Citation Nr: 21006189 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 16-42 155 DATE: February 3, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) is denied. Entitlement to service connection for a skin disorder is denied. Entitlement to service connection for hypertension, to include as secondary to an acquired psychiatric disorder is denied. FINDINGS OF FACT 1. The Veteran does not have a corroborated stressor to support service connection for PTSD and there is no probative evidence that any currently diagnosed acquired psychiatric disorder had its onset in service or is otherwise related to events in service. 2. The Veteran’s skin disorder is less likely than not related to his active service. 3. The Veteran’s hypertension did not manifest inservice or to a compensable degree within one year of service discharge and is not shown to be otherwise etiologically related to his active service. CONCLUSIONS OF LAW 1. The criteria for service connection for acquired psychiatric condition, to include PTSD, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for a skin disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from June 1972 to April 1978. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of multiple rating decisions issued by a regional office (hereinafter agency of original jurisdiction or AOJ) of the Department of Veterans Affairs (VA). The Veteran testified at a September 2019 travel Board hearing before the undersigned Veterans Law Judge, a transcript of which has been attached to the record. These issues were previously remanded to the AOJ for further development in a March 2020 Board decision and have now been returned for review. Service Connection Service connection will be granted if the Veteran has a disability resulting from personal injury or disease incurred in the line of duty, or for aggravation of a preexisting injury or disease incurred in the line of duty during active service. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. To establish service connection, the evidence must show competent evidence of (1) a present disability, (2) an 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Whenever there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the veteran. 38 U.S.C. § 5107(b). A valid service connection claim requires competent evidence of a current disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). However, the presence of a disability at any time during the claim process or relatively close thereto can justify a grant of service connection, even where such disability has become asymptomatic. McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Certain chronic diseases, such as hypertension, may be presumed to have been incurred during service if manifested to a compensable degree within one year of separation from active service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. Moreover, if a disease listed in 38 C.F.R. § 3.309(a) is shown to be chronic in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. Id. However, if evidence of a chronic condition is noted during service or during the presumptive period, but the chronic condition is not “shown to be chronic, or where the diagnosis of chronicity may be legitimately questioned,” i.e., “when the fact of chronicity in service is not adequately supported,” then a showing of continuity of symptomatology after discharge is required to support a claim for disability compensation for the chronic disease. Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013) (quoting 38 C.F.R. § 3.303(b)). A claimant “can benefit from continuity of symptomatology to establish service connection in the ultimate sense, but only if [the] chronic disease is one listed in § 3.309(a).” Id. at 1337. 1. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD The Veteran asserts that his acquired psychiatric disorder is due to his military service. The Board previously remanded the claim in order to clarify the Veteran’s psychological diagnosis, which was confirmed as PTSD with secondary depression. To establish entitlement to service connection for PTSD, the record must contain the following: (1) medical evidence diagnosing PTSD; (2) credible supporting evidence that the claimed in-service stressor occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304(f). If a stressor claimed by a Veteran is related to his or her fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a PTSD diagnosis and that the Veteran’s symptoms are related to the claimed stressor, then in the absence of clear and convincing evidence to the contrary and provided the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. See 38 C.F.R. § 3.304(f)(3). Otherwise, the law requires verification of a claimed stressor. Where a determination is made that the Veteran did not “engage in combat with the enemy,” or the claimed stressor is unrelated to combat, the Veteran’s lay testimony alone will not be enough to establish the occurrence of the alleged stressor. See Moreau v. Brown, 9 Vet. App. 389, 395 (1996). In such cases, the record must include service records or other credible evidence that supports and does not contradict the Veteran’s testimony. Doran v. Brown, 6 Vet. App. 283, 289 (1994). Moreover, a medical opinion diagnosing PTSD does not suffice to verify the occurrence of the claimed in-service stressors. See Moreau, 9 Vet. App. at 395-396. The Veteran’s