Citation Nr: 18160391
Decision Date: 12/27/18	Archive Date: 12/26/18

DOCKET NO. 17-05 403
DATE:	December 27, 2018
ORDER
1. Entitlement to service connection for high cholesterol is denied. 
2. Entitlement to service connection for arthritis is denied.
3. Entitlement to service connection for hypertension, to include on a secondary basis, is denied.
FINDINGS OF FACT
1. High cholesterol is a laboratory test result, and is not a “disability” for VA purposes. 
2. The preponderance of the evidence shows that the Veteran’s arthritis is not related to his military service.
3. The preponderance of the evidence shows that the Veteran’s hypertension did not have its onset in service, was not caused or aggravated by service or a service-connected disability, and did not manifest itself to a compensable degree within one year of service.
CONCLUSIONS OF LAW
1. The criteria for service connection for high cholesterol have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. § 3.303 (2017).
2. The criteria for service connection for arthritis have not been met. 38 U.S.C. §§, 5107 (2012); 38 C.F.R. §§ 3.303 (2017). 
3. The criteria for service connection for hypertension, to include on a secondary basis, have not been met. 38 U.S.C. §§ 1101, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2017).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran served on active duty from June 1965 to May 1968.
These matters come before the Board of Veterans’ Appeals (BVA or Board) on appeal from a November 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. 
Service Connection
Under the relevant laws and regulations, service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). In general, service connection requires competent evidence showing: (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).
Certain chronic diseases, including hypertension, may be presumed to have been incurred during service if they become disabling to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309.
In addition to the regulations cited above, service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id.  
Additionally, where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Charles v. Principi, 16 Vet. App 370, 374 (2002).
When considering whether lay evidence is competent, the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011). In this regard, the Veteran may be competent in certain situations to provide a diagnosis of a simple condition such as a headache, varicose veins, or tinnitus.  However, the Veteran as a lay person is not competent to provide evidence as to more complex medical questions, such as the etiology of psychiatric, respiratory, or orthopedic disorders. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007).
Furthermore, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).
When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of matter, the benefit of the doubt will be given to the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.
1. Entitlement to service connection for high cholesterol is denied.
The evidence indicates that the Veteran has been prescribed medication to treat his high cholesterol. See VA Treatment Record dated January 17, 2017.
At the outset, the Board notes that service connection for high cholesterol must be denied as a matter of law. Under applicable regulations, the term “disability” means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1 (2016); Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991). An elevated cholesterol level represents laboratory findings, and not a disability in and of itself for which VA compensation benefits are payable. See 61 Fed. Reg. 20440, 20445 (May 7, 1996). A clinical finding, such as high cholesterol, without a diagnosed or identifiable underlying malady or condition, does not constitute a disability for which service connection may be granted. Thus, there is no current disability manifested by high cholesterol. See Brammer v. Derwinski, at 225. The Court of Appeals for Veterans Claims (Court) has held that where the law is dispositive of the claim, the claim should be denied because of lack of entitlement under the law. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Therefore, as there is no basis in the law to grant the Veteran’s appeal, the claim for service connection for high cholesterol must be denied.
2. Entitlement to service connection for arthritis is denied.
The Veteran seeks entitlement to service connection for arthritis as a result of his military service. There is no dispute that the Veteran has a current diagnosis of osteoarthritis of the bilateral hands and degenerative joint disease of the bilateral ankles. See March 2017 VA Examination Report. 
The Board notes that the Veteran contends that his arthritis is the result of heavy lifting while working as a mechanic during service. See Notice of Disagreement dated December 2013. However, service treatment records do not reflect any treatment or symptomatology related to the hands or ankles during active duty.
The Veteran underwent a VA examination for his arthritis in March 2017. The examiner opined that the arthritis of the hands and ankles was less likely than not related to his military service. He acknowledged the Veteran’s reports of working as a mechanic during service and his beliefs that his duties resulted in the current arthritis. However, he explained that the osteoarthritis of the hands was more likely due to the aging process, based upon the widespread arthritis found in multiple joints in his body. Additionally, he attributed the left ankle condition to a fracture which resulted from the Veteran’s fall off a ladder after service. The examiner further noted that the Veteran had a long post-service occupational history of physical labor with a phone company and in the construction field, which was more likely the cause of his bilateral ankle arthritis. He also concluded that the arthritis was not related to any of the Veteran’s service-connected disabilities based on medical literature.
Given on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for arthritis. The Board affords the March 2017 VA opinion a high probative value. In this regard, the examiner thoroughly reviewed the Veteran’s file and offered a comprehensive discussion analyzing all of the pertinent evidence of record and explaining the basis for the opinion, as supported by medical literature. The examiner further attributed the condition to alternative causes, including the Veteran’s post-service occupational history. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion comes from when it is the factually accurate, fully articulated, and sound reasoning for the conclusion). 
The Veteran has contended on his own behalf that his arthritis is related to his military service. The Board appreciates that the Veteran believes that his current disability is related to service, and that he is competent to report his personal observations. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, the Board affords the lay opinion no probative value. Although lay persons are competent to provide opinions on some medical issues, see Kahana, supra, as to the specific issue in this case, determining whether arthritis is due to military service, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).
As such, the preponderance of the evidence is against entitlement to service connection for arthritis. Reasonable doubt does not arise, and the benefit-of-the-doubt doctrine does not apply; the Veteran’s claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.
3. Entitlement to service connection for hypertension, to include on a secondary basis, is denied.
For VA 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. 38 C.F.R. § 4.104 (Note (1) to Diagnostic Code 7101). Under Diagnostic Code 710, a 10 percent disability evaluation is assigned for hypertensive vascular disease with diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. 38 C.F.R. § 4.104, (Diagnostic Code 7101). Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days.
The Veteran has been diagnosed with hypertension. See October 2015 VA Examination Report. Thus, the first element of a service connection claim is satisfied. The Veteran asserts that his hypertension is related to his service-connected PTSD and diabetes mellitus. See Notice of Disagreement dated December 2013. The second element of direct service connection is not satisfied because the Veteran did not have hypertension in service, nor has there been probative evidence submitted that any in-service disease or injury caused the hypertension. Notably, upon separation from service, the Veteran’s blood pressure was documented as 138/78. See May 1968 Separation Examination.
In this case, the preponderance of the evidence is against a finding that there is a link between the Veteran’s hypertension and his diabetes, PTSD, or his military service.
In October 2015, a VA examiner opined that it was less likely than not that the Veteran’s hypertension was aggravated by his service-connected diabetes mellitus. The examiner noted that the hypertension had remained well controlled despite the development of diabetes. Additionally, the evidence reflects that the hypertension was not caused by the diabetes mellitus, as the latter was diagnosed 11 years after the hypertension.
In December 2016, a second VA opinion was obtained in which the examiner determined that the hypertension was less likely than not aggravated by the Veteran’s PTSD. He noted that there was no pathophysiologic relationship or mechanism of action to support aggravation of hypertension by PTSD. Additionally, the evidence does not reflect that the Veteran was diagnosed with PTSD prior to the diagnosis of hypertension.
The Board affords the October 2015 and December 2016 VA opinions a high probative value. In this regard, the examiners reviewed the Veteran’s file and offered comprehensive discussions analyzing all of the pertinent evidence of record and explaining the basis for the opinions. See Nieves- Rodriguez; supra.
There is no medical evidence of record indicating that the Veteran’s hypertension is linked to his service-connected disabilities or his military service. The only evidence in support of such a link is his own lay assertion. 
As discussed above, lay persons are competent to provide opinions on some medical issues. See Kahana, supra. In this case, the Veteran is not competent to render an etiology opinion for his hypertension. Determining the etiology of the Veteran’s hypertension requires medical inquiry into cardiovascular processes and functioning. Such internal processes are not readily observable and are not within the competence of the Veteran in this case, who has not been shown by the evidence of record to have medical training or skills. Because the Veteran’s lay opinion is not competent in this case it is not probative. It cannot satisfy the nexus element of a service connection claim. Therefore, service connection may not be established based upon the Veteran’s assertion that his hypertension was caused by his military service. Additionally, it may not be established as secondary to the service-connected diabetes or PTSD, as the probative medical evidence demonstrates that they are unrelated. 
There is no evidence in the record showing that he was diagnosed with or treated for hypertension or high blood pressure within one year of his separation from active duty service, or that his hypertension manifested to a compensable degree during that time. The October 2015 VA examination report indicates that the Veteran was first diagnosed with hypertension in 2000. Thus, the Board finds that the Veteran’s hypertension did not manifest within one year of separation from active duty. 38 C.F.R. §§ 3.307, 3.309.
As such, the preponderance of the evidence is against service connection for a hypertension, to include as secondary to the service-connected diabetes mellitus or PTSD. Reasonable doubt does not arise, and the benefit-of-the-doubt doctrine does not apply; the Veteran’s claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 
 
MICHAEL E. KILCOYNE
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Erin J. Trojanowski, Associate Counsel 

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