Citation Nr: 22016331 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 19-13 951 DATE: March 21, 2022 ORDER Entitlement to service connection for posttraumatic stress disorder is denied. Entitlement to service connection for atrial fibrillation is denied. Entitlement to service connection for stroke is denied. Entitlement to service connection for traumatic brain injury is denied. Entitlement to service connection for hypertension is denied. FINDINGS OF FACT 1. The Veteran has not been diagnosed with posttraumatic stress disorder (PTSD). 2. The Veteran's atrial fibrillation (AFib) did not have onset in service or is otherwise related to service. 3. The Veteran's stroke is not etiologically related to service. 4. The Veteran does not have a current traumatic brain injury (TBI) that had onset in or is otherwise related to service. 5. The Veteran's hypertension did not have onset in service or is otherwise related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for posttraumatic stress disorder (PTSD) have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for atrial fibrillation (AFib) have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.102, 3.303. 3. The criteria for service connection for stroke have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.102, 3.303. 4. The criteria for service connection for traumatic brain injury (TBI) have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.102, 3.303. 5. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1990 to September 1990. In February 2021, the Veteran testified at a virtual hearing before the undersigned. A transcript of the hearing is of record. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § § 3.303 (a). To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). 1. Entitlement to service connection for posttraumatic stress disorder (PTSD) The Veteran contends that he has PTSD that is a result of his military service. Specifically, the Veteran asserts that he experienced racism and racial tension in the form of racial slurs and segregated showers in service that have caused him to have PTSD. A review of the Veteran's service treatment records (STRs) does not reveal any complaints, treatment, or diagnosis of a mental health condition. Post-service medical records do not show the Veteran has been diagnosed with PTSD. There are several notations of the Veteran having PTSD, however, they are all based on the Veteran's reported history of PTSD. There is no psychological evaluation in the claims file that shows a diagnosis of PTSD, or any other mental disorder, that is related to service. In July 2017, after the Veteran suffered a stroke, a psychiatric assessment was requested to assess his capacity. During that assessment the Veteran reported he had no previous psychiatric history, never took any psychiatric medications, denied auditory or visual hallucinations, and denied any suicidal or homicidal ideations. The Veteran was not diagnosed with PTSD and any mention of PTSD was prefaced with 'by history' (of the Veteran). There is a diagnosis of depression noted after the June 2017 stroke which was attributed to being diagnosed with a stroke and other serious medical conditions. An October 2017 cardiovascular treatment note mentions possible post-stroke depression, and an October 2018 note reflects the Veteran was referred to and seen by a psychiatrist to address anger and frustration related to receiving many medical diagnoses. The note also states the Veteran was taking Zoloft for depression. The Board has considered the Veteran's contention that he has a mental health disorder, namely PTSD, that warrants service connection; however, the medical evidence does not show that the Veteran has been diagnosed with PTSD or any other mental health disorder that is related to his military service. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, a diagnosis and etiology of a mental health disorder falls outside the realm of common knowledge of a lay person. In the absence of proof of a current disability, there is no valid claim of service connection. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement that a current disability be present is satisfied when a claimant has a disability at any time during the pendency of a claim. McClain v. Nicholson, 21 Vet. App. 319 (2007). The record does not demonstrate that the Veteran has a current PTSD disability. The threshold element of a service connection claim (a current disability) has not been met; therefore, service connection for PTSD must be denied. Brammer v. Derwinski, 3 Vet. App. 223 (1992). Accordingly, as the evidence is not in approximate balance but is persuasively against the claim, the benefit of the doubt doctrine enunciated in 38 U.S.C. § 5107 (b) is not applicable, as there is no approximate balance of evidence. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 2. Entitlement to service connection for atrial fibrillation (AFib) The Veteran contends that his currently diagnosed AFib is related to his military service. Specifically, the Veteran asserts that his AFib disability is a result of a TBI that he incurred while in basic training. See Hearing Transcript (February 2021). A review of the Veteran's STRs reveal no evidence of complaints, treatment, or a diagnosis of a heart condition or a TBI. Post-service treatment records show that in June 2017 the Veteran had a stroke. Emergency department treatment records show that the Veteran was admitted with an altered mental state and found to be in atrial fibrillation with a rapid ventricular rate and significant hypertension. It was recommended that it was distinctly possible that the Veteran had had a stroke either as a cardioembolism from the atrial fibrillation cardiomyopathy or from hypertensive cerebral vascular disease. Other than the Veteran's statements that his AFib is related to service, there is no medical evidence that supports that contention. There is no evidence of AFib prior to June 2017, when the Veteran was taken to the emergency room. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, a diagnosis and etiology of AFib falls outside the realm of common knowledge of a lay person. The Board accords his statements regarding the etiology of such disorder little probative value as he is not competent to opine on a complex medical question. Accordingly, as the evidence is not in approximate balance but is persuasively against the claim, the benefit of the doubt doctrine enunciated in 38 U.S.C. § 5107 (b) is not applicable, as there is no approximate balance of evidence. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 3. Entitlement to service connection for stroke The Veteran contends that service connection is warranted for a stroke he had in June 2017. Specifically, the Veteran asserts that his stroke was a result of a TBI he incurred on active duty in 1990. A review of the Veteran's STRs reveal no evidence of complaints, treatment, or a diagnosis of a TBI. Post-service treatment records show that in June 2017, the Veteran was taken to the emergency room after being found unresponsive at a friend's home. Emergency department treatment records show that the Veteran was admitted with an altered mental state and found to be in atrial fibrillation with a rapid ventricular rate and significant hypertension. It was recommended that it was distinctly possible that the Veteran had had a stroke either as a cardioembolism from the atrial fibrillation cardiomyopathy or from hypertensive cerebral vascular disease. After further testing and treatment, it was determined the Veteran had a cerebrovascular accident (CVA) or brain attack. Imaging revealed a right middle cerebral artery stroke. Other than the Veteran's claim that his stroke was related to service, there is no medical or other competent evidence that suggests a stroke in 2017 is in any way related to the Veteran's service in 1990. At the February 2021 hearing, the record was held open for 90 days so the Veteran could obtain and submit a medical opinion linking the Veteran's stroke to service. To date that evidence has not been submitted. Accordingly, as the evidence is not in approximate balance but is persuasively against the claim, the benefit of the doubt doctrine enunciated in 38 U.S.C. § 5107 (b) is not applicable, as there is no approximate balance of evidence. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 4. Entitlement to service connection for traumatic brain injury (TBI) The Veteran contends that he has a traumatic brain injury that occurred in service. Specifically, the Veteran asserts that he fell down and hit his head in service, and he has also stated that he was involved in several fights during basic training in which he was hit/kicked in the head. See Hearing Transcript (February 2021). A review of the Veteran's STRs shows no evidence of complaints or treatment for a head injury. Military personnel records are absent any mention of fighting or disciplinary action for fighting. The Board notes that even if the Veteran did have a fall or was hit in the head, there is no evidence he incurred a traumatic brain injury during his four months of active duty service in 1990. Private medical records show that in June 2017, more than 25 years after the Veteran's discharge from service, he suffered a stroke that resulted in a traumatic brain injury. As a result, the Veteran's parents were granted an involuntary conservatorship by a probate court because the court found that as a result of the stroke, the Veteran suffered from memory and cognitive issues and was unable to manage his financial affairs. The court also found that evidence had been presented that the Veteran had suffered a brain injury as a result of his stroke. Additionally, the Veteran's mother submitted a Social Security Disability claim on behalf of the Veteran based on the stroke and the resulting brain injury. The Veteran is currently in receipt of Social Security disability benefits. Post-service treatment records note a history of TBI but only in the context of the Veteran's report of a TBI after a fall during military training. A February 9, 2021 cardiology note states anger management is attributed in part on the reported TBI, and the examiner opined the TBI, and sequelae based on the military accident explained at least 50 percent of the Veteran's confirmed medical morbidities being treated. As already stated, there is no evidence the Veteran sustained a TBI during his active duty in 1990. Any reference to such by the Veteran's physician is based solely on the Veteran's reports. While the Veteran has repeatedly reported to his treating physicians that he sustained a TBI in service, there is no evidence to support that contention in the STRs and the Veteran has not submitted any competent medical evidence to support that contention either. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, a diagnosis of a traumatic brain injury falls outside the realm of common knowledge of a lay person. The Board accords his statements regarding the diagnosis of such disorder little probative value as he is not competent to opine on a complex medical question. The only evidence of a brain injury the Veteran incurred was in 2017 as a result of a stroke. Accordingly, as the evidence is not in approximate balance but is persuasively against the claim, the benefit of the doubt doctrine enunciated in 38 U.S.C. § 5107 (b) is not applicable, as there is no approximate balance of evidence. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 5. Entitlement to service connection for hypertension The Veteran contends that his currently diagnosed hypertension disability is related to his military service. Specifically, the Veteran asserts that his hypertension is a result of a TBI he incurred on active duty in 1990. See Hearing Transcript (February 2021). A review of the Veteran's STRs reveals no evidence of complaints, treatment, or a diagnosis of a hypertension or a TBI. Post-service treatment records show that in June 2017, the Veteran was taken to the emergency room after being found unresponsive at a friend's home. Upon arrival he was found to have blood pressure of 220/105 and was described as being in hypertensive crisis. The Veteran's mother reported that she believed the Veteran had been diagnosed with hypertension previously but had not received any treatment for it. The Veteran himself, in an October 2017 statement, reported he had known of having high blood pressure in the past, but had wished to treat it without any medications. Although the Veteran believes his diagnosed hypertension is due to an in-service TBI, as noted above, there is no evidence the Veteran sustained a TBI in service, nor has the Veteran provided any evidence of such. Accordingly, as the evidence is not in approximate balance but is persuasively against the claim, the benefit of the doubt doctrine enunciated in 38 U.S.C. § 5107 (b) is not applicable, as there is no approximate balance of evidence. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Mitchell, 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.