Citation Nr: 21002023 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 16-19 112A DATE: January 12, 2021 ORDER Service connection for hypertension, claimed as hypertensive cardiovascular disease, is denied. Service connection for erectile dysfunction is denied. Service connection for a back disability, claimed as chronic myositis para lumbar spine muscles and chronic low back pain, is denied. Service connection for a cervical spine disability, claimed as chronic myositis para cervical spine muscles and chronic cervical spine pain, is denied. Service connection for upper extremity peripheral neuropathy is denied. Service connection for lower extremity peripheral neuropathy is denied. FINDINGS OF FACT 1. The Veteran’s hypertension did not onset in service and is not causally related to his service, to include exposure to Agent Orange. 2. The Veteran’s erectile dysfunction did not onset in service and is not causally related to his service, to include exposure to Agent Orange. 3. The Veteran’s degenerative arthritis of the spine, intervertebral disc syndrome, and degenerative disc disease did not onset in service or within a year of his service separation and is not related to service, to include exposure to Agent Orange. 4. The Veteran does not have early-onset peripheral neuropathy. 5. The Veteran’s upper and lower extremity radiculopathy did not onset in service and are not related to service, to include exposure to Agent Orange. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.307, 3.309, 3.310. 2. The criteria for entitlement to service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 1131, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.307, 3.309, 3.310. 3. The criteria for entitlement to service connection for a back disability have not been met. 38 U.S.C. §§ 1110, 1131, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.307, 3.309, 3.310. 4. The criteria for entitlement to service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 1110, 1131, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.307, 3.309, 3.310. 5. The criteria for entitlement to service connection for upper extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1110, 1131, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.307, 3.309, 3.310. 6. The criteria for entitlement to service connection for lower extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1110, 1131, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from April 1969 to November 1970, including service in Vietnam. Service Connection The Veteran has contended that he has peripheral neuropathy of his upper and lower extremities, chronic low back and cervical spine pain, chronic myositis of the para lumbar and cervical spine muscles, hypertension, and erectile dysfunction related to his service, to include his exposure to Agent Orange in Vietnam. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Service connection may also be granted on a presumptive basis for certain chronic diseases, including arthritis and cardiovascular-renal disease, if shown to be manifest to a degree of 10 percent or more within one year following a veteran’s separation from active service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Diseases associated with exposure to certain herbicide agents used in support of military operations in the Republic of Vietnam (Vietnam) during the Vietnam War will be considered to have been incurred in service. 38 U.S.C. § 1116(a)(1). The presumption requires exposure to an herbicide agent and manifestation of the disease to a degree of 10 percent or more within the time period specified for each disease. 38 C.F.R. § 3.307(a)(6)(ii). The diseases presumptively associated with herbicide exposure are: AL amyloidosis, bladder cancer, chloracne or other acneform disease consistent with chloracne, type 2 diabetes, Hodgkin’s disease, hypothyroidism, ischemic heart disease, all chronic B-cell leukemias, multiple myeloma, non-Hodgkin’s lymphoma, Parkinson’s disease, parkinsonism, early-onset peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers, and soft-tissue sarcoma. 38 U.S.C. § 1116(a)(2); 38 C.F.R. § 3.309(e). The presumption may be rebutted by affirmative, though not necessarily conclusive, evidence to the contrary. 38 U.S.C. § 1113(a); 38 C.F.R. § 3.307(d). A veteran who, during active military, naval, or air service, served in the Republic of Vietnam between January 9, 1962, and May 7, 1975 shall be presumed to have been exposed during such service to an herbicide agent containing dioxin, such as Agent Orange, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a)(6)(iii); 38 U.S.C. § 1116(f). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to service connection for hypertension, claimed as hypertensive cardiovascular disease. The Veteran has claimed service connection for hypertension. The Veteran’s service treatment records do not reflect a diagnosis of or treatment for hypertension in service. His November 1970 separation examination lists a blood pressure reading of 124/78. The earliest VA treatment records associated with the Veteran’s claims file are from 1999 and indicate that the Veteran had a history of high blood pressure at that time. The Veteran was afforded a VA examination in September 2019, which indicates that the Veteran’s approximate diagnosis of hypertension was in 1998. The examiner stated that the Veteran reported his claimed symptoms began in 1976 but he was nor formally seen until 1998 per his recollection. The VA examiner opined that the Veteran’s hypertension less likely than not onset in or is causally related to his service. The Veteran has submitted a February 2015 private medical opinion that indicates that the Veteran has hypertension and that his “cardiovascular, metabolics, musculoskeletal and psychiatrics disorders” are “more probable than not secondary to his military service performance.” The Board finds that a preponderance of the evidence is against finding that the Veteran’s hypertension onset in service or within a year of his service separation. Further, hypertension is not among the conditions for which presumptive service connection due to herbicide exposure such as Agent Orange is provided under 38 U.S.C. § 1116(a)(2). Finally, the Board finds that a preponderance of the evidence is against finding that the Veteran’s hypertension is causally related to his service, to include herbicide exposure in Vietnam. The Board acknowledges the 2015 private medical opinion that generally states that all of the Veteran’s claimed disorders are secondary to the Veteran’s service. However, the Board finds that it has little probative weight as it includes no specific discussion of hypertension or rationale for how and why the condition is related to the Veteran’s service. The Board also acknowledges the Veteran’s own opinion that his hypertension is causally related to his service, but finds that as a lay person the Veteran does not have the education, training, or experience to competently opine as to the etiology of hypertension, a complicated, unseen condition diagnosed with medical testing. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). Accordingly, the Veteran’s lay statements in this regard are not competent or probative evidence supporting his claim. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Based on the forgoing, the Board finds that a preponderance of the evidence is against service connection for hypertension, the benefit of the doubt doctrine does not apply, and the claim must be denied. 2. Entitlement to service connection for erectile dysfunction The Veteran has claimed entitlement to service connection for erectile dysfunction. The Veteran’s service treatment records do not reflect a diagnosis of or treatment for erectile dysfunction in service. Erectile dysfunction is first noted in VA treatment records in April 2003 when the Veteran reported a worsening of the condition. The Veteran was afforded a VA examination in September 2019. The examination report states that the Veteran could not identify the date of onset of his erectile dysfunction but stated that it was progressive over time. The examiner opined that it is less likely than not that the Veteran’s erectile dysfunction was incurred in or caused by his service. The Veteran has submitted a February 2015 private medical opinion that notes the Veteran’s diagnosis of erectile dysfunction and states that his “cardiovascular, metabolics, musculoskeletal and psychiatrics disorders” are “more probable than not secondary to his military service performance.” Erectile dysfunction is not among the conditions for which presumptive service connection due to herbicide exposure such as Agent Orange is provided under 38 U.S.C. § 1116(a)(2). The Board further finds that a preponderance of the evidence is against finding that the erectile dysfunction onset in service or is causally related to his service. The Board acknowledges the Veteran’s own opinion that there is a relationship between his service and his erectile dysfunction but finds that as a lay person he does not have the education, training, or experience to opine as to the etiology of erectile dysfunction. The Board further finds that the 2015 private medical opinion has little probative value as it includes no specific discussion of erectile dysfunction or rationale for how and why the condition is related to the Veteran’s service. The Board also acknowledges the Veteran’s own opinion that his erectile dysfunction is causally related to his service, but finds that as a lay person the Veteran does not have the education, training, or experience to competently opine as to the etiology of such a complicated condition. See Kahana, 24 Vet. App. At 438. Accordingly, the Veteran’s lay statements in this regard are not competent or probative evidence supporting his claim. See Davidson, 581 F.3d at 1316; Jandreau, 492 F.3d at 1376-77. Based on the forgoing, the Board finds that a preponderance of the evidence is against service connection for erectile dysfunction, the benefit of the doubt doctrine does not apply, and the claim must be denied. 3. Entitlement to service connection for a back disability, claimed as chronic myositis para lumbar spine muscles and chronic low back pain The Veteran has claimed service connection for a back disability. The Veteran’s service treatment records do not reflect complaints or treatment related to his back. Post-service VA treatment records reflect a complaint of back pain in November 2001 with a lumbar spine x-ray showing spondylosis. Of record is a February 2015 private medical opinion that indicates that the Veteran has chronic myositis of the para-lumbar spine muscles and chronic low back pain and that his musculoskeletal disorders are “more probable than not secondary to his military service performance.” On VA examination in September 2019, the Veteran was diagnosed with degenerative arthritis of the spine, intervertebral disc syndrome, degenerative disc disease, and bilateral radiculopathy. The examiner stated there is no objective evidence of lumbar myositis. The examiner indicated that the Veteran reported that his symptoms developed in 1976, although he was not formally seen for medical treatment until 1998 per his recollection. The Veteran reported a slow onset of neck and back pain unrelated to trauma. The examiner stated that the record indicated that the onset of the Veteran’s back condition was well after service. The examiner opined that the Veteran’s claimed conditions are less likely than not incurred in or causally related to his service. The Board finds that a preponderance of the evidence is against finding that the Veteran’s back disability onset in service or within a year of his service separation. There are no medical records reflecting a diagnosis of arthritis in the Veteran’s spine until decades after service. The evidence further does not show, and the Veteran has not contended, that his back symptoms began in service or within a year of his service discharge. Further, degenerative arthritis of the spine, intervertebral disc syndrome, and degenerative disc disease are not among the conditions for which presumptive service connection due to herbicide exposure such as Agent Orange is provided under 38 U.S.C. § 1116(a)(2). Finally, the Board finds that a preponderance of the evidence is against finding that the Veteran’s back disability is causally related to his service, to include herbicide exposure in Vietnam. The Board acknowledges the 2015 private medical opinion that generally states that all of the Veteran’s claimed disorders are secondary to the Veteran’s service. However, the Board finds that it has little probative weight as it includes no specific discussion of the Veteran’s back disability or rationale for how and why any back disability is related to the Veteran’s service. The Board also acknowledges the Veteran’s own opinion that his back disability is causally related to his service, but finds that as a lay person the Veteran does not have the education, training, or experience to competently opine as to the etiology of his back disability, a complicated condition diagnosed with medical testing. Based on the forgoing, the Board finds that a preponderance of the evidence is against service connection for a back disability, the benefit of the doubt doctrine does not apply, and the claim must be denied. 4. Entitlement to service connection for a neck disability, claimed as chronic myositis para cervical spine muscles and chronic cervical spine pain The Veteran has claimed service connection for a cervical spine disability. The Veteran’s service treatment records do not reflect complaints or treatment related to his neck. Post-service VA treatment records first note a complaint of cervical pain in 2003. In October 2008 he was referred by his primary physician for evaluation of cervical spine pain, which the record indicates had been present for about three years. Of record is a February 2015 private medical opinion that indicates that the Veteran has chronic myositis of the para-cervical spine muscles and chronic cervical spine pain and that his musculoskeletal disorders are “more probable than not secondary to his military service performance.” On VA examination in September 2019, the Veteran was diagnosed with degenerative arthritis of the spine, intervertebral disc syndrome, and bilateral radiculopathy. The examiner stated there is no objective evidence of cervical myositis. The examiner indicated that the Veteran reported that his symptoms developed in 1976, although he was not formally seen for medical treatment until 1998 per his recollection. The Veteran reported a slow onset of neck and back pain unrelated to accidents of trauma. The examiner stated that the record indicated that the onset of the Veteran’s cervical spine condition was well after service. The examiner opined that the Veteran’s claimed conditions are less likely than not incurred in or causally related to his service. The Board finds that a preponderance of the evidence is against finding that the Veteran’s cervical spine disability onset in service or within a year of his service separation. There are no medical records reflecting a diagnosis of arthritis in the Veteran’s spine until decades after service. The evidence further does not show, and the Veteran has not contended, that his cervical spine symptoms began in service or within a year of his service discharge. Further, degenerative arthritis of the spine and intervertebral disc syndrome are not among the conditions for which presumptive service connection due to herbicide exposure such as Agent Orange is provided under 38 U.S.C. § 1116(a)(2). Finally, the Board finds that a preponderance of the evidence is against finding that the Veteran’s cervical spine disability is causally related to his service, to include herbicide exposure in Vietnam. The Board acknowledges the 2015 private medical opinion that generally states that all of the Veteran’s claimed disorders are secondary to the Veteran’s service. However, the Board finds that it has little probative weight as it includes no specific discussion of the Veteran’s cervical spine disability or rationale for how and why any cervical spine disability is related to the Veteran’s service. The Board also acknowledges the Veteran’s own opinion that his cervical spine disability is causally related to his service, but finds that as a lay person the Veteran does not have the education, training, or experience to competently opine as to the etiology of his cervical spine disability, a complicated condition diagnosed with medical testing. Based on the forgoing, the Board finds that a preponderance of the evidence is against service connection for a cervical spine disability, the benefit of the doubt doctrine does not apply, and the claim must be denied. 5. Entitlement to service connection for upper and lower extremity peripheral neuropathy The Veteran has claimed service connection for peripheral neuropathy of his upper and lower extremities. Of record is a February 2015 private medical opinion that indicates that the Veteran has peripheral neuropathy of the upper and lower extremities and that his “cardiovascular, metabolics, musculoskeletal and psychiatrics disorders” are “more probable than not secondary to his military service performance.” On VA examination in September 2019 the Veteran was diagnosed with bilateral radiculopathy. The examiner stated that the Veteran’s neurological impairment is secondary to the Veteran’s spine condition. The examiner indicated that the Veteran reported that his symptoms developed in 1976, although he was not formally seen for medical treatment until 1998 per his recollection. The Veteran reported a slow onset of neck and back pain unrelated to accidents of trauma. The examiner stated that the record indicated that the onset of the Veteran’s spine condition was well after service. The examiner opined that the Veteran’s claimed conditions are less likely than not incurred in or causally related to his service. The Board notes that early-onset peripheral neuropathy is among the conditions for which presumptive service connection due to herbicide exposure such as Agent Orange is provided under 38 U.S.C. § 1116(a)(2). However, the evidence does not support that the Veteran has early-onset peripheral neuropathy. Instead, the most probative evidence of record, that of the September 2019 VA examiner, is that the Veteran’s neurological symptoms are due to radiculopathy secondary to his spine condition. The Board finds that a preponderance of the evidence is against finding that the Veteran’s radiculopathy onset in service or is otherwise causally related to service. The Board notes that secondary service connection is not warranted as the Veteran’s spine condition is not service-connected. The Board acknowledges the 2015 private medical opinion that generally states that all of the Veteran’s claimed disorders are secondary to the Veteran’s service. However, the Board finds that it has little probative weight as it includes no specific discussion of the Veteran’s neuropathy or rationale for how and why his radicular symptoms are related to the Veteran’s service. The Board also acknowledges the Veteran’s own opinion that his upper and lower extremity neuropathy is causally related to his service, but finds that as a lay person the Veteran does not have the education, training, or experience to competently opine as to the etiology of his neuropathy, a complicated condition diagnosed with medical testing. Based on the forgoing, the Board finds that a preponderance of the evidence is against service connection for upper and lower extremity neuropathy, the benefit of the doubt doctrine does not apply, and the claim must be denied. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Christensen 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.