Citation Nr: 21006237 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 16-28 282 DATE: February 3, 2021 ORDER Entitlement to service connection for a back disorder is denied. Entitlement to service connection for hypertension as secondary to service-connected tension headaches is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that a back disability began during active service or is otherwise related to an in-service injury or disease. 2. The Veteran’s hypertension is not secondary to service-connected headaches and is not otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a back disorder 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 hypertension as secondary to service-connected tension headaches have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service in the U.S. Army from August 1975 to August 1979. In November 2018, the Board remanded the Veteran’s service connection claims for a back disability and hypertension for additional development. As all additional development has been completed, the Board is satisfied there was substantial compliance with its remand orders. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999); Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board notes that, in November 2018, the Board also remanded the Veteran’s service connection claims for a gastrointestinal disorder, an acquired psychiatric disorder, and erectile dysfunction. In an October 2019 rating decision, the Regional Office (RO) granted the Veteran’s service connection claims for posttraumatic stress disorder (PTSD) and gastric ulcers. Additionally, in an October 2020 rating decision, the RO granted the Veteran’s service connection claim for erectile dysfunction. As these grants represent a full grant of benefits sought by the Veteran on appeal, the Veteran’s service connection claims for a gastrointestinal disorder, an acquired psychiatric disorder, and erectile dysfunction are no longer before the Board. See Grantham v. Brown, 114 F.3d. 1156 (Fed. Cir. 1997). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To establish entitlement to service-connected compensation benefits, 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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service 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). For veterans with 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Pursuant to 38 C.F.R. § 3.303(b), where a chronic disease such as arthritis is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected. If a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303(b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101(3) or 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 1. Entitlement to service connection for a back disorder is denied. The Veteran contends that he has a back disability that is related to his military service. Specifically, at the February 2017 hearing, the Veteran reported that he injured in back while on active training in the Army Reserve in Panama sometime during the 1980s. First, with respect to a diagnosis, the September 2019 VA examiner noted that the Veteran has a diagnosis of lumbar degenerative disc disease. Accordingly, the first element of service connection, a diagnosis, has been met. As to an in-service incurrence, as noted above, at the February 2017 hearing, the Veteran reported that he injured his back while on active training in the Army Reserve in Panama sometime during the 1980s. However, a review of the Veteran’s periods of active service does not show that he had active duty service periods with the U.S. Army Reserves. Regardless, the Board notes that the Veteran’s service treatment records (STRs) document treatment of low back pain in August 1975, May 1976, and May 1979. Given that the Veteran’s STRs note a history of treatment for back pain, the Board finds that the second element of service connection, an in-service incurrence, has been met. Therefore, the only remaining issue is whether a nexus may be established. With respect to a nexus, in an October 2013 disability benefits questionnaire (DBQ) completed by a private provider, the provider noted that the Veteran had no history of back pain until an April 1975 motor vehicle accident. The provider also noted that the Veteran was seen twice, in August 1975 and May 1976, for lower back pain, and is currently seeing an orthopedist and physical therapist for treatment. As the provider did not opine on whether the Veteran’s back disability began in service or is otherwise related to active service, the Board does not find the October 2013 provider’s statements probative as to a nexus for the Veteran’s back disability. The September 2019 VA examiner opined that the Veteran’s back disability was less likely as not (less than 50 percent probability) incurred in or caused by time in service. The examiner reasoned that the evidence shows that the Veteran had acute and transitory muscle strains in service. The examiner noted that it is commonly accepted in the medical literature that acute and transitory muscle strains would not provide an etiology for the development of degenerative axial skeletal findings as strains are muscular. Rather, the examiner noted that the degenerative findings of his lumbar spine are consistent with the normal aging process as well as with his post-service back trauma documented in his 2006 hospitalization that was secondary to a motor vehicle accident. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran believes his back disability is related to his active service. However, the Veteran in this case is not competent to provide a nexus opinion regarding this issue. The etiology of a back condition is medically complex; it requires knowledge of interpretation of complicated diagnostic medical testing. 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). Consequently, the Board gives more probative weight to the September 2019 VA opinion. Lacking a nexus, entitlement to service connection for a back disorder is denied. 2. Entitlement to service connection for hypertension as secondary to service-connected tension headaches is denied. The Veteran also contends that hypertension is secondary to service-connected tension headaches. See October 2013 statement; April 2014 report of general information. First, with respect to a diagnosis, as the September 2014 and September 2019 VA examiners noted a diagnosis of hypertension, the first element of service connection, a diagnosis, has been met. Additionally, with regard to secondary service connection, the Board notes that the Veteran is service-connected for headaches. As to inservice incurrence, the Veteran’s service treatment records are silent to treatment for hypertension in service or a diagnosis in service. Thus, inservice incurrence has not been established. Turning to a nexus, addressing direct service connection, in September 2019, the VA examiner opined that the Veteran’s hypertension is less likely as not (less than 50 percent probability) incurred in or caused by time in service. The examiner reasoned that the Veteran’s STRs are silent for hypertension in service. The examiner noted that the evidence of record shows the Veteran was not diagnosed with hypertension until February 2006, which is decades after the Veteran’s military service. As to whether the Veteran’s hypertension is secondary to the Veteran’s service-connected headaches, the September 2019 VA examiner concluded that it is less likely as not (less than 50 percent probability) incurred in or caused by his service-connected headaches. The examiner also concluded that the Veteran has a diagnosis of benign essential hypertension that is less likely as not (less than 50 percent probability) aggravated by his service-connected headaches. The examiner reasoned that it is commonly accepted in the medical literature that a headache will not cause the development or aggravation of benign essential hypertension, which is a chronic condition of elevated blood pressure. Therefore, the examiner concluded that this etiology has not been established. The Board finds the September 2019 VA opinions probative because they are based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board acknowledges that the Veteran believes his hypertension is related to his military service or secondary to his service-connected headaches. However, the Veteran in this case is not competent to provide a nexus opinion regarding his hypertension. While he can report light headedness or dizziness as observable symptoms, the etiology of hypertension is not observable. The issue is medically complex. 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). Consequently, the September 2019 VA opinions are the most probative evidence of record regarding nexus. Accordingly, entitlement to service connection for hypertension on a direct basis as related to service and as secondary to service-connected tension headaches is denied. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. E. Grossman, 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.