Citation Nr: 20052967 Decision Date: 08/10/20 Archive Date: 08/10/20 DOCKET NO. 19-20 456 DATE: August 10, 2020 ORDER Service connection for bilateral hearing loss is denied. Service connection for tinnitus is denied. Service connection for lymphangiosarcoma is denied. REMANDED Entitlement to service connection for heart disease, to include atrial fibrillation, is remanded. Entitlement to service connection for hypertension is remanded. FINDINGS OF FACT 1. The Veteran’s bilateral hearing loss neither had its onset in nor is it otherwise related to his active duty service. See April 2016 VA Examination. 2. The Veteran’s tinnitus neither had its onset in nor is it otherwise related to his active duty service. See April 2016 VA Examination. 3. The evidence does not reflect any diagnosis of lymphangiosarcoma or any other sarcoma or cancer throughout the claim period. See October 2015 VA Treatment Record (VATR) (noting angiolymphoid hyperplasia with eosinophila); June 2019 VATR (noting history of benign tumors, excised from right cheek and temporal area). CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for tinnitus are not met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for lymphangiosarcoma are not met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from September 1964 to September 1968. This case is before the Board of Veterans’ Appeals (Board) on appeal from a May 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). 1. Bilateral Hearing Loss and Tinnitus Generally, in order to prove service connection, there must be competent, credible evidence of 1) a current disability, 2) in-service incurrence or aggravation of an injury or disease, and 3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). The evidence reflects that the Veteran currently experiences tinnitus and hearing loss constituting a disability for VA purposes. See April 2016 VA Examination; 38 C.F.R. § 3.385 (“[I]mpaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent.”). The Veteran contends that his hearing loss and tinnitus were caused by noise exposure in service during his work as a military police officer and helicopter gunner. See, e.g., June 2016 Notice of Disagreement. The Veteran has not reported that either his hearing loss or his tinnitus had their onset in service. However, the evidence indicates that the Veteran’s hearing loss and tinnitus is not related to his active duty service. The Veteran was afforded one VA examination and nexus opinion during the claim period, in April 2016. The examiner opined that neither the Veteran’s hearing loss nor his tinnitus was related to his active duty service. In reaching this determination, she emphasized that the Veteran’s in-service audiograms revealed no auditory threshold shift during service nor other evidence of acoustic trauma, and cited a report by the Institute of Medicine concluding that “there [is] no scientific basis to conclude that permanent hearing loss directly attributable to noise exposure will develop long after such noise exposure.” The examiner further stated that while hearing loss is the most common cause of tinnitus, the Veteran’s tinnitus was not related to his active duty service because there was no evidence that his hearing loss itself was related to his active duty service. The opinions of the April 2016 VA examiner are competent, credible, and entitled to significant weight. Moreover, there is no competent evidence to the contrary. (Although the Veteran is competent to report his own symptoms, as a lay person he is not competent to opine as to the etiology of his own disabilities. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (lay testimony is competent as to features or symptoms, but not etiology, of an injury or illness).) Therefore, the Board finds that the Veteran’s bilateral hearing loss and tinnitus neither had their onset in nor are they otherwise related to his active duty service. Accordingly, service connection for bilateral hearing loss and tinnitus is not warranted. Lymphangiosarcoma The Veteran is seeking service connection for lymphangiosarcoma, a cancer involving upper or lower lymphedematous extremities. However, there is no evidence of a diagnosis of lymphangiosarcoma at any point throughout the claim period, nor of any other sarcoma or cancer. See, e.g., October 2015 VATR (noting angiolymphoid hyperplasia with eosinophila, but no sarcoma). Although the Veteran’s July 2019 VA Form 9, Appeal to the Board, references the excision of tumors from his face, the medical record indicates that these tumors were not cancerous. See June 2019 VATR (noting history of benign tumors, excised from right cheek and temporal area). The Veteran has not provided any other evidence of a diagnosis of lymphangiosarcoma or any other sarcoma or cancer. Therefore, the Board finds that the preponderance of the evidence indicates that the Veteran has not had a diagnosis of lymphangiosarcoma or any sarcoma or cancer throughout the claim period. Accordingly, service connection for lymphangiosarcoma is not warranted. REASONS FOR REMAND 1. Heart Disease, to Include Atrial Fibrillation, and Hypertension Because lay claimants may not be competent to diagnose their particular conditions, their claims should be considered claims for any diagnoses reasonably encompassed by their descriptions and submissions, as well as information gathered by VA in support of the claims. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Veteran originally filed a claim for service connection for ischemic heart disease (IHD). See February 2016 Claim for Disability Compensation. However, an April 2016 VA examination instead yielded diagnoses of atrial fibrillation and hypertension. Therefore, the Board finds that the Veteran’s claim for service connection for IHD properly includes claims for service connection for atrial fibrillation and hypertension. VA must provide a VA medical examination when there is evidence of a disability that may be associated with an in-service event, injury, or disease, but the competent medical evidence of record is insufficient to adjudicate the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Veteran has been afforded one VA examination in support of his claim for service connection for a heart condition, in April 2016. The Veteran initially contended that his claimed IHD was caused by in-service exposure to herbicide agents. See June 2016 Notice of Disagreement. Service connection may be established presumptively for diseases, including IHD, listed in 38 C.F.R. § 3.309(e) for any Veteran who was exposed to an herbicide agent as defined in 38 C.F.R. § 3.307(a)(6) during active duty service. However, the April 2016 VA examination yielded no diagnosis of IHD. Subsequently, in a May 2020 brief, the Veteran’s representative contended that his heart condition was aggravated by his service-connected posttraumatic stress disorder (PTSD). There is currently no competent medical evidence of record as to whether the Veteran’s heart disease, to include atrial fibrillation, or hypertension may be aggravated by his service-connected PTSD. Therefore, a remand is necessary to provide the Veteran a new VA examination and opinions in support of these claims. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records and associate them with the claims file. 2. After completing the development outlined in Item 1., schedule the Veteran for a VA examination and nexus opinions in support of his claims for service connection for heart disease, to include atrial fibrillation, and hypertension. Upon thorough review of the claims file and physical examination of the Veteran, the examiner should respond to the following: (a.) Is it at least as likely as not (50 percent probability or more) that the Veteran’s heart disease, to include atrial fibrillation, was either 1) caused or 2) aggravated by his service-connected posttraumatic stress disorder (PTSD)? Aggravation here means worsening beyond the ordinary progression of the Veteran’s heart disease. If you determine that the Veteran’s heart disease was aggravated by his service-connected PTSD, please estimate the degree of aggravation beyond the baseline level of the heart disease that is caused by his PTSD. (b.) Is it at least as likely as not that the Veteran’s hypertension was either 1) cause or 2) aggravated by his service-connected PTSD? Aggravation here means worsening beyond the ordinary progression of the Veteran’s hypertension. If you determine that the Veteran’s hypertension was aggravated by his service-connected PTSD, please estimate the degree of aggravation beyond the baseline level of the hypertension that is caused by his PTSD. The examiner must provide a fully articulated medical rational for each opinion, citing to peer-reviewed medical literature referenced in formulating it, if any. If the examiner finds that an opinion cannot be provided, this conclusion should also be clearly explained (e.g. lack of sufficient information/evidence in this case, or a lack of knowledge among the medical community at large, and not the insufficient knowledge of the individual examiner). S.C. KREMBS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. Timmerman 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.