Citation Nr: 21012994 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 14-10 321 DATE: March 8, 2021 ORDER Entitlement to service connection for hypertension is denied. Entitlement to service connection for a psychiatric disability, to include anxiety disorder and depressive disorder, is denied. Entitlement to service connection for hyperlipidemia or dyslipidemia (high cholesterol) is denied. Entitlement to service connection for diabetes mellitus is denied. Entitlement to service connection for a heart disability is denied. Entitlement to service connection for heat exhaustion residuals is denied. Entitlement to service connection for an adrenal gland disability, to include hyperaldosteronism, is denied. REMANDED Entitlement to service connection for a dental disability, to include third molar extraction residuals and disability manifested by jaw pain, is remanded. Entitlement to service connection for an eating disability, to include obesity, is remanded. Entitlement to service connection for a sleep disability, to include sleep apnea, is remanded. FINDINGS OF FACT 1. Hypertension was not shown during active service or for many years thereafter. Diagnosed hypertension has not been shown to have originated during active service or be otherwise related to active service. 2. A psychiatric disability was not shown during active service or for many years thereafter. Diagnosed anxiety disorder and major depressive disorder have not been shown to have originated during active service or be otherwise related to active service. 3. Hyperlipidemia or dyslipidemia (high cholesterol) is not a disability for which Department of Veterans Affairs (VA) disability benefits may be awarded. 4. Diabetes mellitus was not shown during active service or for many years thereafter. The diagnosed diabetes mellitus has not been shown to have originated during active service or be otherwise related to active service. 5. A heart disability was not shown during active service or at any time thereafter. 6. Heat exhaustion residuals were not shown during active service or at any time thereafter. 7. An adrenal gland disability, including hyperaldosteronism, was not shown during active service or at any time thereafter. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for a psychiatric disability, to include anxiety disability and depressive disorder, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. Service connection for hyperlipidemia or dyslipidemia (high cholesterol) may not be granted. 38 U.S.C. § 1131; 38 C.F.R. § 3.303; 61 Fed. Reg. 20440, 20445 (May 7, 1996). 4. The criteria for service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. 5. The criteria for service connection for a heart disability have not been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 6. The criteria for service connection for heat exhaustion residuals have not been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 7. The criteria for service connection for an adrenal gland disability, including hyperaldosteronism, have not been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from July 1978 to July 1981. He had active duty or active duty for training with the Army Reserve and the Puerto Rico Army National Guard from September 3, 1983, to September 17, 1983; from May 26, 1984, to June 9, 1984; from August 10, 1985, to August 24, 1985; and from May 31, 1986, to June 14, 1986. The Veteran appeared at a November 2015 videoconference hearing before the undersigned Veterans Law Judge. The hearing transcript is of record. Service Connection Service connection may be established for disability arising from disease or injury incurred in or aggravated by active service or while performing active duty for training. 38 U.S.C. §§ 101(24), 106, 1110, 1131. Service connection may be established for any disease diagnosed after separation from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Where a veteran served continuously for 90 days or more during a period of war or during peacetime service after December 31, 1946, and hypertension or diabetes mellitus becomes manifest to a degree of ten percent within one year of termination of that service, the disease shall be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Hypertension The Veteran asserts that service connection for hypertension is warranted as the claimed disability initially manifested during active service. The service medical records do not refer to hypertension. The report of a June 1981 physical examination for service separation shows that the Veteran reported experiencing a single episode of elevated blood pressure in the past. On examination, the Veteran exhibited a blood pressure reading of 110/70. Hypertension was not diagnosed. A December 1981 VA treatment record shows that the Veteran exhibited a blood pressure reading of 110/80. Clinical documentation from Hospital Damas dated in January 1982 shows that the Veteran exhibited a blood pressure reading of 130/70. At an April 1982 VA examination, the Veteran reported having “developed hypertension” during active service. On examination, the Veteran exhibited blood pressure readings of 120/80, 100/80, and 118/80. The examiner stated, “no hypertension found.” The report of a March 1985 Puerto Rico Army National Guard examination for appointment as a second lieutenant indicates that the Veteran had a blood pressure reading of 120/85. In a May 2002 informal claim, the Veteran asserted that “a couple of times during my military service, I was diagnosed as having high blood pressure” and “I was diagnosed again with high blood pressure two months after discharge at the VA clinic in Ponce, Puerto Rico.” A September 2003 private treatment record shows that the Veteran was diagnosed with hypertension. In February 2004 notice of disagreement, the Veteran stated that “I was verified with hypertension while I was in the service.” Clinical documentation from P. Carbajo, M.D., dated in September 2007 notes that the Veteran had “a 10 year history of hypertension.” At the November 2015 Board of Veterans’ Appeals (Board) hearing, the Veteran testified that “I was first informed that I had hypertension” in active service; “I went on sick call and the doctor, as soon as they did my blood pressure, they noticed my blood pressure was elevated and they took my blood pressure in many different positions;” and “as soon as I got out, I went to the VA clinic that was in Damas Hospital in Ponce and that’s when I first was prescribed medications for high blood pressure.” The service medical records do not refer to hypertension. VA and private clinical documentation dated within one year of service separation did not report either a diagnosis of hypertension or elevated blood pressure readings. The report of the March 1985 Puerto Rico Army National Guard examination for appointment as a second lieutenant indicates that the Veteran exhibited a blood pressure of 120/85. The Veteran’s private physician reported that the Veteran was initially diagnosed with hypertension in approximately 1997, over 10 years after his last period of active duty. The Veteran asserts that hypertension was initially manifested during his first period of active service or within one year of service separation. No competent medical professional has concluded that hypertension originated during active service or active duty. The Veteran’s claim is supported solely by his own testimony and statements on appeal. Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). Lay evidence can be competent and sufficient to establish a diagnosis or etiology when (1) a lay person is competent to identify a medical condition; (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Board finds that the Veteran’s lay statements and testimony do not constitute competent evidence to establish a relationship between active service and the currently diagnosed hypertension. The Veteran has not offered any medical qualifications. The Veteran is not competent to offer an opinion regarding the relationship between hypertension and active service. The Veteran is not competent to diagnose hypertension. The question of such an etiological relationship requires medical training and specific clinical testing and is too complex to be addressed by a layperson. The Veteran has not submitted any competent evidence relating hypertension to service. Hypertension was not manifested during active service or for many years thereafter. The disability has not been shown to have originated during active service or to have manifested to a compensable degree within one year following separation from service. Accordingly, the Board finds the preponderance of the evidence is against the claim for service connection for hypertension and the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Psychiatric Disability The Veteran contends that service connection for a psychiatric disability is warranted as anxiety disorder and depressive disorder were initially manifested during active service as the result of weight gain and high blood pressure readings in service. The service medical records do not refer to any anxiety disorder, depressive disorder, or any other psychiatric disability. The service records do not indicate that the Veteran was counseled for not meeting service weight standards. Private clinical documentation dated in 2009 shows that the Veteran was diagnosed with depression. A March 2019 VA mental health clinic treatment record states that the Veteran was diagnosed with anxiety disorder and major depressive disorder. At the November 2015 Board hearing, the Veteran testified that he had been treated for anxiety and depression during active service. He clarified that he was counseled at Walter Reed Army Medical Center for an eating disorder and conduct issues. The service medical records do not refer to a psychiatric disability, including anxiety disorder and depressive disorder. The first clinical documentation of the claimed disability is dated in 2009, over 20 years after the Veteran’s final period of active duty. The Veteran asserts that an anxiety disability and a depressive disability were initially manifested during active service. No competent medical professional has concluded that a psychiatric disability originated during active service or active duty. The Veteran’s claim is supported solely by his own testimony and statements on appeal. The Board finds that the Veteran’s lay statements and testimony do not constitute competent evidence to establish a relationship between active service and the currently diagnosed anxiety disorder and major depressive disorder. The Veteran has not offered any medical qualifications. While he may report that he was felt anxious and depression during active service, the Veteran is not competent to offer an opinion regarding the relationship between the diagnosed psychiatric disabilities and active service. The question of such an etiological relationship requires medical training and specific clinical testing and is too complex to be addressed by a layperson. The Veteran has not submitted any competent evidence relating the diagnosed anxiety disorder and major depressive disorder to service. A psychiatric disability was not manifested during active service or for many years thereafter. The diagnosed anxiety disorder and major depressive disorder have not been shown to have originated during active service. Accordingly, the Board finds the preponderance of the evidence is against the claim for service connection for a psychiatric disability, to include anxiety disorder and depressive disorder, and the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Hyperlipidemia or Dyslipidemia The Veteran asserts that service connection for high cholesterol is warranted. VA clinical documentation dated in July 2020 notes that the Veteran was diagnosed with hyperlipidemia (high cholesterol). The clinical record does not show, and the Veteran has not claimed, that the elevated cholesterol level is a symptom of a specific disability. An elevated cholesterol level alone represents a laboratory finding. Hyperlipidemia, dyslipidemia, or high cholesterol is not a disability for which VA disability compensation may be granted. 