Citation Nr: 22016594 Decision Date: 03/22/22 Archive Date: 03/22/22 DOCKET NO. 18-23 258A DATE: March 22, 2022 ORDER Entitlement to service connection for headache disability is granted. Entitlement to service connection for cubital tunnel syndrome (CTS) is granted. REMANDED Entitlement to service connection for erectile dysfunction is remanded. Entitlement to service connection for hypertension is remanded. FINDING OF FACT The Board finds that the evidence of record is at least in relative equipoise that the Veteran's headache disability and CTS are related to his active-duty service. CONCLUSIONS OF LAW 1. The criteria for service connection for headache condition have been met. 38 U.S.C. §§ 1153, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for service connection for cubital tunnel syndrome (CTS) have been met. 38 U.S.C. §§ 1153, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty in the United States Army from September 1973 to September 1993. In October 2021, the Veteran was provided a hearing with the undersigned Veterans Law Judge and a transcript of the proceeding is of record. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). In order to establish service connection, the record must show competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d, 1362, 1366 (Fed. Cir. 2009). When considering such a claim for service connection, the Board must consider on a case-by-case basis, the competence and sufficiency of lay evidence offered to support a finding of service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 Fed. Cir. 2007)). The mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). 1. Entitlement to Service Connection: Headache Condition The Veteran contends that he currently suffers from a headache condition that is related to his active-duty service. As an initial matter, the Board acknowledges that the Veteran has been diagnosed with tension headaches. Further, the Veteran's service treatment records show the Veteran was in an accident and suffered an injury to his head. He also reported on his May 1993 separation examination that he had periodic severe headaches since the accident. Thus, the issue turns upon whether there is evidence of a nexus between the claimed in-service event or injury and the present disability. See Sheldon v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In June 2014, the Veteran attended a VA examination. The examiner opined that the claimed condition was at least as likely as not incurred in or caused by the claimed in-service injury, event, or illness. The examiner rationalized that the Veteran's in-service records show complaints of headaches. The Board acknowledges that a July 2014 VA addendum opinion was obtained, and the examiner opined that the Veteran's condition was not related to service. However, the Board notes that the examiner did not provide any rationale, only noting that the Veteran was discharged in 1993. Further, as provided above, the Veteran's in-service records show he was in May 1992 motor vehicle accident where he hit his head, as well as the Veteran reported at separation that he suffered from headaches on and off since the incident. Thus, the Board does not put probative value to the addendum opinion. Therefore, the Board finds the June 2014 VA opinion to be of significant probative value in determining the Veteran's headache condition is related to his active-duty service. The Board notes that the probative value of medical opinion evidence is based on the medical experts' personal examination of the patient, their knowledge, and skill in analyzing the data, and their medical conclusion. As is true with any piece of evidence, the credibility and weight to be attached to these opinions are within the province of the adjudicator. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Here, the examiner showed knowledge of the Veteran's background and based the opinion on the Veteran's lay contentions, the examiner's medical knowledge, and examination of the Veteran. Additionally, a complete rationale was provided for the opinion rendered and is consistent with the medical evidence of record. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). In light of the foregoing, the Board concludes that the probative evidence of record is for the claim and the benefit of the doubt doctrine has been applied. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 2. Entitlement to Service Connection: Cubital Tunnel Syndrome The Veteran contends that his cubital tunnel syndrome (CTS) is related to his active-duty service. As an initial matter, the Board acknowledges that the Veteran has been diagnosed with CTS. Further, the Veteran's service treatment records show he complained of issues of strength in his right hand, an inability to fully squeeze, and an odd feeling there was something sliding in his hand. Thus, the issue turns upon whether there is evidence of a nexus between the claimed in-service event or injury and the present disability. See Sheldon v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In June 2014, the Veteran attended a VA examination. The examiner opined that the claimed condition was at least as likely as not incurred in or caused by the claimed in-service injury, event, or illness. The examiner rationalized that the Veteran's bilateral CTS began in service due to the nature of the Veteran's training and his last military occupational specialty involved a lot of work with his hands, which increases the symptoms of CTS. The Board acknowledges that a July 2014 VA addendum opinion was obtained, and the examiner opined that the Veteran's condition was not related to service due to there being no evidence to support CTS being present in military. However, as noted above, the Veteran reported pain, weird feeling in his hands, and issues squeezing his right hand in October 1979, as well as his right hand was injured in January 1992, which resulted in a laceration, pain in the wrist and limited flexion. Therefore, in applying the benefit of the doubt, the Board does not put probative value to the July 2014 opinion. Accordingly, the Board finds the June 2014 VA opinion to be of significant probative value in determining the Veteran's CTS is related to his active-duty service. The Board notes that the probative value of medical opinion evidence is based on the medical experts' personal examination of the patient, their knowledge, and skill in analyzing the data, and their medical conclusion. As is true with any piece of evidence, the credibility and weight to be attached to these opinions are within the province of the adjudicator. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Here, the examiner showed knowledge of the Veteran's background and based the opinion on the Veteran's lay contentions, the examiner's medical knowledge, and examination of the Veteran. Additionally, a complete rationale was provided for the opinion rendered and is consistent with the medical evidence of record. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Thus, the Board concludes that the probative evidence of record is for the claim and the benefit of the doubt doctrine has been applied. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). REASONS FOR REMAND Although the Board regrets further delay, additional development is required prior to adjudication of the Veteran's remaining claims. Entitlement to Service Connection: Erectile Dysfunction, and Hypertension The Veteran contends that he suffers from erectile dysfunction (ED) and hypertension that are related to his active-duty service. The Board finds that the Veteran has not been afforded VA examinations for the claims of entitlement to service connection for ED and service connection for hypertension. VA's duty to assist includes providing a medical examination and obtaining an opinion when it is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159. Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of a diagnosed disability or symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). The threshold for finding a link between a current disability and service so as to require medical examination is low. Locklear v. Nicholson, 20 Vet. App. 410 (2006); McLendon, 20 Vet. App. at 83. Here, the medical evidence of record shows the Veteran has reported issues with sexual performance and has been diagnosed with hypertension. Further, the Veteran's service treatment records show the Veteran was diagnosed with multiple sexually transmitted disease (STDs) and/or urethral issues, as well as his records show multiple elevated blood pressure readings. The Board additionally notes that his medical records suggest his ED may also be related to his hypertension. Given the above, the Board finds that a remand is required in order to obtain VA examinations with opinions as to the etiologies of the claimed conditions. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Obtain and associate with the Veteran's electronic claims file any outstanding VA treatment records and private medical records relevant to the Veteran's claims. 2. After all outstanding records have been associated with the file, schedule the Veteran for VA examinations to determine the etiology of the Veteran's erectile dysfunction and hypertension. The record and a copy of this Remand must be made available to the examiner. Following a review of the entire record, the Veteran's competent lay statements, as well as the Veteran's report regarding the onset and progression of his current symptomatology, the examiner should opine as to the following: (a) For the Veteran's hypertension, is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's hypertension had its onset during, or is otherwise related to, his active-duty service, to include his May 1993 separation examination where his blood pressure was 132/86, the September 1990 reading of 120/80, and the January 1976 reading of 120/86 with the notation of nosebleed for several days? (b) For the Veteran's erectile dysfunction, is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's erectile dysfunction had its onset during, or is otherwise related to, his active-duty service, to include his in-service diagnoses of chlamydia, gonorrhea, and condyloma? (c) If the Veteran's erectile dysfunction is NOT directly related to his service, then is it at least as likely as not (50 percent probability or more) that the erectile dysfunction is due to his hypertension, to include any medications taken for his hypertension? (d) Is at least as likely as not (50 percent probability or more) that the Veteran's erectile dysfunction is aggravated by his hypertension, to include any medications for his hypertension? "Aggravation" is defined as any worsening beyond the natural progression of the disability. In offering any opinion, the examiner must consider the full record, to include the lay statements regarding in-service incurrence, and the opinion should reflect such consideration. A clearly-stated rationale for any opinion offered should be provided and must not be based solely on the lack of any in-service records. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain whether the inability is due to the limits of the examiner's medical knowledge, medical knowledge in general or there is evidence that, if obtained, would permit the opinion to be provided. JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Negron, 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.