Citation Nr: 18156307 Decision Date: 12/07/18 Archive Date: 12/07/18 DOCKET NO. 16-57 745 DATE: December 7, 2018 ORDER Service connection for sleep apnea is denied. Service connection for hypertension is denied. Service connection for acid reflux is denied. Service connection for erectile dysfunction is denied. Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) is denied. FINDINGS OF FACT 1. The Veteran’s sleep apnea did not begin during active service and is not otherwise related to an in-service injury, event, or disease. 2. The Veteran’s hypertension did not begin during active service and is not otherwise related to an in-service injury, event, or disease. 3. The Veteran’s acid reflux did not begin during active service and is not otherwise related to an in-service injury, event, or disease. 4. The Veteran’s erectile dysfunction did not begin during active service and is not otherwise related to an in-service injury, event, or disease. 5. The Veteran has not had at any time during the appeal, a current diagnosis of posttraumatic stress disorder (PTSD) and any acquired psychiatric disorder, to include depression and anxiety, did not begin during active service and is not otherwise related to an in-service injury, event, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for sleep apnea are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a) (2018). 2. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3.307, 3.309 (2018). 3. The criteria for service connection for acid reflux have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a) (2018). 4. The criteria for service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a) (2018). 5. The criteria for service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1969 to July 1971. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from December 2014 and January 2016 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. Service Connection 1. Service connection for sleep apnea The Veteran contends that his sleep apnea is related to his active duty military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of obstructive sleep apnea, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). No examination was provided with regard to this issue. VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006). Although the record shows a current diagnosis of obstructive sleep apnea, the Veteran’s service treatment records fail to show any complaints of sleep apnea or sleep problems during service. The Veteran has not identified any in-service event, injury, or disease to which his current sleep apnea can be linked. Thus, there is no evidence establishing the requisite injury, disease, or event during service and so no examination is necessary. While the Veteran believes his sleep apnea is related to his military service, the Board reiterates that the preponderance of the evidence weighs against findings that any related in-service injury, event, or disease occurred. For the reasons stated above, the Board finds that the preponderance of evidence is against the Veteran’s claim of entitlement to service connection for sleep apnea and his appeal must be denied. There is no reasonable doubt to be resolved as to this issue. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Service connection for hypertension The Veteran contends that he has hypertension related to his active duty military service. For VA rating purposes, the term hypertension means that the diastolic blood pressure is predominantly 90 millimeters (mm) or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160 mm or greater with diastolic blood pressure of less than 90 mm. 38 C.F.R. § 4.104, DC 7101, Note 1 (2018). Certain chronic diseases will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). The question for the Board is whether the Veteran has a chronic disease that manifested to a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service. The Board concludes that, while the Veteran has hypertension, which is a chronic disease under 38 C.F.R. § 3.309(a), it was not chronic in service or manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. VA treatment records show the Veteran was not diagnosed with hypertension until decades after his separation from service and decades outside of the applicable presumptive period. A June 2012 VA treatment record noted a history of elevated blood pressure without a diagnosis of hypertension. An October 2012 VA treatment record noted a history of hypertension but normal blood pressure at that time. VA treatment records since February 2013 have more consistently diagnosed the Veteran with hypertension. Service connection for hypertension may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s hypertension and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Again, no examination was provided with regard to this issue. VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McLendon, 20 Vet. App. 79, 81-82. Although the record shows a current diagnosis of hypertension, the Board finds that there is no indication from the record that a cardiovascular injury or disease occurred during service. The service treatment records are silent for any high blood pressure readings during his active duty service. In the report of medical history, he completed in conjunction with his separation examination, the Veteran specifically denied current and historic high or low blood pressure. Thus, there is no evidence establishing the requisite injury, disease, or event during service and so no examination is necessary. While the Veteran believes his hypertension is related to his military service, the Board reiterates that the preponderance of the evidence weighs against findings that any related in-service injury, event, or disease occurred. For the reasons stated above, the Board finds that the preponderance of evidence is against the Veteran’s claim of entitlement to service connection for hypertension and his appeal must be denied. There is no reasonable doubt to be resolved as to this issue. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. 3. Service connection for acid reflux The Veteran contends that his acid reflux is related to his active duty military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of acid reflux/ gastroesophageal reflux disease (GERD), the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). No examination was provided with regard to this issue. VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McLendon, 20 Vet. App. 79, 81-82. Although the record shows a current diagnosis of acid reflux, the Veteran’s service treatment records fail to show any complaints of acid reflux or GERD or digestion problems during service. In the report of medical history, he completed in conjunction with his separation examination, the Veteran specifically denied current and historic symptoms of frequent indigestion. Thus, there is no evidence establishing the requisite injury, disease, or event during service and so no examination is necessary. While the Veteran believes his acid reflux is related to his military service, the Board reiterates that the preponderance of the evidence weighs against findings that any related in-service injury, event, or disease occurred. For the reasons stated above, the Board finds that the preponderance of evidence is against the Veteran’s claim of entitlement to service connection for acid reflux and his appeal must be denied. There is no reasonable doubt to be resolved as to this issue. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. 4. Service connection for erectile dysfunction The Veteran contends that his erectile dysfunction is related to his active duty military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran is currently treated for erectile dysfunction, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). No examination was provided with regard to this issue. VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McLendon, 20 Vet. App. 79, 81-82. Although the record shows current erectile dysfunction, the Veteran’s service treatment records fail to show any complaints of erectile dysfunction or sexual problems during service. Thus, there is no evidence establishing the requisite injury, disease, or event during service and so no examination is necessary. While the Veteran believes his erectile dysfunction is related to his military service, the Board reiterates that the preponderance of the evidence weighs against findings that any related in-service injury, event, or disease occurred. For the reasons stated above, the Board finds that the preponderance of evidence is against the Veteran’s claim of entitlement to service connection for erectile dysfunction and his appeal must be denied. There is no reasonable doubt to be resolved as to this issue. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. 5. Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) The Veteran contends that he has posttraumatic stress disorder (PTSD) related to his active duty military service. Service connection for PTSD requires: (1) a medical diagnosis of PTSD utilizing the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders criteria, in accordance with 38 C.F.R. § 4.125 (a); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a causal nexus between current symptomatology and the specific claimed in-service stressor. See 38 C.F.R. § 3.304 (f); Cohen v. Brown, 10 Vet. App. 128, 139 (1997). In this case, despite the Veteran’s repeated report of PTSD in his medical history, the available treatment records fail to show a clinical diagnosis of this condition. As such, service connection is not warranted for PTSD. See 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The Board notes that the Veteran has a long-standing diagnosis of personality disorder. Regulation provides that personality disorders are not diseases or injuries within the meaning of applicable legislation but rather are congenital or developmental defects. 38 C.F.R. § 3.303 (c). As such, service connection is not available for a personality disorder. There are, however, multiple current diagnoses of polysubstance abuse, substance-induced mood disorder, depressive disorder, and anxiety disorder. The scope of a claim includes any disability that may reasonably be encompassed by the claimant’s description of the claim, reported symptoms, and other information of record and, as such, the Board will consider whether service connection is warranted for any acquired psychiatric condition. See Clemons v. Shinseki, 23 Vet. App. 1 (2009); Brokowski v. Shinseki, 23 Vet. App. 79 (2009). As such, the Board has also considered whether service connection is warranted for one of the Veteran’s current psychiatric diagnoses. To this end, no examination was provided with regard to the issue of service connection for an acquired psychiatric condition, to include depression or anxiety. Again, VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McLendon, 20 Vet. App. 79, 81-82. Although the record shows a current diagnosis of depression and anxiety, the Veteran’s service treatment records fail to show any complaints of psychiatric problems during service. He was diagnosed with a personality disorder in service and that diagnosis is reflected in the current treatment records. In the report of medical history, he completed in conjunction with his separation examination, the Veteran specifically denied current and historic symptoms of trouble sleeping, nightmares, depression, excessive worry, and nervous trouble of any sort. Thus, there is no evidence establishing the requisite injury, disease, or event during service and so no examination is necessary. While the Veteran believes his acquired psychiatric disorder is related to his military service, the Board reiterates that the preponderance of the evidence weighs against findings that any related in-service injury, event, or disease occurred. Finally, service connection is not available for a disability that is the result of a veteran’s willful misconduct or the result of his abuse of alcohol or drugs. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. However, service connection may be granted for alcohol abuse that is a secondary to or is caused by a primary service-connected disorder. Allen v. Principi, 237 F.3d 1368, 1381 (Fed. Cir. 2001). Such compensation would only result “where there is clear medical evidence establishing that the alcohol or drug abuse disability is indeed caused by a veteran’s primary service-connected disability, and where the alcohol or drug abuse disability is not due to willful wrongdoing.” Id. As such, service connected for substance abuse can only be awarded on a secondary basis. To date, the Veteran’s lone service connected disability is appendectomy with scar. The Veteran has not submitted evidence showing any indication that his polysubstance abuse may be associated with his appendectomy with scar. As such, no examination is necessary and secondary service connection for substance abuse is not warranted. For the reasons stated above, the Board finds that the preponderance of evidence is against the Veteran’s claim of entitlement to service connection for acquired psychiatric disorder and his appeal must be denied. There is no reasonable doubt to be resolved as to this issue. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. JAMES G. REINHART Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Houbeck, Counsel