Citation Nr: 1240407 Decision Date: 11/27/12 Archive Date: 11/30/12 DOCKET NO. 06-09 365 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to service connection for a psychiatric disorder variously claimed as depression, anxiety, panic attacks, bipolar disorder, and personality disorder, including as a qualifying chronic disability under 38 C.F.R. § 3.317 (2012). 2. Entitlement to service connection for gastroesophageal reflux disease (GERD) and hiatal hernia, including as a qualifying chronic disability under 38 C.F.R. § 3.317. 3. Entitlement to service connection for a disorder manifested by low back pain, including as a qualifying chronic disability under 38 C.F.R. § 3.317. 4. Entitlement to service connection for a disorder manifested by numbness and tingling of the arms, including as a qualifying chronic disability under 38 C.F.R. § 3.317. 5. Entitlement to service connection for a disorder manifested by facial numbness, including as a qualifying chronic disability under 38 C.F.R. § 3.317. 6. Entitlement to service connection for a disorder manifested by tremor, including as a qualifying chronic disability under 38 C.F.R. § 3.317. 7. Entitlement to service connection for a disorder manifested by blurred vision, including as a qualifying chronic disability under 38 C.F.R. § 3.317. 8. Entitlement to service connection for a disorder manifested by dizziness, including as a qualifying chronic disability under 38 C.F.R. § 3.317. 9. Entitlement to service connection for a disorder manifested by fatigue, including as a qualifying chronic disability under 38 C.F.R. § 3.317. 10. Entitlement to service connection for a disorder manifested by chest pain, including as a qualifying chronic disability under 38 C.F.R. § 3.317. 11. Entitlement to service connection for a disorder manifested by shortness of breath, including as a qualifying chronic disability under 38 C.F.R. § 3.317. 12. Entitlement to service connection for obstructive sleep apnea and sleep disturbance, including as a qualifying chronic disability under 38 C.F.R. § 3.317. 13. Entitlement to service connection for a neck disorder, including as a qualifying chronic disability under 38 C.F.R. § 3.317. ATTORNEY FOR THE BOARD D.J. Drucker, Counsel INTRODUCTION The Veteran had active military service from January 1985 to May 1992, including service in Southwest Asia from January to April 1991. This matter initially came to the Board of Veterans' Appeals (Board) on appeal from a February 2004 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. In November 2010, the Veteran was scheduled to testify during a hearing at the RO before a Veterans Law Judge but failed to appear and did not request that the hearing be rescheduled. The Board finds that all due process requirements were met regarding the Veteran's hearing request. The Board notes that, in December 1992, the Veteran appointed the Tennessee Department of Veterans Affairs as his representative in his VA claim at the Nashville, Tennessee, RO. However, in May 2003, his case was transferred to the VA RO in Atlanta and, to date, he has not appointed a new in-state representative or an attorney to represent him in his current appeal. In April 2011, the Board remanded the Veteran's case to the RO via the Appeals Management Center (AMC) in Washington, D.C., for further evidentiary development. FINDINGS OF FACT 1. Psychiatric symptoms have been attributed to the known clinical diagnoses of a major depressive disorder, anxiety, and bipolar disorder, that were not manifested during active service and are not otherwise related to active service. A personality disorder is not a disability within the meaning of legislation providing for VA benefits, and there is no evidence of superimposed injury or disease that caused resultant psychiatric disability in military service. 2. GERD and hiatal hernia are known clinical diagnoses that were not manifested during active duty service and are not otherwise related to any period of service. 3. The Veteran does not exhibit a chronic disability manifested by low back pain that had its clinical onset or is otherwise related to active duty. He does not exhibit a qualifying disability manifested by low back pain from an undiagnosed illness or a chronic multisymptom illness manifested to a compensable degree. 4. Symtoms of numbness and tingling of the arms have been attributed to clinical diagnoses of episodic peripheral neuropathy of the left upper extremity, anxiety, and the possibility of hyperventilation syndrome that were not manifested during and are not otherwise related to active service. 5. The Veteran does not exhibit a chronic disability manifested by facial numbness that had its clinical onset or is otherwise related to active duty. He does not exhibit a qualifying disability manifested by facial numbness from an undiagnosed illness or a chronic multisymptom illness manifested to a compensable degree. 6. The Veteran does not exhibit a chronic disability manifested by tremor that had its clinical onset or is otherwise related to active duty. He does not exhibit a qualifying disability manifested by tremor from an undiagnosed illness or a chronic multisymptom illness manifested to a compensable degree. 7. The Veteran does not exhibit a chronic disability manifested by blurred vision that had its clinical onset or is otherwise related to active duty. He does not exhibit a qualifying disability manifested by blurred vision from an undiagnosed illness or a chronic multisymptom illness manifested to a compensable degree. 8. The Veteran does not exhibit a chronic disability manifested by dizziness that had its clinical onset or is otherwise related to active duty. He does not exhibit a qualifying disability manifested by dizziness from an undiagnosed illness or a chronic multisymptom illness manifested to a compensable degree. 9. Symtoms of chest pain have been attributed to the known clinical diagnoses of costochondritis and anxiety that were not manifested during and are not otherwise related to active service. 10. Symtoms of shortness of breath have been attributed to the known clinical diagnoses of granulomatous disease, asthma, reactive airway disease, and anxiety, that were not manifested during and are not otherwise related to active service. 11. Sleep disturbance and fatigue have been attributed to the known clinical diagnosis of obstructive sleep apnea that was not manifested during active duty service and is not otherwise related to any period of service. 12. Neck pain has been attributed to the known clinical diagnosis of mild hypertrophic degenerative osteophytosis of the cervical spine at C5, C6 that was not manifested during active duty service and is not otherwise related to any period of service. CONCLUSIONS OF LAW 1. A psychiatric disability variously claimed as depression, anxiety, panic attacks, bipolar disorder, and personality disorder, and including as a qualifying chronic psychiatric disability from an undiagnosed illness or a chronic multisymptom illness, was not incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1117, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.317 (2012). 2. A gastrointestinal disability, including GERD and hiatal hernia, and including as a qualifying chronic gastrointestinal disability from an undiagnosed illness or a chronic multisymptom illness, was not incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1117, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.317. 3. A disability manifested by low back pain, including as a qualifying chronic low back disability from an undiagnosed illness or a chronic multisymptom illness, was not incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1117, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.317. 4. A disability manifested by numbness and tingling of the arms, including as a qualifying chronic undiagnosed illness or a chronic multisymptom illness, was not incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1117, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.317. 5. A disability manifested by facial numbness, including as a qualifying chronic disability from an undiagnosed illness or a chronic multisymptom illness, was not incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1117, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.317. 6. A disability manifested by tremor, including as a qualifying chronic disability from an undiagnosed illness or a chronic multisymptom illness, was not incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1117, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.317. 7. A disability manifested by blurred vision, including as a qualifying chronic l disability from an undiagnosed illness or a chronic multisymptom illness, was not incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1117, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.317. 8. A disability manifested by dizziness, including as a qualifying chronic disability from an undiagnosed illness or a chronic multisymptom illness, was not incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1117, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.317. 9. A disability manifested by fatigue including as a qualifying chronic fatigue disability from an undiagnosed illness or a chronic multisymptom illness, was not incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1117, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.317. 10. A disability manifested by chest pain, including as a qualifying chronic disability from an undiagnosed illness or a chronic multisymptom illness, was not incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1117, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.317. 11. A disability manifested by shortness of breath, including as a qualifying chronic pulmonary disability from an undiagnosed illness or a chronic multisymptom illness, was not incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1117, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.317. 12. A disability manifested by obstructive sleep apnea and sleep disturbance, including as a qualifying chronic disability from an undiagnosed illness or a chronic multisymptom illness, was not incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1117, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.317. 13. A disability manifested by neck pain, including as a qualifying chronic disability from an undiagnosed illness or a chronic multisymptom illness, was not incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1117, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.317. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duty to Notify and Assist In June and September 2003 and July 2011 letters, the agency of original jurisdiction (AOJ) satisfied its duty to notify the appellant under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b). The AOJ notified the Veteran of information and evidence necessary to substantiate his claims. He was notified of the information and evidence that VA would seek to provide and the information and evidence that he was expected to provide. In a December 2006 letter regarding other claims, the Veteran was informed of how VA determines disability ratings and effective dates, as required by Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VA has done everything reasonably possible to assist the Veteran with respect to his claims for benefits in accordance with 38 U.S.C.A. § 5103A and 38 C.F.R. § 3.159(c). His service treatment and personnel records and VA and non-VA medical records have been associated with the claims file, to the extent available. All reasonably identified and available medical records have been secured. A review of the Veteran's Virtual VA electronic file reveals no additional evidence relevant to his case. The Veteran was afforded VA examinations in October 2003 and June 2012, in conjunction with his claims, and the examination reports are of record. The October 2003 and June 2012 examination reports are adequate for rating purposes as the claims file was reviewed, the examiners reviewed the pertinent history, examined the Veteran, provided clinical findings and diagnoses, and offered etiological opinions with a rationale from which the Board can reach a fair determination. The records satisfy 38 C.F.R. § 3.326 (2012). As noted above, in April 2011, the Board remanded the Veteran's case to the RO for further development that included, obtaining medical records regarding his treatment at the VA medical center (VAMC) Mountain Home in Johnson, City, Tennessee, from 1993 to the present, and from the VAMC in Atlanta, from 1997 to the present, and scheduling him for VA gastrointestinal and mental disorders examinations. There has been substantial compliance with this remand, as his VA treatment records from the VAMC Mountain Home, dated from May 1992 to March 1995, and from the VAMC in Atlanta, dated from October 1997 to October 2004, were obtained. The Veteran was also scheduled for a VA gastrointestinal examination in June 2012, and a mental disorders examination in July 2012. However, the Veteran did not appear for the July 2012 VA mental disorders examination. He has provided no rationale showing good cause explaining why he failed to report for the examination. There is no indication in the record that the letter notifying the Veteran of the scheduled July 2012 VA mental disorders examination was not received. See Ashley v. Derwinski, 2 Vet. App. 62 (1992) (regarding the presumption of regularity that public officers have properly discharged their official duties in absence of clear evidence to the contrary); Mindenhall v. Brown, 7 Vet. App. 271 (1994) (regarding the applicability of the presumption of regularity to RO actions). The report from the VA medical facility notes that the Veteran failed to report for the scheduled examination. The August 2012 supplemental statement of the case informed the Veteran of his failure to report (see page 11) and there being no showing in the record of good cause for his failure to report. There is no record in the claims folder of a response from the Veteran. In short, there is no evidence of any VA error in notifying or assisting the Veteran that reasonably affects the fairness of this adjudication. The Board finds that additional efforts to schedule an examination would be futile. In the absence of clear evidence to the contrary, the law presumes the regularity of the administrative process. Notification for VA purposes is a written notice sent to the claimant's last address of record. See 38 C.F.R. § 3.1(q) (2012). The Board finds the duties to notify and assist have been satisfied in this case II. Legal Analysis In his March 2006 substantive appeal, the Veteran contended that some of his claimed conditions existed prior to the Gulf War and were "without a doubt" aggravated by his military service. He also believed that he had some undiagnosed illnesses. 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). Service connection will be granted if it is shown that the veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also 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). Even if there is no record of certain chronic disorders, including psychoses, certain neurological disorders, and arthritis, while in service, its incurrence in service will be presumed if the disease was manifest to a compensable degree within one year after discharge from active service. See 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.307, 3.309 (2012). Congenital or developmental defects and personality disorders are not diseases or injuries within the meaning of the applicable legislation. See 38 C.F.R. § 3.303, 4.9 (2012). To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service" - the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). This is a direct service connection theory of entitlement. A Persian Gulf veteran is defined as a veteran who served on active duty in the Armed Forces in the Southwest Asia Theater of operations during the Persian Gulf War. See 38 U.S.C.A. § 1117(f); 38 C.F.R. § 3.317(d). A "qualifying chronic disability" includes (a) undiagnosed illness, (b) a medically unexplained chronic multi-symptom illness (such as chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders (excluding structural gastrointestinal diseases) that is defined by a cluster of signs or symptoms, or (c) any diagnosed illness that the Secretary determines, in regulations, warrants a presumption of service connection. See 38 C.F.R. § 3.317(a)(2); see also 75 Fed. Reg. 61995-97 (2010); see also 76 Fed. Reg. 41696-98 (July 15, 2011). Under 38 U.S.C.A. § 1117(a)(1), compensation is warranted for a Persian Gulf veteran who exhibits objective indications of a "qualifying chronic disability" that became manifest during service on active duty in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent during the presumptive period prescribed by the Secretary. VA extended the presumptive period in 38 C.F.R. § 3.317(a)(1)(i) through December 31, 2016 (for qualifying chronic disabilities that become manifest to a degree of 10 percent or more after active duty in the Southwest Asia theater of operations). See 77 Fed. Reg. 63225-28 (Oct. 16, 2012). Furthermore, the chronic disability must not be attributed to any known clinical disease by history, physical examination, or laboratory tests. See 38 U.S.C.A. § 1117; 38 C.F.R. § 3.317(a),(b). The term "objective indications of a qualifying chronic disability" include both "signs," in a medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. See 38 C.F.R. § 3.317(a)(3). Signs or symptoms that may be manifestations of undiagnosed illness or a chronic multi-symptom illness include the following: fatigue, unexplained rashes or other dermatological signs or symptoms, headache, muscle pain, joint pain, neurological signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the upper or lower respiratory system, sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, or menstrual disorders. See 38 U.S.C.A. § 1117(g). Functional gastrointestinal disorders are a group of conditions characterized by chronic or recurrent symptoms that are unexplained by any structural, endoscopic, laboratory, or other objective signs of injury or disease and may be related to any part of the gastrointestinal tract. Specific functional gastrointestinal disorders include, but are not limited to, irritable bowel syndrome, functional dyspepsia, functional vomiting, functional constipation, functional bloating, functional abdominal pain syndrome, and functional dysphagia. These disorders are commonly characterized by symptoms including abdominal pain, substernal burning or pain, nausea, vomiting, altered bowel habits (including diarrhea, constipation), indigestion, bloating, postprandial fullness, and painful or difficulty swallowing. Diagnosis of specific functional gastrointestinal disorders is made in accordance with established medical principles, which generally require symptom onset at least 6 months prior to diagnosis and the presence of symptoms sufficient to diagnose the specific disorder at least 3 months prior to diagnosis. Note to 38 C.F.R. 3.317(a)(2)(i)(B)(3); see also 76 Fed. Reg. 41696-98 (July 15, 2011). There must be medical evidence of a current disability, medical or lay evidence of in-service incurrence or aggravation of a disease or injury, and medical evidence linking the current disability to that in-service disease or injury. Pond v. West, 12 Vet. App. 341, 346 (1999); Hickson v. West, 12 Vet. App. 247, 253 (1999). A service connection claim must be accompanied by evidence which establishes that the claimant currently has the claimed disability. See Degmetich v. Brown, 104 F. 3d 1328 (1997); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). Inasmuch as the Veteran's service records show that he served in Southwest Asia from January to April 1991, he is a Persian Gulf War Veteran within the meaning of the applicable statute and regulation. The question remains, however, as to whether the record supports a finding that his claimed disorders are manifestations of an undiagnosed illness or other qualifying chronic disability associated with her Persian Gulf War service. A. Psychiatric Disorder Variously Claimed as Depression, Anxiety, Panic Attacks, Bipolar Disorder, and a Personality Disorder The Veteran has claimed service connection for a psychiatric disability, including as due to an undiagnosed illness. In his March 2004 notice of disagreement (NOD), he noted that he had four years of psychotherapy since 1997, that should not have been included in his claim, and he did not claim service connection for any mental disease. Rather, he said that "my military service changed the way I look at people". He noted that after discharge he completed a college degree and worked as a software developer. The Veteran also indicated that he experienced anxiety and depression related to service and that he tried to seek treatment in service for stress and anxiety. The Veteran said that personality disorders were lifelong patterns of behavior and pointed to his propensity for meritorious service in the Army and his work performance. He said he did not submit a claim for compensation due to a personality disorder. An October 2003 VA psychiatric examination reflects that the Veteran gave a history of pre-service hospitalization for drug abuse, drug use in college and in service, receiving psychiatric treatment in service for depression and stress, and VA treatment for psychiatric symtoms from 1997 to 1999. Upon clinical evaluation, the diagnosis was a major depressive disorder, moderate to severe, without psychotic features. In order to establish service connection for his claimed disability due to an undiagnosed illness, the legal criteria provide, in pertinent part, that the illness or symptoms not be attributable to any known clinical diagnosis by history, physical examination, and/or laboratory tests. 38 C.F.R. § 3.317. While acknowledging the Veteran's complaints of psychiatric symtoms since serving in the Gulf War, such symptoms have been attributed most recently to a known clinical diagnosis of a major depressive disorder, and earlier to a bipolar disorder, a depressive disorder, and anxiety disorder, discussed infra, and thus, service connection for a psychiatric disorder as due to an undiagnosed condition is not warranted. The Board has also considered the Veteran's claim of entitlement to service connection for a psychiatric disability under a direct theory of entitlement. Service treatment records include the Veteran's complaints of work-related stress in August 1990, for which he was sent to a stress management workshop. A March 1992 psychiatric consultation report indicates that the Veteran was evaluated for "FLT". He was stable but irritated by the "stress of moving" and it was noted that he seemed to be ruminating about "stuff about Saudi Arabia". The clinical impression was that he was cleared for "FLT" as scheduled. The Veteran's Certificate of Release or Transfer from Active Duty (DD Form 214) indicates that, in May 1992, he was separated from service due to a personality disorder. Post service, VA outpatient records, dated in December 1992, indicate that the Veteran reported having a stress problem and was evaluated "in the field" for stress. On examination it was noted that he may be depressed. VA medical records, dated during 1997 reflect that the Veteran had paranoia. An October 1997 VA medical record includes diagnoses of a need to rule out a bipolar disorder, a depressive disorder, and generalized anxiety, rendered by a social worker. Records dated from February to December 1998 describe the Veteran's psychiatric treatment for a bipolar disorder. Private medical records, dated in February 2002, include the Veteran's complaints believed related to a panic disorder and, in May 2002, an anxiety disorder was noted. In June 2003, the Veteran was treated for complaints of dizziness, nervousness, and blurred vision, and, in November 2003, he was treated for chest pain and anxiety. The October 2003 VA psychiatric examination includes a diagnosis of a major depressive disorder, moderate to severe, without psychotic features. October 2004 VA medical records indicate that the Veteran was treated for multiple non-specific complaints and seemed paranoid. A history of a bipolar disorder was noted. The Veteran was reported to have a severe anxiety component and needed a mental health referral but refused and became angry/violent when it was mentioned. As noted above, the Veteran