Citation Nr: 18145685 Decision Date: 10/29/18 Archive Date: 10/29/18 DOCKET NO. 16-37 952 DATE: October 29, 2018 ORDER Entitlement to service connection for a left knee disability. Entitlement to left eye vision changes. Entitlement to service connection for a stomach disability, to include as due to exposure to contaminated water at Camp Lejeune is denied. Entitlement to service connection for a bladder disability, to include as due to exposure to contaminated water at Camp Lejeune is denied. REMANDED Entitlement to service connection for hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for brain damage, to include memory loss, is remanded. FINDINGS OF FACT 1. The Veteran was stationed at Camp Lejeune from July 1981 to December 1981, and his exposure to contaminated drinking water is conceded. 2. There is no competent evidence of record that shows the Veteran currently has a left knee disability. 3. There is no competent evidence of record that shows the Veteran has left eye vision changes that are related to his time in service. 4. There is no competent evidence of record that shows the Veteran has a stomach disability. 5. There is no competent evidence of record that shows the Veteran has a bladder disability. CONCLUSIONS OF LAW 1. The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 2. The criteria for service connection for left eye vision changes have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 3. The criteria for service connection for a stomach disability have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 4. The criteria for service connection for a bladder disability have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from December 1978 to December 1981. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision by the Louisville, Kentucky Regional Office (RO) of the United States Department of Veterans Affairs. The Veteran’s claim of entitlement to service connection for posttraumatic stress disorder has been recharacterized to broadly reflect that the scope of the claim includes any acquired psychiatric disorder, pursuant to Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. 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). In order to establish service connection on a direct basis, the record requires competent evidence showing: (1) the existence of a present disability; (2) in service incurrence or aggravation of an injury or disease; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In addition to the law above, service connection may also be granted on a presumptive basis for certain diseases associated with exposure to contaminants (defined as the volatile organic compounds trichloroethylene (TCE), perchloroethylene (PCE or PERC), benzene, and vinyl chloride) in the on-base water supply located at Camp Lejeune, even though there is no record of such disease during service, if they manifest to a compensable degree at any time after service, in a veteran, former reservist, or a member of the National Guard, who had no less than 30 days (consecutive or nonconsecutive) of service at the United States Marine Corps Base Camp Lejeune and/or Marine Corps Air Station New River in North Carolina, during the period beginning on August 1, 1953 and ending on December 31, 1987. 38 C.F.R. § 3.307(a)(7) (2017). The following diseases are deemed associated with exposure to contaminated water at Camp Lejeune: kidney cancer, liver cancer, Non-Hodgkin’s lymphoma, adult leukemia, multiple myeloma, Parkinson’s disease, Aplastic anemia and other myelodysplastic syndromes, and bladder cancer. 38 C.F.R. § 3.309(f). Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is 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 lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). A layperson is generally not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997). See also Bostain v. West, 11 Vet. App. 124, 127 (1998). In determining whether service connection is warranted for a disability, 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 the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. Service connection for a left knee disability The Veteran is seeking service connection for a left knee disability. The Veteran’s service treatment records (STRs) show that the Veteran was treated for knee pain due to a knee trauma in September 1978. The Veteran’s separation examination is negative for record of a left knee disability. In July 2013, the Veteran underwent a VA knee examination. The examiner determined that there were no objective findings to support a diagnosis of a left knee disability. Range of motion of the left knee was normal, and there was no objective evidence of painful motion. There was no functional loss or functional impairment of the left knee. X-rays taken in conjunction with the examination showed normal knees, bilaterally, with no post-traumatic or arthritic change. Medical records from Social Security Administration were also reviewed; these records contained no medical evidence establishing a diagnosis of a left knee disability. In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is not warranted. Service connection for left eye vision changes The Veteran is seeking service connection for left eye vision changes. The Veteran’s service treatment records (STRs) show that the Veteran was treated for a left eye laceration in service. The Veteran’s separation examination is negative for a record of left eye vision changes, including double vision or blurred vision. The Veteran underwent a VA eye examination in April 2015 which revealed that the Veteran has a current diagnosis of cataracts. The Veteran reported left eye double vision and blurriness. The examiner determined that the blurred vision and double vision the Veteran experiences is less likely than not due to the 1981 trauma to his left eyes, and is typically due to refractive error or his cataracts. He reasoned that on testing, the blurred and double vision were present in both eyes, and not only the one that had been injured. Service connection for the Veteran’s claimed left eye vision changes must be denied because the competent evidence of record does not show that the Veteran’s currently diagnosed left eye disability, cataracts, was either caused by or began in military service. While the Veteran may be credible to describe the symptoms of blurred vision and double vision he experiences, determining the exact nature and diagnosis of any eye disorder requires specialized testing and medical knowledge or training which the Veteran is not shown to have. He lacks the knowledge and training to conclude whether such observable symptoms are part of a chronic disease or disorder, or to opine regarding the cause of such. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The preponderance of the evidence is therefore against a finding of service connection for left eye vision changes and the claim must be denied. There is no reasonable doubt to be resolved in this case. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, at 1 Vet. App. 49 (1990). Service connection for a stomach disability, to include as due to exposure to contaminated water at Camp Lejeune The Veteran is seeking service connection for a stomach disability, to include as due to exposure to contaminated water at Camp Lejeune, and/or to exposure to water tainted with jet fuel aboard ship. The Veteran’s service at Camp Lejeune has been verified and his exposure to contaminated water is conceded. However, none of the listed conditions relate to stomach problems. Therefore, service connection for a stomach disability on a presumptive basis need not be considered further. The Veteran’s service treatment records (STRs) show that the Veteran was treated for an upset stomach on one occasion in service. Such was related to viral gastritis. The Veteran’s separation examination is negative for a record of a stomach disability. The Veteran underwent a VA stomach examination in July 2013. The Veteran reported experiencing periodic episodes of abdominal pain with nausea and similar symptoms. The examiner determined, however, that there was no chronic, ongoing stomach problem. The examiner determined there were no objective findings to support a diagnosis of a chronic stomach disability. The reported periodic symptoms were separate and discrete reactions or illnesses, and not a long-term disease. Medical records from Social Security Administration were also reviewed; these records contained no medical evidence establishing a diagnosis of a stomach disability. While the Veteran is competent to report having episodes of abdominal pain, as these are observable symptoms, he lacks the knowledge and training to conclude whether such are part of a chronic disease or disorder. He cannot observe a link between separate incidents. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The Board concludes that the Veteran does not have a current diagnosis of a chronic stomach disorder, and has not had one at any time since the filing of the claim. In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 255 (1992). Accordingly, service connection for a stomach disability is not warranted. The Board has considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the Veteran’s claim for service connection for a stomach disability, the doctrine is not applicable. See 38 C.F.R. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Service connection for a bladder disability, to include as due to exposure to contaminated water at Camp Lejeune The Veteran is seeking service connection for a bladder disability, to include as due to exposure to contaminated water at Camp Lejeune. The Veteran’s service at Camp Lejeune has been verified and his exposure to contaminated water is conceded. However, the claimed condition of a bladder disability is not one of the diseases recognized by VA as being potentially associated to exposure to contaminated water at Camp Lejeune. The Veteran does not have a diagnosis of bladder cancer, which is listed. Therefore, service connection for a bladder disability on a presumptive basis is not warranted. The Veteran’s service treatment records (STRs) show that the Veteran was treated for symptoms of urinary tingling on one occasion in service. The Veteran’s separation examination is negative for a record of a urinary and/or bladder disability. The Veteran underwent a VA urinary tract examination in July 2013. The Veteran reported experiencing frequent urination which he has been told is related to the quantity of liquids he drinks. The examiner determined that there were no objective findings to support a diagnosis of a urinary and/or bladder disability. Medical records from Social Security Administration were also reviewed; these records contained no medical evidence establishing a diagnosis of a bladder disability. While the Veteran is competent to report experiencing frequent urination, as this is an observable event, he lacks the knowledge and training to conclude whether such are part of a chronic disease or disorder. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The Board concludes that the Veteran does not have a current diagnosis of a bladder disability, and has not had one at any time since the filing of the claim. In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 255 (1992). The Board understands that frequent urination, particularly at night, can be an irritant or inconvenient, but at this time there is no disease or disability associated with such. Accordingly, service connection for a bladder disability is not warranted. The Board has considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the Veteran’s claim for service connection for headaches, the doctrine is not applicable. See 38 C.F.R. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). REASONS FOR REMAND Service connection for an acquired psychiatric disorder, to include PTSD, and for memory loss, claimed as brain damage A letter was received from the Veteran’s Health Administration for Mental Health in February 2018 indicating the Veteran has been in the care of VA and has been diagnosed with obsessive compulsive disorder, PTSD, and major depressive disorder. The doctor indicates there are outstanding treatment records since April 2017. These must be secured prior to adjudication. Further, although memory loss is a symptom often associated with mental illnesses, and it appears the Veteran has abandoned his initial allegation of a head injury form boxing. All avenues must be explored, however. Service connection for hearing loss and tinnitus The Veteran was scheduled for a VA hearing loss and tinnitus examination in April 2015, which was not completed due to complete occlusion of the Veteran’s ears. The Veteran was informed that the examination would be rescheduled after his ears were flushed, but this did not occur. Examination is required on remand. The matters are REMANDED for the following action: 1. Associate with the claims file updated VA treatment records from the medical center in Savannah, Georgia, and all associated clinics. 2. Reschedule the Veteran for a VA audiology examination. The claims folder must be reviewed in conjunction with the examination. If necessary, make arrangements for flushing of impacted wax prior to the examination. Identify any hearing loss or tinnitus disability. The examiner must provide an opinion as to whether any such is at least as likely as not (50 percent or greater probability) related to military service, to include reports of noise exposure aboard an aircraft carrier as a member of the Marine contingent. 3. Upon completion of the above, arrange for any additional required development, such as a psychiatric examination if records justify such. Then, readjudicate the remanded issues. If the benefits sought remain denied, the Veteran should be provided with a supplemental statement of the case. The case should then be returned to the Board for appellate review if otherwise in order. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. M. Lunger, Associate Counsel