Citation Nr: 21041672 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 17-02 009 DATE: July 9, 2021 ORDER Service connection for headaches is denied. Service connection for a psychiatric disorder, to include anxiety, depression, stress, and sleep deprivation, is denied. Service connection for hypertension, as secondary to a psychiatric disorder, is denied. Service connection for peripheral neuropathy of the hands and feet, as secondary to hypertension, is denied. FINDINGS OF FACT 1. The record does not show that the Veteran was exposed to jet fuel in-service. 2. The record does not show a diagnosis of a headache condition. 3. The Veteran was presumed sound on service entrance as to any psychiatric disorder. 4. The Veteran's psychiatric disorder did not manifest to a compensable degree within one year of service separation. 5. The Veteran's psychiatric disorder did not originate during service and was not caused by any in-service event, injury, disease, or disorder. 6. The Veteran's hypertension is not caused or aggravated by a service-connected disability. 7. The record does not show a diagnosis of peripheral neuropathy of the hands and feet. CONCLUSIONS OF LAW 1. The criteria to establish entitlement to service connection for headaches have not been met. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria to establish entitlement to service connection for a psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. The criteria to establish entitlement to service connection for hypertension, as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 1110, 1154, 5107; 38 C.F.R. §§ 3.102, 3.310(a), 3.303, 3.304. 4. The criteria to establish entitlement to service connection for peripheral neuropathy of the hands and feet, as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 1110, 1154, 5107; 38 C.F.R. §§ 3.102, 3.310(a), 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the U.S. Air Force from October 1976 to October 1980 and served as an administrative specialist for the entirety of his service. The Veteran did not appear for his November 2019 Board hearing. His hearing request is considered withdrawn. 38 C.F.R. § 20.704(d). The Veteran's initial theory of service connection regarding the issues on appeal included that the conditions are related to in-service jet fuel exposure. The Veteran's military records do not contain any indication that he was exposed to jet fuel in-service. As noted, his records show that he served as an administrative specialist for his entire period of service. The Veteran does not specify any incident when he was exposed to jet fuel nor does he contend that he was assigned any specific duty in-service that would have exposed him to jet fuel. Instead, the Veteran has submitted references to prior Board decisions pertaining to other veteran's claims and publications about dermal exposure to jet fuel among U.S. Air Force personnel. However, the Veteran's military personnel records and treatment records do not contain any indication of jet fuel exposure. Given the absence of any in-service indication of exposure to jet fuel in-service, any further analysis of the Veteran's allegation of jet fuel exposure ment to service connection for all issues on appeal, as due to jet fuel exposure, is not necessary. Although the Veteran has asserted other theories of entitlement, the preponderance of the evidence is against the claims as below and the appeal will be denied. Service Connection Service connection may be granted for a current disability arising from disease or injury incurred or aggravated by active service. 38 U.S.C. §§ 1110. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. §§ 3.303(d). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for a disability that is proximately due to, or the result of, a service-connected disability. See 38 C.F.R. § 3.310(a). To prevail on the issue of secondary service connection, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). In deciding an appeal, the Board must first determine the competency of evidence. "Competency" means that the person who makes the statement is qualified by training, education, an occupation, or other reason to make the statement. For example, medical professionals are generally competent through training and experience to express opinions about whether a disability was caused by service. Generally, the opinions of medical professionals such as doctors, psychiatrists, nurses, and others who work in the health care field are evaluated by their apparent training, as well as the detail of their reports and knowledge of the facts in individual cases. Medical professionals may also report various findings of laboratory studies and testing that could be evidence in a claim, such as the level of hearing impairment, blood tests, range of motion testing in joint pain, etc. If a person making a statement is not medically trained (i.e., a "layperson"), the Board must determine in individual cases whether a veteran's particular disability is the type where a layperson's statement may be competent. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms, as symptoms require only personal knowledge of what is observed through senses and not medical expertise. Lay testimony is competent to establish the presence of observable symptoms, where the determination is not medical in nature and is capable of lay observation. Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. See Jandreau, 492 F.3d at 1377. If the Board finds that the evidence is competent, it must then determine whether the evidence is credible. Credibility is a factual determination it involves deciding whether the testimony or other evidence is believable. Whether a statement is credible is decided after the evidence has been found competent. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). The Board must decide whether the evidence supports the claim, with the veteran prevailing; or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. §§ 5107(b); 38 C.F.R. §§ 3.102. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. §§ 5107(b). 1. Service connection for headaches is denied. In December 1976, the Veteran had a cold and reported that he had an accompanying headache and chest pain for three days. In April 1977, the Veteran was treated for an upper respiratory infection, including a headache. A January 1979 sick call notes shows that the Veteran was treated for viral syndrome. He complained of headache. The August 1980 report of medical history at service separation shows a normal clinical evaluation of the head, face, neck, and scalp. There is no notation of any headache condition. The Veteran's post-service medical records do not show treatment for a headache condition. A December 2013 VA treatment note written to establish medical care indicates that the Veteran did not then report headaches in a review of systems. The pertinent question is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Veteran does not have a current diagnosis and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The post-service medical records show no diagnosis or treatment for headaches related to military service during the pendency of this claim. Although the service treatment records show complaints of headache in-service, these were associated with colds or viral syndrome. The August 1980 report of medical history at separation shows no reports of headache. There is no medical evidence showing that the Veteran has a current headache condition that is related to his service. To the extent that the Veteran believes that he has a current disability for VA purposes, he is not competent to provide a diagnosis in this case. The Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the cause of the medically complex disorder. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Given the absence of any present disability or in-service disease or injury, none of the elements of service connection have been met. In reaching this conclusion, the applicability of the benefit-of-the-doubt doctrine has been considered. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 2. Service connection for a psychiatric disorder, to include anxiety, depression, stress, and sleep deprivation, is denied. The Veteran contends that his psychiatric disorder preexisted his service and was aggravated by his service. The preponderance of the evidence is against the claim and the claim will be denied. The August 1976 report of medical examination at service entrance shows a normal psychiatric clinical evaluation. In the August 1976 report of medical history, the Veteran reported he then had or once had frequent trouble sleeping, and depression or excessive worry. The examiner noted that the Veteran reported mild anxiety with "ups and downs." However, there is no notation of a diagnosis, treatment prior to service, and there is otherwise no documentation of a preexisting psychiatric condition. The Veteran denied a history of serious illness and hospitalization. There was no mental disorder noted at entry. The remainder of the Veteran's service records do not reflect any mention of mental disorder complaints or symptoms. In fact, they show that while the Veteran was on active duty, he largely performed at an excellent level of skill and professionalism without difficulty. A March 1978 airman performance report shows that the Veteran "has demonstrated outstanding abilities in providing the services needed in the hospitality business pleasant personality, quick and efficient service to the guest." In a September 1978 airman performance report, the commander stated that "I have been especially impressed with [the Veteran's] bearing and the interest he has taken in learning new tasks and responsibilities." A February 1979 airman performance report states that the Veteran "is a dedicated and professional airman who has proven his competence by actively seeking additional responsibility and discharging all assigned duties in an outstanding manner. He displays the initiative, intellect, and loyalty essential for career status in today's Air Force." An August 1979 military personnel record states that the Veteran "is truly an outstanding young airman. He accomplishes his duties with tact and in a professional, timely manner. He has already displayed his leadership abilities by taking charge of situations when his supervisor is not present. His appearance and bearing are always above reproach [...] [h]e will make a fine NCO." An October 1979 military personnel record characterizes the Veteran as "an outstanding young airman [...] a definite asset to the U.S. Air Force." His supervisors recommended he be "promoted to NCO status at the earliest possible date." A March 1980 airman performance report attests to the Veteran's "exemplary behavior." The record states that the Veteran's "can do attitude, and initiative have contributed immensely towards the efficient operation of the Police Administration and Reports Branch." A March 1980 airman performance report states that the Veteran's "'ready now' attitude and professional bearing and behavior is above reproach. His total effort has enhanced the operation of the Police Administration and Reports Branch in a commendable manner. On and off the job he has rendered outstanding service and unselfish community activity support to the Security Police Squadron at all times." A July 1980 military personnel record states that the Veteran's "bearing and personal appearance are an example for all to follow, and that he is deserving of the opportunity to assume greater leadership responsibilities by selection to noncommissioned officer (NCO) status." The August 1980 report of medical history at service separation shows a normal psychiatric clinical evaluation. An August 2013 VA psychology note shows that the Veteran reported recurring nightmares regarding his service in Korea. However, the examiner noted that, aside from the occasional nightmare, the Veteran's sleep was adequate. The Veteran reported that he has worked as a plant operator for 23 years and reported a good salary. The Veteran reported that he worked as a clerk in law enforcement in-service, and that he was never in a combat situation. The Veteran denied a history of prior mental health treatment. The examiner noted a diagnosis of adjustment disorder with anxious mood. A September 2013 VA psychology note shows that the Veteran did not present with significant symptoms of mental illness. However, the Veteran reported periodic nightmares related to his service in Korea, which were reported to occur less than once monthly. He also reported highly irregular sleep cycle, which he related to his work at a chemical plant. A February 2019 VA medical record shows that the Veteran was assessed for anxiety and nightmares. The Veteran reported the beginning of his symptoms in October 2018 when he was married to his spouse, but that he was unaware of his condition prior to having a bed partner. He stated that when in-service while stationed in South Korea, he often worried about North Koreans crossing the border to attack. The examiner noted that the assessment revealed moderately severe depression and moderate anxiety. As the Veteran contends that he had a condition prior to service that was aggravated by his service, thereby causing his current condition, an analysis of the presumption of soundness as it relates to the Veteran's psychiatric disorder is necessary. The presumption of soundness attaches only where there has been an induction examination in which the later complained-of disability was not detected. See Bagby v. Derwinski, 1 Vet. App. 225 (1991). The provisions of 38 C.F.R. § 3.304(b) clarify that the term "noted" denotes "[o]nly such conditions as are recorded in the examination reports" and that "[h]istory of pre-service existence of conditions recorded at the time of examination does not constitute a notation of such conditions." Crowe v. Brown, 7 Vet. App. 238, 245 (1994); see also Cotant v. Principi, 17 Vet. App. 116 (2003). When no preexisting condition is noted upon entry into service, a veteran is presumed to have been found sound upon entry. The burden then falls on the Government to rebut the presumption of soundness by clear and unmistakable (obvious or manifest) evidence that the veteran's disability was both preexisting and not aggravated (i.e. increased in severity beyond its natural progression) by service. If this burden is met, then the veteran is not entitled to service connection benefits. However, if the Government fails to rebut the presumption of soundness under section 1111, the veteran's claim is one for service connection. Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). As noted above, the August 1976 report of medical examination at service entrance shows a normal psychiatric clinical evaluation. In the August 1976 report of medical history, the Veteran endorsed then having or once having frequent trouble sleeping, and depression or excessive worry. The examiner noted that the Veteran reported mild anxiety with "ups and downs." However, there is no notation of a diagnosis, treatment prior to service, there is otherwise no documentation of a preexisting psychiatric condition, and the Veteran denied a history of serious illness and hospitalization. Therefore, the presumption of soundness attaches. 38 U.S.C. § 1111; 38 C.F.R. § 304(b). VA must then determine if the presumption of soundness is rebutted. There is no clear and unmistakable evidence (obvious and manifest) that the Veteran's psychiatric disorder both preexisted and was not aggravated by service. Instead, the only indication of any preexisting psychiatric disorder is the Veteran's endorsement of then having or ever having had frequent trouble sleeping, and depression or excessive worry in his August 1976 report of medical history at service entrance. There is no other evidence of record that the Veteran had a preexisting psychiatric condition, and the August 1976 report of medical examination at service entrance shows a normal psychiatric clinical evaluation. Therefore, there is no clear and unmistakable evidence that the Veteran's psychiatric disorder preexisted service and the presumption of soundness has not been rebutted. Wagner, 307 F.3d at 1096. The claim is therefore one for service connection. Id. The preponderance of the evidence is against the claim and the appeal will be denied. The service treatment records are silent for psychiatric symptoms. The August 1980 separation evaluation is absent any complaints or reports of psychiatric symptoms. While the Veteran believes that his current psychiatric condition is related to his service, he is not competent to establish a nexus between his current condition and his service. The issue is medically complex, as it requires specialized medical knowledge. Therefore, it is outside the competence of the Veteran because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). The record indicates that the Veteran did not complain of any psychiatric condition during service. Rather, his military personal records show his excellent performance as a servicemember. The Veteran's medical records are highly probative both as to the Veteran's subjective reports and their resulting objective findings. They were generated with a view towards ascertaining the Veteran's then-state of psychological fitness and are akin to statements of diagnosis or treatment. Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (observing that although formal rules of evidence do not apply before the Board, recourse to the Federal Rules of Evidence may be appropriate if it assists in the articulation of the reasons for the Board's decision); see also LILLY'S: AN INTRODUCTION TO THE LAW OF EVIDENCE, 2nd Ed. (1987), pp. 245-46 (many state jurisdictions, including the federal judiciary and Federal Rule 803(4), expand the hearsay exception for physical conditions to include statements of past physical condition on the rationale that statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy since the declarant has a strong motive to tell the truth in order to receive proper care). Although the record shows that the Veteran has moderately severe depression and moderate anxiety, the preponderance of the evidence weighs against a finding that his psychiatric condition is causally related to his service. Instead, the Veteran's military personnel records show that his performance in-service was excellent, and there is no medical evidence of any treatment for a psychiatric condition in-service, at separation, or for many years thereafter. Since the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. 3. Service connection for hypertension, as secondary to a psychiatric disorder, is denied. The Veteran contends that his hypertension is secondary to his psychiatric disorder. He does not contend that his hypertension is directly related to his service. Therefore, the following analysis will focus solely on service connection on a secondary basis. The preponderance of the evidence is against the claim and the claim will be denied. A December 2013 VA medical problem list notes hypertension. As discussed above, the Veteran does not have a service-connected psychiatric disorder. As the Veteran does not contend that his hypertension is secondarily related to his only service-connected disability, eczema of the hands and feet, any further analysis of service connection on a secondary basis is not necessary. Therefore, service connection on a secondary basis is not warranted. See 38 C.F.R. § 3.310(a). Service connection for hypertension, as secondary to a psychiatric disorder, is not warranted. Although the record shows that the Veteran has hypertension, the Veteran is not service-connected for a psychiatric disorder. Therefore, the second element of service connection on a secondary basis is not met, and the claim must be denied. 38 C.F.R. § 3.310(a). 4. Service connection for peripheral neuropathy of the hands and feet, as secondary to hypertension, is denied. The Veteran contends that he has peripheral neuropathy of the hands and feet, as secondary to hypertension. He does not contend that his peripheral neuropathy of the hands and feet is directly related to his service. Therefore, the following analysis will focus solely on service connection on a secondary basis. The preponderance of the evidence is against the claim and the claim will be denied. The Veteran's post-service medical records do not show treatment for peripheral neuropathy of the hands and feet. As discussed above, the Veteran is not service-connected for hypertension. As the Veteran does not have a current diagnosis of peripheral neuropathy of the hands and feet, and his hypertension is not service-connected, the first and second elements of service connection on a secondary basis are not met, and any further analysis of service connection on a secondary basis is not necessary. Therefore, service connection on a secondary basis is not warranted. See 38 C.F.R. § 3.310(a). Service connection for peripheral neuropathy of the hands and feet, as secondary to hypertension, is not warranted. The Veteran does not have a current diagnosis of peripheral neuropathy of the hands and feet, and he is not service-connected for hypertension. Therefore, the first and second elements of service connection on a secondary basis are not met, and the claim must be denied. 38 C.F.R. § 3.310(a). Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Timothy T. Emmart 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.