Citation Nr: 21041234 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 18-10 341 DATE: July 8, 2021 ORDER The claim for service connection for lumbar spine is granted. The claim for service connection for cervical spine, degenerative stenosis is granted. The claim for service connection for left shoulder disability is granted. The claim for service connection for left deltoid bursitis is granted. The claim for service connection for left ulnar neuropathy is granted. The claim for service connection for right hip disability is granted. The claim for service connection for left hip disability is granted. The claim for service connection for tinnitus is granted. The claim for service connection for heart disability is granted. REMANDED The claim for service connection for asthma is remanded. The claim for service connection for hypertension is remanded. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, lumbar spine osteopenia is at least as likely as not related to his active duty service. 2. Resolving reasonable doubt in the Veteran's favor, cervical spine degenerative stenosis is at least as likely as not related to his active duty service. 3. Resolving reasonable doubt in the Veteran's favor, left shoulder disability is at least as likely as not related to his active duty service. 4. Resolving reasonable doubt in the Veteran's favor, left deltoid bursitis is at least as likely as not related to his active duty service. 5. Resolving reasonable doubt in the Veteran's favor, left ulnar neuropathy is at least as likely as not related to his active duty service. 6. Resolving reasonable doubt in the Veteran's favor, right hip disability is at least as likely as not related to his active duty service. 7. Resolving reasonable doubt in the Veteran's favor, left hip disability is at least as likely as not related to his active duty service. 8. Resolving reasonable doubt in the Veteran's favor, tinnitus is at least as likely as not related to his active duty service. 9. Resolving reasonable doubt in the Veteran's favor, his heart disability is at least as likely as not related to his active duty service. CONCLUSIONS OF LAW 1. The criteria for service connection for lumbar spine osteopenia are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for cervical degenerative stenosis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for left shoulder disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for left deltoid bursitis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for left ulnar neuropathy are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for right hip disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for left hip disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for tinnitus are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for service connection for a heart disability are 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 February to July 1988 and from December 1996 to September 1997. The Veteran provided testimony during a Decision Review Officer (DRO) personal hearing in September 2016. He and his spouse provided testimony during a videoconference hearing before the undersigned in March 2020. A transcript from each hearing are of record. Service Connection 1. Entitlement to service connection for lumbar spine osteopenia 2. Entitlement to service connection for cervical spine, degenerative stenosis 3. Entitlement to service connection for left shoulder disability 4. Entitlement to service connection for left deltoid bursitis 5. Entitlement to service connection for left ulnar neuropathy 6. Entitlement to service connection for right hip disability 7. Entitlement to service connection for left hip disability The Veteran contends that he incurred lumbar spine, cervical spine, left shoulder, left deltoid bursitis, left ulnar neuropathy, right hip, and left hip disabilities during service as a result of a fall off of a truck with heavy gear on his back in addition to wear and tear from his highly physical job as a wheeled vehicle mechanic. Resolving all doubt in the Veteran's favor the Board concludes that the Veteran currently has each of the above claimed disabilities that began during and/or as a result of his active duty military service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The current diagnoses, confirmed by VA and private treatment providers, include lumbar spine osteopenia, cervical degenerative stenosis, left shoulder exostosis, left deltoid bursitis, left ulnar nerve neuropathy, and degenerative joint disease of the right and left hip. Throughout the claim, including during the Board hearing, the Veteran reported current symptoms of his lumbar and cervical spine, left shoulder, arm, and wrist/hand, and his hips, that he began to experience such symptoms during military service, and that he had reported to fellow service members his complaints contemporaneous with their onset. Indeed, buddy statements from his former service-members as well as his former commander confirmed that the Veteran told them that he had begun to experience such symptoms while on duty. Service treatment records document the fall from the truck. Moreover, his MOS of wheeled vehicle mechanic is confirmed and his reports regarding the physical nature of that position are consistent with duties of such an MOS. Based upon this evidence, a private opinion from Dr. B. H. stated that each of the above claimed disabilities are more likely than not related to active duty service based upon service treatment records documenting related symptoms and treatment, lay statements confirming the Veteran's complaints and treatment in service, and continuity of symptoms. Further, a private opinion from Dr. E. A. stated that the Veteran's claimed conditions at least as likely as not had onset during active duty service and have continued since. She explained that the fall the Veteran sustained with the amount of weight he was carrying in his pack as well as the physical and repetitive nature of his MOS duties, were sufficient to cause his back, neck, left shoulder, left arm/hand/wrist, and right and left hip disabilities. She also found significant the buddy statements of record which confirmed the Veteran's reports. She also found that there was no evidence against such opinions in the claims file. The Board acknowledges a 2017 VA examiner's opinion against service connection for each of these disabilities. However, the Board notes that that examiner did not consider the buddy statements which have been so informative of the Veteran's in-service injuries and symptoms and the continuity since discharge. As such, the opinions are inadequate as they are based upon an incomplete history or facts. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current lumbar spine osteopenia, cervical degenerative stenosis, left shoulder exostosis, left deltoid bursitis, left ulnar nerve neuropathy, and degenerative joint disease of the right and left hip had onset in service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for tinnitus is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 8. Entitlement to service connection for tinnitus The Veteran contends that he incurred tinnitus during service as a result of noise exposure from his work as a wheeled vehicle mechanic and weapons noise. The Board concludes that the Veteran has a current disability that began during active duty military service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Throughout the claim, including during the Board hearing, the Veteran reported current ringing in his ears, that he began to experience such symptoms during military service, and that he had reported to fellow service members his complaints contemporaneous with their onset. Indeed, a statement from his former roommate confirmed that the Veteran told him that he had begun to experience ringing in his ears while on duty. Based upon this evidence, a private opinion from Dr. E. A. stated that the Veteran's tinnitus at least as likely as not had onset during active duty service and that there was no evidence against such an opinion in the claims file. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current tinnitus had onset in service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for tinnitus is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 9. Entitlement to service connection for heart disability The Veteran contends that he incurred a heart disability during service. Resolving all doubt in the Veteran's favor the Board concludes that the Veteran currently has a current heart disability, to include valvular heart disease, mitral valve prolapse, and hypertensive heart disease, that began during and/or as a result of his active duty military service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Service treatment records document complaints of and treatment for heart symptoms, such as chest tightness, palpitations, and a pounding heart during active duty. The Veteran's commander also submitted a statement confirming the Veteran's reports of such symptoms and treatment and describing the strenuous nature of his active duty service. Following service, an April 2009 cardiology treatment record documented the Veteran's reports of palpitations since 1996, and the doctor's opinion that his mitral valve prolapse more likely than not started when he began active duty and were probably exacerbated by physical exertion therein. In March 2013, a VA examiner concluded that the Veteran's current heart condition is at least as likely as not incurred in active duty and related to the chest pain he was treated for while on active duty. Then, Dr. E. A. concluded that the Veteran must have had a pre-existing heart condition which was aggravated by the strenuous work and stress and anxiety of his deployment. The opinion relied on the fact that the Veteran was treated for chest pain and complained of heart issues during service. The physician did not explain a rationale Weighing against the claim is an August 2017 VA examination and opinion in which the examiner stated that there was no evidence of the Veteran's mitral valve prolapse or valvular heart disease during service. However, the examiner did not specifically consider the in-service complaints and treatment for chest pain and heart palpitations or the Veteran's reports of such symptoms continuing since discharge. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current currently diagnosed heart disability had onset in service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a heart disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to service connection for asthma Dr. E.A. provided an opinion that the Veteran's current asthma is etiologically related to his military service due. She explained that his MOS was commonly known to involve exposure to airborne dust and chemicals, that the Veteran was treated for chest tightness during service, and that he reported issues with his lungs and chest tightness at the time he redeployed. However, the Veteran was not treated for shortness of breath or any other asthma-related or lung-related symptomatology. Further, Dr. E.A. did not discuss the negative evidence of record, such as a November 2013 private treatment record in which the Veteran is noted to have denied any chest symptoms in his early years after joining the National guard at age 18 and that it was only in recent years that he developed asthma. However, the August 2017 VA opinion did not provide an opinion as to why asthma is not etiologically related to in-service chemical or dust exposures or why his asthma is not proximately related to any service-connected disability. As such, a new VA opinion is required in this case. 2. Entitlement to service connection for hypertension An August 2017 VA examiner concluded that the Veteran's hypertension is not directly related to military service and is not proximately related to a service-connected disability, to include posttraumatic stress disorder (PTSD). However, the examiner did not provide an adequate rationale for either opinion. Dr. E. A. concluded that the Veteran's hypertension was caused as a result of the strenuous work during service and also as a result of his PTSD. However, a rationale for that opinion was not provided. Rather, the physician said the opinion was based on her knowledge, training, and experience as well as medical literature. A complete rationale regarding direct and proximate service connection is warranted. In addition, the Board notes that the service connection for the Veteran's heart disease in the decision above needs to be considered in terms of proximate service connection for hypertension. The Board finds that a new VA opinion is necessary. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to assess the etiology of his asthma. The examiner must review the claims file. The examiner is asked to provide a response to the following: Is asthma at least as likely as not related to service, including his exposure to dust, chemical, and materials used by a mechanic? Provide a rationale to support the opinion(s). The opinion must specifically address the positive but inadequate opinion provided by Dr. E. A. Is asthma at least as likely as not proximately due to a service-connected disability? Is asthma at least as likely as not aggravated, i.e., worsened beyond its natural progression, by a service-connected disability. 2. Schedule the Veteran for a VA examination to assess the etiology of his hypertension. The examiner must review the claims file. The examiner is asked to provide a response to the following: Is hypertension at least as likely as not proximately due to a service-connected disability, to include PTSD and the newly service-connected heart disability. Is hypertension at least as likely as not aggravated, i.e., worsened beyond its natural progression, by a service-connected disability, to include PTSD and heart disability. Cynthia M. Bruce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. B., 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.