Citation Nr: 18148586 Decision Date: 11/08/18 Archive Date: 11/07/18 DOCKET NO. 11-19 932 DATE: November 8, 2018 ORDER Entitlement to service connection for coronary heart disease (CAD) is denied. Entitlement to service connection for hypertension (HTN) is denied. Entitlement to service connection for diabetes mellitus is denied. Entitlement to service connection for headaches is denied. FINDINGS OF FACT 1. Military personnel and service treatment records associated with the claims file which reflect the Veteran’s less than 90 days of active service do not indicate that the Veteran was adversely affected by exposure to chemical agents, to include participation in a “gas chamber.” 2. Headaches, CAD, HTN and diabetes mellitus were not manifested in active service and are not otherwise etiologically related to such service. CONCLUSIONS OF LAW 1. The criteria for service connection for disabilities manifested by headaches; CAD; HTN; and diabetes mellitus have not been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active duty with the Georgia Army National Guard from May 1976 to July 1976. These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2009 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. In March 2014, the Board denied service connection and the Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In a May 2015 Joint Motion for Partial Remand (JMPR), the parties requested that the Court vacate the portion of the Board's decision that denied the claims of service connection for headaches, CAD, hypertension, and diabetes mellitus, Type II. Thereafter, this matter was returned to the Board where it was remanded for additional development, most recently in November 2017. This most recent development having been substantially complied with, these issues are now ripe for adjudication and this matter is now again before the Board. Service Connection The Veteran contends that he is entitled to service connection for CAD, headaches, HTN and diabetes as the result of active service. More specifically, the Veteran asserts that his disorders are the result of gas chamber exposure during basic training. See i.e. January 2008 Veteran statement (“pain and suffering that occurred from the injury that I received while I was on-duty being exposed to the gas these are the symptoms I have had ever since”); November 2015 R.M. statement (“we both left for basic training at the same time…I am a witness that the gas chamber caused [Veteran] health conditions…I witnessed [Veteran] health decline from 1976 to 2015.”) According to the JMPR, the parties agreed that a remand was warranted because the Board erred when it did not adequately consider whether the appellant was entitled to a VA examination. Since the May 2015 JMPR, VA examinations for each issue were incorporated into the claims file. Therefore, the problem has been addressed, and as no additional medical evidence has been provided by the Veteran or his attorney which contradict the nexus medical opinions of record. 1. Entitlement to service connection for coronary heart disease (CAD) 2. Entitlement to service connection for hypertension (HTN) 3. Entitlement to service connection for diabetes 4. Entitlement to service connection for headaches Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Certain chronic diseases will be presumed related to service, such as the claimed HTN and diabetes, if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). At the outset, the Board notes that the Veteran is not entitled to a presumptive service connection for any of his claimed disorders, to include HTN and diabetes. The record does not reflect medical evidence showing that any of the claimed disorders were diagnosed during either service or during the one-year presumptive period after the Veteran's separation from service. On the contrary, the record does not reflect any complaints or findings consistent with HTN, headaches, diabetes or heart disease for nearly twenty years after separation. Specifically, the Veteran reported he was first treated for diabetes and HTN in approximately 1998, and his headaches began in March 2000. See, e.g., March 2000 Evans Memorial Hospital Physical Examination. Having determined that a presumptive service connection is not available for the Veteran's claims, the Board's inquiry turns to whether service connection on a direct basis is warranted. Regarding service connection on a direct basis, the Board notes that the competent and probative evidence of record document current diagnoses of the claimed issues which arose, at the earliest, in the late 90’s, as noted by the June 2018 VA examinations. See also March 2000 Evans Memorial discharge note (“admitting diagnosis: 1. accelerated hypertension…3. Headache secondary to #1…4. diabetes mellitus.”) Therefore, the Veteran is shown to currently have the claimed disabilities. As such, his case turns on the other two elements of service connection, an in-service disease or injury; and medical nexus. Regarding an in-service disease or injury, the Board notes that service treatment records for the Veteran’s months of active service identify various orthopedic complaints, but are devoid of references to any heart condition, hypertension, headaches, or other laboratory result which could indicate a pre-diabetic condition. Rather, as noted above, the Veteran claims that his current disabilities are the result of his exposure to the “gas chamber” while in service. In this regard, lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, the specific issues in this case fall outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). The disabilities at issue are not conditions that are readily amenable to probative lay comment regarding etiology. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). The Board acknowledges that the Veteran is competent to report observable symptoms, but there is no indication that he is competent to etiologically link any such symptoms to a current diagnosis. He is not shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that he received any special training or acquired any medical expertise in evaluating these disorders. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). Moreover, the Board notes that the record indicates that the Veteran is a “poor historian,” such as his June 2015 statement asserting that he has been “totally disabled since 1974” despite his serving on active duty until 1976. See also November 2014 Memorial Health note (“who is a poor historian”). Accordingly, the lay evidence does not constitute competent medical evidence and lacks probative value. The lay opinions are also outweighed by the existing medical evidence of record. In this regard, there is no competent evidence of record that establishes a causal relationship between the Veteran's currently diagnosed disorders and his military service, to include consideration of “gas chamber” exposure. The Board notes that the Veteran was afforded VA examinations with corresponding opinions in June 2017, then again in June 2018. These examiners universally issued conclusions finding it less likely than not that the Veteran's HTN, CAD, headaches and diabetes were caused by service. In their reasoning, the examiners identified that the Veteran’s headaches were demonstrated to be a function of his hypertensive heart medication which, in consideration of the medical record and a review of pertinent literature, would place the onset of cardiac disorders far from his 1976 discharge and with no relationship to “gas chamber” exposure. Likewise, the medical record identified that the earliest indication of diabetic treatment was also in the late 1990’s, nearly twenty years following discharge. The nearly 20-year break between service and onset, coupled with the lack of complaints in-service or identification of any “gas chamber” related issues to these claimed disorders, provided the foundation for which the negative nexus opinions were based. The Board finds that the June 2017 and 2018 physicians' opinions, as a whole, include meaningful rationales that are rooted in the examiners' review of the Veteran's claims. Based on the above, the Board finds that a preponderance of the evidence is against the Veteran's claims for service connection. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). As such, the appeal is denied. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Department of Veterans Affairs