Citation Nr: 24031663 Decision Date: 10/09/24 Archive Date: 10/09/24 DOCKET NO. 16-08 815 DATE: October 9, 2024 ORDER Entitlement to service connection for hypertension is denied. Entitlement to service connection for a heart disability is denied. Entitlement to service connection for hypothyroidism is denied. FINDINGS OF FACT 1. The evidence of record is persuasively against a finding that hypertension manifested during the Veteran's period of active service, or within a year of separation from active service, or that it is otherwise the result of a disease or injury during active service, and it is against a finding that hypertension is secondary to a service-connected disability or is otherwise related to an in-service injury or disease. 2. The evidence of record is persuasively against a finding that a heart disability manifested during the Veteran's period of active service, or within a year of separation from active service, or that it is otherwise the result of a disease or injury during active service, and it is against a finding that a heart disability is secondary to a service-connected disability or is otherwise related to an in-service injury or disease. 3. The evidence of record is persuasively against a finding that hypothyroidism manifested during the Veteran's period of active service or that it is otherwise the result of a disease or injury during active service, and it is against a finding that hypothyroidism is secondary to a service-connected disability or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection for a heart disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for hypothyroidism have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1969 to March 1973. He also served in the Air Force Reserves from March 1973 to March 1975 and the Army National Guard from March 1975 to October 1996. These matters came to the Board of Veterans' Appeals from a July 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). These matters were remanded in November 2019 and February 2022. Service Connection The Veteran asserts that his hypertension, heart disability, and hypothyroidism are due to active service and/or due to or aggravated by a service-connected disability. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. Service connection may be granted for an injury or disease incurred or aggravated during a period of active duty for training (ACDUTRA). 38 U.S.C. § 101 (24)(B); 38 C.F.R. § 3.6 (a). ACDUTRA is, among other things, full-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c)(1). Inactive duty training (IDT) is part-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c)(1). Active duty also includes authorized travel to or from such duty or service. 38 C.F.R. § 3.6 (e). ACDUTRA is not defined as "active" service unless the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty while performing ACDUTRA. 38 U.S.C. § 101 (24); 38 C.F.R. § 3.6 (a). IDT is not defined at "active" service unless the individual concerned was disabled or died from an injury incurred or aggravated in line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident which occurred during such training. Id. Service connection is in effect for degenerative disc disease and spondylosis of the lumbar spine status post vertebral fracture and spinal fusion (10% 09/04/2013; 20% 03/10/2020); neurogenic bladder associated with degenerative disc disease and spondylosis of the lumbar spine (60% 03/10/2020); right lower extremity radiculopathy (20% 03/10/2020; 40% 10/07/2020); right knee status post knee replacement (30% 09/04/2013); left knee status post knee replacement (30% 09/04/2013); left lower extremity radiculopathy, sciatic nerve (20% 03/10/2020); left lower extremity radiculopathy, femoral nerve (20% 03/10/2020); right lower extremity radiculopathy, femoral nerve (20% 10/07/2020); left knee osteoarthritis (10% 09/04/2013); right knee osteoarthritis (10% 09/04/2013); right foot hallux valgus with hammer toes and tarsal tunnel syndrome (10% 09/04/2013); surgical scar, lumbar spine (10% 09/04/2013); and, scars, bilateral knees (0% 09/04/2013). The question for the Board is whether the Veteran has current disabilities of hypertension, a heart disability, and hypothyroidism that are due to active service or that are proximately due to or the result of, or were aggravated beyond their natural progress by a service-connected disability. The Board concludes that while the Veteran has a diagnosis of hypertension, myocardial infarction and CABG, and hypothyroidism, the evidence of record persuasively weighs against finding that such diagnoses began during service or are otherwise related to an in-service injury, event, or disease and are against a finding that such are proximately due to or aggravated by a service-connected disability. Service treatment records do not reflect any complaints of, treatment for, or diagnosis of hypertension, a heart disability, or hypothyroidism. A February 1969 Report of Medical Examination does not reflect a finding of hypertension, a heart disability, or hypothyroidism. His heart was clinically evaluated as normal. His blood pressure reading was 130/72. A chest x-ray was negative. A September 1972 Report of Medical Examination does not reflect a finding of hypertension, a heart disability, or hypothyroidism. His heart was clinically evaluated as normal. His blood pressure reading was 120/70. A September 1972 Report of Medical History reflects that the Veteran checked the 'No' boxes for 'thyroid trouble,' 'palpitation or pounding heart,' 'heart trouble,' and 'high or low blood pressure.' 10/02/1978 STR-Medical. A January 1979 Report of Medical Examination does not reflect a finding of hypertension, a heart disability, or hypothyroidism. His heart was clinically evaluated as normal. His blood pressure reading was 136/60. A chest x-ray was negative. A January 1979 Report of Medical History reflects that the Veteran checked the 'No' boxes for 'thyroid trouble,' 'palpitation or pounding heart,' 'heart trouble,' and 'high or low blood pressure.' A January 1983 Report of Medical Examination does not reflect a finding of hypertension, a heart disability, or hypothyroidism. His heart was clinically evaluated as normal. His blood pressure reading was 130/70. A January 1983 Report of Medical History reflects that the Veteran checked the 'No' boxes for 'thyroid trouble,' 'palpitation or pounding heart,' 'heart trouble,' and 'high or low blood pressure.' A December 1986 Report of Medical Examination does not reflect a finding of hypertension, a heart disability, or hypothyroidism. His heart was clinically evaluated as normal. His blood pressure reading was 110/58. A December 1986 Report of Medical History reflects that the Veteran checked the 'No' boxes for 'thyroid trouble,' 'palpitation or pounding heart,' 'heart trouble,' and 'high or low blood pressure.' A January 1991 Report of Medical Examination does not reflect a finding of hypertension or a heart disability. His heart was clinically evaluated as normal. The report reflects that he has hypothyroidism and is currently on Synthroid. His blood pressure reading was 124/80. A January 1991 Report of Medical History reflects that the Veteran checked the 'Yes' box for 'thyroid trouble and the 'No' boxes for 'palpitation or pounding heart,' 'heart trouble,' and 'high or low blood pressure.' He reported a diagnosis of and treatment for hypothyroidism two years prior. A September 1995 Report of Medical Examination does not reflect a finding of hypertension or a heart disability. His heart was clinically evaluated as normal. The report reflects that he has hypothyroidism and is currently on Synthroid. His blood pressure reading was 140/88. A September 1995 Report of Medical History reflects that the Veteran checked the 'No' boxes for 'palpitation or pounding heart,' 'heart trouble,' and 'high or low blood pressure.' In October 1995, he failed a cardiovascular screening and was to obtain follow-up. 10/21/1997 Medical Treatment Record-Government Facility. An August 1991 cardiovascular evaluation reflects a blood pressure reading of 130/88 and a normal treadmill stress test. 10/21/1997 Medical Treatment Record-Non-Government Facility. In June 2021 the Veteran underwent a C&P examination wherein hypothyroidism was diagnosed, which was noted to be initially diagnosed in 1987. The examiner noted that service treatment records are silent for complaints of hypothyroidism. His September 1972 exam was also normal, and he had no thyroid complaints. A January 1979 exam was normal. A January 1991 exam was positive for hypothyroidism for the past 2 years and he had been on Synthroid for 2 years. He has chronically been on Synthroid since then. The examiner stated that this is a condition that will require medication for the rest of his life. Unfortunately, it appears that the hyperthyroidism started after he separated from active military duty. He reported that he has a family history of thyroid disorder, so his hypothyroidism is likely genetic by nature. The examiner stated that there is nothing that the Veteran was exposed to that could have caused or aggravated the hyperthyroidism while he was on active duty. A nexus is not established. The examiner opined that his hypothyroidism is less likely than not due to service. In March 2024 the Veteran underwent a C&P examination wherein the examiner diagnosed hypothyroidism. The examiner found to supportive medical evidence to link neurogenic bladder and degenerative disc disease to the Veteran's hypothyroidism. The examiner further opined that his hypothyroidism is less likely than not aggravated by neurogenic bladder. The examiner stated that there is no objective link between his hypothyroidism and neurogenic bladder. In a separate opinion, the examiner opined that hypothyroidism and degenerative disc disease are not medically related. The hypothyroidism is a separate entity entirely from the degenerative disc disease and unrelated to it. A thorough review of medical literature failed to demonstrate a causal relationship. A nexus has not been established. The examiner opined that there is no supportive medical evidence to support the link between neurogenic bladder and degenerative disc disease and his hypothyroidism. The examiner opined that hypothyroidism is less likely than not caused by the Veteran's service-connected medical conditions. In a May 2024 addendum opinion, the examiner opined that there is no supportive medical evidence linking his neurogenic bladder and degenerative disc disease aggravating his hypothyroidism. Upon exhausting the limit of medical knowledge, the examiner opined that hypothyroidism is less likely than not aggravated beyond its natural progression by his neurogenic bladder and degenerative disc disease. In March 2024, the Veteran underwent a C&P examination wherein hypertension was diagnosed. The initial diagnosis was around August 2023. The examiner opined that the conditions of hypertension and neurogenic bladder are not medically related. The hypertension is a separate entity entirely from the neurogenic bladder and unrelated to it. A thorough review of medical literature failed to demonstrate a causal relationship. A nexus has not been established. The examiner proffered a negative opinion regarding aggravation. In a separate opinion, the examiner opined that his hypertension is not related to his service-connected degenerative disc disease with spondylosis as well as neurogenic bladder. The examiner stated that it is feasible that the medication used to control pain such as NSAID has the propensity of triggering hypertension but there is no objective evidence linking his degenerative disc disease and neurogenic bladder in themselves with hypertension. Therefore, the examiner opined that the claimed condition of hypertension is less likely than not caused by his service-connected conditions. In a separate opinion, the examiner opined that the conditions of hypertension and degenerative disc disease and spondylosis are not medically related. The hypertension is a separate entity entirely from the degenerative disc disease and spondylosis and unrelated to it. A thorough review of medical literature failed to demonstrate a causal relationship. A nexus has not been established. In a May 2024 addendum opinion, the examiner noted that the Veteran takes antihypertensive medication for the diagnosis of hypertension. Review of the medical record indicates that he has a history of neurogenic bladder and degenerative disc disease with spondylosis for which he is currently service-connected. Upon exhaustive search there is no medical evidence supporting the service-connected condition aggravating his hypertension. Therefore, the examiner opined that hypertension is less likely than not aggravated beyond its natural progression by the service-connected medical conditions. In March 2024, the Veteran underwent a C&P examination reflects diagnoses of acute, subacute, or old myocardial infection in 2016, and CABG in 2023. The examiner opined that the conditions of myocardial infarction status post CABG and neurogenic bladder are not medically related. The myocardial infarction status post CABG is a separate entity entirely from the neurogenic bladder and unrelated to it. A thorough review of medical literature failed to demonstrate a causal relationship. A nexus has not been established. In a separate opinion, the examiner opined that there is no supportive medical evidence to support the link between neurogenic bladder and degenerative disc disease and he has myocardial infarction, status post CABG. Therefore, the examiner opined that that the claimed condition of MI status post CABG is less likely than not caused by the Veteran's service-connected medical conditions. In a May 2024 addendum opinion, the examiner opined that there is no supportive medical evidence linking his neurogenic bladder and degenerative disc disease aggravating his myocardial infarction (MI), status post CABG. Upon exhausting the limit of medical knowledge, the examiner opined that the claimed condition of MI status post CABG is less likely than not aggravated beyond its natural progression by his neurogenic bladder and degenerative disc disease. The examiner noted that the Veteran is noted to have coronary artery disease status post CABG. Upon exhaustive search, there is no medical evidence supporting the service-connected condition aggravating his heart condition. Therefore, the examiner opined that MI status post CABG is less likely than not aggravated beyond its natural progression by service-connected medical conditions. As detailed above, service treatment records from the Veteran's period of active service are negative for any complaints of or treatment for hypothyroidism, hypertension, or a heart disability. There is no assertion that the Veteran experienced any symptoms related to hypothyroidism, hypertension, or a heart disability during active service. Hypothyroidism was initially diagnosed in 1987, thus approximately 14 years after separation from active service. Such is documented in an examination conducted during a period of reserve service, but the evidence of record does not reflect that hypothyroidism was manifested or diagnosed during a period of active duty or a period of ACDUTRA. Hypertension was diagnosed in or about August 2023, thus decades after separation from active service. A myocardial infarction was diagnosed in 2016, thus decades after separation from active service. Hypertension and a heart disability were not manifested or diagnosed during a period of ACDUTRA. Moreover, as detailed above, the C&P examiners proffered negative etiological opinions on a direct basis and on a secondary basis. The collective opinions are probative as they are based on an accurate medical history, to include the lay assertions of the Veteran and contain clear conclusions and support data for the negative etiological opinions. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There are no contrary opinions of record. While the Veteran may believe his hypothyroidism, hypertension, and heart disability are due to service or due to a service-connected disability, he is not competent to provide nexus opinions regarding these issues. The issues are medically complex, as such requires knowledge of the interaction between multiple organ systems in the body/anatomical relationships/pathology/interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). The Veteran is competent to report his recollections and symptomatology regarding his claimed disabilities but there is a 14-year lapse in time between his active service and the showing of hypothyroidism; a period of approximately 5 decades between his active service and the showing of hypertension; and a period of over 4 decades between his active service and the showing of a heart disability. There is also no medical evidence which reflects that these conditions were diagnosed during a period of ACDUTRA. ? (Continued on the next page) ? Accordingly, the weight of the evidence is against a finding that his hypothyroidism, hypertension, and a heart disability manifested during service and is against a finding that his hypothyroidism, hypertension, and a heart disability are due to or aggravated by his service-connected disabilities. Indeed, the overall conclusions of the trained medical examiners was that his hypothyroidism, hypertension, and a heart disability did not have an onset in service and that his hypothyroidism, hypertension, and a heart disability are not due to or aggravated by a service-connected lumbar spine disability or neurogenic bladder. Therefore, the claims of service connection are denied. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.W. Kreindler, 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.