Citation Nr: 18160716 Decision Date: 12/27/18 Archive Date: 12/27/18 DOCKET NO. 11-02 301 DATE: December 27, 2018 ISSUE Entitlement to service connection for a blood disability, claimed as anemia. ORDER Entitlement to service connection for a blood disability, claimed as anemia, is denied. FINDINGS OF FACT 1. The Veteran does not have anemia. 2. A blood disability was not manifest in service or within one year of separation, and is not otherwise attributable to service. CONCLUSION OF LAW A blood disability was not incurred in or aggravated by service, and anemia may not be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from March 1966 to February 1969. This matter is before the Board of Veterans Appeals (Board) on appeal from a January 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. The appeal was remanded by the Board in April 2017 for additional development. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§3.102, 3.156(a), 3.159, 3.326(a) (2017). The Veteran in this case has not referred to any deficiencies in either the duties to notify or assist; therefore, the Board may proceed to the merits of the claim. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015, cert denied, U.S.C. Oct.3, 2016) (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 [appellant] fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to an appellant's failure to raise a duty to assist argument before the Board). The Board has reviewed all of the evidence in the Veteran’s claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on her behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000). Entitlement to service connection for a blood disability, claimed as anemia To establish service connection a Veteran must generally 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, 1167 (Fed. Cir. 2004). Service connection may also 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). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “Chronic.” When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303 (b). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154 (a). Lay 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). Lay evidence cannot be determined not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran’s lay statements. Id. The Board, as fact finder, is obligated to, and fully justified in, determining whether lay evidence is credible in and of itself, i.e., because of possible bias, conflicting statements, etc. Id. Further, a negative inference may be drawn from the absence of complaints for an extended period. See Maxson v. West, 12 Vet. App. 453, 459 (1999), aff’d sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). 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 sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a current disability, there can be no valid claim. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). As a threshold matter, service connection for anemia was denied in a January 2011 rating decision. The Veteran filed a February 2011 Notice of Disagreement (NOD). She perfected her appeal in July 2011. The claim was not immediately certified to the Board. Additional medical evidence continued to be associated with the claims file. The Veteran filed a May 2014 Supplemental Claim to reopen her claim for service connection for anemia, but the claim was never final in the first instance. It continued to undergo development. It was ultimately certified to the Board in October 2016. Therefore, the claim will not be addressed as a claim to reopen the previously denied claim, and there has been no prejudice in this regard to the Veteran. 38 C.F.R. § 3.156 (b). By way of background, the Service Treatment Records (STRs) include a Patient Evaluation associated with other documents from 1967. It shows that the Veteran took “vitamin iron pills” under a list of recent medications. An August 19, 1968 notation in the STRs shows that the Veteran would like to have a blood test. The February 1969 Report of Medical Examination from separation disclosed a clinically normal evaluation of the vascular system, G-U system, and endocrine system. The Veteran’s Report of Medical History from separation from February 1969 shows that the Veteran denied dizziness or fainting spells, stomach, liver, or intestinal trouble. A Physical and Mental Status on Release from Active Service form from February 1969 shows that the Veteran’s physical condition was such that she was considered physically qualified for separation or for re-enlistment without re-examination provided she re-enlist within 90 days. In a Serviceman’s Statement Concerning Application for Compensation from the Veterans Administration, the Veteran declined to file an application for compensation at that time, though she indicated that she understood that she could file one at a later date. Years later, VA treatment records show reports of low iron. For example, a July 2010 VA treatment record shows, “The CBC (complete blood count) results were normal but you are iron deficient. Usually, this is from inadequate intake of iron or from chronic blood loss.” A March 2012 Primary Care Letter shows a notation of “Your iron is a bit low.” A June 2014 VA treatment record shows, “her neuroloigst (sic) mentioned that she is anemic. will check iron studies. if anemic, will need egd/colo since no uterine bleeding (s/p tah).” A May 2017 VA examination shows, “No objective evidence to support Veterans claim of Anemia. No diagnosis warranted.” May 4, 2017 diagnostic laboratory testing was considered. The VA examination further shows, “The Veteran did not have a diagnosis of anemia at any time since September 2010.” The VA examiner rendered a negative nexus opinion. The VA examiner noted that symptoms are subjective only, with a clinically normal objective examination and no objective evidence of a chronic condition. A December 2018 VA medical opinion was obtained. The physician reviewed the claims file, including laboratory results from 2010 and 2011. The VA examiner did not find evidence to support a diagnosis of iron deficiency anemia during that period. The VA examiner further opined, “It is not likely that any current anemia-was either caused or aggravated by the Veteran’s service-connected disabilities. Gastritis and diverticulosis are the cause of her current iron deficiency and are unrelated to her service connected disabilities listed above.” The VA examiner noted treatment for iron deficiency. The Veteran contends that she has had anemia continuously since service. She explains that her doctors have told her that she has anemia, and that it is recurrent. The Veteran is competent to provide evidence of that which she experiences, including her symptomatology and medical history. Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Veteran is competent to relate what she has been told by a professional. She is competent to report when she began receiving treatment for iron deficiency. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran’s own lay opinions as to the diagnosis and cause of any anemia are not probative evidence, although the Veteran’s observed symptoms described may be useful to an expert in evaluating whether the Veteran has a disability and in determining the etiology thereof. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). Because the record does not indicate that the Veteran has medical expertise, the Veteran’s lay opinion beyond a description of her symptoms is of limited probative value. The most probative evidence is the contemporaneous treatment records, including the STRs, and the opinions of the May 2017 and December 2018 VA examiners. First, the separation examination is clinically normal for the vascular, G-U, and endocrine systems. The Veteran denied dizziness upon separation. We have considered notations in the STRs of vitamin iron pills. Years later, in 2010, VA and private treatment records show notations of iron deficiency. The Board assigns substantial probative weight to the contemporaneous treatment records. Second, we assign substantial probative weight to the opinions of the May 2017 and December 2018 VA examiners. Both VA examiners reviewed the claims file, including laboratory results, and found no evidence to support a diagnosis of anemia. The December 2018 VA examiner considered the Veteran’s treatment with iron supplements starting in July 2010. The December 2018 VA examiner explained, “Gastritis and diverticulosis are the cause of her current iron deficiency and are unrelated to her service connected disabilities listed above.” Both VA examiners also rendered negative nexus opinions regarding any possible iron deficiency. The Board observes that in the absence of proof of a current disability, there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Accordingly, VA has been unable to verify that the Veteran has a blood disability, including anemia, and she continues to offer only conclusory statements. Any notations of iron deficiency have been attributed to other factors, as discussed by the physician in the December 2018 VA medical opinion. In sum, we find the lack of objective medical evidence as to the existence and diagnosis for any current blood disability or anemia to be probative. Consequently, service connection for a blood disability, claimed as anemia, is not warranted. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). (Continued on the next page.) In reaching this conclusion, the Board finds that the preponderance of the evidence is against this claim. As such, the benefit of the doubt rule is not for application, and the claim must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Michael Pappas Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Bodi, Associate Counsel