Citation Nr: 18139703
Decision Date: 10/01/18	Archive Date: 09/28/18

DOCKET NO. 17-12 499
DATE:	October 1, 2018
ORDER
Entitlement to a bilateral eye disorder, to include pterygium and refractive disorder is denied.
Entitlement to service connection for hypertension is denied.
Entitlement to service connection for a prostate disability is denied.
Entitlement to service connection for an acquired psychiatric disorder is denied.
FINDINGS OF FACT
1. The Veteran is not presumed to have been exposed to herbicides during service, and the record does not otherwise show that the Veteran was otherwise exposed to herbicides in service.
2. The Veteran’s pterygium is not etiologically related to an in-service injury, event, or disease.
3. The Veteran’s hypertension did not manifest in service, was not continuous since service, was not shown to a compensable degree within one year of separation from service, and is not etiologically related to his active service
4. The Veteran’s benign prostatic hyperplasia is not etiologically related to an in-service injury, event, or disease.
5. The Veteran’s acquired psychiatric disorder is not etiologically related to an in-service injury, event, or disease.
CONCLUSIONS OF LAW
1. The criteria for entitlement to a bilateral eye disorder, to include pterygium and refractive disorder have not been met.  38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2017).
2. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309 (2017).
3. The criteria for entitlement to service connection for a prostate disability have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2017).
4. The criteria for entitlement to service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 4.125 (2017).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran served on active duty from July 1968 to July 1970.
This matter comes before the Board on appeal from an October 2015 rating decision of the Department of Veterans Affairs (VA) RO in San Juan, Puerto Rico.
VA’s duty to assist also includes providing a medical examination and/or obtaining a medical opinion when necessary to decide the claim. See 38 U.S.C. § 5103A; 38 C.F.R. §§ 3.159(c)(4), 3.326(a); see also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). However, the Veteran has not been provided with a VA examination for the claims of service connection for a bilateral eye disorder, a prostate disorder, and low blood pressure. VA has a duty to provide a medical examination where there is (1) competent evidence of a current disability or symptoms thereof; (2) evidence establishing that an event, injury, or disease occurred in service; (3) an indication that the disability is associated with service; and (4) insufficient competent medical evidence to decide the claim. McLendon, 20 Vet. App. at 81; see 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i). As explained below, the Board finds that there was no event, injury, or disease related to the Veteran’s bilateral eye disorder and prostate disorder that occurred in service. Further, there is no evidence of a current low blood pressure disability. VA, therefore, has no duty to provide medical examinations for these claims.
Service Connection
Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any 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). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).
The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; Degmetich v. Brown, 104 F.3d. 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). Evidence must show that the Veteran currently has the disability for which benefits are being claimed. In the absence of proof of a present disability due to disease or injury that occurred in service, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).
The requirement for a current disability is satisfied when a claimant has a disability either at the time a claim for VA compensation is filed, or at any time during the pendency of that claim. A claimant may be granted service connection even though the disability resolves prior to the Secretary’s adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).
Hypertension is considered a chronic disease listed under 38 C.F.R. § 3.309(a). For specific enumerated diseases designated as “chronic,” there is a presumption that such chronic disease was incurred in or aggravated by service even though there is no evidence of such chronic disease during the period of service.  For the presumption to attach, the disease must have become manifest to a degree of 10 percent or more within one year of separation from active duty.  38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307(a)(3), 3.309(a).  Presumptive service connection for the specified chronic diseases may alternatively be established by way of continuity of symptomatology under 38 C.F.R. § 3.303(b).
Additionally, a veteran who, during active military service, served in the Republic of Vietnam during the period beginning in January 1962 and ending in May 1975 is presumed to have been exposed to herbicide agents. 38 C.F.R. §§ 3.307, 3.309. However, the Veteran’s DD Form 214 shows the Veteran had no foreign service. Further, the Veteran was not in receipt of any medals indicating service in the Republic of Vietnam. Accordingly, herbicide exposure is not conceded. In his August 2016 Notice of Disagreement, the Veteran asserted that he was exposed to Agent Orange during active duty while stationed at the Homestead Air Base. A review of VA public health resources indicates Agent Orange and other herbicides used in Vietnam were tested or stored elsewhere, including many military bases in the United States. However, information provided by the Department of Defense on herbicide testing and storage in the U.S. shows no herbicide use or storage of herbicides at the Homestead Air Base at any point. U.S. Depart. Veterans Affairs, Public Health, Herbicide Tests and Storage in the U.S., http://www.publichealth.va.gov/exposures/agentorange/locations/tests-storage/usa.asp.  Outside of his own assertion that he was exposed to herbicide in Florida at Homestead Air Base, the Veteran has submitted no evidence suggesting herbicide was used or stored at Homestead Air Base during his period of active duty service. Because the most probative evidence of record indicates that there was no Agent Orange, or any other tactical herbicide, used by the U.S. military at Homestead Air Base while the Veteran served, the Board finds that the weight of the evidence is against a finding the Veteran was exposed to an herbicide agent during active service.
In rendering a decision on appeal, the Board must also analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (“although interest may affect the credibility of testimony, it does not affect competency to testify”).
When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran’s particular disability is the type of disability for which lay evidence may be competent. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. at 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. See Barr, 21 Vet. App. at 303. Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. See Jandreau, 492 F.3d 1372, 1377. 
Entitlement to a bilateral eye disorder, to include pterygium and refractive disorder
The Veteran contends his bilateral eye disorder is due to service, to include exposure to herbicides. 
First, the Board notes that for purposes of entitlement to benefits, the law provides that refractive errors of the eyes are developmental defects and not a disease or injury within the meaning of applicable legislation. 38 C.F.R. §§ 3.303(c), 4.9 (2017). In the absence of a superimposed disease or injury, service connection may not be allowed for refractive error of the eyes, including myopia and astigmatism, even if visual acuity decreased in service, as this is not a disease or injury within the meaning of applicable legislation relating to service connection. 38 C.F.R. §§ 3.303 (c), 4.9; Thus, VA regulations specifically prohibit service connection for refractory errors of the eyes unless such defect was subjected to a superimposed disease or injury which created additional disability. See VAOPGCPREC 82-90 (service connection may not be granted for defects of congenital, developmental or familial origin, unless the defect was subject to a superimposed disease or injury).
Further, the preponderance of the evidence is against a finding that the Veteran’s pterygium was incurred in or related to service.
At his March 1968 pre-induction examination, the Veteran’s eyes were normal. In a May 1970 examination shortly before separation, the Veteran’s eyes were again deemed normal upon clinical evaluation. The Veteran’s physical profile (PULHES) included E-1, for normal eyes.
The first indication of pterygium in the Veteran’s treatment records was a VA treatment note in September 2012. A November 2013 VA treatment record noted the Veteran had pterygium of the left eye. 
There is no objective medical evidence relating the Veteran’s pterygium to his active service. The Veteran’s service treatment records are absent of complaints of, treatment for, or a diagnosis of any eye disorders. The Veteran was not diagnosed with pterygium until September 2012—more than 40 years after separating from service. The Veteran has not articulated a theory of entitlement outside of a general claim of exposure to herbicides, which the Board has deemed not credible.
The Board has considered the statements from the Veteran attributing his pterygium to service. However, the evidence of record does not demonstrate that the Veteran has the requisite medical training, expertise, or credentials needed to provide a competent opinion as to medical causation. The question of causation involves a complex medical question, and they do not have the medical expertise to provide such an opinion. Therefore, he is not competent to provide opinions as to the etiology of pterygium. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).
Accordingly, the claim for service connection for an eye disorder must be denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56.
Entitlement to service connection for hypertension
The Veteran contends that he has hypertension as the result of his active service. 
The Veteran initially filed a claim for service connection for low blood pressure, which was denied in an October 2015 rating decision. In his August 2016 notice of disagreement, the Veteran indicated his claim was for hypertension, and not low blood pressure. As such, the Board proceeds by adjudication of hypertension only.
In July 1968, the Veteran’s blood pressure readings were 110/50, 108/60, and 102/60. In March 1970, the Veteran’s blood pressure reading was 122/60. In a May 1970 examination shortly before separation, the Veteran’s blood pressure reading was illegible. However, the Veteran’s vascular system was deemed normal upon clinical evaluation. 
VA treatment records in January 1983 note blood pressure readings of 110/80 and 90/70. An October 1983 VA examination for chest pain noted a blood pressure reading of 180/70. A February 1985 VA treatment record noted a blood pressure reading of 120/80. VA treatment records in September 2012 and April and November 2013 note “[hypertension] well controlled.” An April 2017 VA treatment record notes “[hypertension] heart studies positive 3-2017.”
The preponderance of the evidence is against a finding that the Veteran’s hypertension was incurred in or related to service. There is no objective medical evidence relating the Veteran’s hypertension to his active service. The Veteran’s service treatment records are absent of complaints of, treatment for, or a diagnosis of hypertension. The Veteran first mention of hypertension following separation from service was in September 2012—more than 40 years after separating from service. The Veteran did not experience a continuity of symptomatology of hypertension after separation from service. The Veteran has not articulated a theory of entitlement outside of a general claim of exposure to herbicides, which the Board has deemed not credible.
The Board has considered the statements from the Veteran attributing his currently diagnosed hypertension to service. However, the evidence of record does not demonstrate that the Veteran has the requisite medical training, expertise, or credentials needed to provide a competent opinion as to medical causation. The question of causation involves a complex medical question, and they do not have the medical expertise to provide such an opinion. Therefore, he is not competent to provide an opinions as to the etiology of the hypertension. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).
Accordingly, the Board concludes that the preponderance of the evidence is against the claim for service connection for low blood pressure or hypertension. Therefore, the claim must be denied. 38 U.S.C. § 5107 (b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).
Entitlement to service connection for a prostate disability
The Veteran contends he has a prostate disorder, diagnosed as benign prostate hypertrophy, which is due to service, to include exposure to herbicides.
The Veteran’s service treatment records are absent of complaints of, treatment for, or a diagnosis of any prostate disability. A May 1970 examination shortly before separation was absent of any complaints regarding the Veteran’s prostate.
A December 2011 VA treatment record noted the Veteran had previously undergone a transurethral resection of the prostate (TURP) to treat his benign prostate hypertrophy. A digital rectal examination noted normal results. 
The Board finds that the evidence of record does not support a finding of service connection for a chronic prostate disorder, to include benign prostate hypertrophy.
There is no objective medical evidence relating the Veteran’s prostate disorder to his active service. As noted above, the Veteran’s treatment records are absent of complaints of, treatment for, or a diagnosis of any prostate disability. The first indication of a prostate disorder was in 2011—more than 40 years after separation from service. The Veteran has not articulated a theory of entitlement outside of a general claim of exposure to herbicides, which the Board has deemed not credible. 
The Board has considered the statements from the Veteran attributing his prostate disorder to service. However, the evidence of record does not demonstrate that the Veteran has the requisite medical training, expertise, or credentials needed to provide a competent opinion as to medical causation. The question of causation involves a complex medical question, and they do not have the medical expertise to provide such an opinion. Therefore, he is not competent to provide opinions as to the etiology of benign prostate hypertrophy. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).
Accordingly, the Board concludes that the preponderance of the evidence is against the claim for service connection for a chronic prostate disorder. Therefore, the claim must be denied. 38 U.S.C. § 5107 (b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).
Entitlement to service connection for an acquired psychiatric disorder
The Veteran contends that his acquired psychiatric disorder manifested in service. However, the preponderance of the evidence is against the Veteran’s claim. 
A July 1968 service treatment record notes a recurrent hyperventilation attack. A September 1969 service treatment record noted anxiety symptoms. A March 1970 service treatment record noted he Veteran experienced recurrent hyperventilation syndrome with syncope. The Veteran reported anxiety beginning at approximately age 17. After clinical evaluation, the impression was recurrent hyperventilation syndrome secondary to routine stress of military life. A May 1970 examination shortly before separation from service noted normal psychiatric condition following clinical evaluation. The Veteran’s PULHES profile included S-1, for normal psychiatric condition.
The Veteran underwent a general VA examination in June 1973. The examiner noted an impression of “anxiety neurosis?” 
The Veteran’s VA treatment records note that depression screenings in December 2011, April 2012, and April 2013 were negative.
A July 2014 VA treatment record noted the Veteran underwent a psychological evaluation and was diagnosed with major depressive disorder with psychotic features. The Veteran reported that he was diagnosed with a heart condition and was not sent to Vietnam. A November 2014 VA treatment record notes the Veteran reported that he “continue[s] to think about the discrimination that [he] was exposed [to] in Vietnam.” A July 2015 VA treatment record notes the Veteran continued to be “severely depressed” and he mentioned “the environment and Vietnam” as “the important factor.”
An August 2015 VA mental disorder examination report and opinion notes that an in-person examination was conducted, includes a review of the Veteran’s file, and recounts the Veteran’s history and complaints. The diagnoses included “unspecified anxiety disorder.” The examiner opined that the Veteran’s condition was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner reasoned there was no evidence of psychiatric complaints, findings, or treatment during service of or within one year of separation from service. The Veteran first sought psychiatric treatment in 2014, forty-four years after separation from service. The examiner indicated the recurring symptoms of anxiety and hyperventilation in service were acute, transient, and resulted in no residual disability. 
The Board finds that the August 2015 VA examiner’s opinion is the most probative evidence as to the etiology of the Veteran’s acquired psychiatric disorder. Based on the VA examiner’s conclusion that the Veteran’s symptoms of anxiety and hyperventilation in service were acute and transient, as well as the forty-four-year gap between separation from service and diagnosis, the VA examiner opined that the Veteran’s acquired psychiatric disorder was not related to his active service. As the VA examiner provided a well-reasoned opinion based on a thorough review of the evidence, the Board concludes that the Veteran is not entitled to service connection for an acquired psychiatric disorder. 
Although the March 1970 service treatment record noted the Veteran reported anxiety symptoms prior to service, this does not constitute clear and unmistakable evidence that the Veteran’s acquired psychiatric disorder predated service. The Veteran was deemed to have normal psychiatric condition at entry into service. A Veteran is considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable evidence demonstrates that an injury or a disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304. In light of the normal psychiatric condition found at the time of enlistment, the Board finds that the March 1970 service treatment record indicating that the Veteran demonstrated anxiety symptoms prior to service was an aberration, and does not demonstrate clear and unmistakable evidence of a preexisting acquired psychiatric disability. 
The Board has considered the statements from the Veteran attributing his acquired psychiatric disorder to service. However, the evidence of record does not demonstrate that the Veteran has the requisite medical training, expertise, or credentials needed to provide a competent opinion as to medical causation. The question of causation involves a complex medical question, and they do not have the medical expertise to provide such an opinion. Therefore, he is not competent to provide opinions as to the etiology of his acquired psychiatric disorder. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).
Accordingly, the Board concludes that the preponderance of the evidence is against the claim for service connection for an acquired psychiatric disorder. Therefore, the claim must be denied. 38 U.S.C. § 5107 (b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).
 
JONATHAN B. KRAMER
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	E. Duthely, Associate Counsel