Citation Nr: 21042732 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 18-12 306 DATE: July 13, 2021 ORDER Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. Entitlement to service connection for esophageal varices is granted. REMANDED Entitlement to service connection for bilateral hearing loss is remanded. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has had PTSD at any time during or approximate to the pendency of the claim. 2. The Veteran's esophageal varices were proximately due to his service-connected non-alcoholic fatty liver disease, which was recharacterized as hepatocellular carcinoma. CONCLUSIONS OF LAW 1. The criteria for service connection for PTSD are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for esophageal varices are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1968 to January 1970. This matter comes before the Board of Veterans' Appeals (Board) from a February 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The Veteran died in March 2021. The appellant is the Veteran's surviving spouse and has been properly substituted in the pending appeal. See June 2021 Notification Letter. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). 1. Service connection for PTSD is denied. The Veteran maintained that he was diagnosed with PTSD that was related to in-service stressors. The question for the Board is whether the Veteran was diagnosed with a disability during the appeal that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran did not have a current diagnosis of PTSD and did not have any clinically diagnosed psychiatric disability at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In February 2016, the Veteran underwent a VA examination. The VA examiner found that the Veteran's symptoms did not meet the diagnostic criteria for PTSD under the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria and the Veteran did not have a mental disorder that conforms with DSM-5 criteria. The VA examiner considered the Veteran's service treatment records, military personnel records, and lay statements. The February 2016 VA examiner explained that although the Veteran had some painful memories of Vietnam, the Veteran did not have symptoms stemming from those experiences that were at a clinically significant level to meet PTSD criteria. The VA examiner found that there was no functional impairment associated with the Veteran's combat-related symptoms. The VA examiner found that the Veteran's symptoms did not rise to the level of a diagnosis or disorder. The VA examiner noted that the Veteran has never been diagnosed with or treated for PTSD or any other mental health condition and the service treatment records did not document any in-service mental health symptoms, diagnoses, or treatment. A review of the medical evidence is consistent with the VA examiner's findings. The Veteran's February 1968 induction and January 1970 separation examinations showed a "normal" psychiatric clinical evaluation. The Veteran denied frequent trouble sleeping, frequent or terrifying nightmares, depression or excessive worry, and loss of memory or amnesia. VA depression and PTSD screens conducted in April 2018 were negative. In February 2020, a VA social worker called the Veteran about anxiety at a recent appointment. The Veteran reported not knowing why the appointment was scheduled. Once this was explained, the Veteran reported feeling "much better." The Veteran denied feeling any current symptoms of anxiety. The Veteran reported having "a great crew of folks" who support the Veteran at home. There are no medical opinions in the record that support the Veteran's claim. While the Veteran believed he had a current diagnosis of PTSD, the Veteran was not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education that the Veteran did not have. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence, including the February 2016 VA examination report. The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F. 3d 1328 (1997). Congress has specifically limited entitlement to service connection for disease or injury to cases where such in-service events have resulted in a current disability. See 38 U.S.C. § 1110. Thus, without "competent evidence of current disability," there can be no award of service connection. Caluza v. Brown, 7 Vet. App. 498, 506 (1995). Based on a careful review of the evidence, the Board finds that service connection is not warranted for PTSD as the evidence in the record weighs against a finding of diagnosis of any psychiatric disability. As the preponderance of the evidence is against the Veteran's claim, the benefit-of-the-doubt rule does not apply, and his service connection claim must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Service connection for esophageal varices is granted. The Veteran contends he suffered from throat lesions. A September 2016 VA examination report shows the Veteran was diagnosed with esophageal varices. The VA examiner opined that it is at least as likely as not proximately due the Veteran's cirrhosis of the liver. The examiner stated that esophageal varices were known complications of and a progression of cirrhosis of the liver. Upon review of the record, the Board finds the evidence to be at least even as to whether the Veteran's current esophageal varices were proximately due to the service-connected hepatocellular carcinoma. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for esophageal varices is warranted. The claim is granted. REASONS FOR REMAND Service connection for bilateral hearing loss is remanded. The Board cannot make a fully informed decision on the issue of entitlement to service connection for bilateral hearing loss because no VA examiner has considered the Veteran's lay statements. Once VA undertakes to provide an examination, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The February 2016 VA examiner diagnosed bilateral hearing loss but opined that it was less likely than not due to military noise exposure. The VA examiner explained that the Veteran's February 1968 entrance examination and January 1970 exit examinations both indicated normal hearing bilaterally with no significant shift from entrance to exit. The VA examiner also noted that the Veteran also denied hearing loss at the January 1970 exit examination. The Board finds this opinion is inadequate for adjudication. Service connection for a current hearing disability is not precluded where hearing was within normal limits at separation. See Hensley v. Brown, 5 Vet. App. 155, 159-60 (1993). While normal audiological examinations at separation can be considered, normal hearing upon separation by itself does not bar service connection, rather, a normal hearing test on separation must be weighed with all the evidence of record. Id. The opinion also did not reflect consideration of all relevant evidence of record, including lay statements. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Dalton v. Nicholson, 21 Vet. App. 23 (2007). In October and November 2015 and March 2018, the Veteran reported in-service exposure to heavy machinery and weapons without hearing protection. An addendum VA medical opinion addressing the Veteran's lay statements is warranted. The matter is are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding the Veteran's bilateral hearing loss. The examiner must review the claims file, including the Veteran's October 2015, November 2015 and March 2018 lay statements and a copy of this remand order. The examiner is asked to provide a response to the following question: Is it at least as likely as not (50 percent probability or greater) that the Veteran's hearing loss had its onset in or is otherwise related to in-service hazardous noise exposure without adequate hearing protection? Provide a rationale to support the opinion. The examiner should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge, or literature, etc., relied upon in reaching the conclusions. If the medical professional cannot provide an opinion without resorting to mere speculation, the medical professional shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. In providing the requested opinion, consider the Veteran's description of in-service injury and symptoms as well as his post-service symptoms. In October 2015, November 2015 and March 2018, the Veteran reported in-service exposure to heavy machinery and weapons without hearing protection. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? J. Komperda Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James Hekel 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.