Citation Nr: 18155088 Decision Date: 12/03/18 Archive Date: 12/03/18 DOCKET NO. 15-15 023 DATE: December 3, 2018 ORDER Service connection for a left knee condition is denied. Service connection for a right knee condition is denied. Service connection for bilateral hearing loss is denied. Service connection for a lung condition is denied. Service connection for obstructive sleep apnea is denied. Service connection for a navel hernia is denied. Service connection for a liver condition is denied. Service connection for a skin condition is denied. VETERAN’S CONTENTIONS The Veteran is seeking service connection for posttraumatic stress disorder (PTSD), bilateral hearing loss, obstructive sleep apnea (OSA), and disabilities of the lungs, liver, kidney, skin, and bilateral knees. The Veteran contends that each of these conditions either had its onset in or is otherwise related to his active duty service. The Veteran asserts specifically that his right and left knee conditions were caused by his twenty-six in-service parachute jumps. He also asserts that his kidney condition is secondary to treatment for his service-connected prostate cancer. REMANDED Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder is remanded. Service connection for a kidney condition, to include as secondary to prostate cancer, is remanded. FINDINGS OF FACT 1. The Veteran’s current right and left knee conditions neither had their onset in nor are otherwise related to service. 2. The Veteran’s current bilateral hearing loss neither had its onset in nor is otherwise related to service. 3. The Veteran’s obstructive sleep apnea, umbilical hernia, skin condition, lung condition, and liver condition neither had their onset in nor are otherwise related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for a right knee disability are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for a bilateral hearing loss disability are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for service connection for a lung disability are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 5. The criteria for service connection for obstructive sleep apnea are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 6. The criteria for service connection for a navel hernia are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 7. The criteria for service connection for a liver disability are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 8. The criteria for service connection for a skin disability are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from June 1966 to May 1973, to include service in combat. He is the recipient of several awards and medals, including but not limited to the Bronze Star, a Parachutist badge, and an Army commendation for heroism. This case is before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. 1. Service Connection for Right and Left Knee Conditions Generally, in order to prove service connection, there must be competent, credible evidence of 1) a current disability, 2) in-service incurrence or aggravation of an injury or disease, and 3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). The Veteran has current diagnoses of right and left knee osteoarthritis, which he contends result from his more than twenty parachute jumps with the Army Airborne. See September 2013 VA Examination; May 1969 DD Form 214 (noting Major Command: 82nd Airborne Division). However, the evidence does not indicate that the Veteran’s current knee conditions are related to his in-service parachute jumps. First, while the Board accepts that the Veteran conducted parachute jumps in service; the service records do not show treatment for any knee symptomatology. The records do not show evidence of arthritis in the first post-service year. In addition, the weight of the medical opinion evidence is against the claims. The Veteran has been afforded one VA examination and opinion on his knee claims, in September 2013. The examiner opined that the Veteran’s current bilateral osteoarthritis was not related to his in-service parachute jumps. The examiner noted that there is no record of complaints of or treatment for any knee condition in the Veteran’s service treatment records—including his separation examination—or in his post-service treatment records for nearly thirty years after service. The examiner further noted that knee osteoarthritis is a typical condition for someone of the Veteran’s age, “with the expected effects of aging and lifestyle.” The examiner’s opinion is competent, credible, and entitled to significant weight. Significantly, there is no probative evidence to the contrary—the Veteran has not detailed how the knee disability was continuous since service or is otherwise related to service. Therefore, the Board finds that the Veteran’s right and left knee conditions are not caused by his in-service parachute jumps, or otherwise related to his active duty service. Accordingly, service connection is not warranted. 