service treatment records are silent for complaints of or treatment for an acquired psychiatric disorder. In his March 1978 separation examination, the Veteran denied being hospitalized or receiving treatment for other than minor illnesses. In a March 2007 statement in support of his claim, the Veteran reported that he was given an inservice spinal tap and then put into a bathtub of ice due to high temperature. He stated that while sitting in the tub he saw a person being unsuccessfully revived with a “shock machine.” According to February 2008 VA treatment records, the Veteran reported reexperiencing an incident in Germany where he witnessed a car accident in which two soldiers were decapitated and another event wherein he discovered the bodies of four soldiers whose tent had been run over by a tank in the dark. In a January 2009 statement in support of his claim, the Veteran reported seeing a fellow soldier, PFC R.T., go through the windshield after a vehicle collision and “his head came apart like a puzzle.” He indicated he was injured in this accident and treated for back, neck and chest injuries and that an investigation was conducted. September 2009 VA treatment records indicate the Veteran was diagnosed with PTSD and comorbid depressive disorder. The treating clinician opined that the Veteran’s traumatic exposure promoted the development of PTSD and that his depression was secondary to his PTSD symptoms. In September 2009 correspondence, he reported nightmares and flashbacks regarding an incident on morning patrol during Operation Reforger. The Veteran described making rounds of the camp on perimeter patrol when he discovered the remains of four bodies that had been crushed inside their tent by a passing tank. He stated all he could recognize of the bodies were their uniforms and that he was not told the names of the soldiers but indicated that the incident was investigated by CID agents. The Veteran also claimed he was in an inservice car accident on the autobahn. In November 2009 correspondence, the Veteran reported he woke up in the hospital after being admitted for respiratory problems and saw a Sergent Major die after “electroshock treatment.” He also stated he witnessed a CID vehicle collide with a convoy truck and that the passenger in the CID vehicle was decapitated, his head rolling by the Veteran’s group during Operation Reforger. The Veteran also reported driving up Kugel Mountain with no lights on in the middle of the night and being scared he was going to fall over the edge to his death. The AOJ attempted to corroborate the Veteran’s stressors, and in August 2010 received a Defense Personnel Record Information Retrieval System (DPRIS) response regarding Operation Reforger, which took place from September 20 to November 21, 1974. The DPRIS report, coordinating multiple databases, indicated that from April 1973 to November 1974 there were no reports of corpses being discovered or soldiers being killed in motor vehicle accidents. In September 2010 correspondence, the Veteran indicated that PFC R.T. did not die in the car accident on the autobahn, but instead had approximately “2,000 stitches.” A June 2011 DPRIS response indicated that there was no record pertaining to the injury or death of PFC R.T. in a car accident. The AOJ twice attempted to corroborate the Veteran’s car accident and tent incident stressors with the United States Crime Records Center, with no success. The Veteran reiterated seeing a fellow soldier severely injured and another decapitated according to June 2011 VA treatment records. September 2011 VA treatment records indicate the Veteran reported witnessing the suicide of a fellow solider as well as multiple accidents resulting in serious injury and the death of two other soldiers. In May 2013, the Veteran told a treating clinician he was injured in two separate motor vehicle accidents while on active duty. In April 2013, he reported he had to walk in front of a jet fuel tanker truck to guide it across a narrow bridge, but if the truck had fallen off the bridge the explosion would have killed himself and the driver. In his August 2016 Form 9 appeal, the Veteran stated that he was injured in a car accident in Germany, and that four other people were with him. At the September 2019 Board hearing, the Veteran indicated that the source of his psychological symptoms was an inservice car accident in which he was ejected from the vehicle and witnessed his fellow soldier’s face go through the windshield. He indicated he later heard the soldier’s treatment required approximately 2000 stitches. The March 2020 Board decision remanded the claim in order to afford the Veteran additional VA psychological examination, which took place in May 2020. The examiner confirmed the diagnosis of PTSD with secondary major depressive disorder. The examiner opined that, based on a review of the record, it was likely that trauma exposure promoted the development of PTSD with secondary depression and found the Veteran met all the criteria for a diagnosis of PTSD. The Veteran reported three inservice stressors: witnessing a soldier decapitated in an accident on the autobahn, witnessing his friend’s face go through the windshield during another accident and finding four soldiers inside a tent crushed by a tank while on patrol. The examiner indicated that the Veteran’s reported stressors were significant enough to