Citation Nr: 0210929 Decision Date: 08/30/02 Archive Date: 09/05/02 DOCKET NO. 00-01 485 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUES 1. Entitlement to service connection for a visual disorder. 2. Entitlement to service connection for chronic headaches. 3. Entitlement to service connection for chronic hemorrhoids. 4. Entitlement to service connection for chronic leg spasms. 5. Entitlement to service connection for a back disorder. 6. Entitlement to service connection for a bilateral knee disorder. 7. Entitlement to service connection for residuals of right index finger laceration. 8. Entitlement to service connection for residuals of a right little finger laceration. 9. Entitlement to service connection for gastroesophageal reflux disease (GERD) to include peptic esophagitis and hiatal hernia. 10. Entitlement to service connection for sinusitis, to include as secondary to asbestos exposure. 11. Entitlement to service connection for sleep apnea, to include as secondary to asbestos exposure. REPRESENTATION Veteran represented by: Disabled American Veterans ATTORNEY FOR THE BOARD L. Cramp, Associate Counsel INTRODUCTION This case comes before the Board of Veterans Appeals (the Board) on appeal from an August 1999 rating decision of the Department of Veterans Affairs (VA) Regional Office in Louisville, Kentucky (the RO). Procedural history The veteran had active service from January 1984 to January 1988. The RO received the veteran's claim for service connection in January 1999. In an August 1999 rating decision, the RO denied the claims. The veteran disagreed with the August 1999 rating decision and initiated this appeal. The appeal was perfected with the timely submission of a the veteran's substantive appeal (VA Form 9) in December 1999. The Board notes that although the veteran requested a Board hearing in his December 1999 VA Form 9, he specifically withdrew his request in a January 2000 letter, signed by him. There are no other outstanding hearing requests of record. FINDINGS OF FACT 1. The veteran does not have a diagnosed visual disorder; no such disorder was noted in service, and no such disorder has been medically related to service. 2. The veteran does not have diagnosed chronic headaches; no such disorder was noted in service, and no such disorder has been medically related to service.. 3. The veteran does not have diagnosed chronic hemorrhoids; no such disorder was noted in service, and no such disorder has been medically related to service.. 4. The veteran does not have diagnosed chronic leg spasms; no such disorder was noted in service, and no such disorder has been medically related to service. 5. The veteran does not have a diagnosed back disorder; no such disorder was noted in service, and no such disorder has been medically related to service. 6. The veteran does not have a diagnosed bilateral knee disorder; no such disorder was noted in service, and no such disorder has been medically related to service. 7. The veteran currently has a scar on the right index finger; he did not injure the right index finger in service. 8. The veteran injured his right little finger during service; he has no currently diagnosed disability of the right little finger. 9. Competent medical evidence does not reveal that the veteran's claimed GERD is causally related to any incident of his military service. 10. Competent medical evidence does not reveal that the veteran's claimed sinusitis is causally related to any incident of his military service. 11. Competent medical evidence does not reveal that the veteran's claimed sleep apnea is causally related to any incident of his military service. CONCLUSIONS OF LAW 1. A visual disorder was not incurred in active military service. 38 U.S.C.A. § 1131 (West Supp. 2001); 38 C.F.R. § 3.303 (2001). 2. Chronic headaches were not incurred in active military service. 38 U.S.C.A. § 1131 (West Supp. 2001); 38 C.F.R. § 3.303 (2001). 3. Chronic hemorrhoids were not incurred in active military service. 38 U.S.C.A. § 1131 (West Supp. 2001); 38 C.F.R. §§ 3.303 (2001). 4. Chronic leg spasms were not incurred in active military service. 38 U.S.C.A. § 1131 (West Supp. 2001); 38 C.F.R. § 3.303 (2001). 5. A back disorder was not incurred in active military service. 38 U.S.C.A. § 1131 (West Supp. 2001); 38 C.F.R. § 3.303 (2001). 6. A bilateral knee disorder was not incurred in active military service. 38 U.S.C.A. § 1131 (West Supp. 2001); 38 C.F.R. § 3.303 (2001). 7. Residuals of a right index finger laceration were not incurred in active military service. 38 U.S.C.A. § 1131 (West Supp. 2001); 38 C.F.R. § 3.303 (2001). 8. Residuals of a right little finger laceration were not incurred in active military service. 38 U.S.C.A. § 1131 (West Supp. 2001); 38 C.F.R. § 3.303 (2001). 9. GERD was not incurred in active military service. 38 U.S.C.A. § 1131 (West Supp. 2001); 38 C.F.R. § 3.303 (2001). 10. Sinusitis was not incurred in active military service or as a result of exposure to asbestos. 38 U.S.C.A. § 1131 (West Supp. 2001); 38 C.F.R. § 3.303 (2001). 11. Sleep apnea was not incurred in active military service or as a result of exposure to asbestos. 38 U.S.C.A. § 1131 (West Supp. 2001); 38 C.F.R. § 3.303 (2001). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran is seeking entitlement to service connection for several disorders claimed to have resulted from active service. In the interest of clarity, the Board will initially discuss certain preliminary matters and will then address the pertinent law and regulations and their individual application to the facts and evidence for each issue. The VCAA The Board has given consideration to the provisions of the Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, 114 Stat. 2096 (2000) (VCAA) [codified as amended at 38 U.S.C.A. § 5100 et seq. (West Supp. 2001)]. This law eliminated the former statutory requirement that claims be well grounded. Cf. 38 U.S.C.A. § 5107(a) (West 1991). The VCAA includes an enhanced duty on the part of VA to notify a claimant as to the information and evidence necessary to substantiate a claim for VA benefits. The VCAA also redefines the obligations of VA with respect to its statutory duty to assist claimants in the development of their claims. Regulations implementing the VCAA have been enacted. See 66 Fed. Reg. 45,620 (Aug. 29, 2001) [to be codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a)]. The VCAA is applicable to all claims filed on or after the date of enactment, November 9, 2000, or filed before the date of enactment but not yet final as of that date. Except for provisions pertaining to claims to reopen based on the submission of new and material evidence, which are not applicable in the instant case, the implementing regulations are also effective November 9, 2000. In this case, the veteran's claim is not final and remains pending. The provisions of the VCAA and the implementing regulations are, accordingly, applicable. See Holliday v. Principi, 14 Vet. App. 282-83 (2001) [the Board must make a determination as to the applicability of the various provisions of the VCAA to a particular claim]. The Board has carefully considered the provisions of the VCAA and the implementing regulations in light of the record on appeal, and for reasons expressed immediately below finds that the development of these issues has proceeded in accordance with the provisions of the law and regulations. The former well grounded claim requirement The RO initially denied the veteran's claims by finding that they were not well grounded. The VCAA eliminated the concept of a well grounded claim, and superseded the decision of the United States Court of Appeals for Veterans Claims (Court) (formerly the U.S. Court of Veterans Appeals) in Morton v. West, 12 Vet. App. 477 (1999), withdrawn sub nom Morton v. Gober, 14 Vet. App. (2000) (per curiam), in which the Court held that VA could not assist in the development of a claim that was not well grounded. The current standard of review is as follows. After the evidence has been assembled, it is the Board's responsibility to evaluate the entire record. See 38 U.S.C.A. § 7104(a) (West Supp. 2001). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107 (West Supp. 2001); 38 C.F.R. § 3.102 (2001). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the Court stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. After notifying the veteran of the evidence needed to substantiate his claims, in the September 2001 SSOC the RO reviewed the issues listed above based on the substantive merits of the claims. The veteran was given the opportunity to submit evidence and arguments in response. The Board finds, therefore, that it can consider the substance of the veteran's appeal without prejudice to him. See Bernard v. Brown, 4 Vet. App. 384 (1993); VAOPGCPREC 16-92. The Board will apply the current standard of review in evaluating the veteran's claims below. Notice The VCAA requires VA to notify the claimant and the claimant's representative, if any, of any information and any medical or lay evidence not previously provided to the Secretary that is necessary to substantiate the claim. As part of the notice, VA is to specifically inform the claimant and the claimant's representative, if any, of which portion, if any, of the evidence is to be provided by the claimant and which part, if any, VA will attempt to obtain on behalf of the claimant. In May 2001, the RO sent the veteran a letter which set forth in detail the requirements of the VCAA, including the responsibilities of the VA and the veteran with respect to obtaining evidence. The veteran was specifically informed that he was to contact the RO and tell them about any "any information and evidence that you want us to try to get for you." The veteran did not identify any such evidence. In addition, the veteran was notified by a February 1999 letter from the RO of the specific evidence needed to support his claims. Again in February 2000 and March 2000, the RO sent the veteran detailed letters, stating what kind of evidence was need to support his claims, and describing what the veteran was responsible for submitting, and what the RO would obtain. The RO also contacted the veteran's mother to ask her to supply evidence in his behalf. The veteran was notified of the relevant law and regulations, and of the types of evidence that could be submitted by him in support of his claims, by the August 1999 rating decision, by the October 1999 statement of the case (SOC), and by the January 2000, February 2000, April 2000 and September 2001 supplemental statements of the case (SSOCs). It is clear from the above that the veteran has been adequately notified of the VCAA, the evidence he needed to submit and the law and regulations which are pertinent to his claims. Duty to assist In general, the VCAA provides that VA shall make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate a claim for VA benefits, unless no reasonable possibility exists that such assistance would aid in substantiating the claim. The law provides that the assistance provided by VA shall include providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on the claim. An examination is deemed "necessary" if the record does not contain sufficient medical evidence for VA to make a decision on the claim. The Board finds that reasonable efforts have been made to assist the veteran in obtaining evidence necessary to substantiate his claims, and that there is no reasonable possibility that further assistance would aid in substantiating them. The veteran identified records from Suburban Medical Plaza, Jewish Hospital, Caritas Health Services, Audubon Hospital, Family Medicine Associates, and A.S.M., MD. The RO requested and obtained these records. The veteran requested copies of his records in April 2000, and these were supplied in June 2000. The RO obtained the veteran's service medical records, and the veteran was afforded a VA physical examination in February 2001. There is no indication that there exists any evidence which has a bearing on this case which has not been obtained, and the veteran has pointed to none. The veteran and his representative have been accorded ample opportunity to present evidence and argument in support of his appeal. The veteran was scheduled for a hearing to present personal testimony to a member of the Board; however, he canceled the hearing, and did not request that it be rescheduled. The veteran submitted several statements, and his representative submitted written argument on his behalf. In short, the Board has carefully considered the provisions of the VCAA in light of the record on appeal, and for the reasons expressed above finds that the development of the claim has been consistent with the provisions of the new law. Under these circumstances, the Board can identify no further development that would avail the veteran or aid the Board's inquiry. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991). Accordingly, the Board will proceed to a decision on the merits. Pertinent Law and Regulations Service connection - in general Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1131 (West Supp. 2001); 38 C.F.R. § 3.303 (2001). That a condition or injury occurred in service alone is not enough; there must be a current disability resulting from that condition or injury. A "current disability" means a disability shown by competent medical evidence to exist at the time of the award of service connection. Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); Chelte v. Brown, 10 Vet. App. 268 (1997). In order to establish service connection for the claimed disorder, 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 these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1, 8 (1999). The resolution of issues pertinent to a determination of entitlement to service connection must be considered on the basis of the places, types, and circumstances of service as shown by service records, the official history of each organization in which the veteran served, and all pertinent medical and lay evidence. Determinations relative to service connection will be based on review of the entire evidence of record. 38 U.S.C.A. § 7104(a) (West Supp. 2001); 38 C.F.R. § 3.303(a) (2001); see Wilson v. Derwinski, 2 Vet. App. 16, 19 (1991). Congenital or developmental defects and refractive error of the eye as such are not diseases or injuries within the meaning of applicable legislation concerning service connection. 38 C.F.R. §§ 3.303(c), 4.9 (2001); see also Winn v. Brown, 8 Vet. App. 510, 516 (1996), and cases cited therein. Asbestos exposure There is no specific statutory guidance with regard to asbestos-related claims, nor has the Secretary promulgated any regulations in regard to such claims. However, VA has issued a circular on asbestos-related diseases. DVB Circular 21- 88-8, Asbestos-Related Diseases (May 11, 1988) (DVB Circular) provides guidelines for considering compensation claims based on exposure to asbestos. The information and instructions from the DVB Circular have been included in a VA Adjudication Procedure Manual, M21-1 (M21- 1), Part VI, 7.21. The Court has held that VA must analyze an appellant's claim to entitlement to service connection for asbestosis or asbestos-related disabilities under the administrative protocols under these guidelines. Ennis v. Brown, 4 Vet. App, 523, 527 (1993); McGinty v. Brown, 4 Vet. App. 428, 432 (1993). The guidelines provide that the latency period for asbestos- related diseases varies from 10-45 years or more between first exposure and development of disease. M21-1, part VI, para. 7.21(b)(1) and (2). It is noted that an asbestos- related disease can develop from brief exposure to asbestos or as a bystander. In Dyment v. West, 13 Vet. App. 141, 145 (1999), the Court found that provisions in former paragraph 7.68 (predecessor to paragraph 7.21) of VBA Manual M21-1, Part VI, did not create a presumption of exposure to asbestos. Medical-nexus evidence is required in claims for asbestos related disease related to alleged asbestos exposure in service. VA O.G.C. Prec. Op. No. 04-00. Factual background Before moving on to separate discussion of the issues on appeal, the Board wishes to provide an overview of the pertinent medical history. With certain exceptions noted below, the veteran's service medical records for the period of his active duty from 1994 to 1994 are essentially negative. His December 1987 separation physical examination was essentially normal, with defective vision the only finding which is relevant to the issues currently on appeal. In April 1990, the veteran underwent a physical examination for the stated purpose of enlistment in the Army National Guard. This examination, too was negative except for refractive error of the eyes (myopia). The veteran reported an episode of cramping abdominal pain in May 1989, which had resolved with Maalox. The veteran was found to be physically qualified for National Guard service. In October 1995, the veteran underwent yet another examination, this time for reenlistment in the United States Navy. No defects were noted (again with the exception of defective vision) and he was found to be qualified for enlistment. The first evidence of post-service medical problems was with respect to gastrointestinal problems in 1997. He filed a claim of entitlement to service connection for a number of claimed disabilities in January 1999. Pertinent medical evidence, including the results of a VA physical examination in February 2001, will be reported where appropriate below. As a final introductory note, the Board observes that the medical and procedural histories and legal issues presented with respect to all of the issues on appeal essentially overlap. Because of this, the Board's discussion of the issues may at times be somewhat repetitious. This cannot be avoided. 1. Entitlement to service connection for a visual disorder. The veteran contends that he has a visual disorder which is related to an incident of his military service. Analysis As noted above, in order for service connection to be granted, three elements must be present: (1) a current disability; (2) in-service incurrence of such disability; and (3) medical nexus. See Hickson, supra. The Board has reviewed the evidence of record, and for reasons which will be expressed in greater detail below, the Board finds that a visual disorder not incurred in service. Although the veteran reported that he was examined for problems with his vision during service and that these problems continue to get worse, there is no indication from the service medical records or any post service medical record that the veteran has a diagnosed visual disorder. The veteran's service entrance examination shows his uncorrected vision for both eyes measured at 20/200, corrected to 20/20. The report of examination at separation indicates uncorrected vision in the left eye at 20/100 and in the right eye at 20/200, both corrected to 20/40. The examiner noted defective visual acuity, but checked the "normal" box corresponding with the entry for eyes. At a December 1987 examination, the examiner noted good systemic health, but noted a change in visual acuity. Post-service evidence is silent for any diagnosis or notation of a visual disorder. An April 1990 report of medical history contains the physician's notation "wears glasses - myopia." The Board acknowledges the veteran's statements and those of his mother that his vision was worse when he got out of the service than when he went in; however, the evidence does not show any visual disorder other than defective visual acuity. As discussed above, refractive errors of the eye are not disabilities for which service connection may be granted. 38 C.F.R. §§ 3.303(c), 4.9 (2001). It is now well-settled that in order to be considered for service connection, a claimant must first have a disability. See Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992); Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998) [service connection may not be granted unless a current disability exists]. Further, symptoms alone, without a finding of an underlying disorder, cannot be service-connected. See Sanchez-Benitez v. Principi, 259 F.3d 1356 (Fed. Cir. 2001). The Board therefore believes that in the absence of an identified visual disability, the first Hickson element is not satisfied, and service connection may not be granted. See Brammer v. Derwinski, 3 Vet. App. 223 (1992). The Board therefore finds that a preponderance of the evidence is against a showing that the veteran has a visual disorder that is related to an incident of active service. The veteran's claim of entitlement to service connection for a visual disorder will accordingly be denied. 2. Entitlement to service connection for chronic headaches. The veteran contends that he has headaches which are due to his period of active service. He attributes the headaches to breathing fumes and chemicals during the refitting of his ship. Analysis As noted above, in order for service connection to be granted, three elements must be present: (1) a current disability; (2) in-service incurrence of such disability; and (3) medical nexus. See Hickson, supra. The Board has reviewed the evidence of record, and for reasons which will be expressed in greater detail below, the Board finds that a chronic headache disorder was not incurred in service. The evidence does not show a current diagnosed headache disorder. Although the veteran currently reports symptoms of severe headaches and the veteran's mother stated in March 1999 that she observed the veteran suffering from headaches after he returned from service, no chronic disorder has been diagnosed to account for these complaints. Service medical records are virtually silent for complaints of headaches. Nothing was noted in this regard at separation, and on examinations in April 1990 and October 1995, the veteran checked "no" corresponding to the item "frequent or severe headaches." Post-service evidence is silent as to a chronic headache disorder. The Board therefore believes that in the absence of an identified headache disorder, the first Hickson element is not satisfied, and service connection may not be granted. See Brammer, supra. Further, as there is no showing of such disorder in service and no medical evidence which purports to establish a nexus between an incident of service and the veteran's current complaints, the second and third Hickson elements are likewise not satisfied. The Board therefore finds that a preponderance of the evidence is against a showing that the veteran has a chronic headache disorder that is related to an incident of active military service. The veteran's claim of entitlement to service connection for a headaches will accordingly be denied. 3. Entitlement to service connection for chronic hemorrhoids. The veteran contends that he has hemorrhoids, which were incurred in active military service as a result of straining to lift heavy motors. Analysis As noted above, in order for service connection to be granted, three elements must be present: (1) a current disability; (2) in-service incurrence of such disability; and (3) medical nexus. See Hickson, supra. The Board has reviewed the evidence of record, and for reasons which will be expressed in greater detail below, finds that hemorrhoids were not incurred in or as a result of service. The Board notes no evidence which would support a showing that the veteran currently suffers chronic hemorrhoids. Such a disorder has not been diagnosed, and there is no record of current treatment for such a disorder. Further, the service medical records have been reviewed, and they do not indicate that the veteran was diagnosed with or treated for hemorrhoids in the service. The Board therefore believes that in the absence of an identified disorder manifested by hemorrhoids, the first Hickson element is not satisfied, and service connection may not be granted. See Brammer, supra. Further, as there is no showing of hemorrhoids in service and no medical evidence which purports to establish a nexus between an incident of service and the veteran's current complaints, the second and third Hickson elements are likewise not satisfied. The Board therefore finds that a preponderance of the evidence is against a showing that the veteran has chronic hemorrhoids that are related to an incident of active military service. The veteran's claim of entitlement to service connection for chronic hemorrhoids will accordingly be denied. 