Citation Nr: 21025238 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 10-11 257A DATE: April 27, 2021 ORDER Entitlement to service connection for hypertension, to include as secondary to type II diabetes mellitus, is denied. Entitlement to service connection for hypothyroidism, to include as secondary to type II diabetes mellitus, is denied. REMANDED Entitlement to service connection for temporal lobe epilepsy, to include as secondary to type II diabetes mellitus, is remanded. Entitlement to service connection for an eye disorder, claimed as cataracts and glaucoma, to include as secondary to type II diabetes mellitus, is remanded. FINDINGS OF FACT 1. The Veteran's hypertension is not related to an in-service injury or disease, did not manifest to a compensable degree within the applicable presumptive period, and is not caused or aggravated by his service-connected type II diabetes mellitus. 2. The Veteran’s hypothyroidism is not related to an in-service injury or disease, did not manifest to a compensable degree within the applicable presumptive period, and is not caused or aggravated by his service-connected type II diabetes mellitus. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension, to include as secondary to type II diabetes mellitus, are not met. 38 U.S.C. §§ 1101, 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309, 3.310. 2. The criteria for service connection for hypothyroidism, to include as secondary to type II diabetes mellitus, are not met. 38 U.S.C. §§ 1101, 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1962 to September 1966. These matters come before the Board of Veterans' Appeals (Board) on appeal from a July 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. Jurisdiction was subsequently transferred to the RO in New Orleans, Louisiana. These claims were most recently before the Board in May 2020 and remanded for additional development. In September 2020, the RO granted service connection for bilateral vitreous hemorrhages and epiretinal membrane, left eye. 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, 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 between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Further, service connection may be established on a secondary basis for a disability which was either caused or aggravated by a service-connected disability. 38 C.F.R. § 3.310 (a); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Entitlement to service connection for hypertension, to include as secondary to service-connected type II diabetes mellitus The Veteran contends that his hypertension is secondary to his service-connected type II diabetes mellitus. He does not contend that his hypertension is directly related to his active service nor does the evidence support such a finding. Moreover, there is no evidence that hypertension manifested in the year following his discharge from service in 1966. In addition, while the Veteran served during the Vietnam Era, he does not contend, nor does the evidence show that he served in the Republic of Vietnam and thus, he is not afforded the presumptions for diseases associated with exposure to herbicides. See VA Memo and Request of Information dated in January 1967. Accordingly, the Board will address his claim of entitlement on a secondary basis only. Here, a current disability is confirmed by the evidence of record. More specifically, the Veteran's post-service VA medical records document a current diagnosis of hypertension. See August 2017 Hypertension VA Examination Report. Thus, the only question remaining is whether hypertension is secondary to his service-connected diabetes mellitus. The evidence of record includes an opinion from an August 2017 VA examiner finding that it is less likely than not that the Veteran's hypertension was proximately due to or the result of the Veteran's service-connected type II diabetes mellitus. The examiner reasoned that there was no evidence that the Veteran had chronic kidney disease and that serum creatinine and glomerular filtration rate (GFR) were within normal limits in February 2017. The July 2020 VA examiner opined that hypertension was less likely than not proximately due to or the result of the Veteran’s service-connected diabetes mellitus. The examiner also opined that it was less likely than not that the Veteran’s hypertension was aggravated beyond its natural progression by his service-connected type II diabetes mellitus. The examiner reasoned that diabetes does not cause hypertension; renal dysfunction due to type II diabetes mellitus does, which was not shown. Review of the medical record shows normal renal function (BUN, creatinine, eGFR) without proteinuria and no evidence of nephropathy. The Board finds the August 2017 and July 2020 VA opinions to be highly probative. The opinions were based on review of the claims file and relevant facts, and the examiners provided a detailed rationale. To the extent that the Veteran has stated that he has hypertension attributable to his service-connected type II diabetes mellitus, the Board finds that he is competent to report on his symptoms and that of which he has personal knowledge, but he is not competent to provide an opinion as to the etiology of the disability because such a question is not answerable by the application of knowledge within the realm of a lay person. See Layno, 6 Vet. App. at 469-70; Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Therefore, the Board finds that the Veteran is not competent to relate his current hypertension to his service-connected type II diabetes mellitus. In light of the foregoing, the Board finds that the Veteran's hypertension was not caused or aggravated by the service-connected type II diabetes mellitus. The Veteran has not reported any other link between his hypertension and his active duty service. Therefore, service connection is not warranted. There is no doubt to be resolved in this case. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). Entitlement to service connection for hypothyroidism, to include as secondary to service-connected type II diabetes mellitus The Veteran contends that his hypothyroidism is secondary to his service-connected type II diabetes mellitus. He does not contend that his hypothyroidism is directly related to his active service nor does the evidence support such a finding. Moreover, there is no evidence that hypothyroidism manifested in the year following his discharge from service in 1966. In addition, while the Veteran served during the Vietnam Era, he does not contend, nor does the evidence show that he served in the Republic of Vietnam and thus, he is not afforded the presumptions for diseases associated with exposure to herbicides. See VA Memo and Request of Information dated in January 1967. Accordingly, the Board will address his claim of entitlement on a secondary basis only. Here, a current disability is confirmed by the evidence of record. More specifically, the Veteran's post-service VA medical records document a current diagnosis of hypothyroidism. See August 2017 Thyroid and Parathyroid Conditions VA Examination Report. Thus, the only question remaining is whether hypothyroidism is secondary to his service-connected diabetes mellitus. The evidence of record includes an opinion from an August 2017 VA examiner finding that it is less likely than not that the Veteran's hypothyroidism was proximately due to or the result of the Veteran's service-connected type II diabetes mellitus. The examiner reasoned that there was no medical causal relationship that would create a nexus between the two conditions. The July 2020 VA examiner opined that the claimed condition was less likely than not proximately due to or the result of the Veteran’s service-connected condition. The examiner also opined that it was less likely than not that the Veteran’s hypothyroidism was aggravated beyond its natural progression by his service-connected type II diabetes mellitus. The examiner reasoned that diabetes has not been shown to cause or aggravate hypothyroidism. The most common cause of hypothyroidism is Hashimoto’s thyroiditis, an autoimmune disorder. The examiner further reasoned that hypothyroidism is also caused by radiation which damages cells in the thyroid making it more difficult for the gland to produce hormones; thyroid surgery; and too little iodine in the diet. The Board finds the August 2017 and July 2020 VA opinions to be highly probative. The opinions were based on review of the claims file and relevant facts, and the examiners provided a detailed rationale. To the extent that the Veteran has stated that he has hypothyroidism attributable to his service-connected type II diabetes mellitus, the Board finds that he is not competent to provide an opinion as to the etiology of the disability. See Layno, 6 Vet. App. at 469-70; Jandreau, supra. In light of the foregoing, the Board finds that the Veteran's hypothyroidism was not caused or aggravated by the service-connected type II diabetes mellitus. The Veteran has not reported any other link between his hypothyroidism and his active duty service. Therefore, service connection is not warranted. There is no doubt to be resolved in this case. See 38 U.S.C. § 5107 (b); Ortiz, 274 F.3d at 1364; Gilbert, 1 Vet. App. at 55-56. REASONS FOR REMAND Entitlement to service connection for temporal lobe epilepsy, to include as secondary to type II diabetes mellitus The Veteran contends that his temporal epilepsy was caused by his type II diabetes mellitus. He additionally contends that his temporal epilepsy is the result of a combination of the following in-service injuries: (1) severe leg infection which resulted in a very high fever (2) knock out/concussion while playing football and (3) knock out/concussion during combat training. See June 2006 VA 21-4138 Statement in Support of Claim. The August 2017 and July 2020 VA examination opinions did not address these theories of entitlement. Therefore, an addendum opinion should be obtained on remand. The issue of entitlement to service connection for an eye disorder, to include cataracts and glaucoma In pertinent part, the evidence of record includes an opinion from an August 2017 VA examiner that the Veteran was diagnosed with glaucoma suspect but there was no confirmation he was diagnosed with glaucoma. The examiner indicated that the Veteran did have peripheral iridotomies for narrow angles as narrow angles are a risk factor for glaucoma. However, the examiner further stated that without confirmation in the reviewed records that the Veteran was diagnosed with glaucoma, it could not be stated that he has glaucoma secondary to service-connected type II diabetes mellitus. The Board notes that the August 2017 VA examiner’s statement that the Veteran was not diagnosed with glaucoma is inaccurate. The evidence of record indicates that the Veteran was diagnosed with glaucoma and that he received peripheral iridotomy for narrow angle glaucoma. See June 2007 and August 2008 Ohio Department of Rehabilitation and Correction Records. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (medical opinion based upon an inaccurate factual premise has no probative value). Therefore, an addendum opinion should be obtained on remand. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The matters are REMANDED for the following action: 1. Return the file to the July 2020 VA examiner for an addendum opinion. If that examiner is unavailable, the opinion should be provided by another examiner. The claims file, and a copy of the remand, must be reviewed by the examiner. Following review of the file, and the remand, the examiner is to address the following: a) Is it at least as likely as not (50 percent probability or more) that the Veteran has temporal lobe epilepsy that had its onset in service, or within one year of his separation from service, or is otherwise related to service? The examiner is asked to specifically address the Veteran's contention that he has temporal epilepsy as a result of a combination of the following in-service injuries: (1) severe leg infection which resulted in a very high fever (2) knock out/concussion while playing football and (3) knock out/concussion during combat training. Please also specifically discuss the left leg infection documented in the Veteran’s service treatment records. b) All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. 2. Return the file to the August 2017 VA examiner for an addendum opinion. If that examiner is unavailable, the opinion should be provided by another examiner. The claims file, and a copy of the remand, must be reviewed by the examiner. Following review of the file, and the remand, the examiner is to address the following: (a) Is it at least as likely as not that the Veteran's glaucoma was caused or aggravated beyond the natural progression by the Veteran's service-connected type II diabetes mellitus? Please address both causation and aggravation and explain why or why not. (b) If the examiner determines that prior glaucoma diagnoses are not/were not valid, the examiner must reconcile his or her opinion with these previous diagnoses. (c) All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. 3. If upon completion of the above action the claims remain denied, the matters must be returned to the Board after compliance with appellate procedures. K. L. WALLIN Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Smith-Jennings, 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.