Citation Nr: 18156869 Decision Date: 12/11/18 Archive Date: 12/11/18 DOCKET NO. 15-00 533 DATE: December 11, 2018 ORDER Entitlement to service connection for a left groin disability is denied. Entitlement to service connection for a right groin disability is denied. REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected lumbosacral spondylosis and degenerative disk disease, is remanded. Entitlement to service connection for a headache disability, claimed as migraines, to include as secondary to service-connected lumbosacral spondylosis and degenerative disk disease, is remanded. Entitlement to service connection for a right ankle disability is remanded. Entitlement to service connection for a left ankle disability is remanded. Entitlement to service connection for an acquired psychiatric disability, to include as secondary to service-connected lumbosacral spondylosis and degenerative disk disease, is remanded. Entitlement to service connection for a left leg disability is remanded. Entitlement to service connection for a right leg disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a neck disability, to include as secondary to service-connected lumbosacral spondylosis and degenerative disk disease, is remanded. Entitlement to service connection for a right arm disability, to include as secondary to service-connected lumbosacral spondylosis and degenerative disk disease, is remanded. Entitlement to service connection for a right shoulder disability, to include as secondary to service-connected lumbosacral spondylosis and degenerative disk disease, is remanded. Entitlement to service connection for a left shoulder disability, to include as secondary to service-connected lumbosacral spondylosis and degenerative disk disease, is remanded. FINDING OF FACT The Veteran’s left and right groin disabilities were not shown in service. The competent and credible evidence fails to establish an etiological relationship between the Veteran’s left groin or right groin disabilities and his active service. CONCLUSIONS OF LAW 1. The criteria for service connection for a left groin 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 groin 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 FINDING AND CONCLUSIONS The Veteran served on active duty from December 1968 to September 1972, and from August 1983 to July 1988. As noted above, the Board is recharacterizing the Veteran’s unspecific mental disorder, claimed as stress, to include all psychiatric disorders that have been diagnosed. See Brokowski v. Shinseki, 23 Vet. App. 79 (2009); see also Clemons v. Shinseki, 23 Vet. App. 1 (2009) (holding that the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant’s description of the claim, reported symptoms, and the other information of record). The Board will consider the issue as entitlement to service connection for an acquired psychiatric disability. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131 (2012). Generally, the evidence must show: (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 or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a). Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d). Finally, 38 U.S.C. § 1154(a) requires that VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Specifically, “[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). 1. Entitlement to service connection for a left groin disability and a right groin disability. The Veteran asserts that he has left and right groin disabilities related to service. As an initial matter, the Board notes that the service treatment records reflect no complaints of, treatment for, or a diagnosis related to a left groin disability or a right groin disability. Next, and more importantly, post-service evidence does not reflect complaints of problems associated with right or left groin disabilities for many years following separation from service. The evidence clearly shows that the Veteran’s claimed disabilities did not develop until many years following separation from service. The Board has also considered the Veteran’s statements regarding continuity of symptoms since service. However, the Federal Circuit has held that the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); 38 C.F.R. § 3.309(a). As the Veteran’s groin disabilities are not listed under § 3.309(a), entitlement to service connection based on a theory of continuity of symptomatology is simply not applicable in the present case. The Board next considers that service connection may be granted when the evidence establishes a medical nexus between active duty service and current complaints. The service and post-service evidence provides particularly negative evidence against these claims. The Board has closely reviewed the medical and lay evidence in the claims file and finds no evidence that may serve as a medical nexus between the Veteran’s service and either his right groin disability or left groin disability. Although the Board recognizes that the Veteran is competent to report symptoms of groin pain, the evidence in this case clearly demonstrates that his right groin disability and left groin disability developed many years following separation from service. There is simply nothing in the record to support a finding that his right groin disability or left groin disability began in or is otherwise in any way related to service. In light of the above discussion, the Board concludes that the preponderance of the evidence is against the claims for service connection for a right groin disability and a left groin disability, and there is no doubt to be otherwise resolved. As such, the appeal as to these issues is denied. REASONS FOR REMAND Further evidentiary development is required prior to reviewing the issues remaining on appeal. 1. Entitlement to service connection for hypertension and headache disabilities, to include as secondary to service-connected lumbosacral spondylosis and degenerative disk disease, are remanded. The Veteran asserts that his hypertension and headache disabilities are secondary to his service-connected lumbosacral spondylosis and degenerative disk disease. December 2012 secondary service connection medical opinions were obtained; however, these opinions obtained are not adequate. Specifically, although the December 2012 VA examiners concluded that the Veteran’s claimed hypertension and headache disabilities were not due to his service-connected lumbosacral spondylosis and degenerative disk disease, the VA examiners did not adequately discuss whether the Veteran’s lumbosacral spine disability aggravated (worsened) his claimed hypertension and headache disabilities. 38 C.F.R. § 3.310(b). The Board thus finds new opinions should be obtained. 2. Entitlement to service connection for right ankle, left ankle, and acquired psychiatric disabilities are remanded. The Veteran asserts that he has an acquired psychiatric disability caused by his service-connected lumbosacral spondylosis and degenerative disk disease. He additionally asserts that he has right ankle, left ankle, and acquired psychiatric disabilities related to service. Although the Veteran underwent VA examinations in June 2012 (ankles) and in December 2012 (psychiatric), the VA examiners did not provide medical nexus opinions, instead noting that the Veteran did not have current disabilities. Nevertheless, recent treatment records reflect reduced ankle function. See August 2014 Back Disability Benefits Questionnaire (DBQ). Additionally, the Veteran continues to complain of psychiatric symptomatology. The Board finds that additional VA examinations and opinions are needed to address the Veteran’s contentions. 3. Entitlement to service connection for left and right leg disabilities are remanded. Various VA outpatient records reflect the Veteran’s complaints of left and right leg numbness and pain. It is unclear, based on the available evidence, whether the Veteran’s left and right leg complaints are disabilities, or whether they are symptoms of his now service-connected sciatic nerve radiculopathy of the left and right lower extremities or his femoral nerve radiculopathy of the left and right lower extremities. On remand, the RO should arrange for an examination to determine if the Veteran’s claimed left and right leg disabilities are symptoms of his service-connected radiculopathy (sciatic nerve and femoral nerve), or, whether they are separate disabilities. If his right leg and left leg complaints are separate disabilities, the examiner should opine as to whether the conditions are at least as likely as not caused by, or aggravated by, his service-connected lumbosacral spondylosis and degenerative disk disease or are at least as likely as not causally related to service. 4. Entitlement to service connection for a right knee disability is remanded. The Veteran was afforded a June 2012 VA examination of his right knee. He was diagnosed with degenerative joint disease of the right knee. Although the VA examiner concluded that the Veteran’s knee disability was related to normal degenerative changes, he then opined that it was “accelerated by increased BMI which caused increased pressures in the low back and lower extremities.” A December 2012 VA hypertension examiner has stated that the Veteran’s hypertension had been attempted to be treated with exercise but that was is limited by his back injury. It is unclear from the June 2012 opinion provided whether or not the Veteran’s right knee disability has been caused or aggravated by a service-connected disability. The Board finds that an additional VA examination and opinion are warranted. 5. Entitlement to service connection for a neck disability, to include as secondary to service-connected lumbosacral spondylosis and degenerative disk disease, is remanded. The Veteran has additionally claimed that his neck disability is secondary to his service-connected lumbosacral spondylosis and degenerative disk disease. While on remand, an etiological opinion should be obtained to determine whether this disorder is related to the Veteran’s service-connected lumbosacral spine disability. 6. Entitlement to service connection for right arm, right shoulder, and left shoulder disabilities, to include as secondary to service-connected lumbosacral spondylosis and degenerative disk disease, are remanded. A June 2012 VA examiner stated that the Veteran’s shoulder complaints were likely radiculopathy from his neck. Additionally, it is unclear if the Veteran has a separate right arm disability from his right shoulder complaints. The Board finds that the Veteran’s claims for right arm, right shoulder and left shoulder disabilities are inextricably intertwined with the claim for entitlement to service connection for a neck disability being remanded. Therefore, the Board will not issue a decision on these claims at this time. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (issues are ‘inextricably intertwined’ when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated). The matters are REMANDED for the following actions: Arrange for the Veteran to undergo VA examinations to determine the nature and etiology of his (a) hypertension disability; (b) headache disability; (c) right ankle disability; (d) left ankle disability; (e) acquired psychiatric disability; (f) left leg disability; (g) right leg disability; (h) right knee disability and (i) neck disability. Any necessary testing should be conducted. The claims file must be reviewed in conjunction with such the examination, and the examiner must indicate that such review occurred. The examiner should provide well-reasoned opinions on: Hypertension (a) Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s hypertension was caused by his service-connected lumbosacral spondylosis and degenerative disk disease. (b) Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s hypertension was aggravated by his service-connected lumbosacral spondylosis and degenerative disk disease. Headache Disability (a) Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s headache disability was caused by his service-connected lumbosacral spondylosis and degenerative disk disease. (b) Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s headache disability was aggravated by his service-connected lumbosacral spondylosis and degenerative disk disease. Right Ankle Disability Whether it is at least as likely as not (a probability of 50 percent or greater) right ankle disability had its clinical onset during the Veteran’s active duty service or is otherwise etiologically related to his active service. Left Ankle Disability Whether it is at least as likely as not (a probability of 50 percent or greater) left ankle disability had its clinical onset during the Veteran’s active duty service or is otherwise etiologically related to his active service. Acquired Psychiatric Disability (a) Whether it is at least as likely as not (a probability of 50 percent or greater) acquired psychiatric disability had its clinical onset during the Veteran’s active duty service or is otherwise etiologically related to his active service. (b) Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s acquired psychiatric disability was caused by his service-connected lumbosacral spondylosis and degenerative disk disease. (c) Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s acquired psychiatric disability was aggravated by his service-connected lumbosacral spondylosis and degenerative disk disease. Left Leg Disability (a) Whether it is at least as likely as not (a probability of 50 percent or greater) left leg disability had its clinical onset during the Veteran’s active duty service or is otherwise etiologically related to his active service. (b) Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s left leg disability was caused by his service-connected lumbosacral spondylosis and degenerative disk disease. (c) Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s left leg disability was aggravated by his service-connected lumbosacral spondylosis and degenerative disk disease. Right Leg Disability (a) Whether it is at least as likely as not (a probability of 50 percent or greater) right leg disability had its clinical onset during the Veteran’s active duty service or is otherwise etiologically related to his active service. (b) Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s right leg disability was caused by his service-connected lumbosacral spondylosis and degenerative disk disease. (c) Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s right leg disability was aggravated by his service-connected lumbosacral spondylosis and degenerative disk disease. Right Knee Disability (a) Whether it is at least as likely as not (a probability of 50 percent or greater) a right knee disability had its clinical onset during the Veteran’s active duty service or is otherwise etiologically related to his active service. (b) Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s right knee disability was caused by his service-connected lumbosacral spondylosis and degenerative disk disease. (c) Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s right knee disability was aggravated by his service-connected lumbosacral spondylosis and degenerative disk disease. Neck Disability (a) Whether it is at least as likely as not (a probability of 50 percent or greater) a neck disability had its clinical onset during the Veteran’s active duty service or is otherwise etiologically related to his active service. (b) Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s neck disability was caused by his service-connected lumbosacral spondylosis and degenerative disk disease. (c) Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s neck disability was aggravated by his service-connected lumbosacral spondylosis and degenerative disk disease. Any opinions offered should be accompanied by a clear rationale consistent with the evidence of record. If the examiner finds it impossible to provide any part of the requested opinions without resort to pure speculation, he or she should so indicate and provide a rationale as to why such a finding is made. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A.M. Clark, Counsel