Source: https://va-claim.com/2018/11/05/entitlement-to-service-connection-for-multiple-myeloma-claimed-as-bone-cancer-high-blood-pressure-residuals-of-a-right-eye-injury-denied-citation-nr-18131287/
Timestamp: 2019-04-19 08:52:14+00:00

Document:
Entitlement to service connection for multiple myeloma (claimed as bone cancer) is denied.
Entitlement to service connection for high blood pressure is denied.
Entitlement to service connection for residuals of a right eye injury is denied.
1. The weight of the competent and credible evidence of record is against a finding that multiple myeloma began during or was caused by the Veteran’s military service.
2. High blood pressure was not manifest in service or within the first post-service year, and is not otherwise attributable to service.
3. An in-service right eye blunt trauma has not resulted in any current disability; currently diagnosed vision impairments are related to multiple myeloma.
1. The criteria for service connection of multiple myeloma are not met. 38 U.S.C. §§ 1110, 1131, 5103, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018).
2. The criteria for entitlement to service connection for a high blood pressure condition have not been met. 38 U.S.C. §§ 101, 106, 1101, 1112, 1113, 1137 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2018).
The Veteran served on active duty with the US Army from March 1979 to February 1983.
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 (West 2014); 38 C.F.R. § 3.303 (a) (2016). In general, service connection requires competent and credible evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).
The first instance in the record of a diagnosis or treatment for multiple myeloma is a September 2016 VA treatment record indicating an impression of multiple myeloma for the Veteran. No discussion on its etiology is provided. The diagnosis was verified in private medical records, but no opinion was provided with regard to etiology.  The Veteran’s service treatment records did not show complaints, treatment, or a diagnosis of multiple myeloma.
The remaining evidence includes no indication of any relationship to service.  The bare allegation of exposure to blood, even if accepted, includes no basis for suspecting a relationship to a diagnosis almost 30 years later.  For this reason, no examination is required.  McLendon v. Nicholson, 20 Vet. App. 79 (2006).  No nexus is established.
In the absence of evidence, there cannot be even equipoise, and there can be no resolution of doubt.  The Veteran still ultimately bears some burden of production.  38 U.S.C. § 5107(a); Cromer v. Nicholson, 455 F.3d 1346 (Fed. Cir. 2006).  As there is no competent evidence to support any finding of a nexus between service and any multiple myeloma, entitlement to the benefit sought is not warranted.
The Veteran contends that his high blood pressure is the result of his active service.
The Veteran’s service treatment records did not show complaints, treatment, or a diagnosis of high blood pressure. The separation examination revealed the Veteran’s heart and chest were clinically evaluated as normal. His blood pressure reading was 130/70. Compensably disabling hypertension is also not shown within a year of separation from active duty.
While VA and private treatment records establish a current diagnosis of hypertension, they do not include findings or opinions regarding etiology or a relationship to service.  The sole evidence of nexus is the opinion of the Veteran.
Although the Veteran is competent to report his blood pressure readings or a diagnosis of hypertension from an examiner, he has not presented any evidence of blood pressure readings suggestive of hypertension - as defined by VA - in service or blood pressure readings to a compensable degree within one year of discharge. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), in this case the etiology of his high blood pressure falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) Hence, the Veteran is not competent to address the etiology of any current high blood pressure.
Additionally, the Veteran has not provided competent evidence of persistent or recurrent symptoms of hypertension since service to warrant service connection on the basis of continuity of symptomatology under 38 C.F.R. § 3.303 (b). Further, while the Board notes the private medical assessment of hypertension, it brings attention to the lack of opinion and rationale provided with regard to this diagnosis. Indeed, the Board finds that the record is silent for any evidence indicating a nexus between the Veteran’s claim of high blood pressure and his active service.
For the reasons stated above, service connection for high blood pressure is denied. The Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 U.S.C. § 5107 (b).
Entitlement to service connection for residuals of a right eye injury.
Service treatment records establish a blunt trauma to the right eye while playing sports in service; a corneal abrasion was diagnosed.  The Veteran currently complains of impaired vision, to include light sensitivity, and is diagnosed with reduction of visual fields, bilateral retinal hemorrhages, and a refractive error.  The sole question remaining is whether a nexus between service and a current disability at least as likely as not exists.
Initially, the Board notes that a refractive error is not considered a disability by VA, and is not subject to service connection.  38 C.F.R. § 3.303(c).  Analysis will therefore focus on the other diagnosed conditions.
The October 2016 VA examiner reviewed the complete file, examined the Veteran in person, and rendered negative nexus opinions regarding all current right eye conditions. He did note the in-service right eye trauma and treatment in rendering his opinions. The bilateral retinal hemorrhages are consistent with the chemotherapy received for nonservice-connected multiple myeloma, and hence are not related to the trauma.  He also stated that light sensitivity is a common complaint, and it would be difficult to relate such to the December 1982 injury.  Further, he noted that while the Veteran was struck and did require a period of conservative treatment for the right eye, there were no further complaints or findings related to the right eye.  The abrasion resolved completely. While there was a reduction in field of vision, this was not consistent with a corneal injury.
The Veteran did report he has had eye trouble, particularly light sensitivity, since service, but the Board finds his lay association of such with his injury is less probative than the learned medical opinion noting this common complaint could not be associated with the injury, even citing the appropriate legal standard of at least as likely as not.  Finally, the Board notes that the Veteran’s report of treatment in service differs from contemporaneous records, undermining the probative value of his assertions due to the vagaries of memory.
As the preponderance of the evidence is against the claim, service connection for residuals of a right eye disability is not warranted.  There is no doubt to be resolved.

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