Citation Nr: 18158347 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 12-03 250 DATE: December 14, 2018 ORDER Entitlement to service connection for a recurrent lumbosacral spine disorder to include degenerative disc disease (low back disability) is denied. Entitlement to service connection for recurrent hypertension is denied. Entitlement to service connection for a recurrent prostate disorder to include prostatitis and an enlarged prostate (prostate condition) is denied. FINDINGS OF FACT 1. The Veteran’s low back disability is not shown to be causally or etiologically related to any disease, injury, or incident during service and did not manifest within one year of discharge. 2. The Veteran’s recurrent hypertension is not shown to be causally or etiologically related to any disease, injury, or incident during service and did not manifest within one year of discharge. 3. The preponderance of the evidence shows that the Veteran’s prostate condition is not related to his military service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a low back disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for recurrent hypertension have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. The criteria for entitlement to service connection for a prostate condition have not been met. 38 U.S.C. § 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Navy from October 1977 to June 1988. In June 2012, the Veteran testified before the undersigned at a travel board hearing. This matter was most recently remanded by the Board in April 2018 for further development. Service Connection Service connection may be granted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in or aggravated by active military service. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, a veteran 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”--the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted for chronic disabilities, such as arthritis and hypertension, if the disability is shown to have been manifested to a compensable degree within one year after the Veteran was separated from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. As an alternative to the nexus requirement, service connection for these chronic disabilities may also be established through a showing of continuity of symptomatology since service. 38 C.F.R. § 3.303(b). The option of establishing service connection through a demonstration of continuity of symptomatology rather than through a finding of nexus is specifically limited to the chronic disabilities listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 1. Low Back Disability The Veteran contends that his low back disability is related to his military service. The Veteran has current diagnoses of degenerative disc disease and intervertebral disc syndrome (IVDS). Service treatment records demonstrate that the Veteran complained of back pain following exercise in November 1977, and was diagnosed with musculoskeletal pain. In September 1983, the Veteran complained of back pain and was diagnosed with muscle strain. A May 1988 separation examination revealed a normal spine. The Veteran received a VA examination in June 2010 and the examiner opined that the Veteran’s lumbar disc disease was not related to his military service. The examiner noted that there was no chronicity established in service treatment records and the Veteran’s separation examination was normal. In January 2014, a VA examiner opined that the Veteran’s low back disability was less likely than not caused by his military service. The examiner noted the Veteran’s acute complaint of back pain in service, but stated that there was no evidence of chronicity or of a chronic low back condition on separation. In a May 2017 addendum opinion, the examiner reiterated his January 2014 findings that there was no evidence of chronicity. In a July 2017 addendum opinion, the examiner considered the Veteran’s lay statements that he had back problems since 1977, but found that there was no evidence of a chronic back condition following separation. The Veteran received a VA examination in April 2018 and the examiner opined that the Veteran’s low back disability was less likely than not caused by his military service. The examiner noted the records showing chronic back pain beginning in 2007 and that neurosurgical consultations were silent for a history of trauma as a causative factor in the Veteran’s condition. The examiner explained that degenerative disc disease is multifactorial, with risk factors including obesity, diet, lifestyle, heredity, and general commonality. Ultimately, the examiner opined that the Veteran’s single episode of musculoskeletal pain did not cause degenerative disc disease 30 years later. The Board places high probative weight on the VA opinions of record taken together, as the examiners reviewed the Veteran’s claims file, including medical history and lay statements, in providing the opinions that the Veteran’s low back disability is less likely than not related to his period of active service. In addition, there is no competent medical evidence to the contrary. The most probative evidence of record demonstrates that the Veteran’s current low back disability is not related to his November 1977 treatment for musculoskeletal pain. While the examiners ultimately determined that the Veteran has a low back disability, the probative medical evidence of record does not support a link between the Veteran’s disability and his period of active duty. The Board acknowledges the Veteran’s assertions during his June 2012 hearing testimony that he hurt his back during basic training. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159. Lay evidence may be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition (i.e., when the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer); (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 Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). In ascertaining the competency of lay evidence, the Courts have generally held that a layperson is not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183 (1997). In certain instances, however, lay evidence has been found to be competent with regard to a disease with “unique and readily identifiable features” that is “capable of lay observation.” See, e.g., Barr v. Nicholson, 21 Vet. App. 303 (2007) (concerning varicose veins); see also Charles v. Principi, 16 Vet. App. 370 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398 (1995) (flat feet). Laypersons have also been found to not be competent to provide evidence in more complex medical situations. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (concerning rheumatic fever). While the Veteran is competent to describe his symptoms, without medical training, he has not demonstrated the competency to opine on matters requiring medical expertise, such as the etiology or natural progression of a low back disability. See Jandreau, 492 F.3d at 1376. As such, the Board assigns little probative weight to the Veteran’s assertions that his low back disability is related to his military service or his November 1977 injury. In regard to continuity of symptoms and presumptive service connection, the Board finds that the Veteran’s disability is properly afforded such consideration, as arthritis is an enumerated condition under 38 C.F.R. § 3.309 (a). See Walker, 708 F.3d at 1331. The Board acknowledges the Veteran’s assertion that he has had back pain continuously since service. However, the Board notes that these assertions are not consistent with the medical evidence of record. While the service treatment records contain reports of back pain, examination of the spine was normal at separation and there is no evidence of treatment for back pain until the Veteran was diagnosed with lumbar disc disease in 2007. The Board does not find that the lay statements of pain since service constitute credible evidence of a nexus between the Veteran’s military service and the currently diagnosed disability. As discussed above, the probative medical evidence of record demonstrates that the low back disability is not due to the Veteran’s period of active service. Accordingly, the Board places more probative value on the VA examinations of record in determining the etiology of the Veteran’s condition. Furthermore, the most competent and credible evidence of record is against a finding that that the Veteran’s disability manifested to a compensable degree within one year of the Veteran’s discharge from service. See 38 C.F.R. § 3.307 (a), 3.309(a). Instead, the probative evidence of record shows that the Veteran was not diagnosed with lumbar disc disease until 2007, almost 20 years after service. The competent evidence does not establish that the Veteran’s currently diagnosed low back disability is related to his period of active duty. There is no evidence of record to demonstrate a probative medical link between the Veteran’s low back disability and his time in service. As the weight of the evidence is against this claim, the “benefit of the doubt” rule is not for application, and the Board must deny the claim. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Hypertension The Veteran contends that his hypertension was caused by his active military service. Service treatment records show that in August 1983, the Veteran received emergency treatment for abdominal pain, and his blood pressure readings were 148/88, 150/94, 152/104. The following day, his blood pressure readings were 140/96, 140/102, and 140/110. In April 1985, the Veteran was treated for an upper respiratory infection and was noted to have blood pressure of 154/106. In August 1985, the Veteran received emergency treatment for electric shock and was noted to have blood pressure of 132/98. An undated treatment record also noted a blood pressure reading of 148/80 during emergency treatment for chest pain. Post-service, VA treatment records document extensive treatment for hypertension. The Veteran received a VA examination in June 2010 and the examiner opined that the Veteran’s hypertension was not related to his military service. It was noted that the Veteran had a few minor elevations of blood pressure when seen for acute illness, but his readings were normal, including a reading of 120/70 at his separation examination. In January 2014, a VA examiner opined that the Veteran’s hypertension was less likely than not caused by his military service. As rationale, the examiner stated that the Veteran was not diagnosed with or being treated for hypertension at discharge, and he did not begin treatment until years after service. In a May 2017 addendum opinion, the examiner restated his January 2014 findings. In a July 2017 addendum opinion, the examiner stated that in consideration of the Veteran’s lay statements, there was no evidence of a chronic condition or evidence that the Veteran sought treatment for his hypertension for several years following separation. The Veteran received a VA examination in April 2018 and the examiner opined that the Veteran’s hypertension was less likely than not caused by his military service. The examiner noted the Veteran’s elevated in-service blood pressure readings when he was diagnosed with a viral syndrome and later episode of pain. The examiner explained that the Veteran did not meet the criteria for hypertension until 2006 when he became obese. She further noted that risk factors for developing hypertension include obesity, diet, sedentary lifestyle, and family history. Upon review of the Veteran’s claim folder, the examiner stated that there was no evidence of chronicity in service or post-separation, until 18 years after service. The evidence does not show that the Veteran’s hypertension is related to his military service. Although the Veteran had elevated blood pressure readings while treating for various illnesses in service, he was not diagnosed with hypertension. As noted by the April 2018 VA examiner, the Veteran’s elevated in-service blood pressure readings were noted in connection with treatment for viral syndrome and later episode of pain. The examiner found that the Veteran did not meet the criteria for hypertension until 2006, when he was noted to be obese, a risk factor developing hypertension. As such, the Board finds that the evidence does not warrant a finding of service connection under the traditional criteria. See 38 C.F.R. § 3.303(a); Holton v. Shinseki, 557 F.3d, 1362, 1366 (Fed. Cir. 2009). The Board acknowledges the Veteran’s belief that he has hypertension related to service because of the elevated blood pressure readings documented in service treatment records. While the Veteran is competent to describe his symptoms, without medical training, he has not demonstrated the competency to opine on matters requiring medical expertise, such as the etiology of hypertension. See Jandreau, 492 F.3d at 1376. As such, the Board assigns little probative weight to the Veteran’s assertions that his hypertension is related to his military service. The Board also considers the Veteran’s condition with regard to continuity of symptoms and presumptive service connection, as hypertension is an enumerated condition under 38 C.F.R. § 3.309 (a). See Walker, 708 F.3d at 1331. The Board acknowledges the Veteran’s assertion that he has had hypertension continuously since service. However, the Board notes that these assertions are not consistent with the medical evidence of record. The record indicates that the Veteran first met the criteria for hypertension in 2006, 18 years after separation from service. There is no evidence of continuous symptoms or treatment for hypertension since service. The Board does not find that the lay statements regarding hypertension since service constitute credible evidence of a nexus between the Veteran’s military service and the currently diagnosed disability. As discussed above, the most probative medical evidence demonstrates that the Veteran’s hypertension is not due to his period of active service. Therefore, the Board places more probative value on the VA examinations of record in determining the etiology of the Veteran’s condition. Additionally, there is no evidence that the Veteran was diagnosed with or exhibited any symptoms of hypertension within one year of separation. As such, service connection for hypertension on a presumptive basis under 38 C.F.R. 3.309 (a) is also not warranted. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 3. Prostate Condition The Veteran contends that his prostate disorder was caused by his military service. Service treatment records show the Veteran was diagnosed with prostatitis in August 1981. On VA examination in June 2010, the examiner diagnosed the Veteran with hyperactive bladder disease, but found that there was no evidence of chronic prostatitis. The examiner noted that the Veteran was diagnosed with prostatitis in August 1981, but was not diagnosed with chronic prostatitis. It was further noted that the Veteran’s urinary symptoms began one year prior. Post-service, the Veteran received a VA examination in January 2014, and the examiner opined that the Veteran’s urinary condition and prostatitis were less likely than not related to his military service. The examiner explained that there was no evidence of chronicity, recurrence, or treatment following the single in-service episode of prostatitis. It was further noted that the Veteran’s symptoms of urinary frequency began about 5 years prior to the VA examination, whereas he separated form service about 25 years previously. In a May 2017 addendum opinion, the examiner restated his January 2014 findings. In a July 2017 addendum opinion, the examiner stated that in consideration of the Veteran’s lay statements, there was no evidence of a chronic prostatitis condition in service. In an April 2018 opinion, a VA examiner opined that the Veteran’s recurrent prostate disability was less likely than not related to his military service. She noted that there was only one in-service episode of prostatitis in 1981, and no evidence of chronicity. Additionally, the examiner explained that post-service treatment records did not show a diagnosis of chronic prostatitis until an ER visit in 2010. Based on the foregoing, the Board finds that the most probative evidence of record establishes that the Veteran’s prostate condition is less likely than not related to his period of active service. The Board notes that medical opinions are regarded as more probative when they include clear conclusions and supporting data with a reasoned analysis connecting the data and the conclusions. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Moreover, the examiner should clearly and rationally consider all procurable and assembled evidence in arriving at a conclusion. Jones v. Shinseki, 23 Vet. App. 382, 390 (2010). The Board places high probative weight on the VA opinions of record taken together, as the examiners reviewed the Veteran’s claims file, including medical history and lay statements, and provided adequate rationales for the opinion that the Veteran’s prostate condition is less likely than not related to his period of active service. In addition, there is no competent medical evidence to the contrary. The Board acknowledges the Veteran’s belief that his prostate condition and urinary frequency are related to his in-service diagnosis of prostatitis. While the Veteran is competent to describe his symptoms, without medical training, he has not demonstrated the competency to opine on matters requiring medical expertise, such as the etiology of a prostate condition. See Jandreau, 492 F.3d at 1376. As such, the Board assigns little probative weight to the Veteran’s assertions that his prostate condition is related to his military service. (Continued on the next page)   As the weight of the evidence is against this claim, the “benefit of the doubt” rule is not for application, and the Board must deny the claim. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Freeman, Associate Counsel