Citation Nr: 21010973 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 16-36 640 DATE: February 26, 2021 ORDER Entitlement to service connection for hematologic disability is denied. Entitlement to service connection for respiratory disability is denied. REMANDED Entitlement to service connection for right leg/hip disability is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that any current hematologic disability began during active service, or is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence is against finding that any current respiratory disability began during active service, or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a hematologic disability are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a respiratory are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1982 to January 1985. In October 2018 and October 2020, the Board remanded the appeal for further development. With respect to the issues decided herein, the Board finds there has been substantial compliance with the prior remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Entitlement to service connection for hematologic disability The Veteran generally asserts that service connection for a hematologic disability is warranted. He has not provided any evidence of an in-service incident or injury that caused such disability. Rather, he indicates that in 2008, he was unable to donate blood because of his travel to Europe while in service. In support of his claim, he submitted a February 2008 letter from the American Red Cross, which simply indicates that due to health history information, the Veteran should not donate blood, but the gave no further information concerning the Veteran’s health history, or any indication that it was due to a chronic blood disorder. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. Although it is unclear from the record whether the Veteran has a current hematologic disability as current VA clinical records are silent with respect any such disorder, private treatment records dated in June 2012 show mild anemia. Moreover, the Veteran has asserted that he has a hematologic disability. As such, for the purposes of this analysis, the Board finds that the Veteran has a current disability. However, the preponderance of the evidence is against finding that any disability began during active service, or is otherwise related to an in-service injury, event, or disease. In this regard, the preponderance of the evidence weighs against finding that an injury, event or disease occurred in service. Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993). Importantly, service treatment records do not show any findings of a hematologic disability. Moreover, with the exception of being stationed in Germany, neither the Veteran nor his representative have provided any medical or lay evidence of any injury, event or disease in service. Again, the Veteran appears to indicate a link between his inability to give blood in 2008 and service; however, this incident was 23 years after his discharge from active duty. Likewise, with the exception of generally claiming service connection, there has been no medical or lay evidence linking any current disability to service. While the Veteran believes his hematologic disability is related to service, the Board reiterates that the preponderance of the evidence weighs against finding that an in-service injury, event, or disease occurred. Consequently, the Board finds that VA is under no obligation to provide the Veteran with an examination in connection with this claim. See McLendon v. Nicholson, 20 Vet. App. 79 (2006) (recognizing that 38 C.F.R. § 3.159 (c) (4) presents a low threshold for the requirement of a VA examination). In conclusion, based on the analysis above, a preponderance of the evidence is against the Veteran’s claim for service connection for a hematologic disability. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107 (b). Entitlement to service connection for respiratory disability The Veteran contends that his respiratory disability is due to service. Service treatment records show reports of difficulty breathing and wheezing as well as various assessments of asthma and questionable bronchitis. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of restrictive lung disease as found in the August 2015 VA examination, and evidence shows the in-service respiratory incidents as described above, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of restrictive lung disease began during service or is otherwise related to an in-service injury, event, or disease. Importantly, post-service, the first medical evidence of any sort of respiratory disability is dated in May 2012, 27 years after the Veteran’s separation from service. While the Veteran is competent to report having experienced symptoms since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of his current respiratory disability. The issue is medically complex, as it requires knowledge of specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Moreover, given the lack of a diagnosis for many years after service, the Board finds the Veteran’s reports of continuity of symptomatology not credible as they are internally inconsistent with reports made in contemporaneous treatment records. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). The August 2015 VA examiner determined that the Veteran’s claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner summarized the relevant service treatment records and post-service records. The examiner rationalized that the Veteran's recent PFT study indicate a moderate restrictive defect that is partially due to the Veteran's body habitus. The FEV 1, FEVI/FVC, and DLCO are normal. This is consistent with no problems at the alveolar capillary membrane, and no obstruction. The examiner continued that it appears that the decrease in TLC, and RV are related to the Veterans body habitus. People with a restrictive lung disease have a much more difficult time filling their lungs with air. This is a result of the lungs being restricted from fully expanding. Most of the time, restrictive lung diseases occur when there is stiffness in the lungs themselves. Sometimes, this can occur when there is stiffness in the chest wall, weak muscles or damaged nerves that can restrict the expansion of the lungs. These are some of the conditions classified as restrictive lung disease: Interstitial lung disease, sarcoidosis and obesity. In this case, the examiner noted that there is no documentation of chronicity concerning a respiratory condition in the service treatment records. There is no evidence to suggest interstitial lung disease or sarcoidosis. He was treated over a period of a few days for a single occurrence. There is also no evidence of continuity of care for respiratory condition in the 25 years since military service, which portends against the existence of any chronic disabling condition, much less supporting a nexus back to any in service conditions. The examiner therefore opined that diagnosis of a respiratory condition that is less likely than not (less than 50 percent probability) incurred in or caused by the complaints of chest pain and trouble breathing and diagnosis of asthma during service. 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 that his current respiratory disability is related to an in-service injury, event, or disease. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. Again, the issue is medically complex, as it requires knowledge. Therefore, it is outside the competence of the Veteran in this case because the record does not show that she 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 VA examination with opinion. In conclusion, based on the analysis above, the Board finds that the preponderance of evidence is against the Veteran’s claim for service connection for a respiratory disability. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107(b). REASONS FOR REMAND Entitlement to service connection for right leg/hip disability is remanded. The Veteran is also seeking service connection for right leg/hip disability. The Board previously remanded this case to obtain a VA examination with opinion. The November 2020 VA examiner diagnosed the Veteran with right hip strain and opined that it was not related to service. The examiner rationalized that there was no evidence for any treated right thigh or hip conditions while the Veteran was in active duty. The examiner continued that wearing boots and wearing gear is challenging, but majority of the active duty soldiers do not experience lasting residuals in the right hip. However, the Board finds this rationale is inadequate as the examiner did not specifically address whether the Veteran’s diagnosed right hip strain was due to physical activity and training while wearing boots and carrying a machine gun. In other words, the examiner must address the Veteran’s contentions, his medical history and apply them to his disability as opposed to simply finding that most service members are not affected, which is a general assertion with no context to the Veteran’s specific claim. See Nieves, cited above. As such, the Board finds that an addendum opinion is necessary. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate medical professional concerning the nature and etiology of the Veteran’s right hip strain. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. The examiner should opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s right hip strain is related to service, to include physical activity and training while wearing boots, and carrying a machine gun. A detailed rationale should be provided with specific discussion of the Veteran’s medical history, his current right hip disability and his contentions concerning the in-service incidents. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.N. Moats 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.