Citation Nr: 21021219 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 20-09 964 DATE: April 12, 2021 ORDER Entitlement to service connection for coronary artery disease (CAD) (claimed as 50 percent blockage) is denied. Entitlement to service connection for paranoid schizophrenia is denied. Entitlement to service connection for cervical disc disease (previously claimed as back condition) is denied. Entitlement to service connection for chronic disability of the eyes is denied. Entitlement to service connection for acid reflux is denied. Entitlement to service connection for high cholesterol is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that coronary artery disease began during active service, or is otherwise related to an in-service injury, event, or disease. 2. The preponderance of the evidence is against finding that paranoid schizophrenia began during active service, or is otherwise related to an in-service injury, event, or disease. 3. The preponderance of the evidence is against finding that the Veteran’s cervical disc disease began during active service, or is otherwise related to an in-service injury, event, or disease. 4. The competent medical evidence does not demonstrate objective findings of a bilateral vision loss, or eye, disability other than refractive error. 5. The preponderance of the evidence is against a finding that the Veteran’s current acid reflux was incurred in or caused by service. 6. High cholesterol is not a disability for VA benefits purposes. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for coronary artery disease (CAD) (claimed as 50 percent blockage) have not been met. 38 U.S.C. §§ 1110, 5103(a), 5103A, 1131, 1112, 1113; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for paranoid schizophrenia have not been met. 38 U.S.C. §§ 1110, 5103(a), 5103A, 1131, 1112, 1113; 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. The criteria for entitlement to service connection for cervical disc disease (previously claimed as back condition) have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for entitlement to service connection for chronic disability of the eyes have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 5. The criteria for entitlement to service connection for acid reflux have not been met. 38 U.S.C. §§ 1110, 1131, 1117, 5107; 38 C.F.R. § 3.102, 3.303. 6. The criteria for entitlement to service connection for high cholesterol have not been met. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the Army from May 1965 to April 1967. This case is before the Board of Veterans’ Appeals (Board) on appeal from September 2015, March 2016, and March 2017 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). Although the Veteran did not explicitly appeal the September 2015 and March 2016 decisions, but rather filed new claims to reopen, he did submit new and material evidence within one year of both of those decisions, thus keeping the initial decisions open for review. See 38 U.S.C. § 7105 (c); 38 C.F.R. § 20.1103. The Veteran initially requested a hearing before a Veterans Law Judge. His hearing was scheduled for February 24, 2021, however, one day prior to his hearing, at 2:13pm, the Veteran’s representative notified the RO that the Veteran wished to withdraw his hearing request. The Veteran did not appear for his hearing, as scheduled, on February 24, 2021, and to date has not requested a new hearing be scheduled. As such, the issues before the Board are ripe for review. Service Connection The law provides that 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, 3.304. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, establishing service connection requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). In addition, certain chronic diseases, including arthritis, cardiovascular-renal disease, and psychoses, may be presumed to have been incurred during service if the disorder becomes manifest to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). Regardless of whether a condition is listed as “chronic” for presumptive service connection purposes, a continuity of symptoms from the time of service is a factor to consider in assessing the claim. 1. Entitlement to service connection for coronary artery disease (CAD) (claimed as 50 percent blockage) The Veteran is seeking service connection for coronary artery disease. In this case, after reviewing all evidence currently of record, the Board determines that service connection for coronary artery disease (CAD) is not warranted. While the Veteran's medical records from 2014 document coronary artery disease the evidence does not show that the Veteran's condition is related to or had its onset during his service or within a year after separation. Specifically, the Veteran's service treatment records show no treatment for or symptoms of coronary artery disease in service, or within the presumptive one-year period after separation. In fact, the post-service evidence does not reflect symptoms related to the Veteran's claims on appeal until 2014, more than 47 years after discharge from military service. Specifically, according to the medical records, the Veteran was diagnosed with mild CAD in 2014. Moreover, the Veteran has never truly asserted that such symptoms have existed since service. Therefore, based on the clinical evidence of record, service connection cannot be established through continuity of symptomatology or the Veteran's statements. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007). Despite the lack of continuous symptoms, service connection may still be warranted if the evidence otherwise indicates a relationship between his current disorder and his active duty service. However, there is no medical nexus between the Veteran's active duty and current diagnoses. Specifically, the Veteran has not submitted competent medical evidence that his current CAD was incurred during or due to service nor has any physician provided such a nexus. Therefore, the Board finds that the weight of the competent evidence does not attribute the Veterans CAD to military service. The Board notes that the Veteran has not been afforded an examination in connection with this claim. Absent evidence of any in-service incident, illness or injury to which the present CAD could be etiologically linked, VA’s duty to assist does not require it to provide an examination in this matter. 38 C.F.R. § 3.159(c)(4)(i). In arriving at these conclusions, the Board recognizes the statements of the Veteran relating his coronary artery disease to his service. The Federal Circuit has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (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." Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this case, however, the Veteran is not competent to testify regarding the etiology of heart disease. See Jandreau, 492 F.3d 1372 at 1377, n.4. Because such disorders are not diagnosed by unique and readily identifiable features, they do not have a simple identification that a layperson is competent to make. In addition, a qualified medical opinion is required to link the Veteran's current symptoms to his time in service, especially when it relates to a condition with a multifactorial etiology. In this case, a qualified medical professional did not make such a finding. Therefore, the lay statements of belief that the Veteran's coronary artery disease is related to his time in service are found to lack competency. Considering the above discussion, the Board concludes that the preponderance of the evidence is against the claims for service connection and there is no doubt to be otherwise resolved. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Therefore, the appeal is denied. 2. Entitlement to service connection for paranoid schizophrenia The Veteran is seeking service connection for his psychiatric disorder diagnosed as paranoid schizophrenia. Specifically, he contends that his psychiatric disorder is due to his military service. Initially, the Board acknowledges that the Veteran was not provided with a VA examination for his service-connection claim. However, the Board finds that a VA examination is not required here because competent evidence has not been presented indicating that the existence of a disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's active service. Additionally, there is no evidence to show that the claimed disability occurred in service or is associated with service. See McClendon v. Nicholson, 20 Vet. App. 79 (2006). The Veteran's service treatment records show no treatment for or symptoms of a psychiatric disorder in service. In fact, the Veteran's December 1966 separation examination reflects no psychiatric complaints. Of note, the post-service evidence does not reflect symptoms related to the Veteran's psychiatric disorder until approximately 4 years after service. The Veteran's medical records show that he was hospitalized from April 6, 1971 to May 5, 1971 and diagnosed with paranoid schizophrenia. However, the remainder of the Veteran’s medical treatment records are silent for complaints of or treatment for paranoid schizophrenia. Therefore, continuity of symptomatology is not shown by record. Next, the evidence does not reflect that there is a nexus between the Veteran’s paranoid schizophrenia and his active duty service. In this case, there is no medical evidence of record connecting his psychiatric disorder to service. Again, the earliest evidence of record of a diagnosis of paranoid schizophrenia is 4 years after the Veteran's separation from active service. Further, current medical records are silent for treatment for paranoid schizophrenia. The Board has considered the Veteran's assertions that his psychiatric disorder was caused by his military service. The Federal Circuit has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (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." Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this case, however, the Veteran is not competent to testify regarding the etiology of a psychiatric disorder. See Jandreau, 492 F.3d 1372 at 1377, n.4. Because such disorders are not diagnosed by unique and readily identifiable features, they do not have a simple identification that a layperson is competent to make. Therefore, the Veterans statements, by themselves, are insufficient to establish service connection In sum, the most probative evidence of record shows no presently diagnosed psychiatric condition, to include paranoid schizophrenia. Although such a diagnosis was given in 1971, there is no evidence that it has been treated since that time. Further, there is inadequate evidence of any in-service psychiatric symptoms or diagnoses to which the Veteran's psychiatric disorder, which was present in 1971, could be etiologically linked. Based on the evidence of record, the Veteran's claim must be denied. 3. Entitlement to service connection for cervical disc disease (previously claimed as back condition) The Veteran seeks entitlement to service connection for a cervical spine disorder. In this case, after reviewing all evidence currently of record, the Board determines that service connection for a cervical spine condition is not warranted because the evidence of record does not show that the Veteran's cervical spine condition is related to or had its onset during service. The Veteran's service treatment records are silent for symptoms of, treatment for, or diagnosis of a cervical spine condition. Further, the Veteran's December 1966 separation examination was silent for any such spine complaints and the Veteran indicated no for recurrent back pain. The first indication of treatment for a cervical spine injury was not until October 1990 when the Veteran underwent an MRI which confirmed C4-C5 disc which was considered small. The treating physician noted that the Veteran seems to have cervical radiculitis as the source of his pain. The Board notes that the Veteran’s diagnosis of a cervical spine condition was approximately 23 years after his military service. Therefore, a continuity of symptoms is not established based on the clinical evidence of record. For his part, the Veteran has asserted that his condition pre-existed service and was worsened thereby. While certainly competent to report observable symptoms such as pain, once basic competency is met, the Board must consider credibility of the evidence. In this matter, there is no evidence of any back or neck issues upon entrance to service, throughout service, or upon separation. There is no evidence that he was treated for a neck or spine issue in the intervening years between separation and 1990. As such, the Board finds that the Veteran’s assertions regarding presence of symptoms prior to and during service to be less than credible for purposes of evaluating this appeal. See Caluza v. Brown, 7 Vet. App. 498 (1995) (giving factors to consider in assessing the credibility of lay statements and evidence, to include facial plausibility, internal consistency, consistency with other evidence, self interest or bias, bad character, malingering, time of creation of the evidence, erroneous recollection, and lay statements made during treatment or lack thereof). The Board has also considered the statements made by the Veteran regarding the cause or aggravation of his cervical spine disorder. The Federal Circuit has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (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." Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this case, however, the Veteran is not competent to testify regarding the etiology of a disorder of the cervical spine. Because such disorders are not diagnosed by unique and readily identifiable features, they do not have a simple identification that a layperson is competent to make. As discussed above, the Board notes that Veteran's initial diagnosis of a cervical spine condition was not until approximately 23 years after he left active service. Further, during an examination in January 1994, the Veteran reported that he sustained an injury to his back on January 7, 1994 while moving some desks. Therefore, continuity is not established based on the clinical evidence. The Board notes that although the Veteran was afforded a low back examination in connection with a thoracolumbar spine claim, which has not been pursued, he has not been afforded an examination in connection with his cervical spine appeal. In that regard, absent any evidence of a cervical spine diagnosis or symptoms in service, the duty to assist has not been triggered in this matter and VA is not obligated to provide such an examination. 38 C.F.R. § 3.159(c)(4)(i). Service connection may be granted when the evidence establishes a medical nexus between his claimed disorder and his active duty. In this case, the Board finds that the weight of the competent evidence does not attribute the Veteran's claimed disorder to active duty, despite his contentions to the contrary. In this case, the Board finds that there is no medical nexus between the Veteran's active duty and current diagnosis. Specifically, the Veteran has not submitted competent medical evidence that his current cervical spine condition was incurred during or due to service nor has any physician provided such a nexus. Therefore, the Board finds that the weight of the competent evidence does not attribute the Veterans cervical spine condition to military service. Finally, the Board finds that the evidence does not support a finding that the Veteran’s disability had onset during active service or within one year of separation. Rather the competent and credible evidence of record does not show any such diagnosis until 1990, many years thereafter. As such, service connection on a presumptive basis for arthritis is not supported. In sum, the Board finds that the Veteran’s cervical spine disability did not have onset during service or within one year of separation from service. He did not sustain any in-service cervical spine injuries or incidents to which the present condition may be etiologically linked; his condition did not preexist service. Therefore, based on the evidence of record, the Veteran’s claim must be denied. 4. Entitlement to service connection for chronic disability of the eyes The Veteran is seeking service connection for his eye condition. Specifically, he asserts that his eye condition was aggravated by his military service. Service connection may not be granted for refractive error of the eyes even if visual acuity decreased in service, as this is not a disease or injury within the meaning of applicable legislation relating to service connection. 38 C.F.R. §§ 3.303(c), 4.9. Refractive errors of the eyes are congenital or developmental defects and not disease or injury within the meaning of applicable legislation. 38 C.F.R. §§ 3.303 (c), 4.9. VA regulations specifically prohibit service connection for refractory errors of the eyes unless such defect was subjected to a superimposed disease or injury which created additional disability. See VAOPGCPREC 82-90 (July 18, 1990) (cited at 55 Fed. Reg. 45,711) (Oct. 30, 1990) (service connection may not be granted for defects of congenital, developmental or familial origin, unless the defect was subject to a superimposed disease or injury). See also O'Bryan v. McDonald, 771 F.3d 1376, 1380-81 (Fed. Cir. 2014) (refractive error of the eye is not a compensable disease because it is specifically excluded from the regulation even though refractive errors of the eye can progress) (citing Terry v. Principi, 340 F.3d 1378, 1383-84 (Fed. Cir. 2003)). The Board finds that the weight of the evidence does not demonstrate objective evidence of a current diagnosis of a bilateral eye or vision disability. There is no evidence of record that would imply any eye condition beyond a refractive error. While the Veteran’s service treatment record dated July 1966 reveal complaints of difficulty focusing and eye strain, they do not document treatment or diagnosis of an eye or vision disability beyond his pre-service refractive error which was present at induction. At most, the Veteran was recommended for glasses, which he declined. That the Veteran was supplied with glasses to correct a refractive error is not considered indicative of aggravation by service. Further, the Veteran’s May 1965 enlistment examination and December 1966 separation examination show that his vision was unchanged from the time of entrance, also failing to show any sign of aggravation. Examination of the eyes at separation was otherwise normal, and an eye disease was not found. The Veteran did not have any other vision complaints during service. Post-service medical evidence including the VA treatment records do not show any objective evidence of a bilateral eye or vision disability beyond his pre-service refractive error. There are no objective findings of a diagnosis of a bilateral eye disability at this time. Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C. § 1110. In the absence of proof of present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The probative evidence of record demonstrates that the Veteran does not have a current diagnosis of a bilateral eye or vision disability and has not at any time during the pendency of this claim (i.e., since the filing of them). See McClain v. Nicholson, 21 Vet. App. 319, 312 (2007). For the reasons expressed above, the Board finds that the weight of the evidence does not demonstrate objective evidence of a current diagnosis of a bilateral eye disability that affects visual acuity other than refractive error. The preponderance of the evidence is against the Veteran's claim for service connection for chronic disability of the eyes. The claim for service connection must be denied. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. Entitlement to service connection for acid reflux The Veteran contends that he incurred acid reflux as a result of military service. The Board finds that service connection for acid reflux is not warranted. The Board acknowledges that the medical evidence demonstrates a present diagnosis of acid reflux. However, the first evidence of acid reflux in the claims file is the Veteran's November 2009 medical treatment record, which is more than 42 years post-discharge. Service treatment records are negative for any complaints, treatment, or diagnosis of acid reflux or symptoms related thereto (it is observed that in August 1966, he presented with nausea, however, he also presented with pain, anorexia and high fever, which were specifically attributed to a convulsive disorder, and not to any abdominal issues). The Veteran’s present treatment records from May 2011 note that his acid reflux is improving, but does not include any indication as to the etiology of the Veteran's acid reflux symptoms. The Board notes that the Veteran has not been afforded a VA examination in connection with this claim. Absent evidence of any in-service incident, illness or injury to which the present acid reflux could be etiologically linked, VA’s duty to assist does not require it to provide a VA examination in this matter. 38 C.F.R. § 3.159(c)(4)(i). To the extent that the Veteran has suggested that his acid reflux is etiologically related to service, the Board finds that he is not competent to render such an opinion. To diagnose a specific disability like acid reflux and opine as to the etiology of such symptoms requires medical expertise, which he has not been shown to possess. See Jandreau v. Shinseki, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Indeed, acid reflux is a disease that requires specialized training for a diagnosis. Moreover, the fact that his service treatment records, and post-service treatment records are negative for any such symptoms or treatment for more than 42 years after discharge weighs significantly against his claim. The Veteran has not submitted competent evidence indicating that acid reflux was incurred during or due to service. Additionally, the weight of the competent evidence in the claims file demonstrates that the disability had onset over 42 years post-discharge. Based on the foregoing, the Board finds that the evidence of record weighs against a finding of service connection for acid reflux as the preponderance of the evidence is against the claim. Therefore, it is denied. As there is not an approximate balance of evidence, that benefit of the doubt rule is not applicable in this case. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). 6. Entitlement to service connection for high cholesterol The Veteran contends that he has high cholesterol that is related to his service. Based on the evidence as detailed below, the Veteran's claim is denied. Initially, the Board notes that a threshold requirement in all service connection claims is that there is a current disability. The Board finds that the record does not show that the Veteran has a current disability with regards to his claim. (Continued on the next page)   Hyperlipidemia (high cholesterol), elevated triglycerides, and elevated cholesterol are actually laboratory results and are not, in and of themselves, disabilities for compensation purposes. See 61 Fed. Reg. 20,440, 20,445 (May 7, 1996). Therefore, even if the Board accepted the Veteran's statements asserting a link between his condition and military service, the evidence still does not demonstrate the first element required for service connection-a current disability. See 38 C.F.R. §§ 3.102, 3.303, 3.385 (2017); Brammer v. Derwinski, 3 Vet. App. 223 (1995) (Congress specifically limited entitlement for service-connected disease or injury to cases where such incidents had resulted in a disability); see also McClain v. Nicholson, 21 Vet. App. 319 (2007) (the requirement that a current disability be present is satisfied "when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim... even though the disability resolves prior to the Secretary's adjudication of the claim."). Accordingly, entitlement to service connection for high cholesterol must be denied. M. Pryce Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Vample, Erica 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.