Citation Nr: 21040890 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 18-31 978 DATE: July 7, 2021 ORDER Entitlement to service connection for a deviated septum (claimed as broken nose) is denied. Entitlement to service connection for a sinus disorder is denied. Entitlement to service connection for knots on chest is denied. Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. REMANDED Entitlement to service connection for schizophrenia is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has a deviated septum due to an in-service event, injury, or disease. 2. The preponderance of the evidence is against finding that the Veteran has a sinus disorder due to an in-service event, injury, or disease. 3. The preponderance of the evidence is against finding that the Veteran has knots on his chest due to an in-service event, injury, or disease. 4. The preponderance of the evidence is against finding that the Veteran has PTSD due to an in-service event, injury, or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a deviated septum have not been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for a sinus disorder have not been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for knots on chest have not been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for entitlement to service connection for PTSD have not been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from March 1984 to February 1987. The Veteran also served in the Army National Guard. This matter is before the Board of Veterans' Appeals (Board) on appeal from August 2014 and February 2015 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2021, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge of the Board. A transcript of the hearing is of record. SERVICE CONNECTION Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection requires competent evidence showing: (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); 38 C.F.R. § 3.303. The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence. Therefore, the Veteran prevails in a claim when: (1) the weight of the evidence supports the claim, or (2) when the evidence is in equipoise. It is only when the weight of the evidence is against the claim that the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Board acknowledges that the Veteran was not afforded a VA examination for his claims for service connection for a deviated septum, sinus disorder, PTSD, and knots on his chest. Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), in initial service connection claims, the VA must provide a VA medical examination where there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service; (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service; and (4) insufficient competent medical evidence on file for VA to make a decision on the claim. In this regard, the Board finds that the Veteran has submitted insufficient evidence to indicate that he has a diagnosis of a deviated septum, sinus disorder, PTSD, and knots on his chest that are related to an event, injury, or disease that occurred in service. Accordingly, the Board finds that no further development of the Veteran's claims for service connection for a deviated septum, sinus disorder, PTSD, and knots on his chest is required. 1. Entitlement to service connection for a deviated septum is denied. 2. Entitlement to service connection for a sinus disorder is denied. The Veteran contends that he has a deviated septum and sinus disorder that are related to an in-service, event, illness, or injury, as he reported that he broke his nose in service, which resulted in a sinus infection. In September 2014, the Veteran filed a service connection claim for a broken nose that caused sinus infections. A February 2015 rating decision denied service connection claims for a deviated septum and a sinus disorder. Turning to the evidence, at the Veteran's January 2021 Board hearing, he testified that, when he was assigned to Fort Polk, Louisiana, he slipped after taking a shower and broke his nose. He stated that he's been having breathing problems ever since and was told he has sinusitis due to his broken nose. He testified that he went to sick call after he broke his nose but was told there was nothing that could be done for it. He stated he his deviated septum has resulted in sinus infections and breathing troubles. A review of the Veteran's service treatment records does not reflect any complaints, findings, or treatment for any conditions related to a deviated septum or sinus disorder. A December 1995 private treatment record reported that the Veteran complained of a recent onset of a runny nose, cough, and sore throat. He was diagnosed with an upper respiratory infection. An October 1996 private treatment record reported that an examination of the Veteran's ear, nose, and throat found them to be normal. The Veteran denied any medical problems. An April 2010 private medical record reported that the Veteran had no septal deviation. A July 2014 VA primary care note reported that an examination of the Veteran's ear, nose, and throat found no congestion. A March 2018 VA gastroenterology consult reported that the Veteran did not have sinusitis. VA psychiatry notes from November 2018 and March 2019 reported the Veteran was in good health and had no problems with labored breathing. As previously described, a review of the Veteran's service treatment records does not reflect any complaints, findings, or treatment for any conditions related to a deviated septum or sinus disorder. Although, in December 1995, the Veteran reported a recent onset of a runny nose and was diagnosed with an upper respiratory infection, an October 1996 examination of the Veteran's ear, nose, and throat found them to be normal. Moreover, an April 2010 private medical record reported that the Veteran had no septal deviation. As described above, the first prong of a service connection claim is a current disability. The evidence does not demonstrate that the Veteran had a deviated septum or sinus disorder during the pendency of the appeal. The U.S. Court of Appeals for Veterans Claims has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran's service connection claims for a deviated septum and sinus disorder. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not helpful to this claimant. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Service connection has not been established and the Veteran's claims for a deviated septum and sinus disorder must be denied. 3. Entitlement to service connection for knots on chest is denied. The Veteran contends that he has knots on his chest that are related to an in-service, event, illness, or injury, as he reported that he tore cartilage in his chest as a result of doing push-ups during his active service. In September 2014, the Veteran filed a service connection claim for knots on his chest, which was denied by a February 2015 rating decision. Turning to the evidence, at the Veteran's January 2021 Board hearing, he testified that, during his period of active service, he developed knots on his chest from doing a lot of push-ups. He also described this as torn cartilage. He stated that he complained about this during service but was told "there's really nothing that they could do about." A December 1986 service treatment record reported the Veteran had experienced chest pain for four months, which lasted two to three days at a time. The treating provider noted "doubt cardiac." A February 1987 service treatment record reported the Veteran did not request a separation physical examination for his upcoming separation on February 17, 1987. An undated service treatment record reported that a medical examination for separation was not required. It was also reported that the Veteran had not been in a medical surveillance program and his February 10, 1987 statement was attached for filing. A November 2013 VA treatment record reported that the Veteran was not experiencing any chronic pain. It was also reported that he suffered a heart attack in 2008. The Veteran stated that stents were placed in his heart and that he "feels great." He denied any current health concerns. A July 2014 VA primary care note reported that the Veteran denied any chest pain. A February 2018 VA treatment record reported that the Veteran denied any chest pain. VA psychiatry notes from November 2018 and March 2019 reported the Veteran was in good health and did not experience any chest pain. A review of the evidence of record shows that the first complaint of knots on the chest, which the Veteran described at his hearing as torn chest cartilage, was when the Veteran filed a claim in September 2014. The Veteran complained of chest pain for four months in December 1986 and suffered a heart attack in 2008. However, the records are silent for a diagnosis of knots on the chest or torn chest cartilage. Moreover, the Veteran denied chest pain in VA treatment records compiled in July 2014, February 2018, November 2018, and March 2019. As described above, the first prong of a service connection claim is a current disability. The evidence does not demonstrate that the Veteran had a current disability of knots on the chest during the pendency of the appeal. The U.S. Court of Appeals for Veterans Claims has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran's service connection claims for knots on the chest. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not helpful to this claimant. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Service connection has not been established and the Veteran's claims for knots on the chest must be denied. 4. Entitlement to service connection for PTSD is denied. The Veteran contends that he has PTSD related to an in-service, event, illness, or injury. In September 2014, the Veteran filed a service connection claim for PTSD, which was denied by a February 2015 rating decision. Service connection for PTSD requires (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. See 38 C.F.R. § 3.304(f). For cases certified to the Board on or after August 4, 2014, such as this case, the diagnosis of PTSD must be in accordance with the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5). 79 Fed. Reg. 45,093 (Aug. 4, 2014). A review of the Veteran's service treatment records does not reflect any complaints, findings, or treatment for any conditions related to PTSD. A February 1987 service treatment record reported the Veteran did not request a separation physical examination for his upcoming separation on February 17, 1987. An undated service treatment record reported that a medical examination for separation was not required. It was also reported that the Veteran had not been in a medical surveillance program and his February 10, 1987 statement was attached for filing. A November 2013 VA treatment record reported that the Veteran was not engaged in combat and did not experience any military sexual trauma. Veteran stated that he really enjoyed the service and that it "taught me how to be responsible I just got lost somewhere along the way". He described being hospitalized for a mental breakdown and diagnosed with schizophrenia about ten years ago but denied any symptoms since his breakdown. A March 2014 letter from a physician, Dr. H.V., reported that he had been treating the Veteran for chronic schizophrenia since October 1996. According to Dr. H.V., the Veteran started having symptoms related to schizophrenia in his early twenties. Dr. H.V. did not diagnose the Veteran with PTSD. In January 2018, the Veteran submitted a VA Form 21-0781, Statement in Support of Claim for Service Connection for PTSD. While assigned to Germany in 1984, he reported that he started having nightmares and hearing voices and gunshots. He also indicated that he sometimes seemed to be hallucinating. While assigned to Fort Polk in 1986, he stated that he started having nightmares almost every night. He also reported that hearing gunshots increased, and he started hallucinating more. The Veteran did not describe a stressor incident. At the Veteran's January 2021 Board hearing, he testified that he was in a motor vehicle accident returning from a field exercise in a two-ton truck. According to the Veteran, the truck turned over and hit a guardrail, which prevented him from going over a cliff. He stated that it scared him, and he had bad feelings about it afterward. The Veteran's representative submitted a January 2021 psychiatric evaluation report written by a private psychologist. The report included the following assessment regarding PTSD: It is unclear who first diagnosed Mr. [REDACTED] with PTSD. Records initially carried forth this diagnosis as part of the historical record, but eventually it was removed. It appears that [the Veteran's] hallucinations of gunshots and nightmares about fighting were the principal reason he was thus diagnosed. However, [the Veteran] has no history of combat and no history of trauma that qualifies as a PTSD stressor. His symptoms of hearing gunshots and disorganized nightmares with violent themes are related to his schizophrenia diagnosis, not true PTSD. As previously described, a review of the Veteran's service treatment records does not reflect any complaints, findings, or treatment for any conditions related to PTSD. In November 2013, the Veteran stated that he really enjoyed his military service and did not describe any stressors. In 2014, a physician who had been treating the Veteran since 1996 reported that the Veteran has exhibited symptoms of schizophrenia since his twenties but did not diagnose the Veteran with PTSD. Although the Veteran reported an in-service motor vehicle accident at his January 2021 Board hearing, there is no record of the accident and the Veteran never previously described the incident. Notably, the Veteran did not describe the incident on his January 2018 statement in support of his service connection claim for PTSD. Instead, the Veteran reported that he started having nightmares and hearing voices and gunshots but did not describe a stressor. Moreover, the January 2021 private psychiatric evaluation report submitted by the Veteran's representative concluded that the Veteran had no history of trauma that qualifies as a PTSD stressor and that his symptoms of hearing gunshots and nightmares are related to his schizophrenia diagnosis. As described above, the first prong of a service connection claim is a current disability. The evidence does not demonstrate that the Veteran had a current disability of PTSD during the pendency of the appeal. The U.S. Court of Appeals for Veterans Claims has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran's service connection claims for PTSD. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not helpful to this claimant. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Service connection has not been established and the Veteran's claims for PTSD must be denied. REASONS FOR REMAND Entitlement to service connection for schizophrenia is remanded. The Veteran asserts that he has a current diagnosis of schizophrenia that began during his active service. The Veteran has a current disability of schizophrenia. A March 2014 letter from a physician, Dr. H.V., reported that he had been treating the Veteran for chronic schizophrenia since October 1996. According to Dr. H.V., the Veteran started having symptoms of schizophrenia in his early twenties and by the time he first saw him he had been hospitalized four times and was in severe distress. At the Veteran's January 2021 Board hearing, he testified that his schizophrenia symptoms began during his active service when he was stationed in Germany. After he left active service, he began serving in the Army National Guard. However, he stated that the condition "got so bad that I couldn't even make my National Guard's meetings." He testified that he did not seek treatment for his schizophrenia in service as he was fearful that, if he reported his symptoms, "bad things would happen." A January 1988 military personnel record reflects that the Veteran's Army National Guard commander initiated a bar to reenlistment as the Veteran was absent without leave in May 1987, June 1987, November 1987, and December 1987. Military orders that the Veteran was reduced in rank from E-3 to E-2 due to inefficiency, effective January 13, 1988. A review of the evidence of records, reflects that the onset of the Veteran's schizophrenia is unclear as the date reported by the Veteran has changed over time. A September 1996 private treatment record reported the onset of schizophrenia was 1992. A June 1999 private medical record reported that the Veteran's problems with psychosis began in 1992. An April 2010 private medical record documented the Veteran's report that he was diagnosed with schizophrenia in 1991 and hospitalized in 1994 and 2008. An October 2017 VA psychiatry note documented the Veteran's report that he was diagnosed with schizophrenia in 1989. The Veteran has not been provided a VA examination to address the nature and etiology of his claimed schizophrenia. Considering the evidence of a current disability and a potential link between his disability and active service, the Board finds that the Veteran should be provided a VA examination to address this issue. McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). The Board acknowledges that the Veteran's representative submitted a January 2021 psychiatric evaluation report written by a private psychologist in which the psychologist opined that it was as likely as not that the Veteran's schizophrenia began during his military service and continues to the present. As rationale, the psychologist explained that the Veteran's final term of service ended in the latter part of 1988, and medical records document a history of first diagnosis of schizophrenia in 1989, within one year of leaving service. However, the Board finds that this opinion is inadequate as the Veteran left active service in February 1987 and subsequently performed only inactive duty training and a total of 25 days of active duty for training between April 1987 and September 1987. Moreover, the initial diagnosis of schizophrenia is unclear, as the Veteran reported in 1996 that the onset of schizophrenia was in 1992, not 1989. The matter is REMANDED for the following action: 1. Obtain all outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain all outstanding relevant private treatment records. 3. Schedule the Veteran for a VA psychiatric examination, with a psychiatrist or psychologist. The examiner should diagnose any current Axis-I psychiatric disability and should offer the following opinion: Is it at least as likely as not (a 50 percent or greater probability) that any current acquired psychiatric disorder, to include schizophrenia, either began during or was otherwise caused by the Veteran's active service. A complete rationale for any opinion offered is required. 4. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. If any determination remains unfavorable to the Veteran, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Moore, 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.