Citation Nr: 21063102 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 15-07 231 DATE: October 13, 2021 ORDER Entitlement to an increased rating in excess of 10 percent for bilateral glaucoma is denied. Entitlement to service connection for a left ankle disability is denied. Entitlement to service connection for a low back disability is denied. REMANDED Whether new and material evidence has been submitted to reopen the claim for service connection for hypertension is remanded. FINDINGS OF FACT 1. The Veteran's bilateral glaucoma causes visual field impairment manifesting in concentric contraction with an average remaining visual field between 46 and 50 percent bilaterally and does not cause any other visual impairment or incapacitating episodes. 2. The preponderance of the evidence is against finding that a left ankle disability began during active service or is otherwise related to an in-service injury or disease. 5. The Veteran's low back disability was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is attributable to intercurrent causes; and the disability is not otherwise etiologically related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for bilateral glaucoma are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.25, 4.75, 4.76, 4.77, 4.78, 4.79, Diagnostic Code 6080. 2. The criteria for service connection for a left ankle disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a low back disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1986 to May 1990. These matters are on appeal to the Board of Veterans' Appeals (Board) from a June 2010 rating decision. The Board remanded the claims for further development in a May 2019 decision. In addition to obtaining VA examinations, the Agency of Original Jurisdiction (AOJ) was directed to contact the Veteran to obtain authorization for any outstanding private treatment records, and to attempt to obtain any such records. A development letter was sent to the Veteran on October 9, 2019, requesting that the Veteran complete and return a VA Form 21-4142 so that private treatment records could be obtained. In September 2020, a completed VA Form 21-4142 was associated with the file listing VA treatment facilities, Southeast Georgia Health System, and Advance Pain Management as treatment locations. These records were subsequently associated with the claims file. As both private and VA treatment records have been obtained, and VA examinations have been conducted, the Board finds that the remand directives have been complied with. 1. Increased rating - bilateral glaucoma By way of background, the Veteran was granted service connection for glaucoma of the left eye in a January 2007 rating decision, rated 10 percent disabling effective August 29, 2006. The Veteran appealed the initial rating to the Board, and in an April 2009 decision, the Board denied an increased rating, and that decision became final. A June 2010 rating decision subsequently granted service connection for glaucoma in both eyes, with a combined 10 percent rating effective January 23, 2009. The Veteran is currently rated under Diagnostic Code (DC) 6080 for visual field defects due to glaucoma. During the pendency of the appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the organs of special sense and schedule of ratings-eye. 89 Fed. Reg. 15316 (Apr. 10, 2018). The final rule went into effect May 13, 2018. Where there is a change in the rating criteria during the appeal period, the Board will consider the claim in light of both the former and revised schedular rating criteria, although an increased evaluation based on the revised criteria cannot predate the effective date of the amendments. There were no substantive changes as to how visual impairment is rated. The definition of incapacitating episodes did change; however, there is no indication that the Veteran experiences incapacitating episodes under either definition throughout the appeal period. At the outset, it should be noted that open-angle glaucoma is listed under DC 6013. Both the former and revised criteria under DC 6013 indicate that a minimum 10 percent rating was warranted if continuous medication was required, which is the case here. Under the former criteria, DC 6013 instructed to evaluate pursuant to visual impairment due to open-angle glaucoma. Under the revised criteria, DC 6013 instructs to evaluate pursuant to the General Rating Formula for Diseases of the Eye, which instructs that to evaluate a condition based on visual impairment or its rating criteria for incapacitating episodes. The rating schedule provides for ratings based on visual impairment due to visual acuity, diplopia, and visual field. There is no indication in the record that the Veteran experiences diplopia or compensable decreased visual acuity. In prior examinations and treatment records, the Veteran's corrected distance visual acuity is, at most reduced, 20/30. Based on the evidence relating to the Veteran's glaucoma manifestations, there are no other potentially applicable diagnostic codes. Under DC 6080, visual field defects are evaluated as follows: A 10 percent evaluation for concentric contraction of visual field with remaining field of 46 to 60 degrees bilaterally or unilaterally; with remaining field of 31 to 45 degrees unilaterally; with remaining field of 16 to 30 degrees unilaterally; loss of superior half of visual field bilaterally or unilaterally; loss of interior half of visual field unilaterally; loss of nasal half of visual field bilaterally or unilaterally; and loss of temporal half of visual field unilaterally. A 20 percent evaluation is assigned for concentric contraction of visual field with remaining field of 6 to 15 degrees unilaterally. A30 percent evaluation is assigned for concentric contraction of visual field with remaining field of 31 to 45 degrees bilaterally; remaining field of 5 degrees unilaterally; loss of inferior half of visual filed bilaterally; loss of temporal half of visual field bilaterally; and homonymous hemianopsia visual field defects. A 50 percent rating is assigned for concentric contraction of visual field with remaining field of 16 to 30 degrees bilaterally. A 70 percent rating is assigned for concentric contraction of visual field with remaining field of 6 to 15 degrees bilaterally. A 100 percent rating is assigned for concentric contraction of visual field with remaining field of 5 degrees bilaterally. In a March 2010 VA examination, the Veteran reported symptoms of dryness and blurring. There was no history of incapacitating episodes. A subretinal scar was noted in the right eye. There was no homonymous hemianopsia, though scotomas not centrally located were noted bilaterally. His corrected distance visual acuity was 20/20 in the right eye and 20/25 in the left. Goldman visual field testing conducted in April 2010 revealed an average concentric contraction with remaining field of approximately 47.5 degrees in the left eye and 55.9 degrees in the right. Based on these findings, the Veteran's remaining field was between 46 and 60 degrees bilaterally, warranting a 10 percent rating. Throughout the appeal period, VA treatment records show several eye visits with Humphrey visual field testing. A February 2010 treatment record from Miami VAMC shows bilateral visual acuity of 20/30. Visual field testing showed severe superior nasal defect, arcuate defects, and inferior nasal defects in the right eye, and severe dense superior altitudinal defect with mostly absolute visual field loss, severely reduced central defects, and severe inferior altitudinal defects with areas of absolute visual field loss, sparing of central fixation. In May 2010, the right eye visual field defects were labeled as a cluster of moderate superior nasal defects and scattered inferior defects. In December 2010, severe dense field defects were noted in the left eye, while the right eye was stable without progression. In some treatment notes, the retinal scar in the right eye was noted with questionable etiology, appearing trauma related. It was noted to be likely contributing to visual field loss. In June 2011 visual field testing, the right eye showed improved superior and inferior arcuate defects, while the left eye showed large constriction but improved from the prior study. May 2012 testing showed a stable right eye defect since the prior study, with an unreliable left eye study. October 2013 testing showed dense super-nasal arcuate defect of the right eye and a remaining small area of central field with central fixation compromised in all quadrants of the left eye. April 2015 testing showed a severe super-nasal defect of the right eye and severe superior and inferior nasal field loss with partial central vision being compromised in the left. March 2016 testing showed severe superior nasal defect of the right eye and severe superior nasal defect extending inferior in the left. April 2018 testing shows a nasal defect in the right eye and superior defect with no encroachment on fixation in the left. The retinal scar was noted with questionable etiology, and the cataracts were noted to be not visually significant. In February 2019 correspondence, the Veteran contended that his vision, particularly peripherally, had worsened since his 2010 examination. He endorsed pressure and pain in his eyes that frequently become bloodshot, requiring eyedrops. Another examination was obtained in October 2019. Only the Veteran's left eye glaucoma diagnosis as well as early bilateral cataracts were noted. The examiner clarified in the remarks section that he has pre-glaucoma in the right eye with normal visual function and no significant visual field loss in that eye. He reviewed the Veteran's past visual field testing results and stated that the April 2015 and October 2013 testing showed minimal superior nasal depression in the right eye, otherwise within normal limits, and advanced visual field loss 360 degrees in the left eye consistent with glaucoma. His best corrected visual acuity was 20/20 bilaterally. The examiner opined that the Veteran's visual impairment was due to his left eye glaucoma, and that the cataracts did not cause visual impairment. No incapacitating episodes were noted. Goldman visual field testing was not conducted. Another VA examination was conducted in November 2020. The listed diagnoses were bilateral primary open-angle glaucoma, chorioretinal scars of the right eye, and bilateral nuclear sclerosis. The Veteran complained of blurred vision at night. He attributed the right eye scar to trauma sustained in an in-service fall, though the examiner stated there was no evidence of an eye injury in the service records. His bilateral corrected distance visual acuity was 20/20 or better. The examiner opined that the visual impairment was due to solely to the glaucoma, and that the scarring and cataracts did not cause visual impairment. There were no incapacitating episodes. The examiner opined that the Veteran's chorioretinal scar is separate and unrelated to glaucoma, and that the etiology was most likely inflammation. He further opined that the nuclear sclerosis is unrelated to glaucoma and is most likely due to age-related changes to the lens. Goldman testing conducted the same month showed an average concentric contraction with remaining field of approximately 54.5 degrees in the left eye and 58.6 degrees in the right. Based on these findings, the Veteran's remaining field was between 46 and 60 degrees bilaterally, warranting a 10 percent rating. While the VA treatment records do reflect visual field defects, they do not provide these visual field findings in terms of remaining field in degrees required by the rating criteria. See 38 C.F.R. § 4.77. Thus, while relevant to show the existence of visual field defects, the evidence does not entitle the Veteran to a higher rating. Moreover, these findings were reviewed and considered by the 2019 and 2020 VA examiners. The objective visual field findings of record shows defects with remaining field between 46 and 60 degrees bilaterally both in 2010 and 2020. Therefore, in accordance with DC 6080, the Veteran is entitled to a 10 percent, but no higher, for his bilateral glaucoma. His increased rating claim is denied. Service Connection In order to prove service connection, there must be competent and credible evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus or link between the current disability and the in-service disease or injury. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Alternatively, service connection may be established under 38 C.F.R. § 3.303 (b) by (a) evidence of (i) the existence of a chronic disease in service or during an applicable presumption period under 38 C.F.R. § 3.307 and (ii) present manifestations of the same chronic disease, or (b) when a chronic disease is not present during service, evidence of continuity of symptomatology. However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309 (a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In the instant case, MRI reports of the lumbar spine show degenerative changes (arthritis); thus, presumptive service connection could potentially be applicable since arthritis is listed as a chronic disease under 38 C.F.R. § 3.309 (a). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "Chronic." When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303 (b). Under 38 C.F.R. § 3.303 (b), service connection may be established by demonstrating continuity of symptomatology. Continuity may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Board has considered the applicability of the benefit of the doubt in each claim. 3. Service connection - left ankle disability The Veteran contends he injured his left ankle in service, and he has had left ankle pain ever since. In February 2019 and May 2007 correspondence, the Veteran stated he sustained a fall and received treatment for his ankle during service. He reported self-medicating post-service. The service records do not reflect any complaints or treatment relating to the ankle. In December 1985, he complained of pain in both feet, which was attributed to pes planus. On his separation examination, he indicated "yes" to painful joints, but he does not specify which joints, and there are no specific injuries or complaints relating to the ankle at separation. Turning to the post-service treatment records, the Veteran sprained his left ankle in August 2006. Physical examination revealed minimal lateral malleolus swelling and tenderness, and the injury was assessed as an ankle strain. A June 2007 treatment note indicates a history of an ankle fracture in the military. The assessment was "ankle pain actually is heel. Flat foot and plantar fasciitis." He complained of ankle pain again in February 2009, though it is not clear which ankle. In December 2010, he reported ankle pain from a motor vehicle accident. In August 2013, the Veteran reported spraining his ankle a few days prior. A VA examination was conducted in November 2019. X-rays conducted at the time revealed an old healed fibula fracture. The listed diagnoses were lateral collateral ligament sprain of the left ankle (chronic/recurrent) and a distal fibular fracture. The Veteran stated that in service he would load ammunition into gun mounts which required passing shells from one sailor to another in a line. He recalled an instance of slipping on the wet deck and sustaining a left ankle inversion-type injury with onset of pain. He recalled going to medical where a short two-hour period of rest and ibuprofen were prescribed. His ankle improved in two to three weeks, but it would continue to hurt after about 30 minutes of weight-bearing. Since service the left ankle has worsened, and he has continuous pain and stiffness. Upon reviewing the x-ray, the examiner (Dr. J.K.) concluded that the finding of an old distal fibular fracture could be (at least as likely as not) a consequence of a left ankle injury that occurred aboard ship. He explained that although the Veteran's statement is subjective in nature, the Veteran described the mechanism of a left ankle inversion that occurred in-service. The Veteran's statements along with the physical examination were consistent with residuals of a left ankle sprain, yet the x-ray found an old fracture, which can be the result of the inversion-type mechanism the Veteran described. Considering all the available information, the examiner concluded that a left ankle sprain residual and old distal fibular fracture are, in the absence of other known injury, at least as likely as not related to the slip/fall injury that the Veteran described that occurred aboard ship. An addendum opinion was subsequently requested from the examiner. However, as that examiner was no longer employed as a VA examiner, a new examiner (Dr. L.K.) provided another opinion in November 2020. Upon review of the claims file, Dr. L.K. stated that service records yield no evidence of the Veteran ever seeking treatment for ankle pain or injuries while on active duty. There were no documented ankle abnormalities on physical examination at separation. The first documented report of ankle pain found in the available post-military medical records was an ankle sprain in August 2006. The next mention of ankle pain is in June 2007, at which time the Veteran presented requesting paperwork to reopen a claim for a left ankle condition. At that time, no condition of the left ankle was diagnosed; instead, the provider stated that flat feet and plantar fasciitis were the etiology of the Veteran's left ankle pain. The only other report of ankle pain was in February 2009; however, the specific ankle involved is not documented. In the previous examination, Dr. J.K. documented that the Veteran reported left ankle pain since service. Dr. J.K. also found that the Veteran had full active range of motion of the joint with no objective evidence of pain. There was some mild tenderness to palpation noted over the lateral aspect of the ankle. Dr. L.K. found it important to note that this is the same area of the left ankle that was injured in August 2006. While the Veteran endorsed continuous ankle pain since service, Dr. L.K. found this is not supported by the evidence, to include his separation physical examination when the Veteran did not report having any ankle pain, and no ankle abnormalities were noted. The Veteran did not report having any left ankle pain until August 2006 following an acute injury, and the symptoms are described to be in the same area as the 2006 injury. For these reasons, the examiner concluded that it is less likely than not that the Veteran's current ankle condition was incurred in or caused by military service. In evaluating the evidence, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Owens v. Brown, 7 Vet. App. 429, 433 (1995). While there are contrasting medical opinions of record, the Board finds the most recent November 2020 opinion by Dr. L.K. most probative. Dr. J.K. stated that absent any other known injury, the Veteran's ankle injury was more likely than not related to service. However, he does not discuss the August 2006 ankle sprain. This diminishes the probative value because there was, in fact, another injury to the ankle that could have played a causal or contributory role that was not considered. Dr. L.K., on the other hand, finds this acute injury to be of significant relevance as it is in the same area of the ankle that was tender on physical examination in 2019, and, thus, is the more likely cause. Regarding the Veteran's testimony, while he is competent to recall past injuries, as well as his symptoms and the time of their onset, the Board does not find him credible. First, while the Veteran stated he was treated for an ankle injury in service, the treatment records do not reflect this. Second, while he endorsed pain since his in-service injury, he did not endorse pain at separation. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the claimant). Third, to the extent the Veteran suffered a fractured ankle in service, this is a type of injury that one would reasonably be expected to seek treatment for at the time. See Fountain v. McDonald, 27 Vet. App. 258, 272 (2015) (the Board can weigh lay statements against the absence of contemporary medical evidence as long as it establishes a proper foundation for why the absence weighs against the claim). The fact that there is no indication of a fractured ankle in service weighs against the Veteran. The Board finds that the preponderance of the evidence is against the Veteran's claim. The most probative medical evidence of record attributes the Veteran's ankle disability to a post-service injury. There is no evidence of an in-service injury aside from the Veteran's testimony, which the Board has deemed not credible. To the extent that the record (i.e., the June 2007 treatment record) reasonably raises the theory of secondary to pes planus or plantar fasciitis, the Veteran is not currently service connected to any foot disability; thus, that theory of entitlement is not applicable. While the Veteran does have a current pes planus claim pending on appeal, he has not raised the secondary theory himself and, thus, the Board finds no reason to deem the issues as intertwined. As the evidence is against an in-service incurrence, the Veteran's claim must be denied. 2. Service connection - low back disability The Veteran contends he injured his low back in service, and he has had back pain ever since. In February 2019 and May 2007 correspondence, the Veteran stated he sustained a fall and received treatment for his back during service. He reported self-medicating post-service. The service records do not reflect any complaints or treatment relating to the back. On his separation examination, he indicated "yes" to painful joints, but does not specify which joints, and there are no specific injuries or complaints relating to the back at separation. Turning to the post-service treatment records, a December 1997 treatment record reflects back pain following a recent motor vehicle accident. An October 2004 indicates that the Veteran was involved in a motor vehicle accident and fractured his pelvis in September 2004. In 2008, the Veteran sustained two falls at home which prompted an MRI of the lumbar spine following subsequent complaints of back pain. The MRI revealed central disc bulging at L4-5 and L5-S1 and central canal stenosis at L4-5. The Veteran continued to seek treatment for back pain since 2008. The treatment records notate a motor vehicle accident in 2004 and a questionable pelvis/hip fracture. A fractured pelvis was listed as a diagnosis. In 2011, the Veteran complained of chronic low back pain for several years. A February 2012 Emergency Department record reflects a fall on an Amtrak train that resulted in back pain. The assessment was acute on chronic back pain, and the physical examination was unremarkable for acute injury. A 2011 lumbar spine x-ray showed mild spondylosis from L3 to L5. In an April 2011 note, the Veteran endorsed onset of back pain in January 2011. In March 2017, the Veteran reported an onset of back pain in 2014. A July 2018 treatment record reflects low back pain for the past five years. The Veteran mentioned no recent injury but did refer to the 2004 motor vehicle accident. A VA examination was conducted in November 2019. X-rays conducted at the time revealed mild degenerative changes of the lower lumbar spine as seen on the prior 2011 x-ray study. The listed diagnoses were lumbosacral disc disease (diagnosed by September 2008 MRI), mild lumbar spondylosis (diagnosed by May 2011 x-ray), a chronic lumbar strain, and sciatica. The examiner also indicated IVDS. The Veteran explained that while in service, he was loading ammunition into gun mounts which required passing shells from sailor to another in a line using a twisting body motion. He recalled onset of back pain and stiffness during the activity on more than one occasion and would medicate with short periods of bedrest and ibuprofen. He also recalled an incident when he slipped on the wet deck and landed with his back on a nearby stack of shells. He endorsed ongoing back issues since service. The examiner (Dr. J.K.) conceded that the service records are silent concerning back issues. However, he found that the Veteran's statements, though subjective in nature, provide information concerning the work performed and the injury sustained with conceptualization of body mechanics involved and how the back injury could have resulted. While the degenerative disease and spondylosis are at least as likely as not multi-factorial in origin, he opined that the factors include residuals related to the work performed and injury sustained during service. Thus, the Veteran's current disability was at least as likely as not related to service. An addendum opinion was subsequently requested from the examiner. However, as Dr. J.K. was no longer employed as a VA examiner, a new examiner (Dr. L.K.) provided another opinion in November 2020. Upon review of the claims file, Dr. L.K. stated that the service records yield no evidence of the Veteran seeking or receiving any treatment for back pain or injuries on active duty. The separation examination contains no documented reports of pain and there were no documented spinal abnormalities on physical examination. Post-service, the Veteran sought treatment for back pain one day after involvement in a motor vehicle accident in 1997. The note documents pain in the lower back, but there are no x-rays of the spine in the records from that incident. The next documented report of pain is in October 2004 when the Veteran had been in a motor vehicle accident the month prior and had been experiencing back pain. He then sought treatment for back pain after falling in his home on two occasions in 2008. Dr. L.K. noted that there are multiple documented reports of low back pain since that time. Dr. L.K. acknowledged Dr. J.K.'s opinion that while the etiology of the back condition is multi-factorial, the factors include residuals related to the work performed and injury sustained in service. However, he did not cite any of the above-documented evidence showing at least two motor vehicle accidents between discharge from service and the diagnosis of degenerative disc disease in 2008. There is documented spinal injury in the 1997 accident, and a pelvic fracture in the 2004 accident. According ot the American Academy of Orthopedic Surgeons, most pelvic fractures are caused by some type of traumatic, high-energy event, such as a car collision. The forces that cause pelvic fractures are also severe enough to cause severe stress on the spine, particular the lumbosacral area. The records also show that the Veteran was subject to frequent falls, which cause stress and injury to the spine. Therefore, while the reported in-service injury may have played some part in the later development of the degenerative dis disease, based upon the available evidence, it is less likely than not that it played at least a 50 percent role in the development of the Veteran's degenerative disc disease. As explained above, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson, 581 F. 3d 1313; Jandreau, 492 F. 3d 1372. While there are contrasting medical opinions of record, the Board finds the most recent November 2020 opinion by Dr. L.K. most probative. See Owens, 7 Vet. App. 429. As pointed out by Dr. L.K., Dr. J.K. failed to consider and address several injuries resulting in back pain between discharge from service and the diagnosis of a low back disability. Further, his statement that the cause of the back disability was at least as likely as not multi-factorial in origin but that the in-service injury was included as a factor falls short of the requisite standard of 50 percent or greater probability. Dr. L.K., on the other hand, considered the objective medical evidence and provided a logical explanation for the Veteran's current condition, to include a fractured pelvis in a motor vehicle accident and falls at home putting stress on the spine. Dr. L.K. found no evidence to support an in-service injury, and therefore opined it was less likely than not related to service. Regarding the Veteran's testimony as it relates to his back, the Board finds him not credible. First, while he has stated he was treated in service for his back, the service records do not support this. Second, while he has endorsed pain since his in-service injury, he did not endorse pain at separation. See Curry, 7 Vet. App. at 68. Third, the Veteran was inconsistent with his reported onset of back pain throughout the medical records. The Board finds that the weight of the evidence is against the Veteran's claim. The most probative medical evidence of record attributes the Veteran's low back disability to post-service accidents and/or injuries. There is no evidence of an in-service injury aside from the Veteran's testimony, which the Board has deemed not credible. While the Veteran has a chronic disease under 38 C.F.R. § 3.309 (a), his degenerative disc disease did not manifest in service sufficient to establish chronicity at the time. Nor is continuity of symptomatology established as the condition was not noted during service. Thus, service connection under this theory of entitlement is not applicable. As the evidence is against an in-service incurrence, the Veteran's claim must be denied. REASONS FOR REMAND 5. New and material evidence - hypertension In its May 2019 decision, the Board found that because the Veteran was contending his hypertension was secondary to his claimed condition of PTSD, the claims are inextricably intertwined, and the hypertension claim must be deferred pending resolution of the acquired psychiatric claim remanded in that decision. Following the May 2019 decision, the psychiatric and hypertension claims were placed into separate appeal streams, and at the time of this decision, the psychiatric claim remained on appeal at the Board pending a hearing. A letter was sent to the Veteran in July 2021 requesting clarification on whether he desired a hearing on his hypertension claim as well. No response was received within 30 days as requested in the letter; as explained in the letter, the Board must assume the Veteran does not want a hearing as to that claim because he has not requested one. Nevertheless, as the claim has already been deemed inextricably intertwined with another claim currently pending on appeal, the Board finds that adjudication must be deferred adjudication of the intertwined psychiatric claim. The matter is REMANDED for the following action: After the Veteran's claim for service connection for a psychiatric disability is adjudicated, adjudicate his intertwined hypertension claim. L.M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Carroll, Associate 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.