Citation Nr: 21030810 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 19-38 188 DATE: May 19, 2021 ORDER Service connection for bilateral eyes disorder is denied. Service connection for hypertension is denied. Service connection for rheumatoid arthritis of the entire system is denied. REMANDED Service connection for diabetes type II is remanded. Service connection for heart condition is remanded. FINDINGS OF FACT 1. The preponderance of the probative evidence of record is against finding that the Veteran has had bilateral eyes disorder at any time during or approximate to the pendency of the claim. 2. The preponderance of the probative evidence is against finding that hypertension began during active service or is otherwise related to an in-service injury or disease. 3. The preponderance of the probative evidence of record is against finding that the Veteran has had rheumatoid arthritis of the entire system at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral eyes disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for rheumatoid arthritis of the entire system 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 July 1961 to June 1963. The Veteran testified at an April 2021 videoconference hearing before the undersigned Veterans Law Judge (VLJ); a copy of the transcript is of record. The Veteran also had a hearing with a different VLJ on a separate issue, entitlement to service connection for erectile dysfunction, and this issue will be decided in a separate decision. 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. Service connection for bilateral eyes disorder is denied. The Veteran contends a current bilateral eyes disorder related to service. The claim was received by the VA in August 2018. At a May 2017 VA eye visit, it was assessed that the Veteran had barely visually significant cataracts in both eyes. May 2018 VA diagnostic imaging showed no retinopathy. At a September 2018 VA eye visit, it was assessed that the Veteran had refractive errors and barely visually significant cataracts in both eyes. As noted, service connection may be granted for a 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. Refractive error, however, is considered a congenital defect. See M21-1 Part III, Subpart iv, 4.B.1.d. Generally, congenital defects are not diseases for VA compensation purposes. 38 C.F.R. § § 3.303(c); see also 38 C.F.R. § § 4.9; Winn v. Brown, 8 Vet. App. 510, 516 (1996). In the absence of a superimposed disease or injury, service connection may not be allowed for congenital defects or refractive errors of the eyes, even if visual acuity decreased in service, as refractive errors are not diseases or injuries within the meaning of applicable legislation relating to service connection. Id. There is no evidence of an event or trauma to the eyes in service. In other words, there is no evidence that the Veteran's refractive errors were aggravated or subject to a superimposed disease or injury during his military service that resulted in additional disability. Service treatment records are silent with respect to any complaints or injuries to the eyes. The Veteran's March 1961, July 1961, and June 1963 Reports of Medical Examination showed "normal" clinical evaluations of the eyes with "20/20" distant vision. At an April 2021 Board hearing, the Veteran denied sick calls, profiles, or glasses during service, but testified to being examined and prescribed glasses "right after [he] got out." The Veteran did not recall any eye disorder diagnoses. VA treatment records show the Veteran was not diagnosed with cataracts until May 2017, more than five decades after separation from service. While the Veteran is competent to report having experienced symptoms of eye problems since service, the Veteran has not alleged any symptoms outside of a possible refractive error correctible by prescription lenses until May 2017. The Veteran is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of cataracts. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). There are no medical opinions in the record to support the Veteran's claims. There is no evidence of an in-service event, injury, or disease. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Veteran' service treatment records showed no eye complaints and "20/20" vision. The Veteran reported that treatment began shortly after service, but for a condition correctible with prescription glasses. Therefore, for the reasons outlined above, the Board finds that the preponderance of evidence is against the claim of entitlement to service connection for bilateral eyes disorder. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b). The claim is denied. 2. Service connection for hypertension is denied. The Veteran contends service connection is warranted for hypertension. The claim was received by the VA in August 2018. Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board's adjudication will consider only entitlement to secondary service connection. Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of or was aggravated beyond its natural progress by service-connected disability. The Board concludes that, while the Veteran has a current disability, the preponderance of the evidence is against finding that the Veteran's hypertension is proximately due to or the result of or aggravated beyond its natural progression by service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). Service treatment records are silent with respect to any complaints or treatment for hypertension. The Veteran's March 1961, July 1961, and June 1963 Reports of Medical Examination showed 130/70, 128/78, and 112/64 systolic over diastolic blood pressure readings, respectively. July 1961, October 1961, June 1962, and June 1963 chest X-rays were "negative." The Veteran denied high or low blood pressure during service. VA treatment records show the Veteran was assessed with hypertension in May 2017. Blood pressure reading at that time showed 154/88 and 150/85 systolic over diastolic. The Veteran was on medication and denied any headaches, dizziness, or blurred vision. At the April 2021 Board hearing, the Veteran denied using blood pressure medication, headaches, or blurred vision during service. The Veteran testified to high blood pressure and low-dose medication beginning in the Veteran's "mid-20s" after separating from service at age 21. The Veteran's representative linked the Veteran's hypertension to a heart condition which has also not been service-connected (see below). While the Veteran is competent to report experiencing symptoms since service, the Veteran has alleged blood pressure symptoms that began several years after separation. The Veteran believes his hypertension is proximately due to, the result of, or aggravated beyond its natural progression by a service-connected disability. The Veteran in this case, however, is not competent to provide a nexus opinion with regard to the hypertension. The issue is medically complex, as it requires knowledge of pathology and interpretation of medical testing. It is outside the competence of the Veteran in this case because the record does not show the necessary skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). There are no medical opinions in the record to support the Veteran's claims. There is no evidence of an in-service event, injury, or disease. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Veteran specifically denied high blood pressure or related symptoms during service, the service treatment records do not show any readings of high blood pressure, and the Veteran testified that treatment began several years after separation. Therefore, for the reasons outlined above, the Board finds that the preponderance of evidence is against the claim of entitlement to service connection for hypertension. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b). The claim is denied. 3. Service connection for rheumatoid arthritis of the entire system is denied. The Veteran contends rheumatoid arthritis related to service. The claim was received by the VA in August 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. The Board concludes that the Veteran does not have a current diagnosis of rheumatoid arthritis and has not had one at any time during the pendency of the claim 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). In Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the Federal Circuit held that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. In April 2021, the Veteran testified to a diagnosed skeletal rheumatoid of the whole body, medication, and unspecified hand problems, but there was no indication at the Board hearing or in the medical evidence of record about any specific functional limitations related to the Veteran's hands that would interfere with the ability to work. There are no complaints or treatment of rheumatoid arthritis or hand limitations in the medical evidence of record. Service treatment records are silent with respect to any complaints or treatment for rheumatoid arthritis. The Veteran's March 1961, July 1961, and June 1963 Reports of Medical Examination showed "normal" clinical evaluations. The Veteran denied arthritis or rheumatism during service. Post-service medical records do not show any complaints or treatment of rheumatoid arthritis or hand limitations. While the Veteran believes he has a current diagnosis of rheumatoid arthritis, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). There are no medical opinions in the record to support the Veteran's claims. There is no competent evidence of a current disability. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The evidence of record does not show a current disability and the Veteran did not allege any specific functional limitations that would interfere with the ability to work. Therefore, for the reasons outlined above, the Board finds that the preponderance of evidence is against the claim of entitlement to service connection for rheumatoid arthritis of the entire system. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b). The claim is denied. REASONS FOR REMAND 1. Service connection for diabetes type II is remanded. 2. Service connection for heart condition is remanded. During an April 2021 hearing, the Veteran identified relevant outstanding private treatment records. The Veteran testified to being treated by a primary care physician for 25 years as well as a diabetes specialist in Beaumont, Texas. The Veteran also identified treatment with a heart stent in 2004. A remand is required to allow VA to obtain authorization and request these records. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for Dr. Halbert from SETMA in Beaumont, Texas. Make two requests for the authorized records unless it is clear after the first request that a second request would be futile. 2. Ask the Veteran to complete a VA Form 21-4142 for Dr. Hood from SETMA in Beaumont, Texas. Make two requests for the authorized records unless it is clear after the first request that a second request would be futile. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James Hekel 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.