Citation Nr: 21005750 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 14-35 334 DATE: February 2, 2021 ORDER Entitlement to service connection for hypertensive vascular disease is denied. Entitlement to an initial evaluation in excess of 10 percent for service-connected wrist condition is denied. FINDING OF FACT 1. The preponderance of the evidence is against finding that hypertension began during active service, or is otherwise related to an in-service injury or disease. 2. The Veteran’s left wrist condition has not resulted in ankylosis. CONCLUSION OF LAW 1. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for an initial evaluation in excess of 10 percent for left wrist condition have not been met. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.71a, Diagnostic Code 5215. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from November 1958 to February 1962. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Little Rock, Arkansas. In a July 2019 Board decision, the matter was remanded for additional development. It has now returned for further appellate review. 1. Entitlement to service connection for hypertensive vascular disease The Veteran is seeking service connection for a hypertensive vascular disease (hypertension), which he asserts began while on active duty service and has continued since that time. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted for disability which is proximately due to or the result of service-connected disability. 38 C.F.R. § 3.310(a). Certain chronic diseases, such as arthritis and hypertension, will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). A review of the Veteran’s service treatment records (STRs) does not reveal any treatment for high blood pressure or hypertension during active duty service. At the time of the Veteran’s entrance to service, his blood pressure measured 120 systolic and 80 diastolic. Subsequently, at separation from service, the Veteran’s blood pressure measured 128 systolic and 70 diastolic. Accordingly, the Board finds that the Veteran does not have a qualifying in-service injury, event, or illness. The Veteran received a VA examination regarding his claimed hypertension in October 2020. The examiner diagnosed the Veteran with hypertension for VA purposes. However, after reviewing the Veteran’s claims file, the examiner opined that “there is no link between [the Veteran’s] current hypertension and having high blood pressure while in service.” The record did not include other competent evidence demonstrating that the Veteran’s disabilities were incurred in or due to his active duty service. In this, and in other cases, the Board may not base a decision on its own unsubstantiated medical conclusions. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). The only competent and probative opinion of record is that of the October 2020 VA examiner, which is negative to the Veteran’s claims. The Board notes that the Veteran has asserted that his hypertension began in service, however, the Veteran has not provided testimony regarding any symptoms that he experienced in service and the record is silent for any treatment for or diagnosis of any symptoms associated with hypertension while on active duty service. To the extent that the Veteran asserts that his claimed disability was incurred in or due to his active duty service, the Board finds that as a lay person, the Veteran has not shown that he has specialized training sufficient to render etiological opinions. Accordingly, his assertions on such matters are not competent evidence because such a question requires medical expertise to determine. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). As the preponderance of the evidence is against the Veteran’s claims, the benefit-of-the-doubt rule does not apply. Accordingly, service connection for hypertension is not warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; see Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to an initial evaluation in excess of 10 percent for service-connected wrist condition The Veteran was granted service connection for his left wrist condition in a January 2011 rating decision and assigned an initial noncompensable evaluation. The evaluation was increased to 10 percent effective September 16, 2010, in an October 2020 rating decision by the RO. Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. In determining the degree of limitation of motion, the provisions of 38 C.F.R. § 4.40 concerning lack of normal endurance, functional loss due to pain, and pain on use and during flare-ups; the provisions of 38 C.F.R. § 4.45 concerning weakened movement, excess fatigability, and incoordination; and the provisions of 38 C.F.R. § 4.10 concerning the effects of the disability on the veteran’s ordinary activity are for consideration. See DeLuca v. Brown, 8 Vet. App. 202 (1995). Limitation of motion of the wrist is assigned a maximum 10 percent rating for dorsiflexion less than 15 degrees or palmar flexion limited in line with forearm. Higher ratings are available for ankylosis of the wrist. 38 C.F.R. § 4.71a, Diagnostic Codes 5214, 5215. Pursuant to the July 2019 Board remand decision, the Veteran received a VA examination regarding the severity of his service-connected left wrist condition in October 2020. The examiner noted that the Veteran did not have ankylosis of the wrist and that initial range of motion (ROM) measured zero to 45 degrees for palmar flexion, zero to 35 degrees for dorsiflexion, and zero to 10 degrees for both ulnar and radial deviation. Pain was noted on exam in all areas of measurement and the measurements remained the same when estimated for flare-ups. The Veteran reported that he experienced flare-ups “every once in a while” consisting of pain and weakness. Passive ROM measured the same as initial ROM and pain was noted when nonweight-bearing. Motor strength was 4/5. There was no atrophy. There was no ankylosis. The Veteran also received a VA examination regarding the nature and severity of the Veteran’s left wrist in November 2010. The examiner noted that at the time of the examination, the Veteran’s palmar flexion measured zero to 80 degrees, dorsiflexion measured zero to 70 degrees, radial deviation measured zero to 20 degrees, and ulnar deviation measured zero to 45 degrees. No pain was noted on active ROM, however, the Veteran was noted to have decreased manual dexterity and pain with periodic flare-ups. A review of the Veteran’s VA treatment records show notations of wrist pain, but no other complaints or descriptions of limitations. A private clinic note provides that the Veteran experiences aching pain on and off with activity and a lot of stiffness, with some rare numbing and tingling. Upon consideration of the evidence, the Board finds a rating higher than 10 percent is not warranted at any time during the period of the claim. There is no evidence, to include history, of ankylosis, including during flare-ups. Notably, although the Veteran reported limitation of function during flare-ups, he has never reported an inability to move the wrist or forearm during flare-ups or at any other time. The Board has considered whether there is any other schedular basis to assign a higher or separate rating but finds no basis for such a rating: there is no evidence of associated limitation of motion of the elbow, hand, and/or fingers which might warrant a higher rating under an alternate diagnostic code. As explained above, the evidence indicates the Veteran’s left wrist disability is manifested by pain and limitation of motion, which have been contemplated by the rating assigned. The Board acknowledges that the Veteran was noted to have diminished strength in the October 2020 examination. Although the rating criteria do not explicitly contemplate impairment of strength, the functional effect of loss of strength is limitation of motion or use which is explicitly contemplated by the rating criteria. In other words, the effect of the loss of strength is considered in the rating currently assigned. The rating criteria provide higher ratings for more severe manifestations and impairment, notably ankylosis. In reaching the decision to deny a rating in excess of 10 percent, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable to this component of the claim because the preponderance of the evidence is against the claim. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Gorum, 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.