61 Fed. Reg. 20440, 20445 (May 7, 1996). Therefore, as a matter of law, service connection for hyperlipidemia or dyslipidemia must be denied. Sabonis v. Brown, 6 Vet. App. 426 (1994). Diabetes Mellitus The service medical records do not refer to diabetes mellitus. An August 2010 VA diabetic retinopathy surveillance note states that the Veteran reported that he had been initially diagnosed with diabetes mellitus in January 1999. At the November 2015 Board hearing, the Veteran testified that, while he was told that “he had “a potential for diabetes when he was in the service,” he was not diagnosed with diabetes mellitus during active service. He stated that he was initially diagnosed with and treated for diabetes mellitus following service separation. The Veteran acknowledged that his doctors had not related the diabetes mellitus to active service. Diabetes mellitus was not diagnosed during active service or for over ten years following the Veteran’s last period of active duty. The record does not establish, and the Veteran does not allege, that diabetes mellitus was incurred during active service or became manifest to a compensable degree within one year of service separation. Therefore, the Board concludes that service connection for diabetes mellitus is not warranted. Heart Disability The Veteran asserts that service connection for a heart disability is warranted as the claimed disability was manifested during active service. The service medical records do not refer to a heart disability. An October 2009 electrocardiographic study from R. Orchard, M.D., states that the Veteran exhibited abnormal left ventricular diastolic function. The Veteran was diagnosed with benign essential hypertension. At the November 2015 Board hearing, the Veteran testified that he was found to have “a heart murmur” during active service. He denied receiving any treatment for a heart disability. The Veteran stated that he was treated for hypertension “to make sure my heart is okay.” The service medical records do not show that the Veteran was diagnosed with a heart murmur or any other heart disability. The post-service clinical records do not establish that the Veteran has been diagnosed with a heart disability. While he was found to have abnormal left ventricular diastolic function, the Veteran’s treating physician associated that abnormality with the nonservice connected hypertension. The Veteran asserts that he has a heart murmur and that disability was initially manifested during active service. No competent medical professional has diagnosed the Veteran with a heart murmur or other heart disability. The Veteran’s claim is supported solely by his own testimony and statements on appeal. The Board finds that the Veteran’s lay statements and testimony do not constitute competent evidence to establish the diagnosis of a heart disability. The Veteran has not offered any medical qualifications. The Veteran is not competent to offer an opinion regarding the diagnosis of a heart disability. The question of such a diagnosis requires medical training and specific clinical testing and is too complex to be addressed by a layperson. The Veteran has not submitted any competent evidence of a heart disability. A heart disability was not manifested during active service or at any time thereafter. Accordingly, the Board finds service connection for a heart disability must be denied. Heat Exhaustion Residuals The Veteran contends that service connection for heat exhaustion residuals is warranted as he was seen for heat exhaustion following a road march during active service and he has had difficulty with excessive sweating following service separation. The service medical records do not refer to heat exhaustion or any residuals of any heat exhaustion an episode. The post-service clinical record does not show any diagnosis of or treatment for heat exhaustion residuals. At the November 2015 Board hearing, the Veteran testified that he experienced heat exhaustion during a road march at Fort Gordon, Georgia and was treated by being given “a Gatorade-type thing to help get my levels up.” He denied experiencing any heat exhaustion residuals or receiving any treatment for heat exhaustion residuals. The service medical records and the post service clinical record do not establish that the Veteran been diagnosed with or otherwise found to have any heat exhaustion residuals. The Veteran has acknowledged that he has no heat exhaustion residuals. In the absence of current disability, the Board concludes that service connection for heat exhaustion residuals must be denied. Adrenal Gland Disability The Veteran asserts that service connection for an adrenal gland disability to include hyperaldosteronism is warranted as the disability was caused by his “initial problems in active duty.” The service medical records do not refer to hyperaldosteronism or any other adrenal gland disability. A May 2009 treatment record from Dr. Orchard states that “I suspect that he has hyperaldosteronism although this has not been proven.” The remainder of the clinical record does not refer to an adrenal gland disability. At the November 2015 Board hearing, the Veteran testified that he was diagnosed with hyperaldosteronism following service separation and was no longer being treated for an adrenal gland disability. He acknowledged that no medical professional had related the disability to active service. The service medical records and the post service clinical record do not establish that the Veteran been diagnosed with or otherwise found to have any adrenal gland disability. The Veteran has acknowledged that he has no current adrenal gland disability. In the absence of current disability, the Board concludes that service connection for an adrenal gland disability, to include hyperaldosteronism, must be denied. REASONS FOR REMAND 1. Entitlement to service connection for a dental disability, to include third molar extraction residuals and jaw pain, is remanded. The Veteran asserts that service connection for a dental disability is warranted as he has experienced jaw pain since having four wisdom teeth removed during active service. The service dental records show that the Veteran underwent removal of the third molars in November 1979. VA’s duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121 (1991). The Veteran has not been provided a VA examination to determine the nature of the claimed jaw pain and any relationship to active service. Clinical documentation dated after August 2020 is not of record. VA should obtain all relevant VA and private treatment records which could potentially be helpful in resolving the Veteran’s claims. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). 2. Entitlement to service connection for an eating disability to include obesity, and a sleep disability, to include sleep apnea, is remanded. The Veteran contends that service connection for an eating disability, to include obesity, is warranted as he was treated for the claimed disability during active service. He asserts further that service connection for sleep apnea is warranted as he experienced sleeping difficulties during active service including snoring and was subsequently diagnosed with obstructive sleep apnea. Obesity is not a disease or disability for which service connection may be granted. VAOPGCPREC 1-2017 (the “longstanding policy of the Department of Veterans Affairs is that obesity per se is not a disease or injury for purposes of 38 U.S.C. §§ 1110 and 1131 and therefore may not be service connected on a direct basis, is consistent with Title 38, United States Code” and “obesity per se is not a ‘disability’ for purposes of 38 C.F.R. § 3.310.”) Service connection may be established under 38 C.F.R. § 3.310(a) if obesity was an “intermediate step” between a service connected disability and a current disorder. VAOPGCPREC 1 2017. In order for secondary service connection to be established, the record must demonstrate that: (1) the service connected disability caused a veteran to become obese or aggravated his obesity; (2) the obesity or the aggravation of obesity as a result of the service connected disability was a substantial factor in causing the claimed disability; and (3) the claimed disability would not have occurred but for obesity caused or aggravated by the service-connected disability. Walsh v. Wilkie, 32 Vet. App. 300 (2020). The service medical records show that the Veteran was found to be overweight. Clinical documentation dated in October 1979 states that the Veteran was overweight and diagnosed with exogenous obesity. A November 1979 treatment entry indicates that the Veteran was sent to Walter Reed Medical Center “for weight loss.” VA clinical documentation dated in August 2010 shows that the Veteran was diagnosed with obstructive sleep apnea and used a C PAP machine. At the November 2015 Board hearing, the Veteran testified that he was counselled for an eating disability at Walter Reed Medical Center during active service and received ongoing post service treatment for an eating disorder. He stated further that he experienced sleeping difficulty and significant snoring during active service. The issues of service connection for an eating disability to include obesity and a sleep disability to include sleep apnea are inextricably intertwined because of the general nature of sleep apnea. The Veteran has not been provided a VA eating disability examination or a VA sleep examination. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider who treated him for any dental, jaw, eating, and sleep disabilities. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran’s VA clinical documentation not already of record, including treatment records dated after August 2020. 3. Schedule the Veteran for a VA examination conducted by the appropriate medical or dental professional to ascertain the nature of any third molar extraction residuals, including jaw pain, and any relationship to active service. The examiner must review the record and should note that review in the report. The examiner should: (a) Identify all third molar extraction residuals found and specifically opine whether any disability manifested by jaw pain is present. If third molar extraction residuals or disability manifested by jaw pain are not found, the examiner should expressly state that fact. (b) State whether any identified third molar extraction residuals and disability manifested by jaw pain had its onset during active service or are related to any incident of service including the documented in service third molar extraction residuals. 4. Schedule the Veteran for a VA examination conducted by the appropriate medical professional to ascertain the nature of any eating disability and any relationship of such disability to active service. The examiner must review the record and should note that review in the report. The examiner should: (a) Identify all eating disorders found. If an eating disability is not found, the examiner should expressly state that fact. (b) State whether any identified eating disability had its onset during active service or are related to any incident of service including the documented in service obesity. 5. Schedule the Veteran for a VA sleep disability examination conducted by a medical doctor to assist in determining the nature and etiology of any identified sleep disability and any relationship to active service. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all sleep disabilities, to include sleep apnea, found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified sleep disability, to include sleep apnea, had its onset during active service or is related to any incident of service, included the Veteran’s subjective history of in service sleep difficulties and snoring. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. T. Hutcheson, 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.