Citation Nr: 21007837 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 15-31 444 DATE: February 10, 2021 ORDER Entitlement to service connection for residuals of a groin injury is denied. Entitlement to a total disability for individual unemployability (TDIU) is dismissed. FINDINGS OF FACT 1. The most probative evidence of record does not indicate that there are residuals of a groin injury incurred in service. 2. The award of a 100 percent disability rating for posttraumatic stress disorder (PTSD) for the entire period on appeal with no additional compensable rated disabilities rendered the issue of entitlement to a TDIU moot. CONCLUSIONS OF LAW 1. The criteria for service connection for residuals of a groin injury have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303(a)-(b)(d) (2019). 2. The issue of entitlement to TDIU is moot. 38 U.S.C. §§ 7104, 7105 (2012); 38 C.F.R. §§ 4.14, 4.16 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran has active duty service in the United States Navy from January 1989 to February 2002 and from February 2002 to April 2002. This claim comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. This claim was last before the Board in April 2019 at which time it was remanded for further development. The Board is satisfied that the RO has substantially complied with the development called for in the remand directions such that the claim is now prepared for adjudication. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for residuals of a groin injury Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Service connection may also be granted for a disease first 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 order to establish service connection on a direct basis, the record must contain competent evidence of: (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, 1167 (Fed. Cir. 2004). Presumptive service connection for a disease enumerated on the list of chronic diseases in 38 C.F.R. § 3.309(a) shall be considered on three bases: chronicity during service, continuity of symptomatology since service, and manifestation to a compensable degree within one year of the Veteran's separation from service. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). That an injury occurred in service alone is not enough; there must be chronic (i.e., permanent) disability resulting from that injury. If there is no showing of a resulting chronic condition during service, or this is legitimately questionable, then a showing of continuity of symptomatology after service is required to support a finding of chronicity and the claim. 38 C.F.R. § 3.303(b).   The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a 3-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007) (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence considering the entirety of the record. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. Layno v. Brown, 6 Vet. App. 465 (1994). Lay evidence may be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition (i.e., when the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer); (2) the layperson is reporting a contemporaneous medical diagnosis, or; (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case, the claim is denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A review of the Veteran’s service treatment records (STRs) indicates that in 1989 the Veteran was treated for injuries sustained on a few occasions after consuming alcohol. These incidents occurred prior to a July 1991 incident in which the Veteran fell on steps and sustained a straddle injury to his groin. The following day the Veteran had blood visible in his urine. No blood alcohol level was obtained but the medical note indicates that the member smelled of alcohol and had slurred speech. Upon examination the Veteran’s ureter was intact. A urologist ordered a series of urinalyses which showed no blood in the urine. The Veteran was assessed as having resolved hematuria. In the Veteran’s separation Report of Medical History in December 1991, he endorsed blood in urine and recurrent back pain, further describing his fall on the ladder steps and hurting his private area, and a sharp burning back pain that came and went. The examining physician noted that the Veteran had no current complaints, had a normal urinalysis after full urologic work-up also determined that the Veteran did not have a ureteral laceration or other injury. The Veteran’s recurrent back pain was described as occasional mid-thoracic pain, musculoskeletal in nature. The Veteran’s clinical examination was normal including a negative screening for alcohol. In a January 2000 Navy Reserves Report of clinical evaluation, the Veteran had a normal genitourinary system. In his post-deployment health assessment competed in April 2002 the Veteran denied having an unresolved medical problem or concerns about his health. Private treatment records reflect that in July 2009 the Veteran had intermittent dysuria with burning pain. He gave a history of unprotected sexual contact with a new sexual partner. In a follow-up visit in April 2010 the Veteran was noted to be “still drinking.” He admitted to drinking a six pack of beer per day. His prostate specific antigen level within the normal range and there was no blood in the Veteran’s urine. In October 2011, the Veteran was afforded a VA examination regarding residuals of his groin injury, the examiner provided a negative opinion, noting that the Veteran did not currently have hematuria on urinalysis. In April 2018, the Veteran presented with an abscess of the left upper thigh/groin area that was treated with antibiotics followed by an incision and drainage of a left groin cystic lesion and acute inflammation. The lesion was determined to be an infected sebaceous cyst. In October 2018 during a Board hearing the Veteran testified that since his groin injury in service, he had occasionally experienced blood in his stool which he alleged was the result of that injury. In April 2019 the Board remanded the claim for additional development. VA received a packet of treatment records provided by the social security administration which did not reference blood in the urine or stool. In October 2020 the Veteran underwent an in-person VA Examination for residuals of his groin injury. The VA examiner reviewed the entire claims folder and considered the Veteran’s self-reported history. The Veteran complained of bloody stools and benign prostatic hyperplasia (BPH) as residuals of his groin injury in service. The evidence of record indicates that the Veteran was evaluated for possible BPH in 2009 but received no treatment. His most recent prostate specific antigen (PSA) test in 2012 was a normal with no testosterone level available. The Veteran reported experiencing bloody stools 10 years ago which was almost two decades after his groin injury in service. The VA examiner concluded that the Veteran’s bloody stools were less likely than not proximately due to or the result of the Veteran’s groin injury in service. No evidence was found to support that a groin injury could cause or lead to BPH. Regarding bloody stools, the Veteran was diagnosed with polyps of the colon as the cause of his bloody stools. In addition, there are no treatment records that support a nerve, artery, muscle or tissue damage associated with his service groin injury. The Board appreciates that the Veteran sincerely believes that he has residual symptoms of his groin injury in service. In fact, the Veteran has experienced bloody stools and was evaluated for benign prostatic hypertrophy all of which he is competent to report as a layperson. See Layno, supra. The evidence of record however does not indicate follow-up treatment since the filing of the claim in August 2010 for these symptoms. The Veteran’s treating physicians and the VA examiners took detailed histories from the Veteran and performed examinations prior to firmly attributing the Veteran’s bloody stools and his assessment for possible BPH more than 10 years ago to other causes. The Board affords great probative weight to the competent findings of the VA examiner who determined the Veteran did not have residuals of a groin injury. The Veteran has not been shown to have the requisite medical knowledge or expertise to be considered competent to diagnose residuals of a groin injury. Accordingly, the Board concludes that the preponderance of the evidence is against the claim for entitlement to service connection for residuals of a groin injury. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 510 (b); see also Gilbert, 1 Vet. App. 49. Entitlement to a TDIU VA received the Veteran’s VA Form 21-9840 on March 22, 2012. The Veteran indicated that due to his PTSD he had become too disabled to work as of February 28, 2011. Since that time, the Veteran was granted a 100 percent disability rating for PTSD effective June 28, 2010. A TDIU is provided where the combined schedular rating for service-connected diseases and disabilities is less than total, or 100 percent. 38 C.F.R. § 4.16(a). A TDIU is considered a lesser benefit than the 100 percent rating, and the grant of a 100 percent rating generally renders moot the issue of entitlement to a TDIU for the period when the 100 percent rating is in effect. The United States Court of Appeals for Veterans Claims (Court) has recognized that a 100 percent rating under the Schedule for Rating Disabilities means that a veteran is totally disabled. Holland v. Brown, 6 Vet. App. 443, 446 (1994). Thus, if VA has found a veteran to be totally disabled as a result of a particular service-connected disability or combination of disabilities pursuant to the rating schedule, there is no need, and no authority, to otherwise rate that veteran totally disabled on any other basis. See Herlehy v. Principi, 15 Vet. App. 33, 35 (2001) (finding a request for TDIU moot where 100 percent schedular rating was awarded for the same period). However, a grant of a 100 percent disability does not always render the issue of TDIU moot. VA's duty to maximize a veteran's benefits includes consideration of whether his disabilities establish entitlement to special monthly compensation (SMC) under 38 U.S.C. § 1114. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). Specifically, SMC may be warranted if the veteran has a 100 percent disability rating for a single disability, and VA finds that TDIU is warranted based solely on the disabilities other than the disability that is rated at 100 percent. See Bradley, 22 Vet. App. 280. In this case, the Veteran has not sought SMC at the housebound rate and the record did not otherwise reasonably raise that issue. Further, other than the Veteran's psychiatric disability, the Veteran was only service connected for erectile dysfunction associated with PTSD with a noncompensable evaluation. He receives SMC for loss of use of a creative organ. However, there is no indication in the record that the Veteran's service-connected erectile dysfunction rendered the Veteran unemployable. Accordingly, as the Veteran does not have any additional service-connected disabilities independently ratable at 60 percent, an award of SMC is not warranted. In addition, although the Veteran submitted his claim for a TDIU in March 2012, he also submitted a claim for PTSD in June 2010. See Rice v. Shinseki, 22 Vet. App. 447, 453 (2009) (holding that, in the context of an initial adjudication of a claim of entitlement to service connection or in the context of a claim for an increase "a request for TDIU, whether expressly raised by a veteran or reasonably raised by the record, is not a separate claim for benefits, but rather involves an attempt to obtain an appropriate rating for a disability"). While a claim for a TDIU may be inferred back to the date of the claim for service connection of PTSD, the RO assigned a 100 percent disability rating for the Veteran's PTSD effective June 2010, rendering the claim for TDIU moot. The appeal as to the claim for a TDIU is therefore dismissed. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Adams Hill, 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.