Citation Nr: 18141988 Decision Date: 10/12/18 Archive Date: 10/12/18 DOCKET NO. 16-33 353 DATE: October 12, 2018 ORDER Entitlement to service connection for hypertension is granted. Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. REMANDED Entitlement to service connection for diabetes mellitus is remanded. FINDINGS OF FACT 1. The Veteran’s currently diagnosed hypertension had its onset during his active duty service. 2. The evidence weighs against a finding that the Veteran has had a confirmed diagnosis of PTSD at any time relevant to the appeal period. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for service connection for posttraumatic stress disorder (PTSD) have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3.304(f), 4.125a. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 2001 to June 2010. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from September 2014 and August 2015 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110. Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Cardiovascular-renal disease, including hypertension, is a “chronic disease” listed under 38 C.F.R. § 3.309(a); therefore, the theory of continuity of symptomatology under 38 C.F.R. § 3.303(b) applies. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. For the showing of “chronic” disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease, at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally a showing of “continuity of symptoms” after service is required for service connection. 38 C.F.R. § 3.303(b). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a layperson. 38 C.F.R. § 3.159(a)(2). Lay evidence may be competent evidence to establish incurrence. See Davidson v. Shinseki, 581 F.3d 1313 (Fed, Cir. 2009). However, competent medical evidence is necessary where the determinative question is one requiring medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b). When all of 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 fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 1. Entitlement to service connection for hypertension. The Veteran contends that service connection is warranted for hypertension as it manifested in service or within one year of his discharge from service in June 2010. Specifically, he contends that while on deployment in Iraq and after returning from Iraq, he was repeatedly placed on 5-day testing cycles for his blood pressure. He stated that he was only placed on medication once while in-service. The medical evidence of record establishes that the Veteran currently has hypertension. See generally VA treatment records. Therefore, a current disability is established. Furthermore, the Veteran’s service treatment records (STRs) contain high blood pressure readings on numerous occasions, to include some high enough to be considered hypertensive for VA purposes. However, the record does not reflect these readings were taken two or more times on at least three different days. See 38 U.S.C. § 4.104, Diagnostic Code 7101, Note 1. Nevertheless, STRs show a March 2009 diagnosis of systemic hypertension. At that time, the Veteran’s blood pressure was 143/89 and he was started on hydrochlorothiazide. In addition to the official May 2009 diagnosis of hypertension, the Veteran’s STRs contain several elevated blood pressure readings. In July 2008, the Veteran’s blood pressure was recorded as 139/90 and in May 2008, his blood pressure was 143/108. In October 2009, after he was diagnosed with hypertension, the Veteran’s blood pressure was 128/98. An undated entry contains blood pressure recordings of 140/100 with a notation of hypertension and a 5-day blood pressure check of 145/86. Based on the foregoing, the Board finds that service connection for hypertension is warranted as such disease had its onset during service. In this regard, such was diagnosed in service in March 2009 and the Veteran has competently and credibly reported high blood pressure readings since such time with the prescription of Lisinopril in September 2012 following an aspirin regimen. Therefore, the probative evidence of record, particularly the Veteran’s reports of the treatment for and onset of his hypertension, especially when considered with the correlating medical evidence showing an in-service diagnosis, support the claim for service connection for hypertension. Therefore, the finds that service connection for such disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. 2. Entitlement to service connection for posttraumatic stress disorder (PTSD). There are particular requirements for establishing PTSD in 38 C.F.R. § 3.304(f), that are separate from those for establishing service connection generally. Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. §§ 3.304, 4.125. The Veteran’s STRs are silent for complaints of or treatment for psychiatric disorders. The Veteran reported several in-service stressors related to his deployment in Iraq. The Veteran was afforded a VA examination in June 2015. The examiner noted that the Veteran’s symptoms did not meet the diagnostic criteria for PTSD under DSM-5 criteria, as he did not exhibit any intrusive symptoms or negative symptoms. The examiner diagnosed the Veteran with other specified trauma- and stressor- related disorder. The Board notes that the Veteran is service-connected for other specified trauma- and stressor- related disorder, which is currently rated as 50 percent disabling under Diagnostic Code 9413. In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223 (1992); Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998) (service connection may not be granted unless a current disability exists). The Veteran has not had a confirmed diagnosis of PTSD during any period in appellate status or relevant to this appellate status period. The only suggestion of a diagnosis of PTSD comes from the Veteran’s lay statements. To the extent that the Veteran has contended that he has PTSD, he has not shown that he has specialized training sufficient to diagnose PTSD or determine its etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, while the Veteran is competent to report his observable symptoms, the diagnosis of PTSD is not capable of lay observation, and requires medical expertise to determine. Accordingly, his opinion as to whether a disability existed and the etiology of such is not competent medical evidence. Accordingly, the Board concludes that the preponderance of the evidence is against the claim for service connection for PTSD. The evidence weighs against a finding that the Veteran has had a confirmed diagnosis of PTSD at any time relevant to the appeal period. Accordingly, the claim must be denied. 38 U.S.C. § 5107(b); Gilbert. REASONS FOR REMAND 1. Entitlement to service connection for diabetes mellitus is remanded. The Veteran contends that his diabetes mellitus is related to service in that he began to experience symptoms within one year of his June 2010 discharge from the Army. VA treatment records from October 2011 show that the Veteran presented with high blood sugar and reported that he had been having symptoms such as thirst, weight loss, nocturia, and dry cough for 2-3 months. The Veteran has not been afforded a VA examination in connection with his diabetes mellitus. In light of the facts above, the Board concludes that a remand is necessary to determine the nature and etiology of his disabilities. McClendon v. Nicholson, 20 Vet. App. 79 (2006). The matter is REMANDED for the following action: 1. Obtain updated VA treatment records. 2. After completing directive #1, the AOJ should arrange a VA examination with the appropriate medical professional regarding the nature, extent, and etiology of the Veteran’s diabetes. The record, to include a copy of this remand, must be made available to and reviewed by the examiner in conjunction with the examination. The examiner should review the record, to include this Remand. Based on the record, the examiner should provide a response to the following: Is it at least as likely as not (a 50% or higher degree of probability) that the Veteran’s diabetes is related to service? It is requested that the rationale for this opinion include some discussion of the Veteran’s reported symptoms within one year of his discharge from service. A rationale for all opinions offered should be provided. If the examiner cannot render an opinion without resorting to mere speculation, a full and complete explanation for why an opinion cannot be rendered should be provided. J. CONNOLLY Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Thompson, Associate Counsel