Citation Nr: 21041776 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 17-04 587 DATE: July 10, 2021 ORDER Entitlement to service connection for high cholesterol is denied. REMANDED Entitlement to service connection for strokes is remanded. Entitlement to service connection for diabetes mellitus, type II is remanded. Entitlement to service connection for myocardial infarctions is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for coronary artery disease is remanded. Entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. Entitlement to special monthly compensation (SMC) based upon the need for aid and attendance or upon housebound status is remanded. FINDING OF FACT Elevated cholesterol is a laboratory finding and not a chronic disability for which VA disability benefits may be awarded. CONCLUSION OF LAW Elevated cholesterol is not a disease, disability, or injury for which applicable law permits compensation or service connection. 38 U.S.C. §§ 101(16), 105(a), 1110, 1131; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from August 1976 to November 1976 and from December 1990 to May 1991. Thereafter, he served in the Army National Guard until May 1996. The Board has considered the Veteran's claim and decided entitlement based on the evidence or record. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, with respect to his claims. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 1. Entitlement to service connection for high cholesterol Service connection may be established for a disability resulting from disease or injury which was clearly present in service or for a disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Veteran contends that service connection is warranted for elevated cholesterol. Hyperlipidemia is a "general term for elevated concentrations of any or all of the lipids in the plasma." See Dorland's Illustrated Medical Dictionary 586, 903 (31st ed. 2012). at 903. The findings of elevated cholesterol and the diagnoses of hyperlipidemia only represent laboratory findings, and not an actual disability for which VA compensation benefits are payable. See 61 Fed. Reg. 20440, 20445 (May 7, 1996) (Diagnoses of hyperlipidemia, elevated triglycerides, and elevated cholesterol are actually laboratory test results, and are not, in and of themselves, disabilities. They are, therefore, not appropriate entities for the rating schedule). As elevated cholesterol and hyperlipidemia are not "disabilities" for VA compensation benefits purposes, i.e., not a "service-connectable" disability entity, the Veteran has not presented a valid claim of service connection. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Accordingly, service connection for elevated cholesterol is not warranted, nor is there any possibility that any medical records or other evidence would change this determination. As such, the preponderance of the evidence is against the claim for service connection for hyperlipidemia, and the benefit-of-the-doubt doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for strokes; entitlement to service connection for diabetes mellitus, type II; entitlement to service connection for myocardial infarctions; entitlement to service connection for hypertension; and entitlement to service connection for coronary artery disease are remanded. In an October 2015 VA examination, the VA examiner opined that the Veteran's myocardial infarctions were caused by coronary artery disease; that coronary artery disease was caused by atherosclerosis; that congestive heart failure was due to cardiomyopathy; that cardiomyopathy was due to hypertension; and that coronary artery disease was related to atherosclerosis, which was due to hypertension, hypercholesterolemia, diabetes, and other factors. The examiner noted that hypercholesterolemia, a risk factor for cardiovascular disease, was documented in April 1995, during the Veteran's service with the Army National Guard. While the examiner noted that the Veteran's cardiovascular disease was not related to hypercholesterolemia because elevated cholesterol "would not contribute 50% or more to the disease," the standard for determining service connection is whether it is at least as likely as not (a 50 percent probability or greater) that the in-service event or injury caused or contributed to the development of the disease, not whether it contributed 50 percent or more to the disease. Thus, the October 2015 VA opinion applied an incorrect standard for determining whether any of the Veteran's cardiovascular diagnoses were related to his elevated cholesterol. Accordingly, a new VA examination is required. Additionally, as noted above, elevated cholesterol was first documented in 1995, during the Veteran's service with the Army National Guard. In general, service connection is available for diseases and injuries incurred during a period of active duty or active duty for training (ACDUTRA) and for injuries incurred during a period of inactive duty for training (INACDUTRA). See generally 38 U.S.C. §§ 101 (24), 106; 38 C.F.R. § 3.6. Review of the record does not reflect that the Agency of Original Jurisdiction (AOJ) has obtained the Veteran's dates of ACDUTRA during his service with the Army National Guard. Determining the Veteran's ACDUTRA dates is necessary in this case to determine whether the Veteran's elevated cholesterol was incurred during a period of ACDUTRA. Accordingly, the AOJ should determine the Veteran's dates of ACDUTRA and INACDUTRA in the Army National Guard. 2. Entitlement to a TDIU and entitlement to SMC based upon the need for aid and attendance or upon housebound status are remanded. The Veteran's claims for entitlement to SMC and entitlement to a TDIU are intertwined with the claims remanded herein; accordingly, they must also be remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that two issues are "inextricably intertwined" when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated). The matters are REMANDED for the following action: 1. Obtain the Veteran's complete service personnel records, to include all documents pertaining to his service in the Army National Guard of Mississippi. Verify all active ACDUTRA and INACDUTRA dates for alleged service in the Army National Guard of Mississippi from May 1976 to May 1996. If necessary, a request should be made to the Defense Finance and Accounting Service (DFAS). Document all requests for information as well as all responses in the claims file. 2. Thereafter, provide the Veteran with a new VA examination by an appropriate physician to determine the etiology of his strokes, myocardial infarction, hypertension, coronary artery disease, and diabetes mellitus, type II. The Veteran's claims file and a copy of this remand must be reviewed by the examiner, and the examiners must state that this evidence was reviewed in the examination report. All pertinent symptomatology and findings must be reported in detail. All indicated tests and studies must be accomplished. Based upon a complete review of the evidence of record, to include the Veteran's lay statements, the VA examiner must opine whether it is at least as likely as not (i.e., a 50 percent probability or more) that the Veteran's strokes, myocardial infarction, hypertension, coronary artery disease, and diabetes mellitus, type II were incurred in or caused by his active duty service or a period of ACDUTRA or INACDUTRA, to include whether they had their onset during active duty service, ACDUTRA, or INACDUTRA. A complete rationale for all opinions must be provided. The examiner must consider and discuss the Veteran's lay statements as to the onset of his symptoms and the objective medical evidence documenting elevated cholesterol in 1995 and elevated blood pressure during the October 1991 VA examination. Also, the examiner is advised that the Veteran is competent to report observable symptomatology. B. G. LeMoine Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Katz, 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.