Citation Nr: 18139665
Decision Date: 09/28/18	Archive Date: 09/28/18

DOCKET NO. 16-02 510
DATE:	September 28, 2018
ORDER
Entitlement to service connection for a dental condition is denied.
Entitlement to service connection for high blood pressure (hypertension) is denied.
Entitlement to service connection for a left knee disorder, diagnosed as arthritis is denied.
FINDINGS OF FACT
1.  The Veteran does not have a current dental disorder for which compensation may be paid.
2.  The Veteran’s hypertension was not present in service or manifest to a compensable degree within one year of service discharge, and is not otherwise related to service.
3.  The Veteran’s left knee arthritis was not present in service or manifest to a compensable degree within one year of service discharge, and is not otherwise related to service.
CONCLUSIONS OF LAW
1.  The criteria for service connection for a dental disorder for compensation purposes are not met.  38 U.S.C. §§ 1131, 1712, 5107(b) (2012); 38 C.F.R. §§ 3.303, 3.381, 4.150 (2018). 
2.  The criteria for service connection for hypertension are not met.  38 U.S.C. §§ 1112, 1113, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2018).
3.  The criteria for service connection for a left knee disorder, diagnosed as arthritis are not met.  38 U.S.C. §§ 1112, 1113, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2018).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran served with the Texas Army National Guard and had a period of active duty training (ADT) from August 1976 to December 1976.  This matter is before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. 
In this case, 38 U.S.C. § 5103(a)-compliant notices were provided in September 2012 and October 2012.  The record also shows that VA has fulfilled its obligation to assist the Veteran in developing the claims, including with respect to VA examinations.  He has not identified any deficiency in VA’s notice or assistance duties.  
Service Connection
The Veteran is seeking service connection for a dental condition, hypertension, and a left knee disability.  As noted above, his service with the National Guard included a period of ADT August 1976 to December 1976.  He did not otherwise serve a period of active duty and there is no official documentation of any other periods of ADT or inactive duty for training(IDT).  However, in his initial application for VA compensation, the Veteran referred to that specific period of ADT in 1976 as being the pertinent time frame at issue in this appeal.  
Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service.  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 - the so-called “nexus” requirement.  Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).  
“Active service” includes active duty, a period of active duty for training (ADT) in which the individual was disabled from a disease or injury incurred or aggravated in the line of duty, and a period of inactive duty training (IDT) in which the individual was disabled from an injury incurred or aggravated in the line of duty.  38 U.S.C. § 101(21), (24)(B); 38 C.F.R. § 3.6(a).  See also Brooks v. Brown, 5 Vet. App. 484 (1994).
ADT includes full-time duty performed for training purposes by members of the Reserves or National Guard.  38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c).  IDT is generally duty (other than full-time duty) prescribed for Reserves or duty performed by a member of the National Guard of any State (other than full-time duty).  38 U.S.C. § 101 (23); 38 C.F.R. § 3.6(d).  Annual training is an example of ADT, while weekend drills are IDT.  
Certain chronic diseases are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service.  38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a).  Continuity of symptomatology may also provide a basis for a grant of service connection for those diseases defined as “chronic” by VA, which include both arthritis and hypertension.  38 C.F.R. §§ 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).  
Because the Veteran is alleging that he has an injury or disease incurred or aggravated during ADT with the National Guard from August 1976 to December 1976, he must first establish “veteran” status with respect to that period service and that he was disabled from disease or injury incurred or aggravated in the line of duty during that service, such as while on ADT.  38 C.F.R. § 3.1(a),(d); Harris v. West, 13 Vet. App. 509 (2000); Paulson v. Brown, 7 Vet. App. 466 (1995).  In this case he has already established veteran status as he is service-connected for hearing loss, tinnitus and a lumbar spine disability based on this period of ADT.  See Hill v. McDonald, 28 Vet. App. 243, 251-52 (2016) (holding that once a claimant has achieved veteran status for a single disability incurred or aggravated during a period of active duty for training, veteran status applies to all disabilities claimed to have been incurred or aggravated during that period of active duty for training).
When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, any reasonable doubt is resolved in favor of the Veteran.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.  
1.  service connection for a dental condition
The Veteran seeks service connection for a dental condition.  
