Citation Nr: 18158400 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 16-61 677 DATE: December 14, 2018 ORDER Entitlement to service connection for a headache disorder is denied. REMANDED Entitlement to service connection for a respiratory condition is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for insomnia is remanded. Entitlement to service connection for peripheral vascular disease of the left lower extremity is remanded. Entitlement to service connection for peripheral vascular disease of the right lower extremity is remanded. Entitlement to an acquired psychiatric disability, to include anxiety, depression, and posttraumatic stress disorder (PTSD). FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of a headache disorder. CONCLUSION OF LAW The criteria for entitlement to service connection for a headache disorder have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from July 1966 to May 1969. Additional VA treatment records were associated with the record following issuance of the statement of the case as to the issue decided herein. However, those additional records are not relevant to the issue decided herein. Accordingly, a remand for issuance of a supplemental statement of the case as to that issue is not necessary, and the Board may proceed with appellate consideration. See 38 C.F.R. § 19.37. Neither the Veteran nor his representative has raised any issues with regard to the duty to notify or duty to assist as they pertain to the issue decided herein. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). In that regard, the Board notes that the development directed in the Remand section below pertains to the issues remanded herein, and there is no indication that evidence developed as part of those actions may be relevant to the issue decided herein. The analysis in this decision focuses on the most relevant evidence and on what the evidence shows or does not show with respect to the issues decided herein. The Veteran should not assume that evidence that is not explicitly discussed herein has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed). Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of section 1110 as requiring the existence of a current disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Entitlement to service connection for a headache disorder The Veteran seeks entitlement to service connection for headaches. In a July 2018 brief, the Veteran’s representative asserts that radiation treatment for the Veteran’s service-connected disabilities causes restricted blood flow, which in turn causes headaches. A review of the medical treatment evidence of record reveals an absence of complaints of or treatment for headaches. The only mention of headaches in those records is a July 2015 VA treatment record documenting that the Veteran denied chronic headaches during the review of systems portion of a primary care visit. Although the Veteran is considered competent to report headaches, see Layno v. Brown, 6 Vet. App. 465, 469 (1994), the lack of evidence of treatment for headaches and the fact that he denied any chronic headache problems in July 2015 render his statements not credible. See Caluza v. Brown, 7 Vet. App. 498 (1995) (in determining whether evidence submitted by a Veteran is credible, the Board may consider internal consistency, facial plausibility, and consistency with other information submitted on behalf of the claimant); see also See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (the lack of contemporaneous medical records may be a fact that the Board can consider and weigh against a veteran’s lay evidence, although the lack of such records does not, in and of itself, render lay evidence not credible). As such, the Board concludes that there is no credible evidence of record that the Veteran had headaches during or in proximity to the pendency of the claim. As noted above, in the absence of proof of a current disability, there can be no valid claim for entitlement to service connection. Brammer, 3 Vet. App. at 225. In view of the foregoing, the Board concludes that the preponderance of the evidence is against the claim for entitlement to service connection for headaches. Because the preponderance of the evidence is against that claim, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for a respiratory condition, hypertension, and insomnia are remanded. The Veteran seeks entitlement to service connection for a respiratory condition, hypertension, and insomnia, which he contends are related to in-service exposure to herbicide agents. The medical treatment records indicate that he currently has diagnoses of those conditions. In addition, his service personnel records reflect that he had service in the Republic of Vietnam during the Vietnam era. Therefore, he is presumed to have been exposed to herbicide agents. See 38 C.F.R. § 3.307(a)(6)(iii). There are no respiratory conditions included on the regulatory list of diseases associated with exposure to certain herbicide agents. See 38 C.F.R. § 3.309(e). Hypertension and insomnia are also not on that list. However, in the statement received in January 2015, Dr. Hill opines that the Veteran’s chronic airway obstruction, insomnia, and hypertension are most likely due to his exposure to Agent Orange. Although Dr. Hill’s statement cannot be accepted as probative evidence etiologically linking those disabilities to the Veteran’s active service because Dr. Hill provided no rationale to support the conclusion reached, it may be accepted as an indication that such a link may exist. In addition, the National Academy of Sciences (NAS) Institute of Medicine’s Veterans and Agent Orange: Update 2010, concludes that there is “limited or suggestive” evidence of an association between exposure to herbicide agents and hypertension, which provides further indication that the Veteran’s hypertension may be related to his active service. M0ore recently, in November 2018, hypertension was moved by NAS to the category of “sufficient” evidence of an association from its previous classification in the “limited or suggestive” category. As such, the Board finds that the low threshold for providing a VA examination has been met, and that the Veteran must be provided examinations as to his claimed respiratory condition, hypertension, and insomnia. See 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). 2. Entitlement to service connection for peripheral vascular disease of the left and right lower extremities is remanded. A VA examiner opined in June 2017 that it is less likely than not that the Veteran’s peripheral vascular disease of the left and right lower extremities is proximately due to or the result of the Veteran’s service-connected coronary artery disease because “Unable to confirm a current chronic diagnosis with current available records and/or today’s exam. Therefore no nexus or plausible secondary relationship is established.” A review of the record reveals that the Veteran has been diagnosed with peripheral vascular disease of the bilateral lower extremities, to include at a May 2015 VA artery and vein conditions examination. Therefore, a current diagnosis of peripheral vascular disease of the bilateral lower extremities is of record, even if that condition subsequently resolved and was not shown on examination in June 2017. See Romanowsky v. Shinseki, 26 Vet. App. 303 (2013). A medical opinion with full supporting rationale as to whether that condition is proximately due to or aggravated by the Veteran’s service-connected disabilities is required. The June 2017 VA examiner did not provide such an opinion. Therefore, the issue must be remanded so that an addendum opinion may be obtained. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 3. Entitlement to service connection for an acquired psychiatric disability, to include anxiety, depression, and PTSD, is remanded. The Veteran underwent a VA initial PTSD examination in May 2015. The examiner reviewed the record and interviewed the Veteran. He noted that the only psychiatric symptom the Veteran endorsed was chronic sleep impairment. He determined that the Veteran does not have PTSD or any other mental disorder that conforms to the diagnostic criteria set forth in the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition. However, since that examination, the Veteran and his spouse submitted statements detailing the Veteran’s psychiatric symptoms beyond his chronic sleep impairment and describing in-service stressful events. In view of this additional information, it is unclear whether the Veteran now has a diagnosable acquired psychiatric disability. The Board concludes that the Veteran should be provided another VA examination to determine whether he has a diagnosable acquired psychiatric disability and, if so, whether that disability is directly related to his active service or is proximately due to or aggravated by his service-connected disabilities. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any diagnosed respiratory condition, hypertension, and/or insomnia. The examiner must opine whether it is at least as likely as not (50 percent probability or greater) that the condition is related to an in-service injury, event, or disease, including presumed exposure to herbicide agents. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s diagnosed peripheral vascular disease of the bilateral lower extremities, even if currently resolved, is at least as likely as not (50 percent probability or greater) proximately due to or aggravated beyond its natural progression by the Veteran’s service-connected disabilities, to include coronary artery disease. 3. Schedule the Veteran for a psychiatric examination to determine the nature and etiology of any diagnosable acquired psychiatric disability, including anxiety, depression, and PTSD. If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met. Consideration must be given to the statements provided by the Veteran and his wife as to his psychiatric symptoms and his in-service stressful events. For each acquired psychiatric disorders diagnosed, the examiner must opine whether the condition is at least as likely as not (50 percent probability or greater) directly related to the Veteran’s active service or is proximately due to or aggravated beyond its natural progression by the Veteran’s service-connected disabilities. 4. If the psychiatric examiner diagnoses the Veteran with PTSD based on an in-service stressor, then attempt to corroborate the Veteran’s in-service stressors. If more   details are needed, contact the Veteran to request the information. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. J. Anthony, Counsel