Citation Nr: 1039949 Decision Date: 10/25/10 Archive Date: 11/01/10 DOCKET NO. 06-05 191 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in North Little Rock, Arkansas THE ISSUES 1. Entitlement to an initial compensable evaluation for histoplasmosis of lung. 2. Entitlement to service connection for residuals of injury to the left hand (claimed as due to injury while on active duty for training [ACDUTRA] in March 1984). 3. Entitlement to service connection for bilateral ankle condition (claimed as due to injury during active service and additional injury while on ACDUTRA). 4. Entitlement to service connection for right elbow condition. 5. Entitlement to service connection for bilateral arm condition (claimed as a combat injury during active service and/or as peripheral neuropathy due to exposure to herbicides and/or PCB poisoning). 6. Entitlement to service connection for right knee condition. 7. Entitlement to service connection for high blood pressure (claimed as due to herbicide exposure and/or as secondary to service-connected histoplasmosis). 8. Entitlement to service connection for a skin disorder of the feet (claimed as persistent small blisters on feet since active service, due to herbicide exposure, and/or as secondary to service-connected histoplasmosis). 9. Entitlement to service connection for residuals of injury to the neck and right shoulder (claimed as occurring during a period of ACDUTRA in approximately May 1986). 10. Entitlement to service connection for headaches (claimed as due to an undiagnosed illness, exposure to pesticides manufactured for use in the Persian Gulf War and/or as secondary residuals of service-connected malaria and histoplasmosis). 11. Entitlement to service connection for multiple joint pains (claimed as due to an undiagnosed illness, exposure to pesticides manufactured for use in the Persian Gulf War and/or as secondary residuals of service-connected malaria and histoplasmosis). REPRESENTATION Appellant represented by: Military Order of the Purple Heart of the U.S.A. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD T. Mainelli, Counsel INTRODUCTION The Veteran had active service with the U.S. Marines from April 1968 to February 1970, to include a tour of duty in the Republic of Vietnam during the Vietnam War. He served with the Arkansas Army National Guard (ARNG) from December 1974 to May 1996. This case comes before the Board of Veterans' Appeals (Board) on appeal from a February 2005 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in North Little Rock, Arkansas. In that decision, the RO granted service connection for histoplasmosis of lung and assigned an initial zero percent rating effective April 30, 2004. The Veteran has appealed the initial rating assigned. The RO also denied claims of service connection for residuals of right hand injury; a claim described as involving a bilateral ankle condition, a right elbow condition, a bilateral arm condition, a right knee condition, a bilateral hand condition, joint pains, high blood pressure, a hernia and small blisters on feet directly and as result of exposure to herbicides; residuals of injury to the neck and right shoulder; and headaches. In October 2007, the Veteran appeared and testified before the undersigned. The hearing transcript is associated with the record. As a result of testimony from that hearing and review of the record, the Board, to the best of its ability, has rephrased on the title page the issues certified for appeal to better reflect the Veteran's theories of service connection and to better address the Veteran's claims. The Board makes the factual determination, based on a direct hearing with the Veteran and the procedural history of this case, that these are the sole issues before the Board at this time. In a decision dated January 2008, the Board dismissed issues of entitlement to service connection for hernia and a right hand disorder as the Veteran had withdrawn those claims from appeal. The remaining issues listed on the title page were REMANDED to the RO via the Appeals Management Center (AMC), in Washington, D.C., for further evidentiary development. The issue of entitlement to service connection for eye disease as secondary to service-connected histoplasmosis of the lung has been raised by the record, but has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over this claim which is referred to the AOJ for appropriate action. FINDINGS OF FACT 1. The Veteran's histoplasmosis is not manifested by chronic, active pulmonary mycosis. 2. There is no credible evidence that the Veteran injured his left hand during active duty, ACDUTRA and/or inactive duty training (INACDUTRA) service nor is it credibly shown that a current left hand disability results from any such service. 3. There is no credible evidence that the Veteran injured his right ankle during active duty, ACDUTRA and/or INACDUTRA service nor is it credibly shown that a current right ankle disability results from any such service. 4. There is no credible evidence that the Veteran injured his right elbow during active duty, ACDUTRA and/or INACDUTRA service nor is it credibly shown that a current right elbow disability results from any such service. 5. There is no credible evidence that the Veteran injured both arms during active duty, ACDUTRA and/or INACDUTRA service nor is it credibly shown that a current bilateral arm disability results from any such service. 6. There is no credible evidence that the Veteran injured his right knee during active duty, ACDUTRA and/or INACDUTRA service nor is it credibly shown that a current a right knee disability results from any such service. 7. The Veteran's hypertension, which first manifested many years after active service, is not shown to have been aggravated beyond the normal progression of the disorder by any event during ACDUTRA or INACDUTRA service. 8. The Veteran's fungal infection of the feet was incurred during active service. 9. There is no credible evidence that the Veteran injured his neck and right shoulder during active duty, ACDUTRA and/or INACDUTRA service nor is it credibly shown that current neck and right shoulder disabilities result from any such service. 9. The Veteran's headache disorder first manifested during active service. 10. There is no credible evidence that the Veteran's alleged multiple joints pains are shown to be related to active duty, ACDUTRA and/or INACDUTRA service. CONCLUSIONS OF LAW 1. The criteria for a compensable evaluation for histoplasmosis of lung have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. § 4.97, Diagnostic Code (DC) 6834 (2010). 2. The criteria for entitlement to service connection for residuals of injury to the left hand (claimed as due to injury while on ACDUTRA in March 1984) have not been met. 38 U.S.C.A. §§ 101(24), 1110, 1112, 1116, 1131, 1137, 1154(b), 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2010). 3. The criteria for entitlement to service connection for bilateral ankle condition (claimed as due to injury during active service and additional injury while on ACDUTRA) have not been met. 38 U.S.C.A. §§ 101(24), 1110, 1112, 1116, 1131, 1137, 1154(b), 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2010). 4. The criteria for entitlement to service connection for right elbow condition have not been met. 38 U.S.C.A. §§ 101(24), 1110, 1112, 1116, 1131, 1137, 1154(b), 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2010). 5. The criteria for entitlement to service connection for bilateral arm condition (claimed as a combat injury during active service and/or as peripheral neuropathy due to exposure to herbicides and/or PCB poisoning) have not been met. 38 U.S.C.A. §§ 101(24), 1110, 1112, 1116, 1131, 1137, 1154(b), 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2010). 6. The criteria for entitlement to service connection for right knee condition have not been met. 38 U.S.C.A. §§ 101(24), 1110, 1112, 1116, 1131, 1137, 1154(b), 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2010). 7. The criteria for entitlement to service connection for high blood pressure (claimed as due to herbicide exposure and/or as secondary to service connected histoplasmosis) have not been met. 38 U.S.C.A. §§ 101(24), 1110, 1112, 1116, 1131, 1137, 1154(b), 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2010). 8. The criteria for entitlement to service connection for fungal infection of the feet have been met. 38 U.S.C.A. §§ 101(24), 1110, 1112, 1116, 1131, 1137, 1154(b), 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2010). 9. The criteria for entitlement to service connection for residuals of injury to the neck and right shoulder (claimed as occurring during a period of ACDUTRA in approximately May 1986) have not been met. 38 U.S.C.A. §§ 101(24), 1110, 1112, 1116, 1131, 1137, 1154(b), 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2010). 10. The criteria for entitlement to service connection for headaches have been met. 38 U.S.C.A. § 1110 (West 2002). 11. The criteria for entitlement to service connection for multiple joint pains (claimed as due to an undiagnosed illness, exposure to pesticides manufactured for use in the Persian Gulf War and/or as secondary residuals of service-connected malaria and histoplasmosis) have not been met. 38 U.S.C.A. §§ 101(24), 1110, 1112, 1116, 1117, 1131, 1137, 1154(b), 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2010). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran claims entitlement to a compensable disability rating for service-connected histoplasmosis of the lung. He also seeks service connection for residuals of injury to the left hand, a bilateral ankle condition, a right elbow condition, a bilateral arm condition, a right knee condition, high blood pressure, a skin disorder of the feet described as persistent small blisters on feet, residuals of injury to the neck and right shoulder, headaches and multiple joint pains. Notably, the Veteran has filed claims, and then other new claims, and then filed different theories as to why service connection should be granted, which has frustrated the ability of the VA to timely and effectively adjudicate all claims. As the U.S. Court of Appeals for Veterans Claims (Court) has stated: Advancing different arguments at successive stages of the appellate process does not serve the interests of the parties or the Court. Such a practice hinders the decision-making process and raises the undesirable specter of piecemeal litigation. Fugere v. Derwinski, 1 Vet. App. 103, 105 (1990), aff'd 972 F.2d 331 (Fed. Cir. 1992). At the outset, the Board must discern the claims on appeal according to several alternative service connection theories offered by the Veteran over the course of the appeal, creating difficulties at the RO in fully addressing the Veteran's appeal as the Veteran has not also been always consistent as to why he believes a particular problem is related to his military service. At the video-conference hearing in October 2007, the Veteran provided additional clarification as to his service connection theories. Service connection is in effect for posttraumatic stress disorder (PTSD), residuals of malaria, histoplasmosis of lung, boils/furuncles of the skin and tinea cruris, all of which are related to the Veteran's period of active service with the U.S. Marines April 1968 to February 1970. With regard to this period of active service, the Veteran reports injury to an unspecified arm during combat circumstances in Vietnam, a twisting injury to an unspecified ankle during Infantry Training Regimen (ITR), the onset of persistent and recurrent headaches, and having a recurrent blister condition of the feet that he claims is common to combat soldiers. The Veteran has additionally submitted medical articles that he believes establishes that his headaches and multiple joint pains are due to exposure to herbicides and/or are complications of his service-connected malaria and histoplasmosis. He claims that his elevated blood pressure and foot blisters are attributable to herbicide exposure. He has clarified that his claim for bilateral arm disability includes peripheral neuropathy due to herbicide exposure and/or "PCB" exposure. He further claims that his foot blisters may be proximately due to service- connected histoplasmosis. Finally, the Veteran has provided pictures of a motor transport accident which he alleges resulted in disability. Notably, a service connection claim includes all theories under which service connection may be granted. Bingham v. Principi, 421 F.3d 1346, 1349 (Fed. Cir. 2005); Ashford v. Brown, 10 Vet. App. 120, 123 (1997). The Veteran also attributes some his claimed disabilities as being related to his service with the ARNG. He claims a left hand injury during a summer camp exercise at Fort Hood in approximately May 1984, neck and right shoulder injuries during a summer camp exercise at Fort Chaffee in May 1986, and an ankle injury during summer camp exercises in Little Rock (date of incident and side of extremity involved not specified). He claims the onset of multiple joint pains during summer camp in 1994 caused by use of insecticides manufactured for use in the Persian Gulf. He generally alleges that his high blood pressure had its onset while he was an ARNG member. Disability rating claim Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. If there is disagreement with the initial rating assigned following a grant of service connection, separate ratings can be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119, 126 (1999). See AB v. Brown, 6 Vet. App. 35 (1993) (a claim for an original or an increased rating remains in controversy when less than the maximum available benefit is awarded). Reasonable doubt as to the degree of disability will be resolved in the veteran's favor. 38 C.F.R. § 4.3. Histoplasmosis of the lung is to be evaluated under the General Rating Formula for Mycotic Lung Disease. Under this formula, asymptomatic healed and inactive mycotic lesions warrant a noncompensable evaluation. 38 C.F.R. § 4.97, DC 6834. A 30 percent evaluation requires chronic pulmonary mycosis with minimal symptoms such as occasional minor hemoptysis or productive cough. A 50 percent evaluation is warranted for chronic pulmonary mycosis requiring suppressive therapy with no more than minimal symptoms such as occasional minor hemoptysis or productive cough. A 100 percent evaluation is warranted for chronic pulmonary mycosis with persistent fever, weight loss, night sweats, or massive hemoptysis. Historically, a June 1970 VA Compensation and Pension (C&P) examination found that chest X-ray examination demonstrated miliary calcinosis throughout both of the Veteran's lung fields consistent with histoplasmosis. No active lung disease was seen. Respiratory examination was otherwise unremarkable. In pertinent part, the post-service medical records include an October 2003 radiology report interpreted as showing granulomatous change with no active infiltrate. An August 2005 private clinical record noted the Veteran's report of productive cough with difficulty of breathing after eating. On examination, the lungs were clear to auscultation. A chest X- ray examination was interpreted as showing no acute infiltrate with small calcified granuloma in both lungs. A September 2005 neurology evaluation noted the Veteran to have a cough. An August 2006 VA clinical record noted the Veteran's complaints of shortness of breath with moderate exercise which worsened after eating a big meal. He also experienced a daily cough productive of a small amount of thick mucus in the morning. A pulmonary function test (PFT) demonstrated normal obstructive breathing, and mild restrictive breathing. The remaining evidence of record is absent for any medical evidence suggesting that the Veteran manifests chronic, active pulmonary mycosis. Additional evidence includes the Veteran's allegations that the service-connected histoplasmosis has resulted in scarring which has destroyed non-restorable air sacks. He describes symptoms of coughing in the middle of his chest, in an approximate 6 inch circle, which feels raw and filled with mucous. At times, the Veteran can see small drops of mucous blown out of his mouth when he coughs. He has greater breathing difficulty after eating, and cannot breath if lying on a couch. He believes that he has a lower oxygen level which has caused other problems. He also argues that his service-connected histoplasmosis is responsible for a 42 percent reduction in his overall breathing capacity. A medical article reports that histoplasmosis results from a fungal infection common in places with moderate temperatures and moisture. It is noted that many healthy people infected with this fungus are asymptomatic as their bodies fought off the disease. Patients with acute symptomatic pulmonary histoplasmosis demonstrate symptoms such as fever, chills, cough and chest pain when breathing in. Patients with chronic pulmonary histoplasmosis have additional symptoms of excessive sweating and fever, which can resemble symptoms of pulmonary tuberculosis and include hemoptysis. Patients with disseminated histoplasmosis manifest fevers, headache, neck stiffness, skin lesions and mouth sores. Other histoplasma syndromes include joint pain, skin nodules (lumps) and rashes. The mainstay of therapy for histoplasmosis is anti-fungal therapy. In cases of pulmonary histoplasmosis, treatment can include oral agents such as oral itraconazole or ketoconazole. In disseminated histoplasmosis, therapy includes intravenous amphotericin followed by long-term suppression with an oral agent such as itraconazole. Applying the criteria to the facts of the case, the Board finds that the criteria for a compensable rating for histoplasmosis of the lung have not been met for any time during the appeal period. In this respect, the credible lay and medical evidence demonstrates that the Veteran does not manifest chronic, active pulmonary mycosis. The Veteran has described symptoms such as coughing, restrictive breathing and decreased oxygen levels which he attributes to active histoplasmosis of the lung. In support of these allegations, the Veteran has submitted a medical treatise article regarding active and disseminated histoplasmosis. The Veteran is clearly competent to describe respiratory symptomatology. However, the Veteran is not competent to correlate these symptoms to his past history of histoplasmosis. See 38 C.F.R. § 3.159(a)(2). The medical records associated with the claims folder do not include any medical opinion that the Veteran currently manifests active or disseminated histoplasmosis of the lung. Additionally, the Veteran has no history of treatment with oral or intravenous anti-fungal medications. Thus, the medical treatise articles submitted in support of this claim, if anything, provide evidence against the claim failing to show that the Veteran manifests the type of symptoms and treatment for active or disseminated histoplasmosis of the lung. More importantly, the Board finds that the radiologist opinions in this case indicating that X-ray examinations of the chest show no active histoplasmosis lung disease greatly outweigh the Veteran's contentions, as they have greater training and expertise to speak to the issues at hand. The opinion is based on objective testing. Furthermore, the Board acknowledges the PFT findings that the Veteran demonstrates mild restrictive breathing. However, there is no medical opinion that such disability has any relationship whatsoever to service-connected histoplasmosis, which is not shown to be active. Notably, VA's rating criteria do not contemplate restrictive breathing symptomatology as being associated with active mycotic lung disease. See 38 C.F.R. § 4.97, DC 6834. Therefore, the Board finds no basis to apply any criteria pertaining to PFT findings. Overall, the Board finds that the credible lay and medical evidence demonstrates that the Veteran's histoplasmosis of the lung has not been manifested by chronic, active pulmonary mycosis for any time during the appeal period. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable and the claim must be denied. 38 U.S.C.A. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364, 1365 (Fed. Cir. 2001). Finally, the Board has considered whether the Veteran's claim warrants referral to the Chief Benefits Director of VA's Compensation and Pension Service under 38 C.F.R. § 3.321. In Thun v. Peake, 22 Vet. App. 111 (2008), the Court clarified the analytical steps necessary to determine whether referral for extraschedular consideration is warranted. The Court stated that the RO or the Board must first determine whether the schedular rating criteria reasonably describe the veteran's disability level and symptomatology. Id. at 115. If the schedular rating criteria do reasonably describe the veteran's disability level and symptomatology, the assigned schedular evaluation is adequate, referral for extraschedular consideration is not required, and the analysis stops. Id. The Board is aware of the Veteran's complaints that his service- connected histoplasmosis of the lung has on his ability to work and perform the daily activities of living. The Veteran is clearly competent to describe his pulmonary symptoms, but he is not competent to attribute all pulmonary abnormalities to service-connected mycotic lung disease. The competent evidence demonstrates that the Veteran does not manifest active mycotic lung disease, and these findings are squarely addressed in the schedular criteria. Higher schedular ratings are available based upon active lung disease symptomatology. As the schedular rating reasonably addresses the Veteran's level of disability, there is no basis for extraschedular consideration of this claim. Service connection claims Service connection may be established for a disability resulting from an injury suffered or disease contracted in the line of duty, or for aggravation of a pre-existing injury or disease, contracted in line of duty in the active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131. Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d). 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, such as arthritis and cardiovascular- renal disease (including hypertension), may be presumed to have been incurred in service if manifest to a compensable degree within one year from discharge from service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307 are also satisfied. 38 U.S.C.A. § 1112, 1113; 38 C.F.R. § 3.309(a). In addition, diseases associated with exposure to certain herbicide agents used in support of military operations in the Republic of Vietnam (Vietnam) during the specific time period will be considered to have been incurred in service. 38 U.S.C.A. § 1116(a)(1); 38 C.F.R. § 3.307(a)(6). The term "herbicide agent" means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the Vietnam era. Specifically, this includes 2,4- D; 2,4,5-7 and its contaminant TCDD; cacodylic acid; and picloram. 38 C.F.R. § 3.307(a)(6). Orthopedic disabilities, multiple joint pains, chronic peripheral neuropathy, and hypertension are not among the diseases subject to presumptive service connection under 38 U.S.C.A. § 1116. It is not alleged, or shown, that the Veteran has ever manifested acute and subacute peripheral neuropathy. See 38 C.F.R. § 3.309(e), Note 2 (defining acute and subacute peripheral neuropathy as a transient peripheral neuropathy that appears within weeks or months of exposure to an herbicide agent and resolves within two years of the date of onset). The Secretary of Veterans Affairs has determined that there is no positive association between exposure to herbicides and any other condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. In this regard, the Board observes that VA has issued several notices in which it was determined that a presumption of service connection based upon exposure to herbicides used in Vietnam should not be extended beyond specific disorders, based upon extensive scientific research. See, e.g., 68 Fed. Reg. 27,630-27,641 (May 20,2003); 67 Fed. Reg. 42600 (June 24, 2002); 66 Fed. Reg. 2376 (Jan. 11, 2001); 64 Fed. Reg. 59232 (Nov.2 1999). The Veteran claims an undiagnosed illness related to weapons used in the Persian Gulf War. The Veteran did not serve in the Persian Gulf War. As he does not have the requisite service, the presumptive provisions of 38 U.S.C.A. § 1117 and 38 C.F.R. § 3.317 do not apply. See Pratt v. Nicholson, 20 Vet. App. 252 (2006). Veteran status is the first element required for a claim for disability benefits. D'Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000). The term "veteran" means a person who served in the active military, naval, or air service and who was discharged or released therefrom under conditions other than dishonorable. 38 U.S.C.A. § 101(2). The term "active duty" includes full- time duty in the Armed Forces, other than ACDUTRA. 38 U.S.C.A. § 101(21). The term Armed Forces means the United States Army, Navy, Marine Corps, Air Force, and Coast Guard, including the reserve components thereof. 38 U.S.C.A. § 101(10). Active military, naval, or air service includes any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred in or aggravated in line of duty or a period of INACDUTRA during which the individual concerned was disabled or died from injury incurred in or aggravated in line of duty. 38 U.S.C.A. § 101(21) and (24); 38 C.F.R. § 3.6(a) and (d). With respect members of the ARNG, ACDUTRA means full-time duty under section 316, 502, 503, 505 of title 32, or the prior corresponding provisions of law. 38 U.S.C.A. § 101(22)(c). INACDUTRA includes duty (other than full-time duty) performed by a member of the National Guard of any State, under 32 U.S.C.A. §§ 316, 502, 503, 504, or 505, or the prior corresponding provisions of law. 38 C.F.R. § 3.6(d)(4). Any individual (1) who, when authorized or required by competent authority, assumes an obligation to perform ACDUTRA or INACDUTRA; and (2) who is disabled or dies from an injury or covered disease incurred while proceeding directly to or returning directly from such ACDUTRA or INACDUTRA shall be deemed to have been on ACDUTRA or INACDUTRA, as the case may be. 38 C.F.R. § 3.6(e). Only service department records can establish if and when a person was serving on active duty, ACDUTRA, or INACDUTRA. Cahall v. Brown, 7 Vet. App. 232, 237 (1994). Service department records are binding on VA for purposes of establishing service in the U.S. Armed Forces. Duro v. Derwinski, 2 Vet. App. 530, 532 (1992); see also 38 C.F.R. § 3.203, limiting the type of evidence accepted to verify service dates. A service department finding that an injury occurred in the line of duty will be binding on the VA unless it is patently inconsistent with the requirements of laws administered by the VA. 38 C.F.R. § 3.1(m); see Kinnaman v. Principi, 4 Vet. App. 20, 28 (1993). The presumption of soundness under 38 U.S.C.A. § 1111 does not apply when a claimant, veteran or otherwise, has not been examined contemporaneous to entering a period of ACDUTRA. Smith v. Shinseki, 24 Vet. App. 40, 45 (2010). The presumption pertaining to chronic diseases under 38 U.S.C.A. § 1112 and the presumption of aggravation under 38 U.S.C.A. § 1153 do not apply to ACDUTRA or INACDUTRA service. Id. See also Acciola v. Peake, 22 Vet. App. 320 (2008); Mercado-Martinez v. West, 11 Vet. App. 415, 419 (1998); Paulson v. Brown, 7 Vet. App. 466, 470 (1995). When a claim for service connection is based only on a period of ACDUTRA, there must be some evidence that the appellant became disabled as a result of a disease or injury incurred or aggravated in the line of duty during the period of ACDUTRA. Smith, 24 Vet. App. at 47. In the absence of such evidence, the period of ACDUTRA would not qualify as "active military, naval, or air service," and the appellant would not qualify as a "veteran" by virtue of ACDUTRA service alone. Id. With respect to a claim for aggravation of a preexisting condition during ACDUTRA, the claimant must provide direct evidence both that a worsening of the condition occurred during the period of ACDUTRA and that the worsening was caused by the period of ACDUTRA. Smith, 24 Vet. App. at 48. Service connection may be granted, on a secondary basis, for a disability which is proximately due to, or the result of an established service-connected disorder. 38 C.F.R. § 3.310. Similarly, any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. Allen v. Brown, 7 Vet. App. 439 (1995). In the latter instance, the nonservice-connected disease or injury is said to have been aggravated by the service-connected disease or injury. 