Citation Nr: 0726137 Decision Date: 08/21/07 Archive Date: 08/29/07 DOCKET NO. 03-20 523 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUES 1. Entitlement to service connection for diabetes mellitus type II (DM), as a result of exposure to the herbicide Agent Orange. 2. Entitlement to service connection for a skin condition, as a result of exposure to the herbicide Agent Orange. 3. Entitlement to service connection for sarcoid arthritis (claimed as a disability of the bones and muscles), as a result of exposure to the herbicide Agent Orange. ATTORNEY FOR THE BOARD C. Eckart, Counsel INTRODUCTION The veteran served on active duty from January 1967 to December 1968. Available service personnel records further reflect that the veteran had service in 1979, and the veteran has averred he served in the Reserves. This service has not been verified, and the National Personnel Records Center (NPRC) has indicated that he served no active duty for training (ACTDTRA). This appeal arises before the Board of Veterans' Appeals (Board) from a rating decision rendered in May 2002 by the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. In August 2004 the Board remanded this matter for additional development. Such has been accomplished and this case is now returned to the Board for further consideration. The Board also referred claims of service connection for extreme mental anguish, anxiety, and nightmares, shortness of breath, constant stinging in the chest, respiratory cancers, Hodgkin's disease, and high blood pressure to the RO for appropriate action. Such matters remain pending and are again referred to the RO for appropriate action. This case is returned to the Board for further appellate consideration. FINDINGS OF FACT 1. The veteran did not have "Service in the Republic of Vietnam" and the provisions for presumptive service connection based on herbicide exposure are not applicable in this case. 2. There is no evidence to confirm that the veteran was exposed to herbicides during active duty. 3. Diabetes mellitus was not shown during active service or during the initial post-service year and competent medical evidence of record does not relate diabetes mellitus to active service. 4. A skin disorder diagnosed as lichen nitidus was not shown during active service and competent medical evidence of record does not relate diabetes mellitus to active service. 5. Sarcoid arthritis was not shown during active service or during the initial post-service year and competent medical evidence of record does not relate arthritis to active service. CONCLUSIONS OF LAW 1. Diabetes mellitus was not incurred in or aggravated by active service, nor may it be presumed to have been so incurred, and is not due to herbicide exposure in service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1116, 1137, 5103, 5103A, 5107 (West 2002 & Supp. 2006); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2006). 2. A skin disorder was not incurred in or aggravated by active service, nor may it be presumed to have been so incurred, and is not due to herbicide exposure in service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1116, 1137, 5103, 5103A, 5107 (West 2002 & Supp. 2006); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2006). 3. Sarcoid arthritis was not incurred in or aggravated by active service, nor may it be presumed to have been so incurred, and is not due to herbicide exposure in service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1116, 1137, 5103, 5103A, 5107 (West 2002 & Supp. 2006); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2006). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duty to notify and assist The VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2006); 38 C.F.R. § 3.159 (2006). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a) (West 2002 & Supp. 2006); 38 C.F.R. § 3.159(b) (2006); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper VA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claim in accordance with 38 C.F.R. § 3.159(b)(1). Such notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004). The Board finds that any defect with respect to the notice requirement in this case was harmless error for the reasons specified below. See VAOPGCPREC 7-2004. In the present case, the veteran's claim on appeal was received in August 2001. A duty to assist letter was issued in December 2001 prior to the May 2002 rating decision that denied this claim. Additional duty to assist letters were issued in August 2002, August 2004 and in June 2005. The letters provided initial notice of the provisions of the duty to assist as pertaining to entitlement to service connection, which included notice of the requirements to prevail on these types of claims, of his and VA's respective duties, and he was asked to provide information in his possession relevant to the claims. The duty to assist letters specifically notified the veteran that VA would obtain all relevant evidence in the custody of a federal department or agency. He was advised that it was his responsibility to either send medical treatment records from his private physician regarding treatment, or to provide a properly executed release so that VA could request the records for him. The veteran was also asked to advise VA if there were any other information or evidence he considered relevant to this claim so that VA could help by getting that evidence. VA must also make reasonable efforts to assist the claimant in obtaining evidence necessary to substantiate the claim for the benefit sought, unless no reasonable possibility exists that such assistance would aid in substantiating the claim. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c), (d). All available service medical and personnel records were previously obtained and associated with the claims folder. Attempts were made to verify the veteran's exposure to Agent Orange, which could not be confirmed through official channels. Furthermore, VA and private medical records were obtained and associated with the claims. Assistance shall also 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. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The most recent VA medical examinations of January 2007 were based on examination of the veteran and review of the record in the claims files. During the pendency of this appeal, the Court issued a decision in the consolidated appeal of Dingess v. Nicholson, 19 Vet. App. 473 (2006), which held that the notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service-connection claim, including the degree of disability and the effective date of an award. However, since service connection is being denied for these claims, the failure to send such a letter is harmless error. For the above reasons, it is not prejudicial to the appellant for the Board to proceed to finally decide the appeal. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004); Quartuccio v. Principi, 16 Vet. App. 183 (2002); Sutton v. Brown, 9 Vet. App. 553 (1996); Bernard v. Brown, 4 Vet. App. 384 (1993); see also 38 C.F.R. § 20.1102 (2005) (harmless error). II. Service connection The veteran contends that he is entitled to service connection for diabetes mellitus, a skin disorder and arthritis, to include as secondary to herbicide exposure. He alleges he had such exposure to herbicides while serving in Panama during the Vietnam War and from active duty for training in 1979 in Fort Drum, New York. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West 2002). Service connection may be granted for any disease diagnosed after service when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2006). The chronicity provision of 38 C.F.R. § 3.303(b) (2006) 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). Diabetes mellitus and arthritis are chronic diseases where service connection would be presumed if the disease manifests itself to a certain degree of disability within one year of the veteran's release from active duty. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 2002); 38 C.F.R. §§ 3.307. 3.309 (2006). Under 38 U.S.C.A. § 1116, it provides that a veteran who served in the Republic of Vietnam during the period beginning January 9, 1962 and ending on May 7, 1975, is presumed to have been exposed during such service to certain herbicide agents (i.e. Agent Orange) if he has one of the listed Agent Orange presumptive diseases. Included on this list are diabetes mellitus, type II and chloracne. For this veteran to qualify under 38 U.S.C.A. § 1116, there must be evidence that he went ashore in Vietnam during his time in service. In this case, the veteran does not contend that he ever served in Vietnam during the periods in question. Instead he bases his argument of herbicide exposure on his service in Panama during the Vietnam War, where he said chemical tests took place that included herbicide agents. He also alleges additional Agent Orange exposure in Fort Drum, New York during active duty for training in 1979 while on reserve status. The June 1967 entrance examination revealed his physical examination to be normal skin, musculoskeletal and endocrine, with the only significant findings of burn scars on the back of both hands and a scar of the right eyebrow, measuring 1 inch. The accompanying report of medical history revealed him to deny swollen/painful joints, sugar in his urine, frequent urination, boils or skin diseases. Service medical records reflect that the veteran was seen in February 1967 for complaints of a sore, swollen right foot. In October 1967 he complained of weakness of his left wrist treated with an ace wrap and limited duty. In June 1968 he injured his right ankle again treated with an ace wrap. Also in June 1968 he was seen for complaints of arthritis in his knees and ankles and was again prescribed an ace wrap. His November 1968 separation examination revealed normal skin, musculoskeletal and endocrine, with the only significant findings of circular old scars on the right and left legs. The accompanying report of medical history revealed him to deny swollen/painful joints, sugar in his urine, frequent urination, boils or skin diseases. Service medical records and personnel records confirm that the veteran served in the Panama Canal Zone from March 1967 to December 1969. A March 1979 training certificate issued by the 1031st USAR training school in West Hartford, Connecticut says the veteran completed 126 hours of POI for MOS 11B. VA examinations from August 1991 addressed right eye problems and sarcoidosis without findings pertinent to his claim except that on physical examination bilateral forearm papules were noted as well as below the umbilicus. There was no skin diagnosis made however. VA treatment records from the early 1990's showed treatment for sarcoidosis and associated problems including pulmonary problems and right eye pathology with surgery to treat a right eye cataract in December 1992. Treatment for the sarcoidosis was noted to include Prednisone. In April 1993 his Prednisone was increased and indications were to check glucose with the increased dose. In December 1993 he was having bone pain and questions were raised as to whether it would be advisable to taper off the Prednisone as the dosage he was on might cause osteoporosis by itself in addition to the side effect of sarcoid on bone. Another December 1993 record addressing sarcoid symptoms noted the veteran's complaints of bone pain was especially in his knees and that he had a right wrist fracture recently. A February 1996 letter from a VA doctor said that the veteran received pulmonary care at the VA until April 1994, and had sarcoidosis with iritis and a chronic right upper lobe infiltration. Also consistent with this diagnosis were chronic nodular lesions predominantly on his upper extremities. The veteran said these papules have been present since service. A February 1996 letter from a private doctor stated that the veteran was recently hospitalized and had a history of sarcoidosis. He was being followed by the VA and was taking Prednisone. He was recently hospitalized for complications of an ulcer and was noted at the time to have early diabetic ketoacidosis and elevated blood sugars. VA treatment records from 1996 through 1997 showed continued treatment for sarcoidosis and right eye and pulmonary problems from it. An April 1996 bone scan of the cervical spine showed several areas of high signal in the lower cervical and thoracic spine viewed as compatible with metastatic disease. No pedicle destruction or vertebral body destruction was seen in abnormal areas. A February 1997 treatment note indicated that a bone scan was to be done to rule out sarcoid arthritis. Lay evidence submitted by the veteran included a copy of a VA Agent Orange review report volume 17, number 3 dated in July 2001 which stated that in response to an inquiry from a Congressman Evans regarding the Agent Orange registry examination eligible for veterans exposed to Agent Orange at Fort Drum New York. The Secretary of the VA expressed his belief that it was feasible to include Fort Drum veterans in the registry. The Secretary noted that current VA regulations provided that whenever it can be established that a veteran was exposed to certain herbicide agents in service, whether Fort Drum or elsewhere, that the veteran qualifies for service connection for any disease recognized by the VA as presumptive to Agent Orange exposure. Other additional lay evidence submitted by the veteran are articles from various sources stating that Agent Orange was tested in Panama during the Vietnam War, from the 1960's and 1970's. He also submitted a copy of an online article discussing various systemic complaints said to be due to Agent Orange and claimed that he had a number of these complaints. VA treatment records from 2001 continued to address treatment for sarcoidosis, but also addressed skin and joint problems. In May 2001 he was seen for a history of sarcoidosis and chronic Prednisone use, with new complaints of neck pain for which he saw a chiropractor with X-rays said to show "disc disease." Also in May 2001 a regular appointment for lichen nitidus revealed the condition unchanged from October 2000. He still complained of a diffuse rash with itching and occasional erythema. Physical examination showed small pin sized papules globally on his body. The assessment was lichen nitidus. In August 2001 dermatology note he was noted to have lichen nitidus and still had severe itching and physical examination findings of diffuse nonerythematous small papules on the arms. He was assessed with lichen nitidus by biopsy. Also in August 2001 a rheumatology follow up noted the veteran to complain of pain mainly in the cervical spine, right wrist and right knee. On physical examination he had some pain on examination of the cervical spine and the right knee was essentially normal except for increased prominence of the tibial tuberosity. The impression was degenerative joint disease of the cervical spine and minimal, if any sarcoid arthropathy. X-rays from August 2001 showed degenerative disc disease in the cervical spine. In September 2001 he was seen for 8 month follow up of sarcoid arthritis. Pertinent complaints included pain in his feet with no other joints bothering him much. He saw a chiropractor for his neck. Physical examination showed decreased motions in the shoulders and mild pain on motion of the neck, elbows and wrists. His right knee had a prominent tibial plateau and there was mild swelling in the right ankle. The assessment was history of sarcoidosis and presumed sarcoid arthritis. An October 2001 checkup for history of noninsulin dependent diabetes and sarcoidosis noted the skin to have multiple maculas without erythema, discharge or skin openings. Musculoskeletally he had full range of motion and no pain on palpation. The pertinent diagnoses were history of arthritis, noninsulin diabetes mellitus. Private treatment records from October 2001 to November 2001 document treatment and follow up for diabetes. A November 2001 private treatment record reflects that the veteran was followed up for noninsulin dependent diabetes, uncontrolled. The veteran stated the diabetes was controlled prior to increasing prednisone which the VA ophthalmology clinic had done. An April 2002 response from the National Personnel Records Center (NPRC) indicated that there was no record of exposure to herbicides. A March 2004 State Department response to a Freedom of Information Act (FOIA) request includes some unclassified documents pertaining to chemical agents and unexploded ordnances in the Panama Canal Zone. A creation of export processing zone at Fort Davis was also noted. Documents were noted to discuss problems with hazardous materials and plans to deal with clean up and legal issues regarding the contamination. There was some mention of concerns that Agent Orange may be present at Suberania Park on the Canal's east bank, but without presenting actual evidence. These documents failed to establish that Agent Orange was there during the veteran's service. Documents provided by the Department of Defense in June 2004 in response to a FOIA request confirm that chemical and biological agents were tested in Panama both prior to and during the time the veteran served in the Canal Zone. These included biological agents and Sarin nerve gas agents between February and March 1963, biological agents tested from February 1964 to May 1966, Sarin nerve gas tested from April to May 1967, and riot control agents (tear gas) testing in 1966 and from September 1967 to January 1968. Such tests took place in the Panama Canal Zone as well as other areas where the veteran did not serve. None of the records reflect that herbicides were tested. An August 2004 NPRC response to an inquiry reflects pertinent documents were furnished and that the record fails to indicate ACTDTRA and there were no additional service medical records on file. Another August 2004 NPRC response to an inquiry reflects that there were no records of exposure to herbicides for this veteran. A March 2005 letter from the Department of the Army and Air Force Joint Forces Headquarters of the Mississippi National Guard reveals that they were unable to locate files on the veteran. A September 2005 letter from the NPRC reflects that the original medical record needed to answer the inquiry was not in their files, as it has been loaned to the VA. A November 2006 NPRC letter stated that it was returning the VA's request for information without further action, saying that the veteran has requested that the NPRC stop honoring requests directly from the VA RO and medical centers. According to procedures established by the VA, all requests for service medical records and service personnel records should go through PIES or if not available, through the appropriate RO. The report of a January 2007 VA examination noted that the veteran was claiming service connection for diabetes, a skin condition and sarcoid arthritis. Skin problems were to be addressed in a separate examination. The veteran said he was diagnosed with diabetes in the early 1990's. He said he was in a diabetic coma and was hospitalized. He has been on oral medication since then. The examiner listed the medications the veteran was currently taking. The veteran was unaware of any side effects from the medications he was now on. He said his diabetes has been fairly well controlled and has not required any additional hospitalizations for complications of diabetes such as ketoacidosis, hyperglycemia or hypoglycemia. He did have some hypoglycemic reactions but could not recall when the last one was. The examiner discussed the veteran's current diet and weight fluctuations in detail. He was noted to have a diagnosis of sarcoid uveitis but no history of diabetic retinopathy. He was also said to have a history of hypertension dating to the 1970's. He also complained of numbness in both legs and a history of treatment for neuropathy. He also had frequent urination and erectile dysfunction. He was being followed by the VA clinic and rheumatoid clinic for sarcoid arthritis. The last visit to the clinic in August 2006 revealed complaints of arthralgia although X-rays of his knees at that time were normal. He also complained of joint pain in the shoulders, elbows, hands, wrists, fingers, knees, hips and feet bilaterally. Examination at the time of this VA examination showed no active synovitis, swelling or discomfort on palpation in this area or in any joints. There was no evidence of muscle abnormality. He was hospitalized in 1996 and may have had early ketoacidosis at that time, as per claims file. He has had no subsequent diagnosis of ketacidosis or hypoglycemia. Physical examination revealed pertinent findings of no peripheral edema noted in the extremities, with the feet in good repair without ulcerations. He had good capillary flow. His joints and back examination were noted as above. Neurological examination revealed intact cranial nerves and normal motor strength. He did walk with a cane in the left hand and complained of back pain when walking. His gait was otherwise normal. He had decreased pinprick sensation from the toes to midfoot bilaterally. Sensation was intact on the bottom of both feet. Vibratory sense was intact bilaterally. His reflexes were 1+ and symmetrical in the upper and lower extremities. The diagnosis was type 2 diabetes, essential hypertension and sarcoidosis. The examiner remarked that the veteran had an established diagnosis of Type 2 diabetes. This seemed fairly well controlled based on this examination. Regarding etiology, the veteran gave a history of being in service during the Vietnam War, but was not actually in Vietnam. He said he trained soldiers in Panama and was exposed to Agent Orange at this time in 1967 and 1968. He said he was at Fort Drum on active duty in 1979 and thought he had exposure to Agent Orange at this time. The examiner did not have evidence of that exposure or any amount of alleged exposure and therefore it would require speculation to say that the veteran has diabetes secondary to Agent Orange without evidence provided of such exposure and the extent of the exposure. The examiner noted that Agent Orange is accepted as a cause of Type 2 diabetes. The veteran however was noted to have been started on steroids in the late 1980's by his history prior to the onset of the diabetes. The examiner stated that it was certainly likely that the prednisone is a contributing factor to the development of his diabetes mellitus. However if he was also exposed to Agent Orange, then this should also be considered a contributing factor. If this exposure was confirmed, then it would not be possible to assign a percentage of cause to any one of these factors without resorting to speculation. The rest of the discussion of diabetes mellitus focused on symptoms and their affects on the veterans daily living. The veteran was also noted to have a diagnosis of sarcoidosis and sarcoid arthritis. He presently complained of arthralgias. However there were no active findings of synovitis and the veteran's sed rate was normal. The complaints of arthritis were nonspecific and it could not be related to his sarcoidosis without resorting to speculation. As for whether the sarcoid or sarcoid arthritis was related to Agent Orange exposure, it has not been established that Agent Orange was the cause of his sarcoidosis and this was also not supported in his medical literature. The record did not indicate that the veteran was diagnosed with sarcoidosis on active duty or during reserve service. Therefore it cannot be stated that the sarcoidosis developed or was present during the time of active service. According to the claims file his sarcoid diagnosis was made in 1989 by lymph node biopsy. The claims file was confirmed to have been reviewed in this examination. The report of a January 2007 VA skin examination included review of the claims file. The veteran reported developing a rash over his lower abdomen and on both wrists while on active duty in Panama. He stated that he was exposed to Agent Orange at Fort Dunn New York in 1979. He believed his skin condition was a result of such exposure. He was specific about the area of body where the rash occurred. He said that while in the service he went to the infirmary and the rash was treated with some prescription salve. He said that the rash never cleared and it spread to cover his waist and abdomen. He described the rash as small single nodules that were flat and hypo pigmented. At times they would fill with blood and itch. He denied any other treatment prior to being treated at the VA in 1996. A biopsy of the rash identified it as lichen nitidus. He was prescribed triamcinolone daily and Diphenhydramine every 6 hours as needed for itching. He was also prescribed prednisone for long term treatment of sarcoidosis which he thought improved his rash. He reported that the rash improved on his wrists, but not completely resolved. The rash on his abdomen was unchanged. He denied progression or flare-ups but stated it was constant. On examination there were very small pinpoint papules on both wrists and across the lower abdomen. His papules were hypo pigmented, small, flat, diffused and without any erythema, inflammation or scaling. His skin was dry. There was no disfigurement. No exposed area was affected and only 5 percent of his body was affected. The impression was lichen nitidus. On claims file review there was no documentation of this skin condition treated during service. There was evidence of enlarged lymph nodes and hidradenitis but these conditions have resolved. The skin condition identified as lichen nitidus was not associated with the accepted medical condition associated with Agent Orange. It was not likely that the veteran's skin condition is associated with the veteran's military career or from Agent Orange exposure. Based on review of the evidence, the Board finds that the preponderance of the evidence is against a grant of service connection for diabetes, a skin condition and sarcoid arthritis. Regarding the skin disorder, this has been diagnosed as lichen nitidus as discussed above, and is not a disease that is presumptive to Agent Orange exposure. Thus there is no need to discuss whether the veteran was exposed to Agent Orange in service. There is no evidence of such disease having manifested in service or being caused by any incident therein. The examiner in the January 2007 VA examination gave the opinion that it cannot be stated that the sarcoidosis developed or was present during the time of active service. According to the claims file review his sarcoid diagnosis was made in 1989 by lymph node biopsy. This opinion was made following examination of the veteran and review of the claims file and is not contradicted by any medical evidence in the claims folder. Regarding the sarcoid arthritis, this also is not a disease that is presumptive to Agent Orange exposure and again there is no need to discuss whether the veteran was exposed to Agent Orange in service. The bulk of the evidence reflects that the veteran has sarcoid arthritis secondary to sarcoidosis which is not service-connected. There is no evidence of such disease having manifested in service or being caused by any incident therein. The examiner in the January 2007 VA examination gave the opinion that this disorder was not likely associated with the veteran's military career or from Agent Orange exposure. This opinion was made following examination of the veteran and review of the claims file and is not contradicted by any medical evidence in the claims folder. Regarding diabetes, this is a disease that is presumptive to herbicide exposure and thus the question of exposure must be addressed. As discussed earlier, the veteran did not serve in Vietnam, nor does he allege service in Vietnam. Thus, there is no presumption of exposure to herbicides to establish service connection for diabetes mellitus, type II, pursuant to 38 U.S.C.A. § 1116. See VAOGCPREC 27-97 (July 23, 1997). Regarding his claimed exposure to Agent Orange while in Panama during the Vietnam War or alternately during ACTDRA in Fort Drum, New York in 1979, all attempts to confirm such exposure as documented above have failed to confirm that the veteran was exposed to Agent Orange. Nevertheless, the veteran can still establish service connection for diabetes mellitus, type II, with proof of direct causation. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The veteran does not contend, nor does the evidence show, that diabetes mellitus had its onset during active service or the first post-service year. The earliest mention of a diagnosis for diabetes mellitus is in the February 1996 letter reflecting that he was noted to have diabetic ketoacidosis and elevated blood sugars. The diabetes mellitus is shown to be type II. The veteran's active service ended in December 1968. Therefore, there is no evidence that the veteran's diabetes mellitus manifested itself during service or within the presumptive one-year period following his discharge from service. There is, however, no record of diabetes or of arthritis shown in service or manifestations of such to a compensable degree within one year following the veteran's discharge from service. Again, the first showing of diabetes is in 1996, which is nearly 30 years following the veteran's discharge from service. No medical professional has attributed the diagnosis of diabetes mellitus, type II to service. Thus, there is a lack of competent evidence of a nexus between the post-service diagnosis of diabetes mellitus and service. While the veteran has asserted that his diabetes mellitus, type II, skin condition and arthritis were incurred in service, he does not have the requisite knowledge of medical principles that would permit him to render an opinion regarding matters involving medical diagnoses or medical etiology. See Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). 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 (1990). The Board has carefully reviewed the evidence of record and finds, for the reasons stated above, that the preponderance of the evidence is against the claims for service connection for diabetes mellitus, type II, a skin disease and sarcoid arthritis and there is no doubt to be resolved. See Gilbert, 1 Vet. App. at 55. ORDER Service connection for diabetes mellitus, Type II is denied. Service connection for a skin condition is denied. Service connection for sarcoid arthritis is denied. ____________________________________________ A. BRYANT Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs