Citation Nr: 22019872
Decision Date: 04/03/22	Archive Date: 04/03/22

DOCKET NO. 18-42 262
DATE: April 3, 2022

ORDER

1. Entitlement to service connection for a right shoulder disability, to include as secondary to the service-connected left shoulder disability, is denied.

2. Entitlement to service connection for a headache disability, to include as secondary to service-connected tinnitus, is denied.

3. Entitlement to service connection for a left knee disability is denied.

4. Entitlement to service connection for a right knee disability is denied.

5. Entitlement to service connection for irritable bowel syndrome (IBS), separate from the claim for GERD and to include as secondary to medications taken for service-connected disabilities, is denied.

6. Entitlement to service connection for residuals of a cold weather injury is denied.

7. Entitlement to service connection for a lumbar spine disability is denied.

8. Entitlement to service connection for a left hip disability is denied.

9. Entitlement to service connection for a right hip disability is denied.

10. Entitlement to service connection for a left foot disability is denied.

11. Entitlement to service connection for a right foot disability is denied.

12. Entitlement to service connection for left carpal tunnel syndrome (CTS) is denied.

13. Entitlement to service connection for right CTS is denied.

14. Entitlement to service connection for a psychiatric disorder, claimed as depression, is denied.

15. Entitlement to service connection for obstructive sleep apnea is denied.

16. Entitlement to service connection for allergic rhinitis, claimed as a bilateral sinus disability, is denied.

17. Entitlement to service connection for a left eye disability is denied.

18. Entitlement to service connection for a right eye disability is denied.

19. Entitlement to service connection for a bilateral hearing loss disability is denied.

20. Entitlement to service connection for hypertension is denied.

21. Entitlement to service connection for erectile dysfunction, to include as secondary to medications taken for the service-connected disabilities, is denied.

REMANDED

22. Entitlement to service connection for GERD, to include as secondary to medications taken for service-connected disabilities, is remanded.

FINDINGS OF FACT

1. The evidence persuasively weighs against finding that the Veteran has a right shoulder disability, to include pain that causes functional impairment that affects earning capacity, at any time during or approximate to the pendency of the claim.

2. The evidence persuasively weighs against a finding that the headache disability had an onset in service, is otherwise related to service, or is caused or aggravated by service-connected tinnitus.

3. The evidence persuasively weighs against finding that a left knee disability had an onset in service, manifested within one year of service discharge, or is otherwise related to service.

4. The evidence persuasively weighs against finding that the Veteran has a right knee disability, to include pain that causes functional impairment that affects earning capacity, at any time during or approximate to the pendency of the claim.

5. The evidence persuasively weighs against finding that the Veteran has a diagnosis of IBS or a related disability, to include pain that causes functional impairment that affects earning capacity, at any time during or approximate to the pendency of the claim.

6. The evidence persuasively weighs against finding that the Veteran has residuals of a cold weather injury, to include pain that causes functional impairment that affects earning capacity, at any time during or approximate to the pendency of the claim.

7. The evidence persuasively weighs against finding that the Veteran has a lumbar spine disability, to include pain that causes functional impairment that affects earning capacity, at any time during or approximate to the pendency of the claim.

8. The evidence persuasively weighs against finding that the Veteran has a left hip disability, to include pain that causes functional impairment that affects earning capacity, at any time during or approximate to the pendency of the claim.

9. The evidence persuasively weighs against finding that the Veteran has a right hip disability, to include pain that causes functional impairment that affects earning capacity, at any time during or approximate to the pendency of the claim.

10. The evidence persuasively weighs against finding that the Veteran has a left foot disability, to include pain that causes functional impairment that affects earning capacity, at any time during or approximate to the pendency of the claim.

11. The evidence persuasively weighs against finding that the Veteran has a right foot disability, to include pain that causes functional impairment that affects earning capacity, at any time during or approximate to the pendency of the claim.

12. The evidence persuasively weighs against finding that the Veteran has left CTS, to include pain that causes functional impairment that affects earning capacity, at any time during or approximate to the pendency of the claim.

13. The evidence persuasively weighs against finding that the Veteran has right CTS, to include pain that causes functional impairment that affects earning capacity, at any time during or approximate to the pendency of the claim.

14. The evidence persuasively weighs against finding that a psychiatric disorder had an onset in service or is otherwise related to service.

15. The evidence persuasively weighs against finding that obstructive sleep apnea had an onset in service or is otherwise related to service.

16. The evidence persuasively weighs against finding that the current allergic rhinitis had an onset in service or is otherwise related to service. 

17. The evidence persuasively weighs against finding that the current left eye disability had an onset in service or is otherwise related to service.

18. The evidence persuasively weighs against finding that the current right eye disability had an onset in service or is otherwise related to service.

19. The evidence persuasively weighs against finding that a bilateral hearing loss disability had an onset in service, manifested within one year of service discharge, or is otherwise related to service.

20. The evidence persuasively weighs against finding that hypertension had an onset in service, manifested to a compensable degree within one year of service discharge, or is otherwise related to service.

21. The evidence persuasively weighs against finding that erectile dysfunction had an onset in service or is secondary to medications taken for the service-connected disabilities.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a right shoulder disability, to include as secondary to the service-connected left shoulder disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2020).

2. The criteria for entitlement to service connection for a headache disability, to include as secondary to service-connected tinnitus, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2020).

3. The criteria for entitlement to service connection for a left knee disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020).

4. The criteria for entitlement to service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).

5. The criteria for entitlement to service connection for IBS, separate from the claim for GERD and to include as secondary to medications taken for service-connected disabilities, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2020).

6. The criteria for entitlement to service connection for a cold weather injury have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).

7. The criteria for entitlement to service connection for a lumbar spine disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).

8. The criteria for entitlement to service connection for a left hip disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).

9. The criteria for entitlement to service connection for a right hip disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).

10. The criteria for entitlement to service connection for a left foot disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).

11. The criteria for entitlement to service connection for a right foot disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).

12. The criteria for entitlement to service connection for left CTS have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).

13. The criteria for entitlement to service connection for right CTS have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).

14. The criteria for entitlement to service connection for a psychiatric disorder, claimed as depression, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).

15. The criteria for entitlement to service connection for obstructive sleep apnea have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).

16. The criteria for entitlement to service connection for allergic rhinitis, claimed as a bilateral sinus disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).

17. The criteria for entitlement to service connection for a left eye disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).

18. The criteria for entitlement to service connection for a right eye disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).

19. The criteria for entitlement to service connection for a bilateral hearing loss disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020).

20. The criteria for entitlement to service connection for hypertension have not been met.38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020).

21. The criteria for entitlement to service connection for erectile dysfunction, to include as secondary to medications taken for the service-connected disabilities, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 1981 to December 1988.

The Veteran testified at a virtual hearing before the undersigned Veterans Law Judge in April 2021. A transcript of the hearing was prepared and associated with the claims file.

Concerning the claim for service connection for a psychiatric disorder, claimed as depression, in Clemons v. Shinseki, the United States Court of Appeals for Veterans Claims (Court) noted the Board should consider alternative current disorders within the scope of the filed claim. Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Board has preliminarily reviewed the case at hand and finds that Clemons is applicable here. The RO has separately denied, and the claim has been certified to the Board, as a claim for depression. In light of Clemons, the Board has framed the issue as entitlement to service connection for a psychiatric disorder, claimed as depression, as reflected on the title page.

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 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. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a).

Service connection is also warranted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(b).

The Board must analyze the credibility and probative value of the evidence, account for the evidence it finds persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the veteran. Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011). This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record. See King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012); Kahana, 24 Vet. App. at 43334.

A lay person is competent to report to the onset and continuity of his symptomatology. Id. at 438. Moreover, lay evidence may be competent and sufficient evidence of a diagnosis or nexus if (1) the particular condition at issue is the type of condition that is within the competence or common knowledge of a lay person, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 137677 (Fed. Cir. 2007). The Board must determine on a case-by-case basis whether a particular condition is the type of condition that is within the competence of a lay person. See Kahana, 24 Vet. App. at 433, n. 4.

A veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009); see also Walker v. Shinseki, 708 F.3d 1331, 1334 (Fed. Cir. 2013). In making its ultimate determination, the Board must give a veteran the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. Fagan, 573 F.3d at 1287 (quoting 38 U.S.C. § 5107(b)).

1. Entitlement to a right shoulder disability, to include as secondary to the service-connected left shoulder disability

The Veteran testified at his April 2021 hearing that he believed that following his left shoulder injury in service, he began to overuse his right shoulder, causing a current right shoulder disability. 

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the claim for service connection for a right shoulder disability. The reasons follow.

The Board concludes that the Veteran does not have a current disability related to his right shoulder and has not had a disability at any time during the pendency of the claim or recent to the filing of the claim. While the Veteran is competent to report pain in his right shoulder, which he testified that he experiences due to overuse despite not testifying to specifics related to this pain, his assertions of right shoulder pain are general in nature. At his hearing, the Veteran asserted that he has a current right shoulder problem without specifying symptomatology associated with his right shoulder. The remainder of the claims file is similarly silent as to specific symptomatology in the right shoulder, and beyond that, when the Veteran reported his left shoulder pain to VA treatment providers, he did not mention also having right shoulder pain, which the Board finds as highly probative evidence that the Veteran is not experiencing significant symptomatology in the right shoulder, as he likely would have reported it at the time he was reporting symptoms in the opposing shoulder. In the October 2017 VA examination report, despite documenting a left shoulder disability, the examiner did not diagnose a right shoulder disability. The Board acknowledges that the October 2017 VA examiner documented very mild limitation of range of motion in the right shoulder on flexion, abduction, and internal and external rotation. However, the examiner also documented that there was no functional loss in the right shoulder despite this mild limitation in the range of motion of the joint.

In Saunders v. Wilkie, the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) held that "'disability' in [38 U.S.C.] § 1110 refers to the functional impairment of earning capacity" and "pain in the absence of a presently diagnosed condition can cause functional impairment," en route to its conclusion that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability." Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). However, the Federal Circuit also made clear that a veteran cannot "demonstrate service connection simply by asserting subjective painto establish a disability, the Veteran's pain must amount to a functional impairment. To establish the presence of a disability, a Veteran will need to show that [his or] her pain reaches the level of a functional impairment of earning capacity." Id. at 136768.

Here, the Veteran has not provided evidence that the pain in the right shoulder reaches the level of a functional impairment of earning capacity, as noted above. Thus, the facts cannot satisfy the basic compensation statute. A claim for pain alone is an insufficient factual showing that the pain derives from an in-service disease or injury. Consequently, the evidence does not establish that the Veteran has a current disability manifested by pain in the right shoulder that is related to service. Absent a current disability, service connection is denied.

Absent a current right shoulder disability or pain causing functional impairment of earning capacity constituting a disability for VA purposes, a claim that the right shoulder disability is secondary to the service-connected left shoulder disability is also be denied.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for a right shoulder disability is warranted. Rather, the evidence persuasively weighs against the claim on a direct or secondary basis. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). Thus, the claim for service connection for a right shoulder disability, to include as secondary to the service-connected left shoulder disability, is denied.

2. Entitlement to service connection for a headache disability, to include as secondary to service-connected tinnitus

The Veteran testified at his April 2021 hearing that his headaches began while he was in service, and he stated that his ears kept ringing after he cut his ear drum, causing headaches. At the October 2017 VA examination, the Veteran also reported that he had been experiencing headaches since the 1986 incident in service when a tire exploded near him.

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the claim for service connection for a headache disability. The reasons follow.

As to evidence of a current disability, an October 2017 VA examination report shows that the Veteran was diagnosed with acute, intermittent tension headaches.  Therefore, the facts establish that the first element of a service connection claim is met.

At the April 2021 hearing, the Veteran testified that he believes his headaches had an onset in service related to his now service-connected tinnitus. Thus, the Board will address this contention first. However, the Board finds the evidence persuasively weighs against a finding that tinnitus is causing his tension headaches. The Board acknowledges that a VA medical opinion addressing the secondary theory of entitlement was not provided, in part because the Veteran had not reported that he believed his headaches were related to his tinnitus until the Board hearing, which was after the AOJ issued the initial rating decision as to the Veteran's claim. However, the Board finds the evidence in the claims file weighs against a finding that the headaches are caused or aggravated by the service-connected tinnitus. 

First, and most persuasively, the Veteran was provided a VA examination to address the nature of his tinnitus in October 2017. At that examination, the Veteran was specifically asked whether he had any remarks related to his tinnitus, and the Veteran reported "Gets stopped up," but he did not report that he had headaches related to his tinnitus. Furthermore, the VA examiner specifically reported that the tinnitus did not have an impact on the ordinary conditions of the Veteran's daily life. The Board finds it likely that if there had been evidence, clinically or reported by the Veteran, that tinnitus was causing headaches, the examiner would have documented such symptomatology in this section of the VA examination report. Additionally, in the STRs, when the Veteran mentions that he is experiencing tinnitus, specifically in two, separate March 1986 STRs, he did not mention that he was also experiencing headaches because of the tinnitus, which is inconsistent with the Veteran's testimony made decades later. The Veteran also denied having a history of frequent or severe headaches in the September 1987 Report of Medical History that he completed near service discharge. The Board finds the contemporaneous records to be more probative as they are more consistent with the remainder of the record, including the October 2017 VA examination for tinnitus, than the Veteran's only statement in the record linking his headaches to his tinnitus made decades later at his April 2021 hearing. Given the aforementioned, the Board finds the evidence persuasively weighs against a finding that tinnitus caused or aggravates the current intermittent tension headaches.

Despite not meeting the requirements for service connection on a secondary basis, the Board will still address whether the facts establish entitlement to service connection on a direct basis.

However, as to evidence of a disease or injury in service, the service treatment records (STRs) do not show that the Veteran experienced headaches during service. For example, the STRs repeatedly document that the Veteran denied having or having had headaches. Specifically, on Reports of Medical History, completed by the Veteran in November 1985 and September 1987, the Veteran specifically denied having or having had frequent or severe headaches or a head injury, despite reporting having or having had swollen or painful joints and a painful or "trick" shoulder or elbow. The Board finds this highly probative evidence that the Veteran was not experiencing headaches in service, contrary to his statements and hearing testimony decades after service, as he likely would have reported it on this Reports of Medical History, especially given that he clearly filled out these forms with an attention to detail as he reported experiencing other symptoms in service. 

Furthermore, the Veteran has testified that he began experiencing headaches after the incident in service in which a tire exploded near him. The STRs document that such incident occurred in March 1986. However, despite reporting trauma to the right eye, including blurred vision and swelling, a loss of hearing, and tinnitus, the Veteran did not report that he had a headache, and notably, in the documents in the days and weeks after the incident, he also did not document or report that he had begun to experience headaches. The Board finds it highly probative that the Veteran reported other symptoms, and treatment providers documented other symptoms, following the incident but the Veteran did not report nor did the treatment providers document that the Veteran was experiencing headaches in the contemporaneous records. Furthermore, on Report of Medical History completed approximately 18 months after the incident related to the tire explosion, the Veteran again denied having or having had headaches, as noted above. Given the significant evidence against a finding that the Veteran had headaches during service, the Board finds the facts persuasively weigh against a finding that the second element of a direct service-connection claim is met.

Additionally, the Board finds the evidence weighs against a nexus between the current headache disability and the Veteran's active service. The Veteran was provided a VA examination in October 2017 to address the nature and etiology of his headaches. The examiner opined it was less likely than not that the current headaches were related to the Veteran's service because headache were not diagnosed during the Veteran's treatment for a tire explosion, nor do the STRs document chronicity of care. The examiner noted that the Veteran was evaluated within an hour after the tire explosion that documented other associated injuries but did not document that the Veteran was reporting a headache. 

The Board finds that the October 2017 VA medical opinion is highly probative, as the examiner reviewed the file, listened to the Veteran's report of history, physically examined the Veteran, and provided a rationale for the opinion that relied on the specific facts of the case, which facts are accurate as noted above, and medical principles. This is evidence against a nexus between the current headache disability and service. 

While the Veteran is competent to report symptoms that he has experienced in service and since service, including headaches, he is not competent to directly link the current diagnosis of acute, intermittent tension headaches to his tinnitus or to a specific incident in service, as medical expertise is required. In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's own opinion is nonprobative evidence. To the extent that he has reported observable symptoms, which he is competent to report, the Board finds that his allegations of chronic headaches since service are not credible for the reasons explained above. 

At the present time, there is no competent evidence to weigh against this medical opinion. Thus, the Board finds that the evidence persuasively weighs against finding a nexus between the current diagnosis of acute, intermittent tension headaches and active service.

The evidence is neither evenly balanced nor approximately so with regard to whether service connection for a headache disability is warranted. Rather, the evidence persuasively weighs against service connection on direct and secondary bases. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. See Lynch, 21 F.4th 776. Thus, the claim for service connection for a headache disability, to include as secondary to service-connected tinnitus, is denied.

3. Entitlement to service connection for a left knee disability

4. Entitlement to service connection for a right knee disability

The Veteran testified at his April 2021 hearing that he believes that his current bilateral knee symptoms are caused by exposure to cold weather in service. 

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the claim for service connection for a bilateral knee disability. The reasons follow.

As to evidence of a current disability, October 2015 VA records document osteoarthrosis in the left knee. Therefore, the facts establish that the first element of a service connection claim is met as to the left knee.

However, as to the right knee, the Board concludes that the Veteran does not have a current disability as the claims file does not document pain in the right knee, and the claims file does not document that the Veteran has had a disability of the right knee at any time during the pendency of the claim or recent to the filing of the claim. 

The Veteran presumably has some pain in his right knee given that he filed this claim and testified that his pain in his joints is due to a cold weather injury in service. However, the record does not document that the Veteran has consistently reported pain in his right knee. Rather, the Veteran, despite repeatedly documenting pain in his left knee since 2015, including a history of a surgery in the left knee, does not also report that he experiences pain in his right knee. The Board finds it likely that the Veteran would have reported symptomatology in the right knee had he been experiencing it at the time treatment was provided, as he reported pain in the opposing joint. Further, in a VA examination report, despite specifically diagnosing arthritis of the left knee, the examiner did not provide a diagnosis of a right knee disability. The examiner documented five degrees of loss of range of motion on flexion in the right knee, but the examiner specifically documented that there was no loss of function due to this minor loss of range of motion. 

Thus, the Board finds that the Veteran's allegations of right knee pain are general.  As stated above, the Federal Circuit stated that a veteran cannot "demonstrate service connection simply by asserting subjective pain," but that the pain "reaches the level of a functional impairment of earning capacity." Saunders, 886 F.3d at 1367-68. Here, the Veteran has not provided this evidence.  Thus, the facts cannot satisfy the basic compensation statute. A claim for pain alone is an insufficient factual showing that the pain derives from an in-service disease or injury. Consequently, the Board finds that the facts do not establish that the Veteran has a current disability manifested by pain in the right knee that causes functional impairment of earning capacity that is related to service. Absent a current disability, service connection for a right knee disability is not warranted.

Returning to the claim for service connection for a left knee disability, as to evidence of a disease or injury in service, October 1984 STRs show that the Veteran reported problems in his left knee. Thus, the facts establish that the second element of a service-connection claim as to the left knee is met.

However, as to evidence of a nexus between the current left knee disability and service, the Board finds that this element of a service-connection claim is not met for the left knee. For example, within the October 2017 VA examination report, the examiner opined that it was less likely than not that the current left knee disability was related to the Veteran's active service. The Veteran reported to the examiner that he injured his left knee during a football game during active service. He reported that he was told at the time that he tore something but that the injury did not require surgery. The examiner also noted that the Veteran ultimately had surgery on his left knee for a meniscus tear. Despite this, the examiner opined that despite being evaluated for a left knee injury in service, this injury was acute in nature, resolved during active service, and is not at least as likely as not related to the Veteran's service as the Veteran did not seek evaluation for knee pain until decades after his discharge from service.

The Board finds that the October 2017 VA medical opinion is highly probative, as the examiner reviewed the file, listened to the Veteran's report of history, physically examined the Veteran, and provided a rationale for the opinion that relied on the specific facts of the case, which facts are accurate, and medical principles. Specifically, the STRs do not document that the Veteran had a tear of his meniscus in service. The October 1984 STRs document that he was directed to wrap the knee and limit activity, but he was able to walk after the injury and there is no documentation of a possible tear at that time. Furthermore, the examiner's report that the left knee injury in service resolved is also consistent with the STRs. Specifically, clinical evaluations conducted in November 1985 and September 1987 document that the lower extremities were normal, The November 1985 examination documented a PULHES score of "1" for "L." The "PULHES" profile reflects the overall physical and psychiatric condition of an individual on a scale of 1 (high level fitness) to 4 (medical condition or physical defect is below the level of medical fitness required for retention in military service). The "L" stands for "lower extremities," which means the Veteran was found to be at a high level of fitness for the lower extremities. 

Furthermore, in Reports of Medical History associated with both the November 1985 and September 1987 examinations, the Veteran specifically denied having or having had a trick or locked knee, which the Board finds to be highly probative evidence against ongoing symptomatology in the left knee following the October 1984 incident. The Veteran reported on both of those Reports of Medical History that he had swollen or painful joints and a painful or "trick" shoulder or elbow, which were specifically documented to be related to the left shoulder disability. The Board finds this suggests that the Veteran filled these forms out with attention to detail, and, had he continued to experience symptoms in the left knee, he likely would have reported those symptoms within this document. Finally, consistent with the findings of the VA examiner, the numerous VA treatment records contained within the claims file, beginning in 2005, do not document that the Veteran reported symptoms in his left knee until decades after discharge from active service. Rather, the first documentation of treatment for left knee symptomatology are private treatment records from December 2019 to June 2019 that document that the Veteran had a left knee arthroscopy and meniscotomy in September 2013 and VA treatment records beginning in February 2015 that document a history of a knee surgery. Furthermore, VA treatment records from April 2019 document the Veteran specifically denied joint pain in his knees.

The VA examiner's opinion, which is consistent with the STRs and medical evidence referenced above, is evidence against a nexus between the current left knee disability and service. 

While the Veteran is competent to report symptoms that he has experienced in service and since service, he is not competent to directly link the current left knee disability to service, whether as related to exposure to cold or as due to the reported left knee injury in October 1984, as medical expertise is required. The question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the Veteran's own opinion is nonprobative evidence. At the present time, there is no competent evidence of nexus between the post-service left knee disability and service to weigh against the October 2017 medical opinion. Thus, the Board finds that the evidence persuasively weighs against finding a nexus between the current left knee disability and treatment for the left knee in service. 

Additionally, the Board notes that the claims file does not document that the Veteran had significant cold exposure in service, nor has the Veteran provided other evidence in support of this contention other than a vague assertion that cold exposure could cause his current left knee disability. Absent further support for this contention, the Board finds a VA opinion is not necessary.

Given the aforementioned, the Board finds that service connection for a left knee disability on a direct basis is denied.

Despite not meeting the requirements for service connection on a direct basis, the Board notes that arthritis is a chronic disease under 38 C.F.R. § 3.309, which allows for service connection on a presumptive basis if the chronic disease is manifested to a compensable degree within one year of discharge from service. However, in this case the evidence persuasively weighs against finding that the left knee arthritis had an onset within one year of discharge from service. Rather, the first documentation of a diagnosis of osteoarthritis in the knee is in March 2015 VA treatment records, which note a history of osteoarthritis of the knee without specifying which knee. October 2015 VA treatment records document osteoarthritis of the left knee only; thus, the Board presumes the March 2015 records refer to the left knee. VA treatment records from February 2015 specifically document no significant degenerative changes in the left knee and that an examination of the left knee was normal. Thus, the Board finds the evidence persuasively weighs against an onset of a diagnosis of arthritis in the left knee prior to March 2015, which the Board notes is approximately 27 years after discharge from active service. Thus, service connection for a chronic disease is denied as the disability did not manifest within a year of discharge from service, nor does the record support a finding of continuity of symptoms since service.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for a bilateral knee disability is warranted. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. See Lynch, 21 F.4th 776. 

5. Entitlement to service connection for IBS, separate from the claim for GERD and to include as secondary to medications taken for service-connected disabilities

The Veteran testified at his April 2021 hearing that he did not have issues with IBS before service, but he reported that he now has abnormal bowel movements. 

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the claim for service connection for IBS. The reasons follow.

The first element of service connection requires a current disability. After thoroughly reviewing the evidence of record, the Board finds the evidence persuasively weighs against a finding of a current disability of IBS. While the Veteran testified that he had abnormal bowel movements, the Board finds the evidence persuasively weighs against a finding of a current disability involving his bowel movements, as the treatment records in the claims file, which are extensive and include private and VA treatment records dating back to 2005, do not document a current diagnosis of IBS or symptoms of a bowel disability. Rather, treatment records document the Veteran specifically and repeatedly reporting that he did not have diarrhea or changes in bowel patterns. 

The Board acknowledges that the Veteran, in April 2009, reported having chronic diarrhea. However, in the records that follow, including records in February 2015, October 2015, July 2016, and July 2017, the Veteran denied such symptomatology. Thus, the Board finds the evidence persuasively weighs against a finding that the Veteran has chronic diarrhea as in the vast majority of the treatment records, the Veteran denied such symptoms. The Board also acknowledges that in June 2018 private treatment records, the Veteran reported that he had a history of intermittent blood in his stool that had resolved. In subsequent records from December 2019 to December 2020, the Veteran did not continue to report these symptoms. Thus, again, the Board finds that the evidence weighs against chronic symptoms of blood in the stool to constitute an ongoing bowel disability rather than an acute flare-up. Furthermore, despite medical records covering a 15-year period, which document a fairly extensive list of diagnosed disabilities and medical symptoms, these records do not document a diagnosis of IBS or symptoms related to intermittent diarrhea and/or blood in the stool, other than GERD which is addressed separately herein. Absent evidence of a current disability, service connection for a bowel disability is denied.

The Board acknowledges that the Veteran appears to have had an incident of what was likely food poisoning that caused diarrhea, which was documented in April 1988 STRs. However, absent a current disability, even if this were suggestive of an onset of something other than food poisoning, service connection must still be denied due to the finding of no current disability, to include pain that causes functional impairment of earning capacity.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for IBS is warranted. Rather, the evidence persuasively weighs against the claim. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. See Lynch, 21 F.4th 776. Thus, the claim for service connection for IBS is denied.

6. Entitlement to service connection for a cold weather injury

7. Entitlement to service connection for a lumbar spine disability

8. Entitlement to service connection for a left hip disability

9. Entitlement to service connection for a right hip disability

10. Entitlement to service connection for a left foot disability

11. Entitlement to service connection for a right foot disability

The Veteran testified at his April 2021 hearing that he believes his joint pain, including pain in his lumbar spine, hips, and feet, was caused by his exposure to cold weather in service. He testified that while he served in Colorado and Germany, he was exposed to cold weather for long periods of time while acting as a scout in field exercises, which caused him to go out into the field earlier than everyone else to act as a lookout. He testified that during this time he experienced tingling and numbness in his feet from the elements.  He also testified that he was not given shoes that were equipped for cold weather. He denied going to sick call or being put on light duty. 

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the claims for service connection for residuals of a cold weather injury, a lumbar spine disability, a bilateral hip disability, and a bilateral foot disability. The reasons follow.

The Veteran does not have a current disability related to residuals from a cold weather injury, a lumbar spine disability, a bilateral hip disability, or a bilateral foot disability and has not had disabilities at any time during the pendency of the claims or recent to the filing of these claims. The extensive VA and private treatment records, which date back to 2005, do not document disabilities related to the lumbar spine, bilateral hip, or bilateral foot, nor do they document residuals of a cold weather injury. Rather, the Veteran repeatedly denied pain in his spine and feet in VA treatment records dating back to 2009. During this time, the Veteran also repeatedly denied sensory changes, including symptoms of tingling and numbness. Furthermore, these records are silent for reports of a history of cold weather exposure and, despite a significant list of current medical symptoms, the problem list does not document symptoms or a diagnosis of a lumbar spine disability, a bilateral hip disability, or a bilateral foot disability. 

The Veteran's testimony at his April 2021 hearing regarding symptoms in his lumbar spine, hips, and feet are general, and the Veteran did not specifically testify to a specific functional loss as a result of this generally reported pain. As stated above, the Federal Circuit stated that a veteran cannot "demonstrate service connection simply by asserting subjective pain," but that the pain "reaches the level of a functional impairment of earning capacity." Saunders, 886 F.3d at 1367-68. Here, the Veteran has not provided this evidence.  Thus, the facts do not satisfy the basic compensation statute. A claim for pain alone is an insufficient factual showing that the pain derives from an in-service disease or injury. Consequently, the facts do not establish that the Veteran has a current disability manifested by pain in the lumbar spine, hips, and feet that is related to service. Absent a current disability, service connection is not warranted.

As to evidence of a disease or injury in service, the STRs do not also show that the Veteran sustained a disease or injury to the lumbar spine, hips, or feet during service, nor is there evidence of symptoms related to extreme cold exposure, and, thus, the second element of service connection is also not met. For example, clinical evaluations conducted in December 1982, November 1985, September 1987 document that the lower extremities, feet, and spine were all normal. PULHES scores of 1 were assigned for "L" at both the December 1982 and November 1985 examinations. PULHES scores were not assigned on the September 1987 examination. Furthermore, on Reports of Medical History associated with the November 1985 and September 1987 examinations (the December 1982 examination did not include a Report of Medical History) the Veteran specifically denied having or having had broken bones, recurrent back pain, and foot trouble. The Veteran also specifically denied having or having had neuritis, paralysis, or lameness that may have been suggestive off ongoing tingling or numbness following cold exposure. The Board finds this to be highly probative evidence that the Veteran was not experiencing these symptoms during service, as the Veteran documented having or having had a painful or "trick" shoulder and swollen or painful joints, which he specifically attributed to his left shoulder injury. The Board finds that, given this attention to detail, the Veteran would have likely reported other symptoms he had or was experiencing.

The Board acknowledges that the Veteran denied ever going to sick call for his reported symptoms of numbness and tingling, but, while this may explain the lack of STRs showing treatment for these symptoms, the Board still finds the Veteran would likely have reported these symptoms on the Reports of Medical History referenced above had he experienced such symptoms in service or if he had begun to have residuals resulting in pain in his hips, feet, and lumbar spine. Rather, the Veteran specifically denied having or having had such symptoms, despite reporting other medical symptoms he experienced in service. Thus, the Board finds the contemporaneous records to be more probative as they contradict the Veteran's statements made decades after his discharge from service. Thus, to the extent that the Veteran has alleged treatment for these disabilities in service, the Board finds such statements not credible. 

Given the aforementioned, the Board finds the evidence weighs persuasively against an onset of a disease or injury in service, and the second element of service connection is also not met. 

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for residuals of a cold weather injury, a lumbar spine disability, a bilateral hip disability, and a bilateral foot disability is warranted. Rather, the evidence persuasively weighs against service connection for these disabilities. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. See Lynch, 21 F.4th 776. 

12. Entitlement to service connection for left CTS 

13. Entitlement to service connection for right CTS

The Veteran testified at his April 2021 hearing that he started having trouble with his wrists three years into his military service. He stated he was working on computers doing dictation and working as a keypunch operator. He reported that he told people about these symptoms, but that he was told that it was normal for the fingers to tingle. Thus, he reported he never went to sick call, and he was never put on light duty. He reported that he was diagnosed with CTS in 1986 or 1987.

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the claim for service connection for bilateral CTS. The reasons follow.

The Board concludes that the Veteran does not have a current disability of CTS and has not had a disability at any time during the pendency of the claim or recent to the filing of these claims. The extensive VA and private treatment records, which date back to 2005, do not document a diagnosis of CTS or symptoms of CTS. Rather, the Veteran repeatedly denied sensory changes and tingling and numbness dating back to April 2009. Furthermore, despite a significant list of current medical problems, the problem list in VA treatment records does not include symptoms or a diagnosis of CTS. 

Additionally, the Board notes that the Veteran's testimony at his April 2021 hearing regarding symptoms in his bilateral wrists are general, and the Veteran did not specifically testify to a functional loss as a result of this general report of pain. As stated above, the Federal Circuit stated that a veteran cannot "demonstrate service connection simply by asserting subjective pain," but that the pain "reaches the level of a functional impairment of earning capacity." Saunders, 886 F.3d at 1367-68. Here, the Veteran has not provided this evidence. Thus, the facts cannot satisfy the basic compensation statute. A claim for pain alone is an insufficient factual showing that the pain derives from an in-service disease or injury. Consequently, the Board does not have evidence to establish that the Veteran has a current disability of CTS or a disability manifested by pain in the bilateral wrist that is related to service. Absent a current disability, service connection is not warranted.

As to evidence of a disease or injury in service, the STRs do not show that the Veteran sustained a disease or injury suggestive of an onset of bilateral CTS during service, and, thus, the second element of service connection is also not met. For example, Reports of Medical History, completed in November 1985 and September 1987 specifically document that the Veteran denied having or having had neuritis, paralysis, or lameness, symptoms the Board finds the Veteran may have documented had he been experiencing numbness or tingling in the wrists or upper extremities in service. Clinical evaluations of the upper extremities were not normal at the examinations associated with both of these Reports of Medical History. However, these abnormalities were documented as related to the well-documented left shoulder disability. Both examination reports show that clinical evaluation of the neurological system was normal. Neither examiner documented abnormal symptomatology associated with the wrists or hands, nor did either examiner document reported symptoms of numbness or tingling in the upper extremities. The Board finds this to be highly probative evidence that the Veteran was not experiencing these symptoms during service, as the Veteran documented having or having had a painful or "trick" shoulder and swollen or painful joints, which he specifically attributed to his left shoulder injury. The Board finds that, given this attention to detail, the Veteran would have likely reported other symptoms he had or was experiencing related to his hands and wrists.

The Board acknowledges that the Veteran denied ever going to sick call for his reported symptoms of numbness and tingling, but, while this may explain the lack of STRs suggesting treatment for these symptoms, the Board still finds the Veteran would likely have reported these symptoms on the Reports of Medical History referenced above had he experienced such symptoms in service or if he had begun to have symptoms of numbness or tingling in service. Rather, the Veteran specifically denied having or having had such symptoms, despite reporting other symptoms he experienced in service. Thus, the Board finds the contemporaneous medical records to be more probative as they contradict the Veteran's statements made decades after his discharge from service.

Given the aforementioned, the Board finds the evidence weighs persuasively against an onset of a disability in service, and the second element of service connection is also not met. 

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for bilateral CTS is warranted. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. See Lynch, 21 F.4th 776. Thus, the claim for service connection for bilateral CTS is denied.

14. Entitlement to service connection for a psychiatric disorder, claimed as depression

In a June 2021 statement, the Veteran reported that he worked as a scout during his service in Germany. He reported that he had to make sure everything was clear before everyone else went out. He also reported that he served as a border guard in West Germany. He reported that he was given a weapon but that it did not have ammunition, so he was always scared and stressed that the enemy would come with loaded weapons and he would not be able to protect himself. He also reported stress surrounding his family at that time because he was never sure if they were safe. 

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the claim for service connection for a psychiatric disorder. The reasons follow.

As to evidence of a current disability, VA treatment records from March 2005 document a diagnosis of major depressive disorder and generalized anxiety. Therefore, the facts establish that the first element of a service connection claim is met.

As to evidence of a disease or injury in service, the STRs do not show a disease or injury related to a psychiatric disorder during service. The Board acknowledges that the Veteran now reports experiencing stress and fear during service. However, the Board finds these statements to be less credible than the contemporaneous treatment records. Most probatively, the Board notes that at the time the Veteran was diagnosed with major depressive disorder and generalized anxiety disorder at VA in March 2005, he did not mention stressors or specific concerns from his service, nor did he report a history of these symptoms since service. Rather, the Veteran reported that he felt his depression specifically began in 2002 after the death of his father and the increased responsibility he felt at that time, including issues with multiple family members that were made worse when his stepfather passed away in approximately 2004. The Veteran also reported that working nights had started to make his sleep fragmented with these additional stressors. The Board finds these March 2005 records and the Veteran's statements as to the onset of his depression within the years immediately prior to his 2005 diagnosis to be more credible than the Veteran's statements of an onset of depression in service because the statements made in 2005 are consistent with the STRs, which do not document psychiatric symptoms in service and, instead, document the Veteran's denials of psychiatric symptoms.

Specifically, examinations conducted in December 1982, November 1985, and September 1987 document a psychiatric examination of the Veteran was clinically normal, and the Veteran was assigned a PULHES score of 1 for "S" at both the December 1982 and November 1985 examinations, where "S" stands for psychiatric. A PULHES score was not assigned at the September 1987 examination. Furthermore, on associated Reports of Medical History for the November 1985 and September 1987 VA examinations the Veteran specifically denied having or having had symptoms of depression or excessive worry, loss of memory or amnesia, and nervous trouble of any sort. These are symptoms the Board finds the Veteran would have likely endorsed on these Reports of Medical History had he experienced them during service as the Veteran filled out these forms with attention to detail since he documented experiencing symptoms of swollen or painful joints and a "trick" or locked shoulder or elbow associated with a left shoulder injury he experienced in service. Additionally, on these Reports of Medical History, the Veteran specifically denied having been treated for a mental condition. The Board notes that a Report of Medical History was not associated with the December 1982 examination.

Given the aforementioned, the Board finds the most probative evidence of record persuasively weighs against a finding that the Veteran had a disease or injury involving a psychiatric disorder in service. Thus, the facts establish that the second element of a service-connection claim is not met. As the evidence does not establish a disease or injury in service or a nexus between the post-service psychiatric disorder and service, service connection for a psychiatric disorder is not warranted.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for a psychiatric disorder is warranted. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. See Lynch, 21 F.4th 776. 

15. Entitlement to service connection for obstructive sleep apnea

The Veteran did not testify as to an onset of obstructive sleep apnea in service, but presumably believes he has a disability related to service.  

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the claim for service connection for obstructive sleep apnea. The reasons follow.

As to evidence of a current disability, VA treatment records beginning in 2015 document that the Veteran has a diagnosis of obstructive sleep apnea, and the Veteran testified that he started using a CPAP machine in 2006. Therefore, the facts establish that the first element of a service connection claim is met.

As to evidence of a disease or injury in service, the STRs do not show that the Veteran sustained a disease or injury related to obstructive sleep apnea during service. For example, Reports of Medical History completed in November 1985 and September 1987, the Veteran specifically denied having or having had frequent trouble sleeping. The Board finds this to be highly probative evidence against an onset of obstructive sleep apnea as the Veteran would have likely checked that he had experienced these symptoms in service if he had an onset of symptoms of obstructive sleep apnea in service, especially considering that the Veteran endorsed having or having had symptoms of swollen or painful joints and painful or "trick" shoulder or elbow, which the Board finds to suggest that the Veteran filled out this form with some attention to detail. Furthermore, the first documentation in the claims file of an actual diagnosis of obstructive sleep apnea is in 2015, approximately 27 years after the Veteran's discharge. Finally, the Veteran himself, when given the opportunity to assert an onset of obstructive sleep apnea in service at his hearing, did not do so. Rather, he specifically stated that he did not start using a CPAP until 2006, approximately 18 years after his discharge from service. Thus, the facts do not support a finding of a disease or injury in service, and the second element of a service-connection claim is not met.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for obstructive sleep apnea is warranted. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. See Lynch, 21 F.4th 776. Thus, the claim for service connection for obstructive sleep apnea is denied.

16. Entitlement to service connection for allergic rhinitis, claimed as a bilateral sinus disability,

The Veteran testified at his April 2021 hearing that, though he did not remember when he started having symptoms related to his sinuses, he did not recall it bothering him when he was in service other than a runny nose. However, he testified that his symptoms had gotten worse since service and over the last 30 years, and he reported he now treats his symptoms with medication he gets from VA. 

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the claim for service connection for allergic rhinitis. The reasons follow.

As to evidence of a current disability, an October 2017 VA examination report shows that the Veteran was diagnosed with allergic rhinitis. Therefore, the facts establish that the first element of a service connection claim is met.

As to evidence of a disease or injury, the STRs show that the Veteran was treated in April 1987 for symptoms of coughing, congestion, and rhinitis, which the Veteran reported at that time had been chronic for 6 months. Thus, the facts establish that the second element of a service-connection claim is met.

As to evidence of a nexus between the current disability and service, the Board finds that this element of a service-connection claim is not met. Within an October 2017 VA examination report, the examiner opined that the current diagnosis of allergic rhinitis was less likely than not related to service. There is no rationale to support this opinion, and the Board finds that this opinion is inadequate. However, despite having no adequate nexus opinion in the file, the Board finds an adequate nexus opinion is not necessary as the claims file does not document sufficient evidence of a nexus between the current diagnosis of allergic rhinitis and the documentation in service of 6 months of symptomatology of coughing, congestion, and rhinitis, as the evidence in the STRs and the evidence in the extensive medical records associated with the claims file dating back to 2005 do not document that the Veteran had ongoing symptoms since his initial report in April 1987, which the Board finds to be highly probative evidence that the in-service symptoms resolved prior to the Veteran's discharge from service and did not have an onset again until many years after the Veteran's discharge from service.

Specifically, following the April 1987 report of six months of rhinitis, coughing, and congestion, the nose and lungs and chest were clinically normal at the September 1987 examination. The Board finds this to be highly probative evidence that the April 1987 symptomatology had resolved. Furthermore, on the associated Report of Medical History, the Veteran specifically denied having or having had symptoms of asthma, chronic cough, ear, nose, and throat symptoms, hay fever, chronic or frequent colds, sinusitis, shortness of breath, and pain or pressure in the chest. The Board notes that had the Veteran continued to experience residuals of chronic ongoing symptoms from the documented illness in April 1987, the Veteran likely would have reported having or having had at least some of these symptoms. The Board finds this is also highly probative evidence against ongoing symptomatology throughout active service and after the Veteran's service, especially given that the Veteran completed this form with attention to detail as he reported having or having had symptoms of swollen or painful joints and a painful or "trick" shoulder or elbow. 

VA treatment records, which are extensive and date back to 2005, also document that the Veteran repeatedly denied coughing, wheezing, and shortness of breath dating back to April 2006 through February 2015, when VA treatment records document that the Veteran had a diagnosis of allergic rhinitis, which was stable. The Board finds this is also highly probative evidence that the Veteran did not have ongoing symptomatology of rhinitis after the single, six-month incident in service.

Finally, even the Veteran did not state at this April 2021 hearing that his current symptoms had an onset in service. Rather, he said that he was not diagnosed with a sinus problem until approximately three years prior to the hearing, and, though he reported ongoing symptoms for the last 30 years, the Board notes this suggests an onset in approximately 1991, which is three years after discharge from service and does not lend to a finding that the current disability had its onset in service.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for allergic rhinitis is warranted. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. See Lynch, 21 F.4th 776. Thus, the claim for service connection for allergic rhinitis is denied.

17. Entitlement to service connection for a left eye disability

18. Entitlement to service connection for a right eye disability

The Veteran testified at his April 2021 hearing that he worked on computers in service and prior to that time he had no issues with his vision or eyes. He reported that his eyes started bothering him when he was serving in Germany because he was reading often due to the paperwork and computer work. 

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the claim for service connection for a bilateral eye disability. The reasons follow.

As to evidence of a current disability, a November 2017 VA examination report shows that the Veteran was diagnosed with pinguecula and arcus senilis peripherally. Therefore, the facts establish that the first element of a service connection claim is met.

The Board notes that the November 2017 examination also documented that the Veteran had myopia and an astigmatism in both eyes. However, service connection for vision loss, including the diagnosed myopia and astigmatism, is not warranted because his declining vision is correctable refractive error, and is not a disability for the purposes of service connection. 38 C.F.R. §§ 3.303(c), 4.9. Myopia, astigmatism, and presbyopia are all considered to be forms of refractive error.  M21-1, III.iv.4.B.1.d. Actual pathology, other than refractive error, is required to support impairment of visual acuity.  M21-1, III.iv.4.B.1.b.

As to evidence of a disease or injury, the STRs show that the Veteran experienced trauma surrounding his right eye in March 1986 when the tire exploded near the right side of face. The Veteran reported blurred vision and swelling around the eye at that time. March 1983 STRs also documented that the Veteran reported redness in his right eye that was diagnosed as possible conjunctiva. Thus, the facts establish that the second element of a service-connection claim is met. 

As to evidence of a nexus between the current disability and service, the Board finds that this element of a service-connection claim is not met. The November 2017 VA examiner opined that the incident in service did not cause permanent ocular damage to the right eye, as the current examination did not show scarring or evidence of a previous injury to the eye, and thus, the current bilateral eye diagnoses are not as likely as not related to his active service.

The Board finds that the November 2017 VA medical opinion is highly probative, as the examiner reviewed the file, listened to the Veteran's report of history, physically examined the Veteran, and provided a rationale for the opinion that relied on the specific facts of the case, which facts are accurate, and medical principles. Specifically, the Board notes that the STRs support the examiner's opinion that the Veteran did not have a permanent disability to the eye following the March 1986 incident. While the Veteran had reported blurred vision and swelling in his eye at the time of the incident, the Veteran did not continue to report that these symptoms remained in the days that followed despite ongoing treatment related to the perforation of the right ear drum and the associated hearing loss and tinnitus. The Veteran did not document at that time that he was continuing to experience blurred vision, swelling, or other symptomatology in his right eye. An examination was conducted in September 1987, over a year after the incident, and a clinical ophthalmoscopic examination and general examination of the eyes was normal. The Board finds this is highly probative evidence that blurred vision, swelling, or other eye symptoms related to the March 1986 incident had resolved. 

Furthermore, within the September 1987 Report of Medical History, the Veteran reported that he had vision in both eyes and did not wear glasses or contact lenses, which the Board finds is also highly probative evidence that the Veteran's symptoms, especially the blurred vision, had resolved. This is evidence against a nexus between the current disability and service. There is no competent evidence to weigh against this medical opinion. Thus, the Board finds that the evidence persuasively weighs against finding a nexus between the currently diagnosed bilateral eye disability and treatment for an incident in March 1986 when a tire exploded near the right side of his face.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for a bilateral eye disability is warranted. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. See Lynch, 21 F.4th 776. Thus, the claim for service connection for a bilateral eye disability is denied.

19. Entitlement to service connection for a bilateral hearing loss disability

The Veteran testified at his April 2021 hearing that he believes he has a bilateral hearing loss disability that he attributes to the incident in March 1986 when the tire exploded near the right side of his face. The Veteran testified that he was not currently using hearing aids but had been told he would need them in the future. 

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the claim for service connection for a bilateral hearing loss disability. The reasons follow.

For the purpose of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz (Hz) is 40 decibels or greater; or when the auditory thresholds for at least three of these frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385.

The Veteran's hearing meets the requirements of a current bilateral hearing loss disability for VA purposes. On the authorized VA audiological evaluation in July 2013, pure tone thresholds, in decibels, for the ears were as follows:

 	HERTZ

 	500 Hz	1000 Hz	2000 Hz	3000 Hz	4000 Hz

RIGHT	15	25	15	20	30

LEFT	15	25	25	20	30

The speech recognition scores were 88 percent in the right ear and 88 percent in the left ear. The examiner specifically documented that the speech discrimination scores were appropriate for this Veteran, and, as they are below 94 percent, this finding constitutes a bilateral hearing loss disability for VA purposes despite the pure tone thresholds not meeting VA criteria for a hearing loss disability.

The STRs document hearing loss in the right ear only following the tire explosion in March 1986. At that time, the Veteran reported that he had some loss of hearing that was documented to be due to a perforation of the right ear drum. The Veteran was referred to audiology, and in the days following the incident, the Veteran was documented to have hearing loss and a threshold shift at higher frequencies.

On March 7, 1986, the day after the incident, pure tone thresholds, in decibels, for the ears were as follows:

 	HERTZ

 	500 Hz	1000 Hz	2000 Hz	3000 Hz	4000 Hz

RIGHT	45	50	45	-	60

LEFT	15	10	15	15	25

On March 13, 1986, a week after the incident, pure tone thresholds, in decibels, for the ears were as follows:

 	HERTZ

 	500 Hz	1000 Hz	2000 Hz	3000 Hz	4000 Hz

RIGHT	25	25	25	25	40

LEFT	15	10	15	10	10

The Board notes that this shows improvement in the Veteran's hearing in just one week.

On March 20, 1986, two weeks after the incident, pure tone thresholds, in decibels, for the ears were as follows:

 	HERTZ

 	500 Hz	1000 Hz	2000 Hz	3000 Hz	4000 Hz

RIGHT	5	20	10	15	25

LEFT	0	0	5	5	5

This again shows significant improvement, both from the initial measurements following the incident and from the week prior. The Veteran specifically reported at this time that he no longer had complaints about his hearing.

Additionally, an April 1987 examination, though the pure tone threshold chart was not completed, the examiner documented that the ears generally, as well as the ear drums, were clinically normal, and the Veteran himself, on the associated Report of Medical History specifically denied having or having had hearing loss or wearing hearing aids.

The Veteran is competent to report being around loud noises in service, and the Veteran specifically cited his exposure to loud noises and some hearing loss at the time of the March 1986 incident. The Board finds these incidents in service to be credible examples of acoustic trauma in service.

However, the Board finds the evidence persuasively weighs against a nexus between the in-service acoustic trauma and the current bilateral hearing loss disability. The Veteran was afforded a VA examination in October 2017 to determine the nature and etiology of his hearing loss disability. At this VA examination, the examiner opined, after a complete review of the claims file, that the Veteran's current bilateral hearing loss disability was less likely than not attributable to his service, despite the credible reports of in-service noise exposure. The examiner opined that hearing was within the normal progression for his age.

The Board acknowledges that the examiner did not specifically mention that the Veteran had a period of two weeks of hearing loss related to the March 1986 incident that are documented in the claims file. However, the Board finds that this does not render the opinion inadequate as the opinion relies on the Veteran having essentially normal hearing at discharge, despite credible noise exposure in service, which the Board finds is an accurate assessment of the facts given that the testing shows that the pure tone threshold results had returned to normal levels in both ears within two weeks of the March 1986 incident and, as noted above, despite the September 1987 examination not including documentation of audiological testing, the clinical examination of the ears and the ear drums was normal, and the Veteran specifically denied having or having had hearing loss.

While the Veteran is competent to report symptoms that he has experienced in service and since service, including his experience of decreased ability to hear, he is not competent to directly link the current bilateral hearing loss disability to service, as medical expertise is required. The question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the Veteran's own opinion is nonprobative evidence. Accordingly, at the present time, there is no competent evidence of a nexus between the post-service bilateral hearing loss disability and service to weigh against the October 2017 medical opinion, and the nexus element of a service-connection claim is not met.

Despite not meeting the requirements for service connection on a direct basis, the Board notes that a bilateral hearing loss disability is a chronic disease under 38 C.F.R. § 3.309, which allows for service connection on a presumptive basis if the chronic disease is manifested to a compensable degree within one year of discharge from service. However, in this case the evidence persuasively weighs against finding that the bilateral hearing loss disability had an onset within one year of discharge from service. Rather, the first documentation that the Veteran has even mild sensorineural hearing loss is noted in the October 2017 VA examination, conducted approximately 29 years after discharge from active service.

There is also no evidence of continuity of symptomatology. Although the Veteran reported exposure to loud noises during service, including at least one incident that caused temporary hearing loss, the STRs do not document complaints of hearing loss in service after that time, as noted on the September 1987 examination and associated Report of Medical History discussed above, wherein the Veteran denied a history of hearing loss. Additionally, the extensive VA and private treatment records associated with the claims file dating back to 2005, do not document that the Veteran reported that he was experiencing hearing loss until the Veteran filed this claim in May 2017. Rather, February 2015 VA treatment records document the Veteran specifically denied experiencing decreased hearing. 

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for a bilateral hearing loss disability is warranted. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. See Lynch, 21 F.4th 776. Thus, the claim for service connection for a bilateral hearing loss disability is denied.

21. Entitlement to service connection for hypertension 

The Veteran testified at his April 2021 hearing that his hypertension had an onset in Germany. He testified that he was told at that time that his blood pressure was high but that it was likely stress, and he did not need to be concerned. He then testified that he sought treatment for hypertension and went on medication two years after he was discharged from active service.

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the claim for service connection for hypertension. The reasons follow.

As to evidence of a current disability, April 2007 VA treatment records show that the Veteran was diagnosed with hypertension and prescribed Lisinopril. Therefore, the facts establish that the first element of a service connection claim is met.

As to evidence of a disease or injury in service, the STRs do not show that the Veteran was diagnosed with hypertension in service. Initially, the Board notes that there are two instances of mildly elevated blood pressure in service, including a reading of 128/86 at his entrance examination in December 1980 and a reading of 124/80 at a November 1985 examination. However, The Veteran was not diagnosed with hypertension on either of these examinations, and the Veteran's own testimony at his hearing decades after service, the Veteran acknowledged that he was told in service that these mildly elevated readings were not cause for concern. Further, on the Report of Medical History associated with the November 1985 VA examination, the Veteran specifically denied having or having had shortness of breath, pain or pressure in chest, heart palpitations, or high or low blood pressure, which the Board finds is persuasive evidence against significant symptomatology of high blood pressure suggestive of a possible onset of hypertension in service, especially given that the Veteran endorsed having or had other symptoms suggesting the Veteran was reporting a complete history of his current and past symptoms. Additionally, the Veteran was provided another examination in September 1987. Though a blood pressure reading was not recorded on this examination, on the associated Report of Medical History, the Veteran again specifically denied having or having had shortness of breath, pain or pressure in the chest, heart palpitations, or high or low blood pressure. Again, the Board finds this to be highly probative evidence against an onset of hypertension in service as the Veteran specifically denied having or having had symptoms of hypertension during service despite endorsing having or having had other symptomology at that time.

The Veteran testified that he was on medication for diagnosed hypertension within two years of his discharge from active service, but the Board finds that testimony is not credible. Though the Veteran continued to have mildly elevated blood pressure readings of 130/80 and 130/90, documented in VA treatment records from July and August 1991 respectively, neither of those VA treatment records document a diagnosis of hypertension. Further, in VA treatment records from March 2005, the Veteran specifically denied having hypertension. In April 2006, the Veteran again denied a history or past elevated blood pressure. The Board finds this to be highly probative evidence that the Veteran had not been diagnosed with hypertension or placed on medication for hypertension in the two years after discharge from service as multiple contemporaneous medical records over a period of approximately 18 years after the Veteran's discharge from service directly contradict the Veteran's testimony and document not only that the Veteran was not diagnosed with hypertension during that time period, but the Veteran himself repeatedly denied that he had hypertension or symptoms of hypertension. VA treatment records do not document the Veteran had a diagnosis of hypertension or was placed on new medication, Lisinopril, until 2007, approximately 19 years after the Veteran's discharge from active service. Thus, the Veteran does not meet the second element of a service-connection claim.

Despite not meeting the requirements for service connection on a direct basis, the Board notes that hypertension is a chronic disease under 38 C.F.R. § 3.309, which allows for service connection on a presumptive basis if the chronic disease is manifested to a compensable degree within one year of discharge from service. However, in this case the evidence persuasively weighs against finding that hypertension had an onset within one year of discharge from service. Rather, as noted above, the Veteran was not diagnosed with hypertension or placed on medication for hypertension until 2007, approximately 19 years after his discharge from active service. Thus, service connection based upon the onset of a chronic disease within one year of discharge from service is also denied.

VA did not provide the Veteran with an examination or medical opinion in connection with the claim for service connection for hypertension. The Board finds that entitlement to a VA examination or medical opinion is not warranted. The criteria for a VA examination were laid out above. The evidence is persuasively against the onset of hypertension in service, persistent or recurrent symptoms of hypertension in service, or evidence establishing that hypertension manifested during an applicable presumptive period. For a VA examination and/or medical opinion to be warranted, all the McLendon criteria have to be met, and at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for hypertension is warranted. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001). Thus, the claim for service connection for hypertension is denied.

22. Entitlement to service connection for erectile dysfunction, to include as secondary to medications taken for the service-connected disabilities

The Veteran testified at his April 2021 hearing that he is on so many medications that it has caused erectile dysfunction.

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the claim for service connection for erectile dysfunction. The reasons follow.

As to evidence of a current disability, March 2005 VA treatment records document the Veteran reported a low libido for three years prior to the treatment date, and in February 2015, the Veteran reported he was taking medication for erectile dysfunction as needed. Therefore, the facts establish that the first element of a service connection claim is met.

As to evidence of a disease or injury in service, STRs do not show that the Veteran sustained a disease or injury suggestive of an onset of erectile dysfunction during service. For example, December 1982, November 1985, and September 1987 examinations all do not document any clinical abnormality suggestive of an onset of erectile dysfunction, and the Veteran did not report on November 1985 and September 1987 Reports of Medical History that he had current symptoms or a history of erectile dysfunction, despite reporting having or having had other symptomatology. The Board finds this to be highly probative evidence against an onset of erectile dysfunction in service. Further, the Board notes that the Veteran does not assert that his erectile dysfunction had an onset in service, as noted above. Thus, the Veteran does not meet the second element of a service-connection claim.

VA did not provide the Veteran with an examination or medical opinion in connection with the claim for service connection for erectile dysfunction. The Board finds that entitlement to a VA examination or medical opinion is not warranted. The criteria for a VA examination were laid out above. The evidence is persuasively against evidence establishing that an event, injury, or disease occurred in service, nor does the evidence provided indicate that the disability may be associated with the Veteran's service or with another service-connected disability. For a VA examination and/or medical opinion to be warranted, all the McLendon criteria have to be met, and at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted.

The Board acknowledges that at the April 2021 hearing, the Veteran testified that he believed his erectile dysfunction was caused by medications he takes for his various disabilities. However, the Board notes that, for his service-connected disabilities alone, the Veteran was taking only Ibuprofen. A basic search of the side effects of Ibuprofen does not include erectile dysfunction, and the Veteran has provided no other evidence to support that Ibuprofen causes erectile dysfunction or has caused or aggravated erectile dysfunction in his specific case. The Board finds a vague assertion of relationship between medications and erectile dysfunction, in this instance, is not sufficient to warrant an examination absent any further supporting evidence that a relationship between erectile dysfunction and the Ibuprofen taken for the service-connected disabilities exists.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for erectile dysfunction is warranted. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. Lynch, 21 F.4th 776. Thus, the claim for service connection for erectile dysfunction is denied.

REASONS FOR REMAND

23. Entitlement to service connection for GERD, to include as secondary to medications taken for service-connected disabilities

At the April 2021 hearing, the Veteran testified that he believed his GERD, which is currently diagnosed, was caused by medications he takes for the service-connected left shoulder disability. The Veteran has not been provided VA examinations for GERD, and, as the Veteran has a current disability that he has reasonably asserted may be secondary to medications taken for the service-connected left shoulder disability, medications which reasonably could cause GERD, the Board finds a VA examination is necessary.

The matters are REMANDED for the following action:

Schedule the Veteran for a VA examination to determine the likely etiology of his GERD. The agency of original jurisdiction is asked to provide the examiner a copy of the below facts. 

To assist in a review of the claims file, the examiner is informed of the following facts with citations in the record, when applicable:

	The Veteran is service connected for postoperative status left shoulder for recurrent dislocation. 

	The VA treatment records show that the Veteran takes Ibuprofen, 800 mg, one tablet three times a day for mild pain and inflammation related to the service-connected left shoulder disability. 

	The Veteran also takes Amlodipine Besylate, calcium, Cetirizine, Lisinopril, Omeprazole, and Sildenafil, but these medications are not associated with the service-connected left shoulder disability.

	The Veteran alleges that he has developed GERD due to the medication he takes for the service-connected left shoulder disability. 

The examiner is asked to opine:

(a) Is the currently diagnosed GERD caused by the medication taken for the service-connected left shoulder disability? Please explain upon what facts, medical principles, and/or medical literature the opinion is based.  

(b) If the answer to (a) is negative, is GERD aggravated by the medications taken for the service-connected left shoulder disability? Aggravation is different from causation in that it did not cause the disability but rather caused an increase in severity that is not due to the natural progress of the disability. Please explain upon what facts, medical principles, and/or medical literature the opinion is based.  

(c) If the examiner finds that the medications taken for the service-connected left shoulder disability caused an increase in severity of GERD that is not due to the natural progress of the disability, the examiner is asked to state whether there is medical evidence created prior to the aggravation or at any time between the time of aggravation and the current level of disability that shows a baseline for GERD prior to aggravation. If the examiner is unable to establish a baseline for GERD prior to the aggravation, he or she should state such and explain why a baseline cannot be determined.

The examiner is asked to provide a rationale for each opinion given, including providing the medical principles and evidence relied upon for each opinion. If the examiner is unable to provide an opinion without resorting to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered.

 

A. P. SIMPSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Keninger, 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.