Citation Nr: 18147937 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 09-47 444 DATE: November 6, 2018 ORDER New and material evidence has not been received, and the appeal to reopen a claim of service connection for a right knee disability is denied. New and material evidence has been received, and the appeal to reopen a claim of service connection for a skin disability is granted. Service connection for a skin disability is denied. Service connection for a right shoulder disability is denied. Service connection for a left knee disability is denied. Service connection for a liver disability is denied. Service connection for a gastrointestinal disability is denied. Service connection for a kidney disability is denied. Service connections for lipomas, claimed as multiple internal tumors is denied. Service connection for headaches is granted. REMANDED Entitlement to service connection for a heart disability. Entitlement to service connection for hypertension. FINDINGS OF FACT 1. Evidence received since a final August 2008 rating decision is essentially cumulative of the evidence previously of record with regard to the basis for the prior denial, i.e., lack of a relationship between a current right knee disability and service. 2. Evidence received since a final September 1966 rating decision relates to an unestablished fact, is not cumulative or redundant of the evidence previously of record, and is sufficient to raise a reasonable possibility of substantiating the claim for service connection for a skin disability. 3. A skin disability is not related to service. 4. A right shoulder disability is not related to service and did not manifest within one year of separation from service. 5. A left knee disability is not related to service and did not manifest within one year of separation from service. 6. A liver disability is not related to service. 7. The Veteran does not have a current gastrointestinal disability. 8. The Veteran does not have a current kidney disability. 9. Lipomas are not related to service. 10. Headaches are related to service. CONCLUSIONS OF LAW 1. Evidence received since a final August 2008 rating decision is not new and material and reopening of the Veteran’s claim for entitlement to service connection for a right knee disability is therefore not warranted. 38 U.S.C. §§ 5108, 7105(c) (2012); 38 C.F.R. §§ 3.156(a), 20.1103 (2017) 2. Evidence received since a final September 1966 rating decision is new and material; therefore, the Veteran’s claim of entitlement to service connection for a skin disability is reopened. 38 U.S.C. §§ 5108, 7105(c) (2012); 38 C.F.R. §§ 3.156(a), 20.1103 (2017) 3. The criteria for service connection for a skin disability have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 4. The criteria for service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 5. The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 6. The criteria for service connection for a liver disability have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 7. The criteria for service connection for a gastrointestinal disability have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 8. The criteria for service connection for a kidney disability have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 9. The criteria for service connection for lipomas, claimed as multiple internal tumors, have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 10. The criteria for service connection for headaches have been met. 38 U.S.C. §§ 1101, 1110, 1131, 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 from December 1961 to December 1965. This appeal is before the Board of Veterans’ Appeals (Board) from August 2008 and May 2010 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Portland, Oregon. In July 2018, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge via videoconference. A transcript is included in the claims file. In November 2014, the Board decided multiple issues but remanded the issues remaining on appeal with instruction to complete development and provide a supplemental statement of the case regarding the issues that the RO had erroneously considered withdrawn, and to provide a statement of the case regarding issues for which no statement had yet been issued. A statement of the case was issued in August 2015 and supplemental statements of the case were issued in June 2016, September 2016, and January 2017. The Board additionally instructed that a VA examination be provided for an acquired psychiatric disability, but service connection has since been granted and that issue is therefore no longer before the Board. In September 2017, the Board remanded again with instruction to schedule the Veteran for the abovementioned hearing. The Board is therefore satisfied that the instructions in its remands of November 2014 and September 2017 have been satisfactorily complied with. See Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; 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); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection is also warranted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(b). For certain chronic diseases, such as arthritis and hypertension, a presumption of service connection arises if the disease is manifested to a degree of 10 percent within one year following discharge from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). When a chronic disease is not shown to have manifested to a compensable degree within one year after service, under 38 C.F.R. § 3.303(b) 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. When the fact of chronicity in service is not adequately supported, a showing of continuity after discharge is required to support a claim for such diseases; however, such continuity of symptomatology may only support a claim for those chronic diseases listed under 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). For certain diseases with a relationship to herbicide agent exposure, a presumption of service connection arises if the disease manifests to a degree of 10 percent or more following service in the Republic of Vietnam any time during the period from January 9, 1962 to May 7, 1975. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e). The Board notes that the Veteran has not served in Vietnam and has not established presumptive exposure to herbicide agents. In the analysis below, the Board need not reach the question of whether the Veteran was actually exposed to herbicide agents, because there is no competent evidence of a relationship between such exposure and any of the disabilities for which service connection is herein denied. 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 claimant 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. VA may reopen a claim that has been previously denied if new and material evidence is submitted by or on behalf of a veteran. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). “New” evidence is evidence not previously submitted to agency decision makers and “material” evidence is evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether the evidence presented or secured since the prior final disallowance of the claim is new and material, the credibility of the evidence is generally presumed. Cox v. Brown, 5 Vet. App. 95, 98 (1993); Justus v. Principi, 3 Vet. App. 510, 513 (1992). VA is required to review for newness and materiality only the evidence submitted by a claimant since the last final disallowance of the claim on any basis, whether a decision on the underlying merits or, a petition to reopen. Evans v. Brown, 9 Vet. App. 273, 283 (1996). In Shade v. Shinseki, 24 Vet. App. 100 (2010), the United States Court of Appeals for Veterans Claims (Court) held that § 3.159(c)(4) does not require new and material evidence as to each previously unproven element of a claim for the claim to be reopened and the duty to provide an examination triggered. In a fact pattern where a prior denial was based on lack of current disability and nexus, the Court found that newly submitted evidence of a current disability was, in concert with evidence already of record establishing an injury in service, new and material and sufficient to reopen the claim and obtain an examination. Regardless of any RO determinations that new and material evidence has been submitted to reopen service connection, the Board must still determine whether new and material evidence has been submitted in this matter. Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001). 1. Whether new and material evidence has been received to reopen a claim of service connection for a right knee disability The Veteran seeks to reopen his claim of service connection for a right knee disability. The Veteran’s claim was initially denied in the August 2008 rating decision on appeal for other issues. The denial was based on a finding that his right knee disability neither occurred in nor was caused by service. The Veteran submitted various statements generally disagreeing with all of the findings of the rating decision, and in February 2009 submitted a statement indicating an intent to file a notice of disagreement for his “leg injury.” In a September 2009 statement, the Veteran clarified the issues he was appealing, with a list including left knee chondromalacia but no disability of the right knee. The Board thus finds that the right knee issue was never appealed, and in any event to the extent it was appealed the appeal was withdrawn. There was no new and material evidence submitted during the one-year appeal period or at any time prior to the September 2009 statement, and the August 2008 rating decision therefore became final. VA treatment records reflect that in August 2009 the Veteran was noted to have mild osteoarthritis of the bilateral knees. January 2010 x-rays were stable as compared to x-rays from October 2006. In his March 2010 claim to reopen, the Veteran reported that in November 1962 he caught his foot between two rocks and fell. He reported that he heard a pop in his right knee was unable to walk. He stated that he was treated for this injury and put on crutches. He reported having knee problems ever since. VA treatment records reflect that in August 2012 the Veteran was diagnosed with a severed inferior patellar tendon based on x-rays after injuring it while cutting wood. The Board finds that the evidence received since the August 2008 final rating decision is essentially cumulative to the evidence previously of record with regard to a relationship between the disability and service. The incident described in the Veteran’s March 2010 claim to reopen is evident from his service treatment records, which were added to the record prior to the August 2008 decision. The Veteran’s summation of the event described in his service treatment records is not new, and does not provide any new basis for a relationship between the current disability and service. For these reasons, the Board finds that the evidence received since the August 2008 final rating decision is essentially cumulative to the evidence previously of record with regard to a relationship between the disability and service. His claim to reopen is therefore denied. 2. Whether new and material evidence has been received to reopen a claim of service connection for a skin disability The Veteran seeks to reopen a claim of service connection for a skin disability. Service connection for acne vulgaris was denied in a September 1966 rating decision based on a finding of no current disability. The Veteran neither appealed this decision nor submitted any evidence within the one-year appeal period. The denial therefore became final. Voluminous VA treatment records, described in more detail below, clearly establish that the Veteran has been diagnosed with a skin disability. This evidence relates to an unestablished fact, is not cumulative or redundant of the evidence previously of record, and is sufficient to raise a reasonable possibility of substantiating the claim. The claim of service connection for a skin disability is therefore reopened, and the Board addresses the merits below. 3. Entitlement to service connection for a skin disability The Veteran seeks service connection for a skin disability. Service treatment records reflect that the Veteran was treated for a carbuncle of the neck in February 1964. The only skin abnormality noted at his November 1965 separation examination was mild acne vulgaris of the shoulders and neck. The report noted that the carbuncle had been treated with hot soaks without complications or recurrence. Three days after his separation examination but prior to discharge he reported a rash. The Veteran underwent a general VA examination August 1966. He did not report any skin symptoms beyond occasional low back acne. Examination of the skin was negative and no disability was diagnosed. VA treatment records reflect that when the Veteran was treated for atrial fibrillation in November 1987 he was noted to be diagnosed with psoriasis. At a September 1989 general VA examination, the Veteran reported psoriasis since 1962 or 1963 involving his scalp, penis, buttocks, knees, and elbows. Examination showed the presence of psoriasis in his knees, elbows, ear canals, fingernails, and toenails. He was diagnosed with generalized psoriasis. VA treatment records reflect that at a September 1994 Agent Orange examination the Veteran was diagnosed with psoriasis. In March 1997 he was again diagnosed with psoriasis. In October 2006 he reported that his medication for his atrial fibrillation worsened his psoriasis. His medication was changed and he reported improvement in January 2007. In August 2007 he was again treated for psoriasis. In an October 2008 statement the Veteran reported that he had chloracne due to his exposure to herbicide agents. In a December 2008 statement, the Veteran reported that he has had skin rashes since experiencing a reaction to a typhus vaccination in service. He stated that this disability was secondary to vasculitis he developed from the vaccine. VA treatment records reflect that in December 2010 the Veteran reported to his dermatologist that he had had psoriasis since service in the 1960s. At his July 2018 hearing, the Veteran reported that he has psoriasis and gout from drinking, but he also felt that he had rashes due to exposure to herbicide agents. The Board finds that the evidence weighs against a finding that a current skin disability is related to service. While service treatment records demonstrate the presence of a carbuncle and acne vulgaris, there is no indication of a relationship between these in-service symptoms and his current psoriasis. As to the Veteran’s argument that current skin disabilities are the result of exposure to herbicide agents, such disabilities are not among the disabilities which VA recognizes has a relationship to such exposure. VA recognizes a relationship between such exposure and chloracne, but there is no indication of such a diagnosis in all of the Veteran’s treatment records. He has not provided any basis of knowledge beyond speculation as to how herbicide agents could cause his skin disability, and there is no medical evidence to support such a relationship. Similarly, service treatment records do not show that his February 1962 hospitalization for vasculitis affected his skin in any way, and the Veteran has not provided any reasoning or basis to support his belief of such a relationship. For these reasons, the Board finds that the evidence weighs against a finding that a skin disability is related to service. Service connection is therefore denied. 4. Entitlement to service connection for a right shoulder disability The Veteran seeks service connection for a right shoulder disability. Service treatment records do not reflect any symptoms of or treatment for any disability of the right shoulder. While he reported mild arthralgia in February 1962 when he was admitted for generalized vasculitis in response to his typhus immunization, no joint was specified and there was no indication that the symptom persisted after treatment for vasculitis. No such disability was noted at the Veteran’s November 1965 separation examination. The Board notes that records from August 1965 indicate that the Veteran sprained his left shoulder in a swimming accident, but there is no documentation of injury to his right shoulder. The Veteran underwent a general VA examination August 1966. He did not report any right shoulder symptoms and no right shoulder disability was diagnosed. VA treatment records reflect that at a September 1994 Agent Orange examination the Veteran reported arthritis in all of his joints. He reported that he was not in Vietnam, but he was exposed to some herbicide which he did not know the name of and attributed his symptoms to that. In March 1997 he reported a history of right subacromial bursitis, having received a steroid injection in December 1996. He reported continued pain with some limitation of range of motion and marked cracking. He was diagnosed with right shoulder tendinitis versus subacromial bursitis. At an April 1997 rheumatology consultation, he reported worsening right shoulder pain since a fall approximately one year prior. The rheumatologist found mild adhesive capsulitis versus an adhesion with subacromial bursitis. In January 2007 he reported continued right shoulder pain. X-rays from February 2007 showed degenerative changes. In May 2007 he reported constant shoulder pain, worse with certain movement. He was diagnosed with chronic impingement of the right shoulder. In his June 2007 claim the Veteran reported that he had arthritis which he believed was related to exposure to herbicide agents. In a statement received in December 2007 he clarified that he was exposed to herbicide agents while maintaining property at Stewart Air Force Base in New York. VA treatment records reflect that in August 2007 the Veteran was diagnosed with osteoarthritis. In August 2009 he was noted to have osteoarthritis with right shoulder impingement. He was given an injection. In December 2009 he reported that the injection provided relief for 5 months. In March 2012 he reported chronic bilateral shoulder pain for years. At his July 2018 hearing the Veteran stated that he hurt his right shoulder in a swimming accident in service. The Board finds that the evidence weighs against a finding that the Veteran’s right shoulder disability is related to service or manifested within one year of separation from service. While the Veteran stated at his hearing that he hurt his shoulder while swimming, his service treatment records clearly indicate that this injury was to his left shoulder, not his right. (The Board notes that the concurrent claim of service connection for a left shoulder disability was denied in a final November 2014 Board decision.) The earliest documentation of a right shoulder disability is multiple decades after separation. As to the Veteran’s argument that his shoulder disability is the result of exposure to herbicide agents, a shoulder disability is not among the disabilities which VA recognizes has a relationship to such exposure. The Veteran has not provided any basis of knowledge beyond speculation as to how herbicide agents could cause any of his right shoulder diagnoses. There is no medical evidence to support such a relationship. For these reasons, the Board finds that the evidence weighs against a finding that the Veteran’s right shoulder disability is related to service or manifested within one year of separation from service. Service connection is therefore denied. 5. Entitlement to service connection for a left knee disability The Veteran seeks service connection for a left knee disability. The Board notes that he is already service-connected for a scar on the left knee. Service treatment records reflect that the Veteran was involved in a June 1963 motor vehicle accident. While treatment immediately following the accident did not refer to any left knee injury, at a July 1963 follow-up he was noted to have sustained multiple contusions to his left knee. While he reported mild arthralgia in February 1962 when he was admitted for generalized vasculitis in response to his typhus immunization, no joint was specified and there was no indication that the symptom persisted after treatment for vasculitis. No abnormality was noted at his November 1965 separation examination, which remarked that the motor vehicle accident resulted in no significant injury, no complications, and no sequelae. The Veteran underwent a general VA examination August 1966. He did not report any left knee symptoms and no left knee disability was diagnosed. VA treatment records reflect that at a September 1994 Agent Orange examination the Veteran reported arthritis in all of his joints. He reported that he was not in Vietnam, but he was exposed to some herbicide which he did not know the name of and attributed his symptoms to that. October 2006 x-rays showed stable Pellegrini-Stieda disease of the left knee with minimal osteoarthritic disease of the bilateral patellofemoral joint compartments and bilateral joint effusions. In April 2007 he reported that he had been having problems with his left knee for the prior 4 days. Examination showed acute knee effusion without injury. He was referred to an orthopedist to rule out gout. The orthopedist diagnosed left knee arthralgia with large effusion and suspected gout. He was given an injection. Elevated uric acid in the blood indicated the presence of gout. In May 2007 he reported knee pain and was diagnosed with chondromalacia and spurring about the patella. In his June 2007 claim the Veteran reported that he had arthritis which he believed was related to exposure to herbicide agents. In a statement received in December 2007 he clarified that he was exposed to herbicide agents while maintaining property at Stewart Air Force Base in New York. VA treatment records reflect that in August 2007 the Veteran reported a history of a left knee injury in service. He was diagnosed with mild osteoarthritis and left knee inflammatory effusion. In an April 2008 statement the Veteran reported that his legs had been screwed up since service. VA treatment records reflect that in August 2009 the Veteran was noted to have mild osteoarthritis of the bilateral knees and left knee inflammatory effusion related to gouty arthritis. The Veteran underwent a VA examination in January 2010. He reported left knee pain since an in-service motor vehicle accident in June 1963. Examination showed effusion, pain at rest, and guarding of movement. X-rays showed minimal degenerative changes of the patellofemoral joint compartments. He was diagnosed with left knee gouty arthritis. The examiner opined that the left knee disability was not caused by or a result of the motor vehicle accident in service. This opinion was based on the rationale that he has developed gouty arthritis affecting many joints, especially both knees. At his July 2018 hearing the Veteran reported that he lacerated his knee in his June 1963 motor vehicle accident. He stated that it became a trick knee that was difficult to bend. He also stated that he hurt his leg stepping in a hole while stationed on a mountain and had to be flown by helicopter to the infirmary to have his knee drained. The Board finds that the evidence weighs against a finding that the Veteran’s left knee disability is related to service or manifested within one year of separation from service. The January 2010 VA examiner’s opinion is highly probative. The examiner explained that the Veteran’s knee disability when viewed in conjunction with his other musculoskeletal disabilities was unlikely the result of the left knee injury he experienced in service. There is no medical evidence to contradict the examiner’s opinion, and it is consistent with the November 1965 separation examination and August 1966 VA examination, both of which did not find any current left knee disability. The first post-service documentation of a left knee disability is several decades after separation. As to the Veteran’s argument that his knee disability is the result of exposure to herbicide agents, a knee disability is not among the disabilities which VA recognizes has a relationship to such exposure. The Veteran has not provided any basis of knowledge beyond speculation as to how herbicide agents could cause any of his left knee diagnoses. There is no medical evidence to support such a relationship. For these reasons, the Board finds that the evidence weighs against a finding that the Veteran’s left knee disability is related to service or manifested within one year of separation from service. Service connection is therefore denied. 6. Entitlement to service connection for a liver disability The Veteran claims service connection for a liver disability. Service treatment records do not reflect any symptoms of or treatment for any liver disability. No such abnormality was noted at his November 1965 separation examination. The Veteran underwent a general VA examination August 1966. He did not report any liver symptoms. Examination of the digestive system was normal and no disability was diagnosed. VA treatment records reflect that in October 1987 when the Veteran was admitted for the removal of a lipoma his tests showed abnormal liver function. In his June 2007 claim the Veteran reported that he had cirrhosis of the liver which he believed was related to his exposure to herbicide agents. In a statement received in December 2007 he clarified that he was exposed to herbicide agents while maintaining property at Stewart Air Force Base in New York. In a December 2008 statement, the Veteran reported that he had experienced a reaction to a typhus vaccination in service, and that this reaction caused vasculitis which affected his liver. VA treatment records reflect that in March 2010 the Veteran’s physician noted that x-rays possibly indicated a fatty liver. Private treatment records include an October 2012 record indicating that a CT scan showed a fatty liver. The Veteran’s ongoing alcoholism was noted. VA treatment records reflect that an April 2013 ultrasound showed a mildly enlarged liver. At his July 2018 hearing the Veteran stated that he had been diagnosed with fatty liver and “something else.” He further implied that his condition may be related to his alcoholism caused by his service-connected posttraumatic stress disorder (PTSD). He was informed that evidence was needed to relate a liver condition to alcohol consumption related to his service-connected psychiatric disability, and the record was left open for 60 days. No such evidence was submitted. The Board finds that the evidence weighs against a finding that a liver disability is related to service. The Veteran initially claimed to have cirrhosis of the liver, but there is no medical evidence to support such a diagnosis. A private treatment record refers to a CT scan showing a fatty liver diagnosis, but there is no actual CT scan report in the claims file. At most, a March 2010 record indicates an x-ray showed the possibility of a fatty liver. In any event, there is no competent evidence indicating a link between fatty liver and service. At his July 2018 hearing, he for the first time indicated that his liver condition may be the result of service-connected alcohol abuse, but there is no evidence of such a relationship in the record beyond this baseless implication. A notation in his October 2012 private treatment records indicating his alcoholism did not on its face suggest that his absent but referenced CT scan results were related to alcoholism. As to the Veteran’s argument that it is the result of exposure to herbicide agents, a fatty liver is not among the disabilities which VA recognizes has a relationship to such exposure. The Veteran has not provided any basis of knowledge beyond speculation as to how herbicide agents could cause a fatty liver, and there is no medical evidence to support such a relationship. Similarly, service treatment records do not show that his February 1962 hospitalization for vasculitis affected his liver in any way, and the Veteran has not provided any reasoning or basis to support his belief that the two are related. For these reasons, the Board finds that the evidence weighs against a finding that a liver disability is related to service. Service connection is therefore denied. 7. Entitlement to service connection for a gastrointestinal disability The Veteran seeks service connection for a gastrointestinal disability. Service treatment records reflect that in November 1962 the Veteran reported nausea and vomiting and was prescribed medication. In September 1964 he reported epigastric distress and vomiting for the prior month. He was diagnosed with gastroenteritis. Treatment immediately following a June 1963 motor vehicle accident noted pain and tenderness in the upper abdominal region and splinting of the abdominal musculature, and at a July 1963 follow-up he reported stomach cramps. In October 1964 he was admitted for an acute onset of emesis, nausea, and diarrhea. He reported that for the past 2 months he had had alternating episodes of constipation and diarrhea associated with colicky lower abdominal pain. He was discharged with diagnoses of acute gastroenteritis due to unknown cause and irritable bowel syndrome (IBS). No such disability was noted at his November 1965 separation examination, which noted that he was hospitalized for acute gastroenteritis and IBS with no complications or sequelae. The Veteran underwent a general VA examination August 1966. He did not report any gastrointestinal symptoms. Examination of the digestive system was normal and no disability was diagnosed. At a September 1989 general VA examination, the Veteran did not report any digestive symptoms. Examination showed an unremarkable digestive system. VA treatment records reflect that in October 2007 a colonoscopy revealed benign polyps and internal hemorrhoids but was otherwise normal. In May 2014 he reported epigastric abdominal discomfort. He was diagnosed with dyspepsia and prescribed medication. In October 2014 he reported diarrhea. His physician attributed this and his reported urine symptoms to resolving viral gastroenteritis. In April 2015 he reported that he had diarrhea for the past 4 months. He was diagnosed with chronic diarrhea. At his July 2018 hearing, the Veteran reported that he had diarrhea for 7 months in 2000. He also stated that he has had diarrhea “all along.” He reported that it began in service. He reported that he did not seek treatment after separation from service because he was drinking too much. The Board finds that the evidence weighs against a finding of a current gastrointestinal disability. The Veteran confusingly reports both lengthy periods of diarrhea and constant diarrhea. Despite his statements to VA of constant diarrhea since service, his voluminous VA treatment records rarely refer to any gastrointestinal difficulties. In any event, diarrhea is a symptom, and the Veteran has not been offered an underlying pathology such as IBS since separation from service. Where the evidence does not support a finding of current disability upon which to predicate a grant of service connection, there can be no valid claim for that benefit. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). As such, the Board finds that the evidence weighs against a finding of a current disability and service connection must therefore be denied. 8. Entitlement to service connection for a kidney disability The Veteran seeks service connection for a kidney disability. Service treatment records reflect that the Veteran was hospitalized in February 1962 for nephritis secondary to generalized vasculitis as a reaction to immunization to typhus. His associated hematuria and albuminuria cleared before he was returned to active duty in April 1962. The medical board stated that the possibility of an acute glomerulonephritis could not be ruled out, but diagnosed generalized vasculitis with renal involvement. No such abnormality was noted at his November 1965 separation examination, though the report noted his history of generalized vasculitis. The Veteran underwent a general VA examination August 1966. He did not report any kidney-related symptoms. Examination of the genitourinary system was normal and no disability was diagnosed. VA treatment records reflect that in March 1997 the Veteran reported that he may possibly have only one kidney. In his June 2007 claim the Veteran reported that he had nephritis that he believed was related to his exposure to herbicide agents. In a statement received in December 2007 he clarified that he was exposed to herbicide agents while maintaining property at Stewart Air Force Base in New York. In a December 2008 statement, the Veteran reported that he had renal involvement when experiencing a reaction to a typhus vaccination in service, and has had kidney stones, pain in his kidneys, and blood in his urine. He stated that this disability was secondary to vasculitis he developed from the vaccine. VA treatment records include an October 2009 urology consultation in which the Veteran’s urologist noted that he had had blood in his urine in reaction to his typhus vaccine in 1962. The urologist stated that he was hospitalized with resolution and had had no further problems. Problem lists in the Veteran’s records indicate a history of kidney stones in the 1970s. In March 2014 he reported chronic urinary urgency for years. In May 2014 he reported that his urine was cloudy and smelled bad. A urine culture was negative. In a November 2014 letter, the Veteran’s private physician opined that his in-service typhus immunization caused vasculitis and nephritis. The physician opined that vasculitis/nephritis should be a service-connected condition because he “continues to carry” this diagnosis and is at risk of periodic complications related to this history. The Board notes that this letter was submitted to VA after the Board issued its November 2014 decision denying service connection for vasculitis based on a finding that vasculitis was not a current disability. In a July 2016 statement, the Veteran reported that he has had nephritis since an allergic reaction to his typhus immunization in service. He noted that because of this reaction he was unable to receive further immunizations and for this reason was ultimately medically discharged from service. Private treatment records reflect that in July 2016 the Veteran reported dark and malodorous urine. In July 2016 he reported painful urination as well as painful kidneys. A urine culture was normal. The Board finds that the evidence weighs against a finding of a current kidney disability. While the Veteran’s private treating physician opined that he “continues to carry” is vasculitis/nephritis diagnosis, there is no indication throughout his treatment records of any treatment for nephritis. The physician’s note that he is at risk of complications is irrelevant; service connection may be granted for current disabilities, not potential future disabilities. He has reported urinary symptoms, but all testing has come back negative and no diagnosis has been given related to these symptoms. Where the evidence does not support a finding of current disability upon which to predicate a grant of service connection, there can be no valid claim for that benefit. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). As such, the Board finds that the evidence weighs against a finding of a current disability and service connection must therefore be denied. 9. Entitlement to service connections for lipomas, claimed as internal tumors The Veteran seeks service connection for lipomas, claimed as multiple internal tumors. Service treatment records reflect that in September 1965 the Veteran reported a cyst on his left earlobe. He was diagnosed with a sebaceous cyst and prescribed hot soaks. The cyst was noted to be smaller three days later and he underwent incision and debridement. No current abnormality beyond acne vulgaris was noted at the Veteran’s November 1965 separation examination, which noted the procedure had occurred with no complications or sequelae. The Veteran underwent a general VA examination August 1966. He did not report any skin symptoms beyond occasional low back acne. Examination of the skin was negative and no disability was diagnosed. VA treatment records reflect that in October 1987 the Veteran was admitted for the removal of a lipoma. At a September 1989 general VA examination, the examiner noted a well-healed scar from the removal of a lipoma in the right pectoral area. VA treatment records reflect that at a September 1994 Agent Orange examination the Veteran reported multiple nodules on his torso for 5-6 years. He reported that he was not in Vietnam, but he was exposed to some herbicide which he did not know the name of and attributed his symptoms to that. In October 1994 he was diagnosed with multiple lipomas on his trunk and was scheduled to have them surgically removed. In March 1997 he reported that he recently had several lipomas removed from his abdominal wall. In May 2005 he reported a mass on his left axilla and his left flank that worried him because of its size. In his June 2007 claim the Veteran stated that he believed that his lipomas were due to exposure to herbicide agents. In an accompanying statement he reported that his newborn daughter has the same lipomas. VA treatment records reflect that in November 2007 he was diagnosed with multiple chronic lipomas, none of which required removal. In a December 2008 statement, the Veteran reported that he has had lipomas since experiencing a reaction to a typhus vaccination in service. He stated that this disability was secondary to vasculitis he developed from the vaccine. VA treatment records reflect that in May 2010 the Veteran had another lipoma removed from his left chest wall. Records show that he was treated thereafter for numerous additional benign lipomas, as well as nodules in his lungs and on his lymph node. Carcinoma of the lung was eventually found, and the Veteran also had subsequent diagnoses of skin cancer. At his July 2018 hearing, the Veteran and his representative were unclear on whether the appeal was in regard to lymph nodes, lipomas, or cancer. In a follow-up statement, the representative stated that “lymphoids” were unrelated to “lymphomas,” the subject of the appeal. The Board finds that this appeal is limited to the Veteran’s lipomas, or benign fatty tumors. The Veteran had yet to be diagnosed with a lymph node disability or cancer of any kind at the time of his June 2007 claim, and there is no indication in the record that such disabilities were related to his history of chronic lipomas, which was the issue actually adjudicated by the RO. The Board thus finds that the Veteran’s lymph node issues and cancer diagnoses are outside the scope of this appeal. The Board finds that the evidence weighs against a finding that the Veteran’s chronic lipomas are related to service. Despite the in-service sebaceous cyst, there is no documentation of chronic lipomas until multiple decades after separation from service. There is no evidence of a relationship between the sebaceous cyst and his current chronic lipomas. As to the Veteran’s argument that lipomas are the result of exposure to herbicide agents, lipomas are not among the disabilities which VA recognizes has a relationship to such exposure. The Veteran has not provided any basis of knowledge beyond speculation as to how herbicide agents could cause lipomas, and there is no medical evidence to support such a relationship. Similarly, service treatment records do not show that his February 1962 hospitalization for vasculitis affected his skin in any way, and the Veteran has not provided any reasoning or basis to support his belief of such a relationship. For these reasons, the Board finds that the evidence weighs against a finding that lipomas are related to service. Service connection is therefore denied. 10. Entitlement to service connection for headaches The Veteran seeks service connection for headaches. Service treatment records reflect that the Veteran was hospitalized in February 1962 for nephritis secondary to generalized vasculitis as a reaction to immunization to typhus. Among his symptoms on admission were intense occipital headaches at night. He was subsequently returned to active duty in April 1962. In June 1963 he was the driver in a motor vehicle accident and was diagnosed with a mild concussion. He reported a diffuse headache but did not report a loss of consciousness. He also exhibited a slightly drowsy sensorium, and although it was the impression of the admitting doctor that he showed evidence of alcoholic intoxication, the injury was determined not to be the result of misconduct. No headache abnormality was noted at his November 1965 separation examination, and the report noted that his concussion led to no complications or sequelae. The Veteran underwent a general VA examination August 1966. He reported that he often experienced frontal headaches since 1962. At an associated VA neuropsychiatric examination, he reported that he had a headache in the right side of his face and forehead about once or twice a month since the June 1963 motor vehicle accident. He was diagnosed with a cerebral concussion, no residuals. At a September 1989 general VA examination, the Veteran reported daily headaches occurring around the eyes. He was unsure when the headaches started, but reported that he was also troubled with headaches along with edema and albumin in his urine when hospitalized for six months in 1961 in service after having a reaction to a typhus shot. Headaches were not associated with visual phenomena or neurologic deficit. VA treatment records reflect that at a September 1994 Agent Orange examination the Veteran reported bad headaches on the right side. He reported that he was not in Vietnam, but he was exposed to some herbicide which he did not know the name of and attributed his symptoms to that. In October 1994 he reported chronic headaches that may be migraines. In a December 2008 statement, the Veteran reported that he has experienced headaches ever since experiencing a reaction to a typhus vaccination in service. He stated that this disability was secondary to vasculitis he developed from the vaccine. VA treatment records reflect that in September 2010 the Veteran reported constant headaches and sinus pressure. In March 2012 he reported a history of chronic headaches since a motor vehicle accident in 1963. In April 2014 he reported headaches that started 2-3 weeks prior, coming and going from mild to high, and associated with his sinus problems. Private treatment records reflect that in June 2016 the Veteran reported headaches, which his physician diagnosed as normal sinus headaches. At his July 2018 hearing, the Veteran reported that he has headaches independent of his service-connected sinusitis. He stated that they began in service. The Board finds that the evidence is at least in equipoise as to whether the Veteran’s headaches are related to service. The Veteran has consistently reported headaches during every period from which medical records are available. He reported them in service, at his August 1966 VA examination, at his September 1989 VA examination, at his September 1994 Agent Orange examination, and in his treatment records during the appeal period. Such continuity of reporting of symptoms is highly credible. For these reasons, the Board finds that the evidence is at least in equipoise as to whether the Veteran’s headaches are related to service. Service connection is therefore granted. REASONS FOR REMAND 1. Entitlement to service connection for a heart disability The Veteran seeks service connection for a heart disability. Service treatment records do not reflect any symptoms of or treatment for any heart disability. No such abnormality was noted at his November 1965 separation examination. While the Veteran had a reaction to his typhus immunization in February 1962, treatment records diagnosed nephritis secondary to generalized vasculitis and explicitly noted that the heart was normal. The Veteran underwent a general VA examination August 1966. He did not report any cardiovascular symptoms. Examination of the cardiovascular system was normal and no disability was diagnosed. VA treatment records reflect that in November 1987 the Veteran was admitted to the hospital. His physician explained that 4 years prior he was first found to have atrial fibrillation. At that time, while at work as a construction worker he developed acute palpitations associated with shortness of breath, weakness, flushing, diaphoresis, and lightheadedness. An echocardiogram, stress test, and Holter monitor were normal and he was prescribed Digoxin. Records were not available from this initial admission. After two and a half years he stopped medication, and in August 1987 he began to experience more frequent attacks of palpitations. He was admitted in August 1987 and September 1987. When he was admitted in October 1987 for removal of a lipoma he was found to be in atrial fibrillation at 150 beats per minute. He was advised to remain for treatment but he refused. When he presented in November 1987 he reported at least three episodes over the prior two weeks. He was discharged three days later and instructed to continue outpatient treatment. At a September 1989 general VA examination, the Veteran reported that he had a history of paroxysmal atrial fibrillation known for 3-4 years. He reported getting lightheaded and dyspneic without chest pain and being in and out of intensive care units several times in various institutions. His cardiovascular system with unremarkable on examination. Heartbeat was regular without murmur, rub, or gallop. He was diagnosed with a history of paroxysmal atrial fibrillation. VA treatment records reflect that at a September 1994 Agent Orange examination the Veteran reported that he does not feel right in his heart. He reported that he was not in Vietnam, but he was exposed to some herbicide which he did not know the name of and attributed his symptoms to that. In October 1994 he reported that his heart flutters every now and then. In March 1997 he reported a recent episode of atrial fibrillation. He reported that he was hospitalized for a syncopal episode in March 1996. He reported 2-3 episodes in the prior 5-6 months. He was diagnosed with unexplained recurrent atrial fibrillation and left ventricular hypertrophy. In June 1997 he presented at the emergency room for chronic atrial fibrillation for the prior month. He was diagnosed with stable atypical chest pain. He reported non-exertional chest pain typically 1-2 hours per day. In March 2007 an electrocardiogram (ECG) showed atrial flutter. A November 2007 shows a diagnosis of coronary artery disease. He subsequently reported left anterior chest pain for four days. He was diagnosed with possible angina. Cardiac monitoring showed continuous atrial fibrillation. In December 2007 he was diagnosed with suspected inferior/lateral ischemia, which a stress test showed was probable. A January 2008 letter informed the Veteran that his echocardiogram did not show heart failure but showed that his heart was enlarged due to longstanding high blood pressure. At a February 2008 cardiology consultation, he reported shortness of breath and chest pain since November 2007. He was diagnosed with new onset congestive heart failure and underwent a left heart catheterization with coronary angiography showing moderate coronary artery disease. In a December 2008 statement, the Veteran reported that he had experienced a reaction to a typhus vaccination in service, and that this reaction caused vasculitis which affected his heart. The Veteran underwent a VA examination in January 2010. He reported that right after leaving service, his heart rate started racing very high and he went to the emergency room for treatment. He reported that he had been on medication ever since. He had a history of cardiomegaly but current heart size was normal. He was diagnosed with paroxysmal atrial tachycardia, atrial fibrillation, hypertension, and left ventricular hypertrophy. The examiner opined that his heart disability was less likely than not related to service. This opinion was based on the rationale that in service he was diagnosed with glomerular nephropathy, not generalized vasculitis, and this condition has no medical bearing on the heart. The examiner further noted that his cardiomyopathy could be attributed to his long history of alcohol use. VA treatment records reflect that in February 2010 the Veteran underwent a nuclear stress test that showed no scintigraphic evidence of ischemia or infarction which was therefore unlikely to represent a progression of his coronary artery disease. He continued to exhibit atrial fibrillation. Records indicate that treatment continued, but etiology was never discussed. At his July 2018 hearing, the Veteran stated that his heart disabilities were the result of in-service exposure to herbicide agents. He stated that he sprayed herbicides at base housing and at the airfield of Stewart Air Force Base in New York. The Board finds that remand is unfortunately necessary to obtain an adequate medical opinion. The January 2010 VA examiner’s opinion was based on the rationale that the Veteran did not have an in-service diagnosis of generalized vasculitis. Service treatment records contradict this finding. If the examiner believes that the in-service diagnosis was in error, an explanation must be provided. 2. Entitlement to service connection for hypertension The Veteran seeks service connection for hypertension. VA regulations require that hypertension or isolated systolic hypertension be confirmed by readings taken two or more times on at least three different days. For compensation purposes, hypertension means that the diastolic blood pressure is predominantly 90mm or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm or greater with a diastolic blood pressure of less than 90mm. 38 C.F.R. § 4.104, Diagnostic Code 7101. Service treatment records reflect that in February 1962 the Veteran was diagnosed with nephritis secondary to generalized vasculitis as a reaction to immunization to typhus. When he was admitted his blood pressure was measured at 164/118. On sodium restriction and bedrest, blood pressure dropped to within normal limits at some point before the April 1962 board of medicine survey returning him to active duty. At his November 1965 separation examination his blood pressure was measured at 126/80. No current hypertension was diagnosed at the examination, which noted that he had experienced hypertension among other symptoms related to generalized vasculitis in response to his typhus immunization. The Veteran underwent a general VA examination August 1966. His blood pressure was measured at 124/80 and no hypertension was diagnosed. At a September 1989 general VA examination, the Veteran’s blood pressure was measured at 130/82, 120/80, and 122/80. VA treatment records reflect that in March 1997 his physician noted that he had no history of hypertension. His blood pressure was 131/80. A November 2007 treatment records reflects a diagnosis of hypertension. His blood pressure was measured at 152/87 and he was on medication. In his June 2007 claim the Veteran reported that he had hypertension which he believed was related to exposure to herbicide agents. In a statement received in December 2007 he clarified that he was exposed to herbicide agents while maintaining property at Stewart Air Force Base in New York. In a January 2008 statement he reported that he was initially diagnosed with high blood pressure in service, at which time he was also exposed to herbicide agents. He stated that he should be presumptively service-connected based on exposure to herbicide agents, or alternatively secondary to his claimed heart disability. VA treatment records reflect that a January 2008 letter informed the Veteran that his echocardiogram did not show heart failure but showed that his heart was enlarged due to longstanding high blood pressure. In a December 2008 statement, the Veteran reported that he was diagnosed with hypertension in service after experiencing a reaction to a typhus vaccination. He stated that this disability was secondary to vasculitis he developed from the vaccine. The Veteran underwent a VA examination for his claimed heart disability in January 2010. He reported that he had been diagnosed with hypertension when he had glomerulonephritis related to his typhus immunization, which caused his blood pressure to increase to 160/118. He reported that he had been on medication on and off ever since. His blood pressure at the examination was measured at 145/75. He was diagnosed with hypertension. At his July 2018 hearing, the Veteran stated that his hypertension began in service with his typhus immunization. He stated that his blood pressure went as high as 168/90. He could not remember if he had been given medication at that time. He also stated that it was secondary to his heart disability and to his service-connected PTSD. The Board finds that remand is unfortunately necessary to obtain an adequate medical opinion. The January 2010 VA examiner diagnosed hypertension among the Veteran’s heart disabilities. Hypertension was not explicitly addressed in the provided opinion, and in any event that opinion was inadequate, as discussed above. While VA need not provide a medical examination in all cases, once VA undertakes to provide an examination, it must ensure that it is adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Remand is thus necessary for a medical opinion. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any additional medical evidence that may have come into existence but has not been associated with the record. 2. Return the claims file to the January 2010 VA examiner, or to another qualified examiner if unavailable, to obtain medical opinions regarding hypertension and disabilities of the heart. The claims file must be reviewed by the examiner. A new examination may be scheduled if necessary. Following a review of the claims file and any clinical examination results, the examiner should diagnose any hypertension and heart disabilities exhibited by the Veteran. For each disability diagnosed, the examiner should offer an opinion as to whether it is at least as likely as not (i.e. 50 percent probability or more) that such disability is related to service. If the opinion is the same as that from the January 2010 examination, the examiner must explain why, contrary to service treatment records, the examiner has determined that the Veteran was not diagnosed with generalized vasculitis in service. All opinions are to be accompanied by a rationale consistent with the evidence of record. A discussion of the pertinent evidence, relevant medical treatises, and generally accepted medical principles is requested. If the examiner cannot provide an opinion without resorting to speculation, he or she shall provide complete explanations stating why this is so. In so doing, the examiner shall explain whether any inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. After completing the above, and any other development deemed necessary, readjudicate the appeal. If the benefits sought remain denied, provide an additional supplemental statement of the case to the Veteran and his representative, and return the appeal to the Board. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Gallagher, Counsel