the normal left carotid flow on the cerebroascular duplex 
study in 2004 and mild right internal carotid stenosis (ICA) 
on that same test.  She had denied any current right-sided 
neurologic complaint and the examination of both upper 
extremities had been entirely normal.  

The examiner further opined that the Veteran's right ICA 
stenosis had no hemodynamic significance at present and was 
less likely than not related to the lightning strike in 
service.  The cardiological examiner further opined that it 
is less likely than not that her hypertension was caused by 
or a result of the lightning strike in service.  
Parenthetically, it must also be noted that her various 
periods of service have been carefully recited above, and the 
lightning strike occurred while she was on ACDUTRA.  The 
evidentiary record does not show hypertension during that 
period of duty.  The Board recognizes that, because she has 
been service connected for disabling residuals of that July 
1999 incident, she is entitled to the one-year presumption 
for cardiovascular-renal disease manifested to a compensable 
degree within one year thereafter.  However, the record does 
not show such manifestation.

On audiological evaluation, her hearing was found to be 
normal.  With regard to the tinnitus which she alleges 
started a month after the incident, the examiner noted that, 
while there have been reports in medical literature that 
sometimes with lightning strikes there would be membrane 
damage or rupture; however, the Veteran had not experienced 
such an injury.  Based on the clinical findings history and 
medical literature, the examiner opined that the tinnitus is 
less likely than not related to the lightning strike in 1999.  
Again it is noted that the lightning strike took place while 
on ACDUTRA so any "ordinary" presumptions with regard to 
tinnitus, e.g., when it first was manifest may be legitimate 
observations but in this case, that is not dispositive as to 
in-service incurrence, since medical opinion finds that it 
was not due to the lightning strike.  In that regard, the 
Board would note that it appreciates her contentions and the 
evidence she has supplied.  In fact, her contentions with 
regard the date of onset of hypertension appear relatively 
accurate, but it remains that the disability is not due to 
the lightning strike and does not otherwise fulfill 
requirements for incurrence or aggravation during, or 
otherwise attributable to, a stated period of duty.  

In the aggregate, the Board is now satisfied that the 
relevant, productive substantive evidence is as extensive as 
possible, and that the medical opinions now of record have 
clarified what is and is not due to the lightning strike.  In 
that regard, while the Veteran has already been granted 
service connection for those several disabilities which are 
the result of that incident, there is no sound basis for 
concluding that she has additional residuals of a lightning 
strike to include eye or visual impairment, and 
cardiovascular disability to include of the carotid artery in 
the neck and hypertension on any premise.  The evidence is 
not equivocal, and reasonable doubt is not raised in that 
regard. 


ORDER

Service connection for additional residuals of a lightning 
strike to include eye or visual impairment, and 
cardiovascular disability to include of the carotid artery in 
the neck and hypertension, is denied.  



____________________________
ANDREW J. MULLEN
Veterans Law Judge, Board of Veterans' Appeals


 Department of Veterans Affairs