Citation Nr: 21021170 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 16-44 998 DATE: April 12, 2021 ORDER Entitlement to service connection for left knee degenerative joint disease (DJD) is denied. Entitlement to service connection for right knee DJD is denied. Entitlement to service connection for a right leg disorder, claimed as right calf muscle spasm, is denied. Entitlement to service connection for hypertension is denied. FINDINGS OF FACT 1. The current left knee DJD was not present in service, was not present to a compensable degree within one year of service discharge and was not shown to be causally related to service, to include in-service duties as a Cavalry Scout. 2. The current right knee DJD was not present in service, was not present to a compensable degree within one year of service discharge and was not shown to be causally related to service, to include in-service duties as a Cavalry Scout. 3. A right leg disorder is not causally related to any event, injury, or disease in service, to include in-service duties as a Cavalry Scout as well as isolated in-service treatment for overuse injury of the right leg and complaints of leg cramps. 4. Hypertension was not present in service, was not manifested to a compensably disabling degree within the first year after the Veteran completed his active service and is not shown to be causally related to service, to include documented in-service elevated blood pressure readings. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for left knee DJD have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2020). 2. The criteria for entitlement to service connection for right knee DJD have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2020). 3. The criteria for entitlement to service connection for a right leg disorder, claimed as right calf muscle spasm, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2020). 4. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from January 1992 to June 1997. These matters come before the Board of Veterans' Appeals (Board) on appeal from an October 2013 rating decision. In September 2018, the Veteran testified at a Board hearing at the agency of original jurisdiction (AOJ) before the undersigned Veterans Law Judge (VLJ). A copy of the transcript of that hearing is of record. In June 2019, the Board remanded these matters for additional development. 1. Entitlement to service connection for left knee DJD 2. Entitlement to service connection for right knee DJD 3. Entitlement to service connection for a right leg disorder 4. Entitlement to service connection for hypertension In written statements of record and during the September 2018 Board hearing, the Veteran has contended that his hypertension began during service or basically that his in-service complaints and treatment for elevated blood pressure were early manifestations of his claimed disorder. He has further asserted that his claimed knee and right leg disorders were related to events in service, specifically in-service duties as a Cavalry Scout. He described in-service duties that included running in combat boots, diving on the ground, and jumping off large equipment while performing maintenance (including recurrent falls and hard landings on uneven ground). He also reported getting cramps in the right upper calf area of his leg on road marches or runs. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be established under the provisions of 38 C.F.R. § 3.303(b) when the evidence, regardless of its date, shows that a veteran had a chronic condition in service or during the applicable presumptive period. For certain chronic disorders, such as arthritis or cardiovascular-renal disease, including hypertension, service connection may be granted if the disease becomes manifest to a compensable degree within one year following separation from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. In addition, service connection on the basis of continuity of symptomatology can only be established for the chronic diseases as specified at 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Board also notes the Court of Appeals for the Federal Circuit recently found that pain alone can constitute a “disability” under 38 U.S.C. § 1110, because pain can cause functional impairment. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Under VA regulations, hypertension must be confirmed by readings taken two or more times on at least three different days. 38 C.F.R. § 4.104, Diagnostic Code 7101. Hypertension is defined as meaning that the diastolic blood pressure is predominantly 90 mm or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160 mm or greater with a diastolic blood pressure of less than 90 mm. Under Diagnostic Code 7101, a 10 percent evaluation is assigned for hypertension with diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. Id. In addition, medical authorities have suggested various thresholds ranging from 140 mm Hg systolic and from 90 mm Hg diastolic to as high as 200 mm Hg systolic and 110 mm Hg diastolic as reflective of hypertension. See Dorland’s Illustrated Medical Dictionary, 896 (32nd ed. 2012). Entitlement to service connection for the claimed right knee, left knee, right leg, and hypertension disorders is not warranted. Service treatment records did not reflect findings of hypertension or any other heart disorder at military service discharge and did not reveal any findings of bilateral knee DJD or any other chronic right leg disorder. On entrance examination in October 1991, the Veteran’s blood pressure was listed as 120/88. Elevated blood pressure readings of 140/90 supine, 130/86 sitting, and 134/94 standing were noted with a three-day history of stomach pain in December 1992. Additional blood pressure readings were 136/80 (June 1993), 120/80 (August 1993), and 130/76 as well as 138/88 (September 1993). There were elevated blood pressure readings of 140/100 and 160/100 with a notation of possible hypertension in a May 1994 service treatment note. The Veteran’s blood pressure was listed as 138/80 (September 1994), 130/82 (December 1994), 132/78 (March 1995), 130/80 (December 1995), 130/54 and 110/80 (March 1996), 120/70 and 124/72 (June 1996), 128/74 (August 1996), 118/82 (August 1996), 128/92 (September 1996), and 124/82 (February 1997). In December 1995, the Veteran pulled a muscle, complaining of right calf pain, and was diagnosed with overuse injury of the right leg. He was treated for bilateral shin splints in June 1996. In the March 1997 service exit examination report, blood pressure was listed as 136/88. The feet, heart, and lower extremities were marked as normal on clinical evaluation. In the March 1997 Report of Medical History, the Veteran marked yes for leg cramps. Post-service VA treatment records reflected findings of essential hypertension, bilateral knee pain, and arthralgias. Private treatment records showed blood pressure readings of 140/81 (June 2004) and 138/88 (May 2005). VA examination reports dated in September 2013 listed diagnoses of bilateral knee DJD, hypertension, and right calf cramps (muscle group XI) that caused occasional pain-fatigue but did not affect any muscle substance or function. VA treatment notes dated through 2020 showed the Veteran denied having muscle cramps. As an initial matter, there is no factual basis in the record that any present right knee, left knee, or right leg disorder was incurred during service. Furthermore, evidence of record reflects that arthritis of either knee was not shown to manifest to a compensable degree within one year of service discharge or for years after his discharge from service in 1997. There is also no factual basis in the record that hypertension was incurred during service or manifested as a chronic disease within a year thereafter, or for years after his discharge from service in 1997. Significantly, the record also does not include any probative medical evidence or opinion suggesting a causal relationship between the Veteran’s claimed left knee DJD, right knee DJD, right leg disorder, and/or hypertension and his active military service, and the Veteran has not identified or alluded to the existence of any such opinion. In October 2013 VA medical opinions, the examiner opined that the claimed bilateral knee and right leg conditions were less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. In the cited rationale, the examiner highlighted that there was no pathophysiological relationship/nexus between the Veteran’s in-service shin splints and his current bilateral knee DJD, as shin splints were caused from overuse and DJD of the knee was from the natural ageing process with or without trauma. The examiner further noted that bilateral knee DJD was not found in service. The examiner also concluded that there was no nexus between the Veteran’s in-service right leg overuse injury and his current right calf cramps of muscle group XI. It was noted that muscle cramps were acute and resolve spontaneously. In a December 2019 VA medical opinion, the examiner further found that the Veteran’s bilateral knee DJD was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness, to include asserted duties as a Cavalry Scout (such as jumping off large equipment while performing maintenance with recurrent falls and hard landings on uneven ground) or pain resulting in functional impairment. The examiner opined that the Veteran’s bilateral knee DJD was at least as likely as not (50 percent or greater probability) caused by the natural aging process and obesity. The Veteran reported he was diagnosed with hypertension in the late 1990s. In an October 2013 VA medical opinion, the examiner opined that hypertension was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. In the cited rationale, the examiner noted that documented elevated blood pressure readings in December 1992 were related to the Veteran’s physiological response to pain and did not meet VA’s rating criteria for a hypertension diagnosis (160/90). It was also indicated that hypertension was not shown in the March 1997 service exit examination report and that there was no in-service diagnosis for the condition. The examiner found that there was no nexus between the Veteran’s in-service blood pressure readings and his current hypertension. In a December 2019 VA medical opinion, the examiner again found that the Veteran’s hypertension was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness, to include hypertension or elevated blood pressure readings in May 1992 and May 1993. The examiner opined that the Veteran’s hypertension was at least as likely as not (50 