Citation Nr: 18155602 Decision Date: 12/04/18 Archive Date: 12/04/18 DOCKET NO. 16-55 442 DATE: December 4, 2018 ORDER Entitlement to service connection for right shoulder condition is denied. Entitlement to service connection for left shoulder condition is denied. Entitlement to service connection for lumbar back condition is denied. Entitlement to service connection for tinnitus is denied. Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to non-service-connected schizophrenia, is denied. Entitlement to service connection for heart condition is denied. Entitlement to service connection for high cholesterol is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for headaches, to include as secondary to non-service-connected schizophrenia, is denied. Entitlement to service connection for memory loss, to include as secondary to non-service-connected schizophrenia, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the right shoulder condition began during service, manifested within one year of separation, or is otherwise related to an in-service injury, event, or disease. 2. The preponderance of the evidence is against finding that the left shoulder condition began during service or is otherwise related to an in-service injury, event, or disease. 3. The preponderance of the evidence is against finding that the lumbar back condition began during service or is otherwise related to an in-service injury, event, or disease. 4. The preponderance of the evidence is against finding that tinnitus began during service or is otherwise related to an in-service injury, event, or disease. 5. The preponderance of the evidence is against finding that OSA began during service, is otherwise related to an in-service injury, event, or disease, or is proximately due to or aggravated beyond natural progression by a service-connected disability. 6. The preponderance of the evidence is against finding that the heart condition began during service or is otherwise related to an in-service injury, event, or disease. 7. High cholesterol is not a disability for VA purposes. 8. The Veteran does not have hypertension for VA purposes. 9. The preponderance of the evidence is against finding that headaches began during service, is otherwise related to an in-service injury, event, or disease, or is proximately due to or aggravated beyond natural progression by a service-connected disability. 10. The preponderance of the evidence is against finding that memory loss began during service, is otherwise related to an in-service injury, event, or disease, or is proximately due to or aggravated beyond natural progression by a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for right shoulder condition have not been met. 38 U.S.C. §§ 1131, 5107(b) (West 2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 2. The criteria for entitlement to service connection for left shoulder condition have not been met. 38 U.S.C. §§ 1131, 5107(b) (West 2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 3. The criteria for entitlement to service connection for lumbar back condition have not been met. 38 U.S.C. §§ 1131, 5107(b) (West 2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 4. The criteria for entitlement to service connection for tinnitus have not been met. 38 U.S.C. §§ 1131, 5107(b) (West 2012); 38 C.F.R. § 3.303 (2017). 5. The criteria for entitlement to service connection for OSA have not been met. 38 U.S.C. §§ 1131, 5107(b) (West 2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2017). 6. The criteria for entitlement to service connection for heart condition have not been met. 38 U.S.C. §§ 1131, 5107(b) (West 2012); 38 C.F.R. § 3.303 (2017). 7. The criteria for entitlement to service connection for high cholesterol have not been met. 38 U.S.C. §§ 1131, 5107(b) (West 2012); 38 C.F.R. § 3.303 (2017). 8. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1131, 5107(b) (West 2012); 38 C.F.R. § 3.303 (2017). 9. The criteria for entitlement to service connection for headaches have not been met. 38 U.S.C. §§ 1131, 5107(b) (West 2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2017). 10. The criteria for entitlement to service connection for memory loss have not been met. 38 U.S.C. §§ 1131, 5107(b) (West 2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had qualifying service from June 1977 to July 1978. The issue of entitlement to service connection for schizophrenia is not properly before the Board. Neither VA Form 9 currently associated with the claims file appealed those issues. See November 2016 VA Form 9 (appealed the issues of entitlement to service connection for lumbar back condition, right shoulder condition, headaches, hypertension, and OSA); May 2017 VA Form 9 (appealed the issues of entitlement to service connection for left shoulder condition, heart condition, high cholesterol, memory loss, and tinnitus). Thus, although the representative’s May 2018 Brief presented arguments pertaining to the issue of entitlement to service connection for schizophrenia, that issue is not properly before the Board and will not be addressed in the decision herein. If the Veteran so desires, he may separately pursue that issue. Service Connection Direct service connection generally requires evidence showing: (a) the existence of a present disability; (b) in-service incurrence or aggravation of a disease or injury; and (c) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Secondary service connection may be granted for disabilities which were proximately due to, the result of, or aggravated beyond natural progression by a service-connected disability. 38 C.F.R. § 3.310(a). Arthritis is enumerated as a chronic disease that may be presumptively service connected if the disease became manifest to a degree of 10 percent or more within one year of separation. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). 1. Right Shoulder Disorder The June 1977 entrance examination, July 1978 separation examination, and other service treatment records were negative for pertinent abnormalities. A February 2004 West LA VAMC record documented the Veteran’s reports of right shoulder pain and first injuring his shoulder 17 years ago when he “ran into a car;” associated x-rays showed no evidence of acute osseous injury or significant degenerative changes. A June 2013 x-ray at West LA VAMC revealed a prominent bone spur arising from the inferior aspect of the glenoid fossa, mild degenerative changes of the acromioclavicular and glenohumeral joints, and rotator cuff tendonitis. An October 2013 West LA VAMC record stated that the Veteran’s shoulder pain was likely secondary to intrascapular muscle strain. The Veteran generally contends that his right shoulder condition is etiologically related to service. However, to date, the Veteran has not specified any in-service injury, event, or disease that he associates with this condition. See December 2014 VA Form 21-526EZ (merely lists the disability, without any description); May 2015 Notice of Disagreement (merely lists the disability, without any description); November 2016 VA Form 9 (merely lists the disability, without any description); May 2018 Brief (does not address this claim). Further, as there is no competent indication that this condition is related to service, no VA examination is required. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Thus, the claim must be denied because: (a) the Veteran did not identify any in-service injury, event, or disease; (b) there is no competent indication of a nexus between the disability and an in-service injury, event, or disease; (c) arthritis did not manifest within one year of separation; and (d) secondary service connection is inapplicable because the Veteran has never been service connected for any disability (see April 2015 Codesheet). 2. Left Shoulder Disorder The June 1977 entrance examination, July 1978 separation examination, and other service treatment records were negative for pertinent abnormalities. An October 2013 West LA VAMC record stated that the Veteran’s shoulder pain was likely secondary to intrascapular muscle strain. A January 2017 West LA VAMC record documented the Veteran’s report of shoulder pain following a recent collision between his bike and a car. The evidence does not indicate left shoulder arthritis. The Veteran generally contends that his left shoulder condition is etiologically related to service. However, to date, the Veteran has not specified any in-service injury, event, or disease that he associates with this condition. See December 2014 VA Form 21-526EZ (merely lists the disability, without any description); May 2015 Notice of Disagreement (merely lists the disability, without any description); November 2016 VA Form 9 (merely lists the disability, without any description); May 2018 Brief (does not address this claim). Further, as there is no competent indication that this condition is related to service, no VA examination is required. Jandreau, 492 F.3d 1372; Layno, 6 Vet. App. 465; McLendon, 20 Vet. App. 79. Thus, the claim must be denied because: (a) the Veteran did not identify any in-service injury, event, or disease; (b) there is no competent indication of a nexus between the disability and an in-service injury, event, or disease; (c) arthritis did not manifest within one year of separation; and (d) secondary service connection is inapplicable because the Veteran has never been service connected for any disability (see April 2015 Codesheet). 3. Lumbar Back Disorder The June 1977 entrance examination, July 1978 separation examination, and other service treatment records were negative for pertinent abnormalities. An August 2011 x-ray from West LA VAMC revealed: (a) bullet density with small metallic fragments projected over the sacral bone; (b) spondylosis of the lumbar spine with mild scattered narrowing of the disc spaces; and (c) vascular calcification and minimal sclerosis of sacroiliac joint. A June 2013 West LA VAMC record documented chronic low back strain. A September 2016 West LA VAMC record documented chronic low back pain that was managed with Lyrica. The Veteran generally contends that his lumbar back condition is etiologically related to service. However, to date, the Veteran has not specified any in-service injury, event, or disease that he associates with this condition. See December 2014 VA Form 21-526EZ (merely lists the disability, without any description); May 2015 Notice of Disagreement (merely lists the disability, without any description); November 2016 VA Form 9 (merely lists the disability, without any description); May 2018 Brief (does not address this claim). Further, as there is no competent indication that this condition is related to service, no VA examination is required. Jandreau, 492 F.3d 1372; Layno, 6 Vet. App. 465; McLendon, 20 Vet. App. 79. Thus, the claim must be denied because: (a) the Veteran did not identify any in-service injury, event, or disease; (b) there is no competent indication of a nexus between the disability and an in-service injury, event, or disease; (c) arthritis did not manifest within one year of separation; and (d) secondary service connection is inapplicable because the Veteran has never been service connected for any disability (see April 2015 Codesheet). 4. Tinnitus The June 1977 entrance examination, July 1978 separation examination, and other service treatment records were negative for pertinent abnormalities. An August 2003 West LA VAMC record documented no tinnitus. Although the Veteran is competent to self-diagnose tinnitus (because it is a lay-observable condition), he has not specified a date of onset or any in-service injury, event, or disease that he associates with this condition. See December 2014 VA Form 21-526EZ (merely lists the disability, without any description); May 2015 Notice of Disagreement (merely lists the disability, without any description); November 2016 VA Form 9 (merely lists the disability, without any description); May 2018 Brief (does not address this claim). Further, as there is no competent indication of onset in service, no VA examination is required. Jandreau, 492 F.3d 1372; Layno, 6 Vet. App. 465; McLendon, 20 Vet. App. 79. Thus, the claim must be denied because: (a) the Veteran did not identify any in-service injury, event, or disease; (b) there is no competent indication of onset in service; and (c) secondary service connection is inapplicable because the Veteran has never been service connected for any disability (see April 2015 Codesheet). 5. OSA The June 1977 entrance examination, July 1978 separation examination, and other service treatment records were negative for pertinent abnormalities. An April 2011 sleep study revealed OSA. See December 2013 West LA VAMC record; April 2018 sleep apnea DBQ by private provider MB. The Veteran generally contends that his OSA is etiologically related to service. However, to date, the Veteran has not specified any in-service injury, event, or disease that he associates with this condition. See December 2014 VA Form 21-526EZ (merely lists the disability, without any description); May 2015 Notice of Disagreement (merely lists the disability, without any description); November 2016 VA Form 9 (merely lists the disability, without any description). Attached to the May 2018 Brief, the representative submitted an April 2018 DBQ by private provider MB, who attributed the OSA to the Veteran’s schizophrenia. However, as discussed above, the Veteran is not service connected for schizophrenia and the issue of entitlement to service connection for schizophrenia is not properly before the Board. Thus, the claim must be denied because: (a) the Veteran did not identify any in-service injury, event, or disease; (b) there is no competent indication of a nexus between the disability and an in-service injury, event, or disease; and (c) secondary service connection is inapplicable because the Veteran has never been service connected for any disability (see April 2015 Codesheet). 6. Heart Condition The June 1977 entrance examination, July 1978 separation examination, and other service treatment records were negative for pertinent abnormalities; additionally, a July 1977 chest x-ray was within normal limits. A 2008 EKG showed a possible anterior infarct, but it was not confirmed through further testing. See February 2017 West LA VAMC record. An August 2014 West LA VAMC record documented coronary artery disease with a history of silent myocardial infarction. The Veteran generally contends that his heart condition is etiologically related to service. However, to date, the Veteran has not specified any in-service injury, event, or disease that he associates with this condition. See December 2014 VA Form 21-526EZ (merely lists the disability, without any description); May 2015 Notice of Disagreement (merely lists the disability, without any description); November 2016 VA Form 9 (merely lists the disability, without any description); May 2018 Brief (does not address this claim). Further, as there is no competent indication that this condition is related to service, no VA examination is required. Jandreau, 492 F.3d 1372; Layno, 6 Vet. App. 465; McLendon, 20 Vet. App. 79. Thus, the claim must be denied because: (a) the Veteran did not identify any in-service injury, event, or disease; (b) there is no competent indication of a nexus between the disability and an in-service injury, event, or disease; and (c) secondary service connection is inapplicable because the Veteran has never been service connected for any disability (see April 2015 Codesheet). 7. High Cholesterol The June 1977 entrance examination, July 1978 separation examination, and other service treatment records were negative for pertinent abnormalities. Post-separation treatment records contain high cholesterol readings. See August 2011, April 2014, and July 2014 West LA VAMC records. However, service connection is only warranted where the evidence demonstrates disability for VA purposes. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). “Disability” means impairment in earning capacity resulting from diseases and injuries and their residual conditions; a symptom, without a diagnosed or identifiable underlying malady or condition, does not, by itself, constitute a “disability” for which service connection may be granted. 38 C.F.R. § 4.1; Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Sanchez-Benitez v. West, 13 Vet. App. 282 (1999). High cholesterol is simply a laboratory test result and not a disability that can, by itself, provide a basis for a valid claim for service connection. See 61 Fed. Reg. 20440, 20445 (May 7, 1996); Brammer, 3 Vet. App. at 225. Thus, the claim must be denied. 8. Hypertension For VA purposes, hypertension means diastolic blood pressure predominantly 90 millimeters of mercury (mmHg) or greater, and isolated systolic hypertension means systolic blood pressure predominantly 160 mmHg or greater with diastolic blood pressure of less than 90 mmHg; hypertension or isolated systolic hypertension must 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. The June 1977 entrance examination, July 1978 separation examination, and other service treatment records were negative for pertinent abnormalities. The June 1977 blood pressure was 170/80 mmHg (not hypertension for VA purposes), the July 1977 blood pressure was 100/80 (not hypertension for VA purposes), and the July 1978 blood pressure was 110/60 (not hypertension for VA purposes). Further, post-separation records from West LA VAMC fail to show hypertension for VA purposes. See July 2003 record (145/108); December 2003 record (123/78); February 2004 record (117/79); June 2009 record (119/90); January 2012 record (154/94 and 244/118 during exercise); June 2013 record (108/72); December 2013 record (132/82); April 2014 record (123/73); May 2014 records (140/90, 130/70, and 140/74); August 2014 record (119/74); July 2016 record (149/87); August 2016 record (149/87); September 2016 record (103/65); January 2017 record (136/87); February 2017 record (136/87). Although a few of the diastolic blood pressures measured at 90 mmHg or higher, those measurements were not predominate. As the Veteran does not have hypertension for VA purposes, his condition does not constitute a disability for which service connection may be granted. Brammer, 3 Vet. App. at 225. Thus, the claim must be denied. 9. Headaches The June 1977 entrance examination, July 1978 separation examination, and other service treatment records were negative for pertinent abnormalities. A September 2016 West LA VAMC record documented no headaches. An April 2018 headache DBQ by private provider MB documented the Veteran’s reports of headaches since service. The Veteran generally contends that his headaches are etiologically related to service. However, to date, the Veteran has not specified any in-service injury, event, or disease that he associates with this condition. See December 2014 VA Form 21-526EZ (merely lists the disability, without any description); May 2015 Notice of Disagreement (merely lists the disability, without any description); November 2016 VA Form 9 (merely lists the disability, without any description). Attached to the May 2018 Brief, the representative submitted an April 2018 DBQ by private provider MB, who attributed the headaches to the Veteran’s schizophrenia and/or to service. However, as discussed above, the Veteran is not service connected for schizophrenia and the issue of entitlement to service connection for schizophrenia is not properly before the Board. Further, MB provided no rationale for her conclusion that headaches began in service on a direct basis, which leads the Board to assume that she relied on the Veteran’s self-report of onset; however, that conclusion failed to consider the September 2016 West LA VAMC record negative for headaches, the possibility that his headaches may be associated with medications, and the possibility that his headaches may be associated with withdraws from his history of polysubstance abuse. See August 2014 West LA VAMC records (headaches are an adverse effect of the medication pregabalin; history of polysubstance abuse, including alcohol, cocaine, marijuana, tobacco); Alcohol withdrawal, MedlinePlus, U.S. National Library of Medicine, https://medlineplus.gov/ency/article/000764.htm, last accessed on November 29, 2018 (withdrawal symptoms include headaches). Because MB failed to support her direct service connection opinion with adequate rationale that considered the longitudinal treatment history, the Board finds the conclusion inadequate and of no probative value. Thus, the claim must be denied because: (a) the Veteran did not identify any in-service injury, event, or disease; (b) there is no competent indication of a nexus between the disability and an in-service injury, event, or disease; and (c) secondary service connection is inapplicable because the Veteran has never been service connected for any disability (see April 2015 Codesheet). 10. Memory loss The June 1977 entrance examination, July 1978 separation examination, and other service treatment records were negative for pertinent abnormalities. West LA VAMC records generally indicate intact memory. See July 2003 record (2 out of 3 for immediate and recent memory recall with remote memory intact); December 2013 record (memory grossly intact); May 2014 (recall/memory good); July 2014 record (memory moderate); July 2016 (memory intact); August 2016 (memory intact); September 2016 (memory intact); January 2017 (memory intact). An April 2018 mental health DBQ by private provider MB documented memory loss as a symptom of schizophrenia. The evidence does not indicate memory loss as an independent condition. The Veteran generally contends that his memory loss is etiologically related to service. However, to date, the Veteran has not specified any in-service injury, event, or disease that he associates with this condition. See December 2014 VA Form 21-526EZ (merely lists the disability, without any description); May 2015 Notice of Disagreement (merely lists the disability, without any description); November 2016 VA Form 9 (merely lists the disability, without any description). As previously discussed, the Veteran is not service connected for schizophrenia and the issue of entitlement to service connection for schizophrenia is not properly before the Board. Thus, the claim must be denied because: (a) the Veteran did not identify any in-service injury, event, or disease; (b) there is no competent indication of a nexus between the disability and an in-service injury, event, or disease; and (c) secondary service connection is inapplicable because the Veteran has never been service connected for any disability (see April 2015 Codesheet). R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD H. Daus, Associate Counsel