Citation Nr: 21032270 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 16-02 603 DATE: May 26, 2021 ORDER Entitlement to service connection for hydrocephalus is denied. FINDING OF FACT The probative evidence of record does not show a nexus between the Veteran's hydrocephalus and his military service. CONCLUSION OF LAW The criteria for service connection for hydrocephalus have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Air Force from September 1985 to November 1992. This claim comes before the Board of Veterans' Appeals (Board) on appeal from a January 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In May 2019, the Board issued a remand in order to afford the Veteran a personal hearing before a decision review officer (DRO). The Veteran testified at a DRO hearing in January 2020. The transcript is contained in the Veteran's VA claims file. As such, there has been substantial compliance with Board remand directives. See Stegall v. West,11 Vet. App. 268, 271(1998). Service Connection Service connection may be granted for a disability resulting from personal injury suffered or disease contracted in the line of duty. 38 U.S.C. §§ 1110, 38 C.F.R. §§ 3.303, 3.304. Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). If the evidence is competent, the Board must then determine if the evidence is credible, or worthy of belief. See Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). After determining the competency and credibility of evidence, the Board must then weight its probative value. In this regard, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995). The Veteran is competent to provide testimony concerning factual matters of which he has firsthand knowledge, such as experiencing a physical symptom such as pain. Barr v. Nicholson, 21 Vet. App. 303 (2007). Further, under certain circumstances, lay statements may support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability, or symptoms of disability, susceptible of lay observation. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau, 492 F.3d 1372 (holding that a layperson is competent to identify a simple condition such as a broken leg). Nevertheless, a veteran is not competent to provide evidence as to more complex medical questions and, specifically, is not competent to provide an opinion as to etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007); see also 38 C.F.R. § 3.159 (a)(2). Entitlement to service connection for hydrocephalus. The Veteran contends that he suffers from hydrocephalus due to his military service. A review of his service treatment records (STRs) shows that, in his November 1984 enlistment Report of Medical History, the Veteran reported a head injury that predated service by 2 years in which he suffered from well aligned bone fragments. The Veteran stated that he suffered from headaches once or twice a week, lasting for half a day. See November 1992 STR-Medical, p. 70. The Veteran reported headaches in service. In fact, he was medically disqualified from flying Class III due to headaches with usage of medication. Id at 2. When the Veteran separated in 1992, he was not provided an exit examination. Id at 27. Post-service treatment records indicate that enlargement of the ventricular system was found in February 1995, with the possibility of hydrocephalus described. See September 2012 Medical Treatment Record Government Facility. There are two automobile accidents of record. The Veteran has reported being in motor vehicle accident in 1987 when stationed in Cyprus. The Veteran stated that he was run off the road and his car flipped over several times, after which he lost consciousness and awoke 4-6 hours later in the hospital. The Veteran reports that he did not have any lingering memory deficits following his release from the hospital. See #3 November 2019 CAPRI, p. 8. A review of the Veteran's STRs and medical record has not uncovered any corroborating evidence of the accident taking place. The Veteran also reports an accident that occurred in 2007, when his car was hit by another vehicle. He denied losing consciousness during the accident, but did report feeling "zoned out" and walking sideways afterwards. Id. The Veteran reported suffering from short term memory issues following the 2007 automobile accident. See October 2018 CAPRI, p. 74. In 2008, he was diagnosed with hydrocephalus. See November 2019 CAPRI, p. 1. In September 2012, the Veteran submitted a claim of service connection for hydrocephalus. A VA examination was provided in December 2012. There, the Veteran reported headaches beginning "right after the military" in 1992, with constant dizziness beginning in February 2012. The VA examiner opined that the Veteran's hydrocephalus was less likely than not related to his military service. The examiner explained: The Veteran has a mention in STRs of not being qualified for flight status due to history of headaches in 1985. The Veteran was not given a separation physical exam when he left service. He was given a compensation examination in December of 1992, where he was evaluated for a scar to the left forehead that was a residual of a MVA which occurred in 1986. Hydrocephalus can be acquired from a traumatic brain injury. The STRs are silent for this MVA. The Veteran went on to serve an additional 6 years following this MVA. His compensation and pension examination in 1992 is silent for any headache condition. In 1994, the Veteran underwent a Gulf War registry examination at which time he reported a headache condition. He underwent imaging studies which were suspicious, but not diagnostic for hydrocephalus. He had another MVA in 2007 with marked CT changes of his head at which time he developed gait disturbances. There is no conclusive evidence that he had hydrocephalus until 2007 with the development of gait disturbances and head CT findings. Headache is a common, not specific complaint. A nexus cannot be established. The RO denied the Veteran's claim in January 2013 and the Veteran submitted a timely notice of disagreement (NOD) in August 2013. A January 2016 statement of the case (SOC) was provided explaining the denial of benefits. The Veteran then perfected his appeal via VA Form 9 in January 2016. The Board then issued a remand order in May 2019, as the Veteran indicated that there was further evidence to be made of record. As indicated above, the Veteran testified at a DRO hearing in January 2020. There, the Veteran testified that he was in an automobile accident in 1986 when stationed in Cypress. He stated that he was on duty at the time of the accident and received treatment through the embassy and believed that was why there was no record of the accident in his STRs. The Veteran further argued that the accident in 2007 aggravated problems that began from the 1986 accident. At the DRO hearing, the Veteran submitted pictures of a severely damaged car, which he stated was the rental car he drove in Cypress. See January 2020 Photographs. A supplemental statement of the case (SSOC) was provided in April 2020 and the claim is now properly before the Board. In May 2021, the Veteran's representative wrote an appellate brief, in which he argued that service connection should be granted because the Veteran is service-connected for a scar on his head, which he claims to have been from his in-service automobile accident. See May 2021 Appellate Brief. The Board notes that the question of whether an accident occurred in service speaks to the second element of service connection. In the present case, the Veteran's claim must be denied on the grounds that the criteria for the third element of service connection, a nexus between his current disability and his military service, has not been met. In reaching this conclusion the Board acknowledges the Veteran's sincere belief that his hydrocephalus was caused by an automobile accident during military service. However, the question of whether a diagnosis or nexus exists is a medical determination that requires perquisite medical training, skills and expertise, as the determination of the etiology of the Veteran's disability is a complex medical condition. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The only probative nexus opinion of record is that of the September 2012 VA examiner. Given that the VA examiner reviewed the Veteran's medical records, considered his lay statements, and provided a detailed rationale based upon the evidence of record, the Board finds the September 2012 medical opinion to be of significant probative value. As there is no competing positive nexus opinion of record, the Board finds the Veteran's claim must be denied as there is no nexus between his hydrocephalus and his military service. The benefit-of-the doubt doctrine is not for application, and the claim for service connection for hydrocephalus must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Katherine Kiemle Buckley Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Abels, 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.