4. Entitlement to service connection for chronic leg spasms. The veteran contends that he has a leg disorder which is characterized by jerking of the legs while he sleeps. He contends that he incurred this disorder during service. He also has indicated that this may be due to his claimed sleep and respiratory disorders. Analysis As noted above, in order for service connection to be granted, three elements must be present: (1) a current disability; (2) in-service incurrence of such disability; and (3) medical nexus. See Hickson, supra. The Board has reviewed the evidence of record, and for reasons which will be expressed in greater detail below, finds that chronic leg spasms were not incurred in service. The evidence does not show a current diagnosed leg disorder. Although the veteran currently reports symptoms of jerking of the leg while asleep, and although his wife has testified that he jerks his legs while he sleeps, no chronic disorder has been diagnosed to account for these complaints. See Sanchez-Benitez v. Principi [symptoms alone, without a finding of an underlying disorder, cannot be service-connected]. Service medical records are silent for complaints of leg jerking. Nothing was noted in this regard at separation, or anywhere else in the service medical records. The Board therefore believes that in the absence of diagnosed chronic muscle spasms of the legs, the first Hickson element is not satisfied, and service connection may not be granted. See Brammer, supra. Further, as there is no showing of such disorder in service and no medical evidence which purports to establish a nexus between an incident of service and the veteran's current complaints, the second and third Hickson elements are likewise not satisfied. The Board therefore finds that a preponderance of the evidence is against a showing that the veteran has chronic leg spasms that are related to an incident of active military service. The veteran's claim of entitlement to service connection for chronic leg spasms will accordingly be denied. 5. Entitlement to service connection for a back disorder. The veteran contends that he has a back disorder which is due to lifting heavy motors and other electrical equipment in service. Analysis As noted above, in order for service connection to be granted, three elements must be present: (1) a current disability; (2) in-service incurrence of such disability; and (3) medical nexus. See Hickson, supra. The Board has reviewed the evidence of record, and for reasons which will be expressed in greater detail below, the Board finds that a back disorder was not incurred in service. The evidence does not show a current diagnosed back disorder. Although the veteran contends that he suffers back problems, no chronic disorder has been diagnosed to account for these complaints. See Sanchez-Benitez, supra. Service medical records are silent for complaints of back pain. No defects of the spine were noted at separation or on examinations in April 1990 and October 1995. In the report of medical history for those examinations, the veteran checked "no" corresponding to the item "recurrent back pain." Post-service evidence is silent as to a back disorder. The Board therefore believes that in the absence of an identified back disorder, the first Hickson element is not satisfied, and service connection may not be granted. See Brammer, supra. Further, as there is no showing of such disorder in service and no medical evidence which purports to establish a nexus between an incident of service and the veteran's current complaints, the second and third Hickson elements are likewise not satisfied. The Board therefore finds that a preponderance of the evidence is against a showing that the veteran has a back disorder that is related to an incident of active military service. The veteran's claim of entitlement to service connection for a back disorder will accordingly be denied. 6. Entitlement to service connection for a bilateral knee disorder. The veteran contends that he has a bilateral knee disorder due to lifting heavy motors and other electrical components during service. Analysis As noted above, in order for service connection to be granted, three elements must be present: (1) a current disability; (2) in-service incurrence of such disability; and (3) medical nexus. See Hickson, supra. With respect to Hickson element (2), in service incurrence, service medical records show that in February 1986 the veteran fell and hit his leg on a bulkhead. He had an abrasion on the lateral aspect of the right leg, just below the patella, with a superficial laceration. There was also swelling and reduced range of motion due to pain. The following day, the swelling was gone and the ligaments and range of motion were noted as normal. The impression was a contusion of the right knee. A March 1987 x-ray report shows complaint of trauma to the left leg, and an impression of normal tibia and fibula. No defects of the lower extremities were noted at separation in 1988, or on service enlistment examinations in April 1990 and October 1995. In the report of medical history for those examinations, the veteran checked "no" corresponding to the item "trick or locked knee." The Board finds that the evidence of record is consistent with acute injuries to the veteran's right knee and left leg in service, both of which apparently healed quickly and without residual disability. Accordingly, the Board concludes that Hickson element (2), in-service incurence of disease or injury, has not been satisfied with respect to this issue. With respect to the first Hickson element, the evidence does not show a current diagnosed bilateral knee disorder. Although the veteran, his wife and mother all contend that he suffers popping and cracking in his knees, no chronic disorder has been diagnosed to account for these complaints. Post-service medical evidence is silent as to a bilateral knee disorder. The Board notes by way of clarification that the RO mistakenly filed evidence in the veteran's folder which showed a diagnosis of chondromalacia patella. As pointed out by the veteran's representative in a December 1999 letter, however, the medical reports on which this finding was based were properly associated with another veteran's claims file. The RO removed the incorrectly filed records. However, the February 2000 SSOC still contained an erroneous finding, based on this evidence, that the veteran was diagnosed with chondromalacia patella. The Board notes that there is no evidence currently in the claims file to support a diagnosis of any knee disorder. The Board therefore believes that in the absence of an identified bilateral knee disorder, the first Hickson element is not satisfied, and service connection may not be granted. See Brammer, supra. In addition, because there is no showing of a chronic knee disorder in service, and as there is no medical evidence relating the current symptoms to any incident of service, the second and third Hickson elements are likewise not satisfied. The Board therefore finds that a preponderance of the evidence is against a showing that the veteran has a bilateral knee disorder that is related to an incident of active military service. The veteran's claim of entitlement to service connection for a bilateral knee disorder will accordingly be denied. 7. Entitlement to service connection for a scar to the right index finger. The veteran contends that he has a scar on his right index finger which is due to an injury incurred while in service. The veteran states that he tore his index finger on some grating and the finger had to be sutured. Analysis As noted above, in order for service connection to be granted, three elements must be present: (1) a current disability; (2) in-service incurrence of such disability; and (3) medical nexus. See Hickson, supra. The Board has reviewed the evidence of record. The evidence, specifically the report of a February 2001 VA examination of the veteran's hand, shows that the veteran has a current scar to the proximal phalanx of the right hand, second digit, measuring 1.5 cm in length. However, the examiner stated "there is insufficient clinical at present to warrant a diagnosis of any acute or chronic disorder or residuals thereof". Although this appears to be medical evidence of the absence of a current disability, since a scar has been identified on the veteran's right index finger, Hickson element (1) is satisfied. However, there is no objective evidence of an injury to the right index finger during service. Service medical records do show that the veteran was injured in service when his right hand was caught on some fencing in January 1987. It was stated three times in the medical report that the 5th digit of his left hand was injured. Although the Board has taken into consideration statements of the veteran and his mother that he injured his right index finger in service, these statements are outweighed by the contemporaneous service medical record, which clearly indicate the location of the injury. There is no other medical evidence which indicated that the veteran's right index finger was injured during service. Moreover, Hickson element (3), medical nexus, is not met either. The only opinion concerning nexus, that of the examiner in February 2001, is unfavorable to the veteran's claim. The Board therefore finds that two of the three Hickson elements have not been satisfied, and the veteran's claim of entitlement to service connection for a scar of the right index finger is denied. 8. Entitlement to service connection for a scar to the right little finger. The veteran has never specifically contended that he injured his right little finger, but instead stated to the February 2001 VA examiner that only his right index finger was injured. As noted above, the January 1987 emergency treatment record refers to the finger injured as the 5th digit of the right hand. Hickson element (2), in-service incurrence, is accordingly met. However, because there is no evidence showing a current disability of the right little finger, the Board finds that service connection for a scar to the right little finger must accordingly be denied. 9. Entitlement to service connection for GERD. The veteran contends that he has GERD, which he attributes to his active military service. Analysis The evidence shows a current diagnosis of GERD, August 1997, thus satisfying the first Hickson element. Service medical records are silent for complaints or treatment of symptoms consistent with GERD. Nothing was noted in this regard at separation. On the report of medical history in April 1990 the veteran checked "yes" corresponding to the item "stomach, liver or intestinal trouble", evidently referring to a May 1999 episode, after service, which reportedly was acute and had resolved with Maalox. In October 1995, the veteran checked "no" on this item. Post-service evidence shows that the veteran was initially seen for complaints of difficulty swallowing in August 1995. In July 1997, the veteran was admitted for emergency treatment for inability to tolerate solid food. He was examined by J.N.K., M.D. and G.V.S. M.D. and was diagnosed with severe GERD and dysphagia secondary to peptic stricture. Follow-up letters in September 1997, December 1997 and June 1998, from G.V.S. to J.N.K. show that the veteran's symptoms had subsided. None of the evidence following service provides any medical link or nexus to any incident of the veteran's military service, which ended seven years prior to the first recorded onset of symptoms. The primary evidence in support of the veteran's claim comes from his own contentions. However, it is now well established that although he is competent to report on his symptoms, as a lay person without medical training he is not competent to relate those symptoms to a particular diagnosis or specific etiology. See Espiritu v. Derwinski, 2 Vet. App. 492, 494-5 (1992). The Board therefore finds that in the absence of any evidence of in-service incurrence of GERD, and in the absence of any medical evidence linking the veteran's current GERD with service, the second and third Hickson elements have not been satisfied. The Board therefore finds that a preponderance of the evidence is against a showing that the veteran's GERD is related to an incident of active military service. The veteran's claim of entitlement to service connection for GERD will accordingly be denied. 10. Entitlement to service connection for sinusitis. The veteran contends that he has sinusitis due to work he performed during refitting of his ship, which included cutting of insulation and exposure to asbestos. He contends that he was also exposed to paint and primer fumes. Alternately, he contends that he was hit by a rotor in the nose during service and that this caused a deviated septum. Analysis The Board has reviewed the evidence of record, and for reasons which will be expressed in greater detail below, the Board finds that chronic sinusitis was not incurred in service. The evidence does show the presence of a current disability, stated as chronic sinusitis by the diagnosis of the February 2001 VA examiner and by private treatment records. This is sufficient to satisfy the first Hickson element. Service medical records are virtually silent for complaints of sinus symptoms. The veteran was reported to have a runny nose and congestion in February 1984, and he was diagnosed with an upper respiratory infection. Later in the month, he reported again for complaints of cough, dizziness and congestion and was again diagnosed with an upper respiratory infection. Following that episode, the veteran was treated for other complaints, but did not complain of upper respiratory symptoms again until July 1984, when the veteran complained of a drip in his throat and a stuffy feeling. He was diagnosed with a viral upper respiratory infection. In December 1984, the veteran complained of a cough and head and chest congestion. He was diagnosed with possible cold symptoms. In June 1986, the veteran complained of head cold symptoms and sinus congestion. The examiner noted no symptoms of sinusitis, but instead diagnosed congestion. Sinuses were noted as normal at separation and on the enlistment examinations in April 1990 and October 1995. Significantly, in connection with those examinations, the veteran checked "no" with respect to the item "sinusitis" in the report of medical history. The in-service evidence does not support the veteran's contention that he incurred sinusitis during service. The evidence shows several acute upper respiratory infections, none of which were diagnosed as sinusitis, and all of which resolved without residual disability prior to separation from service. If a chronic disorder is not diagnosed in service, a claim may still be substantiated if (1) the condition is noted during service, (2) continuity of symptomatology is demonstrated thereafter, and (3) competent evidence relates the present condition to that symptomatology. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488 (1997). Following service, the first complaint of sinus symptoms came in November 1995, when the veteran was seen for a sore throat and sinus congestion. At that time, he was diagnosed with acute maxillary sinusitis. In December 1998, J.N.K. submitted a letter stating that he had treated the veteran for upper respiratory infections and sinusitis frequently for the prior 2 years. The Board finds that the occurrence of symptoms seven years after separation from service does not satisfy the requirement of continuity of symptomatology. The lengthy period without treatment weighs heavily against the claim. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). Notwithstanding the lack of a diagnosis of a disability during service, service connection may still be granted if all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. § 1113(b) (West Supp. 2001); 38 C.F.R. § 3.303(d) (2001); Cosman v. Principi, 3 Vet. App. 503, 505 (1992). In this regard, the Board will also address the veteran's contention that asbestos exposure played a possible role in the veteran's symptoms. The veteran contends that he was exposed to asbestos during refitting work. However, service records do not show any evidence of exposure to asbestos as contended by the veteran. Indeed, the only reference to asbestos contained in the records is a May 1984 asbestos medical surveillance program questionnaire, completed by the veteran, in which he has checked "no" on the question whether he had been exposed to asbestos dust during rip-out operations or worked regularly with asbestos or asbestos products during his Navy career. The asbestos questionnaire was entirely negative with respect to asbestos exposure. The Board additionally notes the opinion of the February 2001 VA examiner, who after reviewing the veteran's medical records stated that it was unlikely that the veteran's respiratory condition was secondary to asbestos exposure. According to the examiner, the respiratory conditions claimed by the veteran are upper respiratory problems, including sinusitis, are not associated with asbestos exposure. The examiner further explained that when one is exposed to asbestos, this will cause pleural disease and will affect the lungs and is not associated with an upper airway condition. In regard to the veteran's contention that he was struck by a rotor in service, causing a deviated septum, the Board can find no indication from the service records that would support the injury contended. The post-service evidence shows that the veteran underwent a septoplasty procedure for nasal obstruction and chronic sinusitis in May 1998, and that deflected cartilage and bone were removed and a portion reshaped and reinserted. However, there is no evidence from anywhere in the record that would support attribution of the veteran's deviated septum to any in-service injury. Finally, in regard to the veteran's contention that he inhaled fumes and dust while performing his duties aboard ship, although the Board has no reason to doubt that such may have occurred, there is of record no medical evidence which would support attribution of his current sinusitis to such exposure. And, as discussed above, the veteran is not competent to relate his symptoms to a particular diagnosis or specific etiology. See Espiritu at 494-5. In short, although there is evidence of sinusitis and septal deviation, the Board finds no showing of chronic sinusitis in service, no evidence that medically relates the currently diagnosed disorder to any incident of service, no evidence that the veteran was exposed to asbestos in service, and no evidence that he incurred an injury to the face in service that resulted in a deviated septum. Therefore, the Board finds that the second and third Hickson elements are not satisfied. For the reasons expressed above, the Board concludes that a preponderance of the evidence is against a conclusion that the veteran has chronic sinusitis that is related to an incident of active military service. The veteran's claim of entitlement to service connection for sinusitis is accordingly denied. 11. Entitlement to service connection for sleep apnea, claimed as due to asbestos exposure. The veteran's contentions with respect to this issue are similar to those expressed with respect to sinusitis above. In essence, he contends that he has an upper respiratory disorder which is characterized by sleep apnea and causes snoring and difficulty in swallowing, due to work he performed during refitting of his ship, which included cutting of insulation and exposure to asbestos. He contends that he was also exposed to paint and primer fumes. Alternately, he contends that he was hit by a rotor in the nose during service and that this caused a deviated septum, which in turn led to the claimed sleep apnea/respiratory disability. Analysis The evidence does show a current diagnosed upper respiratory disorder, manifested by and diagnosed as sleep apnea. Se the report of the February 2001 VA examination. This evidence is sufficient to satisfy the first Hickson element. Service medical records are silent for assessments of sleep apnea or complaints associated therewith. Nothing was noted in this regard at separation, or on the service physical examinations in April 1990 and October 1995. The first post-service evidence of a respiratory or sleep disorder came in October 1998, when the veteran was recommended for a sleep study due to complaints of snoring. A November 1998 report of R.J.M., MD shows that the veteran had moderate snoring, not positional in nature and not related to apnea. His sleep efficiency was disrupted with moderately frequent arousals, not related to leg spasms or apnea. In November 1999, P.M. MD interpreted the results of another sleep study, and determined that the veteran was suffering from obstructive sleep apnea, and treated his symptoms with bilevel positive airway pressure therapy. In short, the medical evidence does not demonstrate a medical finding of sleep apnea, or complaints of symptoms thereof, until a number of years after service. No examining or treating physician has suggested that the veteran's sleep apnea had its inception during his naval service. Notwithstanding the lack of a diagnosis of a disability during service, service connection may still be granted if all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. § 1113(b) (West Supp. 2001); 38 C.F.R. § 3.303(d) (2001). In this regard, the Board notes its prior discussion of asbestos exposure. The veteran contends that he was exposed to asbestos during refitting work. However, as stated above, service records do not show any evidence of exposure to asbestos as contended by the veteran. Significantly, the February 2001 VA examiner stated his opinion that it was unlikely that the veteran's respiratory condition was secondary to asbestos exposure, and that sleep apnea was not a condition associated with asbestos exposure. The examiner stated that, normally, when one is exposed to asbestos, this will cause pleural disease and will affect the lungs and that asbestos exposure is not associated with sleep apnea. In regard to the veteran's contention that he was struck by a rotor in service, causing a deviated septum, as stated above, the Board can find no indication from the service records that would support the injury contended, or that would support attribution of the veteran's deviated septum to the claimed injury or indeed to any in-service injury. In regard to the veteran's contention that he inhaled fumes and dust while performing his duties aboard ship, as stated above, there is no competent evidence that would support attribution of the veteran's sleep apnea or any respiratory symptoms to such exposure. And, as discussed above, the veteran is not competent to relate his symptoms to a particular diagnosis or specific etiology. See Espiritu, supra. The Board therefore believes that, as there is no showing of a respiratory disorder manifested by sleep apnea in service and as there is no medical evidence which purports to relate the veteran's current sleep apnea to any incident of service, the second and third Hickson elements are not satisfied, and a preponderance of the evidence is against a showing that the veteran has an upper respiratory disorder manifested by sleep apnea, that is related to an incident of active military service. The veteran's claim of entitlement to service connection for an upper respiratory disorder will accordingly be denied. CONTINUED ON NEXT PAGE ORDER Service connection for a visual disorder is denied. Service connection for headaches is denied. Service connection for hemorrhoids is denied. Service connection for a leg spasms is denied. Service connection for a back disorder is denied. Service connection for a knee disorder is denied. Service connection for a scar to the right index finger is denied. Service connection for a scar to the right little finger is denied. Service connection for GERD is denied. Service connection for sinusitis is denied. Service connection for sleep apnea is denied. Barry F. Bohan Member, Board of Veterans' Appeals IMPORTANT NOTICE: We have attached a VA Form 4597 that tells you what steps you can take if you disagree with our decision. We are in the process of updating the form to reflect changes in the law effective on December 27, 2001. See the Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the meanwhile, please note these important corrections to the advice in the form: ? These changes apply to the section entitled "Appeal to the United States Court of Appeals for Veterans Claims." (1) A "Notice of Disagreement filed on or after November 18, 1988" is no longer required to appeal to the Court. (2) You are no longer required to file a copy of your Notice of Appeal with VA's General Counsel. ? In the section entitled "Representation before VA," filing a "Notice of Disagreement with respect to the claim on or after November 18, 1988" is no longer a condition for an attorney-at-law or a VA accredited agent to charge you a fee for representing you.