Citation Nr: 21076499 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 16-43 893 DATE: December 27, 2021 ORDER Entitlement to service connection for hypertension is denied. Entitlement to service connection for a heart condition, to include as secondary to a hypertension, is denied. Entitlement to service connection for deep vein thrombosis status post amputation of the left leg, to include as secondary to hypertension, is denied. Entitlement to service connection for a right leg disability manifested as loss of sensation, to include as secondary to hypertension, is denied. Entitlement to service connection for a neurogenic bladder, to include as secondary to hypertension, is denied. FINDINGS OF FACT 1. The most probative evidence weighs against a finding that the Veteran's hypertension had onset during active service, manifested within one year of service discharge, or is otherwise related to active service. 2. The most probative evidence weighs against a finding that the Veteran's heart condition had onset during active service, manifested within one year of service discharge, or is otherwise related to active service. 3. The most probative evidence weighs against a finding that the Veteran's deep vein thrombosis status post amputation of the left leg had onset during active service or is otherwise related to active service. 4. The most probative evidence weighs against a finding that the Veteran's right leg disability had onset during active service or is otherwise related to active service. 5. The most probative evidence weighs against a finding that the Veteran's neurogenic bladder had onset during active service or is otherwise related to active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1116, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for entitlement to service connection for a heart disorder, to include as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for entitlement to service connection for deep vein thrombosis status post amputation of the left leg, to include as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for entitlement to service connection for a right leg disability manifested as loss of sensation, to include as secondary to a service-connected disability, have not met. 38 U.S.C. §§ 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for entitlement to service connection for a neurogenic bladder disability, to include as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 1110, 1112, 1116, 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 in the United States Army from June 1970 to January 1972.This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2015 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). The claim was previously before the Board in June 2021, when it was remanded for further development; that development was completed, and the claim has since been returned to the Board for appellate review. SERVICE CONNECTION 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, 1131 (2012); 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 - the "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). In addition, service connection for certain chronic diseases, including hypertension, may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137 (2012); 38 C.F.R. §§ 3.307, 3.309(a) (2020); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Additionally, for certain chronic diseases with potential onset during service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309 (2020); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Under 38 C.F.R. § § 3.310(a), service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). 1. Entitlement to service connection for hypertension The Veteran asserts that he is entitled to service connection for hypertension. Specifically, he attributes his hypertension to his active service as a baker in the military. See November 2019 VA examination. First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran received a November 2019 VA examination. The examination showed a current diagnosis for hypertension. Accordingly, the first element of service connection has been met. Second, the Board finds that there were in-service symptoms, but no diagnosis of hypertension. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). A review of service treatment records (STRs) shows a February 1971 STR documents the Veteran took two muscle relaxers and his blood pressure was 140/90 and 160/108. Also, the Veteran noted high or low blood pressure on his January 1972 separation report of medical history. Thus, the evidence demonstrates there were symptoms in-service, but no diagnosis. Accordingly, the second element of service connection is met. Third, the Board finds that the more probative evidence of record does not support a finding that the currently diagnosed hypertension is related to active service. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). VA obtained a November 2019 VA examination report. The examination report reflected a diagnosis of hypertension. The examiner opined that the Veteran's hypertension is less likely than not related to his active service. The examiner reasoned the Veteran's STRs noted a history of hypertension diagnosed in 1968. Therefore, the examiner concluded that his hypertension existed prior to service and is therefore not related to active service. VA obtained an addendum opinion in April 2020. The examiner reviewed the relevant evidence, including all instances of elevated blood pressure in service, and opined that the currently diagnosed hypertension was not due to the Veteran's period of service. The examiner explained that medical literature indicates a diagnosis of hypertension is made after three consecutive elevated blood pressures. The examiner noted the Veteran did not have three consecutive high blood pressure readings and was not diagnosed on active duty with hypertension. Also, the Veteran's blood pressure was normal during active service other than when he ingested two muscle relaxants which gives an explanation for the rise in his blood pressure. The examiner explained, subsequent treatment notes are silent/negative for complaints of chronic hypertension. The Veteran's blood pressure was normal/excellent on his exit exam without any intervening treatment. The Board assigns this opinion significant probative value as it was based upon review of the claims file and included a persuasive supporting explanation. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (holding that factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions). Overall, the more probative evidence does not show that the Veteran's hypertension manifested in service or is otherwise related to service, and the criteria for direct service connection is not met. Lastly, service connection is not warranted on a presumptive basis for hypertension. The evidence of record does not show the Veteran's hypertension began within one year of separation from service, and hypertension was not diagnosed within one year of separation. Further, the objective and lay evidence does not show that the Veteran's hypertension was continuous in nature since an in-service onset. Thus, service connection for a hypertension disability may not be presumed. 38 C.F.R. §§ 3.307, 3.309. Therefore, the criteria for service connection are not met on a direct or a presumptive basis. The Board has not overlooked the Veteran's statements that his hypertension is related to his duties as baker in the military. While the Veteran is competent to observe his hypertension symptoms, he does not have the medical training or credentials to provide a competent opinion as to the cause of his hypertension or whether it is related to active service. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for a heart condition, to include as secondary to a hypertension, is denied. The Veteran asserts that service connection is warranted for a heart condition. Also, in the October 2016 argument, the Veteran's representative asserted, in part, that his heart condition is due to his hypertension. First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran received a November 2019 VA examination. The examination reflected a diagnosis for status post acuate congestive heart failure. Accordingly, the first element of service connection has been met. Second, the Board finds that there were in-service symptoms. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). A February 1971 service treatment record shows the Veteran complained of palpitations after ingesting two muscle relaxants. Additionally, the Veteran noted pain or pressure in the chest on his January 1972 separation report of medical history. Thus, the evidence demonstrates symptoms in-service, but no diagnosis. Accordingly, the second element of service connection is met. Third, the Board finds that the more probative evidence of record does not support a finding that the currently diagnosed heart condition is related to active service. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). VA obtained a November 2019 VA examination. The examination report reflected a diagnosis of status post acuate congestive heart failure. The examiner opined that the Veteran's status post acuate congestive heart failure is less likely than not related to his active service. The examiner reasoned his hypertension existed prior to service and is therefore not related to service. VA obtained an April 2020 addendum opinion. The examiner opined that the Veteran's heart condition is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned a February 1971 STR notes an isolated and acute complaint related to palpitations after ingesting two muscle relaxants for an acute spasm. Further the examiner noted the Veteran was not diagnosed with congestive heart failure (CHF) or hyperlipidemia during service. The Board assigns this opinion significant probative value as it was based upon review of the claims file and included a supporting explanation. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (holding that factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions). Overall, the more probative evidence does not show that the Veteran's heart condition manifested in service or is otherwise related to service and the criteria for direct service connection is not met. Lastly, service connection is not warranted on a presumptive basis for a heart condition. The evidence of record does not show the Veteran's heart condition began within one year of separation from service, and a heart condition was not diagnosed within one year of separation. Further, the objective and lay evidence does not show that the Veteran's heart condition was continuous in nature since an-inservice onset. Thus, service connection for a heart condition may not be presumed. 38 C.F.R. §§ 3.307, 3.309. Moreover, service connection for a heart condition on a secondary basis is not warranted because service connection for hypertension is denied in the instant case. See 38 C.F.R. § 3.310. Therefore, the criteria for service connection are not met on a direct, secondary, or a presumptive basis. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to service connection for deep vein thrombosis status post amputation of the left leg, to include as secondary to a hypertension, is denied. 4. Entitlement to service connection for a right leg disability manifested as loss of sensation, to include as secondary to a service-connected disability, is denied. First, the Board finds that there are current disabilities. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran received a November 2019 VA examination. The examination reflected a diagnosis for deep vein thrombosis status post amputation of the left leg and a right leg disability. Accordingly, the first element of service connection has been met. Second, the Board finds that there were in-service symptoms. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran noted cramps in his legs on his January 1972 report of medical history. Thus, the evidence demonstrates symptoms, but no diagnosis during service. Accordingly, the second element of service connection has been met. Third, the Board finds that the most probative evidence of record does not support a finding that the currently right and left leg disabilities are related to active service. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). VA obtained a November 2019 VA examination report. The examiner opined that the Veteran's left leg DVT is less likely than not related to the Veteran's active service. The examiner reasoned the Veteran's service entrance examination showed a history of cramp in legs. Therefore, the examiner concluded, it is less likely than not that his currently claimed, and pre-existing, leg condition (namely deep vein thrombosis status post left leg amputation), is related to service. Regarding the right leg disability, the examiner opined the claimed condition is less likely than not related to the Veteran's active service. The examiner reasoned the condition pre-existed service, and therefore is less likely than not related to service. VA obtained an April 2020 addendum opinion. The examiner opined that the Veteran's left leg DVT and right leg loss sensation are less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner explained that it is noted in the Veteran's private treatment records that he developed an infection related to his uncontrolled diabetes that caused him to have the left lower extremity amputation. Moreover, the examiner noted that medical records document the Veteran developed post-surgery blood clots from lack of movement. The examiner further stated that medical literature supports that uncontrolled diabetes is the leading cause of DVT. Therefore, the examiner concluded the Veteran's uncontrolled diabetes contributed to his left leg DVT. The Board assigns this opinion significant probative value as it was based upon review of the claims file and included a persuasive supporting explanation. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (holding that factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions). Overall, the more probative evidence does not show that the Veteran's deep vein thrombosis status post amputation of the left leg or right leg disability manifested in service or is otherwise related to service, and the criteria for direct service connection is not met. Lastly, service connection for deep vein thrombosis status post amputation of the left leg and right leg disability on a secondary basis is also not warranted as service connection for hypertension is denied in the instant case. See 38 C.F.R. § 3.310. Thus, the criteria for service connection are not met on a direct or secondary basis. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 5. Entitlement to service connection for a neurogenic bladder, to include as secondary to a service-connected disability, is denied. The Veteran asserts that service connection is warranted for a neurogenic bladder condition. Specifically, in the October 2016 argument, the Veteran's representative asserted, in part, that the Veteran's neurogenic bladder condition is related to his hypertension. The Veteran also contends his neurogenic bladder is the result of his duties as a baker in the military. See November 2019 VA examination report. First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran received a November 2019 VA examination. The examination reflected a diagnosis for neurogenic bladder. Accordingly, the first element of service connection has been met. Second, although there is a current disability, there is no evidence of an in-service injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran's STRs are silent for any complaints or treatment for a neurogenic bladder condition. At the initial November 2019 VA Urinary Tract examination, the Veteran reported he began having bladder problems post-service around 1980 and was diagnosed with neurogenic bladder in 2012. Accordingly, the Board finds there was no in-service injury or disease. Thus, the second element of service connection is not met. The third element of direct service connection is also not met as the more probative medical evidence of record establishes that the currently diagnosed neurogenic bladder disorder is not etiologically related to service. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). VA obtained a November 2019 VA examination. The examiner opined that the Veteran's neurogenic bladder condition was less likely than not etiologically related to his active service. The examiner reasoned the Veteran's STRs are silent for any complaints, treatment, or diagnoses of neurogenic bladder condition. The examiner explained this condition was diagnosed in 2012 after the Veteran was hospitalized for a 1200+ blood sugar and his kidneys began failing from noncompliance related diabetes type 2. The examiner therefore concluded; it is less likely than not that the Veteran's current neurogenic bladder diagnosed more than 45 years after his active-duty service is related to his active-duty service. The Board assigns this opinion significant probative value as it is supported by objective medical evidence and thorough review of the evidence of record. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (holding that factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions). Overall, the more probative evidence does not show that the Veteran's neurogenic bladder condition manifested in service or is otherwise related to service and the criteria for direct service connection is not met. Lastly, service connection for a neurogenic bladder condition on a secondary basis is also not warranted as service connection for hypertension is denied in the instant case. Thus, the criteria for service connection are not met on a direct or secondary basis. The Board has not overlooked the Veteran's statements that his neurogenic bladder condition is related to his duties as a baker in the military. While the Veteran is competent to observe his bladder symptoms, he does not have the medical training or credentials to provide a competent opinion as to the cause of his neurogenic bladder disorder or whether they it is related to active service. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). (Continued on the next page) In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Braxton, 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.