2. Service Connection for Bilateral Hearing Loss The Veteran’s medical records establish current bilateral hearing loss for VA purposes. See 38 C.F.R. § 3.385; September 2013 VA Examination. However, the evidence does not indicate that the Veteran’s hearing loss had its onset in or is otherwise related to his active duty service. Rather, while the Veteran likely was exposed to significant acoustic trauma in service, no hearing loss disability was shown in service, in the first post-service year, or for many years thereafter. The Veteran has been afforded one VA examination and opinion on his hearing loss claim, in September 2013. The examiner opined that the Veteran’s current bilateral hearing loss was not related to service. She noted that both the Veteran’s entrance and separation audiograms revealed hearing within normal limits bilaterally, and that there were no significant threshold shifts noted at his separation from service. The examiner also noted possible intermediary noise exposure from the Veteran’s thirty years working as a truck driver and recreational shooting. The examiner’s opinion is competent, credible, and entitled to significant weight. Significantly, there is no probative evidence to the contrary. Therefore, the Board finds that the Veteran’s current bilateral hearing loss is not related to his active duty service. Accordingly, service connection is not warranted. 3. Service Connection for OSA, a Navel Hernia, a Lung Condition, a Liver Condition, and a Skin Condition The Veteran has also claimed service connection for OSA, a navel hernia, a lung condition, a liver condition, and a skin condition. His post-service medical records reveal diagnoses of OSA, umbilical hernia, and a neoplasm of the skin, as well as a history of a lung nodule and liver cysts. See VA Treatment Records dated October 2015, December 2015, July 2016. There is no mention of any of these conditions in the Veteran’s service treatment records. The Veteran has not reported that any of these conditions had its onset in service, nor has he alleged any in-service event or injury as their cause. In sum, there is no evidence that any of these conditions had its onset in or is otherwise related to the Veteran’s active duty service. Therefore, the Board finds that the Veteran’s OSA, navel hernia, lung condition, liver condition, and skin condition are not related to his active duty service. Accordingly, service connection is not warranted. REASONS FOR REMAND 1. Service Connection for an Acquired Psychiatric Disorder, to Include Posttraumatic Stress Disorder, is Remanded. The Veteran is currently service-connected for depression associated with prostate cancer. He is also claiming service connection for PTSD. He has been afforded two VA examinations on this claim, in September 2013 and April 2018, both of which noted no diagnosis of PTSD. However, the Veteran’s VA treatment records do reflect a diagnosis of PTSD during the claim period. See, e.g., VA Treatment Records dated February 2015, March 2016. Therefore, a remand is required for a new VA examination to clarify and enumerate any and all psychiatric diagnoses the Veteran has had during the claim period. 2. Service Connection for a Kidney Condition is Remanded. The Veteran has a current diagnosis of chronic kidney disease, which he contends is secondary to his service-connected prostate cancer, to include treatment therefor. See August 2017 VA Treatment Record. In adjudicating a secondary service connection claim, the Board must determine what, if any, level of disability is attributable to aggravation by the directly service-connected disability. See 38 C.F.R. § 3.310; Allen v. Brown 7 Vet. App. 439, 446–49 (1995) (en banc). The Veteran has been afforded one VA examination and opinion on his kidney claim, in August 2017. The examiner opined that the Veteran’s chronic kidney disease was not caused by his service-connected prostate cancer, but failed to provide an opinion as to whether or not the prostate cancer aggravated the kidney disease. Therefore, a remand is necessary for a new VA examination to include an opinion as to whether the Veteran’s chronic kidney disease was caused or aggravated by his service-connected prostate cancer, or treatment therefor. The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records and associate them with the claims file. 2. After completing the development outlined in Item 1., schedule the Veteran for VA psychiatric examination and opinion. Upon examination of the Veteran and complete review of the claims file, the examiner should respond to the following: (a.) Please list each psychiatric diagnosis the Veteran has had within the claim period (from November 15, 2011). (b.) For each listed diagnosis, please state whether it is at least as likely as not (50 percent probability or more) that the diagnosed condition had its onset or is otherwise related to the Veteran’s active duty service. The examiner must provide a fully articulated medical rational for each opinion, citing to peer-reviewed medical literature referenced in formulating it, if any. If the examiner finds that an opinion cannot be provided, this conclusion should also be clearly explained (e.g. lack of sufficient information/evidence in this case, or a lack of knowledge among the medical community at large, and not the insufficient knowledge of the individual examiner). 3. After completing the development outlined in Item 1., schedule the Veteran for a VA examination and opinion on his claim for service connection for a kidney condition. Upon examination of the Veteran and a complete review of the claims file, the examiner should respond to the following: (a.) Is it at least as likely as not that the Veteran’s chronic kidney disease was either 1) caused, or 2) aggravated by his service connected prostate cancer, or treatment prescribed therefor? (Continued on the next page)   (b.) If the examiner determines that the Veteran’s chronic kidney disease was aggravated by his service-connected prostate cancer or treatment therefor, the examiner should estimate the degree of aggravation beyond the baseline level of the kidney disease that is caused by his service-connected disability or treatment. M. TENNER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Timmerman, Associate Counsel