Citation Nr: 20042671 Decision Date: 06/24/20 Archive Date: 06/24/20 DOCKET NO. 16-54 160 DATE: June 24, 2020 ORDER Service connection for hypertension is denied. Service connection for a skin disorder is denied. Service connection for a cranial meningioma is denied. FINDINGS OF FACT 1. The Veteran had active service from February 1965 to February 1967, including service in the Republic of Vietnam. 2. Hypertension did not have onset during service or within one year of service discharge and is not otherwise etiologically related to active service, to include as due to herbicide agent exposure. 3. A skin disorder, diagnosed as lichen planus, did not have onset during service and is not otherwise etiologically related to active service, to include as due to herbicide agent exposure. 4. A cranial meningioma, did not have onset during active service or within one year of service discharge and is not otherwise etiologically related to service, to include as due to herbicide agent exposure. CONCLUSIONS OF LAW 1. Hypertension was not incurred in or aggravated by service, nor is it due to herbicide exposure. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 2. A skin disorder was not incurred in or aggravated by service, nor is it due to herbicide exposure. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 3. A cranial tumor meningioma was not incurred in or aggravated by service, nor is it due to herbicide exposure. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In August 2019, the Veteran testified at a video hearing held before the undersigned Veterans Law Judge. A transcript of the hearing is of record. Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Service connection may be granted on a presumptive basis for certain diseases resulting from exposure to an herbicide agent (including Agent Orange) for veterans who, during active military, naval, or air service, served in the Republic of Vietnam between January 1962 and May 1975, so long as the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § 3.307(a)(6)(iii) are met, and the rebuttable presumption provisions of 38 U.S.C. § 1113 and 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). The Veteran’s service records confirm that he served in the Republic of Vietnam; thus, he is presumed to have been exposed to herbicides. However, none of the diagnosed disabilities in this case are presumed to be related to herbicide exposure. Therefore, only direct service connection will be considered. The availability of presumptive service connection for a disability based on exposure to herbicides does not preclude a veteran from establishing service connection with proof of direct causation, or on any other recognized basis. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Hypertension Turning to the evidence, the first element of service connection – a current diagnosis – is met. VA and private treatment records document a diagnosis of hypertension. Therefore, he has a current disability associated with the claim. As to an in-service incurrence, service treatment records (STRs) show that in August 1966, the Veteran was evaluated for hypertension after experiencing dizziness. Upon observation, it was determined that there was no evidence of hypertension. In the January 1967 clinical examination for separation, the blood pressure reading was normal and there was no diagnosis of hypertension noted. Rather, the event was found to probably be just a “hyper-reactive vasomotor tone.” Therefore, the second element of direct service connection has not been met. To the extent that the Veteran asserts a medical nexus between service and hypertension, an April 2015 private treatment record stated that the Veteran had had hypertension since the incident of unexplained hypertension in service in 1966; however, this statement was reflective only of the Veteran’s subjective report of his medical history without review of the STRs or other post-service treatment notes. In contrast, a November 2015 VA examiner found that it was less likely than not the Veteran’s current benign essential hypertension was caused by, aggravated by, secondary to, or the result of the acute episode of hypertension (of unknown origin) in service, which resolved without residuals. In forming this opinion, the examiner reviewed the STRs and post-service treatment records. Further, the examiner noted that the Veteran reported he began taking medication for hypertension 20 to 25 years prior (approximately 1990). There is no other VA or private medical opinion that alleged any etiological connection between service and the Veteran’s current disability. As such, the medical evidence weighs against finding a nexus and does not support service connection on a direct basis. Hypertension is a chronic disease under 38 C.F.R. § 3.309 and presumptive service connection will be considered. However, no chronic disease or injury was shown in service. As discussed above, the Veteran’s incident of hypertension was acute, and his symptoms found to be vasomotor in nature. Therefore, the medical evidence does not support presumptive service connection on a “chronic disease or injury shown in service” basis. Next, the medical evidence does not support presumptive service connected based on continuity of symptomatology since service. Specifically, the earliest date associated with a hypertension diagnosis was the “25 years prior” documented at and in relation to the June 2015 VA examination, which would have been 1990, over two decades after service. The Veteran separated from service in February 1967. The medical evidence shows that symptoms of his current hypertension developed at least over 20 years after service. While he maintains he has had hypertension since service, this is not supported by the contemporaneous evidence. As such, the medical evidence does not support service connection on a “continuity of symptomatology” basis. Further, the disorder did not manifest itself to a degree of 10 percent or more within one year from the date of separation of service. The Veteran separated from service in 1967 but again, the earliest date of treatment for hypertension was reported to be about 1990. Moreover, a review of VA treatment notes from January 2001, related to treatment for skin lesions, do not note any present or past history of hypertension or elevated blood pressure readings. These records are particularly probative as they were given for the purpose of obtaining treatment, incentivizing accuracy. Thus, the evidence does not support presumptive service connection on a “manifested to a compensable degree within one-year from separation” basis. Therefore, presumptive service connection on any basis is not supported by the medical evidence. The Board has considered the Veteran’s lay statements that hypertension was caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Cranial Meningioma The medical evidence established that the Veteran had a tumor in October 2013, diagnosed as left petrous meningioma, and for which he underwent gamma knife surgery. While there has been no documented recurrence of the tumor, and it is unclear whether he has experienced any residuals of the tumor or its removal, the Board finds that he has a current disability with regard to the claim. As to an in-service incurrence, the STRs are silent for any complaint, treatment, or diagnosis related to symptoms or diagnosis of a tumor. Further, neither post-service treatment notes nor lay statements, including his August 2019 hearing testimony, assert that the tumor first developed in service. Rather, the Veteran has contended only that his tumor developed as a result of exposure to herbicide exposure. While soft-tissue sarcomas are generally presumed to be related to herbicide exposure, meningiomas are not among such disorders. Therefore, the Veteran’s tumor is not presumed to be related to herbicide exposure. Moreover, there is no competent medical opinion relating the disorder to herbicide exposure or otherwise to service. The Veteran stated in the VA Form 9 on this issue that his physician, Dr. RE, indicated that being exposed to herbicide agents could have caused the tumor over a period of time. However, while there is a statement from Dr. RE concerning the etiology of the Veteran’s skin disorder, no such statement or treatment note directly from Dr. RE asserting a connection between the tumor and service is of record. Moreover, the phrase “could have” relegates the statement to little more than speculation, which renders it an insufficient basis for granting service connection. No competent and probative opinion relating the Veteran’s tumor directly to service, to include herbicide exposure, is of record. Therefore, the medical evidence does not support service connection on a direct medical nexus or direct causation basis. Finally, malignant tumors are chronic diseases under 38 C.F.R. § 3.309 and presumptive service connection will be considered. However, no chronic disease or injury was shown in service. Therefore, the medical evidence does not support presumptive service connection on a “chronic disease or injury shown in service” basis. Next, the medical evidence does not support presumptive service connected based on continuity of symptomatology since service. Specifically, the earliest date associated with the tumor diagnosis was 2013, over 45 years after service. The Veteran has also not disputed that his tumor symptoms did not develop until 40 or 50 years after service. Thus, the medical evidence does not support service connection on a “continuity of symptomatology” basis. Further, this evidence establishes that the disorder did not manifest to a degree of 10 percent or more within one year from the date of separation of service in February 1967. As indicated, neither medical nor lay evidence suggests that the Veteran developed symptoms of a tumor within a year of discharge. Therefore, the evidence does not support presumptive service connection on a “manifested to a compensable degree within one-year from separation” basis. Accordingly, presumptive service connection on any basis is also not supported by the medical evidence. Skin Disorder The Veteran testified in August 2019 that he has a skin disorder, indicated to be lichen simplex at the hearing, that has been present since service. Initially, VA treatment notes reflect a history of lichen planus with the diagnosis and treatment occurring in January 2001. No residuals or recurrence of the disorder was subsequently documented. An April 2015 letter from a private dermatologist indicated that the Veteran received a diagnosis of dermal hypersensitivity reaction. Therefore, a current diagnosis has been shown. As to an in-service incurrence, STRs are silent for complaint, treatment, or diagnosis of a skin disorder. The Veteran has asserted that his skin disorder began in service, and as he is competent to report symptoms he perceives, such as lesions on his skin, the Board determines that the second element of service connection – an in-service incurrence – is also met. Nevertheless, the third element of service connection – a medical nexus – is not met. Two statements from private physicians have been received that address the etiology of the skin disorder. In April 2015, Dr. JCE stated that he could neither confirm nor deny that the Veteran’s skin disorder was caused by exposure to Agent Orange. Additionally, his primary care physician, Dr. RGE stated that the skin disorder was chronic and, by history, was contracted during service. The statement of Dr. JCE does not express either a positive or negative opinion, and therefore, carries lesser probative weight. Further, the statement of Dr. RGE reflects the Veteran’s reported medical history but did not provide an objective rationale. Rather, Dr. RGE referred any question as to the further detail regarding the skin disorder to the Veteran’s dermatologist. Accordingly, the statement of Dr. RGE also carries lesser probative weight. There is no competent and probative opinion that associates any of the Veteran’s diagnosed skin disorders with military service, either directly or as a result of herbicide exposure. As such, the medical evidence weighs against finding a nexus and does not support service connection on a direct basis. The Board has considered the Veteran’s lay statements that hypertension, meningioma, and skin disorder were caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. With regard to the Veteran’s skin disorder specifically, he asserts that he has had skin symptoms since service and his competency to describe those symptoms. Nevertheless, as discussed above, his symptoms have been assigned at least two distinct diagnoses over time. Moreover, there are significant periods during which skin concerns, even if inactive, were not clinically referenced, thereby calling into question the chronicity of any given skin disorder since service. Hence, the contention that symptoms of a current skin disorder have been present since service is not alone sufficient to establish a nexus to service for that disorder. In light of the above, the preponderance of the evidence is against the claims for service connection and there is no doubt to be otherwise resolved. As such, the appeals are denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (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). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. M. Schaefer, 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.