cause PTSD. Despite the findings of the May 2020 VA examiner, the Board finds that the asserted inservice stressors, which the VA examiner found to be medically linked to the Veteran’s current symptoms, are not verified. The DPRIS report indicated there was no record of soldiers being crushed by a tank during Operation Reforger. Military personnel records are silent to any inservice event such as those described by the Veteran, including one or more motor vehicle accidents. Furthermore, the Veteran’s service treatment records do not indicate any inservice event or injury of this nature, despite the fact that he reported receiving treatment for injuries incurred during the accidents. Finally, the Veteran’s testimony indicating he witnessed the death of a solider after unsuccessful defibrillation is inconsistent. In one instance, he indicated he was in an ice bath after a spinal tap for back treatment, in another, he had just awoken after hospitalization for serious respiratory issues. These inconsistencies lower the overall probative value of his recollections. See State v. Spadafore, 220 S.E.2d 655, 661 (W. Va. 1975) (observing that, when evaluating inconsistent or contradictory testimony, “[t]he fact that [a witness] has stated the matters differently on a previous occasion tends to demonstrate either a failure of memory, or a lack of integrity, and in either event it weakens and impairs the value of his testimony.”) Furthermore, the Veteran’s testimony is not enough as a matter of law to corroborate the reported stressors. See 38 C.F.R. § 3.304(f)(1-5). The Veteran is not claiming a stressor which allows for a relaxed evidentiary standard under 38 C.F.R. § 3.304(f)(1-5). In other words, because the claimed stressors are not related to combat or personal assault, the Veteran’s lay testimony alone is not enough to establish the occurrence of the alleged stressor. Id. Thus, his stressors must be corroborated by other evidence of record. As noted above, there are no personnel or medical records corroborating the narratives of his claimed stressors. Therefore, the threshold requirement of service connection for PTSD has not been met because the inservice events or stressors have not been corroborated by external evidence. In summary, a preponderance of the evidence is against the claim on that basis, and as such service connection for PTSD is not warranted. 38 U.S.C. § 5107(b). 2. Entitlement to service connection for a skin disorder The Veteran originally claimed entitlement to service connection for a right-hand skin condition. His service treatment records are silent for complaints of or treatment for a skin disorder. VA treatment records indicate that he reported to the hospital in April 2006 for dermatitis blisters on his right hand after coming into contact with hot grill oil. VA treatment records also note the Veteran has been prescribed topical cream to treat skin irritation due to itchy blisters of his right hand since March 2007. At the September 2019 hearing, the Veteran asserted that his condition began during service and was due to exposure to various fuels during his military occupation as a parts man. The Veteran testified that he was treated for skin breakouts during active duty, and stated the treating clinician informed him they were due to his handling of fuels. He reported experiencing recurrent breakouts since service and indicated he had been prescribed topical medication by the VA. At the hearing, the Veteran submitted a medical treatise indicating that direct exposure to some fuels can cause contact dermatitis, and long-term exposure can possibly lead to heart and lung problems. The article noted that the result of long-term exposure to fuels is unknown. In a March 2020 decision, the Board remanded the claim in order to afford the Veteran a VA skin examination. The Veteran was afforded a VA skin examination in May 2020. The examiner noted a current skin condition, dermatitis, diagnosed in 1972 and affecting less than five percent of the body. The Veteran reported that since his inservice work with jet fuels he had experienced repeated skin breakouts affecting only his right hand. He indicated these breakouts include blisters and skin irritation, occur every “couple months” and last for at least a month. The examiner opined that the Veteran’s skin disorder was less likely than not related to his service, as there was no medical evidence of a chronic skin issue inservice. With regard to the medical article submitted by the Veteran, the examiner noted that the article itself indicated the long-term effects of fuel exposure were not generally known. The examiner, a medical doctor, reported being unable to locate any studies or other evidence to validate the Veteran’s assertion that his dermatitis is due to inservice fuel exposure. The Board observes that the Veteran’s current skin condition, dermatitis, is not a chronic disease listed in 38 C.F.R. § 3.309. Therefore, the Veteran cannot benefit from continuity of symptomatology in order to ultimately establish service connection. Furthermore, while the Veteran is competent to report having experienced a skin condition on his right-hand during service, he is not competent to provide a diagnosis or in this case determine that these symptoms were a manifestation of his current disability. This issue is medically complex, as it requires medical training and knowledges of the internal workings of the human body. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Similarly, it is not the place of the Board to substitute its own inadequate lay knowledge for that of the Veteran. See Kahana (Lance, J. concurring). The Board finds the opinion of the VA medical doctor highly probative, as it was based on a thorough examination of the Veteran, review of his medical treatment records, and addressed both the lay and medical evidence submitted by the Veteran. There is no competent opinion to the contrary. As noted above, the Veteran’s inservice and post-service medical records are silent for treatment of a skin disorder until his April 2006 hospitalization after exposure to hot grill oil. Finally, the Board assigns the medical article submitted by the Veteran little probative value, as it discusses only short-term exposure to fuels producing temporary contact dermatitis and does not address the long-term effect of exposure on skin. Therefore, the Board finds that a preponderance of the objective medical and probative opinion evidence is against a finding that the Veteran’s skin disorder is due to his active service. In this case there is no doubt of material fact to be resolved in the Veteran’s favor, and the claim is denied. 38 U.S.C. § 5107(b). 3. Entitlement to service connection for hypertension, to include as secondary to an acquired psychiatric disorder The Veteran asserts that his high blood pressure is due to his military service, to include as secondary to his psychiatric disorder. The Veteran’s service treatment records are silent for complaints of or treatment for high blood pressure. Additionally, there are no treatment records indicating the occurrence of high blood pressure within one year of separation from service. VA treatment records note isolated incidences of hypertensive blood pressure in March and May 2013, after which the Veteran was prescribed medication to control his blood pressure level. In a March 2007 statement in support of his claim, the Veteran reported receiving an inservice spinal tap and sitting in a bathtub full of ice due to a high temperature. The Veteran stated that while sitting in the tub he was told by doctors that he would experience hypertension and other health problems as he got older because of his high temperature. At the September 2019 Board hearing, the Veteran reported being told by his doctor that his PTSD causes his hypertension: he gets angry easily because of his mental condition which raises his blood pressure. He indicated his hypertension was diagnosed in 2008 and reported taking medication to control his blood pressure. The Board observes that the Veteran has not been afforded a VA examination in relation to this claim. A VA medical examination is required when there is competent evidence of a current disability, evidence of an in-service event, injury or disease, indication that a current disability may be service related (to include secondary service connection), and there is otherwise insufficient medical evidence to make a decision. McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). The threshold for determining whether the evidence “indicates” that there “may” be a nexus between a current disability and an in-service event, injury, or disease is a low one. McLendon, 20 Vet. App. at 83. The Board finds that a VA examination under the standards of McLendon is not warranted in this case. While the Veteran is competent to report a contemporary diagnosis by a medical professional, his statements regarding the inservice incident have little probative value due to internal inconsistency, as noted above. There is no medical evidence of high blood pressure or hypertension until 2008, and there is no credible, probative evidence suggesting persistent or recurrent symptoms since service, or the suggestion of a relationship between service and a service-connected disability. Additionally, the submitted medical article does not suggest a link between long-term exposure to fuels and the incurrence of skin disorders. The Veteran’s “conclusory generalized statement” that his hypertension is due to service, in and of itself, is insufficient to require the Secretary to provide an examination. Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). The Federal Circuit explained, “[s]ince all veterans could make such a statement, this theory would eliminate the carefully drafted statutory standards governing the provision of medical examinations and require the Secretary to provide such examinations as a matter of course in virtually every veteran’s disability case.” Id. In sum, the Board finds that the preponderance of the evidence establishes that the Veteran’s hypertension did not manifest in service or to a compensable degree within one year of service discharge and is not shown to be otherwise etiologically related to his active service. There is no doubt of material fact to be resolved in the Veteran’s favor. 38 U.S.C. § 5107(b). As such, the claim of entitlement to service connection for hypertension on a direct basis is denied. Finally, as the Veteran has been denied entitlement to service connection for an acquired psychiatric disorder, an analysis of service connection on a secondary basis is unnecessary. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. C. Schumacher, 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.