Citation Nr: 1009166 Decision Date: 03/11/10 Archive Date: 03/17/10 DOCKET NO. 06-16 518 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Detroit, Michigan THE ISSUES 1. Entitlement to service connection for a cervical spine disability, claimed as secondary to a service-connected left shoulder disability. 2. Entitlement to service connection for multiple joint pain (to include knee pain, right shoulder pain, and back pain). 3. Entitlement to service connection for gastrointestinal problems. 4. Entitlement to service connection for sleep disturbances. 5. Entitlement to service connection for night sweats. 6. Entitlement to an increased disability rating for service-connected glaucoma, currently evaluated 10 percent disabling. REPRESENTATION Veteran represented by: The American Legion ATTORNEY FOR THE BOARD V. Chiappetta, Associate Counsel INTRODUCTION The Veteran served on active duty in the United States Army from January 1985 to October 1992. This matter is before the Board of Veterans' Appeals (the Board) on appeal of September 2005 and September 2006 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan. The Board wishes to point out that the Veteran's service- connection claim for "multiple joint pain" specifically includes consideration of recent complaints of low back pain, as well as knee and right shoulder pain. However, in a previous September 2002 rating decision, the RO specifically denied the Veteran's service-connection claim for a low back disability on a direct basis, based on a lack of evidence demonstrating current disability. Generally, separate theories in support of a claim for a particular benefit are not equivalent to separate claims, and a final denial on one theory is a final denial on all theories. See Ashford v. Brown, 10 Vet. App. 120 (1997). In this case however, the RO has adjudicated all aspects of the Veteran's "multiple joint pain" claim [to include the Veteran's claimed low back pain] on the merits. See, e.g., the September 2005 rating decision. Crucially, the Veteran was not prejudiced by the RO doing so, albeit in error. Therefore for the sake of clarity and consistency, and in light of the fact that the medical evidence now shows that the Veteran in fact has a current low back disability [arthritis], the Board will consider the claim reopened, and will discuss each aspect of the Veteran's "multiple joint pain" claim on the merits as well. The Veteran's service connection claims for gastrointestinal problems, sleep disturbances, and night sweats, as well as his increased rating claim for glaucoma, are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. The competent medical evidence of record does not support a finding that a cervical spine disability currently exists. 2. The competent medical evidence of record does not support a finding that a knee disability currently exists. 3. The competent medical evidence of record does not support a finding that a right shoulder disability currently exists. 4. The competent medical evidence of record does not support a finding that a relationship exists between the Veteran's currently diagnosed lumbar spine disability and his military service. CONCLUSIONS OF LAW 1. A cervical spine disability is not proximately due to nor is the result of a service-connected left shoulder disability. 38 C.F.R. §3.310 (2009). 2. A knee disability was not incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2009). 3. A right shoulder disability was not incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2009). 4. A lumbar spine disability was not incurred in or aggravated by active military service, and may not be so presumed. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran claims entitlement to service connection for a cervical spine disability, as well as for multiple joint pain, to include the knees, right shoulder, and back. In the interest of clarity, the Board will address the pertinent law and regulations and their application to the facts and evidence. The Veterans Claims Assistance Act of 2000 (VCAA) The Board has given consideration to the VCAA. The VCAA includes an enhanced duty on the part of VA to notify a claimant as to the information and evidence necessary to substantiate claims for VA benefits. The VCAA also redefines the obligations of VA with respect to its statutory duty to assist claimants in the development of their claims. See 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2009). The VCAA alters the legal landscape in three distinct ways: standard of review, notice and duty to assist. The Board will now address these concepts within the context of the circumstances presented in this case. The VCAA requires VA to notify the claimant and the claimant's representative, if any, of any information and any medical or lay evidence not previously provided to VA that is necessary to substantiate the claims. As part of the notice, VA is to specifically inform the claimant and the claimant's representative, if any, of which portion, if any, of the evidence is to be provided by the claimant and which part, if any, VA will attempt to obtain on behalf of the claimant. See 