Citation Nr: 22013258 Decision Date: 03/09/22 Archive Date: 03/09/22 DOCKET NO. 16-56 773 DATE: March 9, 2022 ORDER Service connection for a right knee condition (claimed as patellar tendonitis), including as secondary to service-connected left knee disabilities, is denied. Service connection for a right inguinal injury is denied. Service connection for alopecia areata is denied. Service connection for grouped hyperpigmented follicles is denied. Service connection for tinea barbae is denied. Service connection for herpes simplex I is denied. Service connection for lentigo is denied. Service connection for residuals of a right hip injury is denied. Service connection for a lower back strain is denied. REMANDED The claim of entitlement to service connection for an unspecified sleep disorder is remanded. The claim of entitlement to an initial compensable rating for hypertension is remanded. FINDINGS OF FACT 1. The Veteran does not currently have a right knee disability. 2. The Veteran does not currently have a right inguinal disability, to include residuals of any injury. 3. The Veteran does not currently have alopecia areata. 4. The Veteran does not currently have a disability manifesting as grouped hyperpigmented follicles. 5. The Veteran does not currently have tinea barbae. 6. The Veteran does not currently have herpes simplex I. 7. The Veteran does not currently have lentigo. 8. The Veteran does not currently have a right hip disability, to include residuals of a right hip injury. 9. A lower back strain is not related to the Veteran's active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right knee condition (claimed as patellar tendonitis), including as secondary to service-connected left knee disabilities, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113. 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 2. The criteria for entitlement to service connection for a right inguinal injury have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 3. The criteria for entitlement to service connection for alopecia areata have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 4. The criteria for entitlement to service connection for grouped hyperpigmented follicles have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 5. The criteria for entitlement to service connection for tinea barbae have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 6. The criteria for entitlement to service connection for herpes simplex I have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 7. The criteria for entitlement to service connection for lentigo have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 8. The criteria for entitlement to service connection for a residuals of a right hip injury have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 9. The criteria for entitlement to service connection for a lower back strain have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty (AD) from January 1990 to April 2013, including in the Southwest Asia Theater of Operations during the P. His claims come before the Board of Veterans' Appeals (Board) on appeal of a February 2014 Department of Veterans Affairs (VA) rating decision. In December 2014, the Veteran testified in support of these claims at a hearing held before a Decision Review Officer at the Agency of Original Jurisdiction (AOJ). Service Connection Entitlement to service connection for a right knee condition (claimed as patellar tendonitis), including as secondary to service-connected left knee disabilities The Veteran seeks service connection for a right knee disability on a secondary basis, as related to his service-connected left knee disabilities. During his hearing, he testified that, because he is psychologically scared of hurting his left knee, he places pressure on his right side, affecting his right knee. Here, for the reasons noted below, with regard to this issue and all others that follow, the evidence is neither evenly nor approximately balanced with regard to the presence or etiology of the Veteran's claimed disabilities. Rather, it persuasively weighs against granting service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application in each of these cases. Lynch v. McDonough, No. 2020-2067, 2021 U.S. App. LEXIS 37307 (Fed. Cir. Dec. 17, 2021) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). Service connection may be granted on a direct basis 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). Service connection may be granted on a secondary basis for disability proximately due to, the result of, or aggravated by, a service-connected disease or injury. 38 U.S.C. § 1110; 38 C.F.R. § 3.310(a). To establish entitlement on this basis, the evidence must show: (1) that a current disability exists; and (2) that the current disability was either proximately caused or aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Certain chronic diseases, including arthritis, will be presumed related to service if they were noted as chronic in service, manifested to a compensable degree within a year of separation from service, or if continuity of the same symptomatology of those diseases existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). Service connection may be presumed in the case of a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability (includes an undiagnosed or medically unexplained chronic multi-symptom illness such as fibromyalgia) that became manifest during active service in the Southwest Asia theater of operations, or to a degree of 10 percent or more not later than December 31, 2021. 38 C.F.R. § 3.317(a)(1). A Persian Gulf veteran is defined as a veteran who served on active military, naval or air service in the Southwest Asia theater of operations during the Persian Gulf War. 38 C.F.R. § 3.317(e)(1). The Southwest Asia theater of operations refers to Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. 38 C.F.R. § 3.317(e)(2). The period of the Persian Gulf War is from August 2, 1990, through the present. 38 C.F.R. § 3.2(i). Here, the Veteran is not claiming service connection on a presumptive basis. However, his service personnel records confirm that he served in the Southwest Asia Theater of Operations during the Persian Gulf War. The question for the Board is therefore whether the Veteran has current disabilities that began during or is otherwise related to service, including in the Southwest Theater of Operations, or is related to a service-connected disability. The Veteran was seen during service for right knee pain and diagnosed with Osgood-Schlatter disease and is service-connected for left knee disabilities. However, he does not currently have a right knee disability that could be attributed to the in-service right knee pain or his service-connected left knee disabilities and has not been diagnosed with such a disability at any time recent to filing this claim or during the claim's process. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). There are no records of right knee treatment in the claims file, and in June 2016, during a VA knee examination, a VA examiner found that there is no pathology to render a right knee diagnosis. By filing this claim, the Veteran obviously believes he currently has a right knee disability. However, he is not competent to render such a diagnosis. The issue is medically complex, requiring medical education/knowledge of the musculoskeletal system, which the Veteran does not have, and diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board affords the VA examiner's competent medical opinion greater probative weight. Inasmuch as there is no competent evidence of record of a current right knee disability, the criteria for entitlement to service connection for a right knee condition (claimed as patellar tendonitis), including as secondary to service-connected left knee disabilities, are not met. Entitlement to service connection for a right inguinal injury The Veteran seeks service connection for a right inguinal disability on a direct basis, as related to an in-service injury. He testified that in 2011 or 2012, he was exercising, working out and running, when he pulled something in the inguinal area and felt pain for weeks. The doctor told him he had a severe strain and could not exercise. When queried as to whether he has since had a problem, the Veteran testified that due to a psychological fear of reinjuring himself, he doesn't want to do any type of workout that could cause pain. The Veteran was seen during service for inguinal pain and diagnosed with a muscle strain (no hernia). However, he does not currently have a right inguinal disability that could be attributed to the in-service pain and has not been diagnosed with such a disability at any time recent to filing this claim or during the claim's process. Romanowsky v. Shinseki, 26 Vet. App. at 294; McClain v. Nicholson, 21 Vet. App. at 321. There are no records of treatment for complaints involving the inguinal area in the claims file, and in June 2016, during a VA hernias examination, a VA examiner found no hernia on examination and no objective findings that the Veteran had a hernia. Again, the Veteran has no medical training or knowledge; therefore, he is not competent to diagnose a disability involving the inguinal area, hernia or otherwise. The Board thus affords the VA examiner's competent medical opinion greater probative weight. Inasmuch as there is no competent evidence of record of a disability involving the inguinal area, including any residuals of an injury, the criteria for entitlement to service connection for a right inguinal injury are not met. Entitlement to service connection for alopecia areata Entitlement to service connection for grouped hyperpigmented follicles Entitlement to service connection for tinea barbae Entitlement to service connection for lentigo The Veteran seeks service connection for multiple skin disabilities on a direct basis, as related to in-service skin diagnoses. He testified that, in the 1990s, he received treatment for alopecia secondary to stress, which resulted in patches of his hair falling out and is now gone. He further testified that he continues to have problems with tinea barbae, the skin issue affecting his face, and itching on his back associated with the hyperpigmented follicles and/or lentigo. The Veteran was seen during service for skin conditions affecting different areas of his body. Some of these conditions (onychomycosis of the left great toe, pseudofolliculitis barbae and scars on the upper back and left knee) are already service connected. The Veteran does not currently have any of the other skin conditions claimed here and has not been diagnosed with such conditions at any time recent to filing these claims, including during the appeals process. Romanowsky v. Shinseki, 26 Vet. App. at 294; McClain v. Nicholson, 21 Vet. App. at 321. During the hearing and a June 2016 VA skin examination, the Veteran admitted he no longer has alopecia, and there are no records in the file of post-service treatment for grouped hyperpigmented follicles, tinea barbae or lentigo. During the examination, a VA examiner diagnosed multiple skin conditions, to include a scar on the back that resulted from a biopsy showing simple lentigo, all of which are now service connected. The examiner found no evidence of any other skin condition, including those claimed here. The criteria for entitlement to service connection for these conditions are therefore not met. Entitlement to service connection for herpes simplex I The Veteran seeks service connection for herpes simplex I on a direct basis, as related to his active service. He testified that, in 2010 or 2011, he was last treated for this condition (prescribed pills) but since then, he has not received further treatment. As a VA examiner pointed out during a June 2016 VA examination, during service, the Veteran sought treatment for what he was told could be a herpetic lesion on his mouth. He also sought treatment for abrasions on his penis. Herpes was never confirmed and the abrasions were thought to be due to friction. On examination, the Veteran reported that he was not sure he has ever had a recurrence of the lesion and is under no associated treatment. The examiner confirmed that there was no objective evidence of herpes simplex virus (mouth lesions) or herpetic congenital lesions. As the Veteran does not currently have any type of herpes and has not been diagnosed with herpes at any time recent to filing these claims, including during the appeals process, the criteria for entitlement to service connection for this disability are not met. Entitlement to service connection for residuals of a right hip injury The Veteran seeks service connection for a right hip disability on a direct basis, as related to an in-service injury. He testified that the injury occurred awhile back and that he couldn't recall if he was carrying something, something hit him or he fell. He further testified that he never had x-rays, and it hasn't affected the way he walks. He has a tingling sensation under his feet, which he's not sure is coming from his back or hip. Service treatment records do not confirm the Veteran's report of an in-service hip injury or treatment for any hip complaints. Regardless, according to the remainder of the evidence, the Veteran does not currently have a right hip disability and has not been diagnosed with such a disability at any time recent to filing this claim or during the claim's process. Romanowsky v. Shinseki, 26 Vet. App. at 294; McClain v. Nicholson, 21 Vet. App. at 321. There are no records in the file of hip treatment or a hip diagnosis, including any VA examination report. As the Veteran is not competent to render such a diagnosis, the criteria for entitlement to service connection for residuals of a right hip injury are not met. Entitlement to service connection for a lower back strain The Veteran seeks service connection for a lower back strain on a direct basis, as related to an in-service injury. He testified that the injury occurred during his last deployment when he was exercising or working out; he started having a lot of back pains. He believes it was due to a combination of working out and stress. He went to a medical doctor on his ship, who did not take x-rays but told him he had strained his back and gave him chiropractic massages to relieve the pain. In this case, although the Veteran injured his upper back in service, he did not injure or seek treatment for his lower back. During a June 2016 back examination, he was diagnosed with a lumbosacral strain, but the record contains no competent evidence relating the strain to service, including the in-service upper back injury. The examiner specifically ruled out a relationship between the current back disability and service on the basis that there is no in-service documentation of low back problems, treatment or an injury. The examiner's opinion is probative as it is based on an accurate medical history and includes rational. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). As an opinion on the etiology of the lumbosacral strain is beyond the Veteran's competence, Jandreau v. Nicholson, 492 F.3d at 1377 n.4, the criteria for entitlement to service connection for a lower back strain are not met. REASONS FOR REMAND Entitlement to service connection for an unspecified sleep disorder Entitlement to an initial compensable rating for hypertension During a December 2014 hearing at the AOJ, the Veteran testified that he had recently seen a private doctor at Bon Secours Medical Center for hypertension and had undergone a sleep study the prior year. Records of this treatment and the study report are not in the claims file. These matters are therefore REMANDED for the following action: After obtaining any necessary authorization, secure and associate with the file all records of the Veteran's treatment for hypertension and a report of the sleep study to which the Veteran referred during his hearing. LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. N. 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.