Citation Nr: 20021861 Decision Date: 03/27/20 Archive Date: 03/27/20 DOCKET NO. 16-15 136A DATE: March 27, 2020 ORDER Entitlement to service connection for a lower back disability is denied. Entitlement to service connection for an acquired psychiatric disorder is denied. Entitlement to service connection for high blood pressure is denied. Entitlement to service connection for a heart disability is denied. Entitlement to service connection for poor blood circulation is denied. REMANDED Entitlement to service connection for loss of teeth, for compensation purposes is remanded. Entitlement to service connection for a throat disability is remanded. Entitlement to service connection for an eye disability is remanded. FINDINGS OF FACT 1. The Veteran’s low back disability did not incur during active service, was not caused by active service, and did not manifest to a compensable degree within one year of separation from active service. 2. The preponderance of the evidence is against finding that the Veteran has a current diagnosis for an acquired psychiatric disorder, to include anxiety. 3. The Veteran’s high blood pressure did not incur during active service, was not caused by active service, and did not manifest to a compensable degree within one year of separation from active service. 4. The Veteran’s heart disability did not incur during active service, was not caused by active service, and did not manifest to a compensable degree within one year of separation from active service. 5. The Veteran’s poor blood circulation did not incur during active service and was not caused by active service. CONCLUSIONS OF LAW 1. The criteria for service connection for a lower back disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. 2. The criteria for service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. 3. The criteria for service connection for high blood pressure have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. 4. The criteria for service connection for a heart disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. 5. The criteria for service connection for poor blood circulation have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1962 to June 1964. He died in October 2016 during the pendency of the appeal. The Appellant is his surviving spouse, and has been properly substituted for the purposes of claims pending before VA at the time of the Veteran’s death. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). To prevail on the issue of service connection, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service if they were shown as chronic (reliably diagnosed) in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. 1. Entitlement to service connection for a lower back disability The Appellant contends the Veteran should be service connected for a low back disability. The question for the Board is whether the Veteran had a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The record reflects that the Veteran had degenerative changes of the lumbar and the thoracic spine. See March 1994 VA treatment notes; August 2016 VA treatment notes. The Veteran’s service treatment records (STRs), however, are silent for a diagnosis or symptoms of a back condition. Additionally, there is no medical opinion of record establishing a nexus between the Veteran’s back condition and his active service. While the Veteran did not undergo a VA examination for this condition, and a nexus opinion has not been sought, the Board finds that a VA opinion are not necessary. Under VA’s duty to assist, a medical examination or medical opinion is considered necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent medical evidence of a currently diagnosed disability or persistent or recurrent symptoms of a disability; (2) establishes that the Veteran suffered an event, injury, or disease in service; and (3) indicates that the claimed disability or symptoms may be associated with an established event, injury or disease in service or with another service-connected disability. See McClendon v. Nicholson, 20 Vet. App. 79 (2006); 38 C.F.R. § 3.159 (c)(4). The requirements to secure a VA examination are a low bar. Although McClendon sets a low bar, that bar has not been met here. While the record reflects a disability, there is no evidence of a back condition in service, and no indication that the Veteran’s current back condition was related to his active service. The Board notes the record is negative for specific lay evidence from the Veteran or Appellant to support that the back condition is related to active service. The only evidence of a possible connection between the Veteran’s back condition and his service includes the Veteran’s request for service connection via broad and generic statements in the original claim, notice of disagreement, and substantive appeal; such statements are not sufficient to trigger VA’s obligation to obtain an examination or opinion. See Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010). There is no evidence the Veteran had the training or credentials, or evidence the Appellant has the training or credentials to provide a competent opinion as to a diagnosis or etiology. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board finds no competent and credible evidence of in-service manifestations of a back condition, persistent and/or recurrent symptoms of disability since service, or competent evidence suggesting the back condition is due to active service. The other question for the Board is whether the Veteran’s back condition was noted as chronic in service or that manifested to a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service. The Board concludes that, while the Veteran’s degenerative changes would have been a chronic disease under 38 C.F.R. § 3.309(a), such were not shown as chronic in service or within a presumptive period, did not manifest to a compensable degree within a presumptive period, and were not noted in service with attributable continuity of symptomatology based on a review of the medical evidence. The first evidence indicating a back condition in the record is located in November 1984 VA treatment records, in which, the Veteran reported back pain that began approximately 10 years prior to the November 1984 treatment. The medical evidence does not indicate the Veteran’s arthritis developed by June 1965. The Board notes the Veteran has not provided lay evidence to support continuity of symptomatology or the back condition developing to a compensable degree within one year of separation from active service. In conclusion, based on the analysis above, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107(b). 2. Entitlement to service connection for an acquired psychiatric disorder The Board has reviewed the Veteran’s record and finds no current diagnosis of an acquired psychiatric disorder. The Veteran’s entrance and separation examinations are negative for evidence of any psychiatric disorder. The Board notes the Veteran was not afforded a VA examination. While the Veteran had not undergone a VA examination for this condition, and a nexus opinion has not been sought, the Board finds that a VA examination was not necessary. This is per McLendon, as described above. Here, there are no post-service records showing a psychiatric disorder. The Veteran claimed a nervous/anxiety condition. However, based on the information available, the Veteran lacked the training or credentials to provide a competent diagnosis of a psychiatric disability. See Jandreau, 492 F.3d at 1372. As such, the Board finds no competent evidence of an acquired psychiatric disorder at any point during the appeal period. Absent a current diagnosis, the Board must find that the preponderance of the evidence is against the Veteran’s claim for service connection. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107(b). 3. Entitlement to service connection for high blood pressure The Veteran contends that he should be service connected for high blood pressure. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The record reflects that the Veteran had been diagnosed with hypertension. See August 2016 VA treatment records. The Veteran’s STRs, however, are silent for a diagnosis for hypertension or elevated blood pressure readings that rise to the level of hypertension under 38 C.F.R. § 4.104, Diagnostic Code 7101. Additionally, there is no medical opinion of record establishing a nexus between the Veteran’s hypertension and service. While the Veteran had not undergone a VA examination for this condition, and a nexus opinion has not been sought, the Board finds that a VA etiology opinion is not necessary. See McClendon, supra. While the record reflects a disability, there is no evidence of hypertension in service, and no indication that the Veteran’s hypertension was related to his active service. The Board notes the record is negative for specific lay evidence from the Veteran or Appellant to support hypertension was related to active service. The only evidence of a possible connection between the Veteran’s hypertension and his service includes the Veteran’s request for service connection via broad and generic statements in the original claim, notice of disagreement, and substantive appeal; such statements are not sufficient to trigger VA’s obligation to obtain an examination or opinion. See Waters, 601 F.3d at 1274. There is no evidence the Veteran had, or the Appellant has, the training or credentials to provide a competent opinion as to a diagnosis or etiology. See Jandreau, 492 F.3d at 1372. The Board finds no competent and credible evidence of in-service manifestations of hypertension, persistent and/or recurrent symptoms of hypertension since service, or competent evidence suggesting hypertension was due to service. The other question for the Board is whether the Veteran’s hypertension was noted as chronic in service or that manifested to a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service. The Board concludes that, while the Veteran’s hypertension was a chronic disease under 38 C.F.R. § 3.309(a), it was not shown as chronic in service or within a presumptive period, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology based on a review of the medical evidence. The first evidence indicating hypertension in the record is located in February 2002 VA treatment records. The Board notes that in earlier VA treatment notes from approximately 1986 (the Veteran is noted as being 45 years of age) the Veteran denied a history of hypertension. Therefore, the medical evidence does not indicate the Veteran’s hypertension developed by June 1965. No lay evidence has been presented to support continuity of symptomatology of hypertension developing to a compensable degree within one year of separation from active service. In conclusion, based on the analysis above, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107(b). 4. Entitlement to service connection for a heart disability The Veteran contends that he should be service connected for a heart disability. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The record reflects that the Veteran had been diagnosed with coronary heart disease, heart failure, and cardiomyopathy. See August 2016 VA treatment records. The Veteran’s STRs, however, are silent for a diagnosis for diagnoses or treatment for any heart related disabilities. Additionally, there is no medical opinion of record establishing a nexus between the Veteran’s heart disabilities and service. While the Veteran had not undergone a VA examination for the conditions, and a nexus opinion has not been sought, the Board finds that a VA etiology opinion is not necessary. See McClendon, supra. While the record reflects a disability, there is no evidence of a heart disability in service, and no indication that the Veteran’s heart disabilities were related to his active service. The Board notes that the record is negative for specific lay evidence from the Veteran or Appellant to support that the heart disabilities were related to active service. The only evidence of a possible connection between the Veteran’s heart disabilities and his service includes the Veteran’s request for service connection via broad and generic statements in the original claim, notice of disagreement, and substantive appeal; such statements are not sufficient to trigger VA’s obligation to obtain an examination or opinion. See Waters, 601 F.3d at 1274. There is no evidence the Veteran had, or the Appellant has, the training or credentials to provide a competent opinion as to a diagnosis or etiology. See Jandreau, 492 F.3d at 1372. The Board finds no competent and credible evidence of in-service manifestations of heart disabilities, persistent and/or recurrent symptoms of hypertension since service, or competent evidence suggesting the heart disabilities were due to service. The other question for the Board is whether the Veteran’s coronary heart disease was noted as chronic in service or that manifested to a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service. The Board concludes that, while the Veteran’s coronary heart disease was a chronic disease under 38 C.F.R. § 3.309(a), it was not shown as chronic in service or within a presumptive period, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology based on a review of the medical evidence. The first evidence indicating a heart disability in the record is located in April 1986 VA treatment records, and the Veteran was diagnosed with unstable angina and to rule out a myocardial infarction. Therefore, the medical evidence does not indicate the Veteran’s coronary artery disease developed by June 1965. The Board notes the Veteran has not provided lay evidence to support continuity of symptomatology of hypertension developing to a compensable degree within one year of separation from active service. In conclusion, based on the analysis above, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107(b). 5. Entitlement to service connection for poor blood circulation The Veteran contends he should be service connected for a poor blood circulation. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The record reflects that the Veteran had been diagnosed with peripheral vascular disease. See August 2016 VA treatment records. The Veteran’s STRs, however, are silent for a diagnosis for diagnoses or treatment for any blood circulation disability. Additionally, there is no medical opinion of record establishing a nexus between the Veteran’s poor blood circulation and service. While the Veteran had not undergone a VA examination for the condition, and a nexus opinion has not been sought, the Board finds that a VA etiology opinion is not necessary. See McClendon, supra. While the record reflected a current disability, there is no evidence of a poor blood circulation in service, and no indication that the Veteran’s poor blood circulation was related to his active service. The Board notes the record is negative for specific lay evidence from the Veteran or Appellant to support that poor blood circulation was related to active service. The only evidence of a possible connection between the Veteran’s poor blood circulation and his service includes the Veteran’s request for service connection via broad and generic statements in the original claim, notice of disagreement, and substantive appeal; such statements are not sufficient to trigger VA’s obligation to obtain an examination or opinion. See Waters, 601 F.3d at 1274. There is no evidence the Veteran had, or the Appellant has, the training or credentials to provide a competent opinion as to a diagnosis or etiology. See Jandreau, 492 F.3d at 1372. The Board finds no competent and credible evidence of in-service manifestations of poor blood circulation, persistent and/or recurrent symptoms of poor blood circulation since service, or competent evidence suggesting the poor blood circulation was due to service. In conclusion, based on the analysis above, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107(b). REASONS FOR REMAND 1. Entitlement to service connection for loss of teeth is remanded. The Veteran’s STRs show evidence of missing teeth in the Veteran’s dental records upon entrance into active duty. August 2016 VA treatment notes show the Veteran had upper and lower dentures. Under current VA regulations, compensation is only available for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla. Compensation is available for loss of teeth only if such is due to loss of substance of body of maxilla or mandible due to trauma or disease such as osteomyelitis, but not periodontal disease. Otherwise, a Veteran may be entitled to service connection for dental conditions including treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease, for the sole purposes of receiving VA outpatient dental services and treatment, if certain criteria are met. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 17.161; Simington v. West, 11 Vet. App. 41, 44. Accordingly, the Board finds that the Veteran should be afforded a VA opinion in order to determine nature and etiology of the Veteran’s claimed dental disability. See McClendon v. Nicholson, 20 Vet. App. 79 (2006). 2. Entitlement to service connection for a throat disability is remanded. The Veteran was provided VA examinations in March 2014. The throat examiner provided a negative rationale, finding there was no evidence of a throat condition in the service medical records. However, the Board notes the STRs show the Veteran was diagnosed with acute tonsillitis in February 1963. Accordingly, the Board finds the rationale inadequate for it ignored favorable evidence in the STRs. Therefore, an addendum opinion is necessary prior to adjudication to determine the nature and etiology of the Veteran’s throat disability. 3. Entitlement to service connection for an eye disability is remanded. The Veteran was provided VA examinations in March 2014. The examiner stated that no STRs were found in e-file. The Board notes the Veteran’s STRs are located within the Veteran’s service personnel records, and the STRs contain evidence of vision problems in September 1963. Because the examiner was unable to locate the Veteran’s STRs prior to proffering an opinion, an addendum opinion is necessary prior to adjudication to determine the nature and etiology of the Veteran’s eye disability. The matters are REMANDED for the following action: 1. Make efforts to obtain all outstanding medical records, in accordance with the duties set forth in 38 C.F.R. § 3.159(c). 2. After any additional records are associated with the claims file, the RO should arrange for a VA medical opinion. The VA examiner should identify the Veteran’s dental disabilities and should specifically indicate whether the Veteran has loss of teeth due to bone loss of the body of the maxilla or the mandible due to trauma or disease such as osteomyelitis. The examiner is asked to address the following: (a.) Identify and diagnose any dental disability during the period on appeal; (b.) If the Veteran had a pre-existing dental disability, was the disability clearly and unmistakably NOT aggravated by active duty service; and (c.) If the Veteran did not have a pre-existing dental disability, did any diagnosed dental disability at least as likely as not (a 50 percent or greater probability) have its onset during or was otherwise related to any event or injury during the Veteran’s active duty. All opinions must be supported by a detailed rationale 3. After all outstanding records have been associated with the claims file, arrange for a VA medical opinion to obtain nexus opinions as to the nature and etiology of the Veteran’s throat conditions. A full medical history should be documented in the examination report, and the examiner is reminded that the Veteran was diagnosed with acute tonsillitis in February 1963. The claims file should be made available to the examiner. The examiner is asked to address the following: (a.) Identify and diagnose any current (at any point during the appeal period) throat conditions; and (b.) For each diagnosed throat condition, provide an opinion as to whether the condition at least as likely as not (a 50 percent or greater probability) had its onset during or is otherwise related to any event or injury during the Veteran’s active duty. All opinions must be supported by a detailed rationale 4. After all outstanding records have been associated with the claims file, arrange for a VA medical opinion to obtain nexus opinions as to the nature and etiology of the Veteran’s eye conditions. A full medical history should be documented in the examination report. The claims file should be made available to the examiner. The examiner is reminded that service treatment records are included with the Veteran’s service personnel records. The examiner is asked to address the following: (a.) Identify and diagnose any current (at any point during the appeal period) eye conditions; and (b.) For each diagnosed eye condition, provide an opinion as to whether the condition at least as likely as not (a 50 percent or greater probability) had its onset during or is otherwise related to any event or injury during the Veteran’s active duty. All opinions must be supported by a detailed rationale A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. N. Quarles, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.