38 U.S.C.A. § 5103 (West Supp. 2009); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002) [a letter from VA to an appellant describing evidence potentially helpful to the appellant but not mentioning who is responsible for obtaining such evidence did not meet the standard erected by the VCAA]. After having carefully reviewed the record, the Board has concluded that the notice requirements of the VCAA have been satisfied with respect to the issues on appeal. The Board observes that the Veteran was informed of the evidentiary requirements for service connection in a letter from the RO dated July 18, 2005, including evidence of "a relationship between your disability and an injury, disease, or event in military service." The Board notes that the Veteran was not specifically informed of the evidentiary requirements for secondary service connection. However, the essential fairness of the adjudication was not affected because the Veteran and his representative had actual knowledge of what was necessary to substantiate this aspect of his service- connection claim. Indeed, the Veteran specifically argued in April 2005, "I have developed neck problems . . . that I feel are secondary to the [service-connected] shoulder." See the Veteran's April 7, 2005 Statement in Support of Claim. The Veteran's representative has since specifically identified the Veteran's current neck pain as "residuals" of the Veteran's service connected left shoulder condition. See the Veteran's representative's July 2007 VA Form 646, page 2. Consequently, any failure by the VA to notify the Veteran of the elements of secondary service connection constitutes harmless error and does not prejudice the Veteran. Crucially, the RO informed the Veteran of VA's duty to assist him in the development of his claims in the above-referenced July 2005 letter, whereby the Veteran was advised of the provisions relating to the VCAA. Specifically, the Veteran was advised in the letter that VA would assist him with obtaining relevant records from any Federal agency, including records from the military and VA Medical Centers. The Veteran was also advised in the letter that a VA examination would be provided to aid in deciding his claims. With respect to private treatment records, the July 2005 letter informed the Veteran that VA would make reasonable efforts to obtain non-Federal evidence. Included with the letter were copies of VA Form 21-4142, Authorization and Consent to Release Information. The July 2005 letter further emphasized: "If the evidence is not in your possession, you must give us enough information about the evidence so that we can request it from the person or agency that has it. If the holder of the evidence declines to give it to us, asks for a fee to provide it, or VA otherwise cannot get the evidence, we will notify you. It is your responsibility to make sure we receive all requested records that are not in the possession of a Federal department or agency." [Emphasis as in the original letter.] Finally, there has been a significant Court decision concerning the VCAA which is pertinent to the Veteran's claims. In Dingess v. Nicholson, 19 Vet. App. 473 (2006), the Court observed that a claim of entitlement to service connection consists of five elements: (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. Because a claim is comprised of five elements, the notice requirements of section 5103(a) apply generally to all five elements of that claim. Therefore, upon receipt of an application for a service connection claim, section 5103(a) and section 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim. This includes notice that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. In this case, element (1) is not at issue, and the Veteran was provided appropriate notice as to elements (2) and (3) as detailed above. The Veteran was provided specific notice as to elements (4) and (5), degree of disability and effective date, in a March 20, 2006 letter from the RO. In any event, because the Veteran's claims are being denied, elements (4) and (5) are moot. The Board notes that the Veteran was not provided complete notice of the VCAA prior to the initial adjudication of his claims in September 2005. The Board is of course aware of the Court's decision in Pelegrini v. Principi, 17 Vet. App. 412 (2004), which appears to stand for the proposition that VCAA notice must be sent prior to adjudication of an issue by the RO. Crucially, following the issuance of the March 2006 Dingess letter, the Veteran was allowed the opportunity to present evidence and argument in response. The Veteran's claims were readjudicated in an April 2006 statement of the case (SOC), and in a June 2006 supplemental statement of the case (SSOC). See Overton v. Nicholson, 20 Vet. App. 427, 437 (2006) [a timing error may be cured by a new VCAA notification followed by a readjudication of the claim]. The Veteran has pointed to no prejudice or due process concerns arising out of the timing of the VCAA notice. The Board accordingly finds that there is no prejudice to the Veteran in the timing of the VCAA notice. In short, the record indicates that the Veteran received appropriate notice pursuant to the VCAA. There is no indication that there exists any evidence which could be obtained which would have an effect on the outcome of this case as to these issues. Therefore, no further VCAA notice is necessary. See Dela Cruz v. Principi, 15 Vet. App. 143, 149 (2001) [VCAA notice not required where there is no reasonable possibility that additional development will aid the appellant]. Duty to assist In general, the VCAA provides that VA shall make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate claims for VA benefits, unless no reasonable possibility exists that such assistance would aid in substantiating the claims. The law provides that the assistance provided by VA shall include providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on the claims. An examination is deemed "necessary" if the record does not contain sufficient medical evidence for VA to make a decision on the claims. See 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159 (2009). The Board finds that reasonable efforts have been made to assist the Veteran in obtaining evidence necessary to substantiate his claims, and that there is no reasonable possibility that further assistance would aid in substantiating them. In particular, the Veteran's service treatment records, service personnel records, and post-service VA and private treatment records have been associated with the claims folder. Additionally, as the Board will discuss in detail in its analysis below, the Veteran was provided with a VA examinations in May 2005 and February 2007. The reports of these examinations reflect that each examiner reviewed the Veteran's past medical history, recorded his current complaints, conducted an appropriate physical examination and rendered appropriate diagnoses and opinions consistent with the remainder of the evidence of record. The Board therefore concludes that the examinations are adequate for rating purposes. See 38 C.F.R. § 4.2 (2009). The Veteran and his representative have not contended otherwise. The Board additionally observes that all appropriate due process concerns have been satisfied. See 38 C.F.R. § 3.103 (2009). The Veteran has been accorded the opportunity to present evidence and argument in support of his claims. He has retained the services of a representative, and declined the opportunity for a personal hearing. Accordingly, the Board will proceed to a decision. 1. Entitlement to service connection for a cervical spine disability, claimed as secondary to a service-connected left shoulder disability. Relevant law and regulations Service connection - in general In general, service connection may be granted for disability or injury incurred in or aggravated by active military service. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2009). In order to establish service connection for the claimed disorder, there must be (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). Secondary service connection Service connection may also be granted for a disability that is proximately due to, the result of, or aggravated by a service-connected disability. 38 C.F.R. § 3.310(a) (2009); see also Harder v. Brown, 5 Vet. App. 183, 187 (1993). Additional disability resulting from the aggravation of a non-service-connected condition by a service-connected condition is also compensable under 38 C.F.R. § 3.310(a). See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In order to establish service connection for a claimed disability on a secondary basis, there must be (1) medical evidence of a current disability; (2) a service-connected disability; and (3) medical evidence of a nexus between the service-connected disease or injury and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Current disability Essential to the award of service connection is the first Hickson or Wallin element, existence of a disability. Without it, service connection cannot be granted. See Brammer v. Derwinski, 3 Vet. App. 233, 225 (1992) [noting that service connection presupposes a current diagnosis of the claimed disability]; see also Chelte v. Brown, 10 Vet. App. 268 (1997) [observing that a "current disability" means a disability shown by competent medical evidence to exist at the time of the award of service connection]. Analysis The Board initially notes that the Veteran has not claimed that his cervical spine disability is a direct result of his military service, and there is nothing in the record which so suggests. Instead, he contends that the claimed condition is secondary to his service-connected left shoulder disability. See, e.g., the Veteran's April 2005 Statement in Support of Claim; see also the Veteran's representative's July 2007 VA Form 646, page 2. As noted above, to establish service connection for a claimed disability on a secondary basis, there must be (1) medical evidence of a current disability; (2) a service-connected disability; and (3) medical evidence of a nexus between the service-connected disease or injury and the current disability. See Wallin, supra. Turning first to Wallin element (2), it is undisputed that the Veteran has been awarded service-connection for a left shoulder disability. Accordingly, Wallin element (2) is satisfied. Moving to crucial Wallin element (1), current disability, the medical evidence of record fails to demonstrate that the Veteran has a current cervical spine disability. Although the May 2005 and February 2007 VA examiners each acknowledged the Veteran's current complaints of neck pain and stiffness, neither diagnosed the Veteran with a cervical spine disability. Indeed, the May 2005 VA examiner pertinently determined after a thorough physical examination and a review of the Veteran's x-rays that the Veteran's cervical spine had "normal alignment without any cervical spondylosis." Similarly, the February 2007 VA examiner concluded upon physical examination and review of x-rays that the Veteran had a "normal cervical spine without any neurological deficiency." See the May 2005 and February 2007 VA examiner's reports respectively. The Board notes that only one of the Veteran's multiple VA treatment records identifies the presence of a cervical spine abnormality, specifically a "mild cervical strain." See the Veteran's January 26, 2006 VA Consult Report. Indeed, such appears to be an isolated finding, as a cervical strain was not identified by either VA examiner upon physical examination in May 2005 or February 2007. Moreover, both VA examiners pertinently determined that the Veteran's cervical spine muscle tone is "good without any spasm or any atrophy." The Veteran has presented no medical evidence contrary to the opinions of the May 2005 and February 2007 VA examiners. In particular, other than the above-referenced VA Consult Report noting a mild strain, there are no post-service outpatient treatment or other medical records which document a cervical spine disability. The Board adds that the Veteran has had ample opportunity to secure medical evidence in his favor and submit the same to VA. He has not done so. See 38 U.S.C.A. § 5107(a) (West 2002) [it is a claimant's responsibility to support a claim for VA benefits]. The Board does not have any reason to doubt that the Veteran may experience frequent neck pain. However, symptoms such as pain alone are not sufficient to establish the existence of a disability. See Sanchez-Benitez v. West, 13 Vet. App. 282 (1999) [symptoms, 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]. To the extent that the Veteran himself believes that he has a current cervical spine disability, it is well established that lay persons without medical training, such as the Veteran, are not competent to comment on medical matters such as diagnosis, date of onset or cause of a disability. See Espiritu v. Derwinski, 2 Vet. App. 491, 494-5 (1992) see also 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]. The Veteran's statements offered in support of his cervical spine claim are not competent medical evidence and do not serve to establish the existence of a current disability. In the absence of any diagnosed cervical spine disability, service connection may not be granted. See Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998) [service connection cannot be granted if the claimed disability does not exist]. Accordingly, Wallin element (1) has not been met, and the Veteran's cervical spine claim fails on this basis alone. For the sake of completeness, with respect to Wallin element (3), medical nexus, there is no competent medical evidence of a relationship between the Veteran's claimed cervical spine disability and his service-connected left shoulder disability. Indeed, the February 2007 VA examiner pertinently concluded that "the veteran's neck has no residual of traumatic orthopedic pathology and it is not related to his left shoulder condition." See the February 2007 VA examiner's report, page 3. In light of the lack of any current cervical spine diagnosis, medical nexus would be an impossibility. Accordingly, Wallin element (3) has not been met, and the Veteran's claim fails on this basis as well. Conclusion In conclusion, for the reasons and bases expressed above the Board finds that the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for a cervical spine disability on a secondary basis, as Wallin elements (1) and (3) have not been met. Accordingly, the benefit sought on appeal is denied. 2. Entitlement to service connection for multiple joint pain (to include knee pain, right shoulder pain, and back pain). Relevant law and regulations The law and regulations generally pertaining to service- connection claims has been set forth above and will not be repeated. The Board adds that for certain chronic disorders, to include arthritis, service connection may be granted if the disease becomes manifest to a compensable degree within one year following separation from service. See 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2009). Continuity of symptomatology 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, there is no requirement of an evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b) (2009). When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. See 38 C.F.R. § 3.303(b) (2009); see also Savage v. Gober, 10 Vet. App. 488, 495-496 (1997). In Voerth v. West, 13 Vet. App. 117, 120 (1999), the Court stated that in Savage it had clearly held that 38 C.F.R. § 3.303 does not relieve the claimant of his burden of providing a medical nexus. Analysis Initial note - undiagnosed illness The Board notes that upon initiation of his "multiple joint pain" claim, the Veteran indicated this pain [to include knee, right shoulder, and back pain] was due to an undiagnosed illness under 38 C.F.R. § 3.317. See the Veteran's April 2005 Statement in Support of Claim. However, 38 C.F.R. § 3.317 specifically designates that service connection may be established for a chronic disability resulting from an undiagnosed illness which became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War or to a degree of 10 percent or more not later than December 31, 2011. See 38 U.S.C.A. § 1117 (West 2002); 38 C.F.R. § 3.317 (2009). As was made clear to the Veteran in the September 2005 rating decision, although he served on active duty during the time period of the Persian Gulf War, the Veteran's service personnel records crucially fail to demonstrate active duty service at any time in the Southwest Asia theater of operations. Indeed, neither the Veteran nor his representative so contends. The Veteran's DD-214 pertinently indicates approximately 2.5 years of foreign service, which took place in Germany from February 1989 to September 1991. See the Veteran's Record of Assignments. Accordingly, service-connection cannot be awarded for "multiple joint pain" as due to an undiagnosed illness because the Veteran has no active duty service in Southwest Asia during the Persian Gulf War. See 38 C.F.R. § 3.317(d)(1). As such, entitlement to benefits under an undiagnosed illness theory will be discussed no further. With respect to the Veteran's low back pain, the February 2007 VA examiner has diagnosed the Veteran with degenerative arthritis of the lumbar spine, as will be discussed in more detail below. See the February 2007 VA examiner's report, page 2. Therefore, by definition, the Veteran's current arthritic back pain cannot be attributed to an "undiagnosed" illness. Discussion As noted above, the Veteran's service connection claim for "multiple joint pain," encompasses individual claims for the back, knees, and right shoulder. The Board will address each in turn. Also noted above, in order to establish service connection for the claimed disorder, there must be (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, supra. The medical evidence of record clearly demonstrates that the Veteran has complained of, and received treatment for pain in his knees and right shoulder. See, e.g., the Veteran's August 26, 2005 VA Consultation Note, and a January 26, 2006 VA Consult Report respectively. Crucially however, no evidence of record demonstrates that the Veteran has any current knee or right shoulder disability. Indeed, a July 2005 VA treatment record pertinently reported that the Veteran had "rt shoulder pain no traumas." See the Veteran's July 21, 2005 VA outpatient treatment report. Similarly, the above-referenced January 26, 2006 VA Consult Report noted "no recent traumas or fall" in reference to the Veteran's knee pain complaints. As above, the Board has no reason to doubt that the Veteran may experience knee or right shoulder pain, but symptoms such as pain alone are not sufficient to establish the existence of a disability. See Sanchez-Benitez v. West, supra. In the absence of any diagnosed knee or right shoulder disability, service connection may not be granted. See Degmetich, supra. Accordingly, in so far as the Veteran's "multiple joint pain" service-connection claim incorporates pain in the knees and the right shoulder, Hickson element (1) has not been met, and the claim fails on this basis alone. Moving on to the Veteran's complaints of low back pain, recent x-rays reviewed by the February 2007 VA examiner reveal "[m]ild degenerative disk disease and facet arthritis" of the lumbar spine. See the February 2007 VA examiner's report, page 2. Accordingly, current low back disability is demonstrated, and in so far as the Veteran's "multiple joint pain" service-connection claim incorporates low back pain, Hickson element (1) is satisfied. With respect to Hickson element (2), in-service disease or injury, the Veteran's service treatment records fail to indicate a specific diagnosis of "multiple joint pain," and the Veteran's representative so concedes. See the Veteran's representative's VA Form 646, page 2. Additionally, the Veteran's service and private treatment records do not indicate that arthritis of the lumbar spine was present in service, or within the one-year presumptive period following his separation from service in 1992. See 38 C.F.R. § 3.309(a). However, the Veteran's service treatment records do indicate that the Veteran sought treatment on multiple occasions for low back pain, and was diagnosed twice with low back strains. See, e.g., the Veteran's March 23, 1990 and April 18, 1991 Chronological Records of Medical Care. The Veteran specifically noted his history of low back pain on his October 1992 Report of Medical History upon separation. Accordingly, in-service low back injury is demonstrated, and Hickson element (2) is also satisfied. With respect to crucial Hickson element (3), medical nexus, the February 2007 VA examiner specifically stated that the Veteran's current arthritis of the lumbar spine is "not related to the complaint of lower back strain in service." After reviewing the Veteran's complete medical history and examination, the VA examiner pertinently reasoned that the Veteran's degenerative changes were "independent in origin." The Veteran has presented no medical evidence contrary to the opinion of the February 2007 VA examiner. In particular, there are no post-service outpatient treatment or other medical records which establish a link between the Veteran's current lumbar spine disability and his in-service injuries. The Veteran has had ample opportunity to secure medical evidence in his favor and submit the same to VA. He has not done so. See 38 U.S.C.A. § 5107(a) (West 2002) [it is a claimant's responsibility to support a claim for VA benefits]. To the extent that the Veteran himself believes that his current lumbar spine disability is related to his in-service low back pain, as noted above it is well established that lay persons without medical training, such as the Veteran, are not competent to comment on medical matters such as diagnosis, date of onset or cause of a disability. See Espiritu, supra; 38 C.F.R. § 3.159 (a)(1). The Veteran's statements offered in support of his "multiple joint pain" claim are not competent medical evidence and do not serve to establish a positive medical nexus. Although the Veteran has not specifically alleged that he has experienced low back pain since his separation from service in 1992 to the present day, the Board will briefly address whether the evidence of record demonstrates continuity of symptomatology under 38 C.F.R. § 3.303(b), noted above. To establish continuity for a lumbar spine disability, supporting medical evidence of continuity of symptomatology is required. See Voerth v. West, 13 Vet. App. 117, 120-121 (1999) [there must be medical evidence on file demonstrating a relationship between the veteran's current disability and the claimed continuous symptomatology, unless such a relationship is one as to which a lay person's observation is competent]. Such evidence is lacking in this case. Pertinently, although the Veteran complained of low back pain intermittently during his active duty service, his October 1992 separation examination report specifically indicates a "normal" evaluation of the Veteran's spine. Moreover, it does not appear that the Veteran was diagnosed with a lumbar spine disability until March 2006, approximately fourteen years after his separation from service in 1992. See the Veteran's March 16, 2006 VA MRI report [noting multilevel degenerative changes]; see also Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) [affirming Board where it found that a claimant failed to account for the lengthy time period after service for which there was no clinical documentation of the claimed condition]. Moreover, a VA musculoskeletal assessment in November 2002 simply indicated decreased range of motion at the left shoulder, and made no mention of any complaints of low back pain or underlying disability. See the Veteran's November 2, 2002 VA Urgent Care Provider Assessment. Further, at an August 2003 VA joint examination, the Veteran similarly complained only of left shoulder pain. See the August 2003 VA examiner's report, page 1. Subsequently, when discussing subjective complaints at the above-referenced May 2005 VA joint examination, the Veteran only noted pain in his neck and shoulder, and again failed to mention any problems with his low back. See the May 2005 VA examiner's report, page 1. In short, the objective evidence of record fails to demonstrate the presence of low back disability symptomatology for well over a decade after service. Accordingly, service connection cannot be established by continuity of symptomatology. Therefore, with respect to the Veteran's low back pain, Hickson element (3) has not been met, and the claim fails on this basis alone. Conclusion In sum, the Board finds that a preponderance of the evidence is against the Veteran's claim of entitlement to service connection "multiple joint pain," to include knee pain, right shoulder pain, and low back pain. Indeed, the evidence of record fails to demonstrate that the Veteran currently has a knee or right shoulder disability, nor does the evidence indicate a positive relationship between the Veteran's lumbar spine arthritis and his in-service complaints of low back pain. The benefit sought on appeal is accordingly denied. ORDER Entitlement to service connection for a cervical spine disability is denied. Entitlement to service connection for a knee disability is denied. Entitlement to service connection for a right shoulder disability is denied. Entitlement to service connection for a lumbar spine disability is denied. REMAND 3. Entitlement to service connection for gastrointestinal problems. 4. Entitlement to service connection for a sleep disturbances. 5. Entitlement to service connection for night sweats. 6. Entitlement to an increased disability rating for service-connected glaucoma, currently evaluated 10 percent disabling. After having carefully considered the matter, and for reasons expressed immediately below, the Board believes that the remaining issues currently on appeal must be remanded for further evidentiary development. Reasons for remand Additional medical records As the Veteran's able representative has pointed out [see the January 8, 2010 Appellant's Brief, page 3], the Veteran submitted a form dated April 1, 2008 directly to the Board that indicated receipt of additional medical treatment for the disabilities currently being reviewed on appeal. More specifically, with respect to the Veteran's service connection claims [gastrointestinal problems, sleep disturbances, and night sweats], the Veteran indicated on his April 2008 submission that he was hospitalized for "stomach problems" from March 18, 2008 to March 20, 2008, and that he was issued a sleep machine for his sleep problems. With respect to his increased rating claim for glaucoma, the Veteran indicated that he underwent left eye laser surgery on March 27, 2008, and that he has recently found out that he now has right eye glaucoma. See the April 1, 2008 waiver statement from the Veteran, received by the Board on May 12, 2008. No medical records dated later than May 2007 currently exist of record. VA is required to make reasonable efforts to help a veteran obtain records relevant to his claim, whether or not the records are in Federal custody. 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159(c) (2009). In that connection, the Board believes the Veteran's stomach, sleep, and eye claims should be remanded so that these updated treatment records may be obtained. VA eye examination As noted immediately above, the Veteran has indicated that he underwent laser eye surgery on his left eye in March 2008, and that he was recently diagnosed with right eye glaucoma. The severity of the Veteran's service-connected glaucoma was last evaluated prior to this surgery in July 2006. Consequently, a more contemporaneous depiction of the Veteran's service-connected eye disability is required. See Palczewski v. Nicholson, 21 Vet. App. 174, 181-82 (2007), citing Caluza v. Brown, 7 Vet. App. 498, 505-06 (1998) ["Where the record does not adequately reveal the current state of the claimant's disability . . . the fulfillment of the statutory duty to assist requires a thorough and contemporaneous medical examination."]. Therefore, after the above-referenced surgery records are obtained, the Veteran should be scheduled for a VA eye examination to determine the current severity of his service- connected glaucoma. Accordingly, the case is REMANDED to the Veterans Benefits Administration (VBA) for the following action: 1. VBA should contact the Veteran and request that he identify any additional medical treatment he has received for his gastrointestinal problems, sleep disturbances, night sweats, and glaucoma, to include his reported March 2008 hospitalization for stomach problems and laser eye surgery. The Veteran should be provided multiple copies of VA Form 21- 4142, Authorization and Consent to Release Information, and should be asked to complete these releases so that VA can obtain private treatment records on his behalf. VBA should take appropriate steps to secure copies of any such treatment reports identified by the Veteran which are not in the record on appeal. Efforts to obtain these records should also be memorialized in the Veteran's VA claims folder. 2. After obtaining any available records noted above, the VBA should schedule the Veteran for an eye examination to determine the current severity of the Veteran's service-connected glaucoma. The Veteran's VA claims folder and a copy of this Remand should be made available to, and should be reviewed by the examiner. Testing should include uncorrected and corrected central visual acuity for distance and near, with a recording of the refraction. Measurement of the visual field should be made part of the report of examination, with not less than 2 recordings, and 3 should be made if possible. A report should be prepared and associated with the Veteran's VA claims folder. 3. Following the completion of the foregoing, and after undertaking any other development it deems necessary, the VBA should then readjudicate the Veteran's service connection and increased rating claims. If the claims are denied, VBA should provide the Veteran and his representative with a supplemental statement of the case (SSOC) and allow an appropriate period of time for response. Thereafter, the claims folder should be returned to the Board for further appellate review, if otherwise in order. The Veteran has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claims 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). ______________________________________________ MATTHEW D. TENNER Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs