Citation Nr: 21076224 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 17-20 568 DATE: December 22, 2021 ORDER Entitlement to service connection for hypertension is denied. Entitlement to service connection for dizzy spells, to include as secondary to hypertension, is denied. Entitlement to service connection for erectile dysfunction, to include as due to hypertension is denied. Entitlement to service connection for bilateral foot fungus is denied. Entitlement to service connection for bilateral toenail fungus is denied. FINDINGS OF FACT 1. The preponderance of the evidence establishes the Veteran's hypertension condition was not present until more than one year following his discharge from service and is not etiologically related to his active service. 2. The preponderance of the evidence establishes there is no currently diagnosed disability manifested by a dizziness condition that was incurred in or caused by service, and any reported symptoms do not amount to functional impairment of earning capacity. 3. The preponderance of the evidence establishes that the Veteran's claimed erectile dysfunction was not present until more than one year following his discharge from service and is not etiologically related to his active service. Further, the medical evidence suggests the Veteran's erectile dysfunction is etiologically related to his hypertension, however, as the Veteran's hypertension is not service connected this disability cannot be service connected on a secondary basis. 4. The preponderance of the evidence establishes the Veteran's claimed bilateral foot fungus condition was not present until more than one year following his discharge from service and is not etiologically related to his active service. 5. The preponderance of the evidence establishes the Veteran's claimed bilateral toenail fungus condition was not present until more than one year following his discharge from service and is not etiologically related to his active service. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310 2. The criteria for establishing entitlement to service connection for dizzy spells, to include as secondary to hypertension, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for establishing entitlement to service connection for erectile dysfunction, to include as due to hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for establishing entitlement to service connection for bilateral foot fungus have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310 5. The criteria for establishing entitlement to service connection for bilateral toenail fungus have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310 REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 1968 to June 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2013 rating decision from a Department of Veteran's Affairs (VA) Regional Office (RO). When this case was last before the Board in June 2021, it was remanded for additional development. Specifically, the RO was instructed to provide the Veteran with VA medical opinions which opined on the etiology of his claimed disabilities. Appropriate medical opinions were obtained. As such, the Board finds that the AOJ substantially complied with the directives in the June 2021 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service ConnectionLegal Criteria Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). In this case, the Board has reviewed all of the evidence of record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. Hypertension The Veteran is seeking service connection for hypertension which he claims is etiologically related to his active-duty service. The Board notes that the Veteran has a current diagnosis of hypertension. See August 2021 VA Hypertension examination. Therefore, the central issues that must be resolved are whether the Veteran's current disability originated in service or is otherwise related to service. See Newhouse v. Nicholson, 497 F.3d 1298 (Fed. Cir. 2007); Gonzalez v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). While the Veteran has a currently diagnosed hypertension disability, competent medical evidence of record does not support that this disability was incurred in service or otherwise related to service. The Veteran's service treatment records (STRs) contain no complaints, treatment, or diagnoses of hypertension. There are no treatment records for this condition while the Veteran was in service, and no medical examiner has given an opinion linking the Veteran's current disability to his active-duty service. Further, the Board notes that the earliest documented diagnosis of the Veteran's hypertension was in 2003, approximately 33 years after the Veteran had left active-duty service. During his November 2019 Board hearing, the Veteran noted that during his service the stress he was under caused him to have one or two elevated blood pressure readings, though he admitted that he was not given medication to treat his blood pressure. The Veteran stated that he believed that his blood pressure continued to affect him since active service. In response to the Board's February 2020 Remand, the RO provided the Veteran with a March 2020 VA Hypertension examination. The examiner opined that it is less likely than not (less than a 50 percent probability) that the Veteran's hypertension is etiologically related to his active-duty service. The rationale provided was that there was no evidence of chronicity of care regarding the Veteran's hypertension, and his in-service elevated blood pressure was acute only. The Board again remanded the Veteran's claim in June 2021, and the Veteran was provided with the August 2021 VA Hypertension examination, as noted above. Here the examiner opined that the Veteran's currently diagnosed hypertension was less likely than not (less than a 50 percent probability) incurred in or caused by the Veteran's elevated blood pressure in service. The examiner continued that the Veteran did not have a diagnosis of hypertension while in service, with normal blood pressure readings documented. In addition, the examiner noted that elevated blood pressure is a normal physiological response to exercise, pain, illness, stress, or consumption of stimulants like caffeine. Further, the examiner noted that the three days after his elevated blood pressure reading in service he was treated for a sore throat as documented in a December 1969 treatment note. Thus, the examiner noted, suggests that the Veteran's elevated blood pressure was a precursor to an acute illness. Further, the examiner opined that the Veteran's hypertension less likely than not (less than a 50 percent probability) became manifest within a year of exiting service. The examiner continued that the earliest diagnosis of the Veteran's hypertension was in 2003, more than 30 years after he had left active-duty service. The Board weighs the above-mentioned June 2021 VA examination against the Veteran's lay contentions that his hypertension and is due to service. While the Veteran is competent to testify to his symptoms, he is not competent to provide a medical opinion as to the etiology of his disability. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As such, the Board finds the VA examination, which opined against a link between the Veteran's currently diagnosed hypertension and his service to be of high probative value. Again, the Board notes that the Veteran was not diagnosed with hypertension until over 30 years from his separation from active-duty service. Thus, the probative evidence of record preponderates against the Veteran's claim for service connection. In light of the above discussion, there is no evidence that the Veteran sought treatment for or was diagnosed with hypertension while in service, or within a year after service, and there is no medical opinion in the record linking his current disability to his active-duty service. The preponderance of the evidence weighs against granting service connection for the Veteran's hypertension. As the weight of the evidence is against granting the claim, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Therefore, the claim must be denied. Dizziness Pain alone, even without an underlying pathology or diagnosis, can constitute a disability under VA law where such pain results in functional impairment. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The Court recently held that Saunders is not limited to pain, such that a disability for VA purposes includes any condition that results in functional impairment of earning capacity. Martinez-Bodon v. Wilkie, 32 Vet. App. 393 (2020). The Board finds that the probative evidence of record does not document that the Veteran has a current diagnosis of any dizziness disability. Further any symptoms experienced do not rise to compensable levels or result in impairment of functional capacity. As such, service connection is not warranted on direct or presumptive bases for the claimed disabilities. Martinez-Bodon, supra. The Board has thoroughly reviewed the Veteran's medical records. The Veteran's service treatment records (STRs) contain no complaints, treatment, or diagnoses of a dizziness condition or any related symptoms. The Veteran's VA treatment records contain one complaint of dizziness from May 2015 where the Veteran noted he suffered dizziness while mowing the lawn and fell. During his November 2019 Board hearing, the Veteran testified that he believed his dizziness was secondary to his claimed hypertension. However, as noted above, the Veteran is not service-connected for hypertension, and as such, his claimed dizzy condition cannot be granted secondary service-connection. In response to the February 2020 Board remand the Veteran was provided with a March 2020 VA medical opinion regarding his claimed dizzy spells. This examiner opined that they were unable to confirm a current diagnosis of a dizziness condition and therefore no nexus could be established. The Board again remanded the Veteran's claim in June 2021, and he was provided with an August 2021 VA medical opinion regarding his claimed condition. The examiner noted that the Veteran's dizzy spells were only documented one time when he fell while riding a lawnmower, and the evidence suggests this was a one-time event. Further, the examiner noted there was no diagnosis associated with the Veteran's claimed dizzy spells. Based on the above, the Board does not find evidence of any dizziness disability at any time during the pendency of the appeal. Additionally, the Board does not find that the Veteran experiences any compensable symptoms, or functional impairment, thereof. The Board has considered the Veteran's lay contentions and finds the lay statements are competent insofar as they report observable symptoms. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, to the extent that the Veteran asserts that his claimed condition is related to his active service, such statements are of no probative value, as the Veteran lacks the medical expertise to diagnose complex conditions or to render medical nexus opinions. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Moreover, to the extent the Veteran asserts that he has a current condition, such statements are inconsistent with the medical evidence of record that does not document any relevant diagnoses at any time during the pendency of the appeal. See Caluza v. Brown, 7 Vet. App. 498, 506 (1995); see also Martinez-Bodon, supra. Based on the foregoing, and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran's claims for service connection for a dizziness disability. Further, as the Veteran claimed he was seeking secondary service connection for his claimed dizziness as due to his hypertension, the Board again notes that secondary service connection is not warranted as the Veteran's hypertension is not itself service connected. As the preponderance of the evidence is against the Veteran's claims for service connection, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Erectile Dysfunction The Veteran contends that his claimed erectile dysfunction disability is secondary to his hypertension. The Veteran has not claimed, and the evidence does not show, that his erectile dysfunction originated in service. Further, in his November 2019 Boar hearing, the Veteran clarified that he was seeking service connection for erectile dysfunction as secondary to his claimed hypertension. As such service connection is not warranted on a direct basis and will not be discussed further. The Board notes that the Veteran has a current diagnosis of erectile dysfunction which has been causally linked to his diagnosed hypertension. See August 2021 VA medical opinion. However, the Veteran is not service connected for hypertension. As such, the requirements of secondary service connection are not met. See Wallin, 11 Vet. App. at 512. In light of the above discussion, there is no evidence that the Veteran sought treatment for or was diagnosed with erectile dysfunction while in service, or within a year after service, and there is no medical opinion in the record linking his current disability to his active-duty service. The preponderance of the evidence weighs against granting service connection for the Veteran's erectile dysfunction, to include as on a secondary basis. As the weight of the evidence is against granting the claim, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Therefore, the claim must be denied. Bilateral Foot and Toenail Fungus At the outset, the Board notes that the essential facts of the Veteran's claims for service connection for his bilateral foot and toenail fungus are essentially identical. In addition, the resolution of these claims involves the application of identical law to similar facts. As such, in the interest of judicial economy these issues will be addressed together. The Veteran is seeking service connection for bilateral foot and toenail fungus which he claims is etiologically related to his active-duty service. The Board notes that the Veteran has current diagnoses of tinea pedis and onychomycosis. See August 2021 VA Skin Diseases examination. Therefore, the central issues that must be resolved are whether the Veteran's current disabilities originated in service or is otherwise related to service. See Newhouse v. Nicholson, 497 F.3d 1298 (Fed. Cir. 2007); Gonzalez v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). While the Veteran has currently diagnosed disabilities, competent medical evidence of record does not support that this disability was incurred in service or otherwise related to service. The Veteran's service treatment records (STRs) contain no complaints, treatment, or diagnoses of these disabilities. The Board specifically notes the Veteran's March 1970 separation examination shows a normal examination to the feet and skin with no complaints of fungal infections to the feet or toenails. There are no treatment records for this condition while the Veteran was in service, and no medical examiner has given an opinion linking the Veteran's current disabilities to his active-duty service. Further, the Board notes that the earliest documented diagnosis of the Veteran's claimed foot fungus was in 2003, approximately 33 years after the Veteran had left active-duty service. The Veteran's VA treatment records document treatment for bilateral foot and toenail fungus throughout the period of the appeal. Specifically, the Board notes an August 2013 treatment note which indicated that the Veteran had a long history of dry skin and toenail fungus, and the Veteran's treatment notes uploaded February 2017 which document treatment for onychomycosis dating back to June 2003. During his November 2019 Board hearing, the Veteran noted that while on active military service he did not complain of itching feet and just dealt with it by changing socks and using talcum powder. In response to the Board's February 2020 Remand, the RO provided the Veteran with a March 2020 VA Foot Conditions examination. The examiner opined that it is less likely than not (less than a 50 percent probability) that the Veteran's bilateral foot and toenail conditions were etiologically related to his active-duty service. The rationale provided was inadequate and the Board again remanded the Veteran's claims in June 2021. In response to the Board remand, the Veteran was provided with an August 2021 VA Foot Conditions examination. The examiner opined that the Veteran's currently diagnosed conditions were less likely than not (less than a 50 percent probability) etiologically related to the Veteran's active service. The examiner opined that the conditions were less likely than not (less than a 50 percent probability) etiologically related to the Veteran's reports of walking extended distances in military footwear. The examiner continued that the onychomycosis condition is related to a fungal infection that develops under the surface of the Veteran's toenails. The examiner noted that it is caused by a fungal infection of the Veteran's feet would progress to his toenails. Further, the examiner noted that the Veteran's separation examination documented a normal examination to his feet and skin which suggested no tinea pedis or onychomycosis was present during the Veteran's separation. Additionally, the examiner noted that there were no complaints of, treatment for, or diagnoses of any foot or toe conditions during the Veteran's service. The examiner noted that the Veteran's medical records do not document dry skin and toenail function until August 2013 at the earliest. The examiner indicated that this treatment note's documentation of a "long history" of dry skin and toenail fungus most likely refers to the Veteran's initial presentation of symptoms in June 2003, which is the earliest the Veteran's condition was evaluated and diagnosed. The examiner continued that at that time the Veteran had been diagnosed with diabetes mellitus type 2 for a year, and it is well known that diabetes increases the risk for onychomycosis as it weakens the body's immune system. The Board weighs the above-mentioned June 2021 VA examination against the Veteran's lay contentions that his bilateral foot and toe conditions are due to service. While the Veteran is competent to testify to his symptoms, he is not competent to provide a medical opinion as to the etiology of his disability. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As such, the Board finds the VA examination, which opined against a link between the Veteran's currently diagnosed tinea pedis and onychomycosis and his service to be of high probative value. Again, the Board notes that the Veteran's earliest diagnosis did not come until over 30 years from his separation from active-duty service. Thus, the probative evidence of record preponderates against the Veteran's claim for service connection. In light of the above discussion, there is no evidence that the Veteran sought treatment for or was diagnosed with tinea pedis or onychomycosis while in service, or within a year after service, and there is no medical opinion in the record linking his current disabilities to his active-duty service. The preponderance of the evidence weighs against granting service connection for the Veteran's hypertension. As the weight of the evidence is against granting the claim, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Therefore, the claim must be denied. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Gresham 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.