Citation Nr: 18161080 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 16-40 576 DATE: December 28, 2018 ORDER Entitlement to service connection for hypertension is denied. REMANDED Entitlement to service connection for a psychiatric disability, to include posttraumatic stress disorder (PTSD), depression, and anxiety, is remanded. Entitlement to service connection for a bilateral wrist disability, to include carpal tunnel syndrome, is remanded. Entitlement to service connection for a breathing disability, including allergic rhinitis and sinusitis, is remanded. Entitlement to service connection for a bilateral vision loss disability is remanded. Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a dizziness disability, including vertigo, is remanded. Entitlement to service connection for a sleep disability, to include sleep apnea and insomnia, is remanded. Entitlement to service connection for degenerative arthritis is remanded. Entitlement to service connection for irritable bowel syndrome is remanded. Entitlement to service connection for peripheral neuropathy of the right upper extremity is remanded. Entitlement to service connection for peripheral neuropathy of the left upper extremity is remanded. Entitlement to service connection for peripheral neuropathy of the right lower extremity is remanded. Entitlement to service connection for peripheral neuropathy of the left lower extremity is remanded. Entitlement to service connection for a bilateral elbow disability is remanded. Entitlement to service connection for scoliosis is remanded. Entitlement to service connection for traumatic brain injury is remanded. FINDING OF FACT The preponderance of the evidence weighs against a finding that currently diagnosed hypertension is related to any incident of service, or to a service-connected disability, or manifested to a compensable degree within one year following separation from service. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension, to include as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1970 to September 1972. Service Connection 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); 38 C.F.R. § 3.303 (2017). To establish a service connection for a 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. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). That determination requires a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). 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 that was incurred or aggravated in service. 38 C.F.R. § 3.303(d) (2017). Service connection may be presumed for certain chronic diseases which develop to a compensable degree within one year after discharge from service, even though there is no evidence of that disease during the period of service. That presumption is rebuttable by probative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137 (2012); 38 C.F.R. 3.307, 3.309(a) (2017). A Veteran need only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 519 (1996). Entitlement to service connection for hypertension The Veteran asserts that service connection for hypertension is warranted. Hypertension is present when the diastolic blood pressure is predominantly 90 or greater, and isolated systolic hypertension when the systolic blood pressure is predominantly 160 or greater with a diastolic blood pressure of less than 90. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1) (2017). The Board notes that the Veteran’s service medical records do not show any reports or treatments for hypertension. Several blood pressure readings taken during service show that the Veteran’s blood pressure was normal. In an October 1970 report of medical examination, blood pressure was 108/80. In a September 1972, report of medical examination, blood pressure was 120/76. Private medical records dated from May 2015 through May 2017 indicate that the Veteran was seen for repeated follow-ups for essential hypertension. In those records, the Veteran indicated a positive family history of hypertension. At a September 2017 hearing, the Veteran testified that he had no documented hypertension in service. He reported that he went to the doctor a few years after service, at which point he was told his blood pressure was on the high side. After review of the evidence, the Board finds that the Veteran did not manifest hypertension during service or continuously manifest symptoms of hypertension in the years after service, including to a degree of 10 percent within one year of service separation. Moreover, the Veteran was not diagnosed with hypertension by medical personnel in available medical evidence, to include following service for several years. The Board finds that the service medical records are the most probative evidence of record as to whether hypertension manifested during active service and therefore the Board concludes that hypertension did not manifest during active service. The medical records in service are more persuasive than the Veteran’s statement that hypertension is due to active service. Next, the Board finds that hypertension did not manifest within one year of separation from service and therefore cannot be presumed to be service-connected under the provisions for chronic diseases. The first indication of the Veteran being treated for or diagnosed with hypertension is in May 2015 medical records. By his testimony, the Veteran was not first seen for or told about high blood pressure until several years after service. That time period is well beyond the presumptive period of establishing service connection for hypertension as a chronic disease. 38 C.F.R. 3.307, 3.309. Furthermore, the passage of years between separation from active service and the first documentation of the claimed disability is another factor that tends to weigh against a claim for service connection. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). The Board has also considered that Veteran’s statements submitted in support of the claim. The Board finds that the Veteran is a lay person and although lay persons are competent to provide opinions on some medical issues, the specific disability of hypertension falls outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Hypertension is a complex disease that requires specialized training and medical diagnostic testing for a determination as to diagnosis and causation, and it is not susceptible of lay opinions on etiology. Therefore, the Veteran’s statements cannot be accepted as competent evidence sufficient to establish service connection on a direct basis. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection for hypertension and the claim must be denied. 38 U.S.C. § 5107 (2012); 38 C.F.R. § 3.102 (2017); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for a psychiatric disability, to include posttraumatic stress disorder (PTSD), depression, and anxiety is remanded. The Veteran contends that he has a current psychiatric disability related to service. The Board notes that the Veteran initially claimed PTSD. At a December 2013 VA examination, the examiner found that the stressor of receiving incoming fire from an airplane while on a ship deck while deployed to Vietnam was adequate to support the diagnosis of PTSD, and that the stressor was related to the Veteran’s fear of hostile military or terrorist activity. However, the examiner found that the Veteran did not meet the full criteria for PTSD. At the examination, the Veteran reported symptoms including depressed mood, anxiety, and insomnia. During the pendency of the appeal for the claim of entitlement to service connection for PTSD, the Veteran also filed claims for service connection for depression and anxiety. The Board finds that a new VA examination is needed to obtain an opinion on the nature and etiology of any diagnosed psychiatric disability. VA’s statutory duty to assist the Veteran includes the duty to conduct a thorough examination so that the evaluation of the claimed disability will be a fully informed one. Green v. Derwinski, 1 Vet. App. 121 (1991); Snuffer v. Gober, 10 Vet. App. 400 (1997). Assistance by VA includes providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d) (2012); 38 C.F.R. § 3.159(c)(4) (2017); McLendon v. Nicholson, 20 Vet. App. 79 (2006). When the medical evidence is inadequate, VA must supplement the record by seeking an advisory opinion or ordering another medical examination. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Hatlestad v. Derwinski, 3 Vet. App. 213 (1992). Therefore, a remand is necessary to obtain a VA examination. 2. Entitlement to service connection for a bilateral wrist disability, to include carpal tunnel syndrome. The Veteran asserts that service connection is warranted for bilateral carpal tunnel syndrome. At a September 2017 hearing, the Veteran reported that he experienced pain in the arms due to the performance of duties during service. The Veteran reported he currently had problems with his wrists. The service medical records do not show complaints, treatment, or diagnoses related to any wrist disability. The Veteran does not have a current diagnosis of carpal tunnel syndrome. However, the Board finds that remand is necessary to determine the nature and etiology of any bilateral wrist disability. VA’s statutory duty to assist the Veteran includes the duty to conduct a thorough examination so that the evaluation of the claimed disability will be a fully informed one. Green v. Derwinski, 1 Vet. App. 121 (1991); Snuffer v. Gober, 10 Vet. App. 400 (1997). Assistance by VA includes providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d) (2012); 38 C.F.R. § 3.159(c)(4) (2017); McLendon v. Nicholson, 20 Vet. App. 79 (2006). When the medical evidence is inadequate, VA must supplement the record by seeking an advisory opinion or ordering another medical examination. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Hatlestad v. Derwinski, 3 Vet. App. 213 (1992). Therefore, a remand is necessary to obtain a VA examination. 3. Entitlement to service connection for a breathing disability, including allergic rhinitis and sinusitis; service connection for a bilateral vision loss disability; service connection for a cervical spine disability; service connection for dizziness, including vertigo; service connection for a sleep disability, to include sleep apnea and insomnia; service connection for degenerative arthritis; service connection for irritable bowel syndrome; service connection for peripheral neuropathy of the bilateral upper extremities; service connection for peripheral neuropathy of the bilateral lower extremities; service connection for a bilateral elbow disability; service connection for scoliosis; and service connection for traumatic brain injury Regarding the claims for entitlement to service connection for a breathing disability, including allergic rhinitis and sinusitis; service connection for a bilateral vision loss disability; service connection for a cervical spine disability; service connection for dizziness, including vertigo; service connection for a sleep disability, to include sleep apnea and insomnia; service connection for degenerative arthritis; service connection for irritable bowel syndrome; service connection for peripheral neuropathy of the bilateral arms; service connection for peripheral neuropathy of the bilateral hands, service connection for peripheral neuropathy of the bilateral legs; peripheral neuropathy of the bilateral feet; service connection for a bilateral elbow disability; service connection for scoliosis; and service connection for traumatic brain injury, the Veteran submitted a timely January 2018 notice of disagreement with a December 2017 decision denying the claims. No statement of the case addressing those claims has been issued. Therefore, the Board is required to remand the claims for issuance of a statement of the case. Manlincon v. West, 12 Vet. App. 238 (1999). The matter is REMANDED for the following action: 1. Identify any VA or private medical records of treatment that are not already of record and associate them with the claims file. 2. Issue a statement of the case on the issues of entitlement to service connection for a breathing disability, including allergic rhinitis and sinusitis; service connection for a bilateral vision loss disability; service connection for a cervical spine disability; service connection for dizziness, including vertigo; service connection for a sleep disability, to include sleep apnea and insomnia; service connection for degenerative arthritis; service connection for irritable bowel syndrome; service connection for peripheral neuropathy of the bilateral upper extremities; service connection for peripheral neuropathy of the bilateral lower extremities; service connection for a bilateral elbow disability; service connection for scoliosis; and service connection for traumatic brain injury. Notify the Veteran of his appeal rights and that he must submit a timely substantive appeal to receive appellate review of those issues. If a timely substantive appeal is received, return those claims to the Board. 3. Schedule the Veteran for a VA psychiatric examination to determine the etiology of all psychiatric disabilities found. The examiner must review the claims file and should note that review in the report. Any further indicated tests and studies to include psychological studies should be conducted to identify all current psychiatric disorders, to include any diagnosis of PTSD, depression, or anxiety. The examiner must address the Veteran’s lay statements. A complete rationale should be given for all opinions and conclusions expressed. (a.) The examiner should diagnose all psychiatric disabilities present. With respect to PTSD, the examiner should review the claimed in-service stressors to determine whether exposure to the claimed in-service stressors have resulted in PTSD. The examiner should determine whether the diagnostic criteria to support the diagnosis of PTSD have been satisfied. The examiner should specifically state whether or not each criterion for a diagnosis of PTSD is met. If a PTSD diagnosis is deemed appropriate, the examiner should comment upon the link between the current symptomatology and the claimed in-service stressor. (b.) With respect to all psychiatric disorders found upon examination, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that each current psychiatric disability is related to any incident of the Veteran’s active duty service, to include the claimed in-service stressor. 4. Schedule the Veteran for a VA examination to determine the nature and etiology of any bilateral wrist disability. The examiner must review the claims file and should note that review in the report. All tests and studies deemed necessary by the examiner must be performed. Based on a review of the claims file and the clinical findings of the examination, the examiner is requested to provide an opinion on whether it at least as likely as not (50 percent or greater probability) that the Veteran has a wrist disability that was caused by or is related to service or any event during servcie. A complete rationale should be pro vided for all opinions and conclusions. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD H. Ahmad, Associate Counsel