Citation Nr: 0302065 Decision Date: 02/03/03 Archive Date: 02/19/03 DOCKET NO. 95-02 367 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUES 1. Entitlement to service connection for hearing loss of the left ear. 2. Entitlement to service connection for a chronic disability manifested by shortness of breath as resulting from an undiagnosed illness. 3. Entitlement to service connection for a skin disorder. 4. Entitlement to service connection for a chronic disability manifested by memory loss as resulting from an undiagnosed illness. 5. Entitlement to service connection for left arm and shoulder pain. 6. Entitlement to service connection for a chronic disability manifested by multiple joint pain as resulting from an undiagnosed illness. REPRESENTATION Veteran represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD C. L. Mason, Senior Counsel INTRODUCTION The veteran served on active duty from July 1969 to March 1971 and from September 1990 to June 1991. The veteran has several unverified periods of service with the Tennessee Army National Guard. The veteran served in Southwest Asia during the Persian Gulf War from October 1990 to May 1991. This case comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions from the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. The Board remanded this case for additional development in December 1998. While the case was on appeal, the RO, in September 2002, granted service connection for right ear hearing loss and tinnitus. Thus, those issues are no longer before the Board of Veterans' Appeals. FINDINGS OF FACT 1. There was an increase in severity of the veteran's preexisting left ear hearing loss during military service, which has not been determined to be a natural progression of the disorder. 2. There are no objective indications of chronic disability manifested by shortness of breath. 3. The veteran's skin disorders have been attributed to known clinical diagnoses including dyshidrotic eczema and tenia pedis. 4. There is no competent medical evidence of record relating the veteran's skin disorders to include dyshidrotic eczema and tenia pedis to his service. 5. There are no objective indications of chronic disability manifested by memory loss. 6. The veteran's left shoulder and arm disorder has been attributed to carpal tunnel syndrome and arthritis of the left shoulder. 7. There is no competent medical evidence of record relating the veteran's left shoulder and arm disorders to service including his service in the Persian Gulf. 8. The veteran's multiple joint pain complaints have been attributed to overuse syndrome and/or degenerative changes; there is no competent medical evidence relating these multiple joint complaints to service including his service in the Persian Gulf. CONCLUSIONS OF LAW 1. The veteran's left ear hearing loss clearly and unmistakably preexisted his military service, but with resolution of reasonable doubt in his favor, service connection is warranted as the left ear hearing loss was aggravated during service. 38 U.S.C.A. §§ 1101, 1110, 5100 et seq. (West 1991 & Supp. 2002); 38 C.F.R. §§ 3.303, 3.385 (2002). 2. The veteran's shortness of breath was not incurred in or aggravated by service, nor is it due to an undiagnosed illness. 38 U.S.C.A.§§ 1110, 1131, 1117, 5103, 5103A, 5107 (West Supp. 2002); 38 C.F.R. §§ 3.303, 3.317 (2002). 3. The veteran's variously diagnosed skin disorders were not incurred in or aggravated by service, nor are they due to exposure to Agent Orange or an undiagnosed illness. 38 U.S.C.A.§§ 1110, 1131, 1117, 5103, 5103A, 5107 (West Supp. 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317 (2002). 4. Memory loss was not incurred in or aggravated by service, nor is it due to an undiagnosed illness. 38 U.S.C.A.§§ 1110, 1131, 1117, 5103, 5103A, 5107 (West Supp. 2002); 38 C.F.R. §§ 3.303, 3.317 (2002). 5. The veteran's left shoulder and arm pain disorder was not incurred in or aggravated by service, nor is it due to an undiagnosed illness. 38 U.S.C.A.§§ 1110, 1131, 1117, 5103, 5103A, 5107 (West Supp. 2002); 38 C.F.R. §§ 3.303, 3.317 (2002). 6. The veteran's multiple joint pain was not incurred in or aggravated by service, nor is it due to an undiagnosed illness. 38 U.S.C.A.§§ 1110, 1131, 1117, 5103, 5103A, 5107 (West Supp. 2002); 38 C.F.R. §§ 3.303, 3.317 (2002). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran had active duty from 1969 to 1971. Following multiple requests by VA, the National Personnel Records Center (NPRC) advised that the veteran's service medical records from his period of service from 1969 to 1971 were not located. VA also contacted the veteran's Army National Guard unit in Tennessee, which stated that they did not have the veteran's service medical records, but did provide records from the veteran's service in the National Guard including service in the Persian Gulf. The veteran also had active duty service included a period of service in the Persian Gulf in support of Operation Desert Storm. With the exception of his tinea pedis, the veteran contends that his shortness of breath, skin disorders, memory loss, left shoulder and arm pain, and multiple joint pain are the result of an undiagnosed illness stemming from his service in the Persian Gulf. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West Supp. 2002); 38 C.F.R. § 3.303(a) (2002). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (2002). Service connection may be also 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) (2002). Service connection connotes many factors, but basically, it means that the facts, as shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service. A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease in service. See Pond v. West, 12 Vet. App. 341 (1999); Watson v. Brown, 4 Vet. App. 309, 314 (1993). For veterans who served in the Southwest Asia theater of operations during the Persian Gulf War, service connection may also be established for chronic disability that cannot be attributed to a known clinical diagnosis (undiagnosed illness) or for a medically unexplained multisymptom illness (e.g., chronic fatigue syndrome, fibromyalgia, or irritable bowel syndrome). See 38 U.S.C.A. § 1117 (West Supp. 2002); 38 C.F.R. § 3.317 (2002). Objective indications of chronic disability resulting from undiagnosed illness must be manifest to a degree of 10 percent either during active military service in Southwest Asia or no later than December 31, 2006. 38 C.F.R. § 3.317(a) (2002). Signs or symptoms that may be manifestations of undiagnosed illness include, but are not limited to: (1) fatigue (2) signs or symptoms involving skin (unexplained rashes or other dermatological signs or symptoms) (3) headache (4) muscle pain (5) joint pain (6) neurological signs or symptoms (7) neuropsychological signs or symptoms (8) signs or symptoms involving the upper or lower respiratory system (9) sleep disturbances (10) gastrointestinal signs or symptoms (11) cardiovascular signs or symptoms (12) abnormal weight loss (13) menstrual disorders. 38 U.S.C.A. § 1117(g) (West Supp. 2002); 38 C.F.R. § 3.317(b) (2002). Compensation shall not be paid if there is affirmative evidence that an undiagnosed illness was not incurred during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War; or if there is affirmative evidence that an undiagnosed illness was caused by a supervening condition or event that occurred between the appellant's most recent departure from active duty in the Southwest Asia theater of operations during the Persian Gulf War and the onset of the illness; or if there is affirmative evidence that the illness is the result of the appellant's own willful misconduct or the abuse of alcohol or drugs. 38 U.S.C.A. § 1117; 38 C.F.R. § 3.317 (2002). To summarize, then, there are alternative means by which service connection might be established: (1) objective indications of chronic disability resulting from illness that cannot be attributed to a known diagnosis or that is attributable to a chronic multisymptom illness; (2) competent evidence of direct incurrence or aggravation of a diagnosed illness or injury in service, with chronic residuals; or (3) competent medical evidence linking a current diagnosed disability with disease or injury shown in service. Although the veteran served in Vietnam during the Vietnam War and Southwest Asia during the Persian Gulf Conflict, the record does not denote combat participation. The other evidence of record does not show that he engaged in combat with the enemy while in service. Therefore, the provisions of 38 U.S.C.A. § 1154(b) are not for application in this case. Left ear hearing loss The veteran contends that his left ear hearing loss worsened beyond the natural progression as the result of his noise exposure in service in the Persian Gulf. At March 1990 National Guard examination, an audiogram revealed that the veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 1000 2000 3000 4000 LEFT 10 20 30 50 In September 1990, the veteran was ordered to active duty for the Persian Gulf War. A September 1990 military audiogram revealed pure tone thresholds, in decibels, as follows: HERTZ 1000 2000 3000 4000 LEFT 5 0 10 55 The veteran was placed on H-2 hearing profile for high frequency hearing loss on the left above 3000 Hertz. At his redeployment examination in May 2001, audiogram revealed that the veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 1000 2000 3000 4000 LEFT 15 15 30 65 The examiner noted that the veteran reported hearing loss since last year. A December 1991 National Guard examination revealed that the veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 1000 2000 3000 4000 LEFT 25 20 25 75 The diagnoses included high frequency hearing loss in the left ear. At a July 1993 VA audiological examination, the veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 1000 2000 3000 4000 LEFT 10 10 20 70 Maryland CNC word recognition was 80 percent in the left ear. The examiner stated that there was severe to profound sensorineural hearing loss in the left ear after 3000 Hz. VA and Army National Guard audio examinations from 1994 to 1996 continued to show hearing loss in the left ear. A VA audiogram in October 1996 revealed pure tone thresholds, in decibels, as follows: HERTZ 1000 2000 3000 4000 LEFT 15 15 35 75 At a January 2000 VA audiological examination, the examiner stated that after