Citation Nr: 21065373 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 20-20 243 DATE: October 26, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) is granted. Entitlement to service connection for migraine headaches is granted. Entitlement to service connection for a back disability is denied. Entitlement to service connection for a neck disability is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a left knee disability is denied. REMANDED Entitlement to service connection for hypertension is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is for finding that the Veteran's psychiatric disorder began during active service or is otherwise related to an in-service injury or disease. 2. The Veteran's migraine headache disability is proximately due to his service connected tinnitus. 3. The preponderance of the evidence does not show that the Veteran's back disability began during active service or is otherwise related to an in-service injury or disease. 4. The preponderance of the evidence does not show that the Veteran's neck disability began during active service or is otherwise related to an in-service injury or disease. 5. The preponderance of the evidence does not show that the Veteran's right knee disability began during active service or is otherwise related to an in-service injury or disease. 6. The preponderance of the evidence does not show that the Veteran's left knee disability began during active service or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The requirements for establishing service connection for the Veteran's acquired psychiatric disorder have been met. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for establishing service connection for the Veteran's migraine headache disability have been met. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for establishing service connection for the Veteran's back disability have not been met. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for establishing service connection for the Veteran's neck disability have not been met. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for establishing service connection for the Veteran's right knee disability have not been met. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for establishing service connection for the Veteran's left knee disability have not been met. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Navy from July 1986 to October 1988. In March 2021, the Board remanded the case to the Agency of Original Jurisdiction (AOJ) for the Veteran to receive VA examinations for all his disabilities. The Veteran received VA examinations in June 2021. The Board finds that the nexus opinions provided an adequate rationale for each of his disabilities. Accordingly, the Board finds there has been substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). However, as discussed in the remand portion below, the Board finds that a remand is necessary for his hypertension claim as he was not afforded a VA examination for this disability. A VA examination for the Veteran's hypertension was not requested in the previous Board remand. Neither the Veteran nor his representative have raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. To establish service connection for the claimed disorder, there must be (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical, or in certain circumstances, lay evidence of a nexus between the claimed in-service disease or injury and the current disability. See 38 C.F.R. § 3.303 (2021); see also Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. Second, the Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). Third, the Board must weigh the probative value of the evidence in light of the entirety of the record. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102 (2021). When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 4 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). 1. An acquired psychiatric disorder, to include PTSD Establishing service connection for PTSD requires (1) medical evidence diagnosing PTSD in accordance with 38 C.F.R. § 4.125(a); (2) a link, established by medical evidence, between a veteran's present symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. See 38 C.F.R. § 3.304(f) (2021). For VA purposes, a mental disorder diagnosis must conform to the Fourth Edition of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-IV), or, for claims received by or pending before the AOJ on or after August 4, 2014, the Fifth Edition (DSM-5). See 38 C.F.R. §§ 4.125, 4.130; 79 Fed. Reg. 45093 (Aug. 4, 2014). This case was first certified to the Board after August 4, 2014; thus, the regulation changes regarding the release of the DSM-5 applies to the Veteran's claim. The Veteran reported his in-service stressor as witnessing the death of a fellow soldier on the flight deck. He also stated that his in-service disciplinary issues were caused by his mental health struggles. His medical records document his diagnoses of PTSD, depression, and schizophrenia. In June 2021, the Veteran received a VA examination. The examiner opined that the Veteran met the DSM-5 criteria for PTSD and that his PTSD was caused by the traumatic events experienced in service. Specifically, the examiner noted the Veteran's stressor of seeing his fellow soldier killed on the flight deck as the traumatic event. The examiner also noted that schizophrenia is a genetic condition but can be exacerbated by traumatic events. The Board finds service connection for his psychiatric disorder is warranted. The June 2021 VA examiner provided competent, credible evidence of a nexus to service for the Veteran's PTSD. Consequently, as there is no negative, probative evidence of record, the preponderance of the evidence is in the Veteran's favor and service connection is warranted. 2. Migraine Headaches Service connection may be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disability or injury. 38 C.F.R. § 3.310(a) (2021). Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(a) (2021); Allen v. Brown, 7 Vet. App. 439, 448 (1995). To establish entitlement to service connection on this secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The June 2021 VA examiner opined that the Veteran's headache disability was related to his service connected tinnitus. The examiner noted that the medical literature supported a relationship between tinnitus and headaches. Consequently, his tinnitus was the most likely cause of his headaches. Therefore, as the VA examiner provided competent, credible evidence of a relationship between the Veteran's tinnitus and headaches, service connection on a secondary causation basis is warranted. 3. Back, Neck, Left and Right Knees The Veteran received VA examinations for his back, neck, and knees in June 2021. The diagnoses were right knee arthritis, left knee strain, cervical strain, and lumbosacral strain. For each disability the examiner noted that the Veteran's service records showed no documentation for treatment or complaints. Likewise, the Veteran reported the onset of his symptoms years after service. He reported that his back pain started about 10 years ago, his neck pain began around 2015, and his knees started hurting around 2007. Accordingly, the examiner opined his disabilities were not related to service. The Board finds that the preponderance of the evidence is against the Veteran's claims. There is nothing in the Veteran's service records to show that he received treatment for any back, neck, or knee issues. Similarly, the Veteran has not advanced any lay evidence connecting his disabilities to service. Although arthritis is a chronic disease as set forth in 38 C.F.R. § 3.309(a), his right knee arthritis did not manifest within one year of separation from service. The Veteran reported onset of symptoms in 2007. Presumptive service connection is not warranted for his right knee arthritis. Additionally, at the VA examinations he reported the onset of his disabilities as many years after service, which provides probative evidence against continuity of symptoms. A grant of service connection for right knee arthritis under 38 C.F.R. § 3.303(b) is not warranted because there was not continuity of symptoms. For his left knee, cervical, and lumbosacral strains, his reports of onset of symptoms many years after service is probative evidence against the claim. The preponderance of the probative evidence is against the Veteran's claims, the Board finds that service connection for a back disability, neck disability, right knee disability, and left knee disability is not warranted. REASONS FOR REMAND Hypertension The Veteran contends that his hypertension is due to his service connected psychiatric disorder; however, he has not been afforded a VA examination to determine a possible relationship between the two disabilities. Thus, the Board finds a remand is necessary for the Veteran to receive a VA opinion that determines if his hypertension is proximately due to or aggravated by his service-connected psychiatric disorder, including PTSD. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination with an appropriate clinician for his hypertension. The entire claims file and a copy of this remand must be made available to the examiner for review. The examiner must opine as to the following: a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's hypertension began during active service, is related to an incident of service, or began within one year after discharge from active service. b.) Whether it is at least as likely as not that the Veteran's hypertension was proximately due to or the result of his service connected acquired psychiatric disorder. c.) Whether it is at least as likely as not that the Veteran's hypertension was aggravated beyond its natural progression by his service-connected acquired psychiatric disorder. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 2. Then, readjudicate the claim. If any decision is adverse to the Veteran, issue a Supplemental Statement of the Case and allow the applicable time for response. Then return the case to the Board. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Brunot, 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.