Citation Nr: 18154376 Decision Date: 11/29/18 Archive Date: 11/29/18 DOCKET NO. 16-48 641 DATE: November 29, 2018 ORDER Service connection for residuals of a traumatic brain injury (TBI) is denied. Service connection for a seizure disorder is denied. FINDINGS OF FACT 1. The Veteran had active service from July 1974 to July 1976. 2. The Veteran sustained a head injury in service. Residuals of a head injury were not chronic in service, not continuous since service, and not shown to a compensable degree within one year of service. 3. A neurological and cognitive disorder, variously diagnosed as early onset Alzheimer’s disease, neurosyphilis, and dementia, was not shown for many years after service and is not causally or etiologically related to service. 4. A current seizure disorder was not shown in service and is not causally or etiologically related to service. CONCLUSIONS OF LAW 1. Residuals of a TBI were not incurred in service. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2017). 2. A current seizure disorder was not incurred in service. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Service Connection for Residuals of a TBI The Veteran contends that his current neurological and cognitive impairments were caused by a head injury experienced during service. As an initial matter, a current diagnosis is shown. Specifically, private medical records dated in March 2013 show a 3-year history of mental status change and memory loss. The discharge diagnoses included early onset Alzheimer’s dementia with delusions. Additionally, April 2013 private records show that he was treated for neurosyphilis. Next, the Veteran’s service treatment records (STRs) show that he sustained a head laceration in April 1976 when he fell into a sink. No concussive symptoms were noted in the records. He also indicated that he was hit in the head by the military police but there is no record of that in the STRs. Additionally, the July 1976 discharge examination indicate that the Veteran suffered a head injury in a car crash but had no sequela, suggesting that he was having no complaints related a head injury at the time of service separation. Nonetheless, the first and second elements have been met. As to medical nexus, the medical evidence weighs against the claim. In a September 2014 VA examination, the examiner concluded that the Veteran’s symptoms of memory loss, seizures, impaired judgment, orientation, reduction in motor functioning, and others were less likely than not incurred in or caused by an in-service injury. The examiner opined that any current residuals of TBI were overshadowed by symptoms of suspected neurosyphilis. The examiner reasoned that the Veteran did not begin to exhibit cognitive decline a few years previously and the decline had been progressive in the past year. The examiner explained that any cognitive decline caused by an in-service TBI would have happened either acutely following the head injury or would be slowly progressive. The examiner noted that the Veteran’s deteriorated in the past few years rapidly. A reasonable reading of this medical opinion is that the in-service head injury was not related to the rapid decline in the Veteran’s cognitive and neurological functioning that he was experiencing. Therefore, the third element of direct service connection has not been met. On the other hand, a June 2013 private hospital discharge summary report noted that the Veteran had a past medical history of dementia secondary to a TBI when he was in the military secondary to blunt force trauma. However, the Board places less probative value on this finding as it was reported as part of a past medical history and not the reason for the hospitalization. Further, there was no rational for this finding. Rather, it appears that this was a recitation of his past medical history as provided by the Veteran and his family. Moreover, this finding is inconsistent with the STRs that showed no residuals of a head injury and the neurological and cognitive symptoms did not begin for decades after service separation. Therefore, it is given less probative weight on the issue of whether his symptoms were caused by an in-service head injury. As to presumptive service connection, no chronic disease or injury was shown in service. While the Veteran was treated for a head laceration in service, no chronic symptoms were shown as a result of this injury. He was treated with sutures which were removed within ten days. There were no concussive symptoms and he did not report back for treatment with any cognitive issues. Also significant is the lack of head injury residuals at the time of service separation. Next, the evidence does not support continuity of symptomatology since service. Specifically, the Veteran’s in-service injury occurred in April 1976 and he was discharged from service in July 1976 with a notion of no sequela due to the head injury. Moreover, he did not seek treatment for his neurological and cognitive symptoms until 2013. His 2013 treatment records indicate a three-year progressive worsening of his mental condition. This evidence does not support a continuity of symptomatology since service. Further, the disorder did not manifest itself to a degree of 10 percent or more within one year from the date of separation of service. The Veteran separated from service in 1976 but did not seek treatment for his symptoms until 2013. Therefore, presumptive service connection for a chronic condition is not supported by the medical evidence. Service Connection for Seizures Turning to the first element of service connection, a current seizure disorder is shown. Specifically, private treatment records show a diagnosis of unspecified epilepsy. In addition, a private psychologist diagnosed seizures in 2013. This diagnosis is also consistent with VA clinical records which reflect a diagnosis of seizures beginning in 2013. Therefore, a current disorder is shown. As to an in-service incurrence, the STRs do not show treatment for or diagnoses of seizures. In addition, the July 1976 separation examination shows a normal examination of the neurologic system. Therefore, the second element has not been met and the medical evidence does not support a claim for direct service connection. As to presumptive service connection, a seizure disorder was not shown in service. Therefore, the medical evidence does not support presumptive service connection based on a chronic disease or injury shown in service. As to presumptive service connection based on continuity of symptomatology, the STRs do not show seizures in service and the Veteran and his wife reported that he did not experience his first seizure until 2013, nearly 40 years after discharge. Therefore, the medical evidence does not support continuity of symptomatology. Further, a seizure disorder did not manifest itself to a degree of 10 percent or more within one year from the date of separation from service. As noted above, the Veteran’s seizures did not begin until 2013. Therefore, the medical evidence does not support presumptive service connection on any basis. In his substantive appeal, the Veteran’s wife contends that he was never definitively diagnosed with neurosyphilis and that this diagnosis was a rush to judgment. Additionally, she contends that he was exhibiting signs of cognitive decline in 1992 when she first met him. She further asserts that his seizure disorder is a result of the in-service head injury. The Board has considered the Veteran’s lay statements and those of his wife that his neurological and cognitive symptoms, as well as seizures, were caused by an in-service head injury. They are competent to report symptoms and observations because this requires only personal knowledge as it comes to them through their senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, they are not competent to offer an opinion as to the etiology of his current neurological impairment, including seizures, due to the medical complexity of the matters involved. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462. Such competent evidence has been provided by the medical personnel who have examined the Veteran during the current appeal and by service records obtained and associated with the claims file. Here, the Board attaches greater probative weight to the examination report and clinical findings than to their statements. In light of the above discussion, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Kokolas, Associate Counsel