Citation Nr: 22014307 Decision Date: 03/12/22 Archive Date: 03/12/22 DOCKET NO. 17-00 978 DATE: March 12, 2022 ORDER Service connection for irritable bowel syndrome (IBS) is denied. Service connection for allergies (bee sting, iodine, and shellfish) is denied. REMANDED The issue of entitlement to service connection for a right knee disability is remanded. The issue of entitlement to service connection for a left knee disability is remanded. The issue of entitlement to service connection for right rotator cuff repair residuals is remanded. The issue of entitlement to service connection for left rotator cuff repair residuals is remanded. The issue of entitlement to service connection for a respiratory disorder, to include environmental allergy and asthma, is remanded. The issue of entitlement to service connection for left hand cold injury residuals is remanded. The issue of entitlement to service connection for hernia residuals claimed as a stomach condition is remanded. The issue of entitlement to service connection for a skin condition is remanded. The issue of entitlement to service connection for headaches is remanded. The issue of entitlement to service connection for right arm nerve damage is remanded. The issue of entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded. FINDINGS OF FACT 1. The Veteran does not have a current diagnosis of IBS. 2. There is no probative evidence suggesting the Veteran's allergies (bee sting, iodine, and shellfish) are related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for IBS are not met. 38 U.S.C. §§ 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for allergies (bee sting, iodine, and shellfish) are not met. 38 U.S.C. §§ 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1983 to April 1988. These matters come to the Board of Veterans' Appeals (Board) on appeal from an October 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. The representative's most recent statement indicated that the appeal was sufficient to proceed to a Veterans Law Judge for review. Therefore, the Board will proceed with adjudication of the Veteran's claims. 1. Entitlement to service connection for irritable bowel syndrome (IBS) VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. § 5103A (d)(2), 38 C.F.R. § 3.159 (c)(4)(i). The third prong, which requires that the evidence of record "indicate" that the claimed disability or symptoms "may be" associated with the established event, is a low threshold. McLendon, 20 Vet. App. at 83. Here, the Board finds that the McLendon criteria have not been satisfied as the Veteran has not been diagnosed with IBS during the period on appeal. Further, in the absence of proof of a present disability, there can be no valid claim for service connection. See Degmetich v. Brown, 104 F.3d 1328 (1997); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The current disability requirement for a service connection claim is satisfied if the claimant has a disability at the time the claim is filed or during the pendency of that claim. McClain v. Nicholson, 21 Vet. App. 319 (2007). As stated above, the record does not substantiate a current diagnosis of IBS. Post-service medical records are void of treatment, or diagnosis of IBS. While the Veteran is competent to state that he experienced symptoms, as a lay person, he is not competent to provide evidence as to more complex medical questions. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). Here, the Veteran does not have a current diagnosis of IBS and the Veteran has not described any symptoms which suggest a current diagnosis of IBS. In short, the objective medical evidence of record does not establish a current diagnosis of IBS for the purposes of establishing entitlement to VA disability compensation. In the absence of a currently diagnosed disability, additional discussion concerning in service incurrence and nexus is not required, and service connection for IBS is denied. 2. Entitlement to service connection for allergies (bee sting, iodine, and shellfish) Here, the Board also finds that the McLendon criteria have not been satisfied. Specifically, there is no competent evidence that the Veteran has bee sting, iodine, or shellfish allergies which may be associated with his active service. As such, remand for an examination is unnecessary and doing so would serve no useful or meaningful purpose and only instead result in unnecessarily imposing additional burdens on VA with no potential benefit flowing to the Veteran. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Therefore, the Board finds there is sufficient evidence to make a decision on the claim. Turning to the evidence of record, in addressing the criterion of a current disability the Veteran's post-service VA treatment records document iodinated contrast media and shellfish allergies. See May 2016 Dorn Veterans' Hospital Records. Next, in addressing in service incurrence, the Veteran's service treatment records (STRs) are void of any complaints of, treatment for, or diagnosis of bee sting, iodine, or shellfish allergies. With regard to nexus, the Veteran has not explained why he believes that he has bee sting, iodine, or shellfish allergies related to service. Additionally, the Veteran has not submitted private medical records, or VA medical records that suggest that he has bee sting, iodine, or shellfish allergies associated with his active service. As the evidence does not demonstrate that the Veteran has bee sting, iodine, or shellfish allergies related to his military service, service connection is denied. As the preponderance of the evidence is against the Veteran's claim (that is to say, the weight of the evidence is neither in approximate balance nor nearly equal) See Lynch v. McDonough, citation pending, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). REASONS FOR REMAND 1. Entitlement to service connection for a right knee disability is remanded. 2. Entitlement to service connection for a left knee disability is remanded. VA must obtain an opinion when there is competent evidence of a disability (or persistent or recurrent symptoms of a disability) that may be associated with an in-service event, injury, or disease, but there is insufficient information to make a decision on the claim. 38 U.S.C. § 5103A (d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Lay testimony as to continuity of symptomatology can satisfy the requirement for evidence that the claimed disability may be related to service, and the threshold for finding that the disability (or symptoms of a disability) may be associated with service is low. Id. at 83. The Veteran contends that he developed a right knee disability and a left knee disability as a result of running through ship hatches and shuttles and climbing steel ladders during rough seas. In this regard, the Veteran's VA treatment records document a current diagnosis of bilateral knee osteoarthritis. See September 2021 VA Treatment Records. The Veteran's military personnel records document service aboard the USS Nitro, USS Duluth, and USS Forrestal. In light of the foregoing evidence that the Veteran may have a right knee disability and left knee disability related to his service, the Board finds that the low threshold of the McLendon standard has been met, and that the Veteran should be afforded an initial VA opinion prior to the adjudication of the claim. 3. Entitlement to service connection for right rotator cuff repair residuals is remanded. 4. Entitlement to service connection for left rotator cuff repair residuals is remanded. The Veteran contends that he has rotator cuff repair residuals as a result of climbing up and down steel ladders during rough seas. In this regard, the Veteran's VA treatment records document right rotator cuff repair surgery in 2000 and left rotator cuff repair surgery in 2013 with ongoing symptoms since then. See July 2020 VA Treatment Records. The Veteran's VA treatment records also document current diagnoses of postoperative and degenerative changes at the right shoulder and tendinosis involving the supraspinatus tendon and to a lesser degree the infraspinatus tendon and injections for bilateral shoulder pain. Id. See also May 2020 Columbia SC VAMC Records. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018); (holding that pain resulting in functional impairment constitutes a disability as contemplated in 38 U.S.C. § 1110, even in the absence of a presently diagnosed condition). The Veteran's military personnel records document service aboard the USS Nitro, USS Duluth, and USS Forrestal. In light of the foregoing evidence that the Veteran may have rotator cuff repair residuals related to his service, the Board finds that the low threshold of the McLendon standard has been met, and that the Veteran should be afforded an initial VA opinion prior to the adjudication of the claim. 5. Entitlement to service connection for a respiratory disorder, to include environmental allergies and asthma, is remanded. The Veteran contends that he has a respiratory disorder, to include environmental allergies and asthma, as a result of environmental exposures including asbestos aboard ship while in dry dock. In this regard, the Veteran's VA treatment records document a current diagnosis of asthma. See July 2014 VA Treatment Records. The Veteran's military personnel records document service aboard the USS Nitro, USS Duluth, and USS Forrestal. In light of the foregoing evidence that the Veteran may have a respiratory disorder related to his service, the Board finds that the low threshold of the McLendon standard has been met, and that the Veteran should be afforded an initial VA opinion prior to the adjudication of the claim. 6. Entitlement to service connection for left hand cold injury residuals is remanded. The Veteran contends that he has left hand cold injury residuals as a result of standing watch as a Petty Officer without gloves. In this regard, the Veteran's VA treatment records document a rash on hands since exposure to cold weather in the Navy. See July 2014 VA Treatment Records. The Veteran's military personnel records document that the Veteran's duties and responsibilities included standing duty as a Gunner's mate and Petty Officer of the Watch Import. In light of the foregoing evidence that the Veteran may have left hand cold injury residuals related to his service, the Board finds that the low threshold of the McLendon standard has been met, and that the Veteran should be afforded an initial VA opinion prior to the adjudication of the claim. 7. Entitlement to service connection for hernia residuals claimed as a stomach condition is remanded. The Veteran contends that he has a residual painful scar related to an in-service hernia operation. In this regard, the Veteran reported that a mesh implant left a residual painful scar. The Veteran's STRs document a hernia. In light of the foregoing evidence that the Veteran may have a stomach condition related to his service, the Board finds that the low threshold of the McLendon standard has been met, and that the Veteran should be afforded an initial VA opinion prior to the adjudication of the claim. 8. Entitlement to service connection for a skin condition is remanded. The Veteran contends that he has a skin condition as a result of soap that was used on the ship laundry aboard the USS Nitro, USS Duluth, and USS Forrestal. In this regard, the Veteran's VA treatment records document a chronic rash on his upper chest diagnosed as tinea versicolor. See July 2014 VA Treatment Records. The Veteran's military personnel records document service aboard the USS Nitro, USS Duluth, and USS Forrestal. In light of the foregoing evidence that the Veteran may have a skin condition related to his service, the Board finds that the low threshold of the McLendon standard has been met, and that the Veteran should be afforded an initial VA opinion prior to the adjudication of the claim. 9. Entitlement to service connection for headaches is remanded. The Veteran contends that his headaches had onset during service. The Board notes that the Veteran is competent to describe and identify a headache. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (stating that a veteran is competent to report on all things of which he has personal knowledge derived from his own senses). The Veteran's VA treatment records document a current diagnosis of migraine headaches. See July 2014 VA Treatment Records. In light of the foregoing evidence that the Veteran may have migraine headaches related to his service, the Board finds that the low threshold of the McLendon standard has been met, and that the Veteran should be afforded an initial VA opinion prior to the adjudication of the claim. 10. Entitlement to service connection for right arm nerve damage is remanded. The Veteran contends that he has right arm nerve damage as a result of an in-service incident in which a hatchet fell on his elbow while serving aboard the USS Forrestal. In this regard, the Veteran's VA treatment records document a current diagnosis of right ulnar neuropathy. See July 2014 VA Treatment Records. The Veteran's military personnel records document service aboard the USS Forrestal. In light of the foregoing evidence that the Veteran may have right arm nerve damage related to his service, the Board finds that the low threshold of the McLendon standard has been met, and that the Veteran should be afforded an initial VA opinion prior to the adjudication of the claim. 11. Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded. The Veteran contends that he has PTSD as a result of: (1) in-service hazing; (2) racism; and/or (3) witnessing the decapitation of a fellow sailor in an explosion. In this regard, the Veteran's VA treatment records document a positive PTSD screen and that a clinician suggested a PTSD diagnosis. See November 2014 VAMC Columbia Records. The Veteran's military personnel records document an article 86 and other behavioral problems/performance issues. In light of the foregoing evidence that the Veteran may have PTSD related to his service, the Board finds that the low threshold of the McLendon standard has been met, and that the Veteran should be afforded an initial VA opinion prior to the adjudication of the claim. The matters are REMANDED for the following action: 1. Request that the Veteran provide or authorize VA to obtain records of his relevant treatment that have not yet been associated with the claims file, and associate with the claims file any outstanding VA treatment records. 2. Ensure that the Veteran's complete STRs are associated with the claims file. 3. Conduct appropriate development, including obtaining additional information, to verify any potential exposure to asbestos during the Veteran's service. 4. Schedule the Veteran for a VA examination to determine the nature, etiology, and date of onset of a right knee disability and left knee disability. Following review of the claims file and examination of the Veteran, the examiner should respond to the following: (a.) Is it at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran has a right knee disability and a left knee disability that had onset during active service or within one year of the Veteran's separation from active service, or is otherwise related to service? The examiner is asked to discuss the Veteran's contention that he developed a right knee disability and a left knee disability as a result of running through ship hatches and shuttles and climbing steel ladders during rough seas. The examiner is also asked to discuss bilateral knee osteoarthritis documented in the Veteran's VA treatment records. (b.) All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should be explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. 5. Schedule the Veteran for a VA examination to determine the nature, etiology, and date of onset of right rotator cuff repair residuals and left rotator cuff repair residuals. Following review of the claims file and examination of the Veteran, the examiner should respond to the following: (a.) Is it at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran has right rotator cuff repair residuals and left rotator cuff repair residuals, or pain that causes functional impairment that had onset during active service or within one year of the Veteran's separation from active service, or is otherwise related to service? The examiner is asked to discuss the Veteran's contention that he has rotator cuff repair residuals as a result climbing up and down steel ladders during rough seas. The examiner is also asked to discuss rotator cuff repair surgeries in 2000 and 2013 with ongoing symptoms since then; postoperative and degenerative changes at the right shoulder and tendinosis involving the supraspinatus tendon and to a lesser degree the infraspinatus tendon; and injections for bilateral shoulder pain. (b.) All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should be explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. 6. Schedule the Veteran for a VA examination to determine the nature, etiology, and date of onset of a respiratory disorder, to include environmental allergy and asthma. Following review of the claims file and examination of the Veteran, the examiner should respond to the following: (a.) Is it at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran has a respiratory disorder, to include environmental allergies and asthma, that had onset during active service or within one year of the Veteran's separation from active service, or is otherwise related to service? The examiner is asked to discuss the Veteran's contention that he has a respiratory disorder as a result of environmental exposures including asbestos aboard ship while in dry dock. The examiner is also asked to discuss asthma documented in the Veteran's VA treatment records. (b.) All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should be explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. 7. Schedule the Veteran for a VA examination to determine the nature, etiology, and date of onset of left-hand cold injury residuals. Following review of the claims file and examination of the Veteran, the examiner should respond to the following: (a.) Is it at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran has left hand cold injury residuals that had onset during active service or within one year of the Veteran's separation from active service, or is otherwise related to service? The examiner is asked to discuss the Veteran's contention that he has left hand cold injury residuals as a result of standing watch as a Petty Officer without gloves. The examiner is also asked to discuss rash on hands since exposure to cold weather in the Navy, documented in the Veteran's VA treatment records. (b.) All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should be explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. 8. Schedule the Veteran for a VA examination to determine the nature, etiology, and date of onset of hernia residuals claimed as a stomach condition. Following review of the claims file and examination of the Veteran, the examiner should respond to the following: (a.) Is it at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran has hernia residuals claimed as a stomach condition that had onset during active service or within one year of the Veteran's separation from active service, or is otherwise related to service? The examiner is asked to discuss the Veteran's contention that he has a residual painful scar related to an in-service hernia operation. The examiner is also asked to discuss the hernia documented in the Veteran's STRs. (b.) All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should be explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. 9. Schedule the Veteran for a VA examination to determine the nature, etiology, and date of onset of a skin condition. Following review of the claims file and examination of the Veteran, the examiner should respond to the following: (a.) Is it at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran has a skin condition that had onset during active service or within one year of the Veteran's separation from active service, or is otherwise related to service? The examiner is asked to discuss the Veteran's contention that he has a skin condition as a result of soap that was used on the ship laundry aboard the USS Nitro, USS Duluth, and USS Forrestal. The examiner is also asked to discuss chronic rash on upper chest diagnosed as tinea versicolor documented in the Veteran's VA treatment records. (b.) All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should be explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. 10. Schedule the Veteran for a VA examination to determine the nature, etiology, and date of onset of headaches. Following review of the claims file and examination of the Veteran, the examiner should respond to the following: (a.) Is it at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran's headaches had onset during active service or within one year of the Veteran's separation from active service, or is otherwise related to service? The examiner is asked to discuss the Veteran's contention that his headaches had onset during service. The examiner is also asked to discuss migraine headaches documented in the Veteran's VA treatment records. (b.) All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should be explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. 11. Schedule the Veteran for a VA examination to determine the nature, etiology, and date of onset of right arm nerve damage. Following review of the claims file and examination of the Veteran, the examiner should respond to the following: (a.) Is it at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran has right arm nerve damage that had onset during active service or within one year of the Veteran's separation from active service, or is otherwise related to service? The examiner is asked to discuss the Veteran's contention that he has right arm nerve damage as a result of an in-service incident in which a hatchet fell on his elbow while serving aboard the USS Forrestal. The examiner is also asked to discuss right ulnar neuropathy documented in the Veteran's VA treatment records. (b.) All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should be explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. 12. Schedule the Veteran for a VA examination to determine the nature, etiology, and date of onset of PTSD. Following review of the claims file and examination of the Veteran, the examiner should respond to the following: (a.) Is it at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that PTSD had its onset in service, or within one year of separation from service, is related to the Veteran's reported in-service stressors, or is otherwise related to service? The examiner is asked to specifically address the Veteran's contention that he has PTSD as a result of: (1) in-service hazing; (2) racism; and/or (3) witnessing the decapitation of a fellow sailor in an explosion. The examiner is also asked to specifically address the suggested PTSD diagnosis and the positive PTSD screen documented in the Veteran's VA treatment records; and the multiple disciplinary actions documented in the military personnel records. (b.) All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should be explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Smith-Jennings, 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.