Citation Nr: 21041423 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 14-23 356 DATE: July 9, 2021 ORDER Entitlement to service connection for left arm scar is denied. REMANDED Entitlement to an initial evaluation in excess of 20 percent for diabetes mellitus is remanded. Entitlement to service connection for a heart disorder, to include as secondary to service-connected diabetes is remanded. Entitlement to service connection for a neurological disorder (claimed as essential tremor), to include as secondary to service-connected diabetes is remanded. Entitlement to service connection for a gastrointestinal disorder (claimed as diverticulitis), to include as secondary to service-connected diabetes is remanded. FINDING OF FACT A left arm scar did not manifest in service and is unrelated to service. CONCLUSION OF LAW A left arm scar was not incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1966 to October 1968. 1. Entitlement to service connection for left arm scar Veterans are entitled to compensation if they develop a disability "resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty." 38 U.S.C. §§ 1110 (wartime service), 1131 (peacetime service). To establish entitlement to service-connected compensation benefits, a Veteran must show: "(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 -the so-called 'nexus' requirement." Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). A scar is not identified as a "chronic disease" under 38 U.S.C. § 1101 and 38 C.F.R. § 3.309 (a). The Veteran has provided nothing beyond a bare assertion that a left arm scar is related to service. He has not provided any information as to the in-service incident that caused the scar or how the scar may be otherwise related to service. Service treatment records do not document any relevant complaints, objective findings, treatment, diagnosis, or any other manifestations of a left arm scar. At the Veteran's September 1968 separation examination, clinical evaluation revealed normal skin and there was no left arm scar noted. In an accompanying Report of Medical History, the Veteran did not report anything relevant to a left arm scar. VA treatment records do not show a left arm scar. A September 2012 evaluation of the skin noted: "No visible scars/lesions. No open sores/ulcers/wounds." To the extent that the Veteran does have a left arm scar (it is not apparent from post-service treatment records), the contemporaneous records establish that such scar manifested after separation. The Board finds the contemporaneous records to be far more probative and credible than the Veteran's bare assertion. Such assertion is directly contradicted by the normal clinical evaluation upon separation. The more probative evidence establishes that he did not have a left arm scar during service. Furthermore, the evidence establishes that the remote onset a left arm scar (to the extent there is one) is unrelated to service. The Board finds that the preponderance of the evidence is against the claim and the claim must be denied. The Board recognizes that the Veteran was not afforded a VA examination with respect to this issue. However, no examination is necessary for the adjudication of this claim. In determining whether the duty to assist requires that a VA medical examination be provided, or medical opinion obtained, with respect to a veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4). Here, there is no evidence of record with respect to the existence of an in-service event, injury, or disease or any evidence of an association between the Veteran's claimed left arm scar and his service. There is clearly sufficient competent medical evidence of record to adjudicate the Veteran's claim. A mere conclusory generalized lay statement that a service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). In other words, absent such evidence, the Board finds that it is unnecessary to require the Veteran to report for a VA medical examination or to ask a medical expert to review the record because any examination report or medical opinion could not provide competent evidence of the incurrence of the claimed disability in service. REASONS FOR REMAND 1. Entitlement to an initial evaluation in excess of 20 percent for diabetes mellitus is remanded. The Veteran's most recent VA examination to determine the severity of his service-connected diabetes was in October 2016. At this examination there were no recognized complications of diabetes. Since that examination, the Veteran was afforded an October 2018 Diabetic Sensory-Motor Peripheral Neuropathy examination. This examination report did not document any findings specific to evaluating diabetes under Diagnostic Code 7913, but it did find that the Veteran has diabetic peripheral neuropathy, a complication stemming from diabetes. As such complications were not noted upon the October 2016 examination, this suggests a possible worsening of the Veteran's condition. In addition, it is possible that there are additional compensable complications of diabetes pursuant to Note (1) of Diagnostic Code 7913. Given that his last examination was nearly five years ago, and that diabetes may have worsened in the interim, a new examination is necessary to properly adjudicate this matter. 2. Entitlement to service connection for a heart disorder, to include as secondary to service-connected diabetes is remanded. The Veteran asserts that his claimed heart disorder is related to service-connected diabetes mellitus. He has submitted private examinations indicating various diagnoses of heart disorders, but they do not provide opinions as to the etiology. The Board also notes that the Veteran served within the Republic of Vietnam during the applicable time period under section 3.307, and as a result exposure to herbicide agents is presumed. While there is no current evidence of a diagnosis of ischemic heart disease in accordance with section 3.309(e), a medical opinion addressing a possible direct relationship between any diagnosed heart disorder and herbicide agent exposure is warranted upon remand. The Veteran has not been afforded a VA examination specific to this claim. See McLendon v. Nicholson, 20 Vet. App. 79 (2006) 3. Entitlement to service connection for a neurological disorder (claimed as essential tremor), to include as secondary to service-connected diabetes is remanded. A December 2018 rating decision granted service connection for peripheral neuropathy of the lower extremities as related to diabetes mellitus. Clarification is necessary to determine if the Veteran has any other neurological disorders, or if that was in effect a grant of the issue sought on appeal. 4. Entitlement to service connection for a gastrointestinal disorder (claimed as diverticulitis), to include as secondary to service-connected diabetes is remanded. The Veteran asserts that he has a gastrointestinal disorder secondary to service-connected diabetes, to include as due to medication taken for diabetes. VA treatment records indicate a diagnosis of diverticulitis. He has not received a VA examination to address this claim. The Board finds that one is warranted. See McLendon, supra. The matters are REMANDED for the following action: 1. Obtain any updated VA treatment records. 2. Afford the Veteran a VA examination to determine the current severity of his diabetes mellitus. A complete rationale for any opinion offered must be provided. 3. Schedule the Veteran for a VA examination to determine the etiology of the claimed heart disorder. Based on a review of the record, the examiner should: (a) Provide an opinion as to whether it is at least as likely as not (i.e. probability of 50 percent or greater) that a heart disorder is related to the Veteran's active service, to include exposure to herbicide agents. (b) Provide an opinion as to whether it is at least as likely as not (i.e. a probability of 50 percent or greater) that a heart disorder was caused by or is aggravated by service-connected diabetes. If diabetes aggravates a heart disorder, the examiner should identify the percentage of disability which is attributable to the aggravation. 38 C.F.R. § 3.310. A complete rationale for any opinion offered must be provided. 4. Schedule the Veteran for a VA examination to determine the etiology of the claimed tremor or neurological disorder. Based on a review of the record, the examiner should: (a) Indicate if the Veteran has a relevant tremor or neurological disorder other than the now service-connected peripheral neuropathy of the lower extremities. If so... (b) Provide an opinion as to whether it is at least as likely as not (i.e. probability of 50 percent or greater) that a tremor or neurological disorder is related to the Veteran's active service, to include exposure to herbicide agents. (c) Provide an opinion as to whether it is at least as likely as not (i.e. a probability of 50 percent or greater) that a tremor or neurological disorder was caused by or is aggravated by service-connected diabetes. If diabetes aggravates a tremor or neurological disorder, the examiner should identify the percentage of disability which is attributable to the aggravation. 38 C.F.R. § 3.310. A complete rationale for any opinion offered must be provided. 5. Schedule the Veteran for a VA examination to determine the etiology of the claimed gastrointestinal disorder. Based on a review of the record, the examiner should: (a) Provide an opinion as to whether it is at least as likely as not (i.e. probability of 50 percent or greater) that a gastrointestinal disorder is related to the Veteran's active service, to include exposure to herbicide agents. (b) Provide an opinion as to whether it is at least as likely as not (i.e. a probability of 50 percent or greater) that a gastrointestinal disorder was caused by or is aggravated by service-connected diabetes. If diabetes aggravates a gastrointestinal disorder, the examiner should identify the percentage of disability which is attributable to the aggravation. 38 C.F.R. § 3.310. A complete rationale for any opinion offered must be provided. H. N. SCHWARTZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board W. R. Stephens, 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.