Citation Nr: 1023904 Decision Date: 06/28/10 Archive Date: 07/08/10 DOCKET NO. 07-01 938 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Huntington, West Virginia THE ISSUES 1. Entitlement to an initial evaluation in excess of 10 percent for anosmia. 2. Entitlement to service connection for memory loss due to in-service trauma. 3. Entitlement to service connection for loss of taste due to in-service trauma. 4. Entitlement to service connection for asthma, to include as due to exposure to asbestos and herbicide agents and as secondary to service-connected posttraumatic stress disorder (PTSD). 5. Entitlement to service connection for bilateral sensorineural hearing loss. 6. Entitlement to service connection for tinnitus. ATTORNEY FOR THE BOARD J. Murray, Associate Counsel INTRODUCTION The Veteran served on active duty in the United States Army from January 1967 to December 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2005 rating decision of the Department of Veterans Affairs (VA) Regional Office in Huntington, West Virginia (RO). In that rating decision, the RO granted service connection for anosmia and assigned a 10 percent evaluation, effective from February 17, 2004, and it denied service connection for memory loss, loss of taste, breathing difficulties (identified as asthma and rhinitis), hearing loss and tinnitus. In a January 2010 rating decision, the RO granted service connection for chronic rhinitis, but continued to deny service connection for asthma. Since this was only a partial grant of the benefits sought on appeal, the remainder of the claim, entitlement to service connection for asthma, remains on appeal. The Board has recharacterized the matter on appeal to reflect its current status. It is noted that the Veteran was previously represented by the Veteran's of Foreign Wars when he initiated the claims on appeal, but in a February 2006 correspondence, he revoked that representation. The Veteran stated that he would seek other representation for his claims. To date, the Veteran has not identified any other representative in conjunction with his claims. The Veteran had previously indicated his desire to testify at a Travel Board hearing. See January 2007 VA Form 9, substantive appeal. In correspondence received in March 2010, the Veteran withdrew his hearing request. Therefore, the Board will proceed with an adjudication of his claims. The issues of entitlement to service connection for bilateral sensorineural hearing loss and tinnitus are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. Anosmia is assigned a 10 percent evaluation, the maximum evaluation authorized under Diagnostic Code 6275. 2. The Veteran's memory or concentration impairment is not related to his in-service head trauma. 3. The Veteran does not have an impaired sense of taste as a result of his in-service head trauma. 4. Asthma was not shown in service, at separation, or for many years thereafter, and there is no competent medical evidence on file linking asthma directly to any aspect of the Veteran's period of service, including exposure to herbicide agents, alleged exposure to asbestos, or to his service- connected PTSD. CONCLUSIONS OF LAW 1. There is no legal basis for the assignment of a schedular evaluation in excess of 10 percent for anosmia. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.87a, Diagnostic Code 6275 (2009). 2. Loss of memory was not incurred in or aggravated by service and is not proximately due to or aggravated by the Veteran's in-service head trauma. 38 U.S.C.A. §§ 1101, 1110, 5103(a), 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2009). 3. Loss of taste was not incurred in or aggravated by service and is not proximately due to or aggravated by the Veteran's in-service head trauma. 38 U.S.C.A. §§ 1101, 1110, 5103(a), 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2009). 4. Asthma was not incurred in or aggravated by service and is not proximately due to or aggravated by the Veteran's service-connected PTSD. 38 U.S.C.A. §§ 1101, 1110, 5103(a), 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSION 1. VA's Duties to Notify and Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the United States Department of Veterans Affairs 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. 2009); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2009). VA is required to notify the claimant of the information and evidence not of record that is necessary to substantiate the claim. VA will inform the Veteran of the type of information and evidence that VA will seek to provide, and of the type of information and evidence, the claimant is expected to provide. 38 C.F.R. § 3.159(b). VA must provide such notice to the claimant prior to an initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (AOJ), even if the adjudication occurred prior to the enactment of the VCAA. See Pelegrini v. Principi, 18 Vet. App. 112, 119-120 (2004). These VCAA notice requirements apply to all elements of a claim for service connection, so VA must specifically provide notice that a disability rating and an effective date will be assigned if service connection is awarded. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). With respect to the Veteran's disagreement with the initial evaluation following the grant of service connection for anosmia, the Board notes that no additional discussion of the duty to notify is required. The United States Court of Appeals for the Federal Circuit (Federal Circuit) and the Court of Appeals for Veterans Claims (Court) have held that once service connection is granted the claim is substantiated, additional notice is not required, and any defect in notice is not prejudicial. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App.112 (2007). With respect to the Veteran's claims for service connection, prior to the May 2005 RO decision in the matter, VA sent letters to the Veteran in May 2004, November 2004, and January 2005 that addressed some notice elements concerning his claims. The letters informed the Veteran of what evidence is required to substantiate the claims, and apprised the Veteran as to his and VA's respective duties for obtaining evidence. A September 2009 notice letter addressed the Veteran's claim of service connection for asthma on a secondary basis. The Veteran has not been prejudiced by VA's failure to provide notice earlier on these elements of his claim, because they were readjudicated in a January 2010 supplemental statement of the case. Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007). The Board acknowledges that none of these letters provided notice of how to establish a disability rating and effective date, as outlined in Dingess. For the reasons stated below, the preponderance of the evidence is against the claims of service connection for loss of memory, loss of taste, and asthma, and they must be denied. As such, no disability rating and/or effective date are to be assigned or even considered for any of these claims. Consequently, the Board concludes that the Veteran has not been prejudiced by this lack of notification regarding the Court's holding in Dingess. See Bernard v. Brown, 4 Vet. App. 384 (1993). In addition to its duty to notify, or inform, the Veteran with regard to his claim, VA also has a duty to assist the Veteran in the development of the claim. This duty includes assisting the Veteran in the procurement of service treatment records and records of pertinent medical treatment since service, and providing the Veteran a medical examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. In this case, VA has made reasonable efforts to obtain any available pertinent records as well as all relevant records adequately identified by the Veteran. VA provided the Veteran with pertinent medical examinations in August 2004, April 2005, December 2007, and November 2009. In the August 2004 examination, the examiner addressed whether the Veteran had a current disability for loss of memory. The April 2005 VA examination report discussed whether the Veteran has a current disability for loss of taste. The December 2007 and November 2009 VA examination reports were preformed in conjunction with the Veteran's asthma claim, and the second examination report included a discussion of asthma as secondary to service-connected PTSD. The associated reports of examination are thorough and are consistent with the Veteran's outpatient treatment records. Accordingly, the Board concludes that the examinations are adequate and may be considered in deciding the claims. The Veteran has not identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claims that has not been obtained. See Bernard v. Brown, 4 Vet. App. 384 (1993). For the foregoing reasons, the Board therefore finds that VA has satisfied its duty to notify and its duty to assist pursuant to the VCAA. See 38 U.S.C.A. §§ 5102 and 5103 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.159(b), 20.1102 (2009); Pelegrini, supra; Quartuccio v. Principi, 16 Vet. App. 183 (2002). 2. Increased Rating Disability evaluations are determined by the application of the facts presented to a schedule of ratings that is based on the average impairment of earning capacity caused by a given disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. When evaluating the severity of a disability, VA will consider the entire history of the disability including records of social impairment. See 38 C.F.R. § 4.126(a); Peyton v. Derwinski, 1 Vet. App. 282 (1991). In cases involving the assignment of an initial rating following the award of service connection, VA must address all evidence that was of record from the date of the filing of the claim on which service connection was granted (or from other applicable effective date). Fenderson v. West, 12 Vet. App. 119, 126-127 (1999). The analysis in the following decision is undertaken with consideration of the possibility that different ratings may be warranted for different time periods. See id.; Hart v. Mansfield, 21 Vet. App. 505 (2007). This practice is known as "staged" ratings. It is not expected that all cases will show all the findings specified; however, in all instances it is expected that there will be sufficient findings as to identify the disease and the disability therefrom, and to coordinate the rating with the identified impairment of function. 38 C.F.R. § 4.21. Where there is a question as to which of two rating evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Any reasonable doubt will be resolved in favor of granting the veteran's claim. 38 U.S.C.A. § 5107; Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); 38 C.F.R. § 3.102. In this case, the Veteran's anosmia is currently evaluated as 10 percent disabling pursuant to 38 C.F.R. § 4.87a, Diagnostic Code 6275. The Veteran's anosmia is manifested by complete loss of sense of smell and his inability to differentiate between any odors presented. It has been pathologically related to his septal deviation. Diagnostic Code 6275 provides a 10 percent rating where there is anosmia with complete loss of sense of smell. This is the maximum schedular rating under Diagnostic Code 6275. As there is no higher rating available, he is not entitled to an increased evaluation under Diagnostic Code 6275. See 38 C.F.R. § 4.87a, Diagnostic Code 6275. There are no other applicable diagnostic codes under which the Veteran's anosmia may be rated. Accordingly, an initial disability rating in excess of 10 percent is not warranted. The Board has considered whether the case should be referred for extra-schedular consideration. An extra-schedular disability rating is warranted if the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that application of the regular schedular standards would be impracticable. 38 C.F.R. § 3.321(b)(1). Here there is no evidence that shows the Veteran's anosmia presents such an unusual or exceptional disability picture so as to require consideration of an extra-schedular evaluation pursuant to the provisions of 38 C.F.R. § 3.321(b)(1). The objective medical evidence of record shows that manifestations of the Veteran's service-connected disability do not result in a marked functional impairment in any way or to a degree other than that addressed by VA's Rating Schedule. The Veteran has not been hospitalized for his disability and this disability does not impair his ability to work. Consequently, the Board concludes that referral of this issue for consideration of an extra-schedular rating is not warranted. Thun v. Peake, 22 Vet. App. 111 (2008); Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996). The Board has also considered whether staged ratings under Hart, supra, are appropriate for the Veteran's service- connected anosmia; however, the Board finds that his symptomatology has been stable throughout the appeal period. Therefore, the assignment of staged ratings is not warranted. Finally, the Board has considered whether the Veteran's claim of entitlement to an increased initial rating for anosmia includes a claim of entitlement to a TDIU rating. TDIU is an element of all appeals of an increased rating. Rice v. Shinseki, 22 Vet. App. 447 (2009). TDIU is granted where a Veteran's service connected disabilities are rated less than total, but they prevent him from obtaining or maintaining all gainful employment for which his education and occupational experience would otherwise qualify him. 38 C.F.R. § 4.16 (2009). Where a veteran: (1) submits evidence of a medical disability; (2) makes a claim for the highest rating possible; and (3) submits evidence of unemployability, the requirement in 38 C.F.R. § 3.155(a) (2001) that an informal claim "identify the benefit sought" has been satisfied and VA must consider whether the veteran is entitled to a total rating for compensation purposes based on individual unemployability (TDIU). Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001). The Veteran has not alleged that his service-connected anosmia disability prevents him from obtaining or maintaining all gainful employment for which his education and occupational experience would otherwise qualify him and there is no other evidence that the anosmia causes unemployability. While the Veteran is not currently working, in a January 2010 claim of entitlement to a TDIU rating, he asserted that his service-connected PTSD prohibited him from working. He did not allege that his anosmia had affected his employability. Accordingly, the Board concludes that the record does not raise a claim of entitlement to TDIU rating with respect to the claim of entitlement to an increased initial rating for anosmia, and that consideration of a TDIU rating is therefore not warranted. 3. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110; 38 C.F.R. § 3.303(a) (2009). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. See 38 C.F.R. § 3.303(b). The chronicity provision of 38 U.S.C.A. § 3.303(b) is applicable where the evidence, regardless of its date, shows that the Veteran had a chronic condition in service or during an applicable presumption period and still has such condition. Such evidence must be medical unless it relates to a condition as to which, under the Court's case law, lay observation is competent. Savage v. Gober, 10 Vet. App. 488, 498 (1997). In addition, certain chronic diseases may be presumed to have incurred during service if they become manifested to a compensable degree within one year of separation from active duty. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309; see also 67 Fed. Reg. 67792-67793 (Nov. 7, 2002). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). To prevail on the issue of service connection, generally, there must be (1) 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 current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C.A. § 7104(a) (West 2002); Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a) (2009). If there is at least an approximate balance of positive and negative evidence regarding any issue material to the claim, the claimant shall be given the benefit of the doubt in resolving each such issue. 38 U.S.C.A. § 5107 (West 2002); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); 38 C.F.R. §§ 3.102 (2009). On the other hand, if the Board determines that the preponderance of the evidence is against the claim, it has necessarily found that the evidence is not in approximate balance, and the benefit of the doubt rule is not applicable. Ortiz, 274 F.3d at 1365. A. Memory Loss due to In-Service Head Trauma The Veteran seeks entitlement to service connection for memory loss. Specifically, he contends that his memory loss is related to a facial trauma he incurred in October 1969 while he was stationed in Germany. At that time, the Veteran reports he was assaulted by militants and he incurred facial and head trauma. He reports that he has experienced memory loss since this in-service incident. The Veteran's service treatment records corroborate his account of the October 1969 assault but do not show complaints, findings, or diagnoses consistent with memory loss. An October 1969 treatment record shows the Veteran sought treatment for injuries he incurred during a fight. It was noted that Veteran suffered a traumatic blow to his face. The Veteran sustained lacerations, a fractured shoulder, a facture maxilla, and lost several teeth. He required extensive oral surgery and he was hospitalized for 46 days. An October 1969 treatment record showed the Veteran was alert and well adaptive, and there was no indication of neurological problems. The Veteran did not receive a separation examination after the October 1969 incident. The first post-service medical evidence of record is an August 1976 report of VA examination conducted for the purpose of addressing the Veteran's complaints regarding dental problems and headaches. A report of a CT brain scan revealed normal findings. No findings of memory loss were observed on neurological and psychiatric examination. The Veteran was diagnosed with a history of head, mouth and teeth injury. The next medical evidence of record includes treatment records dated from September 2003 to October 2003 from West Virginia University Hospital. These records show that the Veteran was hospitalized for 16 days after falling off a ladder at a height of 15 feet. Since filing his claim for service connection in February 2004, the Veteran has asserted that he fell because he forgot he was on a ladder. In August 2004, the Veteran underwent a VA examination in conjunction with his claim. The Veteran was tested on his attention, concentration and ability to recall. Testing results showed the Veteran was with in the normal range. The Veteran's long-term memory and recent memory were determined to be intact. Mild attention and concentration problems were observed, but the examiner found the Veteran was still able to function well. The examiner also noted that the Veteran had mild symptoms of anxiety. Based on the findings from the examination, the examiner found there was no evidence of a diagnosable memory problem. The examiner also noted that a review of the service treatment records surrounding the October 1969 incident did not reflect any loss of consciousness, head injury or memory defect as a result of the incident. The examiner found that the Veteran had mild concentration and attention problems that were likely related to anxiety. The examiner concluded that there was no likelihood that the October 1969 incident resulted in any memory or other diagnosable mental health problems. The record also contains the Veteran's VA treatment records. A January 2009 treatment record shows that the Veteran reported that he was no longer able to drive a car or climb a ladder while taking his neuroleptic medications. He further reported falling from a ladder four times in the previous summer. It was noted that the Veteran had an inability to concentrate due to his medications. Lastly, the record contains several statements from the Veteran's friends and family members who attested to observing the Veteran "over the years" being forgetful or being unable to concentrate. None of these individuals, however, specifically stated that they observed the Veteran having memory problems or an inability to concentrate immediately after or within a short period of his separation from service. Based on a review of the record, the Board finds that the preponderance of the evidence does not support the Veteran's claim. Although the Veteran's service treatment records show a head trauma from a facial blow in service, there is no medical evidence that links the Veteran's complaints of memory loss to this incident. There was no indication of memory impairment or loss of consciousness noted in the service treatment records associated with the October 1969 assault. The first medical evidence showing that the Veteran has any limited concentration or memory impairment is shown in 2004, which comes almost 35 years after his discharge from service. The significant evidentiary gap between the Veteran's active service and the earliest medical evidence of memory loss or limited concentration weighs heavily against the Veteran's claims on a direct basis. A lengthy period without treatment is evidence against a finding of continuity of symptomatology, and it weighs heavily against the claim. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd 230 F.3d 1330 (Fed. Cir. 2000) (service incurrence may be rebutted by the absence of medical treatment of the claimed condition for many years after service). The Board has considered the Veteran's lay assertions, and those of his friends and family members, alleging that his current disability had an onset in service. It is noted that the Veteran, his friends, and family members are competent to attest to observations of his disability, such as the onset of symptomatology. See Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). The Federal Circuit has held that lay evidence is one type of evidence that must be considered and competent lay evidence can be sufficient in and of itself. The Board, however, retains the discretion to make credibility determinations and otherwise weigh the evidence submitted, including lay evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). Here, the contemporary medical evidence at the time of the Veteran's discharge does not confirm or support his assertions. Rather, none of the service treatment records from October 1969 reflect any neurological or mental problems. The service treatment records prior to the Veteran's separation are considered to be very probative evidence against the Veteran as it is very close in time to the date in question. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (noting that contemporaneous evidence has greater probative value than history as reported by a veteran). Additionally, the record lacks medical evidence establishing a possible relationship between the Veteran's memory loss and his period of active service. The August 2004 VA examiner found that the Veteran's mild concentration and attention problems were related to his anxiety and were not the result of his in-service trauma. Additionally, the VA treatment records shows that the Veteran's memory impairment has been associated with psychiatric medication. It is noted that the Veteran is already service-connected for PTSD, which includes anxiety symptomatology. To the extent that his service- connected PTSD disability includes impairment of memory and concentration, these symptoms are contemplated by the ratings assigned for that disability. To otherwise grant service connection and assign a compensable rating for these symptoms would accordingly amount to impermissible pyramiding. See 38 C.F.R. § 4.14 (2009). Other the Veteran's lay assertions that his disability is related to his service, the record is devoid of any competent evidence demonstrating a link between the disability and the Veteran's service. Although the Veteran is competent to attest to facts surrounding his claim, as a lay person, he is not competent to offer opinions that require medical knowledge. See Espiritu v. Derwinski, 2 Vet. App. 492, 494- 95 (1992). Therefore, to the extent that his statements contain a medical etiology of his current disabilities, this evidence is not competent or persuasive. The preponderance of the evidence does not show that the Veteran's memory loss problems are related to his in-service head trauma. Accordingly, the benefit of the doubt rule is not applicable, and the claim must be denied. See 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). B. Loss of Taste due to In-Service Head Trauma The Veteran seeks entitlement to service connection for loss of taste. He asserts that his loss of taste is related to the facial trauma incurred during service. As noted above, the service treatment records show that the Veteran incurred significant facial trauma in October 1969. None of those service treatment records surrounding the incident, however, shows any complaints for loss of taste. A review of the post-service VA treatment records does not show any complaints or treatment for loss of taste. In November 2004, the Veteran was afforded a VA examination in conjunction with his claim. The examiner noted the Veteran's history of facial trauma and associated septal obstruction. His sense of smell was tested but not his sense of taste. The Veteran underwent an additional VA examination in April 2005. At that time, the examiner noted that although the Veteran reported a worsening sense of smell over the years, he stated that his sense of taste was fairly good and he had no difficulties tasting at the time of the examination. The examiner tested the Veteran's sense of taste with salt, sugar, lemon juice and pickle juice. It was noted that the Veteran tasted items without difficulty and he was able to identify salt, sweet, and sour. The examiner found that the Veteran's sense of taste was intact and it had not been altered by any facial trauma or nasal condition. VA clinical records dated from April 2005 to March 2010 similarly do not show that the Veteran has an impaired sense of taste. Records dated in May 2009 show that the Veteran reported eating a significant amount at each of his three daily meals, although he did not snack in between meals. He stated that he ate eggs, toast, and coffee for breakfast, and that at lunchtime he put a lot of meat and cheese on his sandwiches. He reported drinking regular Pepsi because he could not stand the taste of diet Pepsi. Finally, he stated that he had a sandwich or cookies as a bedtime snack. Records dated in March 2010 show that the Veteran's weight had increased in part as a result of increased caloric intake. Thus, although the Veteran reported in his February 2004 claim that he had no sense of taste, the Board concludes that this statement was not credible, as his dietary habits clearly show that he enjoys the taste of food, and also that he is able to distinguish between tastes he does and does not enjoy. In this case, the Veteran seeks service connection for loss of taste. Here, the record does not show a current diagnosis for lost of taste. The VA examiner noted that the Veteran's sense of taste was intact and had not been altered by his inservice trauma. The Board has considered the Veteran's statement about loss of taste since service; however, the medical examination revealed no abnormal findings. One of the requirements for service connection is competent evidence that a claimed disability currently exists. See Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997). Here, there is no current diagnosis of loss of taste or any sense of taste impairment due to in-service trauma. As there is no current competent diagnosis of loss of taste, service connection for loss of taste must, necessarily, be denied. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992 Should the Veteran be diagnosed with a similar condition in the future that is related to his in-service facial trauma, he is encouraged to submit evidence of that diagnosis and reopen his claim. C. Asthma The Veteran seeks entitlement to service connection for asthma, originally claimed as breathing difficulties. He claims he has had breathing difficulties since service. The Veteran asserts that his breathing problems are related to in-service asbestos exposure or exposure to herbicide agents, and in the alternative, that his condition is secondary to his PTSD. Turning first to the Veteran's claim on the basis of exposure to herbicide agents, a Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam era is presumed to have been exposed to herbicides during that service. 38 U.S.C.A. § 1116; 38 C.F.R. § 3.307. If a veteran was exposed to an herbicide agent during active military, naval, or air service, presumptive service connection for numerous diseases will be established even though there is no record of such disease during service, provided that the disease is are manifest to a degree of 10 percent or more at any time after service. 38 C.F.R. §§ 3.307(a)(6)(ii), 3.309(e) (2009). The availability of presumptive service connection for a disability based on exposure to herbicides does not preclude a veteran from establishing service connection with proof of direct causation. Stefl v. Nicholson, 21 Vet. App. 120 (2007); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Although the Veteran in this case served in the Republic of Vietnam during the applicable time period, presumptive service connection is not available under 38 C.F.R. § 3.309(e) for asthma. In this regard, the Board notes that the Secretary reiterated in 2007 that there is no positive association between exposure to herbicides and any condition for which he has not specifically determined that a presumption of service connection is warranted. See 72 Fed. Reg. 32395 (Jun. 12, 2007). Thus, in the absence of any medical evidence linking asthma to his service, service connection on a direct or secondary basis is not warranted for asthma. Stefl. In this case, there is no such medical evidence linking the Veteran's asthma to his service. Accordingly, service connection for asthma due to exposure to herbicide agents is not warranted. Turning next to the Veteran's claim for service connection on the basis of exposure to asbestos, claims involving asbestos exposure must be analyzed under VA administrative protocols. Ennis v. Brown, 4 Vet. App. 523 (1993); McGinty v. Brown, 4 Vet. App. 428 (1993). Although there is no specific statutory or regulatory guidance regarding claims for residuals of asbestos exposure, VA has several guidelines for compensation claims based on asbestos exposure. See M21-1, VBA Adjudication Procedure Manual M21-1 Manual Rewrite (M21-1 MR), Part IV, Subpart ii, Ch. 2, Section C, Topic 9 and Section H, Topic 29 (Dec. 13, 2005). Additionally, the Board must follow development procedures specifically applicable to asbestos-related claims. Ashford v. Brown, 10 Vet. App. 120 (1997). VA must determine whether military records demonstrate evidence of asbestos exposure during service, whether there was pre-service or post-service occupational or other asbestos exposure, and whether there is a relationship between asbestos exposure and the claimed disease. Mere exposure to a potentially harmful agent is insufficient for eligibility for VA disability benefits. The medical evidence must show not only a currently diagnosed disability, but also a nexus, that is, a causal connection, between the current disability and exposure to asbestos in service. Hickson v. West, 12 Vet. App. 247 (1999). The Veteran contends that he was exposed to asbestos during service and that as a result of this exposure he developed an asbestos-related pulmonary disorder. Specifically, he asserts that he was exposed to asbestos as a result of handling machine guns that required wearing asbestos gloves to change the barrels due to the high levels of heat. The Veteran reports that gloves would tear and asbestos fibers would contact with his skin and clothes. The Veteran's service records do not demonstrate that he was exposed to asbestos during service. Even if the Veteran was exposed to asbestos in service, mere exposure to a potentially harmful agent is insufficient for eligibility for VA disability benefits. The medical evidence must show not only a currently diagnosed disability, but also a nexus, that is, a causal connection, between the current disability and exposure to asbestos in service. Hickson v. West, 12 Vet. App. 247 (1999). The Veteran's service treatment records are negative for any complaints, findings, or diagnosis of respiratory problems. They are also negative for asbestosis or another asbestos- related disease. Because no respiratory problem was found on examination at separation, nor shortly after the October 1969 assault, the Board finds that there was no evidence of a chronic respiratory disability, including asthma, at separation. 