Citation Nr: 1009101 Decision Date: 03/10/10 Archive Date: 03/17/10 DOCKET NO. 01-04 508A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to service connection for upper respiratory infection. 2. Entitlement to service connection for sinusitis. 3. Entitlement to service connection for pneumonia. 4. Entitlement to service connection for a right shoulder disorder. 5. Entitlement to service connection for chronic cervical spine pain with foraminal encroachment and mild degenerative facet joints. 6. Entitlement to service connection for fever, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness. 7. Entitlement to service connection for right knee pain, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness. 8. Entitlement to service connection for right hip pain, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness. 9. Entitlement to service connection for leg pain, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness. 10. Entitlement to service connection for problems controlling anger and problems sleeping, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness. 11. Entitlement to service connection for right foot pain, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness. 12. Entitlement to service connection for left foot pain, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD K. Fitch, Counsel INTRODUCTION The Veteran served on active duty from January 1976 to October 1979, from May 1980 to May 1983, and from November 1990 to May 1991, and had reserve component service as well. The Veteran contends that she was performing active duty for training (ACDUTRA) in August 1993 when she sustained injury in a motor vehicle accident. That period of ACDUTRA has not been verified; such verification is not necessary to the determinations below. This matter comes before the Board of Veterans' Appeals (Board) from a September 2000 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. The RO denied entitlement to service connection for upper respiratory infection, sinusitis, pneumonia, right shoulder disorder, chronic cervical spine pain with foraminal encroachment and mild degenerative facet joints, fever as due to an undiagnosed illness, right knee pain as due to an undiagnosed illness, right hip pain as due to an undiagnosed illness, leg pain as due to an undiagnosed illness, problems controlling anger and problems sleeping as due to an undiagnosed illness, right foot pain as due to an undiagnosed illness, and left foot pain as due to an undiagnosed illness. Although some of the claims were denied as not well grounded, after the passage of the Veterans Claims Assistance Act of 2000 (VCAA) the RO re-adjudicated the claims on the merits. In a July 2007 decision, the Board Remanded the issues listed on the title page of this decision. The characterization of the issues has been changed as noted on the title page of this decision to conform to current regulatory terminology. The Veteran presented testimony at a personal hearing in February 2002 at the RO before a Decision Review Officer. A copy of the hearing transcript was attached to the claims file. The Veteran failed to appear at a Travel Board hearing scheduled for her at the RO in September 2006, thereby effecting a withdrawal of her request for a hearing. 38 C.F.R. § 20.704 (2009). The issue of entitlement to service connection for problems controlling anger and problems sleeping, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. The Veteran served in the Southwest Asia Theater of Operations during the Persian Gulf War. 2. Degenerative arthritis of the cervical spine and chronic rhinitis/maxillary sinusitis are attributable to active military service. 3. The Veteran does not currently manifest pneumonia or an upper respiratory disorder which is separate from the chronic rhinitis/maxillary sinusitis for which service connection has been granted, nor has any medical provider assigned such diagnoses during the pendency of the claims on appeal. 4. The medical evidence establishes that the Veteran's diagnosed mild degenerative changes of the right acromioclavicular joint are not causally or etiologically related to the Veteran's active military service. 5. Because medical diagnoses have been assigned for mild osteoporosis, right hip, minimal osteopenia, right knee, and degenerative arthritis of the interphalangeal joints and joints in the feet, these disorders may not be considered undiagnosed, and the evidence establishes that these diagnosed disorders are not attributable to the Veteran's service. 6. There is no medical evidence that the Veteran currently manifests a fever. 7. The Veteran's complaints of leg pain have been attributed to a known diagnosis, and, to the extent that no diagnosis has been assigned for any complaint of leg pain, that pain has not been attributed to an undiagnosed illness, and the complaints of pain, standing alone, do not constitute a disability for which service connection may be granted. CONCLUSIONS OF LAW 1. Degenerative arthritis of the cervical spine and chronic rhinitis/maxillary sinusitis are attributable to active military service. 38 U.S.C.A. §§ 1101, 1110, 1131, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.159, 3.102, 3.303 (2009). 2. The criteria for service connection for pneumonia or an upper respiratory disorder, separate from diagnosed chronic rhinitis/maxillary sinusitis, have not been met. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303 (2009). 3. Degenerative changes of the right acromioclavicular joint were not incurred in or aggravated by active service, nor may such this disorder be presumed to have been incurred or aggravated therein. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2009). 4. The criteria for service connection for mild osteoporosis on x-ray of the right hip, minimal osteopenia of the right knee, and degenerative arthritis of the interphalangeal and feet joints, to include as due to an undiagnosed illness or an unexplained multisymptom illness, are not met. 38 U.S.C.A. §§ 1101, 1110, 1131 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.317 (2009). 5. The criteria for service connection for fever, to include as due to an undiagnosed illness or unexplained chronic multisymptom illness, are not met. 38 U.S.C.A. §§ 1101, 1110, 1131 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.317 (2009). 6. The criteria for service connection for leg pain, to include as due to an undiagnosed illness or unexplained chronic multisymptom illness, are not met. 38 U.S.C.A. §§ 1101, 1110, 1131 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.317 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. VCAA. With respect to the claimant's claims, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326. VCAA letters were sent in May 2003, December, 2004, March 2006, July 2007, and February 2008, which cumulatively fully satisfied the duty to notify provisions. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). The claimant was aware that it was ultimately the claimant's responsibility to give VA any evidence pertaining to the claim. The VCAA letters told the claimant to provide any relevant evidence in the claimant's possession. See Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004) (Pelegrini II). In particular, the VCAA notification: (1) informed the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) informed the claimant about the information and evidence that VA will seek to provide; and (3) informed the claimant about the information and evidence that the claimant is expected to provide. The Board also finds that any deficiency in the notice to the claimant or the timing of these notices is harmless error. See Overton v. Nicholson, 20 Vet. App. 427, 435 (2006) (finding that the Board erred by relying on various post- decisional documents to conclude that adequate 38 U.S.C.A. § 5103(a) notice had been provided to the claimant, the United States Court of Appeals for Veterans Claims (Court) found that the evidence established that the claimant was afforded a meaningful opportunity to participate in the adjudication of the claim, and found that the error was harmless, as the Board has done in this case.) If any notice deficiency is present in this case, the Board finds that the presumption of prejudice on VA's part has been rebutted in this case by the following: (1) based on the communications sent to the claimant over the course of this appeal, the claimant clearly has actual knowledge of the evidence the claimant is required to submit in this case; and (2) based on the claimant's contentions as well as the communications provided to the claimant by VA, it is reasonable to expect that the claimant understands what was needed to prevail. See Shinseki v. Sanders, 129 S.Ct. 1696, 1706 (2009). VA also fulfilled its duty to obtain all relevant evidence with respect to the issues on appeal. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The claimant's service treatment records, VA medical treatment records, identified private medical records to the extent available, records from the Social Security Administration, and responses from the National Personnel Records Center (NPRC) and Alabama Adjutant General regarding an August 14, 1993 motor vehicle accident, have been obtained. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. There is no indication in the record that any additional evidence, relevant to the issues decided herein, is available and not part of the claims file. The claimant was also afforded a VA examination in January 2009. 38 C.F.R. § 3.159(c)(4). The records satisfy 38 C.F.R. § 3.326. The claimant was also sent information regarding the appropriate disability rating or effective date to be assigned in March 2006, July 2007, and February 2008. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). In summary, the Board finds that "it is difficult to discern what additional guidance VA could have provided to the Veteran regarding what further evidence he should submit to substantiate his claim." Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004); see also Livesay v. Principi, 15 Vet. App. 165, 178 (2001) (en banc) (observing that "the VCAA is a reason to remand many, many claims, but it is not an excuse to remand all claims."); Reyes v. Brown, 7 Vet. App. 113, 116 (1994); Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (both observing circumstances as to when a remand would not result in any significant benefit to the claimant). II. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. In addition, VA regulation provides that, with chronic disease shown as such in service (or within an applicable presumptive period under section 3.307) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of an evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. 38 C.F.R. § 3.303(b). Further, service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). A claim for service connection generally requires competent evidence of a current disability; proof as to incurrence or aggravation of a disease or injury in service, as provided by either lay or medical evidence, as the situation dictates; and competent evidence as to a nexus between the in-service injury or disease and the current disability. Cohen v. Brown, 10 Vet. App. 128, 137 (1997); Layno v. Brown, 6 Vet. App. 465 (1994). Subject to various conditions, service connection may be granted for a disability due to undiagnosed illness of a Veteran who served in the Southwest Asia Theater of Operations during the Persian Gulf War. Among the requirements are that there are objective indications of a chronic disability resulting from an illness or combination of illnesses manifested by one or more signs or symptoms such as fatigue, signs or symptoms involving the skin, headache, muscle pain, joint pain, neurological signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper and lower), sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. The illness must become manifest during either active service in the Southwest Asia theater of Operations during the Persian Gulf War or to a degree of 10 percent or more, under the appropriate diagnostic code of 38 C.F.R. Part 4, not later than December 31, 2011. See 71 Fed. Reg. 75,669 (Dec. 18, 2006). By history, physical examination, and laboratory tests, the disability cannot be attributed to any known clinical diagnosis. There must be objective signs that are perceptible to an examining physician and other non-medical indicators that are capable of independent verification. There must be a minimum of a six-month period of chronicity. There must be no affirmative evidence that relates the undiagnosed illness to a cause other than being in the Southwest Asia Theater of Operations during the Persian Gulf War. 38 U.S.C.A. § 1117; 38 C.F.R. § 3.317. If signs or symptoms have been medically attributed to a diagnosed (rather than undiagnosed) illness, the Persian Gulf War presumption of service connection does not apply. VAOPGCPREC 8-98 (Aug. 3, 1998) (cited at 63 Fed. Reg. 56,703 (Oct. 22, 1998). For purposes of this section, a qualifying chronic disability means a chronic disability resulting from any of the following (or any combination of the following): (A) an undiagnosed illness; (B) the following medically unexplained chronic multisymptom illnesses that are defined by a cluster of signs or symptoms: (1) chronic fatigue syndrome; (2) fibromyalgia; (3) irritable bowel syndrome; or (4) any other illness that the Secretary determines meets the criteria in paragraph (a)(2)(ii) of this section for a medically unexplained chronic multisymptom illness; or (C) any diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C.A § 1117(d) warrants a presumption of service-connection. 38 C.F.R. § 3.317(a)(2)(i). For purposes of this section, the term medically unexplained chronic multisymptom illness means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multisymptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii). For purposes of this section, "objective indications of chronic disability" include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). For purposes of this section, disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a six-month period will be considered chronic. The six-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. 38 C.F.R. § 3.317(a)(4). To qualify for compensation under above-indicated provisions, "Persian Gulf Veteran" is defined as "a Veteran who served on active military, naval or air service in the Southwest Asia Theater of Operations during the Persian Gulf War." 38 C.F.R. § 3.317 (d)(1). "Southwest Asia Theater of Operations" includes Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. 38 C.F.R. § 3.317 (d)(2). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To do so, the Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the appellant. See Masors v. Derwinski, 2 Vet. App. 181 (1992). The Veteran can attest to factual matters of which he or she had first-hand knowledge, e.g., experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). However, a lay person is generally is capable of making medical conclusions, thus, statements regarding causation are generally not competent. Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). 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 Duenas v. Principi, 18 Vet. App. 512, 520 (2004). A layperson is generally not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997); see also Bostain v. West, 11 Vet. App. 124, 127 (1998). Thus, while the Veteran is competent to report what comes through the senses, generally he or she does not have medical expertise. See Layno v. Brown, 6 Vet. App. 465 (1994). However, 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 competent lay evidence can be sufficient in and of itself. The Board, however, retains the discretion to make credibility determinations and otherwise weigh the evidence submitted, including lay evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). This would include weighing the absence of contemporary medical evidence against lay statements. In Barr v. Nicholson, 21 Vet. App. 303 (2007), the Court indicated that varicose veins was a condition involving "veins that are unnaturally distended or abnormally swollen and tortuous." Such symptomatology, the Court concluded, was observable and identifiable by lay people. Because varicose veins "may be diagnosed by their unique and readily identifiable features, the presence of varicose veins was not a determination 'medical in nature' and was capable of lay observation." Thus, the Veteran's lay testimony regarding varicose vein symptomatology in service represented competent evidence. 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. However, although the Veteran is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the Veteran is not competent to provide evidence as to more complex medical questions. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, supra (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")). See Barr. Finally, the Board notes that the Veteran has had both active duty military service and service in the National Guard. In this regard, the notes that the term "active military, naval, or air service" includes: (1) active duty; (2) any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty; and (3) any period of INACDUTRA during which the individual concerned was disabled or died from an injury incurred or aggravated in the line of duty. 38 U.S.C.A. § 101(2), (24); 38 C.F.R. § 3.6(a). In order to establish basic eligibility for Veterans' benefits based upon active duty for training, the appellant must first establish that he or she was disabled from a disease or injury incurred or aggravated in the line of duty. See Laruan v. West, 11 Vet. App. 80,84-86 (1998) (rev'd on other grounds, D'Amico v. West, 12 Vet. App. 264 (1999)); see also Paulson v. Brown, 7 Vet. App. 466, 470 (1995). Until "Veteran" status is established for a period of active duty for training or a period of inactive duty for training, presumptions, including the presumption of soundness and the presumption of aggravation, are not for application. See Laruan, supra; Paulson, supra. In this case, the Veteran's military service satisfies the criteria for Veteran status. See 38 U.S.C.A. §§ 101(2),(24)(B), 1111; 38 C.F.R. § 3.304(b). A. Claims for service connection for sinusitis and a cervical spine disability The Veteran claims that she injured her cervical spine in a motor vehicle accident in August 1993 as she was returning home from active duty for training. She claims that her current symptoms of chronic cervical spine pain with foraminal encroachment and mild degenerative facet joints are related to that accident. Evidence of record shows that on August 14, 1993, she was brought by ambulance to the emergency room at Lyster Army Hospital at Fort Rucker, Alabama, after her involvement in a one-vehicle accident with loss of control of the vehicle which rolled at least once. Her personnel record indicates that her training period ended the day prior to the accident which occurred approximately in the late afternoon as she arrived at the emergency room at five o'clock. However, the emergency room record indicates that she was active duty U.S. National Guard and that after treatment she was sent to quarters for 24 hours. Because the Board's previous review of the record did not find a police accident report or a line of duty investigation, further development was necessary prior to appellate review. On remand, the RO, as requested by the Board, attempted to locate a police accident report or a line of duty investigation that may be related to the August 1993 accident. Reponses from the National Personnel Records Center (NPRC) and Alabama Adjutant General regarding an August 14, 1993 motor vehicle accident, were been obtained. The Alabama Adjutant General responded that they were sending verification of the Veteran's service documents and copies of medical records. However, copies of a line of duty investigation and a police report concerning a vehicle accident on August 14, 1993 were reported to be not on file. Responses from the NPRC also indicated no line of duty determination or accident report for an August 14, 1993 motor vehicle accident were of record. In its remand to the RO, the Board also requested that the Veteran be examined in connection with her claims. This examination took place in January 2009. The January 2009 examiner indicated that the Veteran's claims file had been reviewed in connection with the examination. The examiner noted the Veteran's medical history and indicated that the Veteran reported a history of having had a neck injury in 1993 in a motor vehicle accident while she was in the National Guard. She reported that she had been treated at Fort Rucker for a history of head injury at that time and that she had some stitches in the head. The Veteran reported that she did not remember being treated for any neck injury at the time and did not wear a neck brace. The Veteran denied neck problems while she was in the Army from 1976 to 1983. The Veteran reported going to VA for neck complaints, but indicated that that had been long ago. The examiner noted that the Veteran was seen in February 1991 with a one-week history of back pain radiating to the neck. The examiner assigned a diagnosis of with degenerative arthritis of the cervical spine. The examiner opined that "[r]elated to her cervical spine, there is a note on one occasion from February 14, 1991, where she had been seen for the complaints of one week of back pain radiating to the neck and at that time the examiner had noted decreased range of motion of the neck from side to side." After noting additional medical history, the examiner stated "[a]s such, it is the opinion of the examiner that her currently noted neck condition with diagnosis as above is at least as likely related to the clinical findings recorded in February of 1991." The Veteran was serving on active duty in February 1991. Even though no diagnosis of a cervical spine disorder was noted at the time of the Veteran's May 1991 separation from active service, the examiner's opinion places the evidence at least in equipoise to warrant a finding that the Veteran manifested a cervical spine disorder during a period of active service. As such, a discussion of the Veteran's 1993 motor vehicle accident and its relationship to her National Guard service is unnecessary. With respect to the Veteran's sinus claim, service medical records show treatment for upper respiratory infections during the Veteran's periods of active duty service. A September 1998 report of a National Guard Medical Examination indicates that the Veteran was having more sinus problems. An individual sick slip in November 1990 noted a history of pneumonia. At her hearing, the Veteran testified that her claims of entitlement to service connection for pneumonia, sinusitis and upper respiratory infection were locked together and she was treated for these conditions while on active duty from 1978 to 1983. She has claimed that after serving in the Gulf War her symptoms related to these conditions