Citation Nr: 21027591 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 16-62 588 DATE: May 6, 2021 ORDER Service connection for frostbite residuals is denied. Service connection for a disorder manifested by blackouts and loss of consciousness is denied. Service connection for a right knee disorder is denied. Service connection for a left ankle disorder is denied. Service connection for a low back disorder is denied. Service connection for headaches is denied. REMANDED A rating in excess of 10 percent for a forehead scar is remanded. FINDINGS OF FACT 1. The Veteran served on active duty from November 1990 to October 1994. 2. Current disorders characterized as frostbite or blackouts with loss of consciousness have not been shown. 3. The Veteran sustained a right knee injury in service; symptoms of a right knee disorder were not chronic in service, were not continuous since service, and were not shown to a compensable degree within one year of service. A current right knee disorder, diagnosed as degenerative joint disease (DJD), is not causally or etiologically related to service. 4. The Veteran was diagnosed with a left ankle strain, low back strain, and complained of headaches in service. Current disorders diagnosed as shin splints, lumbar radiculopathy, and headaches are not causally or etiologically related to service. CONCLUSIONS OF LAW 1. A frostbite residuals were not incurred in service. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2020). 2. A disorder manifested by blackouts and loss of consciousness was not incurred in service. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2020). 3. A right knee disorder was not incurred in service and may not be presumed to have been incurred therein. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2020). 4. A left ankle disorder was not incurred in service. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2020). 5. A low back disorder was not incurred in service. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2020). 6. A headache disorder was not incurred in service. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In connection with this appeal, the Veteran testified before the undersigned Veterans Law Judge (VLJ) in September 2020. A copy of the transcript has been associated with the record. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Frostbite Residuals & Blackouts with Loss of Consciousness In order to warrant service connection, the evidence must first show a current diagnosis. In this regard, the Veteran testified at the Board hearing that he had frostbite residuals which manifested as pruning in his fingers in the cold, and dizziness in heat as residuals of loss of consciousness. In this regard, the medical evidence includes a compilation of treatment records and other VA examinations. While there are multiple Problem Lists in the treatment record, none contain any notations black outs or frostbite. Further, the clinical records do not reflect complaints of, treatment for, or diagnoses of such disorders. Additionally, the Veteran was afforded VA examinations in July 2015 for his frostbite disorders which evaluated both his upper and lower extremities, and the examiner found no evidence of frostbite residuals or extremity disorders. The medical records associated with the record for the relevant appeal period have failed to show current, chronic diagnoses with respect to frostbite, frostbite residuals, loss of consciousness or blackouts. Service connection may not be granted for a diagnosis of disability by history. Sanchez-Benitez v. West, 13 Vet. App. 282 (1999). Accordingly, the medical evidence does not support the appeals as no current disorders are shown. Right Knee, Left Ankle, Low Back & Headache Disorders The Veteran asserts that he has right knee, left ankle, low back, and headache disorders which are a result of service. Specifically, he asserts that his right knee and left ankle were the result of a motor vehicle accident (MVA) and injured his back lifting boxes. Finally, he stated that his headaches are a result of a slip and fall, as well the same MVA. As to current disorders, the Veteran has been diagnosed with right knee DJD in 2012, shin splints, lumbar radiculopathy, and headaches. Thus, current diagnoses have been shown and the first element of service connection is met with regard to all appeals. As to an in-service incurrence, the service treatment records (STRs) show that the Veteran received treatment in November 1990 following a slip and fall and hitting his head on the floor with headaches. Additionally, in June 1991 he complained of a bump above his eyelid which resulted in headaches. In May 1992, after an MVA for a minor left ankle strain; however, there was no loss of consciousness or headaches noted at that time. In 1993, he also received treatment for pain in his bilateral knees. In April 1994, the STRs revealed complaints of popping in his back after lifting boxes, with an indication of an overstrained back. While chronic disorders were not shown in service, and his separation examination is not associated with the record, the many instances of treatment noted in his STRs as described above are sufficient for in-service incurrences. This is especially true when considered with the Veteran's testimony of his injuries during service. Thus, the second element of service connection is met with regard to all appeals. As to medical nexus, at a December 2012 VA examination, after examining the Veteran and providing current diagnoses, as well as reviewing the record, the examiner opined that it was less likely than not that these disorders were related to the in-service injuries. The examiner reasoned that the objective evidence submitted for review was not sufficient to confirm linkage between any of these disorders and service. The examiner noted that the relevant injuries to the knee, ankle, and back as documented in the STRs appeared to have been relatively minor incidents which would have been expected to produce only acute and transitory symptoms, and would have been unlikely to cause long-term sequelae. Additionally, the examiner stated that no documentation was provided confirming chronicity of these various symptoms and conditions through the remainder of the Veteran's service, or persistence or recurrence in the 18 years since he left active duty. The examiner noted that the Veteran was evaluated on multiple occasions at the local VA medical center for various conditions, ranging from 1997 to 2012 but that no documentation could be located showing complaints to any symptoms relating to the ankle/ knee, back or a headache disorder. Finally, the examiner noted that objective found on current physical examinations were minimal, non-specific, and non-lateralizing. With regards to the knee and ankle disorder, the physical examination of both right and left sides did not show any significant lateralization, and the X-rays of his knees did not show any lateralization, but only minimal DJD of both knees which was less consistent with an old, unilateral knee injury, and most consistent with the normal aging process. Addendum opinions were also obtained in April 2015, but the examiners only stated that there was no new or differing opinion from the December 2012 VA opinion. With specific regard to the headache disorder, the examiner noted that the Veteran had a slip and fall incident in service, and that he hit his head, and was anxious and confused at first with head pain. However, the examiner opined that it was less likely than not that the Veteran sustained a traumatic brain injury in service (TBI) in service with residual headaches. The examiner reasoned that per STRs, the Veteran sustained a hematoma and was dazed transiently due to impact, but that additional records do not show any residual symptoms. Additionally, notes from 1991 showed a three day history of headaches due to an eye condition, but that once again it was transient in nature. The Board finds that the examinations were adequate for evaluation purposes. Specifically, the examiners reviewed the claims file, interviewed the Veteran, and conducted a physical examinations. There is no indication that the VA examiners were not fully aware of the Veteran's past medical history or that any relevant fact was misstated. Moreover, the examiners have the requisite medical expertise to render medical opinions regarding the etiologies of the disorders and had sufficient facts and data on which to base the conclusions. Further, there is no contradicting medical evidence of record. Therefore, the Board finds the VA examiners' opinions to be of great probative value. With regard to the right knee DJD, presumptive service connection will also be considered. However, as noted by the Veteran at his Board hearing, and as seen in his available records, he was not diagnosed with DJD during service, or within a year following service. Instead, he received this diagnosis in 2012, 18 years following separation from service. Additionally, post-service records did not show chronicity of symptoms following his separation from service. Thus, the medical evidence does not support presumptive service connection. The Board has also considered the Veteran's lay statements that his disorders were caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiologies of his current disorders due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeals are denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND The Veteran's forehead scar was last evaluated in December 2012. At the September 2020 Board hearing, he testified that his scar had become painful. Thus, an updated examination must be obtained. The matter is REMANDED for the following actions: 1. Identify and obtain any outstanding, pertinent, VA and private treatment records and associate them with the claims file. 2. Schedule the Veteran for an examination to assess the current status of his forehead scar. The entire claims file should be made available to, and reviewed by, the examiner. Any indicated studies should be performed. L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Yacoub, Associate 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.