Citation Nr: 0935216 Decision Date: 09/18/09 Archive Date: 09/23/09 DOCKET NO. 06-21 998 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for pneumonia. 2. Entitlement to service connection for right inguinal hernia. 3. Entitlement to service connection for residuals of myocardial infarction. WITNESSES AT HEARING ON APPEAL Appellant and Dr. Bash ATTORNEY FOR THE BOARD Joseph R. Keselyak, Associate Counsel INTRODUCTION The Veteran had active service from March 1984 to March 1986 and additional service with the Texas Army National Guard from July 2002 to July 2004. This matter comes to the Board of Veterans' Appeals (Board) from a May 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The Veteran was afforded a Videoconference Board hearing in October 2008. A transcript of the testimony offered at this hearing has been associated with the record. This matter was last before the Board in December 2008 when it was remanded for further development. That development has been completed and the matter is now ready for consideration by the Board. It appears to the Board that the Veteran is seeking service connection for a right knee disability as well as hypertension. Accordingly, these matters are hereby REFERRED to the RO for appropriate action. FINDINGS OF FACT 1. It has not been shown by competent and probative evidence that the Veteran has pneumonia or any residuals thereof that are causally related to service. 2. It has not been shown by competent and probative evidence that the Veteran has a right inguinal hernia or residuals thereof causally related to service. 3. It has not been shown by competent and probative evidence that the Veteran has residuals of a myocardial infarction causally related to service. CONCLUSIONS OF LAW 1. Service connection for pneumonia is not established. 38 U.S.C.A. §§ 1110, 1131, 5103, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2008). 2. Service connection for a right inguinal hernia is not established. 38 U.S.C.A. §§ 1110, 1131, 5103, 5107 (West 2002); 38 C.F.R. §§ 3.6, 3.102, 3.303 (2008). 3. Service connection for residuals of a myocardial infarction is not established. 38 U.S.C.A. §§ 1110, 1131, 5103, 5107 (West 2002); 38 C.F.R. §§ 3.6, 3.102, 3.303 (2008). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Notice and Assistance Before addressing the merits of the Veteran's claims on appeal, the Board is required to ensure that the VA's "duty to notify" and "duty to assist" obligations have been satisfied. See 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2008). The notification obligation in this case was accomplished by way of a letter from the RO to the Veteran dated in March 2006. See Quartuccio v. Principi, 16 Vet. App. 183 (2002); Pelegrini v. Principi, 18 Vet. App. 112 (2004); Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F. 3d 1328 (Fed. Cir. 2006). Although, this notice did not provide any information concerning the evaluation or the effective date that could be assigned should service connection be granted, Dingess v. Nicholson, 19 Vet. App. 473 (2006), because this decision affirms the RO's denials of service connection, the Veteran is not prejudiced by the failure to provide him that further information. The RO also provided assistance to the Veteran as required under 38 U.S.C.A. §5103A and 38 C.F.R. § 3.159(c), as indicated under the facts and circumstances in this case. In this regard, the Board notes that the Veteran was provided a VA examination to address his claims for service connection of an inguinal hernia and myocardial infarction, including residuals thereof. Although, he was not provided a VA examination with respect to the pneumonia claim, there is sufficient evidence of record to decide this claim, as outlined below. See 38 C.F.R. § 3.159(c) (4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). VA has obtained the Veteran's service treatment and National Guard records, as well as assisted him in obtaining evidence. He has been afforded the opportunity to testify before the Board and has not made the RO or the Board aware of any additional evidence that needs to be obtained in order to fairly decide this appeal. He has not argued that any error or deficiency in the accomplishment of the duty to notify and duty to assist has prejudiced him in the adjudication of his appeal and the Board has found no error resulting in prejudice. See Shinseki v. Sanders, 129 S.Ct.1696 (2009). VA has substantially complied with the notice and assistance requirements and the Veteran is not prejudiced by a decision on the claims at this time. Laws and Regulations Service connection is granted for disability resulting from disease or injury incurred or aggravated in active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection is not granted for disease incurred or injury sustained in service, but for disability resulting from disease or injury in service. Brammer v. Derwinski, 3 Vet. App. 223 (1992). To otherwise establish service connection, there must be evidence of an etiologic relationship between a current disability and events in service or an injury or disease incurred there. Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). The requisite link between a current disability and military service may be established, in the absence of medical evidence that does so, by medical evidence that the veteran incurred a chronic disorder in service and currently has the same chronic disorder, or by medical evidence that links a current disability to symptoms that began in service and continued to the present. Savage v. Gober, 10 Vet. App. 488, 498 (1997); 38 C.F.R. § 3.303(b). Active military, naval, or air service includes active duty, any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty, and any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in the line of duty. 38 C.F.R. § 3.6(a). Under applicable criteria, VA shall consider all lay and medical evidence of record in a case with respect to benefits under laws administered by VA. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Factual Background The Veteran's service treatment records for his period of active service from March 1984 to March 1986 are negative with respect to complaints or diagnosis of a right inguinal hernia or a myocardial infarction. An April 1984 screening note of acute medical care notes a diagnosis of walking pneumonia, with clear lungs. Subsequent service treatment records do not document pneumonia or any residuals thereof. The service treatment records do not document a rendered diagnosis of high blood pressure or a laboratory finding of high cholesterol. The Veteran's diastolic pressure once measured 102mm. and once measured 90mm. but numerous other diastolic readings are all much lower. His systolic pressure never approximated 160mm. In passing, the Board notes that several screening notes of acute medical care contain what appear to be fractional measurements in their margins. These do not appear to be blood pressure readings as they are not indicated as such and a review of these notations shows that they vary significantly from the directly noted blood pressure readings. See e.g. April 24, 1985, screening note of acute medical care. Of record is a May 2002 entrance report of medical examination, pertaining to the Veteran's entrance into the Texas Army National Guard. This report notes a normal heart, lungs, chest and abdomen and viscera, including hernia. At this time, the Veteran's sitting blood pressure measured 142/98 and his standing blood pressure measured 122/92. An EKG at this time revealed NSR (normal sinus rhythm). Of record is a personal statement from the Veteran to Dr. Bash regarding his claimed inguinal hernia. In this statement he explains that while doing some tree pruning for the Army National Guard in April 2004 that he noticed discomfort and pressure in his right abdomen and hip, as well as pain in these areas. The Veteran explained that he notified the NCOIC, who advised him to seek treatment from his private doctor. He related in this statement that he sought treatment the very next day from his private physician, whose records were provided. He stated that his private physician later diagnosed a hernia. He further explained that he notified the National Guard in May 2004 of the fact that he had been diagnosed as having a hernia and that he could not attend drill due to this diagnosis. He related on June 18, 2004, he was placed on a profile for his hernia and could not be deployed due to this malady. Contained within the Veteran's Texas Army National Guard records, is a private referral dated in June 2004, which documents a complaint of a reducible right inguinal hernia. This referral also notes hypertension and high cholesterol. In June 2004 the Veteran was placed on a profile due to his right-sided hernia and was noted to be unfit for deployment, per a private physician's diagnosis of a hernia needing surgery in June 2004. A report of medical history dated June 18, 2004, documents that the Veteran was then taking medication for high blood pressure. Of record are treatment records from the Thomason Hospital. These records document a diagnosis of right inguinal hernia in September 2004, with subsequent surgical repair in October 2004. They do not document the etiology thereof, but do note a history of possible right inguinal hernia repair. The Veteran suffered a myocardial infarction (heart attack) in January 2005. Treatment records from the Del Sol Medical center document diagnoses of acute anterior wall myocardial infarction, coronary artery disease, most likely, as well as hypertension and hyperlipidemia. The Veteran received cardiac catheterization and was hospitalized for a short time. Of record is a report of "independent medical exam" from Craig N. Bash, M.D. dated in January 2006. In opening, this report notes that Dr. Bash reviewed the service treatment records, post-service medical records, imaging reports, the Veteran's lay statements, other medical opinions and medical literature. He stated that it was his medical opinion that "the residuals of the [Veteran's] hernia repair and the residual of his cardiac disease/MI should be service connected (sic)." He also outlined his qualifications. Dr. Bash noted that the Veteran entered the service fit for duty and that he had injured his right groin pulling vegetation in April 2004 and developed a right-sided inguinal hernia during service. He also stated that the Veteran developed high blood pressure and high cholesterol in October 2003, as shown in a private medical record, both of which are known to cause cardiovascular disease. He found that "it [was] clear that the [Veteran] acquired his R. inguinal hernia and high blood pressure/increased cholesterol during his service time" as shown by attached documentation. He noted that the Veteran had no other "more likely" causes for his hernia or his current heart dysfunction and that he had reviewed medical literature, which was consistent with these "medical concepts." The Board notes that attached to this report were private and VA treatment notes. These notes document coronary artery disease, the history of the aforementioned myocardial infarction as well as right-sided inguinal hernia. They are all dated in either 2004 or 2005 and do not show that the Veteran suffered a hernia or a heart attack during a period of ACDUTRA or INACDUTRA, although they do correspond with the time he was in the Texas Army National Guard. On his VA Form 21-526, submitted in February 2006, the Veteran offered a theory regarding the etiology of his heart problems. He explained that his bout of in-service pneumonia resulted in his heart problems. Specifically, he posited that bacteria had damaged the arterial walls, creating long term infection and inflammation, which drew cholesterol and plaque to his arteries, resulting in his heart attack. Of record is a November 2006 report of VA X-ray of the chest. This report notes that erect posteroanterior and lateral views of the chest were obtained and showed that the lungs were clear, and without masses or infiltrates. No pleural effusions or signs of pulmonary vascular congestion were seen. The soft tissue and osseous structures of the chest were unremarkable. The report notes an impression of no active lung disease. In a January 2007 letter from the Veteran to Dr. Bash, the Veteran explained that he had been diagnosed as having high blood pressure and high cholesterol on his initial visit to his private physician in October 2003. He related that he had informed the National Guard of these facts. Of record is an August 2008 VA report of X-ray of the chest. This report notes that examination of the chest in posteroanterior and lateral views showed that both lungs were free of active disease. The impression was of a normal chest. In October 2008 the Veteran and Dr. Bash appeared at a Board hearing. At the Board hearing, Dr. Bash essentially reiterated his aforementioned opinions. He noted that the Veteran had provided a history of incurring a right inguinal hernia in service, as well as a May 2002 note documenting a blood pressure reading of 142/98. He also noted that the Veteran had informed him that he had chest pain in service and the subsequent surgical history in this regard in January 2005. He noted that hypertension can be an early sign of a myocardial infarction and that myocardial infarctions are "kind of a continuous process" which the Veteran "may have had" for a while and then "presented with the need for surgery" in 2005. He also testified that he thought that "the hypertension and the cholesterol" were early signs of or the early cause of the myocardial infarction. He expressed that he had reviewed the rating decision and was unsure if it had addressed the Veteran's National Guard service. He related that he would address the Veteran's claims, including pneumonia, in a subsequent report. The Veterans Law Judge that conducted the hearing asked the Veteran several questions. In response to these questions, the Veteran related that he had been treated for pneumonia in 1984, but that he had not had any other treatment for pneumonia in service or thereafter, but that he had breathing problems after that. He stated that one doctor had told him that it was a possibility that pneumonia had resulted in breathing problems and that he may have the onset of asthma. In regards to the hernia, the Veteran reiterated the history of alleged April 2004 injury in the National Guard during a weekend drill and subsequent treatment. With respect to the myocardial infarction, the Veteran related that he had not been treated for heart disease or hypertension during active service, but that he had been treated for these conditions during the time he was in the National Guard. He related that he had informed the National Guard in November that he had hypertension, which had been diagnosed about a month prior. In October 2008, Dr. Bash provided another opinion in regards to the claims on appeal. He noted that he had found a report noting blood pressure of 142/98 "while in service" in 2002. He also noted that the Veteran experienced chest pain while on duty "as per hearing testimony." He related the Veteran's history of myocardial infarction in January 2005. He stated under the "opinions" section that his opinions are all to "a high degree of medical certainty (much more likely than not)." He noted that he had not conducted a medical examination of the Veteran as it was not needed as the exam would only inform him of the extent of the current disease. With respect to cardiac problems, Dr. Bash noted that the Veteran entered service fit for duty and that he "had high blood pressure and chest pain," while on active duty. He felt that the Veteran likely had the early signs and symptoms of a myocardial infarction in service because chest pain and high blood pressure were early signs and symptoms thereof. He cited a scholarly article in support of this opinion. He noted that the Veteran's current symptoms were per the "attached lay statements and medical records." He found no more plausible etiology for the current cardiac dysfunction. No lay statements accompanied the opinion, but Dr. Bash did attach some service treatment records, which were addressed in his previous opinion and outlined hereinabove. With respect to the right inguinal hernia, Dr. Bash noted that the Veteran "had a hernia while in service in the right inguinal region." He noted that the Veteran was fit upon entrance, sustained such a hernia (per the Veteran's lay statements), that he was put on a profile for limited duty and there was no more plausible etiology for the right hernia region problems other than the reported injury. Dr. Bash also addressed a right knee disability in this opinion. He did not address pneumonia or any residuals thereof, including a cardiac condition. The right knee condition is addressed in the introduction section of the decision. Ultimately, in April 2009 the Veteran was provided a VA examination to address his claims. The report associated with this examination notes that the examiner reviewed the claims file. The examiner addressed each claim in turn, documenting the salient points contained in the record. The examiner noted a June 2004 referral from the emergency department for a reducible right inguinal hernia from the Thomason Hospital. He also referenced the June 2004 profile for a right inguinal hernia. At the time of this examination, the Veteran stated that he was noted to have a right inguinal hernia in June 2004. The examiner noted the October 2004 herhiorrhapy. The examiner found that the condition was not caused by or a result of military service due to the absence of documentation of evaluation or treatment in the military with no causative injury during military service. With respect to the Veteran's cardiac condition, the examiner noted that the date of the onset of this condition was in January 2005. The Veteran reported that at this time he presented with severe chest and left arm pain, at which time he was taken to the hospital and treated. The examiner noted that the Veteran was first diagnosed as having hypertension in October 2003, at which time he was started on medication by his private physician. He referenced a June 2004 Thomason Hospital record that noted hypertension and high cholesterol, as well as the Veteran's statement in June 2004 that he was taking medications for high blood pressure and high cholesterol. The examiner reviewed the Veteran's service treatment and National Guard records, and found no evidence of hypertension or hypercholesterolemia during the Veteran's period of active service from 1984 to 1986. The examiner also noted that on an Initial Medical Review-Annual Medical Certificate, the Veteran acknowledged taking medications for both high blood pressure and high cholesterol. The examiner found that it was evident based on a review of the record that when the Veteran was undergoing this physical examination, he already had hypertension and hypercholesterolemia, which were risk factors for developing heart disease. Accordingly, the examiner concluded that the subsequent residuals of heart disease or a myocardial infarction were not due to military service. The examiner was not requested to address the pneumonia claim and did not. However, the examiner did note the aforementioned August 2008 X-ray that showed that both lungs were free of disease. Pneumonia The Board acknowledges that the Veteran suffered a bout of walking pneumonia in service, but there is no currently diagnosed active pneumonia or any residuals thereof. The United States Court of Appeals for Veterans Claims (Court) has held that Congress specifically limited entitlement to service-connected benefits to cases where there is a current disability. "In the absence of proof of a present disability, there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Repeated chest X- rays have shown no lung abnormalities and no competent evidence of record contains a diagnosis of any pneumonia residuals. See VA chest X-ray reports of November 2006 and August 2008. The Veteran is competent to relate, as he has, that a physician informed him that he may have the onset of asthma related to his bout of walking pneumonia. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (lay evidence is competent to establish a diagnosis when that lay person is reporting a contemporaneous medical diagnosis). Nonetheless, a medical opinion expressed in terms of "may" also implies "may or may not" and is too speculative to establish a causal relationship. Bostain v. West, 11 Vet. App. 124, 127-28 (1998), quoting Obert v. Brown, 5 Vet. App. 30, 33 (1993). Moreover, the record contains no documented diagnosis of any pneumonia or residuals thereof and the VA X- ray reports are far more probative than the Veteran's statement regarding what a physician said. In any case, the Board has the responsibility to assess the credibility and weight to be given to the competent medical evidence of record. See Hayes v. Brown, 5 Vet. App. 60, 69 (1993); Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992); see also Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Accordingly, the overwhelming preponderance of the evidence demonstrates no pneumonia or residuals thereof and the claim must be denied. Right Inguinal Hernia Resolution of this claim depends solely on a finding that the Veteran suffered an injury during a period of active service, including ACDUTRA and INACDUTRA. The Veteran does not assert and the evidence does not show that the Veteran incurred a hernia during his period of active service from March 1984 to March 1986. Resolution of this claim solely involves a finding of fact, as opposed to a medical finding of etiology. It is the duty of the Board as the fact finder to determine the credibility of the testimony and other lay evidence. Culver v. Derwinski, 3 Vet. App. 292, 297 (1992). The Veteran has alleged that he incurred a hernia during a weekend National Guard drill in April 2004. However, there is no documented record of this and the Board would expect to find a line of duty (LOD) finding in his National Guard records as such a finding is usually made when an injury is incurred. Rather, the documented medical evidence pertaining to the incurrence of a hernia is dated, at the earliest, in June 2004. The Board finds that the contemporaneous medical evidence has more probative value than the history provided by the Veteran. See Curry v. Brown, 7 Vet. App. 59, 68 (1994). Moreover, the Board finds difficulty with the Veteran's lay statements regarding suffering a hernia during an April 2004 National Guard drill and the timeline of subsequent treatment, due to his contradictory statements. See April 2009 report of VA examination in which the Veteran related having been diagnosed as having a hernia in June 2004. Moreover, the Board finds that the approximate 2 month time period that the Veteran apparently waited to seek treatment, speaks strongly against a finding that he incurred a right inguinal hernia during a period of active service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (lengthy period of absence of medical complaints for condition can be considered as a factor in resolving claim); see also Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board's denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). For these reasons, the Board concludes that the preponderance of the evidence does not show that the Veteran incurred a hernia during active service or during a period of ACDUTRA or INACDUTRA. Accordingly, the claim must be denied. The Board notes that Dr. Bash has offered a favorable opinion on this matter. The Court has held on a number of occasions that a medical opinion premised upon an unsubstantiated account is of no probative value. See, e.g., Reonal v. Brown, 5 Vet. App. 458, 460 (1993); Moreau v. Brown, 9 Vet. App. 389, 395-396 (1996); Swann v. Brown, 5 Vet. App. 229, 233 (1993). Moreover, "a bare transcription of a lay history is not transformed into 'competent medical evidence' merely because the transcriber happens to be a medical professional." LeShore v. Brown, 8 Vet. App. 406, 409 (1995). As the Board has found that the evidence preponderates against a finding that the Veteran suffered a right inguinal hernia during a period of active service, including ACDUTRA and INACDUTRA, particularly during an April 2004 National Guard drill, the Board affords this opinion no probative value. Residuals of Myocardial Infarction The Veteran does not assert and the evidence does not indicate that the Veteran suffered a myocardial infarction during his period of active service from March 1984 to March 1986. Indeed, the evidence clearly establishes that the Veteran suffered a myocardial infarction in January 2005, well after his discharge in March 1986 and after he was discharged from the Texas Army National Guard in July 2004. The sole remaining theory that this condition should be service-connected, in essence, is that the Veteran developed hypertension and hypercholesterolemia during active service (ACDUTRA), which led to his January 2005 myocardial infarction. The Board does not dispute that the conditions of hypertension and hypercholesterolemia played a part, likely a substantial one, in the Veteran's January 2005 myocardial infarction. The opinions of Dr. Bash and of the April 2009 VA examiner clearly show that these conditions played a role in causing a myocardial infarction. The Board notes that hypercholesterolemia is a laboratory finding, which is not a disability in and of itself subject to service connection. See 61 Fed. Reg. 20,440, 20,445 (May 7, 1996). Hypertension is a recognized disability. See 38 C.F.R. § 4.104, Diagnostic Code 7101. In any event, resolution of this claim depends on when hypertension and hypercholesterolemia first manifested, particularly during a period of active duty or ACDUTRA. The provisions pertaining to INACDUTRA are inapplicable, as they pertain only to injury. See 38 C.F.R. § 3.6(a). In this regard, the Board notes that there were two isolated diastolic readings of 90 mm. and 102mm. during the Veteran's period of active service from March 1984 to March 1986. Nevertheless, the numerous other diastolic readings in the service treatment records related tot his period of active service are all well below 90mm. Thus, the Board does not find that hypertension manifested during this period of active service. See 38 C.F.R. § Diagnostic Code 7101, Note (1). Moreover, by the Veteran's own account, it was not until many years following service when in October 2003 that he was first diagnosed as having hypertension by his private physician and placed on medication therefor. The only other avenue for service connection to be established is through a showing that hypertension and hypercholesterolemia were first diagnosed during a period of ACDUTRA during the Veteran's National Guard service. Initially, the Board will address Dr. Bash's opinions. In his first opinion, dated in January 2006, Dr. Bash purports to relate the myocardial infarction to the development of hypertension and high cholesterol in October 2003, as shown by a private medical record. In his testimony before the Board and in his October 2008 opinion, Dr. Bash then notes a blood pressure reading of 142/98 in 2002. Likewise, in his testimony and in the October 2008 opinion, Dr. Bash related a provided history of chest pain "while on duty." He ultimately concluded that the Veteran had the early signs and symptoms of a myocardial infarction in service because chest pain and high blood pressure were early signs and symptoms thereof. The Board does not dispute the medical reasoning of Dr. Bash. The ultimate problems with Dr. Bash's opinions are not medical in nature, but rather factual and legal. Dr. Bash's reference to the 2002 blood pressure reading undermines his opinion. A review of the record shows that this blood pressure reading was obtained in May 2002, two months prior to the Veteran's entrance into the National Guard. Moreover, the Board finds that the lengthy period of time between the Veteran's alleged chest pains in the National Guard and when he first sought treatment in January 2005 (approximately six months) weighs heavily against a finding that he had such chest pains in service. See Maxson, 230 F.3d at 1333 (Fed. Cir. 2000); see also Mense, 1 Vet. App. at 356 (1991). The Veteran's provided history of chest pain is not transformed into competent medical evidence merely because the Dr. Bash happens to be a medical professional. LeShore, 8 Vet. App. at 409 (1995). Dr. Bash's opinions simply do not show to at least equipoise that hypertension, hypercholesterolemia and chest pains first manifested during a period of ACDUTRA during the Veteran's National Guard service, as required by regulation. See 38 C.F.R. § 3.6. The April 2009 VA examination, although relating the myocardial infarction to hypertension and high cholesterol, does not show that these conditions first manifested during a period of ACDUTRA as outlined above. Id. Moreover, the examination was based upon an adequate history and review of the record and the VA examiner opined that hypertension and hypercholesterolemia predated the Veteran's entrance into the National Guard, based upon this review and history. In sum, the claim must be denied because it is not shown to at least equipoise that a myocardial infarction was suffered during active service, or that the January 2005 myocardial infarction was related to a period thereof. The Veteran did not manifest hypertension or hypercholesterolemia until many years after his March 1986 discharge. The evidence does not show that hypertension, hypercholesterolemia or chest pains first manifested during a period of active duty service or ACDUTRA during the Veteran's National Guard service from July 2002 to July 2004. For these reasons the claim must be denied. Lastly, the Board will address the Veteran's contention that his January 2005 myocardial infarction was due to his in- service bout of walking pneumonia. There is no competent medical evidence supporting this theory. This is a question that obviously requires specialized medical knowledge and cannot be addressed by a layperson. From a review of the record, the Veteran is not a medical professional. He is thus not competent to offer this opinion and the Board affords it no probative value. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The claim is not established on these grounds. ORDER Entitlement to service connection for pneumonia is denied. Entitlement to service connection for right inguinal hernia is denied. Entitlement to service connection for residuals of myocardial infarction is denied. ____________________________________________ RAYMOND F. FERNER Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs