Citation Nr: 18151017 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 16-42 718 DATE: November 16, 2018 ORDER Entitlement to service connection for a bilateral shoulder disability is denied. Entitlement to service connection for a neck disability is denied. Entitlement to service connection for a bilateral knee disability is denied. Entitlement to service connection for hypertension is denied. REMANDED Entitlement to service connection for a gastrointestinal disability is remanded. FINDINGS OF FACT 1. The Veteran’s bilateral shoulder disability did not manifest during active service, and there is no indication that his bilateral shoulder disability is otherwise related to his active service. 2. The Veteran’s neck disability did not manifest during active service, and there is no indication his neck disability is otherwise related to his active service. 3. The Veteran’s bilateral knee disability did not manifest during active service, and there is no indication his bilateral knee disability is otherwise related to his active service. 4. The Veteran’s hypertension did not manifest during active service or within one year of discharge, and there is no indication his hypertension is otherwise related to his active service. CONCLUSIONS OF LAW 1. The criteria for service connection for a bilateral shoulder disability are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 2. The criteria for service connection for a neck disability are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 3. The criteria for service connection for a bilateral knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). 4. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1988 to September 1990 in the United States Army. The Veteran also had a period of active duty for training (ACDUTRA) from October 1986 to April 1987 in the New York Army National Guard. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). Service Connection Claims 1. Neck and Shoulders The Veteran maintains that his neck and bilateral shoulder disabilities were incurred in or are otherwise related to his military service. The Veteran’s service treatment records are unremarkable for any complaints, treatment, or diagnoses related to his neck or shoulders. After service, records from the Social Security Administration (SSA) indicated that the Veteran injured his neck and shoulders during a motor vehicle accident in January 2005. It was also noted that he injured his neck in a motor vehicle accident in 2002. In January 2005, he was diagnosed with cervical paraspinal muscle and ligament sprain/strain; cervical spine derangement; myofascial pain syndrome; and a right shoulder contusion. A February 2005 magnetic resonance imaging (MRI) of the cervical spine showed straightening of cervical lordosis consistent with muscle spasm; and focal disc herniation at C5-6 and C6-7. An April 2007 record indicated that the Veteran reported that his neck pain began two years prior after a motor vehicle accident. An August 2007 orthopedic examination report indicated that the Veteran stated that he had a long-standing history of neck pain since he was involved in a motor vehicle accident in 2006. A September 2013 VA treatment record indicated that the Veteran complained of neck pain since injuries during service. He stated that he was involved in a motor vehicle accident in 2005 and that made his neck pain worse. In December 2013, it was noted that the Veteran had right cervical radiculopathy and left shoulder impingement. In this case, the Board finds the most probative evidence weighs against the claims. Although the evidence indicates that the Veteran has current neck and shoulder disabilities, there is no evidence of those conditions during service and no evidence that they are otherwise etiologically related to his active service. Following active service, the first complaints and objective evidence of neck and shoulder disabilities occurred after motor vehicle accidents in 2002 and 2005, over 12 years after discharge. The passage of time between discharge from active service and the medical documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board has also considered the lay evidence of record. The Veteran is competent to describe what he has personally observed or experienced; however, the ultimate questions of diagnoses and etiology in this case extend beyond an immediately observable cause-and-effect relationship and are beyond the competence of lay witnesses. Accordingly, the Board finds that the preponderance of the evidence is against the claims and entitlement to service connection for neck and bilateral shoulder disabilities is not warranted. 38 U.S.C. § 5107(b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Knees The Veteran maintains that his bilateral knee disability was incurred in or is otherwise etiologically related to his active service. The Veteran’s service treatment records indicated that he complained of a left knee injury during a basketball game in February 1989. He reported experiencing mild discomfort with walking. There was tenderness of the patella with no effusions or laxity. In July 1990, he complained of knee pain and loss of appetite. There were no follow-up records concerning any knee pain. After service, SSA records indicated that the Veteran injured his knees during a motor vehicle accident in January 2005. A January 2005 record noted bilateral knee contusions. A March 2005 record noted a diagnosis of internal derangement of the left knee. A November 2005 X-ray of the right knee showed no acute bony abnormality. A December 2013 VA examination report noted a diagnosis of bilateral patella-femoral syndrome. The examiner noted that the Veteran had a history of trauma to his bilateral knees in a motor vehicle accident in 2005, and an episode of painful left knee in 1989 during service. The examiner opined that the Veteran’s current bilateral knee disability was less likely than not related to service. The examiner noted that there was no evidence of continuity of left knee symptoms following the painful left knee during service and that there was evidence that his current bilateral knee problems were related to trauma during a motor vehicle accident in 2005. In this case, the Board finds the most probative evidence weighs against the claim. There is no evidence that his current bilateral patella-femoral syndrome was incurred during active service and no evidence that it