Citation Nr: 21070596 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 19-08 179 DATE: November 24, 2021 ORDER Entitlement to service connection for a skin disability, to include as due to exposure to herbicides agents (claimed as a sore/rash on body/eczema), is denied. Entitlement to service connection for hypothyroidism is granted. Entitlement to service connection for a back disability (claimed as problems standing up straight without deliberate effort) is granted. Entitlement to service connection for a right arm disorder (claimed as nerve pain right arm and numbness in fingers) is granted. Entitlement to service connection for a left arm disorder (claimed as numbness in left fingers) is granted. Entitlement to service connection for a left hip disability is granted. Entitlement to service connection for a right hip disability is granted. Entitlement to service connection for a right knee disability is granted. Entitlement to service connection for a left knee disability is granted. REMANDED Entitlement to service connection for an eye disorder, including dry eyes, to include as secondary to hypothyroidism, is remanded. FINDINGS OF FACT 1. The probative evidence of record does not show that the Veteran has a current skin disability or has had one at any time during the appeal period. 2. The Veteran is presumed to have been exposed to herbicide agents. 3. The Veteran's hypothyroidism is presumed to be due to exposure to herbicide agents. 4. The probative evidence of record shows that the Veteran's back disability was incurred in service or related to incidents therein. 5. The probative evidence of record shows that the Veteran's right arm disability was incurred in service or related to incidents therein. 6. The probative evidence of record shows that the Veteran's left arm disability was incurred in service or related to incidents therein. 7. The probative evidence of record shows that the Veteran's right hip disability was incurred in service or related to incidents therein. 8. The probative evidence of record shows that the Veteran's left hip disability was incurred in service or related to incidents therein. 9. The probative evidence of record shows that the Veteran's right knee disability was incurred in service or related to incidents therein. 10. The probative evidence of record shows that the Veteran's left knee disability was incurred in service or related to incidents therein. CONCLUSIONS OF LAW 1. The criteria for service connection for a skin disorder are not met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 2. The criteria for service connection for hypothyroidism are met. 38 U.S.C. §§ 1110, 1116, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307. 3. The criteria for service connection for a back disorder are met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for a right arm disorder are met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for a left arm disorder are met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for a right hip disorder are met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 7. The criteria for service connection for a left hip disorder are met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 8. The criteria for service connection for a right knee disorder are met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for service connection for a left knee disorder are met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1967 to June 1971. The issue comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of July 2018 by a Department of Veterans Affairs (VA) Regional Office. In March 2020, the Veteran and his spouse, T. P., testified at a Board hearing held at the Central Office, in Washington, D.C., before the undersigned Veterans Law Judge (VLJ). A copy of the transcript is of record. The Board has expanded the Veteran's above service connection claims as characterized above. Under Clemons v. Shinseki, 23 Vet. App. 1 (2009), the scope of a disability claim includes any disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record. In a March 2018 Report of General Information (RGI), the RO indicated that it was unable to obtain medical records from VAMC DC for the period of February 10, 2018, to February 11, 2018. Thus, those medical records were determined unavailable. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity for certain diseases. 38 C.F.R. §§ 3.303 (a), (b), 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). To establish service connection for the claimed disorder, there must be (1) medical 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. 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247, 253 (1999); Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). 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. The Board must then determine if the evidence is credible or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). The third step of this inquiry requires the Board to weigh the probative value of the evidence considering the entirety of the record. The standard of proof to be applied in decisions on claims for veterans' benefits is outlined in 38 U.S.C. § 5107 (2012). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. Alemany v. Brown, 9 Vet. App. 518 (1996). 1. Entitlement to service connection for a skin disability, to include as due to exposure to herbicides agents, is denied. Before his Board hearing, the Veteran contended that he had a sore/rash on his body that was incurred in service. Specifically, he testified that while stationed at Korat Air Force Base in Thailand, his barracks were close to the runway, where he believed that Agent Orange was sprayed to keep the foliage down. The Board will not address his assertion that he was exposed to herbicides in Thailand. A travel voucher from February 1969 shows that on January 11, 1969, he arrived in Saigon, in the Republic of Vietnam at 7:30am. Because he was in Vietnam during the Vietnam Era, he is presumed to have been exposed to herbicide agents. He developed a rash that continued after service, for which he tried to remedy it with the use of powder to lotion. He also testified that his in-service treatment records (STRs) are absent any complaint, treatment, or diagnosis of a skin disorder or symptoms thereof. Additionally, upon his leaving the Air Force in 1971, he was not afforded an exit examination. In the 80s, post-service, after 12 or 16 years of self-medicating, he saw a doctor at Howard University Hospital who gave him medicine that cleared up the problem "six months after." In response to the Judge's question of when the last time was that he had the rash, the Veteran indicated "probably, '88, '89. But, after that, [he] got something on [his] back and neck ... [a]nd the doctor had to do [an] operation, to get it, get it out in the '90s, or early 2000s." Post-service treatment records dated in September 2013 show a sole entry of skin tags on neck, which were "too small for derm referral at this point- pt to call back if they get larger rash to thigh: appears to be like eczema. Triamcinolone 0.1% cream q day x 4 weeks was prescribed, and the Veteran was told to call back if the "if not better afterward." Based on the evidence as presented, the Board finds that service connection is not warranted for a skin disability. The lay and medical evidence does not support the Veteran having a current skin disability or symptoms of a disability I don't that was incurred in service and continued. The Board acknowledges the Veteran's rash and skin tags of September 2013. However, since then, and especially at the filing of the claim in 2018, the record is void of any complaint, treatment, or diagnosis of a skin condition. The existence of a current disability is the cornerstone of a claim for VA disability compensation. Degmetich v. Brown, 104 F. 3d 1328 (Fed. Cir. 1997); Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). In the absence of evidence of a current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Accordingly, the preponderance of the evidence of record is against the claim, and service connection for a skin disorder must be denied on a direct basis. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence is against the claim, and the claim is denied. 2. Service connection for hypothyroidism is granted. The Veteran's VA treatment records show that he has hypothyroidism. As discussed above, he landed in Saigon, in the Republic of Vietnam, while traveling from the United States to Thailand. He is presumed to have been exposed to herbicide agents. Hypothyroidism is presumptively associated with exposure to herbicide agents. 38 U.S.C. § 1116 (a)(2). Service connection for hypothyroidism is therefore granted. 3. Entitlement to service connection for a back disability is granted. 4. Entitlement to service connection for a right arm disorder, to include as secondary to a back disability, is granted. 5. Entitlement to service connection for a left arm, to include as secondary to a back disability, is granted. 6. Entitlement to service connection for a left hip disability, to include as secondary to a back disability, is granted. 7. Entitlement to service connection for a right hip disability, to include as secondary to a back disability, is granted. 8. Entitlement to service connection for a right knee disability, to include as secondary to a back disability, is granted. 9. Entitlement to service connection for a left knee disability, to include as secondary to a back disability, is granted. The Veteran has been diagnosed with degenerative changes of C and L-spine with central canal stenosis at C6-C7. He contends that his disability is a result of service. The Veteran's post-service treatment records show complaints of chronic back pain. Treatment records dated in November 2016 noted the Veteran's complaint of back pain and his report of feeling like he was moving slower. Also, he reported occasional numbness, tingling in the left leg, lasting 3-7 days and occurring about once every two months. Treatment notes dated in March 2017 note that the Veteran had multilevel degenerative changes to his back. The clinician noted that his left pain was "possibly referred from lumbar spine" disability. He competently and credibly testified that he engaged in reconnaissance training school where he jumped out of aircraft during paratrooper landing falls. During those falls, he had to close his knees and ankles together, land with his feet/knees together, and then roll on his hips to dissipate the impact. Moreover, he participated in 16 - 20 jumps from 34-foot towers. During his last jump, he injured himself but did not say anything because he wanted to get home. Once home, his 87-year-old grandmother gave him home remedies, including Epsom Salt, balms, and rags which she wrapped on his back, helped him to manage the pain. Additionally, he testified to hurting his back further while in Thailand performing the missions, with the carrying of heavy equipment on his back weighing 40 pounds and more, to and from the plane. Also, he testified to not having any concurrent injuries and/or participating in other labor-intensive/physical activities/jobs that may have injured his back, arms, or hips, or knees. As a matter of fact, he reported that post-military, he was an electrical engineer, lawyer, and a student of Theology. His wife, T. P., also testified that she has known the Veteran since 1972, meeting him at Tuskegee, and he had complaints of back pain since then, in the '70s, '80s, and '90s. He talked to her about his jumping out of airplanes and explained how he had to fall. She "thought that was weird, the way they taught them to fall. Because any fall, even from a level surface, if that impacts your butt, your back, all of that, ... you may not feel it, initially." Over the years, she nursed his back pain by massaging and rubbing his back and offering him medication. She also saw changes in his mobility, decreased activity level, and posture. "The [Veteran whom] I met at Tuskegee, [was] slowly becoming bent forward." T. P. further testified that over the years, she diagnosed the Veteran with a back injury. The Veteran also testified that a pinched nerve at C5 and C6 and stenosis causes pain that goes to the right and left arms and fingers, where he is rendered unable to grip anything. Furthermore, the pain runs down the hips and legs, causing constant knee pain, which he rated at 7/8, and instability which forces him to hold on to the railings when he walks to prevent falling. In a March 2018 statement of record, he stated that while in service, he experienced tingling and loss of strength in his hands and fingers, and aches in hips and knees, which continued. The evidence of record shows a May 1972 VA Request for Information for an "alleged diseased or injury" and noting arm and hand conditions and treatment therefor, in June 1971. A June 1972 Report of Medical Examination for Disability Evaluation noted the Veteran's report of acute pain on the right side, "maybe 10-12 times per month" and lasting "2 to 5minutes," since service in 1968. He also reported weakness and lost strength in the grip in the left hand that started while in Thailand and Vietnam. The evidence of record confirms degenerative changes in the bilateral hip. However, there is no medical evidence of diagnoses of any bilateral hand or knee disabilities. Nonetheless, as the Veteran has testified to having had pain in the bilateral hand and knees since service and a functional loss stemming therefrom, bilateral hand and knee disabilities are established. Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Cir. 2018). As to a nexus to service for the above-said disabilities, T. P. credibly and competently testified, in her capacity as a registered nurse with over 40 years of experience, that the pain that he suffers from in his musculoskeletal body and his extremities, today, is a likely result of what he endured in the military. The Board affords this opinion most probative to a finding that the Veteran's back, bilateral hand, bilateral hip, and bilateral knee disabilities are a result or service. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (noting that the probative value of a medical opinion comes from its being factually accurate, fully articulated, and having a sound reasoning for the conclusion.). Thus, this credible and competent medical evidence satisfies the nexus element of the service connection claim. Shedden, 381 F.3d at 1166-67. In such a finding, the Board notes that T. P. is a qualified medical professional who possesses the relevant information, training, and sufficient expertise, and skills needed to diagnose and determine the etiology of the Veteran's back, bilateral hand, bilateral hip, and bilateral knee disabilities. Specifically, she is a licensed registered nurse, with a Bachelor of Science in Nursing, with over 40 years of experience taking care of patients with diagnoses "ranging from anything medical to surgical." She cared for post-transplant patients, preparing patients for transplant and patients with a myriad of diseases and conditions. She has also cared for patients who have jumped out of windows at her hospital and have had back disabilities therefrom. Further, there is not any competent medical evidence of record that contradicts the comprehensive findings her findings. Accordingly, the Board finds that the preponderance of the evidence of record weighs in favor of the Veteran's back, bilateral hand, bilateral hip, and bilateral knee disabilities starting in service and continued. Thus, the Board finds that service connection is granted for the said claims. 38 U.S.C. § 5107 (b) (2012); 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to service connection for dry eyes, to include as secondary to a thyroid disorder, is remanded. The Veteran contends that he has an eye disorder, to include dry eyes that was incurred in service. Also, he avers a secondary service connection theory to his thyroid disorder. During his Board testimony, the Veteran's agent noted that the Veteran's eye disorder might be a symptom of his now service-connected hypothyroidism. There is no medical nexus opinion of record. A medical opinion is necessary to decide the claim. Accordingly, the matters are REMANDED for the following action: 1. Provide the Veteran's claims file to a qualified clinician to provide an examination addressing the nature and etiology of his eye disorder. A physical or telehealth examination of the Veteran is only required if deemed necessary by the clinician. The entire claims file and a copy of this remand must be made available to the clinician to review. Although an independent review of the claims file is required, the Board calls the clinician's attention to the following: a. May 1972 Request for Information for an "alleged diseased or injury," and noting an "eye condition" and treatment therefor in 1971. b. June 1972 Report of Medical Examination for Disability Evaluation finding "no demonstrable eye disability." c. Treatment notes dated in September 2013 noting a complaint of shooting star out of the right eye and a referral to the eye clinic to r/o retinal detachment. d. March 2021 Board testimony. The clinician is asked to opine as to the following: a. Whether the Veteran's dry eye disorder is a symptom of his hypothyroidism. b. IF it is determined as a separate disability from his hypothyroidism, opine as to whether it is at least as likely as not (50 percent or greater probability) that it had its onset in and/or are otherwise etiologically related to his period of active service. c. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's eye disorder is proximately due to or the result of his hypothyroidism. d. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's eye disorder has been aggravated beyond its natural progression by his hypothyroidism. The clinician must provide a complete rationale for his or her opinion(s) in the examination report that reflects consideration of all pertinent evidence of record, including the Veteran's lay statements. (Continued on the next page) If any of the above-requested opinions cannot be made without resorting to speculation, the clinician must state this and provide a rationale for such a conclusion. 2. Then readjudicate the claim. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Stevens, 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.