Citation Nr: 21005846 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 18-41 970 DATE: February 2, 2021 ORDER Entitlement to service connection for a heart condition is denied. REMANDED Entitlement to service connection for a skin condition is remanded. Entitlement to service connection for a sleep disorder is remanded. FINDING OF FACT The record does not reflect a current diagnosis of a heart condition. CONCLUSION OF LAW The criteria for entitlement to service connection for a heart condition have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1966 to April 1969. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously before the Board in February 2019, at which time they were remanded for development. They have been returned to the Board for appellate review. The claimant has not raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument).. 1. Entitlement to service connection for a heart condition Service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service. 38 U.S.C. §§ 1110, 1131; 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 (nexus) between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004)). The absence of any one element will result in denial of service connection. Coburn v. Nicholson, 19 Vet. App. 247, 431 (2006). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223 (1992); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998) (service connection may not be granted unless a current disability exists.) The Court has consistently held that, under the law, a “determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service.” Watson v. Brown, 4 Vet. App. 309 (1993). This principle has been repeatedly reaffirmed by the Federal Circuit, which has stated that “a veteran seeking disability benefits must establish...the existence of a disability [and] a connection between the veteran’s service and the disability.” Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000). In this case, the Veteran has never been explicitly diagnosed with a heart disorder. Service records reflect no heart-related complaints, no treatment linked to any heart condition, and no diagnosis, and post-service medical records are likewise silent for any diagnosis of a heart disorder. The lack of a current heart-related diagnosis was confirmed by the VA examiner who reviewed the medical file in May 2020. That examiner indicated that, based on a thorough review of the evidence of record in this case, there was no indication the Veteran had ever been diagnosed with a heart condition, explaining that “recent diagnostics do not support a diagnosis [of heart disease],” and that despite evidence the Veteran saw a cardiologist between 2006 and 2011, records associated with that treatment did not indicate the presence of a heart condition. In light of the lack of evidence of a heart disability in the record, the Board finds that the Veteran has no such disability, and as such, the preponderance of the evidence is against his claim of entitlement to service connection therefor. The claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102 REASONS FOR REMAND 1. Entitlement to service connection for a skin condition is remanded. The Board finds that additional development must be completed before the Veteran’s claim for service connection for a skin condition can be finally adjudicated. The VA examiner with whom the Veteran met in February 2020 noted several skin-related diagnoses, opining that none were etiologically related to conceded in-service herbicide agent exposure, adding only the conclusory assessment that no diagnosed condition “began in service or is otherwise related to service,” with little explanation. The examiner cited several factors, including the Veteran’s fair skin and inability to tan, but did not explain why these factors, coupled with in-service sun exposure, might not have coalesced to cause in-service onset, or to contribute substantially to post-service onset, as the Veteran has claimed. On remand, a new VA examination must be conducted, and a thorough and reasoned medical opinion as to etiology obtained. 2. Entitlement to service connection for a sleep disorder is remanded. Similarly, the VA examiner with whom the Veteran met in February 2020 for evaluation of his claimed sleep disorder confirmed a current diagnosis of obstructive sleep apnea, but indicated only that the condition was “less likely as not due to herbicide exposure and is secondary to upper airway anatomic conditions leading to airway obstruction and hypoxemia.” No assessment was made with respect to in-service onset, or to any direct etiological connection to service. Moreover, no further explanation was furnished as to why herbicide agent exposure bore no causative or aggravating relationship to development of sleep apnea. On remand, a new VA examination must be conducted and an expert medical opinion as to etiology obtained, with a clear, thorough, and reasoned medical opinion furnished addressing all theories of entitlement the Veteran has proposed. The matters are REMANDED for the following action: 1. After obtaining the necessary authorization, obtain any outstanding VA and private treatment records relevant to the Veteran’s claims. 2. Then, schedule the Veteran for a VA examination to explore the presence and etiology of a skin disorder or disorders. All indicated tests and studies should be conducted and all clinical findings reported in detail. The entire claims file should be made available to and be reviewed by the examiner in conjunction with this request.        Please identify all current skin-related diagnoses. For any identified diagnosis, please state whether it is at least as likely as not (e.g. at least a 50 percent probability or greater) that the condition began in service or is otherwise related to service, to include as secondary to in-service exposure to herbicide agents. The examiner is reminded that such exposure is conceded in the Veteran’s case. 3. Schedule the Veteran for a VA examination to explore the etiology of his diagnosed obstructive sleep apnea. All indicated tests and studies should be conducted and all clinical findings reported in detail. The entire claims file should be made available to and be reviewed by the examiner in conjunction with this request.        The examiner should state whether it is at least as likely as not (e.g. at least a 50 percent probability or greater) that sleep apnea began in service or is otherwise related to service, to include as secondary to in-service exposure to herbicide agents. The examiner is reminded that such exposure is conceded in the Veteran’s case. 4. Review the opinions and any examination reports to ensure that they are in complete compliance with the directives of this remand. If an opinion or report is deficient in any manner, the AOJ must implement corrective procedures.   5. Then readjudicate the claims GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Z. Sahraie, 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.