Citation Nr: 21040610 Decision Date: 07/06/21 Archive Date: 07/06/21 DOCKET NO. 17-00 801 DATE: July 6, 2021 ORDER Entitlement to service connection for epididymitis is denied. Entitlement to service connection for a right hand disability is denied. Entitlement to service connection for a right shoulder disability is denied. Entitlement to service connection for a right wrist disability is denied. Entitlement to service connection for a left wrist disability is denied. Entitlement to service connection for hypertension is denied. REMANDED Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right hip disability is remanded. Entitlement to service connection for a left shoulder disability is remanded. Entitlement to service connection for a skin condition, to include tinea pedis, is remanded. Entitlement to service connection for a gastrointestinal condition, to include gastroesophageal reflux disease (GERD), is remanded. Entitlement to service connection for a sinus condition, to include allergic rhinitis and/or sinusitis, is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has had epididymitis at any time during or approximate to the pendency of the claim. 2. The preponderance of the evidence is against finding that the Veteran has had a right hand disability at any time during or approximate to the pendency of the claim. 3. The preponderance of the evidence is against finding that the Veteran has had a right shoulder disability at any time during or approximate to the pendency of the claim. 4. The preponderance of the evidence if against finding that the Veteran has had a right wrist disability at any time during or approximate to the pendency of the claim. 5. The preponderance of the evidence is against finding that the Veteran has had a left wrist disability at any time during or approximate to the pendency of the claim. 6. The Veteran's hypertension did not have its onset during service or within one-year of discharge from service; the weight of the probative evidence is against finding that the Veteran's hypertension is related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for epididymitis have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a right hand disability have not been met. 38 U.S.C. §§ 1110, 1117, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. 3. The criteria for service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 1110, 1117, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. 4. The criteria for service connection for a right wrist disability have not been met. 38 U.S.C. §§ 1110, 1117, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. 5. The criteria for service connection for a left wrist disability have not been met. 38 U.S.C. §§ 1110, 1117, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. 6. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1985 to December 1995, October 2000 to May 2001, and October 2001 to August 2002. The matters come before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the proceeding is associated with the claims file. Subsequently, the Board remanded the matters for further development in May 2020. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. In order to establish service connection on a direct basis, the record must contain: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Under 38 C.F.R. § 3.317, service connection may be granted on a presumptive basis if there is evidence (1) that the claimant is a Persian Gulf Veteran; (2) who exhibits objective indications of chronic disability resulting from an undiagnosed illness, a medically unexplained chronic multisymptom illness (such as chronic fatigue syndrome, fibromyalgia, or IBS) that is defined by a cluster of signs or symptoms, or resulting from an illness or combination of illnesses manifested by one or more signs or symptoms such as those listed in paragraph (b) of 38 C.F.R. § 3.317; (3) which became manifest either during active military, naval, or air service in the Southwest Asia Theater of Operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021; and (4) that such symptomatology by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. §§ 1117, 1118; 38 C.F.R. § 3.317. Chronic multisymptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317 (a)(2)(ii). In the case at hand, the Veteran has qualifying service under 38 C.F.R. § 3.317(e). 1. Entitlement to service connection epididymitis. After considering all of the evidence of record, the Board concludes that the Veteran does not have a current diagnosis for epididymitis 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). The Veteran was afforded a VA examination in April 2014, in which the examiner noted that the Veteran had acute epididymitis in January 1993 and July 1995. The examiner noted that both episodes were self-limited (three to five days or less) and required only acute treatment with antibiotic therapy. The examiner stated that the Veteran declined a physical examination but reported "no problems." The examiner indicated that the Veteran denied any symptoms or medical treatment for any such condition and no further issues with such condition since 1995. The examiner further indicated that both episodes were self-limited and produced no residual effect/sequelae and the Veteran does not have any current or chronic epididymitis or other reported related genitourinary conditions. The Veteran underwent another examination in October 2020, in which the examiner noted that there was no signs or symptoms of epididymitis. The examiner indicated that the Veteran's 1993 and 1995 episodes of acute epididymitis resolved with no recurrence, progression, chronicity, residuals, or sequelae. The existence of a current disability is the cornerstone of a claim for service connection and VA disability compensation. 38 U.S.C. § 1110; Degmetich v. Brown, 104 F.3d 1328, 1332 (Fed. Cir. 1997). Evidence must show that the Veteran currently has the disability for which benefits are being claimed. Here, although there is record of treatment in service for epididymitis, no permanent residual of chronic disability subject to service connection has been shown in the record. Specifically, the VA examiners found that the Veteran's two episodes of acute epididymitis resolved in service, with no recurrence, progression, chronicity, residuals, or sequelae. While the Veteran's application for service connection illustrates that he believes he has a current disability for VA purposes, he is not competent to provide a diagnosis in this case. The issue is medically complex as it requires the ability to interpret diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board does not question the Veteran's sincerity in his belief that service connection is warranted for epididymitis. However, without evidence of a current disability or symptoms causing functional impairment of earning capacity, the preponderance of the evidence is against the claim. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). As such, service connection is denied. 2. Entitlement to service connection for a right hand disability. 3. Entitlement to service connection for a right shoulder disability. 4. Entitlement to service connection for a right wrist disability. 5. Entitlement to service connection for a left wrist disability. After considering all of the evidence of record, the Board concludes that the Veteran does not have a current diagnosis for a right hand disability, right shoulder disability, right wrist disability, and/or left wrist disability, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky, 26 Vet. App. at 294; McClain, 21 Vet. App. at 321. A review of the record illustrates that the Veteran reported experiencing aching in his right hand and pain in his right shoulder and bilateral wrists; however, there is no diagnosis of a right hand disability, right shoulder disability, left wrist disability, or right wrist disability. Specifically, an April 2014 VA examiner indicated that the Veteran did not have a wrist or right shoulder disability. The examiner indicated that the examinations for the Veteran's wrists and right shoulder were normal and that the Veteran's current complaints of right shoulder pain were unrelated to his previously documented muscle strain. An October 2020 VA examiner noted that the Veteran did not have a current right hand, right shoulder, left wrist, or right wrist disability. The examiner indicated that the Veteran's post-service treatment records were silent as to any wrist or right shoulder disabilities and no wrist or right shoulder condition was noted during the examination as range of motion testing and muscle strength testing revealed normal results. Additionally, upon examination, the Veteran's right hand revealed normal results for range of motion testing and muscle strength testing. The Board finds that the October 2020 VA examinations are probative as the examiner conducted a physical examination, considered the Veteran's medical history, and provided well-reasoned and thorough opinions with adequate rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The examiner's opinions are not contradicted by any other medical evidence of record. The existence of a current disability is the cornerstone of a claim for service connection and VA disability compensation. 38 U.S.C. § 1110; Degmetich, 104 F.3d at 1332. Evidence must show that the Veteran currently has the disability for which benefits are being claimed. Here, the Veteran has not been diagnosed with a right hand disability, right shoulder disability, left wrist disability, and/or right wrist disability at any time relevant to the period under appeal. Additionally, the evidence does not indicate that his symptoms cause functional limitation or functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The Board has also considered whether his claimed disabilities are related to an undiagnosed illness or medically unexplained chronic multi-symptom illness. See 38 C.F.R. § 3.317. The Veteran's post-service treatment records are silent for both complaints of right hand or wrist pain and additional signs and symptoms suggestive of such. In the absence of functional impairment, a compensable rating could not be warranted based on any signs or symptoms as required in 3.317(a)(1)(i). Additionally, a December 2020 VA examiner opined that Veteran's disability patterns did not indicate manifestations of a chronic undiagnosed illness and/or a medically unexplained chronic multisymptom illness and were not related to a specific exposure event experienced by the Veteran during service. Thus, service connection based on Gulf War environmental exposure is not warranted. While the Veteran's application for service connection illustrates that he believes he has a current disability for VA purposes, he is not competent to provide a diagnosis in this case. The issues are medically complex as they require the ability to interpret diagnostic medical testing. Jandreau, 492 F.3d at 1377 n.4. The Board does not question the Veteran's sincerity in his belief that service connection is warranted for a right hand, right shoulder, right wrist, and left wrist disability. However, without evidence of a current disability or symptoms causing functional impairment of earning capacity, the preponderance of the evidence is against the claim. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55. Accordingly, service connection is denied. 6. Entitlement to service connection for hypertension. Certain chronic diseases, to include hypertension, will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). For VA purposes, hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. The term hypertension means the diastolic blood pressure (the bottom number) is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure (the top number) is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note 1. The Board finds that there is no probative evidence supporting the contention that the Veteran's hypertension arose in service or is otherwise etiologically related to service. The Board concludes that, while the Veteran has a current diagnosis of hypertension, it was neither chronic in service, nor manifested to a compensable degree in service or within the one-year presumptive period, and continuity of symptomatology is not established. While the Veteran's service treatment records (STRs) note at least three instances of elevated diastolic readings in May 1986 (132/96), June 1990 (130/90), and April 1991 (131/92); the Veteran was not diagnosed with or received treatment for hypertension during service. The October 2020 VA examination report indicates that the Veteran was not diagnosed with hypertension until 2010, outside of the applicable presumptive period. Additionally, the Veteran has not indicated that he has had symptoms of hypertension since service or during the presumptive period. Moreover, the Board finds that the preponderance of the evidence is against finding that the Veteran's hypertension is etiologically related to service. He has not asserted a specific injury or in-service event which caused his hypertension. Additionally, the October 2020 VA examiner opined that the Veteran's hypertension was less likely than not due to an in-service injury or event as he was diagnosed in 2010. While the Veteran believes that his hypertension began in service, he is not competent to provide a nexus opinion in this case. The Veteran, as a layperson, is not competent to speak to such medically complex matters, such as the etiology of the claimed disability. Jandreau, 492 F.3d at 1377 n.4. Thus, although the Board has carefully considered the lay contentions of record, the Board ultimately affords the objective medical evidence of record, which weighs against finding such a connection, with greater probative weight than the lay opinion. Nieves-Rodriguez, 22 Vet. App. at 304 In sum, the Board finds that the competent and credible evidence of record does not demonstrate that the Veteran's hypertension arose in service, within one year of service, or is otherwise etiologically related to service. Accordingly, as the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55. REASONS FOR REMAND 7. Entitlement to service connection for a low back disability. An October 2020 VA examiner diagnosed the Veteran with spinal stenosis and degenerative disc disease of the thoracolumbar spine. The examiner opined that the Veteran's back conditions were less likely than not related to service as his noted April 2000 mechanical low back pain resolved with no recurrence, progression, chronicity, residuals, or sequelae. The examiner noted that the Veteran slipped and fell in 2017 and has had back pain since then. The Boards finds that the October 2020 medical opinion is based on an inaccurate factual premise. The examiner only noted the Veteran's April 2000 diagnosis of mechanical back pain; however, the Board notes that the Veteran's STRs contain numerous reports for recurrent back pain as well as diagnoses of lumbar strain/muscle strain. See April 2000, May 1995, May 1994, April 1993, December 1993, October 1992, May 1992, and April 1991 STRs; May 2001, December 1995, and June 1993 report of medical history. Moreover, while the examiner indicated that the Veteran's back pain began after a 2017 accident, the Veteran's private treatment records note that he reported and sought treatment for low back pain in 2013 and 2014; he was diagnosed with lumbar spinal stenosis in September 2015. Additionally, a January 2019 private treatment note indicated that the Veteran reported having on and off low back pain for the past 10 years. Accordingly, as there is no adequate medical opinion on which to adjudicate the matter, the Board finds that remand is necessary to obtain a new VA examination and medical opinion regarding the nature and etiology of the Veteran's low back disability. 8. Entitlement to service connection for a right knee disability. 9. Entitlement to service connection for a left knee disability. An October 2020 VA examiner diagnosed the Veteran with left knee meniscal tear and bilateral chondromalacia patella. The examiner opined that the Veteran's bilateral knee conditions were less likely than not etiologically related to service. The examiner noted that the Veteran reported knee pain in May and June 2002; he was diagnosed with patellofemoral syndrome in June 2002, which resolved with no evidence of chronicity, progression, recurrence, or residuals. The examiner indicated that the Veteran reported knee pain in 2017, at which time he was diagnosed with left lateral meniscus tear. The Board regrets the further delay but finds this rationale insufficient to support the conclusion of no nexus to service. Here, the October 2020 VA examiner did not take into consideration the Veteran's lay statements as to continued knee symptoms and pain from the time of service to the present. On remand, the agency of original jurisdiction (AOJ) should afford the Veteran a new VA examination of his bilateral knee disabilities and obtain an adequate etiological opinion. 10. Entitlement to service connection for a right hip disability. An October 2020 VA examiner diagnosed the Veteran with right hip degenerative arthritis. The examiner opined that the condition was less likely than not etiologically related to service as the Veteran's STRs were silent as to right hip injury, trauma, or treatment. The examiner indicated that the Veteran reported right hip pain after a 2017 fall, at which time he was diagnosed with osteoarthritis. The Boards finds that the October 2020 medical opinion is based on an inaccurate factual premise as the Veteran's STRs note complaints of right hip pain in April 1997; he was diagnosed with muscle spasm. Accordingly, as there is no adequate medical opinion on which to adjudicate the matter, the Board finds that remand is necessary to obtain a new VA examination and medical opinion regarding the nature and etiology of the Veteran's right hip disability. 11. Entitlement to service connection for a left shoulder disability. The Veteran's STRs indicate that he reported left shoulder pain in March 1992 and April 1993. In October 2005, the Veteran reported having left shoulder pain for approximately two years; he was diagnosed with left shoulder rotator cuff tendinitis. The Veteran's 2013 private treatment records indicate that he reported shoulder pain. During an April 2014 VA examination, the Veteran reported having shoulder pain since service. The examiner indicated that the Veteran had a normal physical examination and that his complaints of pain were unrelated to his previously documented muscle strain. In April 2017, the Veteran reported left shoulder pain for five or six years. He was diagnosed with left shoulder pain/impingement/tendinitis. An October 2020 VA examiner diagnosed the Veteran with left acromioclavicular joint osteoarthritis. The examiner opined that the Veteran's left shoulder disability was less likely than not etiologically related to service as the Veteran's 2005 left shoulder rotator cuff tendonitis resolved with no recurrence, progression, chronicity, residuals, or sequelae. The examiner noted that the Veteran's rotator cuff tear was treated in July 2018 and resolved. The Board finds that remand is required is necessary to obtain a new VA examination and medical opinion regarding the nature and etiology of the Veteran's left shoulder disability as there is no adequate medical opinion on which to adjudicate the matter. Here, the October 2020 VA examiner did not provide adequate rationale for the conclusion that the Veteran's condition was not etiologically related to service. Additionally, the examiner did not take into consideration the Veteran's lay statements as to continued symptoms and pain from the time of service to the present. 12. Entitlement to service connection for a skin condition. The Veteran seeks service connection for a tinea pedis. During the February 2020 Board hearing, the Veteran reported using cream for this condition. A May 2001 report of medical history noted treatment for tinea pedis. An October 2020 VA examiner opined that the Veteran does not have a current skin condition. The examiner indicated that there was no objective evidence to render a diagnosis during the examination. The Board notes that the Veteran's private treatment records indicate diagnosis of and treatment for tinea pedis. See June 2011 and October 2015 private medical records. Additionally, a January 2018 VA treatment record noted treatment for tinea pedis. In light of this evidence, the Board finds that remand for a supplemental VA medical opinion is required in order to determine the nature and etiology of the Veteran's skin condition. 13. Entitlement to service connection for a gastrointestinal condition. The Veteran originally claimed entitlement to service connection for gastroenteritis. The Veteran's VA medical treatment records note a diagnosis of GERD. Accordingly, the Veteran's claim for service connection has been broadened and recharacterized as a claim for entitlement to service connection for a gastrointestinal disorder. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). The Veteran was afforded a VA examination in October 2020, in which the examiner opined that the Veteran did not have current stomach or duodenum condition. The examiner indicated that he Veteran's acute gastroenteritis episodes resolved in service. The examiner did not address the Veteran's GERD diagnosis. Consequently, the Board finds that remand is necessary in order to obtain an adequate VA examination and medical opinion. 14. Entitlement to service connection for a sinus condition. The Veteran underwent a VA examination in October 2020, in which the examiner opined that the Veteran did not have a sinus, nose, throat, larynx, or pharynx condition. The examiner indicated that the Veteran was treated for acute sinusitis in April 1993 and June 1999. The examiner noted that the two acute episodes resolved with no evidence of progression, chronicity, recurrence, residuals, or sequelae. The examiner further noted that the Veteran's medical records were silent for the last decade as to a sinus condition. However, the Board notes that the Veteran's VA and private treatment records note diagnoses and treatment for allergic rhinitis, sinusitis, and sinus troubles. See January 2020 private medical record; April 2014 private medical record; December 2013 private medical record. Additionally, the Board finds that the examiner failed to provide adequate discussion as to whether the Veteran's symptoms warranted service connection under 38 C.F.R. § 3.317. Accordingly, the Board finds that remand for another VA examination and medical opinion is required. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Thereafter, schedule the Veteran for a VA examination to determine the nature and etiology of his low back, bilateral knee, right hip, and left shoulder disabilities. Following a review of the claims file, the examiner is asked to opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's low back, bilateral knee, right hip, and/or left shoulder disabilities manifested in or are otherwise related to his active service, to include in-service wear and tear (lifting, twisting, moving). In rendering the requested opinions, the examiner should consider and address the Veteran's lay statements regarding onset and continuity of symptoms. A complete rationale must be provided for all opinions expressed. 3. After completing directive #1, obtain a VA medical opinion regarding the nature and etiology of the Veteran's skin condition, to include tinea pedis. If the examiner determines that another physical VA examination is necessary, such an examination should be scheduled. Following a review of the claims file, the examiner is asked to opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's skin condition, to include tinea pedis (even if it has since resolved), manifested in or is otherwise etiologically related to his active service. A complete rationale must be provided for all opinions expressed. 4. After completing directive #1, schedule the Veteran for a VA examination to determine the nature and etiology of any identified gastrointestinal condition, to include GERD. Following a review of the claims file, the examiner is asked to opine as to whether it is at least as likely as not (a 50 percent or greater probability) that any current gastrointestinal condition, to include GERD, manifested in or is otherwise etiologically related to the Veteran's active service. A complete rationale must be provided for all opinions expressed. 5. After completing directive #1, schedule the Veteran for a VA examination to determine the nature and etiology of any identified sinus condition. Following a review of the record, the examiner should provide responses as to the following: a) Please identify, by diagnosis, all disabilities manifesting in sinus issues during the appellate period (March 2013 to present). b) For each disability diagnosed, does such disability have an understood or partially understood etiology and/or pathophysiology? Please explain why. c) If the answer in (b) is yes, then is it at least as likely as not (a 50 percent or greater probability) that such disability was either incurred in or otherwise related to the Veteran's active service? d) Are any of the Veteran's symptoms and disability patterns indications of manifestations of a chronic undiagnosed illness and/or a medically unexplained chronic multisymptom illness? A complete rationale must be provided for all opinions expressed. Nathaniel J. Doan Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Robinson, 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.