is otherwise etiologically related to his active service. Although he was treated for left knee pain during service, there was no follow treatment and no indication that his knee problems did not completely resolve without residual prior to his separation from service. After service, the first documentation of knee problems occurred after a motor vehicle accident in 2005, over 15 years after discharge. The passage of time between discharge from active service and the medical documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. Maxson, 230 F.3d at 1333. In addition, the VA examiner opined that the Veteran’s current bilateral knee disability was less likely than not related to his active service, including the report of left knee pain in 1989. There is no medical opinion to the contrary. The Board has also considered the lay evidence of record. The Veteran is competent to describe what he has personally observed or experienced; however, to the extent those reports conflict with the contemporaneous medical evidence, the Board does not find those statements credible. Furthermore, the ultimate questions of diagnoses and etiology in this case extend beyond an immediately observable cause-and-effect relationship and are beyond the competence of lay witnesses. Accordingly, the Board finds that the preponderance of the evidence is against the claims and entitlement to service connection for neck and bilateral disabilities is not warranted. 38 U.S.C. § 5107(b) (2012); Gilbert, 1 Vet. App. 49. 3. Hypertension The Veteran maintains that his hypertension was incurred in or is otherwise related to his active service. For VA purposes, hypertension is generally defined as diastolic pressure, which is predominantly 90 mm or greater and isolated systolic hypertension is defined as systolic blood pressure predominantly 160 mm or greater with a diastolic blood pressure of less than 90 mm. Hypertension or isolated systolic hypertension must generally be confirmed by readings taken two or more times on at least three different days. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note 1 (2018). The Veteran’s enlistment examination indicated that his blood pressure was 130/90. In April 1989, his blood pressure was 100/90. A January 1990 record noted that his blood pressure was 142/88 (supine), 142/92 (sitting), and 140/98 (standing). Another January 1990 record indicated that his blood pressure was 148/102, and a three-day blood pressure check was ordered. On the first day, his systolic pressure ranged from 114 to 122 in the morning and from114 to 126 in the evening. Diastolic pressure ranged from 72 to 88 in the morning and from 74 to 82 in the evening. On the second day, systolic pressure ranged from 118 to 126 in the evening. Diastolic pressure ranged from 68 to 84 in the evening. On the third day, systolic pressure ranged from 122 to 126 in the morning and from 110 to 130 in the evening. Diastolic pressure ranged from 80 to 88 in the morning and from 78 to 84 in the evening. In February 1990, a follow-up record after the three-day blood pressure check indicated normal blood pressure and no hypertension. In March 1990, his blood pressure was 142/88. In July 1990, his blood pressure was 140/82. In August 1990, his blood pressure was 140/74. After service, SSA records indicated that the Veteran did not exhibit symptoms of hypertension in January 2005. In April 2007, the Veteran reported that he had had hypertension for two years. Hypertension has been noted in his records since in April 2007. In this case, the Board finds the most probative evidence weighs against the claim. Although the evidence indicates that the Veteran has hypertension, there is no evidence of hypertension during service or within one year of discharge from service. Although high blood pressure readings were noted during service, hypertension was not diagnosed after a three-day blood pressure check. Furthermore, there is no evidence that hypertension is otherwise etiologically related to his active service. Following active service, the Veteran first indicated that his hypertension was diagnosed in 2005, over 15 years after discharge. The passage of time between discharge from active service and the medical documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. Maxson, 230 F.3d at 1333. The Board has also considered the lay evidence of record. The Veteran is competent to describe what he has personally observed or experienced; however, the ultimate questions of diagnoses and etiology in this case extend beyond an immediately observable cause-and-effect relationship and are beyond the competence of lay witnesses. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for hypertension is not warranted. 38 U.S.C. § 5107(b) (2012); Gilbert, 1 Vet. App. 49. REASONS FOR REMAND The Veteran’s service treatment records indicated that he was treated for viral gastritis/viral gastroenteritis in January 1990. In July 1990, he complained of loss of appetite and vomiting. After service, VA treatment records indicated that he had stomach problems. In January 2014, it was noted that he had gastroenteritis. Based on the foregoing, the Board finds that a remand is necessary for a VA examination to determine the nature and etiology of the Veteran’s current gastrointestinal complaints. Additionally, current treatment records should be identified and obtained before a decision is made regarding the remaining issue on appeal. The matter is REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Then, schedule the Veteran for a VA examination by an examiner with appropriate expertise to determine the nature and etiology of his claimed gastrointestinal disability. Any indicated studies should be performed. Based on the examination results and a review of the record, the examiner should identify all gastrointestinal disabilities that may be present. The examiner should also provide an opinion as to whether it is at least as likely as not (50 percent probability or better) that any currently present gastrointestinal disability is etiologically related to his active service. A rationale for all opinions expressed must be provided. 3. Confirm that the VA examination report and all opinions provided comport with this remand and undertake any other development found to be warranted. 4. Then, readjudicate the remaining issue on appeal. If a decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Mishalanie, Counsel