11-05 300
11-05 300
| Board of Vet. App. | Jun 15, 2017Background
- Veteran served on active duty in the U.S. Army from March 1970 to March 1972 and appealed several RO rating decisions to the Board. A March 2017 videoconference hearing was held; earlier Board remand in 2016 was to obtain that hearing.
- Claims: service connection for bilateral hearing loss; residuals of jungle rot; costochondritis (chest pain), including secondary to service‑connected anxiety; hypertension, including secondary to anxiety; higher anxiety rating; and TDIU.
- Veteran withdrew his appeal for jungle rot at the March 2017 hearing.
- Medical evidence: service records show normal hearing at entry and separation; post‑service diagnoses include bilateral sensorineural hearing loss, chronic chest pain with numerous cardiac and GI tests largely negative, diagnosed generalized anxiety disorder (service‑connected), and various blood pressure readings generally below VA hypertension thresholds.
- VA examinations (2010, 2014) and private opinions exist; VA examiners' rationale weighed more heavily where private opinions lacked adequate rationale or failed to consider service audiograms.
- Board remanded only the anxiety rating and TDIU for additional development (new anxiety exam addressing worsening symptoms, panic attacks, chest pain as anxiety symptom, and extraschedular TDIU referral); all other claims were denied.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Service connection — bilateral hearing loss | Hearing loss caused by in‑service noise exposure (only time without protection) | Entry and separation audiograms show no threshold shift; VA exam found nexus less likely; private opinion lacks rationale | Denied — preponderance against nexus and no presumptive/continuity basis |
| Service connection — residuals of jungle rot | (Withdrawn by Veteran) | N/A | Appeal dismissed (withdrawn on record) |
| Service connection — costochondritis / chest pain (including secondary to anxiety) | Chest pain is a persistent disability and/or secondary to service‑connected anxiety | Chest pain is a symptom without a separate diagnosable chest disorder; multiple clinicians attribute chest pain to anxiety; diagnostic testing largely excludes cardiac/GI causes | Denied as separate compensable disability; chest pain to be considered as part of anxiety rating; not separately service connected |
| Service connection — hypertension (including secondary to anxiety) | Hypertension caused or aggravated by service‑connected anxiety (medical literature and treating physician opinions) | Blood pressure readings do not meet VA diagnostic criteria (predominantly < systolic 160 and diastolic < 90 on required repeat checks); VA exam found no nexus; treating opinions are conclusory | Denied — no qualifying VA diagnosis (readings insufficient) and nexus not shown |
Key Cases Cited
- Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (Board need not discuss every piece of evidence; focus on salient evidence)
- Gilbert v. Derwinski, 1 Vet. App. 49 (1990) (preponderance of evidence rule and benefit‑of‑the‑doubt standard)
- Savage v. Gober, 10 Vet. App. 488 (1997) (continuity of symptomatology framework for chronic diseases)
- Barr v. Nicholson, 21 Vet. App. 303 (2007) (standards for adequacy of VA medical examinations)
- McLendon v. Nicholson, 20 Vet. App. 79 (2006) (when remand for exam is required versus when existing evidence is sufficient)
- Stegall v. West, 11 Vet. App. 268 (1998) (duty to comply with remand directives)
- Brammer v. Derwinski, 3 Vet. App. 223 (1992) (no service connection without proof of a present disability)