Citation Nr: 21073577 Decision Date: 12/09/21 Archive Date: 12/09/21 DOCKET NO. 18-45 840 DATE: December 9, 2021 ORDER Entitlement to service connection for a prostate disability is denied. Entitlement to service connection for an acquired psychiatric disability other than posttraumatic stress disorder (PTSD), to include depression and generalized anxiety disorder is denied. Entitlement to service connection for diabetes mellitus is denied. Entitlement to service connection for hypertension is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran's prostate condition began during active service, or is otherwise related to an in-service injury, event, or disease. 2. The preponderance of the evidence of record is against a finding that the Veteran's acquired psychiatric disorders, to include anxiety and depression, are related to service. 3. The preponderance of the evidence weighs against a finding that the Veteran's diabetes mellitus was incurred during or as a result of service or manifest to a compensable degree within one year of service. 4. The preponderance of the evidence weighs against a finding that the Veteran's current hypertension was incurred during or as a result of service or manifest to a compensable degree within one year of service. CONCLUSIONS OF LAW 1. The criteria for service connection for a prostate condition are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for an acquired psychiatric disorder are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for diabetes mellitus are not met. 38 U.S.C. §§ 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1956 to November 1958. These matters come before the Board of Veterans' Appeals (Board) on appeal from an April 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously before the Board in February 2019 and February 2021 and were remanded for additional development. The case is once again before the Board. In May 2021, the Veteran executed a VA Form 21-22a, power of attorney, naming S.G.G. as an individual providing representation under 38 C.F.R. § 14.630. Under this provision, an unaccredited individual may represent a veteran one time only so long as a VA Form 21-22a along with a statement signed by the representative and veteran that no compensation shall be paid to the representative is submitted. A review of the VA Form 21-22a submitted in May 2021 shows that the box for an "individual providing representation under section 14.630" was selected. Additionally, no fee agreement is of record, and the individual has never requested the payment of fees from VA, further evidencing the intention to provide representation under Section 14.630. In light of the foregoing, the Board finds that the requested representative is his valid representative for this appeal but will not be permitted to represent him for any other claim in the future absent an applicable exception. SERVICE CONNECTION Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an 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, the so-called "nexus" requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 1. Prostate The Veteran contends his prostate condition is a result of his service. The record indicates that the Veteran was diagnosed with benign prostate hypertrophy (BPH) beginning in 1997. Benign prostate hyperplasia/hypertrophy is defined as an age-associated enlargement of the prostate. See Dorland's Illustrated Medical Dictionary ("Dorland's"). The Veteran's service treatment records do not demonstrate any diagnosis or treatment for the prostate. Additionally, there is no evidence of an ongoing prostate disability on the Veteran's August 1958 separation examination. The 1958 examiner reported the Veteran's genitourinary and urogenital systems were clinically normal. In a corresponding report of medical history, the Veteran self-reported that he was "in good health" and denied having any urinary troubles. In November 2019, a VA examiner found the Veteran's prostate condition less likely than not related to service. Unfortunately, the examiner did not provide sufficient rationale to support their finding. Pursuant to the February 2021 Board remand, a new opinion was obtained. In April 2021, a VA examiner found the Veteran's prostate condition less likely than not related to his service. The examiner reasoned that there was no indication of a prostate condition in service or documentation that the condition began before 1997 and BPH is an age-related prostate gland enlargement that eventually causes urinary difficulty. The examiner concluded that there was no nexus between the Veteran's service and his current prostate condition, and his current condition is related to his age. The Board concludes that, while the Veteran has a current diagnosis of BPH, the preponderance of the evidence weighs against finding that the Veteran's disability began during service or is otherwise related to an in-service injury, event, or disease. The Board acknowledges the Veteran's statements that his prostate disability is related to his service. However, the Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the etiology and pathology of prostate disorders. 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 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the February 2021 VA medical opinion which establishes that the Veteran's prostate condition is attributable to the natural aging process. Moreover, there is no credible evidence to the contrary. Accordingly, the Board finds that the preponderance of the evidence is against a finding of service connection for a prostate disability and the claim must be denied. In denying such rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5170; 38 C.F.R. §§ 4.3, 4.7. 2. Acquired psychiatric The Veteran contends that his acquired psychiatric condition, to include anxiety and depression, is related to his service. The record does not indicate that the Veteran has been diagnosed with PTSD and the Veteran specifically stated that he was not seeking service connection for PTSD. See August 2018 Report of general information. The record shows the Veteran is treated for depression and generalized anxiety disorder. The Veteran's service treatment records do not demonstrate any diagnosis or treatment for a mental disorder. Additionally, there is no evidence of ongoing psychiatric treatment on the Veteran's August 1958 separation examination. In a corresponding report of medical history, the Veteran specifically denied "nervous trouble of any sort" on his self-reported medical history. In December 2019, a VA examiner diagnosed the Veteran with generalized anxiety disorder and found his condition less likely than not related to service given the lack of treatment in service and the length of time between service and the initial diagnosis. The examiner concluded that the Veteran's depression did not meet the diagnostic criteria for established mental disorders but noted that the Veteran's depression was related to sleeplessness since his spouse was diagnosed with cancer. In February 2021, pursuant to a Board remand, a VA examiner diagnosed the Veteran with generalized anxiety disorder associated with depression. The examiner determined the Veteran's depression manifested to generalized anxiety - noting the Veteran's initial diagnosis of anxiety. The examiner found the Veteran's mental disorders less likely than not related to service because there was no evidence of a temporal or causal relationship between the Veteran's service and his current diagnosis. Finding instead that the Veteran's condition manifested following his spouse's diagnosis of breast cancer. Post service treatment records demonstrate the Veteran's depression and anxiety are related to various factors other than his service. As noted, his initial depression was related to his spouse's health. In September 2016, the Veteran reported depression and anxiety related to economic problems. In December 2017, the Veteran stated his symptoms related to his general situation because of Hurricane Maria. And in May 2019, the Veteran reported marital concerns causing his emotional symptoms. The preponderance of evidence is against finding the Veteran's mental disorders are related to service. The Veteran himself reports that his condition is related to service. As noted above, the Veteran does not have the medical training to make such diagnostic conclusions. Consequently, the Board gives more probative weight to the February 2021 examiner's opinion. The Board finds the June 2015 opinion highly probative as it was made by a medical professional with consideration of the specific facts in this case and after examination of the Veteran. Moreover, there is no competent evidence to the contrary. Accordingly, the Board finds that the preponderance of the evidence is against a finding of service connection for an acquired psychiatric disability and the claim must be denied. In denying such rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5170; 38 C.F.R. §§ 4.3, 4.7. 3. Diabetes 4. Hypertension In addition to service connection on a direct basis as delineated above, service connection may be granted on a presumptive basis for certain chronic diseases, to include diabetes and hypertension. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). A chronic disease may be presumptively service connected if it is shown to have manifested to a compensable degree within one year of separation from service or if the evidence establishes chronicity and continuity of symptomatology post-service. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Veteran maintains that his diabetes and hypertension are related to his service. However, the Veteran has not identified any event, injury, or disease that occurred during service to which the claimed disabilities may be related. The Veteran's service treatment records do not demonstrate any diagnosis or treatment for diabetes or hypertension. Additionally, there is no evidence of ongoing diabetic or vascular disabilities on the Veteran's August 1958 separation examination. The examiner found the Veteran's endocrine and vascular systems clinically normal. In the corresponding report of medical history, the Veteran reported he did not have sugar in his urine or high blood pressure. The record demonstrates the Veteran was diagnosed with diabetes mellitus, type II in 2007 and hypertension in 1996. In November 2019, VA examiners found the Veteran's diabetes and hypertension less likely than not related to his service. Unfortunately, the examiners did not provide sufficient rationale to make a decision on these claims. Pursuant to the February 2021 Board remand, new medical opinions were obtained. In February 2021, a VA examiner found it less likely than not that the Veteran's diabetes is related to service. The examiner reasoned that the Veteran did not have any complaints, treatment, or diagnosis in service. The examiner stated the pathogenesis of diabetes is complicated by many factors, but the medical literature does not support any possible etiological link between the Veteran's service and current diabetes. In April 2021, an examiner found the Veteran's hypertension less likely than not related to his service. The examiner stated that hypertension occurs when the force of the blood against the artery is too high. This is generally caused by genetic factors or secondary factors such as kidney disease, high salt or fat diet and hormonal issues. The examiner found no causal link between the Veteran's service and his current hypertension. The Veteran himself asserts his diabetes and hypertension are related to service. As discussed above, the Veteran is not competent to independently render a medical diagnosis or opine as to the specific etiology of these conditions as these are medically complex issues. Thus, his lay assertions do not constitute evidence upon which service connection can be granted. In any event, the Board ultimately assigns greater probative weight to the medical evidence of record, to include the February and April 2021 opinions rendered by trained medical professionals based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. Moreover, there is no medical opinion or competent and credible evidence in conflict with these VA medical opinions. Despite the evidence showing current diagnoses and treatment for diabetes and hypertension, the preponderance of the evidence does not reflect that either of these disabilities or symptoms were incurred during or as a result of the Veteran's service. As noted, the service treatment records do not contain any complaints or treatment for these disabilities or symptoms and the Veteran has not stated that these disabilities began during service or that he has experienced symptoms related to these disabilities since service. Instead, the post-service medical evidence shows that his hypertension and diabetes began many years after service. In this context, the Board notes that the presumption of service connection for certain chronic disabilities is inapplicable in this case, as the earliest evidence of the diabetes is almost 50 years after service and hypertension almost 40 years after service. Therefore, service connection is not warranted for diabetes or hypertension on a presumptive basis as a chronic disease or based upon continuity of symptomatology since service. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Therefore, based on the foregoing, the Board finds the preponderance of the evidence is against the grant of service connection for diabetes or hypertension on a direct or presumptive basis. Accordingly, the benefit-of-the-doubt doctrine is not applicable, and the Veteran's claims are denied. M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E.V. Palatt, 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.