38 C.F.R. § 3.310. In cases of aggravation of a veteran's nonservice-connected disability by a service-connected disability, such veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.322. Effective October 10, 2006, VA amended 38 C.F.R. § 3.310 to implement the decision by the United States Court of Appeals for Veterans Claims (Court) in Allen v. Principi, 7 Vet. App. 439 (1995), which addressed the subject of the granting of service connection for the aggravation of a nonservice-connected condition by a service-connected condition. See 71 Fed. Reg. 52,744-47 (Sept. 7, 2006). The existing provision at 38 C.F.R. § 3.310(b) was moved to sub-section (c). Under the revised section 3.310(b), the regulation provides that: Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice- connected disease, will be service connected. However, VA will not concede that a nonservice- connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice- connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. The rating activity will determine the baseline and current levels of severity under the Schedule for Rating Disabilities (38 C.F.R. part 4) and determine the extent of aggravation by deducting the baseline level of severity, as well as any increase in severity due to the natural progress of the disease, from the current level. 71 Fed. Reg. 52,744 (2006) (codified at 38 C.F.R. § 3.310(b)). The Board finds no prejudice to the Veteran in evaluating the aspect of the claim involving secondary service connection under either the old or new criteria, which came in effect in October 2006 to address the Allen decision. The Board has reviewed this case under both Allen and the old and new criteria. See generally, Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003); VAOPGCPREC 7-2003, 69 Fed. Reg. 25179 (2004). The claimant bears the burden of presenting and supporting his/her claim for benefits. 38 U.S.C.A. § 5107(a). See Fagan v. Shinseki, 573 F.3d 1282 (Fed. Cir. 2009). In its evaluation, the Board shall consider all information and lay and medical evidence of record. 38 U.S.C.A. § 5107(b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board shall give the benefit of the doubt to the claimant. Id. Another way stated, VA has an equipoise standard akin to the rule in baseball that "the tie goes to the runner." Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Notably, the benefit of the doubt doctrine is not applicable based on pure speculation or remote possibility. See 38 C.F.R. § 3.102. A combat veteran's assertions of an event during combat are to be presumed if consistent with the time, place and circumstances of such service. 38 U.S.C.A. § 1154(b); see also Collette v. Brown, 82 F.3d 389 (Fed. Cir. 1996). The provisions of 38 U.S.C.A. § 1154(b), however, can be used only to provide a factual basis upon which a determination could be made that a particular disease or injury was incurred or aggravated in service, not to link the claimed disorder etiologically to a current disorder. See Libertine v. Brown, 9 Vet. App. 521, 522-23 (1996). The provisions of 38 U.S.C.A. § 1154(b) do not establish service connection for a combat veteran; it aids him or her by relaxing the adjudicative evidentiary requirements for determining what happened in service. The Board is not bound to accept any opinion, from a VA examiner, private physician, or other source, concerning the merits of a claim. Hayes v. Brown, 5 Vet. App. 60 (1993). The VA benefits system also does not favor the opinion of a VA examiner over a private examiner, or vice versa. See 38 U.S.C.A. § 5125; White v. Principi, 243 F.3d 1378, 1381 (Fed. Cir. 2001) (declining to adopt the treating physician rule for adjudicating VA benefits). Regardless of the source, an examination report must minimally meet the requirement of being sufficiently complete to be adequate for the purpose of adjudicating the claim. See 38 U.S.C.A. § 5125; 38 C.F.R. § 4.2. The Board has an obligation to weigh the probative value of the medical opinions presented based upon factors such as personal examination of the patient, knowledge and skill in analyzing the data, the knowledge and expertise of the examiner, the expressed rationale forming the basis of the opinion, ambivalence and/or exactness of diagnosis, scope of review of the relevant records, bias, etc. See generally Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); Sklar v. Brown, 5 Vet. App. 140 (1993); Elkin v. Brown, 5 Vet. App. 474, 478 (1993); Austin v. Brown, 6 Vet. App. 547, 551- 52 (1994). A medical examiner's review of the claims folder may heighten the probative value of an opinion, as the claims folder generally contains all documents associated with a veteran's disability claim, including not only medical examination reports and service treatment records (STRs), but also correspondence, raw medical data, financial information, RO rating decisions, Notices of Disagreement, materials pertaining to claims for conditions not currently at issue and Board decisions disposing of earlier claims. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). However, an examiner's review of the claims folder is not required in each case. See Snuffer v. Gobber, 10 Vet. App. 400, 403-04 (1997) (review of claims file not required where it would not change the objective and dispositive findings made during a medical examination); see also D'Aries v. Peake, 22 Vet. App. 97, 106 (2008) (holding that it is not necessary for a VA medical examiner to specify review of the claims folder where it is clear from the report that the examiner has done so and is familiar with the claimant's extensive medical history). A significant factor to be considered for any opinion is based on an accurate factual predicate, regardless of whether the information supporting the opinion is obtained by review of medical records or lay reports of injury, symptoms and/or treatment. See Harris v. West, 203 F.3d 1347, 1350-51 (Fed. Cir. 2000) (examiner opinion based on accurate lay history deemed competent medical evidence in support of the claim); Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005) (holding that a medical opinion cannot be disregarded solely on the rationale that the medical opinion was based on history given by the veteran); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis). Although formal rules of evidence do not apply in the VA benefits system, the Court has indicated that recourse to the Federal Rules of Evidence may be appropriate if it assists in the articulation of the reasons for the adjudicator's decision. Rucker v. Brown, 10 Vet. App. 67, 73 (1997). Within the VA benefits system, VA medical examiners and private physicians offering medical opinions in veterans' benefits cases are essentially considered expert witnesses. Nieves-Rodriguez, 22 Vet. App. 295 (2008). In Nieves-Rodriguez, the Court indicated that the Federal Rules of Evidence for evaluating expert medical opinion before U.S. district courts, Fed.R.Evid. 702, are important, guiding factors to be used by VA adjudicators in evaluating the probative value of a medical opinion. The factors identified in Fed.R.Evid 702 are as follows: (1) The testimony is based upon sufficient facts or data; (2) the testimony is the product of reliable principles and methods; and (3) the expert witness has applied the principles and methods reliably to the facts of the case. A lay claimant is competent to provide testimony concerning factual matters of which he or she has firsthand knowledge (i.e., reporting something seen, sensed or experienced). Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). Under certain circumstances, lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability, or symptoms of disability, susceptible of lay observation. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In Barr, the Court emphasized that when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. In such cases, the Board is within its province to weigh that testimony and to make a credibility determination as to whether that evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. However, there are clearly limitations regarding the competence of a lay claimant to speak to certain matters, such as those involving medical diagnosis and etiology. See Jandreau, 492 F.3d at 1377 (Fed. Cir. 2007) (noting that a layperson not competent to diagnose a form of cancer). As reflected in Fed.R.Evid 701, lay witness testimony in the form of opinions or inferences is permissible if (a) rationally based on the perception of the witness and (b) helpful to a clear understanding of the witness' testimony or the determination of a fact in issue. Otherwise, in matters involving scientific, technical or other specialized knowledge, Fed.R.Evid 702 requires that an opinion be provided by a witness qualified as an expert by knowledge, skill, experience, training or education. The Veteran had active service with the U.S. Marines from April 1968 to February 1970, to include a tour of duty in the Republic of Vietnam during the Vietnam War. With regard to this period of service, the Veteran reports injury to an unspecified arm during a rocket attack in Vietnam wherein another troop fell onto him while in a bunker and cut his arm with a rifle. He also refers to a twisting injury to an unspecified ankle during ITR. The Veteran reports first noticing a boil on the back of his neck at graduation which did not become full blown until he got to ITR, wherein the boils appeared on the back of his neck, arms, legs, and stomach. He further alleges the onset of persistent and recurrent headaches since service. The Board first addresses the Veteran's claim that he currently manifests a recurrent blister condition of the feet since his service in the Republic of Vietnam. Notably, the Veteran is service-connected for dermatophytosis involving the groin, diagnosed as tinea cruris. A dermatophytosis is a fungal infection. See DORLAND'S ILLUSTRATED MEDICAL DICTIONARY, 28TH ed, p. 450 (1994). Tinea cruris is dermatophytosis involving the groin. DORLAND'S, p. 1713. In January 2010, a VA C&P examiner found that the Veteran manifested a fungal infection of the feet, otherwise known as tinea pedis. DORLAND'S, p. 1714. The VA examiner noted that it is well known that fungal infections occurred in tropical areas and usually started in the feet. The VA examiner then provided opinion that it is least as likely as not that the Veteran manifested a chronic fungal infection of the feet associated with his tropical environment service. There is no competent medical opinion to the contrary. Therefore, the Board finds that service connection for a fungal infection of the feet is warranted. See generally 38 C.F.R. § 4.118, DC 7813 (evaluating dermatophytosis, wherever present, as a single disease entity). The Board next addresses the Veteran's claim of a chronic headache disorder since active service. The Veteran did report headaches during his period of active service following an adverse reaction to bubonic plague and cholera injections. Postservice, an October 1974 statement from Dr. A.A.C. indicated that the Veteran was experiencing persistent and recurrent headaches. In January 2010, a VA examiner provided opinion that, based upon review of the claims folder, it is "certainly possible" that the etiology of the Veteran's headache was related to his period of active service. The VA examiner's use of the phrase "certainly possible" falls well short of the level of confidence of opinion to warrant a grant of service connection for headaches when considered by itself. See 38 C.F.R. § 3.102. See generally Tirpak v. Derwinski, 2 Vet. App. 609, 610 (1992) (doctor's letter stating probability in terms of "may or may not" was speculative). Simply stated, no one would ever suggest that it is "certainly impossible" that this disability is related to service, therefore, saying it is "certainly possible" states almost nothing. However, the Veteran has reported persistent and recurrent symptoms of his current headache disorder since service. Given the documented reports of chronic headaches in service and soon thereafter, the VA examiner's opinion providing some mild support for the claim, and the evidentiary value that may be assigned to lay statements according to Barr and Jandreau, the Board resolves reasonable doubt in favor of the Veteran and grants the headache disorder claim. 38 U.S.C.A. § 5107(b). However, with regard to the remaining claims, the Board finds that the service connection criteria have not been met. The Veteran's service treatment records (STRs) show that, in September 1969, he experienced an adverse reaction to bubonic plague and cholera injections manifested by headache, malaise, fever and fatigue. The Veteran was hospitalized for 32 days with discharge diagnoses of fever of undetermined origin (FUO) and falciparum malaria. Thereafter, the Veteran reported continued symptoms of weakness, slight headaches and nerves. The examiner offered a diagnosis of malaria with anemia. The Veteran's February 1970 separation examination did not reflect any complaint of injury to the arms or ankles or any chronic symptoms relating thereto. The Veteran was noted to have serum sickness and malaria in 1969. Physical examination reflected normal clinical evaluations of the skin, the upper extremities, the lower extremities, the spine, the neurologic system and the vascular system. The Veteran had a blood pressure reading of 104/60. Overall, the Veteran's STRs provide evidence against the claims, failing to show lay or medical evidence of injury to the arms or ankles as claimed following detailed examinations for other problems. Furthermore, there is no lay or medical evidence of chronic disability involving the left hand, the ankles, the right elbow, both arms, the right knee, the neck and right shoulder and multiple joint pains. There were no signs of hypertension during this period of service. See, e.g., 38 C.F.R. § 4.104, DC 7101, NOTE 1 (hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days; the term hypertension means that 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.) The Veteran filed a claim of service connection for serum sickness in April 1970. On his initial VA C&P examination in June 1970, the Veteran reported that his malaria attack during service had cleared with no recurrence or symptoms. He did recall that, on one occasion, he became a little nauseated. He took a little Quinine, but had no chills or other symptomatology. On examination, the examiner found no evidence of serious diseases or injuries, or marked scarring. The upper extremities, the lower extremities and the spine showed normal range of motion. Reflexes were normal and equal physiologically. Blood pressure readings were 120/80, 126/82 and 124/86. The examiner was of the impression that the Veteran had no residuals of his serum sickness and/or malaria. Overall, the initial June 1970 C&P examination report provides highly probative evidence against the claims, failing to show lay or medical evidence of disability involving the left hand, the ankles, the right elbow, both arms, the right knee, the neck and right shoulder, multiple joint pains and hypertension. In this regard, even if the Board assumes the Veteran injured these joints during service, the June 1970 VA examination clearly provides evidence against a finding that he had chronic problems associated with these injuries. Notably, the record failed to demonstrate the manifestation of acute or subacute peripheral neuropathy, hypertension and/or arthritis within the first postservice year. As such, presumptive service connection is not warranted under the provisions of 38 U.S.C.A. § 1116, 38 C.F.R. § 3.307 or 38 C.F.R. § 3.309. The Veteran served with the Arkansas ARNG from December 1974 to May 1996. For this service, the Veteran claims a left hand injury during a summer camp exercise at Fort Hood in approximately March/May 1984 during war game exercises. He describes being tasked with building a tank barrier with telephone poles when a pole dropped and locked his hand and arm in place. The Veteran described his hand as being crushed. He was sent to the hospital where an X-ray examination showed that the hand was broke. However, he stated that a second X-ray examination was negative. The Veteran reports private treatment with Dr. S. for the left hand disorder, but that such records are unavailable. He claims current residuals of arthritis of the left hand. The Veteran also reports neck and right shoulder injuries during a summer camp exercise at Fort Chaffee in May 1986, wherein he was a passenger in a truck that slid off a bridge. He was treated at a base medical center for back and neck pain. At that time, the Veteran's arm bleeding had stopped. He claims that the accident caused hemangioma and bulging disc. The Veteran has submitted photographs of the alleged motor vehicle accident. The Veteran next reports a right ankle injury which occurred at Camp Robinson, Little Rock, Arkansas in 1995 wherein he stepped off a truck and fell into a small hole. This was evaluated by a medic. This was a reinjury to the same ankle injured during ITR. The Veteran also describes injury to the left hand and arm during a falling injury during physical training (PT), which required a sick call visit. The Veteran further claims the onset of multiple joint pains, which began in the right shoulder and migrated to his other joints, during summer camp in 1994. He attributed these symptoms to the use of insecticides manufactured for use in the Persian Gulf. Finally, the Veteran generally alleges that his high blood pressure had its onset while he was an ARNG member. On his January 1975 ARNG enlistment examination, the Veteran reported a history of recurrent headaches probably caused by malaria. He further reported eye trouble related to wearing glasses. Otherwise, the Veteran specifically denied a history of swollen or painful joints, arthritis, rheumatism, bursitis, lameness, painful or "trick" shoulder or elbow, "[t]rick" or locked knee, or neuritis. The Veteran also denied having any injury or illness other than those noted. Physical examination reflected normal clinical evaluations of the upper extremities, the lower extremities, the spine, the vascular system and the neurologic system. The Veteran had a blood pressure reading of 120/80. Overall, the Veteran's January 1975 ARNG enlistment examination provides strong evidence against the remaining claims failing to show that chronic disability involving the left hand, the ankles, the right elbow, both arms, the right knee condition, high blood pressure, the neck, the right shoulder and multiple joint pains was present during the period of active service from April 1968 to February 1970. In this regard, it is important for the Veteran to understand that his own prior statements provide highly probative evidence against his own claims at this time. The Veteran underwent periodic ARNG examinations in September 1978, November 1982, January 1987, February 1991 and August 1994. The Veteran reported headaches symptoms but otherwise reported himself to be in good health and not taking medications. He specifically denied a history of swollen or painful joints, skin diseases, arthritis, rheumatism, bursitis, lameness, painful or "trick" shoulder or elbow, "[t]rick" or locked knee, or neuritis. The Veteran also denied having any injury or illness other than those noted. Physical examinations reflected normal clinical evaluations of the upper extremities, the lower extremities, the spine, the vascular system and the neurologic system. The Veteran had blood pressure readings of 140/80, 134/80, 132/86, 130/86 and 120/78. Overall, the Veteran's ARNG examinations dated September 1978, November 1982, January 1987, February 1991 and August 1994 provide strong evidence against the remaining claims failing to show that chronic disability involving the left hand, the ankles, the right elbow, both arms, the right knee, high blood pressure, the neck, the right shoulder and multiple joint pains had been caused and/or aggravated by an event during ACDUTRA or INACDUTRA service. The Veteran's private medical records show elevated blood pressure readings beginning in 1986. A September 2005 neurology evaluation included the Veteran's report of limb pain and numbness which began 20 years prior. The Veteran had first noticed this numbness when using a hammer, and could not hold a razor the next day. The Veteran's right hand had first been affected with numbness in the left hand and both legs developing over the last 10 years. The examiner diagnosed paresthesias, pain in limb, questionable (?) idiopathic peripheral neuropathy not otherwise specified (NOS) and questionable carpal tunnel syndrome. The examiner noted that the Veteran's feet symptoms were suggestive of neuropathy, but it was suspected that focal entrapment syndromes were to blame for most of the symptoms. An X-ray examination of the Veteran's left hand in May 2006 was interpreted as showing mild degenerative skeletal change with subcortical cysts in the head of the 3rd metacarpal bone, but no appreciable fracture, dislocation or other acute osseous abnormality. An X-ray examination of the right hand demonstrated early degenerative changes with no fracture or dislocation. An X-ray examination of the cervical spine was interpreted as showing nonfused ossification center versus old trauma of the anterior aspect of the C6 vertebral body. An X-ray examination of the shoulders demonstrated mild degenerative arthritis of the acromioclavicular joints bilaterally. A magnetic resonance imaging (MRI) scan of the neck in October 2006 demonstrated posterior osteophyte and right lateral disc bulge at C4-C5 causing narrowing of the right foramen and mild indentation on anterior aspect of thecal sac, diffuse disc bulge at C5-C6 causing mild narrowing bilateral neural foramen and mild narrowing of the AP diameter of the spinal canal. An August 2007 statement from Dr. A.T. opined that the Veteran demonstrated degenerative skeletal changes with subcortical cysts in the head of the 3rd metacarpal. As this was such an isolated site, the examiner indicated that it was at least as likely as not caused by trauma. After reviewing all of the records, this examiner found that it was at least as likely as not caused by the telephone pole that fell on his hand while at annual training at Fort Hood. A further review of the record includes the Veteran's report of in service duties which included exposure to the burning of herbicide storage drums, manual siphoning of gasoline and exposure to gasoline fumes while working on engines. He argues that his service-connected histoplasmosis entered his blood stream during oxygen and carbon dioxide transfer which settled into his joints and caused arthritis. The Veteran has also provided photographs which include a motor transport vehicle accident. The Veteran has submitted multiple treatise articles in support of his claims. One article identifies malarial attacks as involving symptoms of headache, muscular pain, nausea and fever. Another article summarizes a multitude of "Reported Agent Orange Symptoms and Effects" such as elevated blood pressure, anemia, headaches, chloracne, rash, and increased skin sensitivity to the heat and sun. Another article posits that peripheral neuropathy has been adopted as a standard symptom of PCB poisoning. A July 2004 statement from the Veteran's spouse since June 1972 recalled the Veteran's two-week VA hospitalization after his discharge from service to treat severe headaches. She recalled the Veteran returning home from summer camp with his arm in a sling, and his hand looking black as tar, mashed flat and swollen. It was recalled that the Veteran saw a local physician, who indicated that surgery would have been performed if it had sought earlier treatment. The Veteran began having migratory joint pain in approximately 1991 to 1992. She had also witnessed skin sores. A July 2004 statement from the Veteran's sister recalled that the Veteran manifested recurrent sores of the body as well as severe headaches following his return from Vietnam. A July 2004 statement from a former co-squad leader of the Arkansas ARNG recalled that the Veteran experienced headaches during summer camp. At a summer camp in Little Rock, the Veteran had twisted his ankle while getting out of the back of a truck, where a medic looked at it on sight. The Veteran had also fallen down on his hands and left arm during a PT run, which required a sick bay visitation. During war games at Fort Hood, the Veteran had crushed his hand between two poles and sent to the hospital. The first X-ray was interpreted as showing a break while the second X-ray was negative. The Veteran had his arm in a sling for the remainder of the summer. His hand looked black, swollen and wide while his finger was bowed. The Veteran reported seeing a private physician, who told him that surgery would have been performed if he had been treated earlier. This individual also experienced pain in his shoulder at about the same time as the Veteran, which he attributed to surplus military bug spray. A July 2004 statement from the Veteran's acquaintance of "several years" reported awareness of the Veteran's complaints of migratory joint pain which he thought had a viral etiology. This individual had also witnessed skin sores. Another July 2004 statement of the Veteran's co-worker, who had worked with the Veteran for "several years," recalled witnessing the Veteran returning from summer camp with his arm in a sling. This individual described the Veteran's hand as being black, swollen and looking like it had been mashed flat. It was recalled that the Veteran saw a local physician, who indicated that surgery would have been performed if it had sought earlier treatment. Two separate statements from Dr. S. dated December 2004 indicated treating the Veteran that same day with multiple somatic complaints that had been with him for a prolonged period of time. The Veteran's symptoms were best described as peripheral neuritis including bilateral tardy ulnar nerve palsies in the cubital tunnel, left greater than right, along with pain in his right shoulder down to his left elbow and pain centered around his right knee that radiated proximal and distal. The pain was superficial over his patella and the Veteran apparently had some irritable somatic nerves in the skin, particularly over his superior patella with marked tenderness. It was noted that the Veteran had apparently suffered from serum sickness and malaria while in Vietnam, had been diagnosed with histoplasmosis, and now had symptoms of peripheral neuritis in both arms and the right leg. Dr. S. indicated that he was not knowledgeable with Agent Orange syndromes. An October 2005 statement from Dr. S. indicated that the Veteran had peripheral neuritis for which no cause other than Agent Orange exposure had been identified. In this case, after a review of all the lay and medical evidence, the Board finds that the weight of the evidence demonstrates that the Veteran's allegations of injury followed by recurrent or persistent symptoms of disability pertaining to the left hand, both ankles, the right elbow, both arms, the right knee, the neck and right shoulder and multiple joint pains, while competent, are not credible. During his period of active service from April 1968 to February 1970, the Veteran alleges injury and chronic disability involving one of his arms (unspecified) and presumably his right ankle. Even assuming that these injuries occurred as claimed, the record does not reflect that any chronic disability was present during service or many decades thereafter, as demonstrated by the competent opinion of military examiners in February 1970, January 1975, September 1978, November 1982, January 1987, February 1991 and August 1994 who found no chronic disability of these bodily systems upon physical examination. Overall, these competent examiner findings provide strong evidence against these claims and undermine the lay allegations that chronic disabilities of the arms and ankles had been present since separation from active service. With respect to the unspecified arm injury allegedly occurring during combat, the relaxed evidentiary provisions of 38 U.S.C.A. § 1154(b) provide no benefit to the Veteran as there is no showing of chronic disability or a link from a current disability to the alleged combat event. Libertine, 9 Vet. App. 522-23. The Veteran claims injury to the left hand during a period of ACDUTRA in March 1984. He argues that he broke his hand and required treatment. However, the record discloses no medical records for this alleged event nor a line of duty determination indicating that an injury occurred. Even if the Board assumes that the Veteran did not report this event/injury, the record does not reflect the existence of a chronic disability of the left hand in 1984 or for many years later, as demonstrated by the competent opinion of military examiners in January 1987, February 1991 and August 1994 who found no chronic disability of the left hand upon physical examination. Overall, these competent examiner findings provide strong evidence against the left hand disability claim which undermine the lay allegations that chronic disability of the left hand since an ACDUTRA injury in March 1984. The Veteran claims residuals of injury to the neck and right shoulder which occurred during a period of ACDUTRA in May 1986. However, the record discloses no medical records for this alleged event or a line of duty determination indicating that an injury occurred. The record does not reflect that the existence of a chronic disability of the neck and/or right shoulder in 1986 or for many years later, as demonstrated by the competent opinion of military examiners in January 1987, February 1991 and August 1994 who found no chronic disability of the neck and right shoulder upon physical examination. Overall, these competent examiner findings provide strong evidence against the neck and right shoulder disability claims which undermine the lay allegations that chronic disability of the neck and right shoulder since an ACDUTRA injury in May 1986. The Veteran next alleges residuals of a right ankle injury which occurred in 1995 at Camp Robinson. Again, the record discloses no medical records for this alleged event or a line of duty determination indicating that an injury occurred. The Veteran's current assertions are also inconsistent with his own statements made to military examiners. As indicated above, the Veteran alleges injury and chronic disability involving one of his arms (unspecified) and presumably his right ankle during his period active duty service. The Veteran specifically did not report such injuries, and specifically denied symptomatic arms and ankles, in his Reports of Medical Examination dated January 1975, November 1982, January 1987, February 1991 and August 1994. It is important for the Veteran to understand that such facts provide factual evidence against the Veteran credibility regarding all claims, not simply the claims cited above. Simply stated, the Board finds that the Veteran, based on his conflicting statements, is not a credible historian. Caluza v. Brown, 7 Vet. App. 498, 510-511 (1995) (Credibility can be generally evaluated by a showing of interest, bias, or inconsistent statements, and the demeanor of the witness, facial plausibility of the testimony, and the consistency of the witness testimony.)." Such a finding undermines all his claims with the Board. The Veteran alleges injury to the left hand during a period of ACDUTRA in March 1984 and residuals of injury to the neck and right shoulder during ACDUTRA in May 1986. However, the Veteran specifically did not report any such injuries, and specifically denied symptomatic left hand, in his Reports of Medical Examination dated January 1987, February 1991 and August 1994. Overall, the Board assigns greater probative value and reliability to the Veteran's report of symptoms at the time of his military examinations as they were made while the events were fresh in his memory. As these reports were generated with a view towards ascertaining the Veteran's then-state of physical fitness, they are akin to a statement of diagnosis or treatment and are therefore of increased probative value, reflecting the Veteran's then state of physical fitness. See LILLY'S: AN INTRODUCTION TO THE LAW OF EVIDENCE, 2nd Ed. (1987), pp. 245-46 (many state jurisdictions, including the federal judiciary and Federal Rule 803(4), expand the hearsay exception for physical conditions to include statements of past physical condition on the rational that statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy since the declarant has a strong motive to tell the truth in order to receive proper care). See generally Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (observing that although formal rules of evidence do not apply before the Board, recourse to the Federal Rules of Evidence may be appropriate if it assists in the articulation of the reasons for the Board's decision). Overall, the Veteran reports injuries of the left hand, ankles, right elbow, both arms, right knee, and the neck and right shoulder which either occurred during active service or ACDUTRA. The Board finds that it is unlikely that so many injuries would have gone unrecorded and that medical records would show no aspects of disability until many decades after the alleged events occurred. Thus, the credibility of the Veteran's assertions is significantly lessened as they are also inconsistent with the entire evidentiary record. The Board further notes that the Veteran has also alleged incurring a shrapnel wound at the small of his back just above the belt line. A review of medical records spanning many decades fails to reflect any evidence of a shrapnel wound to the small of his back, further undermining the overall reliability of the Veteran's assertions. The Board acknowledges the lay witness statements in this case. The Veteran's spouse and a co-worker recall the Veteran returning home from summer camp with his arm in a sling, and his hand looking black as tar, mashed flat and swollen. His Arkansas ARNG service mate recalls that the Veteran had twisted an ankle, injured his left arm, and crushed his left hand, and had to wear a sling. However, these statements were made many years after the alleged events occurred and are subject to the vagaries of memory due to the passage of time. They conflict with the Veteran's own statements made to military examiners denying any such injuries or symptoms on multiple military examinations more contemporaneous in time to the alleged events. These statements are also not consistent with the overall evidentiary record. As such, the Board finds that these statements lack credibility as to the alleged injuries incurred by the Veteran during his ARNG service. Similarly, the Board acknowledges that the Veteran produced a picture of a motor transport accident. However, the picture itself does not prove that the Veteran was actually involved in this incident, and the Veteran's credibility has been impeached to the extent that his allegations of being involved in this accident are entitled to little probative value. Even presuming that the Veteran was involved in this accident, the Veteran has not produced any competent medical evidence linking a current disability to this event and the Board must finds significant evidence against such a connection, even if the Board assumes the accident occurred. The record also contains a statement from Dr. S. who opined in December 2004 that the Veteran's radiographic findings of the left hand are consistent with a prior history of trauma and was at least as likely as not related to the alleged telephone pole trauma during ACDUTRA. Unfortunately, the Board finds that the Veteran's allegations of injuring his left hand during ACDUTRA as claimed are not credible. The issue of left hand trauma could have easily occurred at some other point in time. For example, a September 2005 neurology consultation included the Veteran's report of the onset of limb problems when using a hammer in approximately the 1980's. The Board finds that this opinion holds no probative value as the basis for the opinion, an alleged left hand trauma occurring during ACDUTRA, has been rejected as factually untrue. Reonal, 5 Vet. App. at 461. The Board also acknowledges the statement from Dr. S. who stated that the Veteran had peripheral neuritis for which no cause other than Agent Orange had been identified. Notably, Dr. S. previously admitted to having no competence in diagnosing Agent Orange syndromes. As this physician does not have the requisite knowledge to evaluate residuals of herbicides, the ambiguous statement from Dr. S. holds no probative value in this case. Finally, the Board acknowledges the beliefs of the Veteran and his friend that his various diseases and disabilities are related to active service, ACDUTRA and/or INADUTRA. While the Veteran and his witnesses are clearly competent to describe information within their personal observations and knowledge, their assertions of PCB poisoning and/or some type of viral disease process are unsupported and unsupportable by the evidence of record. The medical treatise articles do not provide a level of specificity to lend any probative value to this case. See generally Sacks v. West, 11 Vet. App. 314 (1998) (a generic medical treatise evidence that does not specifically opine to the particular facts of the appellant's case holds little probative value). Cf. Hensley v. West, 212 F 3d. 1255, 1265 (Fed. Cir. 2000) (in appropriate cases, a veteran who presents a competent medical diagnosis of a current disability may establish the necessary nexus by the submission of treatise information which does not require the services of medical personnel to show how the treatise applies to the case). Overall, the Board has also considered the lay statements asserting a nexus between alleged injuries and exposures during active duty, ACDUTRA and/or INACDUTRA as well as aggravation by service-connected disability. As indicated above, the Veteran's allegations of injuries followed by recurrent symptoms of disability are inconsistent, unreliable and not credible. The Board finds greater probative value in the determination of the many military examiners that the Veteran did not manifest any chronic disabilities on his military examinations as they possess greater expertise and training to speak to the issues at hand. There is simply no competent medical opinion attributing any of the current disabilities being claimed as being caused and/or aggravated by service-connected disability. In light of the above discussion, the Board concludes that the preponderance of the evidence is against the claims of service connection for residuals of injury to the left hand (claimed as due to injury while on ACDUTRA in March 1984), bilateral ankle condition (claimed as due to injury during active service and additional injury while on ACDUTRA), a right elbow condition, a bilateral arm condition (claimed as a combat injury during active service and/or as peripheral neuropathy due to exposure to herbicides and/or PCB poisoning), a right knee condition, high blood pressure (claimed as due to herbicide exposure and/or as secondary to service-connected histoplasmosis), residuals of injury to the neck and right shoulder (claimed as occurring during a period of ACDUTRA in approximately May 1986), and multiple joint pains (claimed as due to an undiagnosed illness, exposure to pesticides manufactured for use in the Persian Gulf War and/or as secondary residuals of service-connected malaria and histoplasmosis). There is no reasonable doubt of material fact to be resolved in his favor. 38 U.S.C.A. § 5107(b). As such, these appeals are denied. The Duty to Notify and the Duty to Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2010). With respect to the histoplasmosis claim, the Veteran is challenging the initial evaluation assigned following a grant of service connection. In Dingess v. Nicholson, 19 Vet. App. 473 (2006), the Court held that in cases where service connection has been granted and an initial disability rating and effective date have been assigned, the typical service-connection claim has been more than substantiated, it has been proven, thereby rendering section 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled. Id. at 490-91. Thus, because the notice that was provided before service connection was granted was legally sufficient, VA's duty to notify in this case has been satisfied. With respect to the remaining claims, the Veteran seeks to service connect multiple disabilities. For a service connection claim, proper notice from VA must inform the claimant of any information and medical or lay 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. Quartuccio v. Principi, 16 Vet. App. 183 (2002). 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). When VCAA notice is delinquent or erroneous, the "rule of prejudicial error" applies. See 38 U.S.C.A. § 7261(b)(2). In addition, the notice requirements of the VCAA apply to all five elements of a service-connection claim, including: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Further, this notice must include information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. at 486. A June 2004 pre-adjudicatory RO notice advised the Veteran of the types of evidence and information deemed necessary to substantiate his claim as well as the relative duties upon himself and VA in developing his claims. He was advised of alternate forms of evidence to substantiate his claim. A pre-adjudicatory RO notice in August 2004 advised the Veteran of the attempts to obtain his STRs, and advised the Veteran to submit any evidence in his possession that pertained to his claims. A pre-adjudicatory RO notice in December 2004 advised the Veteran of the criteria for establishing service connection based upon exposure to herbicides. Overall, the Board finds that the Veteran was provided substantially content and timing compliant VCAA notice on his service connection claims. As the claims remain denied, there is no prejudicial error in failing to notify the Veteran of the downstream issues involving establishing an initial disability rating and effective date of award as these issues are not implicated. In any event, the Veteran has received numerous RO notices regarding its efforts to locate his STRs, and requested the Veteran for specific information to assist in its search. The Veteran has submitted numerous statements raising multiple theories of service connection, and submitted medical treatise information and lay affidavits in an effort to substantiate his claims. Overall, the Veteran is shown to have had a meaningful opportunity to participate in the development of his claims and has been provided substantially compliant VCAA notice on the dispositive issues on appeal. Thus, the Board finds that no prejudicial error accrues to the Veteran in proceeding to adjudicate the claims at this time. See Shinseki v. Sander, S. Ct. 1696 (April 21, 2009) VA has a duty to assist the Veteran in the development of the claims. This duty includes assisting the Veteran in the procurement of STRs and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). In this case, the RO has obtained the Veteran's STRs and made direct requests to the ARNG, Fort Chafee and Camp Robinson to investigate alternate custodians of information. Notably, Fort Chafee and Camp Robinson have no additional records. Notably, the RO received an extensive amount of documentation from the ARNG. Furthermore, the RO has obtained the Veteran's private and VA clinical records. There are no outstanding requests to obtain any private medical records for which the Veteran has identified and authorized VA to obtain on his behalf. There is also no showing that any records exist with the Social Security Administration which would be relevant to the issues on appeal. With respect to the histoplasmosis claim, the Veteran was not afforded VA C&P examination. However, the competent evidence of record demonstrates that the Veteran does not manifest chronic pulmonary mycosis. As such, it would be futile to obtain VA examination on this claim as there is sufficient information to decide the claim. With respect to the service connection claims, the Veteran has alleged the onset of unspecified arm and ankle injuries during his period of active service. The Board has determined that the credible lay and medical evidence establishes that recurrent or persistent symptoms of disability have not been present since this period of service, and that there is no competent evidence that a current disability results from any event during service. As such, VA examination is not warranted. 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the ARNG service, VA normally has a duty to obtain medical examination or opinion when necessary to make a decision on the claim. 38 U.S.C.A. § 5103A(d). In this case, the Veteran is asserting disability related to several periods of ACDUTRA. Thus, the standard of review comes under 38 U.S.C.A. § 101(24). The Board has specifically found that the Veteran's allegations of injury and continuity of symptomatology is not credible. Quite simply, the Veteran has not met his burden of establishing that any disease or disability was either incurred or worsened during a period of ACDUTRA which was caused by a particular period of ACDUTRA. Based upon the Board's factual findings, there is sufficient lay and medical evidence of record to decide this case. The records of this case provide overwhelming evidence against the Veteran's central claims, including prior statements from the Veteran himself. Overall, the Board finds that the evidence of record is sufficient to decide all of the claims on appeal, and that there is no reasonable possibility that any further assistance would aid in substantiating any of these claims. Significantly, neither the Veteran nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claims. Hence, no further notice or assistance is required to fulfill VA's duty to assist him in the development of the claims. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001). For the reasons expressed above, the Board finds that no further notice or assistance to the Veteran is required to fulfill VA's duty to assist him in the development of his claims. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). ORDER The claim of entitlement to an initial compensable evaluation for histoplasmosis of lung is denied. The claim of entitlement to service connection for residuals of injury to the left hand (claimed as due to injury while on ACDUTRA in March 1984) is denied. The claim of entitlement to service connection for bilateral ankle condition (claimed as due to injury during active service and additional injury while on ACDUTRA) is denied. The claim of entitlement to service connection for right elbow condition is denied. The claim of entitlement to service connection for bilateral arm condition (claimed as a combat injury during active service and/or as peripheral neuropathy due to exposure to herbicides and/or PCB poisoning) is denied. The claim of entitlement to service connection for right knee condition is denied. The claim of entitlement to service connection for high blood pressure (claimed as due to herbicide exposure and/or as secondary to service-connected histoplasmosis) is denied. The claim of entitlement to service connection for a skin disorder of the feet is granted. The claim of entitlement to service connection for residuals of injury to the neck and right shoulder (claimed as occurring during a period of ACDUTRA in approximately May 1986) is denied. The claim of entitlement to service connection for headaches is granted. The claim of entitlement to service connection for multiple joint pains (claimed as due to an undiagnosed illness, exposure to pesticides manufactured for use in the Persian Gulf War and/or as secondary residuals of service-connected malaria and histoplasmosis) is denied. ____________________________________________ JOHN J. CROWLEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs