Citation Nr: 20032014 Decision Date: 05/06/20 Archive Date: 05/06/20 DOCKET NO. 14-31 789A DATE: May 6, 2020 ORDER Service connection for posttraumatic stress disorder (PTSD) is denied. Service connection for a right shoulder disorder is denied. Service connection for a right knee disorder is denied. Service connection for sleep apnea is denied. Service connection for a headache disorder, including presumptively as a qualifying chronic disability to include undiagnosed illness and medically unexplained chronic multi-symptom illness, is denied. Service connection for a skin disorder, including presumptively as a qualifying chronic disability to include undiagnosed illness and medically unexplained chronic multi-symptom illness, is denied. FINDINGS OF FACT 1. The Veteran does not currently have PTSD or a right shoulder disability. 2. The Veteran is currently diagnosed with obstructive sleep apnea and has a current right knee disability, which has been diagnosed as a tear, chondromalacia, and synovitis. 3. No right knee or respiratory injury or disease or sleep apnea symptoms were manifested during service. 4. A right knee disorder and sleep apnea are not causally or etiologically related to service. 5. The Veteran did not have an injury, disease, or event involving a headache disorder, to include headache symptoms, during service. 6. The currently diagnosed headache disorder was not incurred in service and is not etiologically related to service. 7. The currently diagnosed posttraumatic headaches are related to a post-service craniotomy. 8. The Veteran does not have, nor has he had at any time proximate to or during the course of this appeal, a skin disability. 9. The claimed skin disorder did not manifest by objective manifestations of a skin disorder, and did not manifest compensable skin symptoms. CONCLUSIONS OF LAW 1. The criteria for service connection for PTSD have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.125. 2. The criteria for service connection for a right shoulder have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 3. The criteria for service connection for a right knee disorder have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 4. The criteria for service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 5. The criteria for service connection for a headache disorder, including as due to a qualifying chronic disability, have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1117, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.317, 3.326. 6. The criteria for service connection for a skin disorder, including as due to a qualifying chronic disability, have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1117, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.317, 3.326. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from January 1994 to January 2001. In December 2017, the Veteran testified at a Board videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In May 2018 the Board remanded the issues on appeal for additional development, to include obtaining VA examinations and VA medical opinions. February 2020 VA examinations and VA medical opinions have been associated with the record; therefore, an additional remand to comply with the May 2018 remand directives is not required. Stegall v. West, 11 Vet. App. 268 (1998). 1. Service Connection for PTSD 2. Service Connection for Right Shoulder Disorder Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). 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). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. With any claim for service connection (under any theory of entitlement), it is necessary for a current disability to be present. See Brammer v. Derwinski, 3 Vet. App. 223 (1992); see also McClain v. Nicholson, 21 Vet. App. 319 (2007) (service connection may be warranted if there was a disability present at any point during the claim period, even if it is not currently present); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013) (when the record contains a recent diagnosis of disability immediately prior to a veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency). The Veteran contends generally that he has PTSD, and that it is related to service. In a November 2011 statement, the Veteran wrote that, while aboard the USS Shasta in 1994 while stationed in Yemen, he was afraid that a bomb would hit the base or a ship. The Veteran also wrote that, while aboard the USS Gladiator from 1997 to 1999, he witnessed an oil tanker hit by a “suicide boat,” which killed “a large majority of the crew.” During April 2012 VA treatment, the Veteran reported that during active combat he shot and killed a 10-year-old. At the outset, in May 2014 and April 2014, VA issued formal findings on the lack of information required to verify the claimed in-service stressors. The DD Form 214 also does not indicate combat service. Having reviewed all the evidence of record, lay and medical, the Board finds that the Veteran does not have a current diagnosis of PTSD. The February 2020 VA examiner specifically opined that the Veteran did not have PTSD. Rather, the February 2020 VA examiner diagnosed major depressive disorder for which service connection was subsequently granted. As such, the evidence shows that the psychiatric symptoms experienced by the Veteran are symptoms of the already service-connected major depressive disorder, for which the Veteran is already compensated. See 38 C.F.R. § 4.14 (prohibiting rating the same disability under different diagnoses); Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits compensating a veteran twice for the same symptoms or functional impairment). As to the claimed right shoulder disorder, upon review of all of the evidence of record, lay and medical, the Board finds that the weight of the evidence shows no current right shoulder disability. Review of the other evidence of record, including the VA treatment records, does not convey that the Veteran is currently diagnosed with any right shoulder disorder or show a functionally impairing right shoulder disability. The September 2012 VA examiner opined that the Veteran did not have a current right shoulder disorder. The September 2012 VA examiner indicated that a right shoulder examination revealed a normal right shoulder with full range of shoulder motion without pain or discomfort. At a September 2012 VA examination, the Veteran reported that he did not remember claiming service connection for a right shoulder disorder, and that the right shoulder did not hurt and was not problematic. Accordingly, the weight of the evidence is against finding that the Veteran is currently diagnosed with PTSD or a right shoulder disability; therefore, the appeals for service connection for these issues must be denied. 3. Service Connection for Right Knee Disorder 4. Service Connection for Sleep Apnea The Veteran has advanced that a right knee disorder is due to an in-service fall, and that the currently diagnosed obstructive sleep apnea had its onset during service. A September 2012 VA examination report reflects right knee chondromalacia, synovitis, and a right knee tear. Various VA treatment records reflect currently diagnosed obstructive sleep apnea. After review of all the lay and medical evidence of record, the Board finds that the weight of the evidence is against finding a right knee or respiratory injury or disease during service. The service treatment records appear complete, contain no complaints, symptoms, diagnosis, or treatment related to the right knee or sleep apnea. As the service treatment records are complete and show complaints and treatment for other disorders, to include a laceration on the left hand, rib pain, a reaction to tomatoes, stomach pains, and passing out, the Veteran similarly would have reported or complained of right knee and sleep apnea symptoms, had such occurred during service. There is no indication from the service treatment records that the Veteran ever sought treatment for any right knee or respiratory injury or reported any history of such injuries during service. Right knee chondromalacia, synovitis, a right knee tear, and sleep apnea are conditions that would have ordinarily been recorded during service during the normal course of treatment or examination for almost any disorder; therefore, the complete service treatment records, which were generated contemporaneous to service, are likely to accurately reflect the Veteran’s physical condition, so are of significant probative value. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). Regarding the theory of direct service connection, the Board finds that the weight of the evidence shows that a current right knee disorder and sleep apnea are not related to service because the weight of the evidence demonstrates no in-service injury or disease or even event to which the disorder could be related. As analyzed above, the weight of the evidence shows no right knee or respiratory symptoms during service, and that the Veteran did not otherwise sustain a right knee or respiratory injury during service. The August 2012 VA examiner opined that the right knee disorder was unrelated to service. The August 2012 VA examiner reasoned that the service treatment records did not reflect treatment for right knee symptoms during service and that the Veteran was first diagnosed with a right knee disorder in 2012, approximately 11-years after separation from service. For these reasons, the Board finds that the preponderance of the lay and medical evidence that is of record weighs against service connection for a right knee disorder and sleep apnea; consequently, the claims must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. Service Connection for Headache Disorder The Veteran contends that he has headaches and an intermittent skin disorder, and that these are related to Gulf War service. The Veteran has not contended that headaches or a skin disorder was caused by an injury in service, but instead seeks presumptive service connection based on service during the Gulf War. See April 2013 claim; see also December 2017 Board hearing transcript. Initially, the Board finds that the Veteran is currently diagnosed with posttraumatic headaches. Specifically, the report from the February 2020 VA examination reflects posttraumatic headaches, which the February 2020 VA examiner specifically attributed to a post-service 2017 craniotomy due to a brain hemorrhage. At the outset, the Board has considered whether service connection is warranted for posttraumatic headaches under the Persian Gulf War presumptions. See 38 U.S.C. § 1117 and 38 C.F.R. § 3.317. The headache disorder is not an undiagnosed illness, but is diagnosed. For the headache disorder to be due to an undiagnosed illness, the symptoms would have to be not attributable to another, specific cause. Only if such symptoms are not related to a diagnosed disability, i.e., headache pain not due to posttraumatic headcases, may they be found to be a qualifying chronic disability, including as due to an undiagnosed illness. The headache disorder is not an undiagnosed illness or medically unexplained chronic multi symptom illnesses. As the disability has been diagnosed, the provisions pertaining to undiagnosed illnesses are not applicable. See U.S.C. § 1117; 38 C.F.R. § 3.317. After review of all the lay and medical evidence of record, the Board finds that the weight of the evidence is against finding a headache injury or disease during service, and the Veteran has not alleged otherwise. The service treatment records appear complete, and contain no complaints, symptoms, diagnosis, or treatment related to a headache disorder. As discussed above, the service treatment records reflect that the Veteran sought treatment for various conditions, including a laceration on the left hand, rib pain, a reaction to tomatoes, stomach pains, and passing out. There is no indication from the service treatment records that the Veteran ever sought treatment for any headache injury, or reported any history of such injuries during service. A headache disorder is a condition that would have ordinarily been recorded during service during the normal course of treatment or examination for almost any disorder; therefore, the complete service treatment records, which were generated contemporaneous to service, are likely to accurately reflect the Veteran’s physical condition, so are of significant probative value. Regarding the theory of direct service connection, the Board finds that the weight of the evidence shows no in-service injury or disease or even event to which a current disability could be related. As analyzed above, the weight of the evidence shows no headache disorder symptoms during service. In addition, the February 2020 VA examiner opined that the diagnosed headache disorder was unrelated to service. The February 2020 VA examiner specifically attributed the posttraumatic headaches to the 2017 craniotomy, which was caused by a post-service brain hemorrhage. See February 2020 VA examination report. The Board finds that the February 2020 VA examiner’s opinion is highly probative as it is based on a review of the record and is supported by adequate rationale. For these reasons, the Board finds that the preponderance of the lay and medical evidence that is of record weighs against service connection for a headache disorder, including presumptively as a qualifying chronic disability to include undiagnosed illness and medically unexplained chronic multi-symptom illness; consequently, the claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 6. Service Connection for Skin Disorder After a review of the evidence, both lay and medical, the Board finds that the Veteran does not have, nor has he had at any time proximate to or during the course of this appeal, a skin disability, including objective indications of a skin disorder to a 10 percent degree. The February 2020 VA examination report reflects that the VA examiner noted the Veteran’s contentions and opined that a diagnosis for a skin disorder could not be established, to include no objective findings of a skin disability. The Board finds the February 2020 VA medical opinion to be highly probative with respect to the service connection issue, as it is based on objective findings as shown by the record and a thorough review of the evidence of record, both lay and medical. The lay statements in this case, under specific facts of this case that include no in-service injury or diagnosis or other findings of a skin disorder, to the extent they assert the etiology of claimed disorder, are not competent to establish current diagnosis and the nexus required for service connection. Although the Veteran is competent to report subjective symptoms such as skin sensitivity, the other competent evidence outweighs the Veteran’s statements as to whether a disability exists. The February 2020 VA examiner, who has medical expertise and training, specifically considered the service treatment records, the VA treatment records, and lay statements, and opined that the Veteran did not have a skin disorder; therefore, the February 2020 VA medical opinion is of significant probative value. In the absence of a current disability, including for Persian Gulf War presumptive purposes of objective manifestations to a degree of 10 percent by analogy, service connection is not warranted. The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F. 3d 1328 (1997). With any claim for service connection (under any theory of entitlement), it is necessary for a current disability to be present. See Brammer, 3 Vet. App. at 225; see also McClain, 21 Vet. App. 319. The Board also finds that service connection is not warranted under the Persian Gulf War presumption. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. The evidence shows that a qualifying chronic disability manifested by skin problems did not manifest during service in Southwest Asia, including no objective manifestations, or to a compensable degree for any six-month period since service. The weight of the evidence, including VA treatment records and the February 2020 VA examination report, do not reflect objective indications of a chronic disability, including an undiagnosed illness. 38 C.F.R. § 3.317(a)(1). As such, on the question of whether the claimed skin disorder manifested to a compensable degree, a skin disorder appears among the rating criteria under Diagnostic Code 7806, Dermatitis or Eczema. 38 C.F.R. § 4.71a. A 10 percent rating is warranted where there is involvement of at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period. Based on these rating criteria, as the evidence shows no objective findings, including rating objective criteria for the 38 C.F.R. § 3.317 presumption, including to 10 percent, are not met. “Objective findings” are necessary to the assignment of a compensable (10 percent) rating by analogy to Diagnostic Code 7806. For these reasons, the Board finds that the Veteran does not have a compensable qualifying chronic disability resulting in skin problems. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. For these reasons, the Board finds that the preponderance of the lay and medical evidence that is of record weighs against the claim for service connection for a skin disorder, including presumptively as a qualifying chronic disability to include undiagnosed illness and medically unexplained chronic multi-symptom illness, and the claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. J. PARKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Tenney, 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.