Citation Nr: 21069111 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 17-16 771 DATE: November 17, 2021 ORDER Entitlement to service connection for a thyroid disorder is denied. Entitlement to service connection for a gastrointestinal disorder is denied. Entitlement to service connection for a sleep disorder is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that a thyroid disorder began during active service or is otherwise related to service. 2. The preponderance of the evidence is against finding that a gastrointestinal disorder began during active service or is otherwise related to service. 3. The preponderance of the evidence is against finding that a sleep disorder began during active service or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a thyroid disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a gastrointestinal disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 3. The criteria for service connection for a sleep disorder are not 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 had active military service from June 1982 to June 1985. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In August 2018, the case was remanded to the Agency of Original Jurisdiction (AOJ) for additional development. The matter has since returned to the Board. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence 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, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (noting that nexus may be demonstrated by a showing of continuity of symptomatology where the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a)). 1. Entitlement to service connection for a thyroid disorder The Veteran contends that service connection is warranted for his thyroid disorder as it began during, and should be connected to, active-duty service. With regard to a present disability, the Veteran appeared for a VA thyroid and parathyroid conditions examination in January 2021, at which time the examiner diagnosed the Veteran with hypothyroidism. See January 2021 C&P Exam Thyroid and Parathyroid Conditions. As such, the current-disability criterion for service connection is met. See Shedden, supra. With regard to an in-service disease or injury, the Veteran's service treatment records have been reviewed and are negative for evidence of benign neoplasms of the thyroid. At his separation examination in April 1985, the Veteran's endocrine system was normal (problems noted in the separation examination report included cramps in legs, broken bones in left forearm, and right knee sprain). See STR Medical (9/28/2015) pg. 38 of 68. As there is no evidence of any endocrine disorder in service, the second element of Shedden is not met. Moreover, the Board has closely reviewed the medical and lay evidence in the Veteran's claims file and finds no evidence that may serve as a medical nexus between his military service and his thyroid disorder. An Appellate Brief submitted in June 2018 noted a nexus letter statement from "RRC;MD Psychiatry" that diagnosed the Veteran with hypothyroidism, among other conditions, and provided an opinion that it is more likely than not related due to service. See Appellate Brief June 2018. Upon review, the only record related to Dr. RRC is from March 2016 that indicated the Veteran presented with problems with his thyroid among other issues. No nexus opinions or medical professional opinions were provided from Dr. RRC regarding the Veteran's thyroid disorder. See Medical Treatment Record Non-Government Facility (6/13/2016). The Board notes that in a private medical treatment record from May 2015, Dr. CEMQ diagnosed the Veteran with hypothyroidism among other conditions. In addition, Dr. CEMQ opined that the Veteran's metabolic disorder is more probable than not secondary to the Veteran's military service performance. See Medical Treatment Record Non-Government Facility (5/27/2015). However, the Board finds Dr. CEMQ's opinion to be inadequate and of minimum probative value. Dr. CEMQ did not indicate that he reviewed, nor did he cite to the Veteran's service treatment records to support his opinion. Moreover, he did not provide a sufficient rationale for his positive nexus opinion. Some bases for finding medical examinations and opinions inadequate include opinions that contain only data and conclusions, do not provide an etiological opinion, are not based upon a review of medical records, or provide unsupported conclusions. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). As a result, the Board finds Dr. CEMQ's opinion to be inadequate and of minimum probative value. As noted above, the Veteran appeared for a VA thyroid and parathyroid conditions examination in January 2021. There, the VA examiner opined that it was less likely as not that the Veteran's hypothyroidism was incurred in or caused by service. In support, the VA examiner noted that hypothyroidism is a common endocrine disorder resulting from deficiency of thyroid hormone and that it usually is a primary process in which the thyroid gland is unable to produce sufficient amounts of thyroid hormone. The VA examiner also noted that worldwide, iodine deficiency remains the foremost cause of hypothyroidism and in the United States and other areas of adequate iodine intake, autoimmune thyroid disease (Hashimoto disease) is the most common cause. The VA examiner indicated that hypothyroidism may also be drug-induced or otherwise iatrogenic. The VA examiner indicated that there was no evidence on record of iodine deficiency, drug induced, or autoimmune thyroid disease. See January 2021 C&P Exam Medical Opinion. The Board finds the January 2021 VA medical opinion to be the most probative evidence of record, as the VA examiner based his opinion on a review of the Veteran's in-service treatment records, post-service medical records, and provides support for his conclusion. Furthermore, the VA examiner's opinions are consistent with the overall record, as none of the Veteran's VA treatment records referenced his military service regarding or otherwise link it to his thyroid disorder. The Board notes that aside from the Veteran's contention that his thyroid disorder should be service connected, the Veteran has provided no specific arguments or evidence in support of this claim nor has he identified a particular event or injury in service that he believes caused this disorder. Nevertheless, the Veteran's contention that his thyroid disorder should be service connected is an issue that is medically complex, as it requires knowledge of anatomical relationships. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training 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). Although the Board is sympathetic to the Veteran's claim, the preponderance of the evidence is against a finding that service connection for a thyroid disorder is warranted. Accordingly, the claim must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001). 2. Entitlement to service connection for gastrointestinal disorder The Veteran contends that service connection is warranted for his gastrointestinal disorder as it began during, and should be connected to, active-duty service. In any event, the Board first notes that, when resolving reasonable doubt in the Veteran's favor, the "current disability" element has been satisfied with respect to these claims. The Veteran appeared for a VA intestinal conditions examination in January 2021, at which time the examiner diagnosed gastritis and gastroesophageal reflux disease without esophagitis (GERD). See January 2021 C&P Exam Intestinal Conditions pg. 5 of 7. As such, the current-disability criterion for service connection is met. See Shedden, supra. With regard to an in-service disease or injury, the Veteran's service treatment records have been reviewed and are negative for evidence of reports or treatment for gastritis, GERD, or any gastrointestinal symptomatology. While there was one instance of constipation in the Veteran's service treatment records in May 1985, this was a symptom associated with a flu. See STR Medical (9/28/2015) pg. 15 and 17 of 68. Most notably, the Veteran's April 1985 separation examination revealed no abnormalities of the gastroesophageal system (problems noted in the separation examination report included cramps in legs, broken bones in left forearm, and right knee sprain). Id. at 38 of 68. As there is no evidence of any gastrointestinal disorders in service, the second element of Shedden is not met. After careful review, the Board finds that the preponderance of the evidence is against the Veteran's claims for service connection for gastrointestinal disorder. As previously mentioned, an Appellate Brief from June 2018 noted a positive nexus opinion from Dr. RRC as to chronic gastritis. However, Dr. RRC did not mention anything related to the Veteran's gastrointestinal disorder. See Medical Treatment Record Non-Government Facility (6/13/2016). In a private treatment record from May 2015, Dr. CEMQ diagnosed the Veteran with, among other conditions, GERD, and chronic gastritis. There, the Veteran presented with nausea, vomits, flatulence, fatty food intolerance, and epigastric burning type pain. Dr. CEMQ noted that gastroenterologist work-up was compatible with GERD and chronic gastritis. In addition, it was indicated that the Veteran has been in medical treatment and irritants free diet with poor control of symptoms. Dr. CEMQ opined that the Veteran's metabolic disorders are more probable than not secondary to the Veteran's military service performance. See Medical Treatment Record Non-Government Facility (5/27/2015). However, the Board gives little probative weight to Dr. CEMQ's opinions. First, Dr. CEMQ did not indicate that he reviewed, nor did he cite to anything from the Veteran's service treatment records in order to support his opinion. Moreover, Dr. CEMQ did not provide a sufficient rationale for his opinion. Some bases for finding medical examinations and opinions inadequate include opinions that contain only data and conclusions, do not provide an etiological opinion, are not based upon a review of medical records, or provide unsupported conclusions. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). As a result, the Board finds that this opinion to be inadequate and of minimum probative value. As noted above, the Veteran appeared for a VA intestinal conditions examination in January 2021. The VA examiner opined that the Veteran's gastrointestinal disorders are less likely than not incurred in or as a result of his period of active-duty service. In support, the VA examiner noted that there was no medical evidence or symptoms during service of gastrointestinal disorders, no evidence during service of chronic gastritis and gastritis reflux, and that the Veteran stated, and medical record documented he had chronic gastritis and gastric reflux since 2015. See January 2021 C&P Exam Medical Opinion. The Board finds the January 2021 VA medical opinion to be the most probative evidence of record, as the VA examiner based his opinion on a review of the Veteran's in-service treatment records, post-service medical records, and lay statements and provides support for his conclusion. The VA examiner's opinions are also consistent with the overall record, as the Veteran's post-service medical records showed that he was first diagnosed with gastritis and gastroesophageal reflux disease in 2015, which is several decades after his separation from active duty. See Medical Treatment Record Non-Government Facility (5/27/2015). Moreover, the VA examiner's opinions are consistent with the overall record, as none of the Veteran's VA treatment records referenced his military service regarding or otherwise link it to his gastrointestinal disorder. The Board notes that aside from the Veteran's contention that his gastrointestinal disorder should be service connected, the Veteran has provided no specific arguments or evidence in support of this claim nor has he identified a particular event or injury in service that he believes caused or this disorder. Nevertheless, the Veteran's contention that his gastrointestinal disorder should be service connected is an issue that is medically complex, as it requires knowledge of anatomical relationships. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training 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). In sum, because there is no competent evidence that the Veteran's current GERD or gastritis were incurred or aggravated in service, or are otherwise related to service, the claims must be denied. 3. Entitlement to service connection for a sleep disorder The Veteran contends that service connection is warranted for his sleep disorder as it began during, and should be connected to, active-duty service. The Veteran has contended a date of onset of 1984. With regard to a present disability, the Veteran appeared for a VA sleep apnea examination in January 2021, at which time the VA examiner diagnosed the Veteran with obstructive sleep apnea. See January 2021 C&P Exam Sleep Apnea. As such, the current-disability criterion for service connection is met. See Shedden, supra. With regard to an in-service disease or injury, the Veteran's service treatment records have been reviewed and are negative for evidence of a sleep disorder. As mentioned before, at the January 2021 VA examination, the Veteran reported an onset date of 1984 and noted chronic snoring, daytime sleeping, weakness, and insomnia. However, the Veteran's service treatment records were silent as to any issues with sleep. In addition, at the April 1985 separation examination, the Veteran indicated that he had no problems with frequent trouble sleeping (problems noted in the examination report included cramps in legs, broken bones in left forearm, and right knee sprain). See STR Medical (9/28/2015) pg. 38 of 68. While the record noted some issues with sleep post-service, this was associated with the Veteran's mental disorders stemming from a failed parachute incident during his service in Korea and was not associated with his obstructive sleep apnea. Here, the Board places more probative value on the contemporaneous service treatment records that show that the Veteran affirmatively denied sleep problems on separation from service. As there is no evidence of any symptomatology of obstructive sleep apnea in service, the second element of Shedden is not met. The Board has closely reviewed the medical and lay evidence in the Veteran's claims file and finds no evidence that may serve as a medical nexus between the Veteran's military service and his obstructive sleep apnea. The Board notes that in a private medical treatment record from May 2015 with Dr. CEMQ, he diagnosed the Veteran with sleep apnea among other issues. There, the Veteran presented with fatigue, excessive daytime somnolence, morning sluggishness, loud snoring with breath cessation episodes, and thrashing movements of the extremities during sleep. It was noted that a polysomnography test was diagnostic of sleep apnea and a CPAP ventilator was advised. Dr. CEMQ opined that the Veteran's pulmonary disorder is more probable than not secondary to the Veteran's military service performance. See Medical Treatment Record Non-Government Facility (5/27/2015). However, the Board gives Dr. CEMQ's opinions minimum probative value. For starters, the private treatment medical provider did not indicate that he reviewed, nor did he cite to anything from the Veteran's service treatment records to support his opinion. Moreover, Dr. CEMQ failed to provide sufficient rationale for his opinion. Some bases for finding medical examinations and opinions inadequate include opinions that contain only data and conclusions, do not provide an etiological opinion, are not based upon a review of medical records, or provide unsupported conclusions. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). As a result, the Board finds this opinion to be inadequate and of minimum probative value. The Veteran appeared for a VA sleep apnea examination in January 2021. The VA examiner opined that it was less likely as not that the Veteran's sleep apnea syndromes were incurred in or caused by service. In support of his opinion, the VA examiner noted that there was nothing found to support a positive answer in the Veteran's medical records. See January 2021 C&P Exam Medical Opinion. The Board finds the January 2021 VA medical opinion to be the most probative evidence of record, as the VA examiner based his opinion on a review of the Veteran's in-service treatment records, post-service medical records, and lay statements and provides support for his conclusion. The VA examiner's opinions are consistent with the overall record, as none of the Veteran's VA treatment records referenced his military service regarding or otherwise link it to his sleep disorder. The Board notes that aside from the Veteran's contention that his sleep disorder should be service connected, the Veteran has provided no specific arguments or evidence in support of this claim nor has he identified a particular event or injury in service that he believes caused or this disorder. Nevertheless, the Veteran's contention that his sleep disorder should be service connected is an issue that is medically complex, as it requires knowledge of anatomical relationships. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training 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). Although the Board is sympathetic to the Veteran's claim, the preponderance of the evidence is against a finding that service connection for his sleep disorder is warranted. Accordingly, the claim must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001). D. SMART Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Kim, 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.