Citation Nr: 21066826 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 07-26 212 DATE: November 2, 2021 ORDER Entitlement to service connection for hypertension is denied. Entitlement to service connection for diabetes mellitus is denied. REMANDED Entitlement to service connection for residuals of left leg fracture is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that hypertension began during active service, or is otherwise related to an in-service event, injury, or disease. 2. The preponderance of the evidence is against finding that diabetes mellitus began during active service, or is otherwise related to an in-service event, injury, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension are not met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309. 2. The criteria for service connection for diabetes mellitus are not met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1976 to May 1979. He also had additional unconfirmed periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA)in the reserves. In March 2020 the Board remanded the issues of service connection for hypertension and diabetes mellitus for further development, and the case has since been returned to the Board. The Board finds that the agency of original jurisdiction (AOJ) has substantially complied with the remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In August 2021 the Board remanded the issue of service connection for residuals of left leg fracture for further development, and the case has since been returned to the Board. The Board finds that the agency of original jurisdiction (AOJ) has not substantially complied with the remand directives. Id. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § § 3.303(a). To establish a right to compensation for a present disability, a veteran must show: (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 or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Entitlement to service connection for hypertension The Veteran contends that his hypertension occurred while he was serving in the reserves. STRs are silent for any complaints, diagnosis, or treatment for hypertension. VAMC treatment records indicate diagnosis and treatment of hypertension but no indication on its etiology. There is no diagnosis of hypertension in the records between the end of the Veteran's active service in 1979 and the May 2006 VA medical treatment records indicating a "1985" assessment of hypertension, more than 5 years after service. This delay, while not conclusive, weighs against the establishment of service connection. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board's denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). Further, while the Board notes the multiple VA and private treatment records indicating said history, none speak to the onset of hypertension. In addition, the Veteran has not provided any medical documentation indicating his condition is the result of his active service. While the Veteran believes his hypertension is related to an in-service injury, event, or disease, he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). There is no showing of an in-service injury or disease to which the current hypertension diagnosis may relate, and no basis shown for an award of benefits for chronic disability seen in the first post service year or based on continuity of symptoms. These facts render no need for any further examination or opinion and provide no basis for an award of service connection for hypertension. In conclusion, the weight of the evidence is against the claim for service connection for hypertension. Entitlement to service connection for diabetes mellitus The Veteran contends that his diabetes mellitus occurred while he was serving in the reserves. STRs are silent for any complaints, diagnosis, or treatment for diabetes mellitus. VAMC treatment records indicate diagnosis and treatment of diabetes mellitus but no indication on its etiology. There is no diagnosis of diabetes mellitus in the records between the end of the Veteran's active service in 1979 and the October 1999 St. Francis Hospital treatment record VA indicating an assessment of diabetes mellitus, more than 20 years following service. This delay, while not conclusive, weighs against the establishment of service connection. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board's denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). Further, while the Board notes the multiple VA and private treatment records indicating said history, none speak to the onset of diabetes mellitus. In addition, the Veteran has not provided any medical documentation indicating his condition is the result of his active service. While the Veteran believes his diabetes mellitus is related to an in-service injury, event, or disease, he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). There is no showing of an in-service injury or disease to which the current diabetes mellitus diagnosis may relate, and no basis shown for an award of benefits for chronic disability seen in the first post service year or based on continuity of symptoms. These facts render no need for any further examination or opinion and provide no basis for an award of service connection for diabetes mellitus. In conclusion, the weight of the evidence is against the claim for service connection for diabetes mellitus. REASONS FOR REMAND Entitlement to service connection for residuals of left leg fracture is remanded. In the August 2021 Board remand, the Board noted that while the October 2018 examiner addressed whether the Veteran had a left leg fracture that was related to service, the examiner diagnosed the Veteran with a left leg strain at the VA examination and it was unclear whether that strain was due to service or due to a service-connected disability and the issue was remanded for an additional VA opinion. In September 2021, an opinion on proximation and aggravation was provided. However, the examiner failed to provide a direct opinion was required by the previous remand. Accordingly, an additional remand is required for an addendum direct opinion. The matters are REMANDED for the following action: Return the claims file to the VA examiner who conducted the October 2018 knee and lower leg examination and opinion, or to a qualified medical professional if the examiner is unavailable. The electronic claims file must be made accessible to the examiner. After reviewing the record, including this Remand, the examiner should address the following: Opine whether it is at least as likely as not (50 percent or greater probability) that the left leg strain diagnosed at the October 2018 VA knee and lower leg examination is related to the Veteran's military service. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. A. Elliott II, 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.