Citation Nr: 21027656 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 14-24 576A DATE: May 6, 2021 ORDER Entitlement to service connection for headaches is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for a coronary artery disease (CAD), to include as secondary to hypertension, is denied. REMANDED Entitlement to service connection for left ear hearing loss is remanded. FINDINGS OF FACT 1. The Veteran's headache condition is not etiologically related to his active duty service. 2. The Veteran's hypertension condition is not etiologically related to his active duty service. 3. The Veteran's CAD is not caused by or aggravated by a service-connected disability, or claimed to be causally related to service on a direct basis. CONCLUSIONS OF LAW 1. The criteria for service connection for headaches have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for CAD, to include as secondary to hypertension, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service for training (ACDUTRA) in the Army National Guard from June 6, 1982 to July 23, 1982, with additional service in the Army Reserves. This matter is before the Board of Veterans' Appeals (Board) on appeal of a February 2011 rating decision of the Montgomery, Alabama, Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran appeared at a hearing before the undersigned Veterans Law Judge in July 2017. A transcript of the hearing is in the Veteran's file. In March 2018, Board remanded the issues noted in the Order above, in addition to entitlement to service connection for hearing loss, entitlement to service connection for tinnitus, and entitlement to service connection for a sleep problem, for further development. Stegall v. West, 11 Vet. App. 268, 271 (1998). Subsequently, in a rating decision dated February 1, 2020, the RO granted service connection for right ear hearing loss and service connection for tinnitus. Additionally, in a rating decision dated February 10, 2020, the RO granted service connection a generalized anxiety disorder (claimed as sleeplessness). As the Veteran has not appealed the evaluations or effective dates assigned to these disabilities, these matters are not before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. "To establish a right to compensation for a present disability, a veteran must show: "(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 or aggravated during service"-the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Additionally, service connection may also be granted on a secondary basis for a disability if it is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either proximately caused or aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995). Compensation is payable (service-connection is warranted) for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. § §§ 1110, 1131. Active military, naval, or air service includes any period of ACDUTRA during which the individual was disabled or died from a disease or injury incurred in or aggravated in the line of duty, or any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from injury incurred in or aggravated in line of duty. 38 U.S.C. § 101(21), (24); 38 C.F.R. § 3.6(a), (d). By way of background, the Veteran's claims file shows that he had a period of ACDUTRA from June 6, 1982 to July 23, 1982. During his July 2017 Board hearing, the Veteran noted that he served on active duty service in 1987. Pursuant to the March 2018 Board remand, the RO was requested to verify all active duty, ACDUTRA and/or INACDUTRA dates. A review of the record shows that the query returned no results for additional service dates for the Veteran. As such, the only service dates are a period of ACDUTRA from June 6, 1982 to July 23, 1982. At his July 2017 videoconference hearing, the Veteran stated that he experienced tightness in his chest in 1987. He also stated that in 2006, he experienced symptoms of hypertension with associated headaches. Statements from the Veteran's mother, wife and brother, in support of the appeal, nothing that the Veteran experienced chest pains and headaches, were received in August 2017. A review of the medical evidence of record shows a VA medical sick slip, dated in June 2002, which reflected that the Veteran had uncontrolled hypertension. A private medical note, dated in November 2008, indicates that the Veteran had CAD. A private medical report, dated in January 2009, shows diagnoses of CAD and hypertension. A private January 2021 medical note shows a diagnosis of ischemic heart disease. The Veteran was afforded a VA hypertension examination in January 2011. It was noted that the Veteran had been diagnosed with hypertension in 2006 and that he was taking medication for his condition. A diagnosis of essential hypertension, due to aging, was provided. In December 2020, the Veteran was afforded a hypertension examination in December 2020. A diagnosis of hypertension was provided. It was noted that the Veteran took medication for his condition. The Veteran was also afforded a VA headaches examination that same month. A diagnosis of headache syndrome was provided. Constant, pulsating pain was found. The Veteran was also afforded a VA heart conditions examination. Diagnoses of CAD and status post percutaneous coronary intervention were provided. The VA examiner opined that the claimed conditions of headaches and hypertension were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner noted the Veteran's ACDUTRA service dates of June 6, 1982 to July 23, 1982. The VA examiner noted that the Veteran's 1981 entrance examination did not indicate that the he experienced any headaches or hypertension and that service treatment records were silent for complaints of hypertension and headache. The VA examiner stated that the Veteran's blood pressure was shown to be normal during a 1985 reenlistment physical and that there was no documentation of headaches. The VA examiner also opined that the claimed condition of CAD was less likely than not proximately due to or the result of a service-connected condition. The VA examiner noted that hypertension was a risk factor for CAD and that the Veteran's CAD was likely due to the hypertension. However, it did not appear that the Veteran's hypertension was service connected. Further, the diagnosed CAD was not least as likely as not aggravated beyond its natural progression by the diagnosed hypertension. It was noted again that hypertension was a risk factor of CAD and that it could aggravate the disorder, but the diagnosed hypertension was not service connected. After a review of all of the evidence, the Board finds that the claimed disabilities of hypertension, headaches, and CAD are neither related to service, nor related to a service-connected disability. As noted above, service-connection is warranted for a disability resulting from a disease or injury incurred in or aggravated by active service. The record contains no competent opinion linking the Veteran's claimed hypertension and headache conditions to the Veteran's period of ACDUTRA. There is no evidence of the disabilities in service, and the VA examination reports concur that there is no nexus between the Veteran's current hypertension and headaches syndrome and any injury in service. The December 2020 VA opinions were provided based upon a comprehensive review of the claims file and examination of the Veteran. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). There are no medical opinions to the contrary; the only evidence to the contrary comes from the Veteran. Regarding the Veteran's assertion that his CAD is caused by or aggravated by his hypertension, secondary service connection requires, as an initial matter, that there be a service-connected disability to which the nonservice-connected disability may be attributed. 38 C.F.R. § 3.310. The Board acknowledges that the Veteran suggested a link between his CAD and his claimed hypertension condition. However, given the denial of hypertension, the Board finds that service connection on a secondary theory of entitlement is not warranted. Since the claimed underlying disorder is not service connected, the Veteran's claim for secondary service connection for a heart condition on this basis is without legal merit. The Veteran has presented no evidence, lay or otherwise, that CAD arose as a direct result of the noted ACDUTRA period. The Board notes the Veteran's assertions that his disabilities are due to his service. Although lay persons are competent to provide opinions on some medical issues, the specific disabilities in this case fall outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Here, the Veteran's complaints as to his symptoms are certainly capable of lay observation. However, the Board finds that the cause of the disabilities is not capable of lay observation. As such, the Veteran's and family members' lay testimony is afforded little weight in the analysis of whether service connection is warranted on a direct and secondary basis. Overall, the claims must be denied. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claims regarding direct and secondary service connection, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b). REASONS FOR REMAND Entitlement to service connection for left ear hearing loss is remanded. As noted above, the issue of service connection for hearing loss was remanded by the Board in February 2018. While the RO granted service connection for right ear hearing loss in the February 1, 2021 rating decision, it did not address entitlement to service connection for left ear hearing loss. The subsequently issued Supplemental Statement of the Case (SSOC) also failed to include the issue of service connection for left ear hearing loss. As such, the Board finds that the issue must be remanded. The matters are REMANDED for the following action: Issue the Veteran a SSOC on the issue of entitlement to service connection for left ear hearing loss unless the benefit sought is granted in full. An appropriate period of time should be allowed for response from the Veteran. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A-L Evans, 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.