Citation Nr: 18151717 Decision Date: 11/20/18 Archive Date: 11/19/18 DOCKET NO. 16-37 283 DATE: November 20, 2018 ORDER Entitlement to service connection for a right total knee replacement is denied. Entitlement to service connection for cervical disc repair (C3-6) is denied. Entitlement to service connection for degenerative disc disease of the lumbar spine (L4-5) is denied. Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is denied. Entitlement to service connection for abdominal aortic aneurysm (repaired) is denied. FINDINGS OF FACT 1. There is no evidence of record indicating that the Veteran’s right knee degenerative joint disease resulting in a total right knee replacement was incurred in or caused by his active service, and this condition is not entitled to a presumption of service connection through exposure to Camp Lejeune water. 2. There is no evidence of record indicating that the Veteran’s degenerative disc disease in the cervical spine resulting in cervical disc repair was incurred in or caused by his active service, and this condition is not entitled to a presumption of service connection through exposure to Camp Lejeune water. 3. There is no evidence of record indicating that the Veteran’s lumbar degenerative disc disease was incurred in or caused by his active service, and this condition is not entitled to a presumption of service connection through exposure to Camp Lejeune water. 4. There is no evidence of record indicating that the Veteran’s COPD was incurred in or caused by his active service, and this condition is not entitled to a presumption of service connection through exposure to Camp Lejeune water. 5. There is no evidence of record indicating that the Veteran’s abdominal aortic aneurysm was incurred in or caused by his active service, and this condition is not entitled to a presumption of service connection through exposure to Camp Lejeune water. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right total knee replacement have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for cervical disc repair (C3-6) have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. The criteria for entitlement to service connection for lumbar degenerative disc disease have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 4. The criteria for entitlement to service connection for COPD have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 5. The criteria for entitlement to service connection for abdominal aortic aneurysm (repaired) have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1977 to January 1978. This appeal comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that the Veteran indicated that he is currently receiving Social Security Administration (SSA) disability benefits. However, as the evidence does not show, nor does the Veteran contend, that there are relevant SSA records that need to be obtained, a remand is not warranted to obtain SSA records. See Golz v. Shinseki, 590 F.3d 1317 (Fed. Cir. 2009) (held that VA’s duty to assist was limited to obtaining relevant SSA records). Service Connection Service connection requires competent evidence of (1) a current disability; (2) the incurrence or aggravation of a disease or injury during service; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may 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). Certain chronic diseases, such as arthritis, are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). An alternative method of establishing the second and third Shedden elements for disabilities identified as chronic diseases in 38 C.F.R. § 3.309(a) is through a demonstration of continuity of symptomatology. 38 C.F.R. § 3.303(b). Continuity of symptomatology may be shown if “the condition is observed during service or any applicable presumption period, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present condition to that symptomatology.” Savage v. Gober, 10 Vet. App. 488, 498 (1997). Service connection may also be established on a presumptive basis for a number of diseases VA has identified as associated with exposure to contaminated water at Camp Lejeune. In order to establish presumptive service connection for a disease associated with exposure to contaminated water at Camp Lejeune, a claimant must show the following: (1) that the veteran served at Camp Lejeune for no less than 30 days (either consecutive or nonconsecutive) from August 1, 1953 to December 31, 1987; (2) that the veteran suffered from a disease associated with exposure to contaminants in the water supply at Camp Lejeune enumerated under 38 C.F.R. § 3.309(f); and (3) that the disease process manifested to a degree of 10 percent or more at any time after service. 38 C.F.R. §§ 3.307(a)(7), 3.309(f). The Veteran asserts he was stationed at Camp Lejeune and lived on base from June to August 1977. The Board notes that the Veteran’s complete personnel records do not appear to be associated with the claims file, and as a result the Board cannot corroborate the Veteran’s assertion. The RO has apparently verified the Veteran’s presence at Camp Lejeune and, accordingly, the Board will consider such service. However, none of the Veteran’s claimed conditions are on the presumptive list of diseases associated with exposure to contaminated water at Camp Lejeune. Nevertheless, if a Veteran is not entitled to service connection on a presumptive basis, service connection may be still established on a facts-found basis with proof of direct causation. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). Finally, the Veteran has also attributed his claimed disabilities to “non-PTSD personal trauma.” The Veteran has not provided any description or evidence of such trauma or how it might be related to the disabilities on appeal. The Board notes that the Veteran is not currently service-connected for “non-PTSD personal trauma.” Accordingly, there is no basis for awarding service connection based on this contention. 