Citation Nr: 21026216 Decision Date: 04/30/21 Archive Date: 04/30/21 DOCKET NO. 20-25 287 DATE: April 30, 2021 ORDER Entitlement to service connection for diabetes mellitus, to include as due to herbicide exposure is denied. Entitlement to service connection for kidney disease is denied. Entitlement to service connection for vascular disease of the upper extremities is denied. Entitlement to service connection for vascular disease of the lower extremities is denied. REMANDED Entitlement to service connection for a skin disorder, to include as due to herbicide exposure is remanded. Entitlement to service connection for erectile dysfunction is remanded. FINDINGS OF FACT 1. Diabetes mellitus has not been diagnosed during the appeal period. 2. Kidney disease has not been diagnosed during the appeal period. 3. A vascular disorder of the upper extremities has not been diagnosed during the appeal period. 4. A vascular disorder of the lower extremities is not etiologically related to the Veteran’s period of service. CONCLUSIONS OF LAW 1. The criteria for service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1110, 1116 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for service connection for kidney disease have not been met. 38 U.S.C. §§ 1110, 1116 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. The criteria for service connection for a vascular disorder of the upper extremities have not been met. 38 U.S.C. §§ 1110, 1116 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309. 4. The criteria for service connection for a vascular disorder of the lower extremities have not been met. 38 U.S.C. §§ 1110, 1116 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably on active duty in the U.S. Army from May 1966 to May 1969, and from February 1972 to November 1972. The Veteran had subsequent service in the U.S. Army Reserves through April 1995, with periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a March 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). 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 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 diabetes mellitus, to include as due to herbicide exposure is denied. The Veteran filed a claim for service-connection for diabetes mellitus in January 2018. 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. Here, the evidence does not show a diagnosis of diabetes mellitus at any point during the appeal period or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Available VA treatment records do not show a diagnosis of diabetes mellitus, and there are no private records showing treatment for diabetes mellitus or a diagnosis of the condition. The Veteran specifically denied a history of diabetes at a private medical appointment in November 2015 and at a June 2020 VA medical appointment. Other than filing the claim for service connection, the Veteran has not identified any record or other evidence that shows he has a diagnosis of diabetes mellitus. No VA examination was provided in this case; however, none was required because there is no evidence of a current disability or symptoms of a current disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). The evidence does not show a diagnosis of diabetes mellitus during the appeal period and for this reason the claim must be denied. 2. Entitlement to service connection for kidney disease is denied. The Veteran also filed a claim for service-connection for chronic kidney disease in January 2018. Here, the evidence does not show a diagnosis of kidney disease or symptoms attributable to a kidney condition at any point during the appeal period or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Available VA treatment records do not show a diagnosis of kidney disease, and there are no private records showing treatment for kidney disease or a diagnosis of the condition. Other than filing the claim for service connection, the Veteran has not identified any record or other evidence that shows he has a diagnosis of kidney disease. No VA examination was provided in this case; however, none was required because there is no evidence of a current disability or symptoms of a current disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). The evidence does not show a diagnosis of kidney disease during the appeal period and for this reason the claim must also be denied. 3. Entitlement to service connection for vascular disease of the upper extremities. The Veteran also seeks entitlement to service connection for vascular disease, adjudicated as entitlement to service connection for peripheral vascular disease of the upper and lower extremities. The Veteran did not provide any testimony specific to symptoms of vascular disease of the upper extremities. Available VA and private treatment records document the presence of vascular disease in the lower extremities, but do not contain any evidence of vascular disease in the upper extremities. The Veteran received regular medical care for his lower extremity vascular disease, but those records do not include any mention of vascular disease of the upper extremities. No VA examination was provided; however, none was required as there is no evidence of a diagnosed condition or symptoms of a condition. In sum, the evidence does not show a vascular disorder of the upper extremities during the appeal period and for this reason the claim must also be denied. 4. Entitlement to service connection for vascular disease of the lower extremities is denied. The Veteran seeks entitlement to service connection for vascular disease of the lower extremities but has not identified a specific theory or reason he believes the claim should be granted. In this case, although there is evidence of a current disability; there is no evidence of an in-service incurrence or nexus between the current disability and the Veteran’s period of service. Available treatment records document varicose veins and chronic venous insufficiency of the bilateral lower extremities. See September 2013 private medical record. The available evidence does not show in-service symptoms of peripheral vascular disease or a diagnosis of peripheral vascular disease. The Veteran has not provided testimony of in-service symptoms or diagnosis. Overall, the evidence does not show an in-service injury or event. Third, the preponderance of the evidence does not show the currently diagnosed chronic venous insufficiency and varicose veins are etiologically related to service. The Veteran has not offered a theory of entitlement, and there is no medical evidence to indicate the currently diagnosed conditions are etiologically related to service. VA did not provide an examination in this case; however, none is required. Although there is a current disability, there is no evidence indicating the disability may be related to service. In sum, the criteria for service connection are not met and the claim is denied. REASONS FOR REMAND 1. Entitlement to service connection for a skin disorder, to include as due to herbicide exposure is remanded. This issue is remanded to obtain an adequate VA opinion that addresses the etiology of the Veteran’s various skin conditions. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). VA treatment records dated April 2002 report a history of basal cell carcinoma of the left anterior cheek that was removed in January 2002. November 2015 private medical records report diagnoses of irritated seborrheic keratosis of left superior malar cheek and right ulnar dorsal hand, actinic keratosis, history of basal cell carcinoma, seborrheic keratosis throughout body, angioma, and lentigines. VA obtained a medical exam and opinion in February 2018 but it is not adequate. That examiner reported multiple excisions of benign and malignant basal cell skin cancer, including during the appeal period, but did report or discuss any other skin diagnoses. The examiner opined that the claimed skin condition was due to service because the Veteran was exposed to environmental chemicals known to cause cancer during his period of service in Vietnam. The rationale is conclusory and unsupported by reference to any medical evidence or literature, and the opinion cannot be the sole basis of a grant of service connection. On remand, VA should obtain an adequate addendum opinion for each diagnosed skin condition that is supported by a fully articulated rationale. 2. Entitlement to service connection for erectile dysfunction, to include as secondary to hypertension The available medical evidence indicates that diagnosed erectile dysfunction is due to non-service-connected hypertension. See September 2020 private medical opinion. The Veteran has appealed the denial of his claim of entitlement to service connection for hypertension under VA’s Appeals Modernization Act, and that issue will be addressed by the Board in a separate decision. The appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to remand the claim on appeal pending the adjudication of the inextricably intertwined claim. Harris v. Derwinski, 1 Vet. App. 180 (1991). Remand is necessary pending adjudication of the inextricably intertwined claim. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding the etiology of any currently diagnosed skin disorder from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. (a.) For each skin condition diagnosed during the appeal period, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the skin disorder had onset in, or is otherwise related to, active service. (b.) For each skin condition diagnosed during the appeal period, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the skin disorder is etiologically related to in-service herbicide exposure despite not being listed as one of the presumptive conditions. (c.) A thorough rationale for all opinions must be provided. (d.) The examiner is requested to address the 1) November 2015 private treatment notes showing diagnoses of diagnoses of irritated seborrheic keratosis of left superior malar cheek and right ulnar dorsal hand, actinic keratosis, history of basal cell carcinoma, seborrheic keratosis throughout body, angioma, and lentigines; and 2) the prior February 2018 VA examination report, including the testimony of chronic lesions since service. LAURA E. COLLINS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Smith, 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.