percent or greater probability) caused by an unknown post-service etiology. It was noted that elevated blood pressure was a nonspecific sign/symptom which was not pathognomonic for hypertension and that a diagnosis of hypertension for rating purposes was not found in service. The examiner also detailed that no immediate objective post-service medical evidence indicated treatment for chronic/ongoing hypertension condition/pathology was found. The Veteran was noted to have essential hypertension. The examiner highlighted that essential was defined in medical dictionaries as “of unknown etiology.” The Veteran’s greatest risk factors for his hypertension were listed as his age and obesity and not the claimed in-service injury, event, or illness (to include hypertension or elevated blood pressure readings in 1992 and 1993). In December 2020 and January 2021 VA medical opinion addendum reports, the examiner agreed with the conclusions reached in the October 2013 and December 2019 VA medical opinions. The examiner reiterated that the Veteran’s hypertension was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness, including elevated blood pressure. The examiner concluded that any elevated blood pressure documented in May 1994 resolved without residual, citing confirmation for his conclusion in blood pressure readings of 132/80 from a December 1994 service treatment note. It was also noted that there was no objective medical evidence to confirm that the Veteran’s hypertension manifested within one year of separation from active military service in 1997. Although there is evidence of currently diagnosed bilateral knee DJD, right calf cramps (muscle group XI), and hypertension, there is no probative evidence of record linking any of those disorders to the Veteran’s active military service or any incident therein. Significantly, the record does not include any probative medical evidence or opinion suggesting a causal relationship between the Veteran’s claimed disorders and his active military service. VA examiners provided a complete rationale for their stated opinions, citing to a detailed review of the evidence of record as well as medical treatises. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion comes from when it is factually accurate, fully articulated, and there is sound reasoning for the conclusion, not the mere fact that the claims file was reviewed). Based on the foregoing, the Board finds that the most persuasive medical evidence that specifically addresses the question of whether the Veteran’s claimed left knee DJD, right knee DJD, right leg disorder, and hypertension were incurred in service, manifested as a chronic disease (arthritis or hypertension) within a year after service discharge, or were etiologically related to events in service weighs against the claims. Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (it is the responsibility of the Board to assess the credibility and weight to be given the evidence) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). See also Guerrieri v. Brown, 4 Vet. App. 467, 470-471 (1993) (the probative value of medical evidence is based on the physician’s knowledge and skill in analyzing the data, and the medical conclusion he reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board). Thus, there is no basis upon which to conclude that the Veteran’s currently diagnosed left knee DJD, right knee DJD, right leg disorder, and hypertension were incurred in or aggravated during military service, including on any direct or presumptive basis. The statements from the Veteran are competent evidence as to observable symptomatology, including pain and muscle cramps. See Barr, 21 Vet. App. at 307. However, the statements that the Veteran’s bilateral knee DJD, right leg disorder, or hypertension began during service, manifested as a chronic disease within a year after service discharge, or were a result of active service draw medical conclusions, which the Veteran is not qualified to make. Although lay persons are competent to provide opinions on some medical issues, the etiology of the Veteran’s claimed disorders falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see also Jandreau, 492 F.3d at 1377. Moreover, VA examiners considered the Veteran’s lay assertions that his claimed knee and leg disorders were causally related to his rigorous in-service duties and that hypertension manifested while he was on active duty or within one year of service discharge, but found those assertions were not supported by evidence of record. Accordingly, service connection for left knee DJD, right knee DJD, right leg disorder, and hypertension is not warranted. The evidence of record simply does not establish either on a direct or presumptive basis that the Veteran’s left knee DJD, right knee DJD, right leg disorder, and hypertension were present in service, manifested to a compensably disabling degree within the first year after service discharge, or were etiologically related to service. In arriving at the decision to deny the claims, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claims, that doctrine is not applicable. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2020); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. D. Deane, 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.