1. Entitlement to service connection for a right total knee replacement is denied. The Veteran asserts that he underwent a right total knee replacement for which service connection is warranted. The Board notes no evidence in the service treatment records of a complaint of, or treatment for, a right knee problem. Additionally, there is no post-service evidence of record suggesting that the Veteran’s right knee degenerative joint disease appeared within one year of service sufficient for presumptive service connection under 38 C.F.R. § 3.307. Nor does the Veteran assert that he has had ongoing right knee pain since service. Rather, as reflected in the Veteran’s private medical records, including his descriptions of medical history, the Veteran identified his right knee problems as beginning with a meniscus tear in 1995 or 1996. He was experiencing pain in the knee in 2005 or 2006. Radiology in May 2009 showed a torn meniscus, with arthroscopic surgery one month later; and degenerative joint disease confirmed by radiology in March 2010. He had a total knee replacement in May 2011. The Board additionally identifies no evidence in the claims file to suggest that any right knee disability the Veteran may currently have had its onset in or is in any way related to his service, to include exposure to contaminated water therein, nor has he presented, identified, or alluded to the existence of any such evidence in the claims file or elsewhere. The Board notes that the Veteran’s first complaint of knee pain contained in the evidence of record arose 17 years after he left service. Evidence of a prolonged period without medical complaints after service may be considered, along with other factors, in resolving a claim. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). Further, as a lay person, he is not competent to relate any current knee disability to his service, or any incidents therein, as such is outside the common knowledge of a lay person and would require medical expertise. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Veteran did not provide, and the record does not contain, any competent, credible medical evidence of a nexus between a current knee disability and his period of active service. Accordingly, the Board finds that service connection is not warranted. 2. Entitlement to service connection for cervical disc repair (C3-6) is denied. The Veteran asserts that he underwent cervical disc repair for which service connection is warranted. The Board notes that the service treatment records contain no evidence of a complaint of, or treatment for, a neck problem during the Veteran’s active service. Further, there is no medical or lay evidence indicating that arthritis was diagnosed within one year of service discharge, sufficient for presumptive service connection under 38 C.F.R. § 3.307. Indeed, when undergoing a May 2006 nerve conduction study of his left arm, the Veteran reported a three- to four-month history of severe left neck pain, but remembered no specific injury and noted that he had done a lot of lifting throughout his career. The Veteran again complained of severe pain in his neck in March 2008; an MRI showed cervical degenerative disc disease with mild disc dessication in multiple discs, but no significant disc herniation or other deformities. Although there was no obvious explanation for his pain, fusion was suggested, which the Veteran underwent in July 2008. In February 2016, complaining of neck pain and right upper extremity radiculopathy, the Veteran underwent an MRI, which showed cervical degenerative disc disease, with the changes at C-5 and C-6 beginning post-surgery. The Board identifies no evidence in the claims file to suggest that any neck disability the Veteran may currently have had its onset in or is in any way related to his service, to include exposure to contaminated water therein, nor has he presented, identified, or alluded to the existence of any such evidence in the claims file or elsewhere. The Board notes that the Veteran’s first complaint of neck pain contained in the evidence of record arose 28 years after he left service. See Maxson, 230 F.3d 1330. Further, as a lay person, he is not competent to relate any current neck disability to his service, or any incidents therein, as such is outside the common knowledge of a lay person and would require medical expertise. Jandreau, 492 F.3d 1372. The Veteran did not provide, and the record does not contain, any competent, credible medical evidence of a nexus between his cervical spine degenerative disc disease resulting in cervical disc repair and his period of active service. Accordingly, the Board finds that service connection is not warranted. 3. Entitlement to service connection for degenerative disc disease lumbar disc (L4-5) is denied. The Veteran asserts that he has a current back disability related to an in-service back injury. The Board notes that the service treatment records include a complaint of lower back pain in October 1977. At that time, he indicated he noticed the pain 3 weeks prior and a private physician diagnosed him with a pinched nerve in the back. He was ultimately diagnosed with a muscle strain, for which he was prescribed a muscle relaxer and a topical cream. There is no evidence of the Veteran seeking further treatment. His December 1977 discharge examination indicates that his spine was normal at that time. The Veteran was diagnosed with lumbar degenerative disc disease by X-ray in 2009. The Veteran was afforded a VA thoracolumbar spine examination in September 2013. The examiner performed a physical examination, reviewed the Veteran’s claims file, including the service treatment records, and obtained from the Veteran an oral history of his back problem. Based on that information, the examiner opined that there was less than a 50 percent probability that the Veteran’s lumbar degenerative disc disease was related to his service. She noted that the service treatment records contained a single instance of the Veteran’s complaining of back pain, leading to a diagnosis of muscle strain, with no identifiable injury and no apparent evidence of any continuing problem. She explained that a simple muscle strain in 1977 would not be expected to cause the Veteran’s claimed back problem many years later. There is no medical opinion to the contrary. The Board identifies no evidence in the claims file to suggest