Citation Nr: 1007490 Decision Date: 03/01/10 Archive Date: 03/11/10 DOCKET NO. 08-17 003 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUES 1. Entitlement to service connection for a heart murmur, claimed as due to Agent Orange exposure. 2. Entitlement to service connection for hypertension, claimed as due to Agent Orange exposure. 3. Entitlement to service connection for a cyst on the liver, claimed as due to Agent Orange exposure. 4. Entitlement to service connection for sinusitis, claimed as due to Agent Orange exposure. 5. Entitlement to service connection for an enlarged prostate, claimed as due to Agent Orange exposure. 6. Entitlement to service connection for a low back disorder. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Douglas E. Massey, Counsel INTRODUCTION The Veteran served on active duty from January 1962 to May 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions dated in November 2006 and June 2007 by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee, which denied the benefits sought on appeal. The Veteran testified at a hearing held before the undersigned acting Veterans Law Judge in September 2009. At that time, the Veteran raised the claim of entitlement to service connection for a cervical spine disability. Since this claim has not been developed for appellate review, or even abjudicated by the RO, it is referred back to the RO for appropriate development and adjudication. The Veteran recently submitted additional evidence without initial consideration by the RO. However, since he submitted a waiver of initial RO consideration, the Board may review this newly submitted evidence in the first instance. 38 C.F.R. §§ 19.31, 20.800, 20.1304(c) (2009). In any event, it appears that these medical records pertain to his cervical spine, which is not before the Board at this time. FINDINGS OF FACT 1. The Veteran served in the Republic of Vietnam during the Vietnam era. 2. A heart murmur is a clinical finding but not a disability for which VA compensation benefits may be granted. 3. Hypertension, sinusitis, and an enlarged prostate are not included in the list of diseases which may be presumed to have been due to exposure to herbicides during the Vietnam era. 4. The Veteran's hypertension, sinusitis, and enlarged prostate were first diagnosed many years after his military service ended and have not been etiologically linked by competent medical evidence to his service, to include herbicide exposure therein. 5. The Veteran's cyst on his liver is a clinical finding and not a disability for which VA compensation may be granted. 6. There is no evidence of a diagnosis or any current existing chronic disability related to the Veteran's lower back. CONCLUSIONS OF LAW 1. A disability involving a heart murmur was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1116 (West & Supp. 2009); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2009). 2. Hypertension was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1116 (West & Supp. 2009); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2009). 3. A disability involving a cyst on the liver was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1116 (West & Supp. 2009); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2009). 4. Sinusitis was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1116 (West & Supp. 2009); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2009). 5. A disability involving an enlarged prostate was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1116 (West & Supp. 2009); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2009). 6. A disability involving a deteriorated disc of the lower back was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1116 (West & Supp. 2009); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In the interest of clarity, the Board will initially discuss whether the claims have been properly developed for appellate review. The Board will then address the issues on appeal, providing relevant VA laws and regulations, the relevant factual background, and an analysis of its decision. The Duties to Notify and Assist As provided by the Veterans Claims Assistance Act of 2000 (VCAA), VA has duties to notify and assist claimants in substantiating a claim for VA benefits. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2009). 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; and (3) that the claimant is expected to provide. 38 C.F.R. § 3.159(b)(1). Quartuccio v. Principi, 16 Vet. App. 183 (2002). 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. In this case, letters satisfying the notice requirements under 38 C.F.R. § 3.159(b)(1) were sent to the Veteran in May 2006 and September 2006, prior to the initial adjudication of his claim in November 2006, the preferred sequence. See Pelegrini v. Principi, 18 Vet. App. 112, 120 (2004) (Pelegrini II). This notice included information as to how a disability evaluation and an effective date are assigned if service connection is ultimately granted. See Dingess, supra. Thus, the duty to notify under the VCAA has been satisfied in this case. VA also fulfilled its duty to assist the Veteran by obtaining all relevant evidence in support of his claims. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board notes that VA has obtained all relevant medical records identified by the Veteran and his representative. The Board notes that the Veteran has not been afforded a VA examination to determine whether the claimed disabilities on appeal are related to service, as the standards of the Court's decision in McLendon v. Nicholson, 20 Vet. App. 79 (2006), have not been met. In McLendon, the United States Court of Appeals for Veterans Claims (Court) held that a medical examination is necessary in a service-connection claim when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for VA to make a decision on the claim. Id., at 81. See also 38 U.S.C.A. § 5103A(d) and 38 C.F.R. § 3.159(c)(4). In this case, however, there is no confirmed evidence of a current disability for which VA compensation may be paid concerning the Veteran's heart, liver, and lower back. In addition, although diagnosed with hypertension, sinusitis, and an enlarged prostate, none of these disorders were noted in the service treatment records. Indeed, all of these disorders were first diagnosed many years after his military service ended and have not been etiologically linked by competent medical evidence to his period of military service, to include herbicide exposure therein. Therefore, it does not appear that the second and third prongs of McLendon have been met. Accordingly, the Board finds that no further action is necessary to meet the requirements of the VCAA or the Court. Legal Criteria Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. See 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). Stated somewhat differently, service connection 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 between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). Certain chronic disease, such as hypertension and heart disease, may 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. See 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. In addition to these provisions, a Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam era, and has a disease listed in 38 C.F.R. § 3.309(e), shall be presumed to have been exposed during such service to an herbicide agent, such as Agent Orange, unless there is affirmative evidence to establish that he or she was not exposed to any such agent during that service. See 38 C.F.R. § 3.307(a)(6)(iii). For the purpose of this section, "the term 'herbicide agent' means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, specifically: 2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; and picloram." If a Veteran was exposed to Agent Orange during active military, naval, or air service, certain specified diseases shall be service-connected, if the requirements of 38 C.F.R. § 3.307(a) are met, even if there is no record of such disease during service. 38 C.F.R. § 3.309(e). The list of diseases includes: chloracne or other acneform disease consistent with chloracne, type 2 diabetes, Hodgkin's disease, multiple myeloma, non-Hodgkin's lymphoma, acute and subacute peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers, and soft-tissue sarcoma. See 38 C.F.R. § 3.309(e). These diseases, however, must have become manifest to a degree of 10 percent or more at any time after service, except that chloracne (or other acneform disease consistent with chloracne) must become manifest to a degree of 10 percent or more within a year after the last date on which the Veteran was exposed to an herbicide agent during active military, naval, or air service. See 38 C.F.R. § 3.307(a)(6)(ii). VA has determined there is no positive association between exposure to herbicides and any other condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. See Notice, 68 Fed. Reg. 27630- 27641 (2003). Thus, service connection may be presumed for residuals of Agent Orange exposure by showing two elements. First, a Veteran must show that he served in the Republic of Vietnam during the Vietnam War era. See 38 U.S.C.A. § 1116; 38 C.F.R. § 3.307(a)(6). Second, the Veteran must be diagnosed with one of the specific diseases listed in 38 C.F.R. § 3.309(e). Brock v. Brown, 10 Vet. App. 155, 162 (1997). However, the availability of presumptive service connection for a disability based on exposure to herbicides does not preclude a Veteran from establishing service connection with proof of direct causation. See Stefl v. Nicholson, 21 Vet. App. 120 (2007); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Heart Murmur The Veteran claims that he developed a heart murmur as a result of his having been exposed to Agent Orange in Vietnam. However, because a heart murmur is merely a physical finding, which has not been attributed to an underlying heart condition, service connection must be denied. Medical records dated in 2005 from The Heart Group at Saint Thomas Hospital note the presence of a soft systolic murmur involving S4, although other records note that no murmur was present. In any event, however, a soft heart murmur cannot be considered an injury or disease for VA compensation purposes. A "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1 (2009). See also Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991). A symptom, 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. See Sanchez-Benitez v. West, 13 Vet. App. 282 (1999). While a soft heart murmur can be a sign of an underling heart disorder, such has not been shown in this case, and it is not a disease or disability in and of itself. Thus, in the absence of a current disability, there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In denying the claim, the Board does not question the sincerity of the Veteran's belief that he has a heart murmur as the result of his period of active service. The Veteran, however, is not competent on his own to establish that his heart murmur is a manifestation of an underlying heart disorder, which is a matter requiring medical expertise. 38 C.F.R. § 3.159(a)(1) (Competent medical evidence means evidence provided by a person who is qualified through education, training or experience to offer medical diagnoses, statements or opinions); see also Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for a heart murmur. And as the preponderance of the evidence is against his claim, the doctrine of reasonable doubt is not for application. See 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. Hypertension The Veteran also claims that he developed hypertension as a result of exposure to Agent Orange during his Vietnam service. For the reasons set forth below, however, the Board finds no basis to grant the Veteran's claim. Hypertension may 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. See 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. The minimum compensable (10 percent) disability rating for hypertension requires 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 (2009). Hypertension is defined as diastolic blood pressure that is predominantly 90 millimeters (mm.) or greater, and isolated systolic hypertension is defined as systolic blood pressure that is predominantly 160 mm. or greater with a diastolic blood pressure of less than 90 mm. To support a diagnosis of hypertension the blood pressure readings must be taken two or more times on at least three different days. See Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992); 38 C.F.R. § 4.104, Diagnostic Code 7101(Note 1) (2009). In this case, the Veteran's service treatment records verify that he served in the Republic of Vietnam during the Vietnam era, so it is presumed that he was exposed to Agent Orange while there. However, service connection is not available on a presumptive basis for hypertension as due to Agent Orange exposure because it is not included in the list of presumptive diseases in 38 C.F.R. § 3.309(e). Additionally, under the authority of the Agent Orange Act of 1991 and supplemental legislation, the Secretary of VA has reviewed reports from the National Academy of Sciences and determined that there is no positive association between exposure to herbicides and any other condition for which he has not specifically determined that a presumption of service connection is warranted. 72 Fed. Reg. 32395, 32407 (June 12, 2007). Thus, service connection is not warranted for hypertension on a presumptive basis. See Stefl, 21 Vet. App. at 120. Therefore, service connection for hypertension may only be established with proof of actual direct causation. Stefl, supra. See also McCartt v. West, 12 Vet. App. 164, 167 (1999) (wherein the Court held that the provisions set forth in Combee, which actually instead concerned radiation exposure, are nonetheless equally applicable in cases, as here, involving claimed Agent Orange exposure). In other words, medical evidence must show the Veteran's hypertension had its onset either in service or during the one-year period after his separation from active duty in May 1968. And mere lay assertions of this purported cause-and-effect relationship do not constitute competent medical evidence with respect to the nexus requirement. Grottveit, 5 Vet. App. at 93; Espiritu, 2 Vet. App. at 494. However, no such medical nexus evidence has been submitted in this case. His service treatment records make no reference to high blood pressure, much less persistently elevated blood pressure. Of particular relevance, his blood pressure was 130/78 at his separation physical in April 1968, just a few weeks prior to his separation from active duty. There is also no indication that he was on medication for high blood pressure while on active duty. These records, therefore, provide highly probative evidence against the claim See Struck v. Brown, 9 Vet. App. 145 (1996). The record also shows that hypertension was not manifested or otherwise diagnosed within one year of the Veteran's separation from active duty in May 1968. Instead, the record shows the Veteran's hypertension was first diagnosed many years after his military service had ended. For example, a February 2006 VA outpatient treatment record notes the Veteran's twelve-year history of hypertension, thereby placing the date of onset in 1994. A July 2006 VA outpatient treatment record also notes that he had been on high blood pressure medication for the past 10 years, so since 1996. It thus appears that the Veteran's hypertension was first identified approximately 26 years after his separation from active duty. This significant gap provides compelling evidence against the claim on a direct-incurrence basis, as well as on a presumptive basis for the one-year period after service. 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). Moreover, none of the medical records in the claims file includes a medical opinion which relates the Veteran's hypertension to service, to include Agent Orange exposure therein. This evidentiary deficiency is fatal to the Veteran's claim. See Watson v. Brown, 4 Vet. App. 309, 314 (1993) ("A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service."). See also Maggitt v. West, 202 F.3d 1370, 1375 (Fed. Cir. 2000); D'Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000); Hibbard v. West, 13 Vet. App. 546, 548 (2000); and Collaro v. West, 136 F.3d 1304, 1308 (Fed. Cir. 1998). For these reasons, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for hypertension. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Despite the Veteran's statements that his hypertension is related to service, as a layperson without medical expertise or training, his statements in this regard are insufficient to prove his claim. See Grottveit, 5 Vet. App. at 93; Espiritu, 2 Vet. App. at 494-95. Accordingly, the appeal is denied. Cyst on the Liver A computerized tomography (CT) scan performed in January 2006 revealed a very small cyst on the left lobe of the Veteran's liver, measuring approximately 16 or 17 centimeters. Testing revealed it to be a benign, non-cancerous cyst. The Veteran is now seeking service connection for this clinical finding. The Board again points out that the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. See 38 C.F.R. § 4.1. See also Hunt, 1 Vet. App. at 296; Allen, 7 Vet. App. at 439. Since this small cyst on the Veteran's liver has not been identified as a manifestation of an underlying liver disability, such as cancer or some other liver disease, it does not, in and of itself, constitute a "disability" for which service connection may be granted. Indeed, no symptoms related to this cyst have been identified. Hence, the appeal is denied. Brammer, 3 Vet. App. at 225; Sanchez-Benitez, 13 Vet. App. at 287. Sinusitis The Veteran has been diagnosed with sinusitis, which he believes was caused by his confirmed exposure to Agent Orange in Vietnam. For the following reasons, however, the Board finds no basis to grant this claim. First, the Board finds that service connection for sinusitis is not available on a presumptive basis as due to Agent Orange exposure because it is not included in the list of presumptive diseases in 38 C.F.R. § 3.309(e). And second, service connection is not warranted on a direct-incurrence basis because the evidence shows that it was first diagnosed many years after his period of active service had ended, with no competent medical evidence relating it to service, to include Agent Orange exposure therein. His service treatment records make no reference to sinus problems. Of particular relevance, his physical examination prior to his separation from active duty notes that a clinical evaluation of his sinuses was normal. In a Report of Medical History at the time of his separation physical, the Veteran also checked the box for "NO" next to "sinusitis" and "Ear, nose, or throat trouble." In the absence of sinus problems in service, the service treatment records provide compelling evidence against the claim under a direct-incurrence theory of service connection. See Struck, supra. The medical evidence also shows that sinusitis was first identified many years after service, with no competent medical evidence attributing it to service. In this regard, a treatment record from Saint Thomas Hospital notes acute sinusitis since July 1998. Sinusitis was eventually confirmed by X-ray in October 2002. These records, therefore, provide compelling evidence against the claim, since they indicate that his sinusitis was first identified in 1998, approximately 30 years after his separation from active duty. See Maxson, 230 F.3d at 1330 (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). Moreover, none of the medical records indicates that his sinusitis is related to his military service, to include Agent Orange exposure therein. See Watson, 4 Vet. App. at 314; Maggitt, 202 F.3d at 1375; D'Amico, 209 F.3d at 1326; Hibbard, 13 Vet. App. at 548; and Collarot, 136 F.3d at 1308. In addition to the medical evidence, the Board has also considered the Veteran's lay statements, including testimony presented at his September 2009 hearing in which he claimed that he was treated for sinus congestion in service, which has continued ever since. Unfortunately, however, his recent assertions concerning the date of onset of his sinusitis are not credible given the fact that there was no mention whatsoever of any treatment for sinus problems in service. The Board acknowledges that the Veteran is competent, even as a layperson, to attest to factual matters of which he has first-hand knowledge, e.g., experiencing sinus congestion in service. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that lay evidence is one type of evidence that must be considered, and that competent lay evidence can be sufficient in and of itself. See Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). In Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007), the Federal Circuit determined that lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition (noting that sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. The relevance of lay evidence is not limited to the third situation, but extends to the first two as well. Whether lay evidence is competent and sufficient in a particular case is a fact issue. Id. Although the Veteran is competent to report that he experienced sinus congestion in service, the Board must still weigh his lay statements against the medical evidence of record. See Layno v. Brown, 6 Vet. App. 465 (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")). In making this credibility determination, the Board does not find the Veteran's statements concerning the etiology of his sinusitis to be credible, since his service treatment records make no reference to sinus problem, thereby contradicting his testimony See Caluza v. Brown, 7 Vet. App. 498, 511, 512 (1995), aff'd per curiam, 78 F.3d. 604 (Fed. Cir. 1996). See also Macarubbo v. Gober, 10 Vet. App. 388 (1997) (holding that the credibility of lay evidence can be affected and even impeached by inconsistent statements, internal inconsistency of statements, inconsistency with other evidence of record, facial implausibility, bad character, interest, bias, self- interest, malingering, desire for monetary gain, and witness demeanor). It is important to point out that the Board does not find that the Veteran's lay statements lack credibility merely because they are unaccompanied by contemporaneous medical evidence. See Davidson v. Shinseki, 2009 WL 2914339 (Fed. Cir.), quoting Buchanon, 451 F.3d at 1337 ("[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence.") Rather, the Veteran's statements are found to be incredible because they are inconsistent with the evidence of record, which fails to show treatment for sinus problems in service, and, in fact, documents that he denied sinus problems at his separation physical in April 1968. For these reasons and bases, the Board places greater probative value on the medical evidence, which shows that the Veteran's sinusitis was first identified approximately 30 years after his separation from active duty, than the Veteran's own statements in support of his claim. Consequently, the Board finds that the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for sinusitis, claimed as due to Agent Orange exposure. Accordingly, the appeal is denied. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. Enlarged Prostate The Veteran developed an enlarged prostate many years after service, which he believes is due to Agent Orange exposure in Vietnam. Prostate cancer, however, is the only disorder pertaining to the prostate which is included in the list of presumptive diseases under 38 C.F.R. § 3.309(e). And since the Veteran does not have prostate cancer, service connection on a presumptive basis due to Agent Orange exposure is not warranted. Thus, service connection for an enlarged prostate can only be established on a direct-incurrence basis. See Combee, 34 F.3d at 1039. Service connection on a direct-incurrence basis is not available, however, because no medical evidence shows that the Veteran's enlarged prostate is related to service. First, his service treatment records make no reference to an enlarged prostate. Indeed, his separation physical notes that his GU (genitourinary) system was entirely normal; the Veteran also denied any history of urinary frequency in his Report of Medical History. See Struck, supra. And second, post-service medical records from Saint Thomas Hospital note a history of benign prostate hyperplasia (BPH) since October 1999, over 30 years after his separation from active duty. See Maxson, 230 F.3d at 1330. In addition, various VA and private treatment records also note that his prostate would periodically become enlarged. None of these records, however, indicates that this condition is related to his military service, to include Agent Orange exposure therein. See Watson, 4 Vet. App. at 314; Maggitt, 202 F.3d at 1375; D'Amico, 209 F.3d at 1326; Hibbard, 13 Vet. App. at 548; and Collarot, 136 F.3d at 1308. In the absence of any competent medical evidence that his enlarged prostate is related to service, the Board finds that the preponderance of the evidence is against the claim. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Despite the Veteran's statements that this condition is related to service, as a layperson without medical expertise or training, his statements are insufficient to prove his claim. See Grottveit, 5 Vet. App. at 93; Espiritu, 2 Vet. App. at 494-95. Hence, the appeal is denied. Low Back Disorder The Veteran claims that he has a low back disability involving a deteriorated disc as a result of his period of active service. The medical evidence, however, makes no reference to a current low back disability. Instead, the only disc problem pertains to his cervical spine, which is a separate disability and has been referred to the RO for appropriate development and adjudication. Thus, his claim for service connection for a low back disability must be denied. The Veteran's service treatment records show that he was seen on one occasion in August 1963 for a two day history of low back pain after heaving lifting. However, no objective findings were shown on physical examination. The diagnostic impression was mild low back strain. The remainder of his service treatment records makes no further reference to back problems. So in the absence of a chronic low back disability in service, the service treatment records provide highly probative evidence against the claim. See Struck, 9 Vet. App. at 145. But more importantly, there is no medical evidence that the Veteran has a current low back disability. Records from Saint Thomas Hospital note the Veteran's history of low back pain since June 2001. A December 2003 record from that facility also lists a diagnostic impression of "back pain." But no diagnosis was provided to account for his subjective complaints of pain. In Sanchez-Benitez, 13 Vet. App. at 285, the Court held 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. Thus, in the absence of a current disability involving his lower back, his claim must be denied. See Degmetich, 8 Vet. App. at 208; 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); Brammer, 3 Vet. App. at 225 (in the absence of proof of the presently claimed disability, there can be no valid claim). In reaching this decision, the Board has also considered the Veteran's own lay statements in support of his claim. While he may well believe that he has a current low back disability as a result of service, as a layperson without any medical training and expertise, the Veteran is simply not qualified to render a medical opinion in this regard. See Grottveit and Espiritu, both supra. The Veteran is competent to comment on any symptoms such as back pain, but is not competent to attribute his pain to a clinical diagnosis. Jandreau, 492 F.3d at 1377; Barr, 21 Vet. App. at 310. See also 38 C.F.R. § 3.159(a)(2) and Layno, 6 Vet. App. at 469. For these reasons and bases, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for a low back disability involving a deteriorated disc. And as the preponderance of the evidence is against his claim, the doctrine of reasonable doubt 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, the appeal is denied. ORDER Service connection for a heart murmur is denied. Service connection for hypertension is denied. Service connection for a cyst on the liver is denied. Service connection for sinusitis is denied. Service connection for an enlarged prostate is denied. Service connection for a deteriorated disc of the lower back is denied. ______________________________________________ DEMETRIOS G. ORFANOUDIS Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs