Citation Nr: 0919306 Decision Date: 05/22/09 Archive Date: 05/26/09 DOCKET NO. 06-19 120 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for coronary artery disease, status post coronary artery bypass graft surgery, to include as due to Agent Orange exposure. 2. Entitlement to service connection for a sleep disorder, to include as due to Agent Orange exposure. 3. Entitlement to service connection for depression, claimed as a nerve disorder-stress, to include as due to Agent Orange exposure. 4. Entitlement to service connection for an eye disorder, claimed as loss of sight, to include as due to Agent Orange exposure. 5. Entitlement to service connection for hypertension, to include as due to Agent Orange exposure. 6. Entitlement to service connection for hyperlipidemia, claimed as high cholesterol, to include as due to Agent Orange exposure. 7. Entitlement to service connection for shortness of breath, to include as due to Agent Orange exposure. 8. Entitlement to service connection for dizziness, to include as due to Agent Orange exposure. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Scott Shoreman, Associate Counsel INTRODUCTION The Veteran had active service from February 1973 to February 1975. This matter comes before the Board of Veterans' Appeals (Board) from a July 2005 rating decision of the above Department of Veterans Affairs (VA) Regional Office (RO). FINDINGS OF FACT 1. The evidence does not establish that the Veteran was exposed to Agent Orange or other herbicide agents during active service. 2. The competent and probative medical evidence of record preponderates against a finding that any currently diagnosed coronary artery disease, status post coronary artery bypass graft surgery, is related to the Veteran's active military service, and coronary artery disease is not shown to have been manifested to a compensable degree within one year after separation from service. 3. The competent and probative medical evidence of record preponderates against a finding that any currently diagnosed sleep disorder is related to the Veteran's active military service. 4. The competent and probative medical evidence of record preponderates against a finding that any currently diagnosed depression, claimed as a nerve disorder-stress, is related to the Veteran's active military service. 5. The competent and probative medical evidence of record preponderates against a finding that any currently diagnosed eye disorder, claimed as loss of sight, is related to the Veteran's active military service. 6. The competent and probative medical evidence of record preponderates against a finding that any currently diagnosed hypertension is related to the Veteran's active military service, and hypertension is not shown to have been manifested to a compensable degree within one year after separation from service. 7. The competent and probative medical evidence of record preponderates against a finding that any currently diagnosed hyperlipidemia, claimed as high cholesterol (to the extent the condition may be considered as a disability), is related to the Veteran's active military service. 8. The competent and probative medical evidence of record preponderates against a finding that any currently diagnosed shortness of breath is related to the Veteran's active military service. 9. The competent and probative medical evidence of record preponderates against a finding that any currently diagnosed dizziness is related to the Veteran's active military service. CONCLUSIONS OF LAW 1. Coronary artery disease, status post coronary artery bypass graft surgery, claimed as a result of Agent Orange exposure, was not incurred in or aggravated by service and may not be presumed to have been incurred as a result of such service. 38 U.S.C.A. §§ 1101, 1110, 1111, 1112, 1113, 1116 (West 2002 & Supp. 2008); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326(a) (2008). 2. A sleep disorder, claimed as a result of Agent Orange exposure, was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1101, 1110, 1111, 1112, 1113, 1116; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326(a). 3. Depression, claimed as a nerve disorder-stressed and as a result of Agent Orange exposure, was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1101, 1110, 1111, 1112, 1113, 1116; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326(a). 4. An eye disorder, claimed as loss of sight and as a result of Agent Orange exposure, was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1101, 1110, 1111, 1112, 1113, 1116; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326(a). 5. Hypertension, claimed as a result of Agent Orange exposure, was not incurred in or aggravated by service and may not be presumed to have been incurred as the result of such service. 38 U.S.C.A. §§ 1101, 1110, 1111, 1112, 1113, 1116; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326(a). 6. Hyperlipidemia, claimed as high cholesterol and as a result of Agent Orange exposure, was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1101, 1110, 1111, 1112, 1113, 1116; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326(a). 7. Shortness of breath, claimed as a result of Agent Orange exposure, was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1101, 1110, 1111, 1112, 1113, 1116; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326(a). 8. Dizziness, claimed as a result of Agent Orange exposure, was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1101, 1110, 1111, 1112, 1113, 1116; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326(a). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) enhanced VA's duty to notify and assist claimants in substantiating their claims for VA benefits, as codified in pertinent part at 38 U.S.C.A. §§ 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2008); 38 C.F.R. §§ 3.102, 3.159, 3.326(a) (2008). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his representative of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 C.F.R. § 3.159(b)(1) (2008). This notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). If complete notice is not provided until after the initial adjudication, such a timing error can be cured by subsequent legally adequate VCAA notice, followed by readjudication of the claim, as in a Statement of the Case (SOC) or Supplemental SOC (SSOC). Moreover, where there is an uncured timing defect in the notice, subsequent action by the RO which provides the claimant a meaningful opportunity to participate in the processing of the claim can prevent any such defect from being prejudicial. Mayfield v. Nicholson, 499 F.3d 1317, 1323-24 (Fed. Cir. 2007); Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). The U.S. Court of Appeals for the Federal Circuit previously held that any error in VCAA notice should be presumed prejudicial, and that VA must bear the burden of proving that such an error did not cause harm. Sanders v. Nicholson, 487 F.3d 881 (2007). However, the U.S. Supreme Court has recently reversed that decision, finding it unlawful in light of 38 U.S.C.A. § 7261(b)(2), which provides that, in conducting review of decision of the Board, a court shall take due account of rule of prejudicial error. The Supreme Court in essence held that - except for cases in which VA has failed to meet the first requirement of 38 C.F.R. § 3.159(b) by not informing the claimant of the information and evidence necessary to substantiate the claim - the burden of proving harmful error must rest with the party raising the issue, the Federal Circuit's presumption of prejudicial error imposed an unreasonable evidentiary burden upon VA and encouraged abuse of the judicial process, and determinations on the issue of harmless error should be made on a case-by-case basis. Shinseki v. Sanders, No. 07-1209 (S. Ct. April 21, 2009). In October 2004, VA sent the Veteran a letter informing him of the types of evidence needed to substantiate his claim and its duty to assist him in substantiating his claim under the VCAA. The letter informed the Veteran that VA would assist him in obtaining evidence necessary to support his claim, such as medical records, employment records, or records from other Federal agencies. He was advised that it is his responsibility to provide or identify, and furnish authorization where necessary for the RO to obtain, any supportive evidence pertinent to his claim. See 38 C.F.R. § 3.159(b)(1). Although no longer required, the appellant was also asked to submit evidence and/or information in his possession to the RO. The Board finds that the content of the letter provided to the Veteran complied with the requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) regarding VA's duty to notify and assist. In addition, the July 2005 rating decision and May 2006 SOC explained the basis for the RO's action, and the SOC provided him with an additional 60-day period to submit more evidence. It appears that all obtainable evidence identified by the Veteran relative to his claim has been obtained and associated with the claims file, and that neither he nor his representative has identified any other pertinent evidence, not already of record, which would need to be obtained for a fair disposition of this appeal. It is therefore the Board's conclusion that the Veteran has been provided with every opportunity to submit evidence and argument in support of his claims, and to respond to VA notices. Moreover, the claimant has not demonstrated any prejudicial or harmful error in VA's notice, and any presumption of error as to the first element of VCAA notice has been rebutted in this case. See Sanders, supra. In addition to the foregoing harmless-error analysis, to whatever extent the decision of the Court in Dingess v. Nicholson, 19 Vet. App. 473 (2006) requires more extensive notice in claims for compensation, e.g., as to potential downstream issues such as disability rating and effective date, the Board finds no prejudice to the Veteran in proceeding with the present decision. Since the claim for service connection is being denied, no effective date will be assigned, so there can be no possibility of any prejudice to the Veteran. The RO did not afford the Veteran a VA examination for his claimed disorders on the basis that there is already sufficient medical evidence to decide the claim, and the Board agrees. In McClendon v. Nicholson, 20 Vet. App. 79 (2006), the Court reviewed the criteria for determining when an examination is required by applicable regulation and how the Board applies 38 C.F.R. § 3.159(c). The three salient benchmarks are: competent evidence of a current disability or recurrent symptoms; establishment of an in-service event, injury, or disease; and indication that the current disability may be associated with an in-service event. The Board finds that the claimed disorders do not have a current diagnosis or symptoms or cannot be associated with an in- service event. Therefore, the Board finds that the evidence of record does not trigger the necessity of an examination in order to decide the claim on the merits. See 38 C.F.R. § 3.159(c). Accordingly, we find that VA has satisfied its duty to assist the Veteran in apprising him as to the evidence needed, and in obtaining evidence pertinent to his claim under the VCAA. Therefore no useful purpose would be served in remanding this matter for yet more development. Such a remand would result in unnecessarily imposing additional burdens on VA, with no additional benefits flowing to the Veteran. The Court of Appeals for Veteran Claims has held that such remands are to be avoided. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). It is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C.A. § 7104(a). When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the Court of Appeals for Veterans Claims held that an appellant need only demonstrate that there is an "approximate balance of positive and negative evidence" in order to prevail. The Court has also stated, "It is clear that to deny a claim on its merits, the evidence must preponderate against the claim." Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert. II. Relevant Law, Factual Background, and Analysis Service connection may be granted for disability which is the result of disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 2002 & Supp. 2008); 38 C.F.R. § 3.303(a) (2008). Service connection may be granted for disease that is diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. § 1113(b); 38 C.F.R. § 3.303(d). The U.S. Court of Appeals for Veterans Claims has held that, in order to prevail on the issue of service connection, there must (1) be medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in- service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in- service disease or injury and the present disease or injury. Hickson v. West, 12 Vet. App. 247, 253 (1999). Where there is a chronic disease shown as such in service or within the presumptive period under 38 C.F.R. § 3.307 so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. This rule does not mean that any manifestation in service will permit service connection. To show 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 disease identity is established, there is no requirement of evidentiary showing of continuity. 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). In addition, the law provides that, where a veteran served ninety days or more of active military service, and certain chronic diseases, such as cardiovascular-renal disease, i.e. coronary artery disease, hypertension, and hyperlipidemia, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. The law further provides that, if a veteran was exposed to a herbicide agent during active service, presumptive service connection is warranted for the following disorders: chloracne or other acneform disease consistent with chloracne; type II diabetes mellitus; Hodgkin's disease; multiple myeloma; non-Hodgkin's lymphoma; acute and subacute peripheral neuropathy; porphyria cutanea tarda; prostate cancer; respiratory cancers (cancer of the lung, bronchus, larynx, or trachea); and, soft-tissue sarcoma (other than ostrosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma). Presumptive service connection for these disorders as a result of Agent Orange exposure is warranted if the requirements of 38 C.F.R. § 3.307(a)(6) are met. 38 U.S.C.A. § 1116; 38 C.F.R. § 3.309(e). As to determining possible exposure, the law provides that a "veteran who, 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, shall be presumed to have been exposed during such service to an herbicide agent . . . unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service." 38 U.S.C.A. § 1116(f). The Veteran maintains that he is entitled to a presumption of exposure to Agent Orange for his claim due to exposure while in service. His DD Form 214 shows that he was awarded the National Defense Service Medal. However, he was not awarded the Vietnam Service Medal or other medal which might be indicative of service in Vietnam. In addition, the record does not show any evidence that the Veteran was exposed to Agent Orange. Absent evidence of exposure, or service in the Republic of Vietnam during the Vietnam era, the Board cannot conclude that service connection is warranted on a presumptive basis for the Veteran's claimed disorders at a result of exposure to Agent Orange. The Secretary, under the authority of the Agent Orange Act of 1991 and based on studies by the National Academy of Sciences (NAS), has determined that there is no positive association between exposure to herbicides and any condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. See Notice, 59 Fed. Reg. 341-346 (1994); see also Notice, 61 Fed. Reg. 41,442-449, and 61 Fed. Reg. 57,586-589 (1996); Notice, 64 Fed. Reg. 59,232-243 (Nov. 2, 1999); Notice, 67 Fed. Reg. 42,600-08 (June 24, 2002); Notice, 72 Fed. Reg. 32,395-407 (June 12, 2007). Since the Secretary has not specifically found any linkage between any of the Veteran's claimed disorders and herbicide exposure, none of them could be presumed to be due to Agent Orange exposure, even if exposure were shown by the evidence. The RO has determined that the Veteran's service treatment records have been lost, and that it would be futile to search for them any further. In the absence of the presumed destroyed service treatment records, the Board's obligation to explain its findings and conclusions, and to consider carefully the benefit-of-the-doubt rule, is heightened. See O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). A. Service Connection for Coronary Artery Disease, Status Post Coronary Artery Bypass Graft Surgery; Hyperlipidemia, Claimed as High Cholesterol; Hypertension; Shortness of Breath; and Dizziness VA treatment records from December 1992, January 1993, and March 1993 show that the Veteran's blood pressure was 140/72, 148/88, and 140/56 respectively. Private treatment notes from the S.M.C. show that in 1995 the Veteran had blood pressure readings of 118/90, 110/84, and 132/86. In 1996 his blood pressure was 130/98 and in 1997 it was 140/96, 120/80, 136/80. The Veteran had blood pressure readings of 126/80, 132/82, 140/100, 134/90, and 130/80 in 1999. At October 1999 treatment the Veteran's heart was found to have regular rhythm with no murmurs. In February 2001 his blood pressure was 130/80. August 2001 treatment notes from D.M.C.M.H. indicate the Veteran had hypertension and heart disease. He had reported to the emergency department with an achy feeling on the side of his head down to his left leg. There were no reports of neurological symptoms, and the Veteran was not found to have any neurological deficits. His sitting blood pressure was 166/106 and 144/94. Private treatment records from C.H.S. show that in December 2001 the Veteran had an electrocardiogram due to angina that showed normal sinus rhythm with inferior and lateral nonspecific ST segment changes. His blood pressure was 110/76. The assessment showed chest pain that was typical for angina with risk factors of age, sex, hyperlipidemia, and a history of smoking. He then underwent coronary artery bypass surgery. It was noted that he had been diagnosed with hypertension in August 2001 and that he had hyperlipidemia. The Veteran was taking Zocor, Clonidine, Procardia, and Lotensin. Later in December 2001, he went to the emergency department of D.M.C.M.H. complaining of low blood pressure. His blood pressure, as measured at the hospital, was 105/64. At January 2002 private treatment with L.B.W., M.D., the Veteran reported that he had not had any angina. He had no congestive heart failure symptoms, dizziness, palpitations, or syncope since the Clonidine he had been taking for his blood pressure was discontinued. His blood pressure was 128/93 and his pulse was 93. He was to continue taking aspirin daily, hydrochlorothiazide, and potassium replacement. Testing showed that his total cholesterol was 237 and that his low-density lipoprotein (LDL) was 170, which were classified as high. In February 2002, the Veteran's total cholesterol was 273 and his LDL was 201. Dr. W opined at February 2002 treatment that the Veteran was doing clinically well and noted that he had been doing cardiac rehab for the last three weeks and had not had any angina, congestive heart failure symptoms, dizziness, palpitations, or syncope. His dosage of Zocor was increased and he was given literature on how to improve his diet. Dr. W wrote in February 2002 that the Veteran would be able to return to work in April 2002 if he was doing well. The Veteran went to Dr. W for unscheduled treatment in March 2002 because of elevated blood pressure over the last few days and lightheadedness that morning. His blood pressure was 134/96 at home and 140/101 in the office, with a pulse of 75. Dr. W increased the dosage of hydrochlorothiazide and prescribed a beta blocker due to dizziness and lightheadedness. March 2002 testing showed his total cholesterol to be 226, which was classified as high, and his LDL was 145. At April 2002 treatment with Dr. W, the Veteran reported that his blood pressure had been better controlled. He got shortness of breath on exertion and had no angina, dizziness, palpitations, or syncope. His blood pressure was 124/80 and his pulse was 74. Dr. W felt that the Veteran's hypertension was better controlled and that his hypercholesterolemia was severe. His Zocor dosage was increased. At April 2002 treatment at the S.C. the Veteran's blood pressure was 120/78 in successive weeks. June 2002 testing showed the Veteran's total cholesterol to be 202, which was classified as high, and his LDL to be 135. At July 2002 treatment the Veteran was described by Dr. W as doing fairly well and he had no angina or congestive heart failure symptoms. The Veteran reported that he got a little tired after a long day of work and his blood pressure was 140/90 and pulse 76. Dr. W felt that the Veteran's hypercholesterolemia was still not adequately controlled on 80 mg of Zocor and he added Lopid to the Veteran's regimen. September 2002 testing showed the Veteran's total cholesterol to be 184 and his LDL to be 103. Dr. W noted at October 2002 treatment that the Veteran was doing fairly well as far as his heart was concerned with no angina, congestive heart failure symptoms, dizziness, palpitations or syncope. Over the last several weeks the Veteran had developed paresthsias in his left upper extremity and pain in his left thigh and calf. It got worse as the day went on but was not worsened by momentary exertion. Dr. W discontinued the Zocor to see whether it was causing the leg pain. He noted that the hypertension and hypercholesterolemia were well controlled. In November 2002 the Veteran reported that there had not been much improvement in his leg pain. He did not have any angina, congestive heart failure symptoms, dizziness, palpitations or syncope. His blood pressure was 144/70 and pulse 77. Dr. W started him back on Zocor and referred him to a neurologist. The Veteran was next treated by Dr. W in March 2003, at which time he had no angina, congestive heart failure symptoms, dizziness, palpitations or syncope. His blood pressure was 160/100, and Dr. W opined that his hypertension was not as well controlled as it had been. He was encouraged to exercise regularly and to watch his salt intake. At March 2004 treatment with Dr. W, the Veteran was noted to be doing "extremely well." He had no angina, congestive heart failure symptoms, dizziness, palpitations, syncope, claudication, or peripheral edema. His blood pressure was 138/86 and Dr. W described his diastolic hypertension as stable. The Veteran continued to take Zocor for hypercholesterolemia. VA treatment notes show that at a March 2005 annual examination the Veteran reported that he was doing better and had not had much shortness of breath. His blood pressure was 123/76 and on examination his heart had no murmur and S1 and S2 were regular. The Veteran was diagnosed with mixed hyperlipidemia, and it was noted that he had been on Zocor 80 mg for sometime but that it was not doing much good as of yet. Therefore, his medication regimen was adjusted. Pulmonary function and stress tests were normal. The Board notes that high blood serum cholesterol, or hyperlipidemia, does not represent a "disability" as contemplated by the controlling legal criteria, but is rather characterized merely as a laboratory finding, and is not, in and of itself, a disability. See 61 Fed. Reg. 20,440-20,445 (May 7, 1996). In any event, since the Veteran has claimed the elevated blood test results as a disability, the Board will adjudicate the matter. The gap of approximately 25 years between the Veteran's military service and the first time he is shown by the documentary record to have been seen for his coronary artery disease, status post coronary artery bypass graft surgery, hyperlipidemia, claimed as high cholesterol, hypertension, shortness of breath, and dizziness militates against a finding that he suffered from these disorders in service. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd, 230 F.3d 1330 (Fed. Cir. 2000) (to the effect that service incurrence may be rebutted by the absence of medical treatment for the claimed condition for many years after service). We recognize the sincerity of the arguments advanced by the Veteran that his coronary artery disease, status post coronary artery bypass graft surgery, hyperlipidemia, claimed as high cholesterol, hypertension, shortness of breath, and dizziness are service connected. However, the resolution of issues that involve medical knowledge, such as the diagnosis of a disability and the determination of medical etiology, requires professional evidence. See Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). The Veteran's lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation, see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Robinson v. Shinseki, No. 2008-7096 (Fed. Cir. March 3, 2009) (confirming that, "in some cases, lay evidence will be competent and credible evidence of etiology"). However, the disorders claimed herein require specialized training for a determination as to diagnosis and causation, and are therefore not susceptible of lay opinions on etiology. In the present case there is no medical evidence of record showing that these disorders are related to the Veteran's active military service or were incurred within any applicable presumptive period. Because the evidence preponderates against the claim of service connection for coronary artery disease, status post coronary artery bypass graft surgery, hyperlipidemia, claimed as high cholesterol, hypertension, shortness of breath, and dizziness, the benefit-of-the-doubt doctrine is inapplicable, and the claim must be denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, supra. B. Eye Disorder, Claimed as Loss of Sight VA treatment records show that in April 1993 the Veteran complained that his eyes had been burning that morning. He was found to have blepharitis. There are no further treatment records related to the Veteran's eyes, and no evidence indicates that the condition treated in 1993 was chronic. As above, the Board recognizes the Veteran's sincere belief in his claim, but the resolution of issues that involve medical knowledge requires professional evidence, and an eye disorder requires specialized training for a determination as to diagnosis and causation. In the present case there is no medical evidence of record showing that the Veteran has a current eye disorder which is related to his active military service. The Board recognizes that the Court of Appeals for Veterans Claims has also held that the presence of a chronic disability at any time during the claim process can justify a grant of service connection, even where the most recent diagnosis is negative. See McClain v. Nicholson, 21 Vet. App. 319 (2007). However, where, as here, the overall evidence of record fails to support a diagnosis of the claimed disorder as a chronic condition at any time, that holding is inapplicable. Because the evidence preponderates against the claim of service connection for an eye disorder, claimed as loss of sight, the benefit-of-the-doubt doctrine is inapplicable, and the claim must be denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, supra. C. Sleep Disorder and Depression, Claimed as a Nerve Disorder-Stress The medical evidence of record does not show any treatment for a sleep disorder or depression. Furthermore, the record does not show that the Veteran has been diagnosed with a sleep disorder or depression at any time. See McClain v. Nicholson, supra. Therefore, where, as here, the overall evidence of record fails to support a diagnosis of the claimed disorders, that holding is inapplicable. Since the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for a sleep disorder and depression, claimed as a nerve disorder- stress, the benefit-of-the-doubt doctrine is inapplicable, and the claim must be denied. 38 U.S.C.A. § 5107(b); Gilbert, supra. ORDER Service connection for coronary artery disease, status post coronary artery bypass graft surgery, is denied. Service connection for a sleep disorder is denied. Service connection for depression, claimed as a nerve disorder-stress, is denied. Service connection for an eye disorder, claimed as loss of sight, is denied. Service connection for hypertension is denied. Service connection for hyperlipidemia, claimed as high cholesterol, is denied. Service connection for shortness of breath is denied. Service connection for dizziness is denied. __________________________ ANDREW J. MULLEN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs