Citation Nr: 22015002 Decision Date: 03/16/22 Archive Date: 03/16/22 DOCKET NO. 07-10 408 DATE: March 16, 2022 ORDER Service connection for an eye disability is denied. Service connection for a right ankle disability is denied. Service connection for hemoptysis (coughing up blood) is denied. FINDINGS OF FACT 1. The Veteran's eye disability is not etiologically related to service. 2. The Veteran's right ankle disability is not etiologically related to service or to his service-connected lower back disability. 3. The Veteran's reported hemoptysis is not attributable to any diagnosed medical condition and does not cause functional impairment. CONCLUSIONS OF LAW 1. The criteria for service connection for an eye disability have not been met. 38 U.S.C. §§ 1110, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a right ankle disability have not been met. 38 U.S.C. §§ 1110, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for hemoptysis have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Introduction The Veteran served on active duty in the United States Marine Corps from June 1975 to April 1979, in the Army from November 1990 to June 1991 (including service in Saudi Arabia), and in the Army from January 2003 to April 2004 (including service in Iraq.) This matter comes before the Board of Veterans' Appeals (Board) on appeal of a rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In July 2015, the Veteran testified at a hearing before the undersigned Veterans Law Judge, and a transcript of the hearing is of record. This case was remanded by the Board in November 2015, July 2017, and October 2020 for additional development. The case has now been returned to the Board for further appellate review. The Board observes that the Veteran's original claim for service connection for "joint pain" was recharacterized by the Board in its October 2020 remand as a claim for service connection for a "bilateral knee and/or a right ankle disability, claimed as painful joints." Service connection for right and left knee disabilities was subsequently granted by the RO. As such, the claim remaining on appeal is for service connection for a right ankle disability. Legal Criteria Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). In addition, a disability which is proximately due to or has been aggravated by a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310(a). "[I]f the positive and negative evidence is in approximate balance ... the claimant receives the benefit of the doubt." Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Background and Analysis The Board has reviewed all the evidence of record, with an emphasis on the evidence relevant to the Veteran's claims. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the Veteran's claims. Service connection for an eye disability In July 2004, the Veteran filed a claim for service connection for light sensitivity. He has maintained that since exposure to a "flashbang" grenade in Iraq in 2003 or 2004, his eyes have bothered him, including due to light sensitivity. The Veteran was afforded a VA eye examination in September 2017. The examiner diagnosed bilateral cataracts, which were noted not to be visually significant. She also noted that according to 2016 VA ophthalmology records, the Veteran was noted to have refractive error, posterior vitreous detachment (PVD), non-visually significant cataracts, and cobblestone degeneration. The examiner ultimately determined the Veteran's eye condition was unrelated to service on the basis of the absence of any eye condition noted in the Veteran's service treatment records (STRs). In its October 2020 remand, the Board interpreted the VA examiner's opinion to address only the Veteran's cataracts. Thus, the Board requested an addendum opinion addressing the remaining diagnoses. In November 2020, an addendum opinion from a separate VA examiner was obtained. The examiner ultimately determined that none of the Veteran's eye conditions was related to service. In support of her opinion, she explained that PVD was a naturally occurring change the takes place during childhood, and that cobblestone degeneration is present in approximately one third of adults over the age of 20. She further noted that no eye complaints or symptoms were present in the Veteran's service records, and that none of the conditions were diagnosed until 2016, more than 12 years following the Veteran's discharge from his last period of active duty. She further stated that exposure to a "flashbang" grenade was not a known risk factor for any of the Veteran's conditions and would not typically cause them. Upon review, the Board finds the VA examiner's opinion to be competent and probative, as the examiner reviewed the claims file and provided a medical opinion supported by well-reasoned rationale. As noted above, the Veteran has contended that his eye condition(s) are related to exposure to a "flashbang" grenade during service. The record does not demonstrate, however, that the Veteran possesses the medical knowledge or training to provide a competent opinion as to the etiology of his eye conditions. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Consequently, the Board must defer to the medical evidence of record in addressing this issue, the entirety of which weighs against the Veteran's claim. Upon review, the Veteran has not submitted, and there is no probative medical evidence of record to contradict the VA examiners' opinions or to otherwise associate the Veteran's eye disability with service. Upon review of the foregoing, the Board finds that the evidence shows the Veteran's eye condition(s) are unrelated to service. Therefore, the claim for service connection for an eye disability must be denied. Service connection for a right ankle disability The Veteran has a right ankle disability, diagnosed as deltoid ligament sprain. He has contended the condition is related to an in-service fall in 2004. Alternatively, he has contended the condition is related to his service-connected lower back disability, which was a result of the fall in question. The Veteran has maintained that he has experienced right lower extremity pain, including ankle pain, since his 2004 fall. The Board observes that to the extent the Veteran has referred to this pain as radiating from his lower back, service connection has been granted for right lower extremity radiculopathy. Thus, the issue remaining on appeal is whether service connection is warranted for a right ankle musculoskeletal disability. In this regard, the Veteran was afforded a VA ankle examination in September 2017. Ultimately, the examiner determined the Veteran's right ankle disability was unrelated to his service or lower back disability. In support of his opinion, the examiner noted that there was no documentation of any right ankle injury during service. He further asserted that the Veteran's lower back pathology was of insufficient severity to reasonably believe it would result in increased biomechanical strain on the Veteran's right ankle. Pursuant to the Board's October 2020 remand, a medical opinion was obtained from a separate VA examiner in November 2020. The examiner ultimately agreed with the September 2017 opinion. In support of his opinion, the examiner noted that while the Veteran had indicated his right ankle pain started in service, the medical records during service and after service did not support a chronic history for right ankle problems that started in service and that persisted since then. The examiner specifically noted that while the Veteran complained of knee pain after service, there was no mention of a chronic right ankle injury or condition that has persisted since service. Upon review, the Board finds the VA examiners' opinions to be competent and probative, as the examiners reviewed the claims file and provided medical opinions supported by well-reasoned rationale. As noted above, the Veteran has contended that his right ankle condition is related to an in-service fall or to his lower back disability. The record does not demonstrate, however, that the Veteran possesses the medical knowledge or training to provide a competent opinion as to the etiology of his right ankle disability. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Consequently, the Board must defer to the medical evidence of record in addressing this issue, the entirety of which weighs against the Veteran's claim. Upon review, the Veteran has not submitted, and there is no probative medical evidence of record to contradict the VA examiners' opinions or otherwise associating the Veteran's right ankle musculoskeletal disability with service or his lower back disability. Upon review of the foregoing, the Board finds that the evidence against the Veteran's claim outweighs the evidence in favor. Consequently, the claim for service connection for a right ankle disability must be denied. Service connection for hemoptysis The record shows the Veteran has intermittently reported coughing up blood since approximately 2004. He has attributed this to inhalation of a "white smoke" while stationed in Iraq that he was told originated from a sulphur fire. Service treatment records reflect that the Veteran reported a history of coughing up blood on his November 2004 report of medical history. The Veteran described this occurring approximately 3 times a week, in the early morning but noted symptoms are sometimes lighter than other times. The physician who signed that form noted that the symptoms were consistent with allergic rhinitis and noted the Veteran attributed the symptoms to exposure while in Iraq. Pursuant to a September 2011 medical examination, a VA examiner noted the Veteran reported a history of coughing up blood, which had resolved at the time of the examination. The examiner indicated the Veteran had no persistent fever, cough with sputum, night sweats, or pain over the chest area on exertion. The examiner indicated the Veteran did not require any treatment, and that he did not experience any overall functional impairment from his condition. Pursuant to an additional VA examination conducted in September 2017, it was noted that on examination, there was no evidence of a pulmonary condition that would result in hemoptysis. The examiner did note that there was a "restrictive lung pattern" on spirometry but stated that this restrictive lung disease was unrelated and would not cause hemoptysis. The examiner further observed that frequent pulmonary and otolaryngology appointments at VA had failed to reveal any pathology that would cause hemoptysis. An additional VA opinion was obtained in November 2020. The examiner again noted that there was no objective evidence to explain the Veteran's reported hemoptysis. He further stated there was no diagnosis or pathology relevant to being exposed to sulphur in service. To the extent to which the hemoptysis is related to the allergic rhinitis as the physician during service indicated, the Veteran is already in receipt of service connection for allergic rhinitis. Apart from the allergic rhinitis, the evidence does not support that there is another separate diagnosis or functional impairment related to the hemoptysis. The Board notes that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability.... In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). For service connection purposes, a particular diagnosis is not required, and pain or other symptoms can constitute disability if they cause impairment in earning capacity. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). In this case, a review of the VA examination reports and the Veteran's outpatient treatment records is absent of any diagnosis associated with the Veteran's reported hemoptysis symptoms other than the already service-connected rhinitis. In addition, the Veteran has not contended, and there is no indication in the record that his reported hemoptysis has caused functional impairment at any time during the period of the claim. After careful consideration of the foregoing, the Board finds that the evidence shows the Veteran's self-reported hemoptysis, which is not associated with any diagnosis and does not cause functional impairment, does not constitute a disability for VA service connection purposes. Accordingly, the claim for service connection for hemoptysis must be denied. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Hampton, 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.