increased. Medical evidence of record shows post service treatment for upper respiratory infection, sinusitis and bronchitis. In essence, she is claiming that these conditions which she has currently were manifested during her periods of active duty prior to her service in the Gulf War and were aggravated during her service in the Gulf War or are linked to her service in the Gulf War. In January 2009, the Veteran was afforded a VA examination for this claim. The examiner indicated that the Veteran's claims file had been reviewed in connection with the examination. The examiner noted that the Veteran gave a history of having been treated at Fort Benning, Georgia, in 1990, during her active service, shortly before her deployment to the Persian Gulf. The Veteran also reported that she had been treated for sinus problems while she was in the Gulf War. In 1999, the Veteran indicated that she had repeated sinus infections after an episode of having been exposed to a leak in a can of bug spray. The Veteran denied a recent history of sinus infections or sinus problems. After examination, the Veteran was diagnosed with chronic rhinitis, chronic maxillary sinusitis, minimal. With respect to this diagnosis, the examiner stated that the Veteran's sinus problems that have been noted in x-rays are chronic, although mild. The examiner then stated that the diagnosed sinus condition was "at least as likely related to the history of sinus problems reported by the patient since 1990 which became aggravated in 1999." As noted above, the January 2009 VA examiner attributed the diagnoses of degenerative arthritis of the cervical spine and chronic rhinitis/chronic maxillary sinusitis to instances and periods of the Veteran's active military service. Accordingly, the criteria for service connection for degenerative arthritis of the cervical spine and for chronic rhinitis/chronic maxillary sinusitis disabilities are met. The claims may be granted. B. Claims for service connection for upper respiratory infection and pneumonia As noted above, the Veteran's service medical records show treatment for upper respiratory infections during her periods of active duty service. An individual sick slip in November 1990 noted a history of pneumonia. A September 1998 report of a National Guard Medical Examination indicates that the Veteran was having sinus problems. At her hearing the Veteran testified that her claims of entitlement to service connection for pneumonia, sinusitis and upper respiratory infection were locked together and she was treated for these conditions while on active duty from 1978 to 1983. She has claimed that after serving in the Gulf War her symptoms related to these conditions increased. Medical evidence of record shows post service treatment for upper respiratory infection, sinusitis and bronchitis. In essence, she is claiming that these conditions which she has currently were manifested during her periods of active duty prior to her service in the Gulf War and were aggravated during her service in the Gulf War or are linked to her service in the Gulf War. The examiner who conducted January 2009 VA examination assigned diagnoses of chronic rhinitis and maxillary sinusitis. The examiner concluded that the current findings were related to instances and periods of the Veteran's active military service. As noted above, service connection for chronic rhinitis/maxillary sinusitis is warranted. However, the examiner who conducted the January 2009 examination determined that no other current respiratory disorder, to include an upper respiratory infection other than chronic sinusitis, was present, nor did the Veteran manifest pneumonia on VA examination. In this regard, the Board notes that the January 2009 examiner noted that the Veteran reported being treated for pneumonia in service, but she had not been hospitalized for pneumonia. She also reported being treated for sinus problems during her service in the Gulf War. The examiner specifically opined that there was no history of any lower respiratory infections or pneumonia since 1990. The examiner also did not offer a diagnosis of any separate upper respiratory condition, other than the diagnosed chronic rhinitis/maxillary sinusitis. There is no clinical evidence that the Veteran has manifested pneumonia, or a current respiratory disorder, at any time during the pendency of this appeal, other than chronic rhinitis/maxillary sinusitis, for which service connection has been granted. The Board notes that the existence of a current disorder is the cornerstone of a claim for VA disorder compensation. See Degmetich v. Brown, 104 F. 3d 1328 (1997) (holding that the interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disorder for VA compensation purposes cannot be considered arbitrary and therefore the decision based on that interpretation must be affirmed); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). The preponderance of the evidence establishes that the Veteran does not currently manifest pneumonia or a current disorder for which a diagnosis of upper respiratory infection may be assigned. In the absence of medical diagnosis of the claimed disorders, service connection may not be granted for pneumonia or an upper respiratory infection. A Veteran can attest to factual matters of which she has first-hand knowledge, e.g., experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). The Veteran observed symptoms of pneumonia and of upper respiratory infection when she had those disorders. However, she does not report current observations of symptoms of those disorders. In the absence of observable symptoms, the Veteran, as a lay person, is not competent to assign a current medical diagnosis on the basis of symptoms observed long in the past. Thus, her lay statements as to her belief that she has pneumonia or a respiratory infection now because such disorder was medically diagnosed many years ago is not competent to establish a current diagnosis of such disorders. Compare Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) with Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). The diagnoses and opinions expressed by the examiner who conducted January 2009 VA examination were based on examination of the Veteran, including both physical findings on objective examination, and radiologic examinations. The examiner also discussed as review of the Veteran's medical records, to include service treatment records and post- service treatment records, as well as an interview and examination of the Veteran. A determination as to the credibility and weight to be attached to the diagnoses assigned by the VA examiner, as well as the credibility and weight of the lay evidence provided by the Veteran, is within the province of the Board. See, e.g., Guerrieri v. Brown, 4 Vet. App. 467, 470 (1993). The Board finds that the report of the January 2009 VA examination provides the most probative evidence of record with respect to the Veteran's current diagnoses and the etiology of such diagnoses, including a determination as to whether the Veteran currently has pneumonia or an upper respiratory disorder other than chronic rhinitis or maxillary sinusitis. The Board concludes that the preponderance of the evidence is against finding that the Veteran currently has pneumonia or an upper respiratory disorder other than chronic rhinitis/maxillary sinusitis. In making this determination, the Board has considered the provisions of 38 U.S.C.A. § 5107(b) regarding benefit of the doubt, but there is not such a state of equipoise of positive and negative evidence to otherwise grant the Veteran's claim. The claims for service connection for pneumonia and for an upper respiratory disorder other than chronic rhinitis/maxillary sinusitis must be denied. C. Claim for service connection for a right shoulder disorder At her June 2000 VA examination, the Veteran reported that she had injured her right shoulder lifting sandbags while in the Persian Gulf. The examiner stated that there was tenderness of the right shoulder on objective examination, and that crepitus was present. The examiner stated that radiologic examination of the right shoulder disclosed no abnormality. VA radiologic examination conducted in June 1998 was interpreted as showing a normal right shoulder. The examiner stated that the Veteran had chronic right shoulder pain with normal x-rays and no functional impairment, and did not assign a diagnosis. SSA records reference a diagnosis of possible bursitis. Recent VA clinical records reflect continued complaints of right shoulder pain. In order to determine whether the Veteran has a right shoulder disorder that is related to her active military service, the Veteran was afforded VA examination in January 2009. The examiner indicated that the Veteran's claims file had been reviewed in connection with the examination. The examiner discussed the Veteran's medical history, including treatment records from January 1998 that indicate that the Veteran was treated for shoulder pain. The Veteran stated that she had strained her shoulder at work lifting a 25-pound bucket the previous month. The Veteran was treated between 1998 and 2000 for right shoulder pain. The examiner noted the prior radiologic examination disclosing a normal shoulder, and the findings of degenerative changes in the 2009 radiologic examination of the right shoulder. During the 2009 examination, the Veteran reported that she had right shoulder pain in the military while lifting sandbags in 1991. She indicated that she had been seen in the VA off and on for right shoulder pain. At the 2009 VA examination, the Veteran reported that she was not seeing any specialists for her joint pain, and that she had not seen a primary care physician for a long period of time. The examiner who conducted the 2009 VA examination assigned a diagnosis of mild degenerative changes of the right acromioclavicular joint. The examiner also indicated that there were suggestions of mild superior subluxation of the humeral head. Referencing the Veteran's medical history, the examiner stated that "it is the opinion of the examiner that her currently noted right shoulder findings ... is (sic) at least as likely as not related to the history of right shoulder strain from 1998." The Veteran had no active service in 1998 or within the prior year, and has not alleged that she sustained an injury during any period of active duty for training or inactive duty for training in 1997 or 1998. Therefore, the 2009 VA medical opinion is entirely unfavorable to the Veteran's claim for service connection for a right shoulder disorder. Based on the foregoing, the Board finds that entitlement to service connection is not warranted in this case for the Veteran's diagnosed degenerative changes of the right acromioclavicular joint. In this regard, the Board notes that there is no diagnosis of a right shoulder disorder during a period of active service or within one year after active service. As discussed above, the examiner who conducted January 2009 VA examination found that the Veteran's current right shoulder diagnosis is more likely related to a 1998 post-service strain of the right shoulder, noted in her medical records. The Board acknowledges that the Veteran reports that she injured her right shoulder lifting sandbags while in the Persian Gulf. In this regard, the Board also notes that the Veteran can attest to factual matters of which she has first- hand knowledge, e.g., experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Her lay statements that she had chronic right shoulder pain are competent as evidence of that fact. The Board may examine the credibility of the lay statement as to chronicity and continuity. 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")). The Board finds that the Veteran's statements that she strained her right shoulder lifting sandbags in service are credible. However, the records from 1997 through 2000 appear to contradict the Veteran's current statements to the extent that she contends that she had chronic and continuous right shoulder pain after service. Rather, the evidence establishes that the Veteran did not have chronic and continuous right shoulder pain until after she sustained a post-service injury more than five years after her service discharge. In this case, statements by the Veteran for purposes of contemporaneous treatment in 1998 appear to contradict current assertions that her right shoulder pain has been both chronic and continuous since service. In particular, the Veteran stated in January 1998 that the right shoulder pain for which she was seeking treatment began the prior month, that is, in December 1997. The clinical records do not support the Veteran's lay contention that current right shoulder pain has been chronic and continuous since the Veteran's last period of active service, in 1991, or within one year after that period of active service. In particular, the Board notes that the examiner who conducted the January 2009 VA examination conducted radiologic examination of the right shoulder. The examiner concluded that current, mild, degenerative changes of the right shoulder were not present on radiologic examination of the right shoulder conducted in 2000. According to Court, "the probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches." Guerrieri v. Brown, 4 Vet. App. 467, 470 (1993). The credibility and weight to be attached to these opinions is within the province of the Board. Id. In this case, the medical evidence establishes that a current right shoulder disorder was not present in 2000. Thus, the currently-diagnosed right shoulder disorder is not etiologically related to the Veteran's military service. The Board finds that the January 2009 VA examiner's diagnoses and opinions, which were based on a review of the Veteran's medical records, to include service treatment records and post-service treatment records, as well as an interview and examination of the Veteran, provides the most probative evidence of record with respect to the Veteran's current diagnoses and the etiology of such diagnoses. Based on all the evidence and on his expertise, the examiner provided a fully articulated opinion and provided sound reasoning for his conclusion that the Veteran's current right shoulder disorder is not etiologically related to the Veteran's military service. The preponderance of the evidence is against finding that the Veteran has a current right shoulder disorder which is etiologically related to her active service. In making this determination, the Board has considered the provisions of 38 U.S.C.A. § 5107(b) regarding benefit of the doubt, but there is not such a state of equipoise of positive and negative evidence to otherwise grant the Veteran's claim. D. Claims for service connection for right knee pain, right hip pain, right foot pain, and left foot pain, to include as due to an undiagnosed illness The Veteran contends that she has other multi-joint symptoms and disorders as a result of her Persian Gulf service, and contends that the multi-joint disorders are manifested by such symptoms as right knee pain, right hip pain, and right and left foot pain. Radiologic examinations of the right foot, right ankle, and pelvis conducted in 1998 disclosed no abnormality. The examiner who conducted VA examination in June 2000 noted the Veteran's complaints of chronic right knee, right leg, right hip, and bilateral foot pain. The examiner found objective evidence of crepitus of the right knee and tenderness on dorsiflexion of the right foot. The Veteran reported that she had sustained a hairline fracture in that foot at work. The examiner assigned diagnoses of chronic right knee pain, with normal radiologic examination, chronic bilateral foot pain with hallux valgus, and chronic right hip pain with normal radiologic examination. The examiner did not indicate that the Veteran's right hip, right knee, or right and left foot pain represented an undiagnosed illness. At a 2002 personal hearing, the Veteran testified that she thought she had frostbite of the feet in service. She also testified that she had neuropathy of the legs. An April 2002 Social Security Administration (SSA) favorable decision discusses medical evidence that the Veteran had hallux valgus of the feet and axonal neuropathy of the upper and lower extremities. The SSA decision, and clinical records obtained on which that decision was based, disclose no diagnosis of a right hip or right knee disorder, and disclose no evidence of a multi-joint disorder. The Veteran was scheduled for VA examinations in November 2004, but did not appear for those examinations. The Veteran was afforded a VA examination in January 2009. The examiner indicated that the Veteran's claims file had been reviewed in connection with the examination. The examiner indicated that the Veteran denied any injury to the right hip or right knee, but indicated that she began noticing more problems with both knees since her August 1993 motor vehicle accident. She reported that she has not received any type of treatment and has not had surgery on any of the joints. The Veteran denied swelling and did not describe any restriction on her range of motion of any of her joints. With respect to her knees, the Veteran denied any history of giving out, locking, instability, and no history of swelling. She indicated that she has not received any treatment for the knee problems. The examiner stated that there was no such information from any VA treatment or otherwise for the knees, hip and feet. With respect to the Veteran's feet, the Veteran reported a history of frostbite in 1982. In addition, the Veteran reported that in 1998, a 25-pound bucket fell on her right foot that resulted in a broken foot. The Veteran described occasional pain in the feet with excessive walking. She reported pain the joints of the feet, but reported no swelling. She was noted to take no medication for her feet, and the examiner noted that the Veteran denied stiffness in the feet, nor did she wear special shoes. With respect to her legs, the Veteran indicated that she has pain in her legs. After examination, the Veteran was diagnosed with mild osteoporosis on x-ray of the right hip, minimal osteopenia of the right knee, and degenerative arthritis of the interphalangeal and feet joints. With respect to these diagnosed disabilities, the examiner state that "[n]either the VA reports nor her service medical records reveal any chronic findings related to her knees, hips, nor the legs and the feet, and as such it is the opinion of the examiner that the currently noted right hip, right knee and feet findings, and diagnosis are not related to the military or National Guard." A medical diagnosis has been assigned for pain in each of the identified joints. There is mild osteoporosis on x-ray of the right hip, minimal osteopenia of the right knee, and degenerative arthritis of the interphalangeal and feet joints. The claimed right hip, right knee, right foot, and left foot pain are not undiagnosed illnesses or indicators of unexplained multisymptom illness, since the identified joint pain has been explained and a diagnosis assigned. As such, these disorders may not be presumed related to the Veteran's service under provisions applicable to undiagnosed illness or unexplained chronic multisymptom illness. 38 C.F.R. § 3.317. The competent and probative VA opinion determined that the Veteran's right hip, right knee, and foot conditions were not related to her active service or any incident of reserve component service. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion.). In this regard, the Board notes that the examiner who provided the January 2009 opinions examined the Veteran, reviewed the claims file, discussed pertinent findings, and provided a rationale for the conclusions stated. The Veteran is competent to describe her symptoms, including pain, as noted above. However, she is not competent to determine what medical diagnosis should be assigned for those symptoms or to determine the etiology of a medical disorder, since none of the diagnosed disorders are disorders are disorders which may be readily observed. See Jandreau, 492 F.3d at 1376 (lay witness capable of diagnosing dislocated shoulder); Barr v. Nicholson, 21 Vet. App. 303 92007) (lay testimony is competent to establish the presence of varicose veins); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (unlike varicose veins or a dislocated shoulder, rheumatic fever is not a condition capable of lay diagnosis). In this case, the Veteran's right foot fracture was not observable by the Veteran, since it was a hairline fracture which was apparently diagnosed only on radiologic examination. Therefore, the Veteran is not competent to provide evidence which distinguishes current right foot pain due to the post- service fracture from right foot pain due to other causes. After giving due consideration to the lay evidence and weighing the competency of that evidence against the weight and probative value of the clinical opinion expressed in January 2009, the Board finds the medical examiner's opinion attributing the Veteran's right hip pain to osteoporosis, and her right knee pain to osteopenia, to be the most probative evidence of record as to the diagnosis of the disorders underlying the Veteran's complaints of pain in those joints. Similarly, the examiner's conclusion that the current findings of degenerative joint disease of the feet, osteoporosis of the right hip, and osteopenia of the right knee, were not attributable to the Veteran's active service, or any incident of service, to include frostbite or accidental injury, is the most probative evidence as to the question of etiology of the current disorders. The examiner concluded that the Veteran's current osteoporosis of the right hip, osteopenia of the right knee, and degenerative joint disease of the feet were not related to an alleged 1993 motor vehicle accident, so no determination as to whether such incident was incurred during a period of verified reserve component service is required. The preponderance of the competent evidence of record establishes that the Veteran does not have a current right hip, right knee, right foot, or left foot disorder which was manifested during or incurred during or as a result of her active service or any incident of active or reserve service. The record also establishes that the current disorders were not present within one year following a period of active service. The record also establishes that the Veteran has diagnosed disorder of the right hip, right knee, and bilateral feet, and that provisions regarding undiagnosed illness or chronic unexplained multisymptom illness are not applicable. There is no reasonable doubt which may be resolved in the Veteran's favor. Accordingly, service connection for a right hip, right knee, or bilateral foot disorder is not warranted on a direct or presumptive basis. E. Claim for service connection for fever, to include as due to an undiagnosed illness The Veteran contends that she has a fever as a symptom of her Persian Gulf service. The Veteran did not report a chronic or unexplained fever at the time of June 2000 VA examination. The examiner who conducted VA examination in June 2000 did not assign a diagnosis of fever. The Veteran was scheduled for VA examinations in November 2004, but did not appear for those examinations. The Veteran was afforded a VA examination dated in January 2009. The examiner indicated that the Veteran's claims file had been reviewed in connection with the examination. The Veteran reported that she had been treated for fever in the Army. She did not remember the date, but indicated that it was probably 1982 when she was in Germany and exposed to cold weather. The Veteran reported that the fever was probably related to her sinus infections. The examiner who conducted the 2009 VA indicated that there was a remote history of fever, noting, in essence, agreement with the Veteran's report that the fever was related to episodes of sinusitis. The examiner noted that there was no history of treatment for fever of unknown etiology or undiagnosed illness, and found no evidence of "fever" on current examination. In the absence of current findings of fever on examination, provisions related to chronic qualifying disability manifested by a Veteran who served in the Persian Gulf are not applicable, as those provisions require current objective indications of the claimed disability. 38 C.F.R. § 3.317(a)(3), (4). With regard to direct service connection, the Court has consistently held that, under the law cited above, "[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." Watson v. Brown, 4 Vet. App. 309, 314 (1993). This principle has been repeatedly reaffirmed by the Federal Circuit, which has stated, "a Veteran seeking disability benefits must establish . . . the existence of a disability [and] a connection between the Veteran's service and the disability." Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). In this case, a history of episodic fever has been attributed to a diagnosed disability, sinusitis. Service connection for sinusitis has been granted, as discussed above. The laws governing service connection do not authorize a separate grant of service connection for fever which is a symptom of sinusitis. 38 C.F.R. § 4.14 (the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided). The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F. 3d 1328 (1997) (holding that the VA's and the Court's interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary and therefore the decision based on that interpretation must be affirmed); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In the absence of proof of a present disability due to "fever," other than the diagnosed sinusitis for which service connection has already been granted, there can be no valid claim for service connection for "fever." Rabideau v. Derwinski, 2 Vet. App. 141, 143- 44 (1992). There is no medical evidence that the Veteran has a present disability due to fever, other than her assertions. The preponderance of the medical evidence establishes that there are no current objective manifestations of fever. There is no reasonable doubt that the Veteran currently has disability due to fever. Thus, the Veteran's claim for service connection for "fever" must be denied. F. Claim for service connection for leg pain, to include as due to undiagnosed illness Finally, as noted above, the Veteran contends that she has other symptoms and disorders as a result of her Persian Gulf service, including leg pain. The Veteran reported leg pain at the time of June 2000 VA examination. The examiner noted that EMG (electromyography) suggested axonal neuropathy. An April 2002 SSA decision discusses clinical evidence that the Veteran had axonal neuropathy of the upper and lower extremities. The Board notes that axonal neuropathy is a diagnosed disorder. As such, it is may not be presumed related to the Veteran's service under provisions applicable to undiagnosed illness or unexplained chronic multisymptom illness. The Veteran was scheduled for VA examinations in November 2004, but did not appear for those examinations. The Veteran was afforded a VA examination dated in January 2009. The examiner discussed review of the Veteran's claims file in connection with the examination. The examiner indicated that the Veteran reported leg pain. The examiner did not assign a diagnosis of a leg disorder other than a diagnosed lumbar disorder, for which service connection has been granted, and diagnosed right hip osteoarthritis and right knee osteopenia, discussed above. The Board notes the Veteran's testimony, at her 2002 personal hearing, that she had "leg pain" as a result of axonal neuropathy. No claim for service connection for axonal neuropathy is before the Board on appeal. Service connection for "leg pain," in the absence of medical diagnosis underlying the leg pain or medical evidence that leg pain is not attributable to an unexplained chronic multisymptom illness or undiagnosed illnesses, cannot be granted. See Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999) (pain alone is not a disability for which service connection may be granted). No provider has identified any pathology underlying the complaints of leg pain, other than the known diagnosis for which service connection, as discussed, cannot be granted. No provider has indicated or opined that the Veteran has "leg pain" which is an indicator of an undiagnosed illness or an unexplained chronic multisymptom illness. Rather, as discussed, the Veteran's complaints of leg pain have been medically attributed to known diagnoses. The Veteran is competent to provide statements and testimony that she has leg pain. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, she is not competent to state that she has leg pain that is not medically explained by the diagnosed lumbar and axonal neuropathy disorders, since the relationship between leg pain, lumbar disability, axonal neuropathy, and an undiagnosed or unexplained illness is a medical question which would require more than direct observation to resolve. The Veteran's contention that she has unexplained leg pain is not in the category of questions that lend themselves to resolution by lay observation. See Jandreau, 492 F.3d at 1376 (lay witness capable of diagnosing dislocated shoulder); Barr v. Nicholson, 21 Vet. App. 303 92007) (lay testimony is competent to establish the presence of varicose veins); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (unlike varicose veins or a dislocated shoulder, rheumatic fever is not a condition capable of lay diagnosis). Thus, the Veteran's statements asserting a relationship between her leg pain and an undiagnosed illness do not provide competent evidence in support of her claim. Given the medical evidence that the Veteran's leg pain is attributable to know disorders, the preponderance of the competent evidence is against a finding that the Veteran has leg pain which may be attributed to an undiagnosed disorder or an unexplained chronic multisymptom illness. There is no evidence favorable to a grant of service connection for any diagnosed leg disorder to which the Veteran's complaints of "leg pain" may be attributed, given that service connection has already been granted for a lumbar disability. The examiner did not assign a diagnosis of a leg disorder other than a diagnosed lumbar disorder, for which service connection has been granted, and diagnosed right hip osteoarthritis and right knee osteopenia, discussed above. The Board notes the Veteran's testimony, at her 2002 personal hearing, that she had "leg pain" as a result of axonal neuropathy. No claim for service connection for axonal neuropathy is before the Board on appeal. Service connection for "leg pain" cannot be granted. See Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999) (pain alone is not a disability for which service connection may be granted). There is no medical evidence that there is any pathology which maybe associated with the Veteran's "leg pain," if she has leg pain other than that attributed to the diagnosed disorder, or that "leg pain" may be associated with an unexplained illness, as discussed above. The preponderance of the evidence is against a grant of service connection for any diagnosed leg disorder to which the Veteran's complaints of "leg pain" have been medically, since service connection has already been granted for a lumbar disability to which the Veteran's leg pain has been attributed, and the Veteran has not sought service connection for axonal neuropathy, another diagnosis to which leg pain has been medically attributed. Thus, the preponderance of the evidence is unfavorable to the claim on either of these bases. No provider has opined that the Veteran has "leg pain" which is a manifestation of an undiagnosed disorder or an unexplained chronic multisymptom illness, so, as discussed above, there is no competent evidence to support the claim on this basis. There is no reasonable doubt under any theory of entitlement to service connection for "leg pain" which may be resolved in the Veteran's favor. 38 U.S.C.A. § 5107(b). Service connection for "leg pain" must be denied. ORDER Service connection for upper respiratory infection is denied. Service connection for chronic rhinitis/maxillary sinusitis is granted. Service connection for pneumonia is denied. Service connection for a right shoulder disorder is denied. Service connection for degenerative arthritis of the cervical spine is granted. Service connection for fever, to include as due to an undiagnosed illness or chronic qualifying disability, is denied. Service connection for minimal osteopenia of the right knee, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness, is denied. Service connection for mild osteoporosis, right hip, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness, is denied. Service connection for leg pain, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness, is denied. Service connection for degenerative arthritis of the interphalangeal and right foot joints, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness, is denied. Service connection for degenerative arthritis of the interphalangeal and left foot joints, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness, is denied. REMAND After a careful review of the claims folder, the Board finds that the issue of entitlement to service connection for problems controlling anger and problems sleeping as due to an undiagnosed illness must be remanded for further action. Here, the Board notes that the Veteran contends that she has problems controlling anger and problems sleeping as due to an undiagnosed illness. However, the Board noted in its July 2007 remand that the record also reflects discussion of sexual trauma during a period of active duty, and reflects that a diagnosis of a specific psychiatric disorder has been assigned. As such the Board, in its July 2007 remand, requested that the RO clarify with the Veteran whether she wished to pursue a claim for direct service connection for a psychiatric disorder, and, if so whether she contends that the disorder resulted from an assault during service. If the Veteran indicated that she wished to pursue the claim for direct service connection for a psychiatric disorder other than as a manifestation of an undiagnosed illness, all necessary development should be conducted. The July 2007 Remand instructions specifically requested that the Veteran should be afforded the opportunity to clarify whether she wished to seek direct service connection for problems controlling anger and problems sleeping on a basis other than as a qualifying chronic disability (undiagnosed illness) or symptoms of a chronic multisymptom illness. Any necessary development, such as to develop an allegation of assault, trauma, or other stressors, should be conducted. The Board directed that the Veteran should be afforded psychiatric examination, after appropriate development. If the Veteran alleged that an assault took place, the Board requested that the examiner provide an opinion as to the likelihood that the claimed in-service assault occurred, and likelihood that a current psychiatric disorder resulted from the Veteran's active military service. Upon remand, however, the RO did not request clarification of the Veteran as requested by the Board in July 2007, and the Veteran was not afforded a VA examination as set forth above. The Board concludes that this matter must be remanded for compliance with the Board's July 2007 remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). Accordingly, the case is REMANDED for the following action: 1. The Veteran should be afforded the opportunity to clarify whether she wishes to seek direct service connection for problems controlling anger and problems sleeping on a basis other than as a qualifying chronic disability (undiagnosed illness) or symptoms of a chronic multisymptom illness. Any necessary development, such as to develop an allegation of assault, trauma, or other stressors, should be conducted. The Veteran should be afforded the opportunity to identify any relevant evidence, including non-clinical evidence that a personal assault took place. The Veteran should identity any non-VA clinical evidence. Current VA clinical records of treatment for a psychiatric disorder from July 2007 to the present should e obtained. 2. If, after the Veteran's clarification, a claim for direct service connection for a psychiatric disorder is raised, the Veteran should be afforded psychiatric examination. A summary of the Veteran's allegations and evidence obtained during development should be prepared for the examiner. The examiner should assign a diagnosis for each psychiatric disorder present. If the Veteran contends that an assault took place, the examiner should provide an opinion as to whether there is evidence, including evidence such as behavioral changes, which indicate that it is at least as likely as not (a 50-percent or greater probability) that the claimed in- service assault occurred. The examiner should offer provide an opinion, in accordance with the guidance set forth in 38 C.F.R. § 3.304(f)(3), as to whether it is at least as likely as not (50 percent or greater likelihood), or whether it is less than likely (less than a 50 percent likelihood), that the Veteran has a current psychiatric disorder that had its onset during or was manifested during, or is a result of, a period of active military service, or is a manifestation of a chronic disability or multisymptom illness. 3. After completion of the above, readjudicate the issue on appeal. If the benefit sought on appeal remains denied, the appellant and her representative should be provided a supplemental statement of the case. An appropriate period of time should be allowed for response. Thereafter, the case should be returned to the Board. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). The purpose of the examination requested in this remand is to obtain information or evidence (or both) which may be dispositive of the appeal. Therefore, the Veteran is hereby placed on notice that pursuant to 38 C.F.R. § 3.655 (2009) failure to cooperate by attending the requested VA examination may result in an adverse determination. See Connolly v. Derwinski, 1 Vet. App. 566, 569 (1991). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). ______________________________________________ Tresa M. Schlecht Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs