Citation Nr: 21005877 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 13-31 525A DATE: February 2, 2021 ORDER Entitlement to service connection for a right shoulder disability is granted. Entitlement to service connection for hypertension is denied. Entitlement to service connection for residuals of cholecystectomy (removal of gallbladder) is granted. Entitlement to service connection for a thyroid disability, to include Grave’s disease and hypothyroidism, is granted. Entitlement to service connection for psoriasis is granted. Entitlement to an initial rating in excess of 30 percent for pseudofolliculitis barbae is denied. Entitlement to an initial rating in excess of 10 percent for allergic rhinitis is denied. FINDINGS OF FACT 1. A right shoulder disability, diagnosed as shoulder impingement syndrome and rotator cuff tendonitis, is related to in-service right shoulder injuries. 2. Hypertension is not etiologically related to service and was not present to a compensable degree within one year of separation from active service. 3. Resolving all reasonable doubt in the Veteran’s favor, residuals of cholecystectomy (removal of gallbladder) are related to service. 4. The Veteran’s thyroid disability, to include Grave’s disease and hypothyroidism, had its onset within one year of service. 5. The Veteran does not have a current diagnosis of psoriasis. 6. The Veteran’s pseudofolliculitis barbae does not affect more than 40 percent of his entire body or more than 40 percent of exposed areas, nor does it require constant or near-constant systemic therapy. 7. The Veteran’s allergic rhinitis has not manifested in nasal polyps. CONCLUSIONS OF LAW 1. The criteria for service connection for a right shoulder disability have been met. 38 U.S.C. §§ 1110 (2018); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 2. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110 (2018); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 3. The criteria for service connection for residuals of cholecystectomy (removal of gallbladder) have been met. 38 U.S.C. §§ 1110 (2018); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 4. The criteria for service connection for a thyroid disability, to include Grave’s disease and hypothyroidism have been met. 38 U.S.C. §§ 1110 (2018); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 5. The criteria for service connection for psoriasis have not been met. 38 U.S.C. §§ 1110 (2018); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 6. The criteria for a rating in excess of 30 percent for pseudofolliculitis barbae have not been met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7806 (2019). 7. The criteria for a rating in excess of 10 percent for allergic rhinitis have not been met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.97, Diagnostic Code 6522 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active air service from September 1977 to December 2002. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2009 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. In July 2015, a Decision Review Officer (DRO) hearing was held at the RO; a transcript of the hearing is of record. The Veteran testified at a hearing before the undersigned Veterans Law Judge in April 2018, and a transcript of the hearing is also of record. In July 2018, the Board remanded the appeal for additional evidentiary development. The case has now been returned to the Board for further appellate action. Service Connection 1. Right shoulder disability The Veteran asserts that his current right shoulder disability is related to service. Service treatment records (STRs) reflect that, in March 1979 the Veteran presented to the emergency room (ER) with complaints of pain behind the right shoulder. He had experienced pain for a week after playing racquetball. The examiner assessed muscle strain. In April 1979, the Veteran again sought treatment for his right shoulder pain. The examiner assessed muscle strain. In August 1981, the Veteran reported bilateral shoulder pain for two weeks after being tackled in football. Finally, an undated ER record noted that the Veteran reported right shoulder pain since [illegible]. The STR noted that the Veteran was 41 years old, suggesting that the Veteran reported to the ER between September 2000 and September 2001. Post-service, the Veteran presented to the ER in March 2003 for right shoulder pain. In July 2003, a treatment record noted right bicep strain. In June 2008, the Veteran submitted his claim for shoulder injury. At a November 2009 VA general medical examination, the Veteran stated that he injured his right shoulder in 1979 when he ran into a fence. He was seen and treated conservatively. The Veteran stated that he was last seen for his right shoulder in 2004. He was treated for tendonitis at that time and it had since resolved. The examiner diagnosed tendonitis right shoulder, resolved. In the Veteran’s June 2010 notice of disagreement, he asserted that his right shoulder still had some pain and tenderness. Pursuant to the Board’s July 2018 remand, the Veteran was afforded a VA examination in June 2019. The examiner diagnosed right shoulder impingement syndrome and rotator cuff tendonitis. The examiner opined that the right shoulder disability was less likely than not related to service, reasoning that there was no evidence of recurrent right shoulder pain during service. Based on the foregoing, the Board finds that service connection for a right shoulder disability is warranted. First, the Veteran has a current disability, namely, right shoulder impingement syndrome and rotator cuff tendonitis. Second, the evidence reflects that the Veteran suffered multiple in-service injuries to the right shoulder warranting ER treatment. Further, the Veteran sought treatment for his right shoulder within four months of separation from active duty. There is no evidence of an intervening cause of the Veteran’s current right shoulder disability. Although the record contains a negative etiological opinion, the opinion is inconsistent with the evidence of record as it is based on the examiner’s erroneous belief that there is no evidence of right shoulder pain during service. Consequently, it has no probative value. In sum, the most probative medical and lay evidence of record suggests that the Veteran’s current right shoulder disability is related to his in-service right shoulder injuries. Resolving all reasonable doubt in the Veteran’s favor, service connection for a right shoulder disability is granted. 38 U.S.C. § 5107 (b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Hypertension The Veteran asserts that his hypertension began during service in the 1990s. For VA purposes, hypertension means diastolic blood pressure predominantly 90 millimeters of mercury (mmHg) or greater, and isolated systolic hypertension means systolic blood pressure predominantly 160 mmHg or greater with diastolic blood pressure of less than 90 mmHg; hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note 1 (2019). STRs note that, in November 1997, the Veteran’s blood pressure reading was 136/69. At his October 2002 retirement physical, his blood pressure reading was 137/72. Post-service, a January 2004 treatment record noted a blood pressure reading of 148/67. Later in January 2004, his blood pressure reading was 155/80. Treatment records note a confirmed diagnosis of systemic hypertension in January 2011. At a June 2019 VA hypertension examination, the examiner noted a diagnosis of hypertension since January 2011. The Veteran reported the onset of recurrent elevated blood pressure readings during service, increasing in severity since onset. The examiner opined that the Veteran’s hypertension was less likely as not related to service, reasoning that there is no evidence of hypertension or recurrent elevated blood pressure readings in the hypertension range during service. Based on the foregoing, the Board finds that service connection for hypertension is not warranted. STRs and post-service treatment records prior to January 2011 fail to show hypertension for VA purposes. Thus, there is no evidence that hypertension manifested during service or within one year of his December 2002 retirement. Further, there is no competent evidence of record indicating that the Veteran’s currently present hypertension was otherwise related to his service. While the Veteran is competent to report observable symptoms of hypertension, he is not competent to diagnose hypertension or provide an opinion linking hypertension to his active service, as that requires medical expertise and is outside the realm of common knowledge of a layperson. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for hypertension is not warranted. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 49. 3. Residuals of cholecystectomy (removal of gallbladder) The Veteran asserts that he had pain related to gallbladder polyps during service that was masked by his service-connected irritable bowel syndrome (IBS). He further states that he experiences residuals from his post-service cholecystectomy. STRs note that the Veteran was treated in August 1983 for possible gallbladder disease. However, a gallbladder sonogram was normal. An October 1997 STR noted abdominal pain in the left quadrant. The examiner noted a history of abdominal pain since 1983, and assessed IBS. Post-service, a February 2004 abdominal ultrasound showed a small polyp in the gallbladder. In November 2004, the Veteran underwent a laparoscopic cholecystectomy to remove his gallbladder. At the April 2018 Board hearing, the Veteran testified that, during service, he was told that he might have gallstones, but that it was not necessary to have them removed. Instead, he managed a diet. At a June 2019 VA examination, the Veteran reported an onset of right upper quadrant abdominal pain in 1983. Since the onset, he has experienced upper abdominal pain, burning in upper stomach, and difficulty tolerating spicy or greasy food. The examiner opined that the Veteran’s residuals of cholecystectomy are not related to service, noting that the cholecystectomy occurred after service and there was no evidence of a gallbladder condition during service. Based on the foregoing, the Board finds that service connection for residuals of cholecystectomy is warranted. Although the Veteran was not diagnosed with gallbladder polyps until approximately 13 months after his discharge from active duty, the Board resolves reasonable doubt in the Veteran’s favor and finds that it is plausible that the polyps existed prior to their discovery, or within one year of discharge from service. Consequently, service connection for residuals of cholecystectomy (gallbladder removal) is granted. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 49. 4. Thyroid disability, to include Grave’s disease and hypothyroidism The Veteran asserts that his thyroid disability began during service. STRs note that, in November 1984, the Veteran lost 30 pounds in the past two to three months. Post-service, a January 2004 treatment record noted that the Veteran complained of increased sweating and heat intolerance for about six months. The examiner noted a history of a 30 pound weight loss in one year despite an increased appetite. His bowel movements had increased in frequency. His labs showed thyrotoxicosis. In February 2004, the Veteran was diagnosed with Grave’s disease. At a June 2019 VA examination, the Veteran reported that within a few months of active service, he began to have hot flashes and weight loss and was diagnosed with Grave’s disease. He was treated with radioactive iodine in 2004, resulting in residual hypothyroidism. The examiner opined that the Veteran’s thyroid disability was less likely related to service, noting that his condition was diagnosed after service and there is no evidence of a thyroid condition found during service or within one year of service. Based on the foregoing, the Board finds that service connection for a thyroid disability is warranted. The evidence reflects that the Veteran experienced symptoms of a thyroid disability during service, namely, extreme weight loss. Post-service, the Veteran sought treatment for hot flashes, heat intolerance, and weight loss in January 2004, symptoms that had begun six months earlier. Such report indicates that the Veteran’s symptoms of a thyroid disability began in mid-2003, within one year of his December 2002 discharge from active duty. There is no evidence of an intervening cause of the Veteran’s thyroid disability. Although the record contains a negative etiological opinion, the opinion is inconsistent with the evidence of record as it is based on the examiner’s erroneous belief that there is no evidence of a thyroid disability during service or within one year of discharge. Consequently, it has no probative value. In sum, the most probative medical and lay evidence of record suggests that the Veteran’s current thyroid disability is related to service. Resolving all reasonable doubt in the Veteran’s favor, service connection for a thyroid disability is granted. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 49. 5. Psoriasis The claim for psoriasis must be denied because there is no showing of a current disability at any time throughout the claims period. On November 2008 VA general medical examination, the VA examiner diagnosed tinea cruris (jock itch) and pseudofolliculitis barbae, both of which are service-connected. At a December 2012 VA skin diseases examination, physical examination of the skin did not reveal psoriasis. The examiner diagnosed pseudofolliculitis barbae. At his June 2018 Board hearing, the Veteran testified that his claimed psoriasis was actually a part of his pseudofolliculitis barbae. At the June 2019 VA skin examination, the Veteran denied any psoriasis. The examiner diagnosed herpes zoster (shingles), tinea cruris, and pseudofolliculitis barbae, all of which are service-connected. Finally, treatment records throughout the appeal period do not show a diagnosis of psoriasis. In sum, psoriasis is not among the many service-connected disabilities pertaining to the Veteran’s skin because he has not had a current diagnosis throughout the appeal period. Where the evidence does not support a finding of current disability upon which to predicate a grant of service connection, there can be no valid claim for that benefit. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Consequently, entitlement to service connection for psoriasis is denied. Increased Rating 6. Pseudofolliculitis barbae The Veteran is currently assigned an initial 30 percent disability rating for pseudofolliculitis barbae under 38 C.F.R. § 4.118, Diagnostic Code (DC) 7806. The Board notes that pseudofolliculitis barbae is not characterized under a specific DC. However, given that the General Rating Formula is the same for all the skin disorders listed under DC 7806 and DCs 7813-7816, the Board agrees with the RO’s characterization. The Board notes that the rating period extends to June 2008. Effective August 2018, the schedule of ratings for the skin was amended. 83 Fed. Reg. 32664 (July 13, 2018) (codified at 38 C.F.R. § 4.118). Claims pending prior to the effective date will be considered under both the old and new schedules, and whatever schedule is more favorable to the Veteran will be applied. Prior to August 2018, DC 7806 provided a higher, 60 percent rating where: 1) more than 40 percent of the entire body or more than 40 percent of exposed areas are affected; or 2) constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs was required during the past 12-month period. Id. Effective August 2018, the General Rating Formula for the Skin provided a 60 percent rating for at least one of the following: (i) characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or (ii) constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. 38 C.F.R. § 4.118. On November 2008 VA examination, the Veteran stated that his pseudofolliculitis barbae was only in the beard area. It consisted of bumps and irritation. He stated it is intermittent in nature. He currently shaved twice a week using a razor called a Bump Fighter. He stated he had no treatment within the past 12 months. Examination revealed pseudofolliculitis barbae in less than one percent exposed area and less than one percent of the total body surface area. At a December 2012 VA skin examination, the Veteran stated that he continued to have flare-ups of large pustules to the beard area and neck after shaving. The examiner stated that the Veteran’s skin condition did not cause scarring or disfigurement of the head, face or neck. He did not use any oral or topical medications in the past 12 months. Examination revealed pseudofolliculitis barbae in less than five percent exposed area and less than five percent of the total body surface area. On June 2019 VA skin diseases examination, the Veteran reported raised irritated flesh colored bumps that occurred after shaving. The Veteran used sensitive skin razors and shaving cream. Examination revealed pseudofolliculitis barbae in five to 20 percent exposed area and less than five percent of the total body surface area. The examiner noted that the Veteran’s pseudofolliculitis barbae was located in the anterior neck and face. At a June 2019 VA scars examination, the Veteran reported scars of the face and anterior neck due to pseudofolliculitis barbae with frequent flare-ups in service causing hyperpigmented scars. The scars were not painful or unstable. The examiner estimated that the approximate total area of the head, face and neck with hyperpigmented scars was 70 square centimeters. After a review of the evidence of record, the Board concludes that an initial rating in excess of 30 percent for Veteran’s pseudofolliculitis barbae is not warranted under the pre-amended (or amended) rating criteria. Although the June 2019 VA examination report reflects a worsening of the disability, at no time during the appeal did the Veteran’s pseudofolliculitis barbae affects more than 40 percent of his entire body or more than 40 percent of the exposed areas. Moreover, the Veteran has not reported use of any systemic therapy. Given that the Veteran was noted to have hyperpigmentation and scarring, the Board has considered whether any other DCs related to disabilities of the skin would provide for a higher disability evaluation. The Board specifically notes that under DC 7800, which applies to scars and disfigurement of the head, face, and neck, a scar with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with four or five characteristics of disfigurement warrants a 50 percent rating. A scar with visible or palpable tissue loss and either gross distortion of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with six or more characteristics of disfigurement warrants an 80 percent rating. 38 C.F.R. § 4.118. Note 1 to DC 7800 list the eight characteristics of disfigurement: a scar 5 or more inches in length; a scar at least one-quarter inch wide at widest part; surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo- or hyper-pigmented in an area exceeding six square inches; skin texture abnormal in an area exceeding six square inches; underlying soft tissue missing in an area exceeding six square inches; and, skin indurated and inflexible in an area exceeding six square inches. Id. The Board finds that although the Veteran has hyperpigmentation and scarring. the evidence does not reflect four characteristics of disfigurement which would warrant a higher rating under a different diagnostic code, including DC 7800. The Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability rating reflects. Moreover, the Veteran is competent to report observable symptoms. Jandreau, 492 F.3d at 1377. However, the Veteran does not assert, and medical treatment records do not show, that the Veteran’s disability more nearly approximates the criteria of the next higher rating. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim of a rating in excess of 30 percent for pseudofolliculitis barbae. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; Gilbert, 1 Vet. App. at 49. 7. Allergic rhinitis The Veteran’s allergic rhinitis is evaluated under 38 C.F.R. § 4.97, DC 6522. To warrant an evaluation in excess of 10 percent for allergic or vasomotor rhinitis, there must be polyps. VA examinations conducted in November 2008, December 2012, and June 2019 indicated that the Veteran did not have nasal polyps. Treatment records throughout the appeal are likewise silent for nasal polyps. Based on the foregoing, the Board finds that a rating in excess of 10 percent for allergic rhinitis is not warranted. The medical evidence of record demonstrates that the Veteran’s rhinitis does not present with nasal polyps. As such, his allergic rhinitis does not warrant a higher evaluation based on the schedular criteria. The evidence preponderates against the claim for an increased rating, and there is no doubt to resolve. 38 C.F.R. § 4.3 (2019). The claim for an increase remains denied. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Roya Bahrami, 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.