Citation Nr: 21002071 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 16-12 460A DATE: January 12, 2021 ORDER 1.Entitlement to service connection for right-side chest pain, to include as due to exposure to contaminated water at Camp Lejeune, is denied. 2.Entitlement to service connection for a disability manifested by fatigue and lack of energy, to include as due to exposure to contaminated water at Camp Lejeune, is denied. 3.Entitlement to service connection for a disability manifested by shortness of breath, to include as due to exposure to contaminated water at Camp Lejeune, is denied. 4.Entitlement to service connection for a disability manifested by blood in the stool, to include as due to exposure to contaminated water at Camp Lejeune, is denied. 5.Entitlement to service connection for a disability manifested by right arm weakness, to include as due to exposure to contaminated water at Camp Lejeune, is denied. 6. Entitlement to service connection for a disability manifested by a runny nose after physical exertion, to include as due to exposure to contaminated water at Camp Lejeune, is denied. 7.Entitlement to service connection for a disability manifested by shaking, to include as due to exposure to contaminated water at Camp Lejeune, is denied. FINDINGS OF FACT 1. The Veteran’s right-side chest pain was not manifested in service, and a preponderance of the evidence is against a finding that it is related to his service, to include as due to exposure to contaminated drinking water therein. 2. A disability manifested by fatigue and lack of energy was not manifested in service, and a preponderance of the evidence is against a finding that it is related to his service, to include as due to exposure to contaminated drinking water therein. 3. A disability manifested by shortness of breath was not manifested in service, and the preponderance of the evidence is against a finding that any such disability is related to the Veteran’s service, to include as due to exposure to contaminated drinking water therein. 4. A disability manifested by blood in the stool was not manifested in service, and the preponderance of the evidence is against a finding that any such disability is related to the Veteran’s service, to include as due to exposure to contaminated drinking water therein. 5. A disability manifested by right arm weakness was not manifested in service, and the preponderance of the evidence is against a finding that any such disability is related to the Veteran’s service, to include as due to exposure to contaminated drinking water therein. 6. During service, the Veteran was seen for acute complaints/symptoms including a runny nose and rhinitis; a current chronic disability manifested by a runny nose after exertion is not shown. 7. A disability manifested by shaking was not manifested in service and the preponderance of the evidence is against a finding that the Veteran has a current disability manifested by shaking. CONCLUSIONS OF LAW 1. Service connection for right-side chest pain is not warranted. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 2. Service connection for a disability manifested by fatigue and lack of energy is not warranted. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 3. Service connection for a disability manifested by shortness of breath is not warranted. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 4. Service connection for a disability manifested by blood in the stool is not warranted. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 5. Service connection for a disability manifested by right arm weakness is not warranted. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 6. Service connection for a disability manifested by a runny nose after exertion is not warranted. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.304. 7. Service connection for a disability manifested by shaking is not warranted. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from March 1976 to April 1979. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision. In March 2019, a Travel Board hearing was held before the undersigned; a transcript is in the record. In October 2019, the case was remanded for further development. The Veteran has not been afforded a VA examination in connection with the claims of service connection for right-side chest pain, a disability manifested by fatigue and lack of energy, a disability manifested by shortness of breath, a disability manifested by blood in the stool, a disability manifested by right arm weakness, a disability manifested by a runny nose, and a disability manifested by shaking. A VA examination to obtain a nexus opinion for each of the asserted disabilities is not necessary, as there is no evidence that suggests a right-side chest pain, a disability manifested by fatigue and lack of energy, a disability manifested by shortness of breath, a disability manifested by blood in the stool, a disability manifested by right arm weakness, a disability manifested by a runny nose, and a disability manifested by shaking may be related to his service. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). 1., 2., 3., 4., 5. Entitlement to service connection for right-side chest pain, a disability manifested by fatigue and lack of energy, a disability manifested by shortness of breath, a disability manifested by blood in the stool, and a disability manifested by right arm weakness, to include as due to exposure to contaminated water at Camp Lejeune, is denied. Service connection may be granted for disabilities due to disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease initially diagnosed after discharge when the evidence establishes that disability was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be established by showing continuity of symptomatology after discharge. 38 C.F.R. § 3.303(b). To substantiate a claim of service connection, there must be evidence of: (1) a current disability (for which service connection is sought); (2) incurrence or aggravation of a disease or injury in service; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-1167 (Fed. Cir. 2004). The determination as to whether these requirements are met is based on an analysis of all evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). In the absence of proof of a current disability, there is no valid claim of service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The United States Court of Appeals for Veterans Claims (CAVC) has held the requirement that a current disability be present is satisfied when a claimant has a disability at the time of a claim for VA disability compensation is filed or at any time during the pendency of that claim. See McClain v. Nicholson, 21 Vet. App. 319 (2007). Competent medical evidence is necessary where the determinative question is one requiring medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Effective March 14, 2017, VA amended 38 C.F.R. §§ 3.307 and 3.309 to provide a presumption of service connection for certain diseases based on exposure to contaminants in the water supply at Camp Lejeune. Two of the eight water treatment facilities supplying water to the base were contaminated with trichloroethylene (TCE), tetrachloroethylene (PERC), or perchloroethylene (PCE) from an off-base dry-cleaning facility. Essentially, as amended, 38 C.F.R. §§ 3.307 and 3.309 establish a presumption of service connection for veterans who served at Camp Lejeune for no less than 30 days (consecutive or nonconsecutive) from August 1, 1953 to December 31, 1987, and have a diagnosis of any of the following eight diseases, even though there is no record of such disease during service: adult leukemia, aplastic anemia and other myelodysplastic syndromes, bladder cancer, kidney cancer, liver cancer, multiple myeloma, non-Hodgkin's lymphoma, and Parkinson’s disease. 38 C.F.R. §§ 3.307(a), 3.309(f). Such listed diseases shall have to become manifest to a degree of 10 percent or more at any time after service. 38 C.F.R. § 3.307(a)(7)(ii). Notably, right-side chest pain, a disability manifested by fatigue, a disability manifested by shortness of breath, a disability manifested by blood in the stool, a disability manifested by a runny nose after physical exertion, a disability manifested by shaking, and a disability manifested by right arm weakness, are not among the eight listed diseases warranting this presumptive service connection. Service connection may nonetheless be established as due to such exposure by affirmative evidence supporting that theory of entitlement. 38 C.F.R. § 3.303(d); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The claimed disability manifested by a runny nose after physical exertion and a disability manifested by shaking are discussed in a separate section, below. The Veteran’s service personnel records confirm that he was stationed at Camp Lejeune primarily from August 1976 to April 1979 (thereby easily meeting the 30-day service at Camp Lejeune requirement). His service treatment records (STRs) are silent for complaints, findings, treatment, or diagnoses related to right side chest pain, a disability manifested by fatigue, a disability manifested by shortness of breath, a disability manifested by blood in the stool, and a disability manifested by right arm weakness. A May 2014 VA treatment record notes that the Veteran reported fatigue, right arm weakness, a history of chest pains, anxiety symptoms, and shortness of breath with exertion. He related that he passed bright red blood 2-3 months prior and that did not experience tingling, numbness, abdominal pain or nausea. The impression was fatigue, dyspnea on exertion, anxiety, and hematochezia (blood in the stool). A September 2014 VA treatment record notes that Veteran reported that he had not sought medical care for the past 20 years except for one visit to a VAMC in Virginia. He related that he experienced mild chest pain with exertion. A March 2015 VA treatment record notes that the Veteran had a history of exertional chest pain with a negative stress test result in October 2014. He reported that his chest pain resolved when he took Isosorbide and that his heartburn was relieved when he took Tums. He denied fever, runny nose, earache, and sore throat. A May 2015 colonoscopy report notes hemorrhoids were found, and that a benign polyp was removed. A May 2015 VA treatment record notes that the Veteran reported ongoing shortness of breath with minimal activity. Moderate to severe obstructive pathology was shown on spirometry, and Tiotropium and Albuterol were prescribed. A July 2015 VA treatment record notes that the Veteran had moderate obstructive sleep apnea (OSA) and that a CPAP was prescribed. A December 2015 VA treatment record notes that the Veteran reported right arm weakness. On examination, pulses were intact in his upper and lower bilateral extremities, no edema was present, he was alert and oriented in all spheres, sensation was intact in all extremities, muscle strength was 5/5 in all extremities, and his reflexes were normal. The provider noted a diagnosis of chronic obstructive pulmonary disease (COPD). SSA records note that the Veteran filed for disability due to breathing problems, lack of energy, and chest pain. A May 2016 SSA consultative examination notes that the Veteran reported progressive dyspnea and some chest pain on exertion, that he used breathing medications daily, and that he could walk up to 1/4 mile on level ground. On examination, mildly reduced strength was shown in the right arm, slightly diminished muscle mass was shown in all four extremities, and there was no motor or sensory loss in any of the extremities. Chest and lumbar spine X-rays showed no acute pulmonary process, multilevel grade 1 spondylolisthesis, and mild facet. The provider opined that the Veteran was capable of light work with limited exposure to fumes and hazards. A May 2016 private treatment record notes diagnoses of diastolic hypertension, mild to moderate COPD, stable angina, moderate degenerative joint disease in both hands and both feet, chronic cervico thoracolumbar strain, diffuse onychomycosis, and tinea manus and pedis. At the March 2019 Travel Board hearing, it was noted that the Veteran has a diagnosis of COPD. He testified that he thought COPD was diagnosed in May 2014, but that it could have been as early as 2007. He related that none of the doctors that he had seen for COPD had related it to his service. He reported that he has experienced blood in his stool since approximately 2005, and did not have any problems with gastrointestinal issues or blood in his stool during service. He related that his providers have attributed the problem to hemorrhoids and that none of the providers have related his bloody stool to exposure to water from Camp Lejeune. He reported that he did not experience any right arm weakness during service and that such weakness began in approximately 2007. He related that his right-side chest pain began about 2003. He reported that he took pain pills but had to decrease the dosage because the pain pills caused headaches. He related that he had GERD (or possibly episodes of heartburn) that was alleviated when he took antacids. Finally, he reported fatigue that occurred whenever he engaged in any type of physical labor. A December 2019 VA treatment record notes that the Veteran reported shortness of breath when he walked for an extended period of time and bilateral leg weakness with no edema. He requested testing for Aplastic Anemia (which is listed as a Camp Lejeune presumptive disease). A December 2019 VA treatment record notes that the provider indicated that the Veteran’s lab results were reviewed and did not suggest Aplastic Anemia. It is not in dispute that the Veteran now has right side chest pain, symptoms of fatigue, episodes of shortness of breath and/or COPD, blood in the stool, and right arm weakness. His service personnel records show that he was stationed at Camp Lejeune for the majority of his service from August 1976 to April 1979. Accordingly, his exposure to contaminated drinking water at Camp Lejeune is conceded, and not in dispute. The critical question remaining is whether there is competent evidence of a nexus between his service, to include his exposure to contaminated drinking water therein, and his right-side chest pain, symptoms of fatigue, episodes of shortness of breath and/or COPD, blood in his stool, and right arm weakness. As noted above, inasmuch as a disability manifested by right-side chest pain, a disability manifested by fatigue, COPD (or a disability manifested by shortness of breath), a disability manifested by blood in the stool, and a disability manifested by right arm weakness are not listed among the 8 diseases for which presumptive service connection based on exposure to contaminated water at Camp Lejeune is warranted, service connection for such diseases/disorders based on such exposure may not be presumed. 38 C.F.R. §§ 3.307(a), 3.309(f). The Veteran’s STRs are silent for complaints, findings, treatment, or diagnosis regarding right-side chest pain, symptoms of fatigue, COPD (or a disability manifested by shortness of breath), blood in his stool, and right arm weakness. On March 1979 service separation examination, his respiratory system, chest, anus and rectum, and upper extremities were normal on clinical evaluation. Right-side chest pain (as reported by the Veteran) was diagnosed no earlier than 2003, COPD was not diagnosed until May 2014 (or possibly as early as 2007 according to the Veteran), blood in his stool was not reported until 2005, and right arm weakness was not shown until 2007. The first postservice notation of fatigue is in a May 2014 VA treatment record. Accordingly, service connection for a disability manifested by right-side chest pain, a disability manifested by fatigue, COPD (or a disability manifested by shortness of breath), a disability manifested by blood in the stool, and a disability manifested by right arm weakness on the basis that each such disability became manifest in service and persisted is not warranted. What remains for consideration is whether the Veteran’s disability manifested by right-side chest pain, disability manifested by fatigue, COPD (or a disability manifested by shortness of breath), disability manifested by blood in the stool, and disability manifested by right arm weakness are otherwise etiologically related to his service. The Veteran has not provided any evidence that his disability manifested by right-side chest pain, disability manifested by fatigue, COPD (or a disability manifested by shortness of breath), disability manifested by blood in the stool, and disability manifested by right arm weakness may somehow otherwise (than by virtue of alleged exposure to contaminated water at Camp Lejeune) be related to his service (and has not asserted that such disabilities are otherwise related to such service) Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). There is no indication in his postservice medical records that a disability manifested by right-side chest pain, a disability manifested by fatigue, COPD (or a disability manifested by shortness of breath), a disability manifested by blood in the stool, and/or a disability manifested by right arm weakness (all) diagnosed many years after his separation from active military service, may be directly related to service (other than as alleged by virtue of exposure to contaminated water at Camp Lejeune). The lengthy interval between service and the earliest postservice clinical documentation of a disability manifested by right-side chest pain, a disability manifested by fatigue, COPD (or a disability manifested by shortness of breath), a disability manifested by blood in the stool, and a disability manifested by right arm weakness is of itself a factor for consideration against a finding of service connection for such disabilities/diseases. Considering the foregoing, the Board finds that the preponderance of the evidence is against the claims of service connection for a disability manifested by right-side chest pain, a disability manifested by fatigue, COPD (or a disability manifested by shortness of breath), a disability manifested by blood in the stool, and a disability manifested by right arm weakness. The benefit-of-the-doubt standard of proof does not apply; the appeals seeking service connection for a disability manifested by right-side chest pain, a disability manifested by fatigue, COPD (or a disability manifested by shortness of breath), a disability manifested by blood in the stool, and a disability manifested by right arm weakness must be denied. 6., 7. Entitlement to service connection for a disability manifested by a runny nose after physical exertion, and a disability manifested by shaking, to include as due to exposure to contaminated water at Camp Lejeune, is denied. A June 1977 service treatment record (STR) notes that the Veteran reported that he had experienced a sore throat, runny nose, and headache for 2 days. Medication was prescribed. A January 1978 STR notes that he reported sinus drainage and inflamed tonsils. The impression was sinus congestion. A September 1978 STR notes that the Veteran sought treatment for running sinuses, and a January 1979 STR notes that he sought treatment for rhinitis and postnasal drip. The provider indicated that he had a seasonal cold. The STRs do not note complaints of, treatment for, or a diagnosis of, a disability manifested by shaking. On March 1979 separation examination, the Veteran’s sinuses, neurologic system, and upper and lower extremities were normal on clinical evaluation. At the March 2019 Travel Board hearing, it was noted that the Veteran had a runny nose in service that was associated with a viral infection that resolved. He testified that he only experienced a runny nose after exerting himself and did not have a diagnosis of a current sinus disorder because he was not working (and therefore not exerting himself). He related that his claimed disability manifested by shaking was also induced by exercise; he explained that he would start to shake if he over-exerted himself. He indicated that he did not have a current diagnosis of a disability manifested by shaking. VA and Social Security Administration (SSA) records do not note complaints of, treatment for, or diagnoses of a disability manifested by a runny nose after exertion or a disability manifested by shaking at any time during the pendency of the claims. His STRs note treatment for various sinus problems such as a runny nose, and rhinitis that resolved, and treatment for episodes of shaking was not documented in the STRs. The Veteran is competent to describe any discernible symptoms related to a runny nose or episodes of shaking without any specialized knowledge or training. See Barr, 21 Vet. App. at 303, 309. However, his own opinions regarding the etiology of such symptoms are not competent evidence. He is a layperson, and does not cite to supporting medical opinion or clinical or medical treatise evidence which pertains to his own specific disability picture. The etiology of disabilities manifested by a runny nose after exertion and shaking is a medical question beyond the scope of lay observation. See Jandreau, 492 F. 3d at 1372. In the absence of competent evidence of a diagnosis of a current chronic disability manifested by a runny nose after physical exertion, and a disability manifested by shaking or evidence, he has not presented a valid claim for service connection for such disabilities. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Accordingly, the appeals in the matters must be denied. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Bayles, 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.