Citation Nr: 21001343 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 16-04 105 DATE: January 7, 2021 ORDER Entitlement to service connection for a back disability is denied. Entitlement to service connection for a nerve condition, bilateral lower extremities, is denied. Entitlement to service connection for a bilateral knee disability is denied. Entitlement to service connection for gouty arthritis is denied. Entitlement to service connection for diabetes mellitus type II (DM) is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for sickle cell trait is denied. FINDINGS OF FACT 1. A back disability and nerve condition of the bilateral lower extremities are not etiologically related to the Veteran’s active service and were not present to a compensable degree within one year of separation from his service. 2. A bilateral knee disability and gouty arthritis are not etiologically related to the Veteran’s active service, were not present to a compensable degree within one year of separation from his service, and are not proximately due to or aggravated by a service-connected disability. 3. DM and hypertension are not etiologically related to the Veteran’s active service, and were not present to a compensable degree within one year of separation from his service. 4. Sickle cell trait is a congenital defect; the defect was not subject to a superimposed disease or injury during active service. CONCLUSIONS OF LAW 1. The criteria for service connection for a back disability have not been met. 38 U.S.C. § 1131 (2018); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 2. The criteria for service connection for a nerve condition, bilateral lower extremities, have not been met. 38 U.S.C. § 1131 (2018); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2019). 3. The criteria for service connection for a bilateral knee disability have not been met. 38 U.S.C. § 1131 (2018); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2019). 4. The criteria for service connection for gouty arthritis have not been met. 38 U.S.C. § 1131 (2018); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2019). 5. The criteria for service connection for DM have not been met. 38 U.S.C. § 1131 (2018); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 6. The criteria for service connection for hypertension have not been met. 38 U.S.C. § 1131 (2018); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 7. The criteria for service connection for sickle cell trait have not been met. 38 U.S.C. § 1131 (2018); 38 C.F.R. §§ 3.303, 4.9 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from June 1972 to June 1974. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a May 2012 rating decision issued by the VA Regional Office (RO). This case was previously before the Board in October 2018, at which time the issues currently on appeal were remanded for additional development. The case has now been returned to the Board for further appellate action. Service Connection 1. Back Disability, Bilateral Lower Extremity Nerve Condition, Bilateral Knee Disability, and Gouty Arthritis The Veteran has contended that his back disability is related to his active service. Specifically, he reported that he was thrown and injured his back after his service vehicle collided with a five-ton truck. He maintains that his nerve condition of the bilateral lower extremities, bilateral knee disability, and gouty arthritis were secondary to his back disability, or alternatively, due to his exposure to contaminated water while stationed at Camp Lejeune. Service treatment records (STRs) documented that the Veteran complained of a low back injury and pain following a motor vehicle accident (MVA) in June 1973; however, his June 1974 separation examination showed a normal spine. There were no in-service complaints, treatment, or diagnosis of a nerve condition, bilateral knee disability, or gout. Furthermore, service records confirmed the Veteran’s service at Camp Lejeune during the relevant period; thus, exposure to contaminated water then is presumed. See 38 C.F.R. § 3.307(a)(7)(i). A review of post-service medical records revealed that the Veteran complained of back pain as early as August 2001. An August 2003 private progress note shows a complaint of right knee pain, and December 2004 private X-ray findings showed degenerative changes/arthritis of the back and left and right knees. In May 2008, the Veteran was diagnosed with radiculopathy and peripheral polyneuropathy of the bilateral lower extremities. Gout was noted in 2011. In August 2005, the Veteran was afforded a VA spine examination. The examiner noted that after service, he reportedly began to experience post-service low back pain in 2001, with the pain worsening in 2004. The examiner opined that the Veteran’s in-service back injury was less likely as not the cause of his currently present back disability. The examiner observed that the Veteran was provided whirlpool treatment for low back strain in June 1973. He stated that the Veteran was apparently “doing fairly well” at that time. Additionally, the Veteran’s back injury did not require any follow-up treatment and there was no indication that the Veteran had a back condition upon separation. The examiner stated that the Veteran had no history of overuse. He explained that aging was one contributing risk factor for the back disability given that the Veteran was 50 years old when he was first diagnosed in 2004. Further, the examiner commented that the Veteran likely had a mild case of low back strain during service and then did not require medical attention until 2001. The Veteran was provided additional VA examinations for his back, nerve condition, and gouty arthritis in April 2012. The examiner opined that it was less likely as not that the Veteran’s back disability was related to the June 1973 MVA given that he only underwent treatment once for low back pain. Regarding the Veteran’s gouty arthritis, the examiner stated that degenerative disc disease (DDD) did not cause gout. Instead, gout was secondary to hyperuricemia which could occur for numerous reasons; however, none were due to DDD. The examiner also diagnosed diabetic peripheral neuropathy and lumbar radiculopathy, and opined that part of the patient’s symptomatology is most likely caused by the lumbar DDD. A December 2019 VA examiner opined that it was less likely than not that the Veteran’s back disability, bilateral knee disability, and gouty arthritis were incurred in or caused by his active service. In support of this opinion, the examiner stated that the Veteran’s STRs and post-service records were silent for chronic pathology of the back, bilateral knee, and gout during or proximate to his active service. Furthermore, the examiner found no evidence or study relating contaminated water at Camp Lejeune to his claimed disabilities. The examiner commented that the Veteran had generalized arthritic disease involving his neck, back, knees, and feet. Additionally, he noted that the Veteran had chronic podalgia secondary degenerative disease as well as onychomycosis and mild wholly sensory peripheral neuropathy related to his DM. In June 2020, a VA examiner opined that the Veteran’s back disability, bilateral knee disability, and gouty arthritis were less likely as not caused by or a result of his exposure to contaminated water given the following risk factors: advanced age, morbid obesity, hypertension, DM, chronic kidney disease, male gender, family history, known etiology and pathology of osteoarthritis and gouty arthritis, short exposure period (627 days), latency to diagnosis (greater than 30 years), and limited supporting scientific evidence. Furthermore, studies evaluating solvent exposure and the development of arthritis were not well supported. The Agency for Toxic Substances and Disease Registry (ATSDR) assessment on the drinking water contaminants at Camp Lejeune did not list arthritis as a health effect. Regarding the Veteran’s nerve condition, the June 2020 examiner opined that it was less likely as not caused by or a result of his exposure to contaminated water given the following risk factors: DM, vitamin B12 deficiency, chronic kidney disease, movement associated with chronic back pain, short exposure period (627 days), latency to diagnosis (greater than 37 years), and limited supporting scientific evidence. Although there was consensus that neurotoxic effects could occur with exposure to solvents, studies showed that the effects usually occurred with current exposure, were associated with high levels over a long period of time (greater than nine years), and were reversible. The neurobehavioral studies did not link contaminated water exposure to peripheral neuropathy. The Board finds the VA medical opinions highly probative and weigh against the claims. In this regard, the examiners’ rationales are based on a review of pertinent service- and post-service medical records and scientific research, and the examiners relied on their own training, knowledge, and expertise in rendering his opinion. There are no competent medical opinions of record to the contrary. Regarding the low back claim, the Veteran received treatment for a back injury during service. However, the VA examiners competently and persuasively opined that this disability is not related to active service, including the documented in-service spine injury and conceded exposure to contaminated water at Camp Lejeune. Thus, service connection is unwarranted for the low back disability on a direct basis. Furthermore, there is no evidence that chronic low back arthritis manifested during service or within one year of separation from service. The Board recognizes the Veteran’s assertions of continuity of low back symptomatology since service, namely the documented, 1973 in-service back injury. See, e.g., December 2019 VA spine examination (noting Veteran reported chronic low back pain, with post-discharge back pain recurring and persisting over the years); July 2010 and April 2012 VA primary care notes (noting Veteran reported low back pain since service). He is competent to report the duration, course, and onset of observable symptoms such as low back pain; however, his reports of continuity of low back symptoms since the in-service back injury are not credible because they are inconsistent with his affirmative, contrary statement. Specifically, the 2005 VA spine examination notes the Veteran reported that after service, he began to experience low back pain in 2001. See Caluza v. Brown, 7 Vet. App. 498, 510-11 (1995) (noting that credibility can be generally evaluated by a showing of interest, bias, or inconsistent statements). In summary, presumptive service connection is unwarranted under the chronic disease provisions for the low back disability. 38 C.F.R. §§ 3.303(b), 3.307(a)(3), 3.309(a). Regarding the bilateral knee, gouty arthritis, and bilateral lower extremity nerve claims, the Veteran did not complain of, receive treatment for, or have a diagnosis of these conditions during active service. Moreover, the VA examiners competently and persuasively opined that these disabilities were not related to active service, including exposure to contaminated water at Camp Lejeune. Thus, service connection is unwarranted for these conditions on a direct basis. Furthermore, there is no indication from the record that any of these chronic conditions manifested during service, or to a compensable degree within a year of service. The Veteran does not appear to contend that he has had continuity of symptomatology of these chronic conditions since service. Thus, presumptive service connection is unwarranted under the chronic disease provision for these conditions. 38 C.F.R. §§ 3.303(b), 3.307(a)(3), 3.309(a). Although the Veteran’s bilateral lower extremity nerve condition was competently deemed secondary to his back disability and DM, neither has been service-connected herein. Thus, these secondary service connection theories for the bilateral lower extremity nerve condition claim fails as a matter of law. The Board recognizes the Veteran’s contentions that his current low back condition, nerve condition of the bilateral lower extremities, bilateral knee disabilities, and gouty arthritis are related to active service, or alternatively, secondary to a condition should be service-connected. However, as a lay person, he is not competent to opine on the etiology of these conditions because such complex issues require specialized medical and scientific expertise, training, and experience. Accordingly, the preponderance of the evidence is against the claims of entitlement to service connection for a low back disability, nerve condition of the bilateral lower extremities, bilateral knee disability, and gouty arthritis. The claims are therefore denied. 38 U.S.C. § 5107(b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. DM and Hypertension The Veteran has contended that his hypertension and DM are related to his active service. Specifically, he attributes these conditions to his conceded exposure to contaminated water while stationed at Camp Lejeune. STRs are silent for any complaints, treatment, or diagnosis of hypertension and DM. A review of post-service medical records confirmed diagnoses for hypertension and DM in 2000; the March 2000 progress note suggests that the Veteran had had DM for “4 years.” As noted above, service records confirmed the Veteran’s service at Camp Lejeune during the relevant period; thus, exposure to contaminated water then is presumed. See 38 C.F.R. § 3.307(a)(7)(i). In December 2019, the Veteran was afforded VA examinations for hypertension and DM. The examiner opined that the Veteran’s hypertension and DM were less likely than not incurred in or caused by his service. The examiner stated that the Veteran’s STRs and post-service records were silent for hypertension and DM during or proximate to his active service. He noted that the Veteran started hypertensive and hypoglycemic medication approximately 20 years post-service. Furthermore, the examiner found no evidence or study relating contaminated water at Camp Lejeune to his claimed disabilities. The Veteran was provided additional VA examinations in June 2020. The examiner opined that the Veteran’s hypertension and DM were less likely than not caused by or a result of his exposure to contaminated water at Camp Lejeune. In this regard, the examiner cited the following risk factors: association between DM and hypertension, morbid obesity, race (African American), age, family history, elevated cholesterol and triglycerides, post-service occupation at a chemical company, short exposure period (627 days), latency to diagnosis (28 years), and limited supporting scientific evidence. Furthermore, studies evaluating solvent exposure and the development of hypertension and DM were not well supported. The ATSDR assessment on the drinking water contaminants at Camp Lejeune did not list hypertension or DM as health effects. The Board finds that the VA medical opinions are highly probative and weigh against the Veteran’s claims. In this regard, the examiners’ opinions are based on a review of the Veteran’s pertinent service and post-service medical records and science-based research, and the examiners relied on their own training, knowledge, and expertise in rendering their opinions. Moreover, the Board finds that there are no competent medical opinions of record to the contrary. In sum, the Veteran did not complain of, receive treatment for, or have a diagnosis of hypertension or DM while in active service. There is no competent evidence of record indicating that the Veteran’s currently present hypertension and DM were otherwise related to his service, including exposure to contaminated water at Camp Lejeune. Therefore, service connection for these conditions on a direct basis is unwarranted. Furthermore, there is no indication from the record that DM and hypertension, chronic diseases listed under 38 C.F.R. § 3.309(a), manifested during active service, or manifested to compensable degree within a year of separation from active service. The Veteran does not appear to appear contend and the evidence of record does not show continuity of DM or hypertension symptomatology since service. Therefore, presumptive service connection for these conditions is unwarranted under the chronic disease provisions. 38 C.F.R. §§ 3.303(b), 3.307(a)(3), 3.309(a). The Board recognizes the Veteran’s contentions that his current hypertension and DM are related to active service, namely his conceded exposure to contaminated water at Camp Lejeune. However, as a lay person, he is not competent to opine on the etiology of these conditions because such complex issues require specialized medical and scientific expertise, training, and experience. Accordingly, that the preponderance of the evidence is against the claims of entitlement to service connection for hypertension and DM. The claims are therefore denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. 49. 3. Sickle Cell Trait The Veteran has contended that his sickle cell trait is related to his active service, to include exposure to contaminated water at Camp Lejeune. Service records revealed that the Veteran had the sickle cell trait after he was screened in July 1972. However, STRs were silent for any complaints or treatment of any hematologic condition. As noted above, service records confirmed the Veteran’s service at Camp Lejeune during the relevant period; thus, exposure to contaminated water then is presumed. See 38 C.F.R. § 3.307(a)(7)(i). In December 2019, the Veteran was afforded a VA examination. The examiner opined that the Veteran’s sickle cell trait was less likely than not incurred in or caused by his active service. He explained that the sickle cell trait was a benign, asymptomatic carrier condition, usually with none of the sickle cell anemia or other sickle cell diseases. Furthermore, STRs and post-service records were silent for any hematological or sickle cell related disease, pathology, or treatment. He found no evidence or study to relating the contaminated water at Camp Lejeune to the Veteran’s current sickle cell trait. The Veteran was provided additional VA examinations in June 2020. The examiner opined that the Veteran’s sickle cell trait was less likely than not caused by or a result of his exposure to contaminated water at Camp Lejeune. The examiner determined that the Veteran’s sickle cell trait was a congenital defect. He explained that people with sickle cell trait did not have any symptoms of sickle cell disease except in rare cases in which they are exposed to low oxygen levels in the air, dehydration, or high altitudes. However, there was no evidence that the Veteran had any sickle cell crises. Furthermore, the examiner found no evidence that the Veteran’s sickle cell trait was subject to a superimposed disease or injury during service. The ATSDR assessment on the drinking water contaminants at Camp Lejeune did not list sickle cell trait as a health effect. The Veteran had been stationed at Camp Lejeune for 627 days and the levels of solvents were well below those identified in studies. The Board finds that the VA medical opinions are highly probative and weigh against the Veteran’s claim. In this regard, the examiners’ opinions are based on a review of the Veteran’s pertinent service and post-service medical records and science-based research, and the examiners relied on their own training, knowledge, and expertise in rendering their opinions. Moreover, the Board finds that there is no competent medical opinion of record to the contrary. In sum, the Veteran did not complain of, receive treatment for, or have a diagnosis of sickle cell disease while in active service. There is no competent evidence of record indicating that the Veteran’s currently present sickle cell trait, a congenital defect, was subject to a superimposed disease or injury or otherwise related to his service, including exposure to contaminated water at Camp Lejeune. The Board recognizes the Veteran’s contention that his sickle cell trait is related to active service, namely his conceded exposure to contaminated water at Camp Lejeune. However, as a lay person, he is not competent to opine on the etiology of this condition because such complex issues require specialized medical and scientific expertise, training, and experience. (Continued on the next page)   Accordingly, the preponderance of the evidence is against the claim of entitlement to service connection for sickle cell trait. The claim is therefore denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. 49. R. JANOFSKY Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Ware, 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.