Citation Nr: 21015325 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 18-55 394A DATE: March 17, 2021 ORDER Entitlement to service connection for an oral condition is denied. Entitlement to service connection for a gastrointestinal condition, to include acid reflux, is denied. FINDINGS OF FACT 1. The preponderance of the probative evidence is against finding that an oral condition began during active service or is otherwise related to an in-service injury or disease. 2. The preponderance of the probative evidence is against finding that a gastrointestinal condition 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 an oral condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a gastrointestinal condition are not 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 served on active duty in the United States Navy from June 1963 to May 1968. The matter is before the Board of Veterans’ Appeals (Board) on appeal from a September 2015 rating decision by the United States Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The claim for service connection was received in May 2015. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, or nexus, between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). 1. Entitlement to service connection for an oral condition is denied. The Veteran contends an oral condition related to service. Alternatively, the Veteran contends that the oral condition was secondary to a service-connected disability. 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 had post-service dental treatment, the preponderance of the probative evidence weighs against finding that the Veteran’s diagnosis of any oral condition began during service or is otherwise related to an in-service injury, event, or disease. VA and private records show the Veteran did not report symptoms of an oral condition until November 1999, three decades after separation from service. While the Veteran is competent to report having experienced symptoms of tooth loss and earlier treatment since service, the Veteran is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of such a diagnosis. The issue is medically complex. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). There is no indication that a current disability may be associated with the Veteran’s service or another service‑connected disability. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Veteran’s service treatment records showed severe dental cavities on entry to service, dental treatment, and treatment for acute instances of maxillary swelling and sore throat. The June 1963 Report of Medical Examination showed severe dental cavities on entry to active service. In November 1965, the Veteran reported maxillary swelling. The diagnosis was “acute parotitis, acute, unilateral right side, due to an unknown organism.” In August 1965, the Veteran reported a sore throat. Between June 1965 and May 1968, the Veteran received dental treatment for the cavities. A July 1967 Report of Medical Examination showed nine restorable teeth. A September 1967 did not any cavities. November 1999 VA and July 2013 private treatment records document post-service oral treatment. In November 1999, the Veteran reported to a VA nurse about an “abscess” of tooth on the right side of mouth and a blister that did not allow the Veteran to eat. The nurse informed the Veteran that he could go to a dental clinic. Between March 2011 and April 2015, the Veteran received private dental treatment. There are no medical opinions in the record connecting any of the in-service dental treatment or incidents to a current oral condition. The Veteran believes the oral condition 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. The issue is medically complex, as it requires knowledge of pathology. Therefore, it is outside the competence of the Veteran in this case because the record does not show that the Veteran 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). Regarding the Veteran’s contention of secondary connection, the Veteran has not been service connected for any disability. Since there is no primary service-connected disability at this time, there cannot be any secondary disability due to a primary service-connected disability either. Therefore, for the reasons outlined above, the Board finds that the preponderance of evidence is against the claim of entitlement to service connection for a gastrointestinal condition, to include acid reflux.  As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt rule does not apply.  38 U.S.C. § 5107(b). The claim is denied. 2. Entitlement to service connection for a gastrointestinal condition, to include acid reflux, is denied. The Veteran contends a gastrointestinal condition related to service. Alternatively, the Veteran contends that the gastrointestinal condition was secondary to a service-connected disability. 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 had post-service gastrointestinal treatment, the preponderance of the evidence weighs against finding that a gastrointestinal condition began during service or is otherwise related to an in-service injury, event, or disease. There was no indication that a current disability may be associated with the Veteran’s service or another service‑connected disability. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Private treatment records show the Veteran was not treated for a gastrointestinal condition until November 2013, more than four decades after separation from service. While the Veteran is competent to report having experienced symptoms of abdominal tenderness and constipation since service, the Veteran is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of a diagnosis. The issue is medically complex. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Veteran’s service treatment records do not show abdominal or gastrointestinal complaints, treatment, or diagnoses. The Veteran’s June 1963, July 1967, and September 1967 Reports of Medical Examination showed a “normal” clinical evaluation. Post-service treatment record showed a history of colon cancer that has not been service connected. In November 2013, the Veteran reported to private health care provider about back pain. On physical examination of the abdomen, there was “mild right flank tenderness to deep palpation present.” In January 2015, the Veteran reported frequent constipation even with fiber supplement. In May 2015, the Veteran reported frequent constipation and acid reflux. An October 2020 Agent Orange examination showed a soft abdomen with bowel sounds throughout all four quadrants, non-tender on deep palpation with no rebound or guarding, hepatosplenomegaly, or masses. There are no medical opinions in the record connecting any gastrointestinal condition to active service. The Veteran’s representative contended that the RO had conceded that there was a private medical opinion in the record. The October 2018 statement of the case (SOC) indeed included the following statement in its rationale denying service connection: “We acknowledge receipt of your private medical opinion intending to link your current disability to a disease, event, or injury from your military service.” The Board finds this RO statement was in error because it is internally inconsistent with the SOC itself and inconsistent with the medical evidence of record. No such private medical opinion is contained in the October 2018 SOC’s evidence list. A review of the medical evidence of record did not reveal the submission of any such private medical opinion. The Veteran believes a gastrointestinal condition 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. The issue is medically complex, as it requires knowledge of pathology. Therefore, it is outside the competence of the Veteran in this case because the record does not show that the Veteran 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). Regarding the Veteran’s contention of secondary connection, the Veteran has not been service connected for any disability. Since there is no primary service-connected disability at this time, there cannot be any secondary disability due to a primary service-connected disability either. (Continued on the next page)   Therefore, for the reasons outlined above, the Board finds that the preponderance of evidence is against the claim of entitlement to service connection for a gastrointestinal condition, to include acid reflux.  As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt rule does not apply.  38 U.S.C. § 5107(b).  The claim is denied. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals James Hekel, Attorney for the Board Department of Veterans Affairs 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.