Citation Nr: 0814159 Decision Date: 04/30/08 Archive Date: 05/08/08 DOCKET NO. 04-20 502A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for residuals of shrapnel wounds to the left leg and left shoulder. 2. Entitlement to service connection for post-traumatic stress disorder (PTSD). 3. Entitlement to service connection for hypertension, including secondary to PTSD. 4. Entitlement to service connection for a heart disorder, including secondary to PTSD. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Douglas E. Massey, Counsel INTRODUCTION The veteran served on active duty from June 1944 to February 1946. This case comes before the Board of Veterans' Appeals (Board) from an April 2003 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. In his June 2004 substantive appeal (VA Form 9), the veteran requested a hearing at the RO before a Veterans Law Judge of the Board, i.e., a Travel Board hearing. In subsequent November 2004 correspondence, the veteran indicated that he instead preferred a video-conference hearing. And pursuant to this request, in a December 2007 letter the RO notified him that his video-conference hearing was scheduled for January 22, 2008. However, he failed to appear for his hearing and has not provided any explanation for his absence or requested to reschedule his hearing. Therefore, his hearing request is considered withdrawn. See 38 C.F.R. §§ 20.702(d), 20.704(d) (2007). FINDINGS OF FACT 1. The veteran did not receive the Purple Heart Medal, and a separation examination report dated in February 1946 makes no reference to a shrapnel wound to his left leg or left shoulder. 2. Evidence indicates that a one-inch piece of shrapnel was removed from the veteran's left leg in 1982. 3. No competent medical evidence indicates the veteran sustained a shrapnel wound to his left leg or left shoulder during his military service. 4. The most probative evidence indicates the veteran does not have PTSD as a result of a stressor related to his military service. 5. The veteran's hypertension and heart disease were first diagnosed many years after service and have not been linked by competent medical evidence to his military service. CONCLUSIONS OF LAW 1. Residuals of shrapnel wounds to the left leg and left shoulder were not incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West Supp. 2005); 38 C.F.R. §§ 3.102, 3.303 (2007). 2. PTSD was not incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West Supp. 2005); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2007). 3. Hypertension was not incurred in or aggravated by service, may not be presumed to have been incurred in service, and is not proximately due to, the result of, or chronically aggravated by a service-connected disability. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113 (West Supp. 2005); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2007). 4. A heart disorder was not incurred in or aggravated by service, may not be presumed to have been incurred in service, and is not proximately due to, the result of, or chronically aggravated by a service-connected disability. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113 (West Supp. 2005); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran is requesting service connection for residuals of shrapnel wounds to his left leg and left shoulder, PTSD, hypertension, and a heart condition. In the interest of clarity, the Board will initially discuss whether these claims have been properly developed for appellate review. The Board will then address these claims on their merits, providing relevant VA laws and regulations, the relevant factual background, and an analysis of its decision. I. The Duties to Notify and Assist As provided by the Veterans Claims Assistance Act (VCAA), VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2007). Proper notice from VA must inform the claimant of any information and medical or lay evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (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). Quartuccio v. Principi, 16 Vet. App. 183 (2002). To the extent possible, VCAA notice must be provided prior to an initial unfavorable decision on a claim by the RO. Pelegrini v. Principi, 18 Vet. App. 112 (2004) (Pelegrini II). If, however, for whatever reason it was not, or the notice provided was inadequate, this timing error can be effectively "cured" by providing any necessary VCAA notice and then going back and readjudicating the claim - such as in a statement of the case (SOC) or supplemental SOC (SSOC), such that the intended purpose of the notice is not frustrated and the veteran is given an opportunity to participate effectively in the adjudication of the claim. See Mayfield v. Nicholson, 499 F.3d 1317, 1323 (Fed. Cir. 2007) (Mayfield IV); Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). In addition, the VCAA notice requirements apply to all five elements of a service-connection claim: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), aff'd sub nom. Hartman v. Nicholson, 483 F.3d 1311 (2007). Further, this notice must include information that a downstream disability rating and an effective date for the award of benefits will be assigned if service connection is granted. Id. at 486. VCAA notice errors are presumed prejudicial unless VA rebuts this presumption by showing the error did not affect the essential fairness of the adjudication. To overcome the burden of prejudicial error, VA must show (1) that any defect was cured by actual knowledge on the part of the claimant; (2) that a reasonable person could be expected to understand from the notice what was needed; or (3) that a benefit could not have been awarded as a matter of law. See Sanders v. Nicholson, 487 F.3d 881 (Fed. Cir. 2007). In this case, letters satisfying the notice requirements under 38 C.F.R. § 3.159(b)(1) were sent to the veteran in May 2002, September 2002, October 2002, August 2003, March 2006, December 2006, and February 2007, three of which were sent prior to the initial RO decision that is the subject of this appeal. The letters informed him of the evidence required to substantiate his claims and of his and VA's respective responsibilities in obtaining supporting evidence. He was also asked to submit evidence and/or information in his possession to the RO. As for the Dingess requirements, these were addressed in the March 2006 letter. In any event, however, there is no prejudice in issuing a final decision because the preponderance of the evidence is against the underlying claims for service connection. So any questions as to the appropriate downstream disability rating or effective date to be assigned are moot. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). See also 38 C.F.R. § 20.1102 (2007) (harmless error). VA also fulfilled its duty to assist the veteran by obtaining all relevant evidence in support of his claims, which is obtainable. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. Concerning this, his service medical records are unavailable, except for the report of his military separation examination. However, it appears the RO made numerous attempts to obtain these missing records from the National Personnel Records Center (NPRC), as well as from the veteran personally. The NPRC indicated there were no service medical records or reports from the Office of Surgeon General (SGO). It thus appears the RO properly searched alternative sources in an attempt to assist the veteran in proving his claims. Moore v. Derwinski, 1 Vet. App. 401 (1991) (holding that the heightened duty to assist a veteran in developing facts pertaining to his claim in a case in which service medical records are presumed destroyed includes the obligation to search for alternative medical records). The RO also requested all medical records identified by the veteran and his representative. Some of these private treatment records, however, could not be obtained either because they no longer exist or because the physicians could not be located. The veteran was also unable to produce these records, as he indicated on several occasions that he had no other evidence or information in his possession to submit. See, for example, his January 2007 statement in support of claim (VA Form 21-4138) and the attached VCAA notice response form. The record shows the veteran was scheduled for a March 23, 2007, VA compensation examination, but like his hearing, he also failed to report for his medical evaluation and did not provide any explanation or other justification. VA regulation provides that, when a claimant fails, without good cause, to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. 38 C.F.R. § 3.655 (2007). Also, the U.S. Court of Appeals for Veterans Claims (Court) has held that the duty to assist is not a one- way street. If a veteran wishes help in developing his claim, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining putative evidence. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). So in light of the veteran's failure to report for his hearing scheduled for January 2008 and his VA examination scheduled for March 2007, the Board finds that no further assistance is needed to meet the requirements of the VCAA or Court. 38 U.S.C.A. § 5103A(d) and 38 C.F.R. § 3.159(c)(4). II. Residuals of Shrapnel Wounds to the Left Leg and Left Shoulder The veteran claims that he sustained shrapnel wounds to his left leg and left shoulder after a bomb exploded in April 1945 while he was stationed in the European theater during World War II. For the reasons set forth below, however, the Board finds that the preponderance of the evidence is against his claim. Service connection may be granted for 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). Stated somewhat differently, service connection generally requires: (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 (i.e., link) between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). As already alluded to, the veteran's service medical records - except for the report of his February 1946 separation examination - are unavailable. And as also already alluded to, when at least a portion of the service medical records are lost or missing, the Court has held that VA has a heightened duty "to consider the applicability of the benefit of the doubt rule, to assist the claimant in developing the claim, and to explain its decision ...." Cromer v. Nicholson, 19 Vet. App. 215, 217-18 (2005) citing Russo v. Brown, 9 Vet. App. 46, 51 (1996). See also Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). Although in this situation - when records are missing, there is a heightened obligation to more fully explain the reasons and bases for a decision, this does not obviate the need to have medical nexus evidence supporting the claim. See Milostan v. Brown, 4 Vet. App. 250, 252 (1993) (citing Moore v. Derwinski, 1 Vet. App. 401, 406 (1991) and O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991)). That is to say, there is no reverse presumption for granting the claim. See Russo v. Brown, 9 Vet. App. 46 (1996). Cf. Collette v. Brown, 82 F.3d 389, 392-93 (Fed. Cir. 1996); Arms v. West, 12 Vet. App. 188, 194-95 (1999). The report of the veteran's military separation examination, which is of record, makes no reference to any injury - shrapnel wounds included - involving his left lower extremity or left shoulder. This report thus provides highly probative evidence against his claim that he injured his left leg and left shoulder in service. See Struck v. Brown, 9 Vet. App. 145 (1996). The veteran argues that, since the record shows he was involved in combat, these injuries must be presumed under the provisions of 38 U.S.C.A. § 1154(b) and 38 C.F.R. § 3.304(d). This statute and regulation provides a relaxed evidentiary standard of proof with respect to the issue of an in-service injury for any injury alleged to have been incurred in combat. Id; see also Collette v. Brown, 82 F.3d 389 (1996). Specifically, satisfactory lay or other evidence that an injury or disease was incurred or aggravated in combat will be accepted as sufficient proof of service connection if the evidence is consistent with the circumstances, conditions or hardships of such service even though there is no official record of such incurrence or aggravation. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(d). The term "combat" is defined to mean "a fight, encounter, or contest between individuals or groups" and "actual fighting engagement of military forces." VAOPGCPREC 12-99 (Oct. 1999) citing WEBSTER'S THIRD NEW INT'L DICTIONARY 452 (1981). The phrase "engaged in combat with the enemy" requires that the veteran "have personally participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality." VAOPGCPREC 12-99. But, contrary to the veteran's assertion, the record does not indicate he engaged in combat with an enemy force. His DD Form 214 notes he was awarded the Victory Medal, the American Theater ribbon, the European-African-Middle Eastern Theater Ribbon with 2 Bronze Battle Stars and 1 Overseas Service Bar, the Good Conduct Medal, and the Croix De Guerre. However, none of these medals or awards indicates combat service. The fact that he did not receive an award for combat, such as the Purple Heart Medal (for his alleged shrapnel wounds), constitutes highly probative evidence that he likely did not participate in combat. As such, the evidence of record does not support the assertion that he engaged in combat while on active duty. See 38 U.S.C.A. § 1154(b) and 38 C.F.R. § 3.304(d). In any event, the reduced evidentiary burden only applies to the question of service incurrence, and not to the question of either a current disability or of a nexus (i.e., link) between the current disability and service, both of which generally require competent medical evidence. See generally, Brock v. Brown, 10 Vet. App. 155, 162 (1997); Libertine v. Brown, 9 Vet. App. 521 (1996). And in this case there is still no evidence of a current disability related to service. The only evidence of a shrapnel wound is correspondence from H.Z., M.D., dated in October 2001, wherein he indicates that he had removed a one-inch piece of shrapnel from the veteran's left leg in 1982. Thus, one can assume that the veteran has a residual scar on his left leg as a result of this piece of shrapnel and its surgical removal, thereby establishing the essential element of a current disability. But the claim still fails because there is still no credible evidence as to how this piece of shrapnel became lodged in the veteran's left leg, and thus no evidence that it occurred in service. Indeed, Dr. H.Z.'s correspondence indicates this piece of shrapnel was first discovered in 1982, approximately thirty-six years after the veteran's separation from active duty, thereby providing compelling evidence against the claim. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000) (ruling that a prolonged period without medical complaint can be considered, along with other factors, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability). By the same token, there is no evidence the veteran has any kind of residual shrapnel wound to his left shoulder. H.Z. only mentioned the veteran's left leg in his October 2001 correspondence. The Board also reviewed VA outpatient treatment records dated from 2002 to 2006, none of which makes any reference to an injury or a residual scar involving the veteran's left shoulder from a shrapnel wound. Since there is no medical evidence of a current disability involving a shrapnel wound to the left shoulder, this part of the veteran's claim must also be denied. See Degmetich v. Brown, 8 Vet. App. 208 (1995); 104 F.3d 1328, 1332 (1997) (holding that compensation may only be awarded to an applicant who has a disability existing on the date of the application, and not for a past disability); Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999) (holding that pain, alone, without a diagnosed or identifiable underlying malady or condition, does not in and of itself constitute a disability for which service connection may be granted); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (in the absence of proof of the presently claimed disability, there can be no valid claim). The only evidence that the veteran has a current disability involving his left leg and left shoulder related to shrapnel wounds in service are the lay statements provided by him and his sister. He is competent to testify as to the circumstances surrounding a shrapnel wound to his left leg and left shoulder in service, as this type of incident is capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303 (2007). But in light of the fact that he did not receive the Purple Heart Medal, or any other combat award, and that no such injuries were noted during his military separation examination, the Board does not find his statements concerning these injuries to be credible. See Smith v. Derwinski, 1 Vet. App. 235, 237 (1991) (determining the credibility of evidence is a function for the Board); Hayes v. Brown, 5 Vet. App. 60, 69- 70 (1993), citing Wood v. Derwinski, 1 Vet. App. 190, 192-193 (1992) (VA decision makers have the responsibility to assess the credibility of evidence and determine the degree of weight to give the evidence). See also 38 C.F.R.§ 3.159(a)(2) and Layno v. Brown, 6 Vet. App. 465, 469 (1994) (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted")). For these reasons and bases, the Board finds that the preponderance of the evidence is against the veteran's claim of entitlement to service connection for residuals of shrapnel wounds to his left leg and left shoulder. In reaching this decision, the Board has carefully considered the doctrine of reasonable doubt. But as the preponderance of the evidence is clearly against his claim, the doctrine is not for application. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Accordingly, the appeal is denied. III. PTSD Service connection for PTSD requires: [1] a current medical diagnosis of the condition in accordance with 38 C.F.R. § 4.125(a) (i.e., DSM-IV, presumed to include the adequacy of the PTSD symptomatology and the sufficiency of a claimed in- service stressor), [2] credible supporting evidence that the claimed in-service stressor(s) actually occurred, and [3] medical evidence of a causal relationship between current symptomatology and the specific claimed in-service stressor(s). See 38 C.F.R. § 3.304(f). The evidence necessary to establish the occurrence of a recognizable stressor during service, to support a PTSD diagnosis, will vary depending upon whether the veteran engaged in "combat with the enemy," as established by recognized military combat citations or other official records. See, e.g., Hayes v. Brown, 5 Vet. App. 60, 66 (1993); Doran v. Brown, 6 Vet. App. 283, 289 (1994). If VA determines the veteran engaged in combat with the enemy and his alleged stressor is combat-related, then his lay testimony or statement is accepted as conclusive evidence of the stressor's occurrence and no further development or corroborative evidence is required - provided his testimony is found to be "satisfactory," i.e., credible, and "consistent with the circumstances, conditions, or hardships of service." 38 C.F.R. § 3.304(f)(1); see also 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(d) and (f)(1); and Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). If, however, VA determines either that the veteran did not engage in combat with the enemy, or that he did engage in combat but that the alleged stressor is not combat related, then his lay testimony, in and of itself, is insufficient to establish the occurrence of the alleged stressor. Instead, the record must contain other objective information that corroborates his testimony or statements. See Zarycki, 6 Vet. App. at 98. The Board notes that credible supporting evidence of the actual occurrence of an in-service stressor cannot consist solely of after-the-fact medical nexus evidence. See Moreau v. Brown, 9 Vet. App. 389, 396 (1996). Corroboration does not require, however, "that there be corroboration of every detail...." Suozzi v. Brown, 10 Vet. App. 307, 311 (1997). See also Pentecost v. Principi, 16 Vet. App. 124 (2002). In this case, the veteran claims that he developed PTSD as a result of stressors he experienced while serving in the European theater during World War II. In particular, he claims that he witnessed the death of two friends during an attack by German forces. He reported that a service member named "Potts" had his legs blown off and that another service member named "Cape" was shot in the head. The veteran also reiterated the story of how he received shrapnel wounds to his left leg and left shoulder, although admitting he did not receive the Purple Heart Medal for either injury. Unfortunately, again, the veteran's service medical records, except for the report of his February 1946 military separation examination, are unavailable. Nevertheless, the separation examination report makes no reference to an injury involving his left lower extremity or left shoulder. Also, a psychiatric evaluation at that time was normal. But irrespective of the unavailability of most of his service medical records, his claim fails because the evidence shows he does not currently have the required PTSD diagnosis - regardless of whether any of his alleged incidents ("stressors") are true. The only reference to this diagnosis is in a June 2001 report by W.D., D.O. In this report, Dr. W.D. recorded the veteran's history of receiving shrapnel wounds to his left leg and left shoulder during a bomb blast in April 1945. The veteran also reported that the man to his left (Cape) was hit in the head, and that the man to his right (Potts) had his legs blown off. Dr. W.D. thus concluded the veteran has post-traumatic shock syndrome as a result of these stressors. So it appears as though Dr. W.D. has diagnosed the veteran with PTSD [post-traumatic shock syndrome] as a result of these alleged in-service stressors. But more comprehensive PTSD screening by VA in February 2006 revealed a score of zero, meaning there is absolutely no evidence of PTSD. This report has greater probative value than Dr. W.D.'s report because PTSD screening - the accepted litmus test to determine if the disorder is present - was entirely negative, while Dr. W.D. provided no supporting rationale at how he arrived at the diagnosis of post- traumatic shock disorder. See Owens v. Brown, 7 Vet. App. 429, 433 (1995) (holding that VA may favor the opinion of one competent medical expert over that of another when decision makers give an adequate statement of reasons and bases). See also Black v. Brown, 10 Vet. App. 279 (1997) (indicating an opinion may be reduced in probative value even where the statement comes from someone with medical training, if the medical issue requires special knowledge). See also Guerrieri v. Brown, 4 Vet. App. 467 (1993) (indicating the probative value of medical opinion evidence is based on the expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches). Because the most probative evidence indicates the veteran does not have PTSD, his claim must be denied based on his failure to prove the essential element of a current disability. Brammer, 3 Vet. App. at 225 (in the absence of proof of the presently claimed disability, there can be no valid claim). This, in turn, also means the Board need not discuss whether there is credible supporting evidence that his claimed in-service stressors actually occurred because, without this required diagnosis, there is no current condition to link to his military service. In addition to the medical evidence, the Board has considered the veteran's lay statements that he has PTSD as a result of the alleged in-service stressors. Although he is competent to report psychiatric symptoms (e.g., anxiety, depression, sleeplessness) that he experienced, he is not competent to attribute his symptoms to a diagnosis of PTSD, which requires medical expertise. See 38 C.F.R. § 3.159(a)(2); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303, 310 (2007). See also Layno v. Brown, 6 Vet. App. 465, 469 (1994) (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted")). For these reasons and bases, the Board finds that the preponderance of the evidence is against the veteran's claim of entitlement to service connection for PTSD. And as the preponderance of the evidence is against his claim, the doctrine of reasonable doubt is not for application. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Accordingly, the appeal is denied. IV. Hypertension and a Heart Disorder, Including Secondary to PTSD The veteran claims that he developed hypertension and a heart condition as a result of his PTSD, which, as mentioned, he believes should be service connected. See 38 C.F.R. § 3.310(a) and (b) and Allen v. Brown, 7 Vet. App. 439, 448 (1995) (indicating service connection is permissible on an alternative secondary basis for disability that is proximately due to, the result of, or chronically aggravated by a service-connected condition). But since service connection has not been established for PTSD, these claims fail under a secondary theory of service connection because there is no underlying service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998), indicating that, in order to establish entitlement to service connection on this secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a nexus (i.e., link) between the service-connected disability and the current disability. The Board also finds that service connection for hypertension and a heart condition are not warranted on a direct incurrence basis either. Nor is presumptive service connection warranted - recognizing that certain chronic diseases, including hypertension and heart disease, will be presumed to have been incurred in service if manifest to a compensable degree of at least 10 percent within one year of discharge from service. This presumption is rebuttable by probative evidence to the contrary See 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. A compensable (10 percent) disability rating for hypertension is warranted for diastolic pressure of predominantly 100 or more or systolic pressure of predominantly 160 or more; or if a claimant has a history of diastolic pressure of predominantly 100 or more and requires continuous medication for control. 38 C.F.R. § 4.104, Diagnostic Code 7101 (2007). Here, though, the record shows that both hypertension and heart disease were first diagnosed many years after the veteran's military service had ended. In this regard, the report of his February 1946 military separation examination indicates his blood pressure was 120/80, so well within normal limits, and that his cardiovascular system also was normal on objective clinical examination. Since this report was generated at the time of his separation from active duty, it provides highly probative evidence against his claims. See Struck, 9 Vet. App. at 147. The Board also reviewed outpatient treatment records dated from 2002 to 2006, several of which list diagnoses of hypertension, coronary artery disease, ischemic heart disease, and a history of myocardial infarction (heart attack) in 1983. Thus, the first evidence of heart disease was not until 1983, approximately thirty-seven years after the veteran's separation from active duty. This lengthy period between service and his myocardial infarction and hypertension provides compelling evidence against his claims. See Maxson, 230 F.3d at 1303. Also significant is the fact that the record contains no competent medical evidence that his hypertension and/or heart disease had their onset either while he was in service or during the one-year presumptive period after his service. Maggitt v. West, 202 F.3d 1370, 1375 (Fed. Cir. 2000). In light of these findings, the Board concludes that the preponderance of the evidence is against the veteran's claims for service connection for hypertension and a heart condition. The Board has carefully considered the doctrine of reasonable doubt in denying these claims. However, since the preponderance of the evidence clearly is against these claims, the doctrine is not for application. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Accordingly, this claim must be denied. ORDER Service connection for residuals of shrapnel wounds to the left leg and left shoulder is denied. Service connection for PTSD is denied. Service connection for hypertension is denied. Service connection for a heart condition is denied. ____________________________________________ Keith W. Allen Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs