Back to BVA DecisionsDENIEDSpecial Benefit NO SPECIAL BENEFIT Docket No. 220628-254267
HYPERTENSION
CHRISTOPHER SEPPANEN · 2023 · Case ID: A23031034
Summary
The veteran served on active duty from March 1965 to March 1968. The veteran appeals the denial of service connection for multiple conditions, including a heart disability, prostate cancer, hypertension, fatigue, syncope, vertigo, erectile dysfunction, glaucoma, and bilateral peripheral neuropathy in the upper and lower extremities. The Board denied service connection for all conditions. For the heart disability, prostate cancer, and hypertension, the Board found no evidence of in-service complaints or symptoms, no evidence of exposure to herbicide agents, and no medical evidence attributing these conditions to service. The Board noted that the veteran's service treatment records did not show complaints consistent with these conditions, and the persuasive weight of the evidence was against a service connection. For fatigue, syncope, and vertigo, the Board found no current diagnosis for fatigue or syncope, and the evidence indicated vertigo was not service-related. The veteran's assertion that these symptoms were due to hypertension was also unavailing, as hypertension was not service-connected. For erectile dysfunction, glaucoma, and peripheral neuropathy, the veteran claimed secondary service connection to diabetes, but since diabetes was not service-connected, secondary claims were denied. The Board also found no direct service connection or evidence of peripheral neuropathy manifesting within a year of service. Consequently, all claims were denied.
Rationale
No in-service complaints or treatment for heart disability; No evidence of herbicide exposure; No medical evidence attributing condition to service
Full Decision Text
Citation Nr: A23031034 Decision Date: 11/06/23 Archive Date: 11/06/23 DOCKET NO. 220628-254267 DATE: November 6, 2023 ORDER Entitlement to service connection for a heart disability is denied. Entitlement to service connection for prostate cancer is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for fatigue is denied. Entitlement to service connection for syncope is denied. Entitlement to service connection for vertigo is denied. Entitlement to service connection for erectile dysfunction is denied. Entitlement to service connection for glaucoma is denied. Entitlement to service connection for left lower extremity peripheral neuropathy is denied. Entitlement to service connection for right lower extremity peripheral neuropathy is denied. Entitlement to service connection for left upper extremity peripheral neuropathy is denied. Entitlement to service connection for right upper extremity peripheral neuropathy is denied. FINDINGS OF FACT 1. A heart disability was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 2. Prostate cancer was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 3. Hypertension was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 4. The evidence of record persuasively weighs against finding that the Veteran has a fatigue disability that began during active service or is otherwise related to an in-service injury or disease. 5. The evidence of record persuasively weighs against finding that the Veteran has syncope that began during active service or is otherwise related to an in-service injury or disease. 6. The evidence of record persuasively weighs against finding that the Veteran has vertigo that began during active service or is otherwise related to an in-service injury or disease. 7. The Veteran's erectile dysfunction is not secondary to a service-connected disease or injury and is not otherwise related to an in-service injury or disease. 8. The Veteran's glaucoma is not secondary to a service-connected disease or injury and is not otherwise related to an in-service injury or disease. 9. The Veteran's left lower extremity peripheral neuropathy is not secondary to a service-connected disease or injury and is not otherwise related to an in-service injury or disease. 10. The Veteran's right lower extremity peripheral neuropathy is not secondary to a service-connected disease or injury and is not otherwise related to an in-service injury or disease. 11. The Veteran's left upper extremity peripheral neuropathy is not secondary to a service-connected disease or injury and is not otherwise related to an in-service injury or disease. 12. The Veteran's right upper extremity peripheral neuropathy is not secondary to a service-connected disease or injury and is not otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a heart disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for prostate cancer have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for fatigue have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 5. The criteria for service connection for syncope have not been met. 38 U.S.C. §§ 1110, 111 .S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for fatigue have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 5. The criteria for service connection for syncope have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 6. The criteria for service connection for vertigo have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 7. The criteria for service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 8. The criteria for service connection for glaucoma have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 9. The criteria for service connection for left lower extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 10. The criteria for service connection for right lower extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 11. The criteria for service connection for left upper extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 12. The criteria for service connection for right upper extremity peripheral neuropathy have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1965 to March 1968. The rating decision on appeal was issued in April 2022 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the June 2022 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held in July 2023. Therefore, the Board may only consider the evidence of record at the time of the April 2022 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could evidence of record at the time of the April 2022 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Service Connection To establish service connection a Veteran must generally show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service." Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also 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). With respect to service connection based on herbicide exposure, VA laws and regulation provide that a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam war (i.e., January 9, 1962, to May 7, 1975), shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to the contrary. 38 U.S.C. § 1116 (a)(3); 38 C.F.R. § 3.307 (a)(6)(iii). Additionally, a veteran who, during active military service, served between April 1, 1968, and August 31, 1971, in a unit that, as determined by the Department of Defense, operated in or near the Korean DMZ (Demilitarized Zone) in an area in which herbicides are known to have been applied during that period, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to the contrary. 38 C.F.R. § 3.307 (a)(6)(iv). The Department of Defense (DoD) has identified specific units it has cited that served in areas along the DMZ in Korea where herbicides were used between April 1, 1968, and August 31, 1972. 38 C.F.R. § 3.307 (a)(6)(iv). If a veteran was exposed to an herbicide agent during active service, certain diseases, coronary artery disease, prostate cancer, and hypertension, will be presumed to have been incurred in service if manifest to a compensable degree within specified periods, even if there is no record of such disease during service. 38 U.S.C. § 1116 (a)(2); 38 C.F.R. §§ 3.307 (a)(6), 3.309(e). In this case, the Veteran did not have any service in the Republic of Vietnam. Further, the evidence of record demonstrates that the entirety of the Veteran's active service took place prior to April 1968, and prior to such date there is no documented evidence of the use of herbicides in Korea. As such, the above presumptive provisions cannot be applied to the Veteran's case. There is also no competent lay or medical evidence indicating that the Veteran was actually exposed to the designated herbicide agents in the course of his duties. Thus, there is no basis for the Board to find that the Veteran was exposed to herbicide agents during his active service. The Board notes the Veteran's reports of being in bunkers that contained barrels. He has stated that he believes these barrels contained pesticides. However, the DoD has not found any evidence of herbicide use in Korea during the period when the Veteran was stationed there. The Veteran stated that he did not know what was in the barrels, only that he guessed it was pesticides. The Board finds the DoD evidence more probative. Therefore, the Board finds that the Veteran was not exposed is also no competent lay or medical evidence indicating that the Veteran was actually exposed to the designated herbicide agents in the course of his duties. Thus, there is no basis for the Board to find that the Veteran was exposed to herbicide agents during his active service. The Board notes the Veteran's reports of being in bunkers that contained barrels. He has stated that he believes these barrels contained pesticides. However, the DoD has not found any evidence of herbicide use in Korea during the period when the Veteran was stationed there. The Veteran stated that he did not know what was in the barrels, only that he guessed it was pesticides. The Board finds the DoD evidence more probative. Therefore, the Board finds that the Veteran was not exposed to herbicide agents during his active service. 1. Entitlement to service connection for a heart disability Regardless of the lack of evidence of the Veteran's exposure to herbicide agents, the Board notes, that the Federal Circuit has held that a claimant is not otherwise precluded from establishing service connection for a disease averred to be related to herbicide exposure, as long as there is proof of direct causation. See Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed. Cir. 1994). VA treatment records show that the Veteran has a diagnosis of coronary artery disease. The Veteran's service treatment records do not contain complaints or treatment for a heart disability or associated symptoms, and the Veteran has not alleged such. In summary, the Veteran's service treatment records do not show complaints of or symptoms consistent with a heart disability, and he has not reported the onset of symptoms in service or in the year after separation from service. The evidence does not demonstrate in-service exposure to herbicide agents as contemplated in 38 C.F.R. §§ 3.307 and 3.309. Further, there is no medical evidence attributing the Veteran's coronary artery disease to his service. Accordingly, the persuasive weight of the probative evidence of record is against a finding that the Veteran's coronary artery disease is etiologically related to his active service. Thus, the benefit-of-the-doubt doctrine is not for application, and the claim of service connection for coronary artery disease must be denied. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 2. Entitlement to service connection for prostate cancer VA treatment records show that the Veteran has a diagnosis of prostate cancer. The Veteran's service treatment records do not contain complaints or treatment for prostate cancer or associated symptoms, and the Veteran has not alleged such. In summary, the Veteran's service treatment records do not show complaints of or symptoms consistent with prostate cancer, and he has not reported the onset of symptoms in service or in the year after separation from service. The evidence does not demonstrate in-service exposure to herbicide agents as contemplated in 38 C.F.R. §§ 3.307 and 3.309. Further, there is no medical evidence attributing the Veteran's prostate cancer to his service. Accordingly, the persuasive weight of the probative evidence of record is against a finding that the Veteran's prostate cancer is etiologically related to his active service. Thus, the benefit-of-the-doubt doctrine is not for application, and the claim of service connection for prostate cancer must be denied. Lynch, 21 F.4th 776 (Fed. Cir. 2021). 3. Entitlement to service connection for hypertension VA treatment records show that the Veteran has a diagnosis of hypertension. The Veteran's service treatment records do not contain complaints or treatment for hypertension or associated symptoms, and the Veteran has not alleged such. In summary, the Veteran's service treatment records do not show complaints of or symptoms consistent with hypertension, and he has not reported the onset of symptoms in service or in the year after separation from service. The evidence does not demonstrate in-service exposure to herbicide agents as contemplated in 38 C.F.R. §§ 3.307 and 3.309. Further, there is no medical evidence attributing the Veteran's hypertension to his service. Accordingly, the persuasive weight of the probative evidence of record is against a finding that the Veteran's hypertension is etiologically related ot his active service. Thus, the benefit-of-the-doubt doctrine is not for application, and the claim of service connection for hypertension must be denied. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 4. Entitlement to service connection for fatigue 5. Entitlement to service connection for syncope 6. Entitlement to service connection for vertigo 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 service. Accordingly, the persuasive weight of the probative evidence of record is against a finding that the Veteran's hypertension is etiologically related ot his active service. Thus, the benefit-of-the-doubt doctrine is not for application, and the claim of service connection for hypertension must be denied. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 4. Entitlement to service connection for fatigue 5. Entitlement to service connection for syncope 6. Entitlement to service connection for vertigo 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. The Veteran asserts that he experiences fatigue, syncope, and vertigo due to his hypertension. As his hypertension is not service-connected, secondary service connection for fatigue, syncope, and vertigo is not warranted. Service treatment records show fainting spells during service. VA treatment records show episodic dizziness and vertigo. A VA examination was conducted in December 2021. The examiner stated that there was insufficient medical evidence to warrant a diagnosis of syncope. The examiner further opined that the Veteran's current dizziness and vertigo were not related to his fainting spells in service, as the fainting spells in service did not indicate symptoms of dizziness or vertigo. The opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran does not have a current diagnosis of fatigue or syncope, and the probative evidence of record indicates that his vertigo is not related to his active service. Further, the Veteran himself has attributed these symptoms to his hypertension, which is not service-connected. The evidence persuasively weighs against service connection for fatigue, syncope, and vertigo. The benefit of the doubt doctrine is therefore not for application. Lynch, 21 F.4th 776 (Fed. Cir. 2021). 7. Entitlement to service connection for erectile dysfunction 8. Entitlement to service connection for glaucoma 9. Entitlement to service connection for left lower extremity peripheral neuropathy 10. Entitlement to service connection for right lower extremity peripheral neuropathy 11. Entitlement to service connection for left upper extremity peripheral neuropathy 12. Entitlement to service connection for right upper extremity peripheral neuropathy The Veteran claims service connection for erectile dysfunction, glaucoma, and bilateral upper and lower peripheral neuropathy all as secondary to diabetes. He is not currently service-connected for diabetes. Therefore, secondary service connection is not warranted. Furthermore, the record does not reflect, and the Veteran does not contend, that any of these disabilities is directly related to his active service. Finally, there is not evidence of record indicating that there was any peripheral neuropathy manifest within a year of active service. Accordingly, service connection for erectile dysfunction, glaucoma, and peripheral neuropathy of the bilateral upper and lower extremities is denied. Christopher Seppanen Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Creegan 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.