reviewing the claim file, the veteran's March 1990 military physical showed mild to moderate high frequency loss in the left ear and the results of the veteran's demobilization examination in May 1991 revealed worsening of the high frequency hearing loss in the left ear. The veteran reported military noise exposure including firing rifles, tanks, and explosions. On evaluation, the veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 1000 2000 3000 4000 LEFT 15 20 40 80 Maryland CNC word recognition was 96 percent in the left ear. The diagnosis was moderate sloping to severe high frequency sensorineural hearing loss in the left ear. In March 2002, a VA audiology physician reviewed the veteran's claims file and examined the veteran. On evaluation, the veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 1000 2000 3000 4000 LEFT 15 15 45 85 The examiner noted that the veteran's left ear hearing loss worsened during his Persian Gulf service, but that the current audiogram showed no decrease in hearing sensitivity since the October 1996 VA audiogram. The examiner stated that the findings indicate that the veteran's hearing did in fact get poorer during his military service. For purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the above frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2002). The provisions of 38 C.F.R. § 3.385 do not have to be met during service. See Hensley v. Brown, 5 Vet. App. 155 (1993). A veteran who served during a period of war or during peacetime service after December 31, 1946, is presumed to be in sound condition except for defects, infirmities, or disorders noted when examined and accepted for service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that a disease existed prior to service. 38 U.S.C.A. § 1111 (West 1991); 38 C.F.R. 3.304(b) (2002). A preexisting injury or disease will be considered to have been aggravated by active military service, where there is an increase in disability during such service, unless there is specific finding that the increase in disability is due to the natural progress of the disease. 38 C.F.R. § 3.306(a) (2002). Clear and unmistakable evidence is required to rebut the presumption of aggravation where the pre-service disability underwent an increase in severity during active service. Aggravation may not be conceded, however, where the disability underwent no increase in severity during service. 38 C.F.R. § 3.306(b). The determination whether a preexisting disability was aggravated by service is a question of fact. Doran v. Brown, 6 Vet. App. 283, 286 (1994). Based on the above-described evidence, the Board finds that the preponderance of the evidence establishes aggravation. It is the judgment of the Board that the facts of this case warrant a grant of service connection for left ear hearing loss on the basis of aggravation of the disability, because it became worse during the veteran's active military service. The objective evidence establishes that there was an increase in severity of the preexisting left ear hearing loss during service. Moreover, there is no clear and unmistakable evidence to rebut the legal presumption of aggravation. Additionally, audiometric evaluations in service in 1991 and from 1994 to 2000 revealed auditory thresholds that were consistent with hearing loss disability in the left ear as defined at 38 C.F.R. § 3.385. Moreover, a VA examiner has provided a competent medical opinion that the veteran's hearing loss worsened during service. There is no other competent evidence, which would suggest that the current left ear hearing loss is in any way attributable to an event or injury after service. Thus, the evidence establishes that the veteran currently has left hearing loss disability under VA standards, which can reasonably be attributed to his military service. In the Board's judgment, and after resolving all reasonable doubt in the veteran's favor, the evidence of record does establish that there was an increase in the severity of the veteran's preexisting left ear hearing loss during military service. Accordingly, the Board concludes service connection is warranted for left ear hearing loss. Shortness of breath Service medical records from 1990 to 1991 show no complaints or findings of shortness of breath. At his May 1991 redeployment examination, evaluation of the lungs was normal. VA, National Guard, and private medical records from 1991 to 1996 show no complaints or findings of shortness of breath. At a September 1996 VA examination, the veteran reported occasional shortness of breath with brisk climbing of stairs and walking long distances, occasional chest pain, and non- productive cough. Lungs were clear to percussion and auscultation. There was no diagnosis of any respiratory disorder. The impression was shortness of breath with exertion. A chest x-ray revealed early chronic obstructive lung disease and small density in the lower left lung. At a January 2000 VA pulmonary examination, the veteran reported occasional shortness of breath and non-productive cough. The examiner noted that the veteran was a smoker. The examiner noted that veteran had been followed for small granuloma in the lower left lung since 1996, but that the most recent x-ray showed no changes. On evaluation, the examiner stated that the veteran weighted 210 lbs. His chest was clear to auscultation with clear air entries and no rales, wheezes or rhonchi. The examiner reported that pulmonary function tests were normal with no evidence of obstructive or restrictive disease and that chest x-rays showed only the small granuloma in the lower left lung, unchanged. On diagnosis, the examiner stated that the veteran had no significant cardiopulmonary symptoms or complaints and that pulmonary function tests were normal. VA medical records from 1997 to 2002 show occasional complaints of shortness of breath without objective medical findings of shortness of breath. Tobacco use was noted. At a March 2002 VA examination, the veteran reported that his occasion shortness of breath was not that bad anymore. He also reported cigarette and cigar smoking. He reported shortness of breath on heavy lifting, but stated he could climb stairs and walk one tenth of a mile without shortness of breath. On examination, lung fields were clear to auscultation and percussion. The examiner noted that the veteran underwent a complete work-up for shortness of breath in 1996. According to the examiner, the veteran's complaint of shortness of breath can be directly related to his obesity, age and deconditioning as well as his history of tobacco use. The examiner stated that this should not be regarded as an undiagnosed illness and is not related to any possible exposures during the Persian Gulf War. The veteran is competent to report that he experiences shortness of breath. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). In the absence of evidence demonstrating that the veteran has the requisite training to proffer medical opinions, the contentions are no more than unsubstantiated conjecture and are of no probative value. See Moray v. Brown, 5 Vet. App. 211 (1993). Additionally, service connection on a presumptive basis for shortness of breath as a manifestation of undiagnosed illness requires objective indications of such a condition. The veteran's complaints of shortness of breath have been evaluated on multiple occasions without objective evidence. His pulmonary function tests have been normal as have examination findings. Moreover, at the most recent examination, the examiner reviewed the veteran's entire claims file and opined that his complaints were directly related to his obesity, age, and tobacco use. The examiner specifically stated that his complaints were not related to his service in the Persian Gulf. The preponderance of the evidence is against entitlement to service connection for a lung condition with shortness of breath. Since the preponderance of the evidence is against this claim, the benefit of the doubt doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, the claim for service connection for shortness of breath is denied. Skin disorder The veteran is seeking service connection for skin disorders to include peeling of the feet. In his statements, the veteran contends that he began to experience peeling of the feet in Vietnam and this continued after his Persian Gulf service. The veteran also contends that he developed skin rashes on other parts of his body subsequent to his Persian Gulf service and that these are due to an undiagnosed illness. Service medical records for the period of service from 1990 to 1991 in the Persian Gulf show no complaints, findings, or diagnoses of any skin disorder. At his May 1991 redeployment examination, the veteran did not complain of any skin diseases and the evaluation of the skin was normal. VA, National Guard, and private medical records dated from 1991 to 1993 do not contain complaints, findings, or diagnoses of any skin disorder. The first objective medical evidence of skin disorder is an October 1994 VA medical record showing that the veteran was complaining of a 5 to 6 month history of scaly, itchy rash and lesions all over his body, primarily on his legs, hips, and elbows. The assessment was dermatophyte versus psoriasis versus seborrheic dermatitis versus nonspecific dermatitis or eczema versus parapsoriasis. VA medical records from 1994 to 2002 show continued complaints and treatment for skin disorders of the feet, legs, arm, and wrist. Diagnoses included lichen simplex of the right wrist, venous stasis dermatitis of the legs, tinea cruris of the groin, tinea pedis of the feet, tinea corporis, eczema, psoriasis, and dyshidrotic eczema. A September 1996 VA examination report noted that the veteran reported skin problems for the past two years. The examiner noted multiple diagnoses of record including dyshidrotic eczema and tinea corporis. Following examination, the diagnoses include dyshidrotic eczema, venous stasis dermatitis of the right leg, and resolving tinea corporis. At his January 2000 VA skin examination, the veteran reported that his skin problems began in 1992 approximately one year after his return from the Persian Gulf. He reported intermittent skin lesions of the right lateral finger, left palm, and right calf. Following evaluation, the diagnoses were dystrophic eczema of the right lateral finger and left palm and tinea corporis of the right calf. At a March 2002 VA examination, the veteran complained of skin disorder of the hands, legs, and feet. The examiner noted that the records reveal that the veteran had been treated for various skin disorders. The examiner noted that the veteran currently received treatment for dyshidrotic eczema and tinea pedis. The examiner noted that these skin diseases were very common in the general population and were not specifically confined to Persian Gulf war veterans or related to war-related illnesses. The veteran is competent to report that on which he has personal knowledge, that is what comes to him through his senses. See Layno, 6 Vet. App. at 470. Here, he contends that his skin disorder developed as a result of service in the Persian Gulf. VA medical records show multiple skin diagnoses to include dyshidrotic eczema and tinea pedis. Because the veteran's dyshidrotic eczema and tinea pedis are known clinical diagnoses, the veteran's skin disorders do not qualify as undiagnosed illness under 38 U.S.C.A. § 1117. Additionally, the veteran's service medical records for the period from 1990 to 1991 contain no complaints, findings, or diagnosis of any skin disorders during service. Accordingly, the preponderance of the evidence is against establishing service connection based on diagnosed skin disorder in service. The Board notes that the veteran has contended that his tinea pedis began in 1970. As noted above, the veteran's service medical records for his period of service from 1969 to 1971 could not be located. Nevertheless, the Board notes that the veteran's active duty included service in Vietnam during the Vietnam era. On December 27, 2001, the President signed into law the Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103(Dec. 27, 2001). Section 201 of this Act amends 38 U.S.C. § 1116 to provide a presumption of exposure to herbicides for all veterans who served in Vietnam during the period beginning on January 9, 1962 and ending on May 7, 1975. Thus, the Board will presume that the veteran was exposed to herbicides. If a veteran was exposed to an herbicide agent during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, the following diseases shall be service-connected, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C.A. § 1113 and 38 C.F.R. § 3.307(d) are also satisfied: chloracne or other acneform disease consistent with chloracne; Hodgkin's disease; multiple myeloma; non-Hodgkin's lymphoma; acute and subacute peripheral neuropathy; PCT; prostate cancer; respiratory cancers (cancer of the lung, bronchus, larynx, or trachea); and soft- tissue sarcomas (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma). 38 C.F.R. § 3.309(e) (2002). Upon review, the Board observes the evidence of record indicates that the veteran has been diagnosed with lichen simplex of the right wrist, venous stasis dermatitis of the legs, tinea cruris of the groin, tinea pedis of the feet, tinea corporis, eczema, psoriasis, and dyshidrotic eczema; these are not listed conditions for which service connection based on herbicide exposure may be presumed. Moreover, the first objective medical evidence of diagnoses of these skin disorders was in the 1994 more than 20 years after any exposure to herbicide agents. Finally, the veteran has not claimed and no medical professional has provided competent medical evidence linking any of the veteran's skin disorders to active service including exposure to Agent Orange. The veteran's own statements, in some cases, concerning non- medical indicators may be sufficient if such indicators are reasonably capable of independent verification. While the veteran has also alleged that his skin disorders resulted from his service in support of the Persian Gulf War, in the absence of evidence demonstrating that the veteran has the requisite training to proffer medical opinions, the contentions are no more than unsubstantiated conjecture and are of no probative value. See Moray, 5 Vet. App. 211. The record shows that VA diagnosed the veteran with multiple skin disorders after service; however, the record does not contain a medical opinion relating the veteran's skin disorders to his service. See Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). In fact, the most recent examiner, in March 2002, specifically stated that the veteran's skin disorders were not related to his service. Accordingly, the Board concludes that the preponderance of the evidence is against a finding that the veteran's skin disorders were related to service. Therefore, the claim for service connection is denied. Memory loss Service medical records show no findings, treatment, or diagnoses of memory loss. At his May 1991 redeployment examination, there were no complaints or findings of memory loss. VA, National Guard, and private medical records dated from 1991 to 1996 show no complaints, findings, or diagnoses of memory loss. At a September 1996 VA mental disorder examination, the examiner noted that memory and concentration were somewhat diminished. The veteran reported that he drank approximately 10 to 12 beers per day about 2 to 3 times per week and consumed approximately 1/5th of Bourbon every 1 to 2 months. On evaluation, remote memory and short-term recall were intact. The diagnosis was alcohol dependence. VA medical records from 1996 to 2002 show no complaints of memory loss and objective findings of intact memory. A February 2000 VA mental disorder examination report showed no complaints of memory loss. On evaluation, the examiner stated that the veteran's remote memory was intact and that his short-term recall was good as he was able to recall three objects after five minutes. The veteran reported that he had been sober for 3 years. The diagnosis was alcohol abuse in complete remission. At a March 2002 VA examination, the examiner noted the veteran's claim of memory loss. On mental examination, the veteran scored 30 out of 30. He did not give any history of substantial memory loss affecting his activities of daily living or his ability to work. The veteran reported memory problems relating to insignificant things such as misplacing the car keys and not remembering to get everything at the store. The examiner stated that these were things that normal people did from time to time and did not indicate any evidence of an underlying emotional or physical disorder. The examiner stated that the veteran's complaints are not unique to veteran's who served in the Persian Gulf and there was no evidence that it was related to his Persian Gulf service. In several statements, the veteran contends that he has short-term memory loss which he related to his service in the Persian Gulf. The veteran is competent as a lay person to report that on which he has personal knowledge. See Layno, 6 Vet. App. at 470. There is no evidence of record that he has specialized medical knowledge in the area of memory loss. Thus, the Board finds that the veteran is not competent to offer medical opinion as to cause or etiology of his reported memory loss. See Moray, 5 Vet. App. 211 (1993); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). Moreover, subsequent VA examinations in 1996, 2000, and 2002 indicated that the veteran's memory testing was good and that there was no evidence of memory loss. Therefore, the Board finds that there is no objective evidence of chronic memory loss as a manifestation of undiagnosed illness. Without objective indications of chronic disability due to memory loss, there is no basis for a claim as a Persian Gulf undiagnosed illness. Furthermore, at the most recent examination, the examiner stated that memory loss complained of by the veteran related to simple insignificant things such as misplacing the car keys, which are experienced by most of the population. The examiner stated that there was no evidence that this memory loss was related to the veteran's Persian Gulf service. Based on review of the evidence of record, the Board concludes that the preponderance of such evidence is against entitlement to service connection for undiagnosed illness manifested by memory loss. Since the preponderance of the evidence is against this claim, the benefit of the doubt doctrine is not for application. See Gilbert, 1 Vet. App. 49 (1990). Accordingly, the claim for service connection is denied. Left arm and shoulder pain Service medical records from 1990 to 1991 show no complaints, findings, or diagnoses of left shoulder or arm pain. At National Guard redeployment and separation examinations in April and May 1991, the veteran reported that he began to experience pain and swelling in his hands approximately one year previously and that he had been diagnosed with arthritis one year previously and was followed by a private physician. A December 1991 VA medical record shows complaints of left shoulder and arm pain which the veteran reported began approximately 3 to 4 weeks prior. The veteran reported weakness, numbness and tingling in his left arm, elbow, and fingers. X-rays of the left shoulder, elbow, and hand were normal except for some spurring in the left elbow joint. The diagnosis was diffuse arthralgias. September 1992 VA medical records noted that the veteran was seen complaining of left shoulder pain for 3 weeks. Evaluations were normal. VA medical records from 1993 to 1996 reveal continued complaints of pain, numbness, and weakness of the left shoulder and arm. EMG/nerve conduction testing performed in 1995 revealed carpal tunnel syndrome on the left. At a September 1996 VA examination, the veteran reported chronic left arm pain without history of injury. It was noted that the veteran injured his low back in a truck accident while on active duty in February 1996. (The Board observes that the veteran is service connected for lumbar spine disorder.) Following evaluation, the diagnoses included musculoskeletal strain of the cervical spine, chronic arthralgia, and mild left carpal tunnel syndrome. A January 2000 VA neurological examination report noted the veteran's complaints of worsening of left arm pain with weakness and numbness. On evaluation, range of motion testing was normal as was sensory perception. It was noted that recent nerve conduction study revealed carpal tunnel syndrome on the left. VA medical records from 1997 to 2002 show continued complaints of left arm and shoulder pain with weakness and numbness. Diagnoses included degenerative joint disease, arthralgia, and carpal tunnel syndrome. A February 2002 VA medical record noted the veteran's complaints of chronic left shoulder and arm pain for 9 years. EMG/ nerve conduction studies performed in February 2002 revealed neuropathy consistent with carpal tunnel syndrome and neurogenic changes possibly consistent with chronic C8 radiculopathy. A February 2002 MRI of the cervical spine revealed central disc herniation at C5-6 causing spinal canal stenosis. A March 2002 VA examination report noted the veteran's history of left shoulder and arm complaints since 1992 with diagnoses of carpal tunnel syndrome. It was noted that the veteran worked as a glass handler at a local mirror plant and utilized his left arm to lift and guide the heavy glass pieces. Following evaluation, the examiner stated that the veteran's left carpal tunnel syndrome and arthritis affecting both shoulders were directly attributable to overuse primarily through his employment. There is no evidence that the veteran sustained any injury or had any sequela as a result of his Persian Gulf service nor is there any evidence that any Persian Gulf illness is responsible for his left carpal tunnel syndrome or arthritis of the left shoulder. The veteran is competent to report that on which he has personal knowledge, that is what comes to him through his senses. See Layno, 6 Vet. App. at 470. Here, he contends that his left shoulder and arm pain developed as a result of service in the Persian Gulf. VA medical records show diagnoses of carpal tunnel syndrome and arthritis. Because these are known clinical diagnoses, the veteran's left shoulder and arm disorders do not qualify as undiagnosed illness under 38 U.S.C.A. § 1117. Additionally, the veteran's service medical records for the period from 1990 to 1991 contain no complaints, findings, or diagnosis of any left shoulder or arm disorders during service. Accordingly, the preponderance of the evidence is against establishing service connection for these disorders in service. Furthermore, the Board notes that the veteran's carpal tunnel syndrome on the left and left shoulder arthritis has not been related to the veteran's service. As noted above, the veteran's own statements, in some cases, concerning non- medical indicators may be sufficient if such indicators are reasonably capable of independent verification. While the veteran has alleged that his left shoulder and arm pain was due to service to include service in support of the Persian Gulf War, in the absence of evidence demonstrating that the veteran has the requisite training to proffer medical opinions, the contentions are no more than unsubstantiated conjecture and are of no probative value. See Moray, 5 Vet. App. 211. The record shows that the veteran was diagnosed with carpal tunnel syndrome on the left and left shoulder arthritis by VA after service; however, the record does not contain a medical opinion relating the veteran's carpal tunnel syndrome on the left and left shoulder arthritis to service. See Tirpak, 2 Vet. App. at 611. In fact, on recent examination, the VA examiner specifically determined that these disorders were not related to the veteran's service including his service in the Persian Gulf. Accordingly, the Board concludes that the preponderance of the evidence is against a finding that the veteran has a disorder of the left shoulder or arm that was related to service. Therefore, the claim for service connection is denied. Multiple joint pain At National Guard redeployment and separation examinations in April and May 1991, the veteran reported that he began experience pain and swelling in his hands approximately one year previously and that he had been diagnosed with arthritis one year previously and was followed by a private physician. However, service medical records do not reflect any complaints, findings, or diagnoses of a joint disorder during active service. VA, National Guard, and private medical records from 1991 to 1997 reveal complaints of multiple joint pains of the hips, shoulders, and hands. The diagnoses included diffuse arthralgias and degenerative joint disease of the hips. At a September 1996 VA examination, the veteran complained of occasional stiffness in his hips and knees. Following evaluation, the diagnoses included normal range of motion joint examination with chronic arthralgia. A January 2000 VA examination report revealed complaints of stiffness and occasional pain in the hips and knees. There was no diagnosis other than arthritis of the lumbosacral spine. VA medical records from 1997 to 2002 show continued complaints of muscle stiffness and pain. The diagnoses included arthralgias, degenerative joint disease, and muscular stiffness throughout. At a March 2002 VA examination, the examiner noted the veteran's complaints of multiple joint pains. The examiner noted that on this examination, the pain affected his feet. The examiner stated that the veteran's complaints were related to overuse syndrome specifically related to his lifting and repetitive movements and prolonged standing related to his work. The examiner opined that these complaints do not relate to undiagnosed illness related to the veteran's Persian Gulf service. The veteran's arthralgia, degenerative joint disease of the hips and elbows, and generalized joint pains have not been related to the veteran's service, nor is there any objective indication of chronic disability attributable to service. In fact, at the recent examination, the examiner attributed the veteran's complaints to overuse and specifically concluded that such complaints and findings were not related to his service or an undiagnosed illness related to his Persian Gulf service. Accordingly, the Board concludes that the preponderance of the evidence is against a finding that the veteran has multiple joint pain that was related to service. Therefore, the claim for service connection is denied. VCAA There was a significant change in the law during the pendency of this appeal. The Veterans Claims Assistance Act of 2000 (VCAA), 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West Supp. 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2002) redefined the obligations of VA with respect to the duty to assist, and imposed on VA certain notification requirements. The final regulations implementing the VCAA were published on August 29, 2001, and they apply to most claims for benefits received by VA on or after November 9, 2000, as well as any claim not decided as of that date, such as the one in the present case. 38 C.F.R. § 3.159. First, VA has a duty to notify the veteran of any information and evidence needed to substantiate and complete a claim. 38 U.S.C.A. §§ 5102 and 5103; 38 C.F.R. § 3.159(b). There is no issue as to providing an appropriate application form or completeness of the application in this case. In the circumstances of this case, the veteran has been advised of the applicable laws and regulations, and the evidence needed to substantiate his claim by September 2002 supplemental statement of the case. In particular, the veteran was notified that VA would obtain all relevant evidence in the custody of a federal department or agency, including VA, Vet Center, service department, Social Security, and other federal agencies. He was advised that it was his responsibility to either send medical treatment records from his private physician regarding treatment for his claimed disabilities, or to provide a properly executed release so that VA could request the records for him. The veteran was also asked to advise VA if there were any other information or evidence he considered relevant to his claim so that VA could help by getting that evidence. Thus, VA's duty to notify has been fulfilled. See Quartuccio v. Principi, 16 Vet. App. 183 (2002). Secondly, VA has a duty to assist the veteran in obtaining evidence necessary to substantiate the claim. 38 U.S.C.A. § 5103A (West Supp. 2002); 38 C.F.R. § 3.159(c)). The record shows that the RO has secured the veteran's National Guard medical records, VA clinical records and examination reports, and private medical records. In view of the foregoing, the Board finds that all reasonable efforts to secure and develop the evidence that is necessary for an equitable disposition of the matter on appeal have been made by the agency of original jurisdiction. Every possible avenue of assistance has been explored, and the veteran has had ample notice of what might be required or helpful to establish his claim. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (strict adherence to requirements in the law does not dictate an unquestioning, blind adherence in the face of overwhelming evidence in support of the result in a particular case; such adherence would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran). The Board concludes, therefore, that a decision on the merits at this time does not violate the VCAA, nor prejudice the veteran under Bernard v. Brown, 4 Vet. App. 384 (1993). ORDER Entitlement to service connection for hearing loss of the left ear is granted. Service connection for shortness of breath is denied. Service connection for skin disorder is denied. Service connection for memory loss is denied. Service connection for left shoulder and arm pain is denied. Service connection for multiple joint pain is denied. C. W. SYMANSKI Member, Board of Veterans' Appeals IMPORTANT NOTICE: We have attached a VA Form 4597 that tells you what steps you can take if you disagree with our decision. We are in the process of updating the form to reflect changes in the law effective on December 27, 2001. See the Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the meanwhile, please note these important corrections to the advice in the form: ? These changes apply to the section entitled "Appeal to the United States Court of Appeals for Veterans Claims." (1) A "Notice of Disagreement filed on or after November 18, 1988" is no longer required to appeal to the Court. (2) You are no longer required to file a copy of your Notice of Appeal with VA's General Counsel. ? In the section entitled "Representation before VA," filing a "Notice of Disagreement with respect to the claim on or after November 18, 1988" is no longer a condition for an attorney-at-law or a VA accredited agent to charge you a fee for representing you.