38 C.F.R. § 3.303(b). The chest X-ray report from the July 1976 VA examination also showed no abnormal lung findings. Images of the lung fields showed no acute or active disease, and there was no evidence of any mass shadows. The first medical evidence showing any respiratory problems comes from the October 2003 hospital summary report from West Virginia University Hospital. It was noted that the Veteran's hospitalization was complicated by shortness of breath. The Veteran was first treated with supplemental oxygen and then with medication management. The next medical evidence comes from a November 2004 VA examination report in conjunction with the claims for loss of taste and smell. It was noted in that report that the Veteran complained of difficulty breathing since he was discharged from service. He reported that his symptoms had become progressively worse over the past two years. The examiner noted the Veteran had nasal obstructions, but he did not examine the Veteran for any other respiratory or lung problems. The claims folder also contains the Veteran's VA treatment records. These records show the Veteran was diagnosed with mild bronchial asthma in January 2007, but the Veteran had reported having breathing problems since 1968. An October 2007 VA pulmonary consult record noted that the Veteran reported his asthma was triggered by physical exertion, cold weather, anxiety, cleaning agents and pollens. On physical examination, the VA pulmonologist noted the Veteran's lungs were clear with no ronchi or wheezes. In December 2007, the Veteran underwent a VA examination in conjunction with his claim. The examiner noted that the Veteran's claims folder had not been reviewed, but it had been reviewed by the VA staff pulmonologist. The Veteran was diagnosed with asthma. The examiner noted that the chest X- ray results revealed no pulmonary nodules and the pulmonary function test (PFT) showed moderate airflow obstruction. The examiner found that there was no evidence of asbestos exposure, asbestosis, or pulmonary fibrosis shown in the PFT or chest X-ray results. The examiner found that the Veteran's asthma was not caused by any exposure to asbestos. At no time has any treating physician related the Veteran's asthma to his alleged in-service exposure to asbestos. The medical evidence of record shows that the Veteran has bronchial asthma. However, the medical evidence of record does not establish that the Veteran has an asbestos-related respiratory disorder. In May 2007 correspondence, the Veteran stated that he sought to clarify his breathing claim by stating his respiratory problems were related to his chronic asthma and rhinitis. He stated that "[a]t this time, there is no evidence of any disease from asbestos exposure." The Veteran's statement is supported by the findings from the December 2007 VA examination report. The Veteran no longer asserts, and the medical evidence of record does not support a finding that asthma is etiologically related to any in-service asbestos exposure. On VA examination in December 2007, the examiner specifically found that the Veteran's pulmonary disorder (asthma) was inconsistent with exposure to asbestos. With no evidence of any current asbestos-related disability or respiratory disorder that is related to his military service, service connection for asthma due to asbestos exposure is not warranted. Service connection may be granted when all the evidence establishes a medical nexus between military service and current complaints. Degmetich v. Brown, 104 F. 3d 1328 (1997); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). As stated above, the Veteran's claim of entitlement to service connection for asthma is not warranted on the basis of either exposure to asbestos or herbicide agents. Additionally, the weight of the evidence of record does not support a finding that the Veteran's asthma is otherwise directly related to service. There is no evidence of treatment or complaint for any respiratory or lung problems during the Veteran's service. The Veteran's lungs were evaluated as normal just prior to his discharge. Moreover, the first medical evidence showing that the Veteran's breathing problems is not shown until 2003. This evidence weighs heavily against the Veteran's claim on a direct basis. 38 C.F.R. § 3.303; see Maxson, 12 Vet. App. at 453. Finally, the record lacks medical evidence establishing a possible relationship between the Veteran's asthma and his period of active service. The Veteran has attributed his asthma to exposure to asbestos and herbicide agents in service. However, as a layperson, the Veteran is not competent to give a medical opinion on causation or aggravation of a medical condition. Bostain v. West, 11 Vet. App. 124 (1998); Routen v. Brown, 10 Vet. App. 183 (1997); Espiritu v. Derwinski, 2 Vet. App. 492 (1992) (layperson is generally not capable of opining on matters requiring medical knowledge). The Board acknowledges that the Veteran is competent to give evidence about what he experienced. Layno v. Brown, 6 Vet. App. 465 (1994). Additionally, the Veteran's statements may be competent to support a claim for service connection where the events or the presence of disability, or symptoms of a disability are subject to lay observation. 38 U.S.C.A. § 1153(a); 38 C.F.R. §§ 3.303(a), 3.159(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (2006). However, a respiratory disorder or a disorder of the lungs, as contrasted with symptoms of breathing or lung difficulties, is not subject to lay diagnosis. The Veteran can report having shortness of breath or difficulty breathing. However, these are subjective symptoms and not readily identifiable the way that varicose veins may be observed, objectively. Barr v. Nicholson, 21 Vet. App. 303 (2007). There are many different respiratory disorders. The Veteran does not have the medical expertise to discern the nature of any current respiratory diagnosis nor does he have the medical expertise to provide an opinion regarding the etiology. In sum, the issue does not involve a simple diagnosis. The Veteran is competent to report that he has been told of a diagnosis of a respiratory disorder, but, as noted, he is not competent to provide a medical opinion regarding the etiology. While the Veteran purports that his symptoms support the current diagnosis by a medical professional, his statements alone are not competent to provide the medical nexus and a medical professional has not made this connection. Thus, the Veteran's lay assertions are not competent or sufficient. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Gravely v. Nicholson, 20 Vet. App. 136 (2005) (noting that the absence of in-service or contemporary medical evidence is a factor in weighing the probative value of lay testimony). The Board has also considered the lay assertions of the Veteran and his friends and family members indicating that his breathing problems had an onset in service. Although the Veteran, his friends, and family members are competent to attest to his observations of his disability, such as the onset of symptomatology, they are not competent to provide an etiological nexus between his current complaints and any in- service problems. Additionally, it is noted that the Veteran has also been diagnosed with rhinitis that has been related to service, which may account for his reports of breathing difficulties since service as oppose to his asthma. As lay persons, the Veteran and his friends and family members are not competent to offer opinions that require medical knowledge. See Espiritu v. Derwinski, 2 Vet. App. 492, 494- 95 (1992). Therefore, to the extent that their statements provide an etiological link between his symptoms since service and his asthma, this is not competent or persuasive evidence. The preponderance of the competent medical evidence of record that is against the claim that the Veteran's asthma is directly related to service. Turning now to the Veteran's final contention in this matter - a claim of secondary service connection - the remaining question is whether the medical evidence supports, or is at least in equipoise as to, the Veteran's assertion that his asthma is related to his service connected PTSD. See 38 C.F.R. § 3.310. Here, the weight of the medical evidence is against such a finding. The Veteran was afforded a VA examination in November 2009 that addressed the issue of secondary service connection. The examiner noted that the Veteran reported he had asthma attacks when he got excited or anxious. The Veteran also reported scents, smoke, exertion, grass, pollen and cold weather as triggers for his attacks. The Veteran had decreased breath sounds and wheezing upon examination. The chest X-ray showed possible calcified granuloma or nodule. The PFT results revealed moderate airflow obstruction. The Veteran was diagnosed with asthma. The examiner found that the Veteran's asthma was not caused by or a result of his PTSD and anxiety. The examiner noted that the Veteran's asthma had many triggers, and although anxiety can trigger an asthma attack, it does not cause asthma. Additionally, the examiner found that since the Veteran's asthma had multiple triggers, there was no evidence that the PTSD with anxiety had permanently aggravated the asthma. The November 2009 VA examiner found that the Veteran's asthma was not caused or aggravated by his service connected PTSD. The examiner noted that asthma is not caused by anxiety or PTSD, and the Veteran had numerous other asthma triggers that it was unlikely that his PTSD with anxiety aggravated his asthma. There is no medical opinion of record which shows the Veteran's asthma is related to his PTSD. The Board has considered the Veteran's own assertions, including his submission of medical literature regarding a possible connection between asthma and PTSD. The Board finds that his assertions are afforded no probative weight in the absence of evidence that the Veteran has the expertise to render opinions about medical matters. See Bostain v. West, 11 Vet. App. 124, 127 (1998). As to the general medical literature that is not specific to the Veteran, this has little probative value in this issue. The selection identifies asthma as a physiological manifestation of PTSD. Nonetheless, the article does not even purport to address the facts of the individual case under consideration. See Wallin v. West, 11 Vet. App. 509, 514 (1998) (holding that treatise evidence cannot simply provide speculative generic statements not relevant to the veteran's claim," but, "standing alone," must include "generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion"). The documents supplied by the Veteran simply provide speculative generic statements. Service connection may not be based on a resort to speculation or remote possibility, such as indicated by that opinion. 38 C.F.R. § 3.102; Obert v. Brown, 5 Vet. App. 30, 33 (1993). Further, while medical treatise evidence can provide important support when combined with an opinion of a medical professional, in the instant case, as discussed above, a supportive nexus opinion is not of record. Mattern v. West, 12 Vet. App. 222, 228 (1999). Therefore, in the absence of probative and competent evidence that links the evidence to the Veteran's claim, the aforementioned medical excerpt lacks probative value in the consideration of the Veteran's particular claim. Lastly, to the extent that the Veteran's PTSD triggers his asthma attacks, the attacks are contemplated by the ratings assigned for his PTSD. To otherwise grant service connection for asthma as secondary to PTSD would in this regard amount to impermissible pyramiding. See 38 C.F.R. § 4.14. In sum, asthma is not shown to be directly related to service and the preponderance of the medical evidence of record is against a finding that the Veteran's asthma is due to his service-connected PTSD. See 38 C.F.R. § 3.310. As shown above, the VA examiners ruled out the likelihood that the Veteran's asthma is caused or aggravated by his PTSD. The claim must therefore be denied. See Hickson, 12 Vet. App. at 253. (CONTINUED ON NEXT PAGE) ORDER Entitlement to an initial rating higher than 10 percent for anosmia is denied Entitlement