Citation Nr: 21030744 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 16-30 914 DATE: May 19, 2021 ORDER Entitlement to service connection of hypertension is denied. Entitlement to service connection of an acquired psychiatric disorder, claimed as posttraumatic stress disorder (PTSD) and depression, and diagnosed as anxiety disorder is denied. FINDINGS OF FACT 1. The Veteran's hypertension is less likely than not related to any incident of active service; it did not manifest to a compensable degree during service or within one year of separation from service. 2. The Veteran has a present diagnosis of unspecified anxiety disorder which is less likely than not related to any incident of active service; he does not meet the diagnostic criteria for PTSD. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for an acquired psychiatric disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1981 to August 1985, and from August 1989 to August 1995. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). As a matter of procedural background, the issues remaining on appeal previously came before the Board in December 2018, at which time they were remanded for additional development. 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 hypertension, 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 disability is listed as chronic for presumptive purposes, a continuity of symptomatology is a factor to consider when assessing service connection of a disability. 1. Entitlement to service connection of hypertension The Veteran seeks service connection of hypertension. The Board finds that the claim should be denied. As an initial matter, the Board recognizes a diagnosis of hypertension, with the initial date of diagnosis in 2002. A review of the Veteran's service treatment records do not indicate any evidence of hypertension, although "borderline hypertension" was noted at separation in July 1995, and in November 1994 he reported shortness of breath with pleuritic left anterior chest pain (no pathology found). The Board remanded this claim in December 2018, noting that the Veteran had not yet been afforded a medical opinion regarding the cause or onset of his post-service hypertension. In June 2019, the Veteran was afforded a VA examination which found no present evidence of hypertension, although a history of hypertension was noted beginning in 2002, by history. A diagnosis of cardiomyopathy was noted. The examiner reviewed the evidence of record and found that the Veteran's claimed hypertension was less likely than not related to any incident of active service. In support of this conclusion, the examiner stated that there is nothing in the records beyond pleuritic chest pain in 1994. The separation examination is in effect negative. In 2002, he was diagnosed with cardiomegaly with underling chronic interstitial fibrosis. In June 2002, after further cardiac evaluation, his diagnosis is idiopathic cardiomegaly, NXHA class III C/D with secondary mitral regurgitation and compensated congestive heart failure. By September 2011, the diagnosis is non-ischemic cardiomyopathy. It is possible that the left anterior chest wall pain with exertion on one occasion in-service in November 1994, but it less likely than not because it did not recur again while in-service. Cardiomyopathy manifested 7 years later and it is more likely than not secondary to genetic predisposition. The Board finds this opinion to be persuasive in this matter. It was given by a medical specialist in contemplation of the complete medical record. It was accompanied by a detailed rationale which applied the facts of the case to known medical principles. Further, the Board has reviewed the evidence buy found no medical evidence or opinions which would contradict this conclusion. The Board recognizes the Veteran's own firmly held beliefs that his hypertension is related to active service, but finds this to be of limited probative value in assessing the claim. While lay evidence may be competent on a variety of matters concerning the nature and cause of disability, etiology of dysfunctions and disorders is a medical determination and generally must be established by medical findings and opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed.Cir.2010) (recognizing that in some cases lay testimony "falls short" in proving an issue that requires expert medical knowledge). In the present case, the Veteran is a lay person without appropriate medical training and expertise, and thus, is not competent to make an etiological conclusion regarding the cause of his hypertension, especially in light of the VA examiner's conclusions to the contrary and the fact that the evidence fails to demonstrate the onset of actual hypertension in service. See id. Finally, to the extent that hypertension is a cardiovascular-renal disease capable of presumptive service connection, the Board finds that the evidence does not support onset during or within one year of separation from active service. While the Veteran's separation examination indicated "borderline" hypertension, the 2019 examiner reviewed the entire claims file and found that examination to be negative for an actual diagnosis of hypertension within the legal and medical meaning of that term. A review of the medical evidence of record does not document any signs of actual hypertension until 2002, seven years after he separated from active service. While the Veteran is competent to report observable symptoms which may be attributed to hypertension such as shortness of breath, he is not competent to provide an actual diagnosis of that disease, which requires specific medical testing. See Jandreau, supra; see also 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1) (requiring hypertension be confirmed by readings taken two or more times on at least three different days, and showing either diastolic pressure predominantly 90 mm mercury, or greater; or systolic pressure predominantly 160 mm mercury or greater with a diastolic pressure of less than 90 mm). In sum, the Board finds that the evidence of record does not support a nexus between the Veteran's hypertension, first diagnosed in 2002, and any incident of active service to include his reported "borderline hypertension" at separation and shortness of breath in 1994. Neither did his hypertension manifest to a compensable degree during active service or within one year of separation from active service. As such, the claim for service connection of hypertension is denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102. 2. Entitlement to service connection of an acquired psychiatric disorder The Veteran seeks service connection of an acquired psychiatric disability, which he has claimed as either depression or PTSD, and which is presently diagnosed as unspecified anxiety disorder. The Board finds that the claim should be denied. At an initial matter, the Board recognizes various diagnoses throughout the period on appeal to include treatment at VA facilities for PTSD and depression, and a diagnosis of unspecified anxiety disorder in a May 2019 VA examination. Unlike most psychiatric disabilities, a diagnosis of PTSD requires specific findings in accordance with 38 C.F.R. § 4.125(a). 38 C.F.R. § 3.304(f). Nonetheless, the Court of Appeals for Veterans Claims (Court), recognizing the shifting diagnostic nature of psychiatric claims, has held that the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record. Clemons v. Shinseki, 23 Vet. App. 1 (2009). As such, the Board has included all three possible diagnoses noted throughout the Veteran's claims file during the period on appeal. For his part, the Veteran has asserted that he witnessed two plane crashes while serving in the Navy. A review of his service treatment records do not indicate any type of psychiatric treatment or symptoms. The only indication of any psychiatric treatment occurred in July 1995 when he was referred for a psychiatric review following his wife's, but not his own, suicide attempt and a notation of obsessive personality traits. A VA examination conducted in March 2012 found no evidence of any psychiatric diagnosis and did not provide an etiology opinion. Likewise, a June 2015 VA examination also declined to give a diagnosis of PTSD, finding that the Veteran does not have a mental disorder that confirms with the DSM-5 (Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition). It also did not provide an etiology opinion based on the lack of a diagnosis. Despite the non-diagnosis of a psychiatric disability, in August 2015, he reported to a VA mental health practitioner that he had been diagnosed with PTSD, and that diagnosis was added to his file by history. A month later he reported that he thought he had PTSD and also had been given a diagnosis, but could not recall who made that diagnosis. A VA report of hospitalization from December 2015 indicated inpatient treatment due to suicidal ideation. In July 2016 he was given a diagnosis of chronic PTSD, and indicated stress about finances. Because he appeared to have some psychiatric pathology, the Board remanded this claim in December 2018 so that a new VA examination could be conducted and a medical opinion obtained. After an in-person examination which included a review of his medical history, the examiner concluded that the Veteran did not meet the criteria for a diagnosis of PTSD. Neither did he meet the criteria for depression which had been previously noted in the claims file. However, he did have a diagnosis of unspecified anxiety disorder. After a careful review of the evidence, the examiner then concluded that all three potential diagnoses, anxiety, depression and PTSD were less likely than not related to any incident of active service. In support of this, the examiner noted that while he does present with anxiety symptoms such as insomnia, irritability and startle, he was first treated for anger management in 2003 after a domestic dispute. He reports insomnia issues arose in 1996, which occurred after he was discharged from active service. He states that he felt he was unfairly discharged. He also reported a substantial history of childhood abuse perpetrated by his stepfather. Records do not reflect treatment for any psychiatric issues during military service and by the Veteran's own admission did not require any type of treatment until 2003. Neither his entrance examination nor his exit examination reflect mental health issues. With regard to depression, it was less likely incurred by any claimed in-service event. In support of this the examiner noted that he was not treated for depression during active service. Although there were some stressors emanating from military service, that primarily involved his inability to continue in the military service. He felt he was unfairly separated but denied any significant depression at that time or at the present. Concerning any potential PTSD, the examiner stated that it was less likely than not related to an in-service stressor as he did not meet the diagnostic criteria for such a diagnosis and he denied significant reexperiencing or avoidance phenomena. The Board finds these opinions persuasive in this matter. They were given by a psychiatric specialist in contemplation of the Veteran's complete medical history, to include a review of the Veteran's medical treatment history and the Veteran's own reports of symptoms and onset. The opinions applied the facts of the case to known medical principles. Further, the Board has reviewed the file but found no medical evidence or opinions that would explicitly contradict the opinion of the VA examiner. The Board does recognize the Veteran's own firmly held beliefs that his psychiatric issues are attributable to his active service, but finds it of limited probative value in this matter. While lay evidence may be competent on a variety of matters concerning the nature and cause of disability, etiology of dysfunctions and disorders is a medical determination and generally must be established by medical findings and opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed.Cir.2010) (recognizing that in some cases lay testimony "falls short" in proving an issue that requires expert medical knowledge). In the present case, the Veteran is a lay person without appropriate medical training and expertise, and thus, is not competent to make an etiological conclusion regarding the cause of acquired psychiatric disability, especially in light of the VA psychologist's conclusions to the contrary and the fact that the evidence fails to demonstrate the onset of any psychiatric issues in service. See id. The Veteran, by his own admission, has stated to the 2019 examiner that his symptoms did not begin until at least a year, if not several years after service. The Board has reviewed the evidence, and found no medical evidence that the Veteran sustained any in-service psychiatric symptoms, with the exception of possible obsessive personality trait related to a non-psychiatric addictive behavior. As such a continuity of symptoms from the time of service is not supported. In sum, the Board finds that the Veteran's acquired psychiatric disorder, claimed as depression and PTSD, and presently diagnosed as anxiety disorder, is less likely than not related to any incident of active service. Therefore, the claim of service connection for an acquired psychiatric disorder should be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102. 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. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Pryce, Counsel