The Board notes that a claim for service connection for a dental condition is also considered a claim for VA outpatient dental treatment.  Mays v. Brown, 5 Vet. App. 302, 306 (1993).  However, in dental claims, the RO adjudicates the claim of service connection and the VA Medical Center (VAMC) adjudicates the claim for outpatient treatment.  As this matter stems from an adverse RO determination, the appeal is limited to the issue of entitlement to service connection for a dental disorder for compensation purposes.  In any event, the claim for dental treatment has been raised and that aspect of the claim was forwarded to the nearest VA dental clinic for adjudication.  See January 2016 Statement of the Case.  Therefore, the separate issue of service connection for a dental condition for treatment purposes only is not on appeal before the Board at this time.
Dental disorders are treated differently than other medical disorders in the VA benefits system.  See 38 C.F.R. § 3.381.  Compensation is only available for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla.
Service connection for a loss of teeth will be considered for compensation purposes, if it is due to a loss of substance of the body of either the maxilla or the mandible provided that the bone loss is due to either trauma or disease such as osteomyelitis and not to the loss of the alveolar process as a result of periodontal disease.  38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 4.150. 
The Veteran does not claim that he suffered dental trauma in service, but instead reports that he had four teeth removed while he was on active duty and feels that “nothing else has been done” for the loss of these teeth.  He reports that currently he has difficulty chewing food, particularly hard foods, such has steak, carrots, apples, and nuts.  He is now reduced to eating soft foods.  See VA Form 21-0958, Notice of Disagreement, dated November 15, 2013 and VA Form, 9, dated January 15, 2016.  
Service dental treatment records show a single entry dated in October 1976, just prior to separation, where the Veteran was evaluated for toothache involving tooth number three.  Service dental records do not otherwise show any trauma to the mouth or teeth or any mention of a tooth being removed due to disease or infection.  The dental chart does not indicate any teeth were missing or defects to teeth.  At separation the Veteran denied history of severe tooth or gum trouble.  See October 1976 Report of Medical History.  The accompanying Report of Medical Examination in December 1976, shows the Veteran’s mouth and throat were normal and the examiner did not indicate any dental defects or diseases.  The only other dental entry is dated in June 1978 during a period of Annual Training (AT) when the Veteran was given a temporary filling after fracturing an old restoration in the lower right molar area.  He was referred to private dentist after completion of AT.
Service connection for a dental disorder for compensation purposes is not warranted.  There is no evidence of in-service dental trauma causing a loss of substance of the body of either the maxilla or the mandible, or loss of teeth due to a disease such as osteomyelitis.  The Board acknowledges that the Veteran’s service records document some dental treatment, however they fail to document any trauma due to an injury or wound.  Generally, service trauma is defined as an injury or wound produced by an external physical force during a service member’s performance of military duties.  See Nielson v. Shinseki, 607 F.3d 802 (Fed. Cir. 2010).  The definition excludes “the intended result of proper medical treatment.” Id.
Moreover, the post-service evidence of record does not show a diagnosis or treatment for a current dental problem and the Veteran has not otherwise identified a specific dental disorder or the source of current dental treatment.  In this case, entitlement to VA compensation benefits for a dental disorder is not warranted.
Accordingly, the preponderance of the evidence is against the claim and there is no reasonable doubt to be resolved.  38 U.S.C. § 5107(b).
2.  service connection for hypertension (high blood pressure)
The Veteran is seeking service connection for hypertension that he states was diagnosed while he was serving in the Army.  He reports that he had problems with high blood pressure while in the service and was put on medication for it at his entry in the service.  See VA Form 21-0958, Notice of Disagreement, dated November 15, 2013 and VA Form, 9, dated January 15, 2016.  In a January 2014 letter the Veteran’s wife stated that he has struggled with high blood pressure since 1985.  See lay statement from K, Ivory, dated January 28, 2014. 
For VA compensation purposes, the term “hypertension” means that the diastolic blood pressure is predominantly 90mm or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm or greater with a diastolic blood pressure of less than 90mm.  Multiple blood pressure readings are required to confirm the diagnosis of hypertension with 2 or more readings on at least 3 different days.  38 C.F.R. § 4.104, DC 7101, Note 1.
Service treatment records fail to reveal any evidence of elevated blood pressure readings sufficiently high to require treatment, or to result in a diagnosis of hypertension prior to the Veteran’s separation from ADT in October 1976.  He also denied having, or ever having had, high blood pressure in the accompanying report of medical history.  As such, there is no evidence of hypertension during active military service.
There is also no objective evidence that the Veteran was diagnosed as having hypertension within one year of his service discharge.  Post-service records show a diagnosis of hypertension since at least 2009.  See clinical records from Parkland Health & Hospital.  Although the record also contains references to hypertension as early as 1985, even this date is years after discharge from his period of active service in 1976.  See lay statement from K. Ivory, dated January 28, 2014.  Because hypertension was not demonstrated until many years following his separation from active duty, the Veteran may not be allowed service connection on a presumptive basis.  38 C.F.R. §§ 3.307, 3.309. 
There is also no competent evidence linking hypertension to the Veteran’s military service many years earlier and he has not submitted any medical opinion that relates it to service/events therein.  The Veteran underwent a VA examination in January 2016, where the examiner noted a history of longstanding hypertension, but did not otherwise indicate date of onset.   
However, since service and post-service treatment records provide no basis to grant this claim, and in fact provide evidence against it, the Board finds no basis for an additional VA examination or medical opinion to be obtained.  Furthermore, as for any assertions by the Veteran, or any representative that there exists a medical relationship between his hypertension and service, the Board notes that the matter of its etiology is one within the province of trained professionals.  Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), determining the etiology of hypertension (as distinguished from merely reporting the presence of symptoms) is a complex medical matter that falls outside the realm of common knowledge of a lay person.  See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007) (providing that lay persons are not competent to diagnose cancer).  As the Veteran is not shown to be other than a layperson, without the appropriate training and expertise he is not competent to render a probative (i.e., persuasive) opinion the medical matter upon which this claim turns.  Id.
Here, the evidence of record fails to establish that the Veteran’s hypertension was present in service and there is no such evidence linking it to military service.  Absent such evidence the claim cannot be granted.  
Accordingly, the preponderance of the evidence is against the claim and there is no reasonable doubt to be resolved.  38 U.S.C. § 5107(b).
3.  service connection for a left knee arthritis 
The Veteran has contended that he injured his left knee during parachute jumps while on active duty and has had constant problems since then.  His DD Form 214 confirms that he was exposed to the physical rigors of parachuting as evidenced by his Basic Airborne Training and receipt of the Parachutist Badge.  Accordingly, his participation in parachuting activities during active service is conceded.  See 38 U.S.C. § 1154(a). 
However, service treatment records show the Veteran did not indicate any specific left knee complaints and there is no evidence is found to support an in-service injury or diagnosis of a left knee disorder.
Moreover, X-ray confirmation of left knee arthritis does not arise in post-service treatment records until 2012, well after one year following his separation from active duty.  See VA physical therapy consult, dated September 12, 2012.  Therefore, the Veteran may not be allowed service connection on a presumptive basis.  38 C.F.R. §§ 3.307, 3.309. 
Furthermore, there is no competent evidence linking the left knee arthritis to the Veteran’s military service decades years earlier.  In October 2015, the Veteran underwent a VA examination where the examiner confirmed the diagnosis of degenerative osteoarthritis of the left knee and concluded that it was less than 50 percent likely directly or indirectly related to service including the Veteran’s jumping activities.  The examiner noted the Veteran’s history as a paratrooper, his complaints of bilateral knee pain for the past 10 years and his recent history of kidney transplant.  She also noted his reports of osteoarthritic spine and hand pain.  She then went on to explain that there was nothing in service treatment records indicating knee problems including at separation.  In addition, the Veteran’s osteoarthritis has been symptomatic for only 10 years, many years after service, and he has diffuse osteoarthritis in other joints.  The examiner also noted that the Veteran has been on dialysis for the past 7 years and had a renal transplant, which likely involved a course of high dose steroids.  She explained that there was a high incidence of renal-related arthritis associated with renal failure.
Since the evidence of record fails to establish that the Veteran’s left knee arthritis was present in service, and there is no evidence relating it to military service, the claim cannot be granted.  
(Continued on the next page)
 
Accordingly, the preponderance of the evidence is against the claim and there is no reasonable doubt to be resolved.  38 U.S.C. § 5107(b).
 
THOMAS H. O'SHAY
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	J.R. Bryant 

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