to service connection for memory loss due to in- service trauma is denied Entitlement to service connection for loss of taste due to in-service trauma is denied Entitlement to service connection for asthma is denied. REMAND The Veteran seeks service connection for bilateral sensorineural hearing loss and tinnitus. The record shows that the Veteran has a bilateral hearing disability as defined under 38 C.F.R. § 3.385. See the report of an August 2004 VA audiological examination. The Veteran has also stated that he experiences "rushing noise" in his ears, which sometimes makes him dizzy. The Board has reviewed the claims file and determined that further development is necessary prior to adjudicating the claims. Initially, the Board notes that the Veteran asserts his bilateral sensorineural hearing loss and tinnitus are related to in-service combat military noise exposure during his service in Vietnam. VA has already conceded that the Veteran participated in combat when he was stationed in Vietnam. The type of acoustic trauma described by the Veteran is consistent with the circumstances, conditions, or hardships of service during a war period. Pursuant to 38 U.S.C.A. § 1154(b), the Veteran was exposed to acoustic traumas in service, including as part of the combat against the enemy; therefore, the element of in-service exposure to acoustic trauma has been established. It is noted that he RO denied the Veteran's claim largely on the basis of the August 2004 VA examiner's opinion that the Veteran's hearing was within normal limits at the time of his 1969 discharge examination. The Veteran contends that the findings from another VA examination report were not considered by the RO. The Veteran asserts he was evaluated on August 17, 2004 in conjunction with his hearing loss and tinnitus claim. He reports that he was informed by the examiner that his disabilities were likely related to his service. The Veteran's assertions are bolstered by his detailed description of events occurring during that examination. See statement attached to December 2005 notice of disagreement. Further, a July 2004 notice letter from the RO informs the Veteran of the Ears, Nose and Throat (ENT) examination dated August 17, 2004. This examination report is missing from the claims folder. A remand is necessary to associate the report of an August 2004 ENT examination with the claims. The RO/AMC should attempt to obtain a copy of the examination report and associate it with the claims. Since the Veteran has reported that he was informed of the favorable resolution of these claims by the VA examiner, a remand is necessary to attempt to obtain a copy of that examination report. In the event that a copy of the August 2004 ENT examination report reflects any discrepancy with the findings of the August 2004 Audiological examination report, the RO/AMC should then schedule the Veteran for another VA examination to determine the etiology of the Veteran's hearing loss and tinnitus and explain any inconsistencies between the previous VA examination reports. Prior to any examination, the RO/AMC should ask the Veteran to identify any outstanding records of pertinent VA and private treatment, and obtain those records. If any identified records cannot be obtained, a memorandum should be included in the file explaining the procedures undertaken to attempt to find the records and why such attempts were not fully successful. Accordingly, the case is REMANDED for the following action: 1. By appropriate means, and with any assistance from the Veteran, the RO/AMC should seek to identify and obtain any VA or private records of pertinent medical treatment that are not yet on file. 2. The RO/AMC should attempt to obtain a copy of the Ears, Nose and Throat (ENT) Compensation and Pension examination report dated August 17, 2004 and associate it with the claims. If the identified report cannot be obtained, a memorandum should be included in the file explaining the procedures undertaken to attempt to find the records and why such attempts were not fully successful. 3. Thereafter, if the August 2004 ENT examination report is associated with the claims folder and it reflects any inconsistent findings from the August 2004 audiological examination report, or the August 2004 report of examination cannot be located, then RO/AMC should schedule the Veteran for another VA examination to determine the etiology of the Veteran's bilateral sensorineural hearing loss and tinnitus. The RO/AMC should instruct the examiner to reconcile any discrepancies or clarify any inconsistencies between the two August 2004 VA examination reports. The examiner should be asked to review the Veteran's complete claims fold, including service medical records, prior examinations, and a copy of this remand. The examiner should provide a detailed review of the Veteran's history and current complaints pertaining to his hearing loss and tinnitus. The examiner should perform all studies deemed appropriate and set forth the findings in detail in the examination report. The RO should make the claims file available to the examiner, who should review the entire claims file in conjunction with the examination. The examiner should indicate this fact in the examination report. 4. After completing the requested actions, and any additional notification and/or development deemed warranted, the RO should re-adjudicate the claims on appeal in light of all pertinent evidence and legal authority. If any benefit sought remains denied, the RO should furnish the Veteran and his representative with a supplemental statement of the case and afford the applicable tie period during which the Veteran can respond. Thereafter, the RO should return the case to the Board for further appellate consideration. The appellant has the right to submit additional evidence and argument on the matters the Board is remanding. Kutscherousky v. West, 12 Vet. App. 369 (1999). The Board will take this opportunity to advise the appellant that the conduct of the efforts as directed in this remand, as well as any other development deemed necessary, is needed for a comprehensive and correct adjudication of his claim. His cooperation in VA's efforts to develop his claim, including reporting for any scheduled VA examination, is critical. This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). ______________________________________________ S.C. KREMBS Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs