Citation Nr: 21003401 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 14-28 347 DATE: January 21, 2021 ORDER Service connection for a left hand disorder is denied. Service connection for a gastrointestinal (GI) disorder is denied. REMANDED Service connection for a back disorder. FINDINGS OF FACT 1. The Veteran served on active duty from December 1985 to May 1986 and from January 1987 to January 1991. 2. A left hand disorder, currently diagnosed as carpal tunnel syndrome (CTS) and Raynaud’s syndrome, was not shown in service or within one year of service, symptoms of a left hand disorder were not continuous since service and the current left hand disorders are not causally or etiologically related to service. 3. A GI disorder has not been shown during the appeal period. CONCLUSIONS OF LAW 1. A left hand disorder was not incurred during service. 38 U.S.C. §§ 1110, 1131, 1116, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2020). 2. A GI disorder was not incurred during service. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. § 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In October 2018, the Board remanded the appeal for additional development. The case has now been returned to the Board for further appellate action. Turning to the relevant laws and regulations, 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 secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Left Hand Disorder Turning to the evidence, the Veteran was diagnosed with left upper extremity CTS in a July 2018 private treatment record. Further, while an April 2014 VA arteries and veins conditions examination report indicated that he was not diagnosed with Raynaud’s syndrome, an October 2020 VA artery and vein conditions examination report reflected a diagnosis of Raynaud’s syndrome. As the such, current disorder is shown and the first element of direct service connection has been met. As to an in-service incurrence, the service treatment records (STRs) do not reflect any complaints, findings, or diagnoses related to the left hand. The October 1990 service separation examination report did not reflect any left hand complaints or findings and the Veteran did not report any problems with his left hand on the accompanying Report of Medical History. As the second element (in-service incurrence) is not met, the medical evidence does not support service connection on a direct basis. To the extent that the Veteran asserts a nexus between his current diagnosis and service, the medical evidence does not support his contentions as no medical provider has established such a connection. Further, he has not indicated that any health care provider told him that CTS/Raynaud’s of the left hand was related to service or that he had any other left hand disorder which was related to service. Therefore, the medical evidence does not support service connection based on medical nexus. At the hearing before the Board, the Veteran indicated that he had a circulation issue in his left hand which he felt was related to his service-connected varicose veins of his lower extremities. He indicated that he would submit a medical opinion in support of his claim; however, no medical opinion was submitted and there is no medical evidence indicating that any current left hand disorder is caused or aggravated by the service-connected bilateral lower extremity varicose veins. Therefore, the medical evidence does not support the claim on a secondary basis. Gastrointestinal Disorder In addition to the laws and regulations outlined above, service connection may only be granted for a current disability; when a claimed condition is not shown, there may be no grant of service connection. See 38 U.S.C. § 1110; Rabideau v. Derwinski, 2 Vet. App. 141 (1992) (Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability). “In the absence of proof of a present disability there can be no valid claim.” See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The presence of a disability at the time of filing of a claim or during its pendency warrants a finding that the current disability requirement has been met, even if the disability resolves prior to the Board’s adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); see also Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013) (Board erred in failing to address pre-claim evidence in assessing whether a current disability existed, for purposes of service connection, at the time the claim was filed or during its pendency). The Veteran claims that service connection is warranted for a GI disorder, which he claimed as stomach problems, because it is related to service. Specifically, he testified that his stomach problems began in service as a result of chemicals that were put in the water when he was aboard ship. While he testified that he did not have stomach problems during service, he testified that he had stomach problems shortly after service. The Veteran filed the claim for service connection for a GI disorder in July 2010. During the appeal period, a GI disorder has not been shown. While he was diagnosed with possible lactose intolerance, gastroesophageal reflux disease (GERD), and possible irritable bowel syndrome (IBS) in December 2000, GERD in November 2001, and lactose intolerance, dyspepsia, and probable IBS in September 2003, these GI findings were made approximately 7-10 years prior to filing the current claim, well outside the appeal period. Medical records dated during the appeal period indicated that the Veteran specifically denied GI problems and there were no GI complaints, findings or diagnoses. At the hearing, he did not testify that he had a current GI diagnosis, that he received any treatment for a current GI disorder, or that any medical professional had ever indicated that any current GI diagnosis was related service. As there is no medical evidence of any GI complaints or any findings of any GI disorder during the appeal period, the medical evidence does not support the claim. In addition, the Board places significant probative value on the clinical records, which do not show a diagnosis of a GI disorder. Further, there is no contradicting medical evidence of record. As such, there is no basis on which to grant the appeal. The Board has considered the Veteran’s lay statements that he has a GI disorder which is related to service and that his left hand disorder is related to service or to service-connected disorder varicose veins. 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 any 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. 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). REASONS FOR REMAND With respect to the claim for a low back disorder, another remand is needed to adjudicate the appeal. The appeal was remanded in October 2018 for a medical opinion. In an October 2020 VA examination, the examiner diagnosed intervertebral disc syndrome (IVDS) and found that it was less likely than not due to or the result of the Veteran’s varicose veins as varicose veins in the lower extremities were not related clinically or in any other way to the development of lumbar pain or vice versa because simply no clinical relationship existed between the two. The examiner opined that the claimed condition was at least as likely as not aggravated beyond its natural progression by “insert service connected condition” (without actually identifying the condition); however, the examiner’s reasoning does not support the opinion. Notably, the examiner reasoned that the physical demands of service including prolonged standing could make varicose veins and lumbar pain worse. As such, the examiner did not address the Veteran’s report of inservice back injury, ongoing symptoms, or a July 2018 private opinion from Dr. Campbell who found that it was “possible that [the Veteran’s] persistent painful varicose veins [have] disrupted his gait and resulted in worsening of his lumbar spine condition.” Therefore, a clarification medical opinion is needed. The matter is REMANDED for the following actions: 1. Return the claims file, to include a copy of this Remand, to the October 2020 VA examiner, if available, in order to obtain an addendum medical opinion regarding the etiology of the Veteran’s IVDS. The examiner is asked to review the claims file, to include a copy of this remand, and provide opinions as to the following: a) Whether it is at least as likely as not that the Veteran’s IVDS is causally or etiologically related to service, to include the Veteran’s report of injuring his back in service? b) Whether it is at least as likely as not that the Veteran’s IVDS is aggravated by his service-connected varicose veins of the bilateral lower extremities, to include an due to an altered gait. The examiner must consider and address the Veteran’s report of injuring his back in service (in approximately 1989) and ongoing symptoms since service, as well as the July 2018 private treatment record from Dr. Campbell which states that “it is possible that [the Veteran’s] persistent painful varicose veins [have] disrupted his gait and resulted in worsening of his lumbar spine condition.” A complete rationale should be provided for any opinions rendered. If the examiner is not available, the requested opinions should be provided by another clinician. If the clinician determines that an examination is required to answer the questions, then one should be scheduled. L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Redman, 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.