that any back disability the Veteran may currently have had its onset in or is in any way related to his service, to include exposure to contaminated water therein, nor has he presented, identified, or alluded to the existence of any such evidence in the claims file or elsewhere. The Board notes that the Veteran’s first post-service complaint of back pain contained in the evidence of record arose over 30 years after service discharge. See Maxson, 230 F.3d 1330. Further, as a lay person, he is not competent to relate any current back disability to his service, or any incidents therein, as such is outside the common knowledge of a lay person and would require medical expertise. Jandreau, 492 F.3d 1372. The Board finds the examiner’s medical opinion to be the most probative evidence of record. The examiner reviewed the claims file and examined the Veteran, acknowledging his reported history, contentions, and current complaints. The Veteran did not provide, and the record does not contain, any competent, credible medical evidence of a nexus between a current back disability and his period of active service. Accordingly, the Board finds that service connection is not warranted. 4. Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is denied. The Veteran asserts that he has COPD related to his period of active service. Specifically, in his September 2012 application for service connection, the Veteran suggested that his COPD might be connected to his exposure to Camp Lejeune contaminated water. As noted above, COPD is not presumed to be associated with exposure to contaminated water at Camp Lejeune. Additionally, the Veteran has presented no evidence, and the Board notes no evidence otherwise in the claims file, suggesting that his COPD has resulted, in this individual case, from his asserted exposure to Camp Lejeune water. The Veteran’s service treatment records are absent of complaint or treatment for COPD. In October 1977, the Veteran complained of difficulty breathing and he was diagnosed with an upper respiratory infection. His December 1977 discharge examination indicates that his lungs were normal at that time. The Board notes the Veteran’s visits to Grace Medical Clinic in April and May 2011, during which radiology of the Veteran’s chest showed clear lungs with no acute cardiopulmonary process but possible air-trapping disease. The Veteran confirmed that he smoked approximately one pack of cigarettes a day, and had done so for 38 years. The Veteran was afforded a VA examination for respiratory conditions in October 2013. The examiner noted a diagnosis of COPD in 2009. She stated that the Veteran reported smoking approximately one pack of cigarettes per day for at least 20 years, and that he was still smoking. She opined that there was less than a 50 percent probability that the Veteran’s COPD stemmed from his service. She noted that the only respiratory condition for which the Veteran was treated in service was upper respiratory infections, and that no other respiratory problems were noted in the service treatment records. She explained that upper respiratory infections do not cause COPD, that these were separate events, and that the upper respiratory infections the Veteran experienced in service would not cause him to have COPD years later. She opined that his COPD was almost surely a direct result of years of smoking. There is no medical opinion of record to the contrary. The Veteran has not provided any competent evidence suggesting that his current COPD had its onset in or is in any way related to his service. The Board notes that the Veteran’s first post-service evidence of COPD arose over 30 years after service discharge. See Maxson, 230 F.3d 1330. Further, as a lay person, he is not competent to relate any current respiratory disorder to his service, including any potential exposure to contaminated water therein, as such is outside the common knowledge of a lay person and would require medical expertise. Jandreau, 492 F.3d 1372. The Board finds the examiner’s medical opinion to be the most probative evidence of record. The examiner reviewed the claims file and examined the Veteran, acknowledging his reported history, contentions, and current complaints. The Veteran did not provide, and the record does not contain, any competent, credible medical evidence of a nexus between his COPD and his period of active service. Accordingly, the Board finds that service connection is not warranted. 5. Entitlement to service connection for abdominal aortic aneurysm (repaired) is denied. The Veteran contends that he underwent a repair of an abdominal aortic aneurysm for which service connection is warranted. The Board notes that the service treatment records contain no evidence of treatment for, or complaints related to, an abdominal aortic aneurysm. The Veteran’s abdominal aortic aneurysm was first diagnosed in July 2007, over 29 years after the Veteran’s discharge. See Maxson, 230 F.3d 1330. It was repaired in May 2010. As with COPD, abdominal aortic aneurysms are not presumed to be associated with exposure to contaminated water at Camp Lejeune. Additionally, the Veteran has presented no evidence, and the Board notes no evidence otherwise in the claims file, suggesting that his abdominal aortic aneurysm has resulted, in this individual case, from his asserted exposure to Camp Lejeune water. (Continued on the next page)   The Veteran has not provided any competent evidence suggesting that his abdominal aortic aneurysm had its onset in or is in any way related to his service. As a lay person, he is not competent to relate any heart disorder to his service, including any potential exposure to contaminated water therein, as such is outside the common knowledge of a lay person and would require medical expertise. Jandreau, 492 F.3d 1372. The Veteran did not provide, and the record does not contain, any competent, credible medical evidence of a nexus between his abdominal aortic aneurysm and his period of active service. Accordingly, the Board finds that service connection is not warranted. Lindsey M. Connor Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD David S. Katz, Associate Counsel