Citation Nr: 18146607 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 14-13 071 DATE: October 31, 2018 ORDER Service connection for ulcers is denied. Service connection for an occult carcinoid tumor is denied. Service connection for obesity is denied. Service connection for medulloadrenal hyperfunction is denied. REMANDED Service connection for chest pain is remanded. Service connection for an acquired psychiatric condition, to include cognitive disorder, anxiety disorder, short-term memory loss, and histrionic personality traits, is remanded. VETERAN’S CONTENTIONS The Veteran is seeking service connection for various physical conditions reflected in his service treatment records (STRs), including ulcers, an occult carcinoid tumor, obesity, chest pain, and medulloadrenal hyperfunction. The Veteran contends that he has one or more current disabilities related to these conditions noted in service. The Veteran is also seeking service connection for various psychiatric conditions, including cognitive disorder, anxiety disorder, short-term memory loss, and histrionic personality traits. The Veteran contends that these disabilities had their onset in or are related to his active duty service. FINDINGS OF FACT 1. The Veteran has neither a current diagnosis nor any signs or symptoms of ulcers, an occult carcinoid tumor, or medulloadrenal hyperfunction. See October 2010 VA Examination. 2. Obesity is not a disability for VA compensation purposes. CONCLUSIONS OF LAW 1. The criteria for service connection for ulcers are not met. 38 U.S.C. §§ 1110, 111, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for obesity are not met. 38 U.S.C. §§ 1110, 111, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for medulloadrenal hyperfunction are not met. 38 U.S.C. §§ 1110, 111, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for service connection for obesity are not met. 38 U.S.C. §§ 1110, 111, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a), 3.310; VAOPGCPREC 1-2017. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Marine Corps from September 1989 to September 1993 and in the Army from January 2007 to June 2010. This case is before the Board of Veterans’ Appeals (Board) on appeal from a May 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. 1. Entitlement to Service Connection for Ulcers, an Occult Carcinoid Tumor, and Medulloadrenal Hyperfunction Generally, in order to prove service connection, there must be competent, credible evidence of 1) a current disability, 2) in-service incurrence or aggravation of an injury or disease, and 3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). As noted in the above findings of fact, there is no evidence of record of any diagnosis or signs or symptoms of ulcers, an occult carcinoid tumor, or medulloadrenal hyperfunction. Rather, an October 2010 VA examination yielded findings of no diagnoses of these conditions. The examiner further noted that the Veteran had no history of ulcer disease, and there was no documented evidence of adrenal hyperfunction. In addition, the examiner noted that although the Veteran’s record contained a note of a possible carcinoid tumor at an evaluation for severe diarrhea, upon subsequent investigation no tumor was diagnosed. In short, the Veteran has no history of and no current diagnoses of ulcers, an occult carcinoid tumor, or medulloadrenal hyperfunction. Therefore, service connection for these conditions is not warranted. 2. Entitlement to Service Connection for Obesity The Veteran contends that his obesity is caused by medicines he is prescribed for headaches, including Keppra. Unfortunately however, the law precludes the Board from considering the Veteran’s claim for service connection for obesity. VA’s Office of General Counsel (OGC) has held that obesity is not considered a disease or injury under VA’s laws and regulations and may not be service connected on a direct or secondary basis. VAOPGCPREC 1-2017. The Board is bound by the General Counsel’s opinion as Chief Legal Officer of the Department. 38 U.S.C. § 7104(c). Consequently, the Veteran’s claim of service connection for obesity must be denied as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426 (1994) (when the law and not the evidence is dispositive, a claim for entitlement to VA benefits should be denied or the appeal to the Board terminated because of the absence of legal merit or the lack of entitlement under the law). REASONS FOR REMAND 1. Entitlement to Service Connection for Chest Pain The Veteran is seeking service connection for “atypical chest pain,” noted as such since January 2008, during his active duty service. An August 2009 STR notes atypical chest pain evaluated in January 2008 with a finding of no cardiac issues. In October 2010, following a general VA examination, the examiner diagnosed atypical chest pain, likely related to anxiety. Even in the absence of a presently-diagnosed condition, any pain resulting in functional impairment constitutes a disability as contemplated in 38 U.S.C. § 1110. Saunders v. Wilkie, 886 F.3d 1356, 1367–68 (Fed. Cir. 2018). The October 2010 VA examiner did not opine as to whether the Veteran’s chest pain causes him any functional limitation, nor did she opine as to whether his pain had its onset in or is related to his active duty service. Consequently, there is no competent medical evidence of record as to whether the Veteran has a current disability related to his active duty service. Therefore, before the Board may adjudicate this claim, a remand is necessary for a new VA examination to include opinions as to these issues. 2. Entitlement to Service Connection for an Acquired Psychiatric Condition The Veteran is seeking service connection for the following psychiatric disorders: cognitive disorder, an anxiety disorder, a short-term memory loss condition, and histrionic personality traits condition. VA must provide a VA medical examination where the evidence reveals an event, injury, or disease incurred in service which may be associated with the Veteran’s current disability, but where the competent medical evidence of record is insufficient to adjudicate the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Veteran’s STRs reflect an impression of cognitive disorder and histrionic personality traits, and a note of possible anxiety. See August 2009 STRs. Since his separation from service, the Veteran’s medical records reflect findings of mild cognitive impairment, features of personality disorder, and a diagnosis of posttraumatic stress disorder (PTSD). See July 2011 VA Treatment Record. The Veteran is currently service connected for PTSD. However, he has not been afforded a VA examination and opinion on his other psychiatric service connection claims. Therefore, because the Veteran’s STRs reveal evidence of psychiatric conditions incurred in service which may be associated with the Veteran’s current psychiatric disabilities, a remand is necessary to provide the Veteran a VA examination and opinion in support of his claim for service connection for these disabilities. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records and associate them with the claims file. 2. After completing the development outlined in Item 1., schedule the Veteran for a VA examination and opinion on his claims for service connection for atypical chest pain and an acquired psychiatric disorder. Upon full review of the claims file and examination of the Veteran, the examiner should respond to the following: (a.) Has the Veteran’s atypical chest pain caused him functional impairment at any point throughout the claim period (from October 15, 2008)? (b.) If you find that the Veteran’s atypical chest pain has caused him functional impairment at any point throughout the claim period, is it at least as likely as not (50 percent probability or more) that the Veteran’s atypical chest pain had its onset in, was caused by, or is otherwise related to his active duty service? (c.) Please list any psychiatric diagnosis other than PTSD the Veteran has had throughout the claim period. For each diagnosed psychiatric condition, is it at least as likely as not that either: i. The condition had its onset in, was caused by, or is otherwise related to the Veteran’s active duty service? Or: ii. The condition was either a) caused, or b) aggravated by the Veteran’s service-connected PTSD? Aggravation here means worsening beyond the normal progression of the non-PTSD psychiatric condition. iii. If you find that a non-PTSD psychiatric condition was aggravated by the Veteran’s service-connected PTSD, please estimate the degree of aggravation beyond the baseline level of the non-PTSD psychiatric condition that is attributable to the PTSD. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Timmerman, Associate Counsel