failed to report for a VA mental disorders examination scheduled in July 2012, in conjunction with his claim. Given the presumption of regularity of the mailing of VA examination scheduling notice and the fact that the Veteran has not contacted the RO with a reason for his failure to report, the Board finds that the Veteran failed to report to the scheduled July 2012 VA examination without good cause. See 38 C.F.R. § 3.655 (2012). The Veteran reported having a stress problem in December 1992 and records indicate that he may have been depressed, although there is no subsequent medical evidence reflecting treatment for a psychiatric disorder prior to 1997; nearly 6 years after the Veteran's period of Gulf War service in 1991 and 5 years after his separation from active service. More significantly, the Veteran failed to report for a VA mental disorders examination scheduled in July 2012, in conjunction with his claim. 38 C.F.R. § 3.655. There is not one medical opinion of record to support his service connection claim. When a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. 38 C.F.R. § 3.655. When a veteran fails without good cause to report for a VA examination requested by VA in conjunction with a claim, VA is not obliged to attempt to provide another. Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant, death of an immediate family member, etc. 38 C.F.R. § 3.655(a). VA offered the Veteran an opportunity to have a VA examination to obtain a medical opinion regarding whether he had a psychiatric disorder incurred in or related to his military service. The Veteran, however, failed to appear for the scheduled VA examination. His failure to cooperate in attending the examination has left the record devoid of any competent opinion whether he has a psychiatric disorder that was incurred in or related to his active military service. 38 C.F.R. § 3.655(b). Given that there is no competent evidence that the claimed disorder is aggravated by a service connected disorder, given that the Veteran failed to report for the scheduled examination, and given that he has not provided good cause for his failure in this regard, his claim must be denied. The duty to assist is not always a one-way street. If he wishes help, the Veteran cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence. Wood v. Derwinski, 1 Vet. App. 190, 192 (1991). While VA has a duty to assist the Veteran in the development of a claim, that duty is not limitless. In the normal course of events, it is the burden of the Veteran to appear for VA examinations. If he does not do so, there is no burden on the VA to "turn up heaven and earth" to find him. Hyson v. Brown, 5 Vet. App. 262 (1993). The Board has considered the Veteran's contention that a relationship exists between his psychiatric disability and his period of service in the Persian Gulf. In adjudicating this claim, the Board must assess the Veteran's competence and credibility. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362, 368- 69 (2005). In Barr v. Nicholson, 21 Vet. App. 303 (2007), the United States Court of Appeals for Veterans Claims (Court), emphasized that lay testimony is competent if it is limited to matters that the witness has actually observed and is within the realm of the witnesses personal knowledge. See also 38 C.F.R. § 3.159(a)(2) (Competent lay evidence means any evidence not requiring that the proponent have specialized education, training or experience. Lay evidence is competent if it is provided by a person who has knowledge of the facts or circumstances and conveys matters that can be observed and described by a lay person). In this capacity, the Board finds that, while the Veteran is competent to attest to his symptomatology related to his psychiatric disability, however, he is not competent to provide an opinion that he has a psychiatric disorder due to service, to include his service in the Persian Gulf, as he does not have the requisite medical expertise. Initially, as to the Veteran's personality disorder noted as the reason for separation on the Veteran's DD Form 214, it cannot be service-connected because it is not a disease or injury for VA compensation purposes; however, if superimposed injury or disease occurred, the resultant disability might be service-connected. 38 C.F.R. § 3.303(c). However, the record is totally devoid of any superimposed injury or disease in service that caused a resultant psychiatric disability. Further, a psychiatric disorder was not diagnosed during the Veteran's period of service in the Persian Gulf and, despite his contentions that he experienced psychiatric symptoms since such service, and although he complained of stress in December 1992, he has clearly stated that he received psychiatric treatment that started in 1997, not right after his Persian Gulf service. The negative clinical and documentary evidence post service for approximately five or six years after his Gulf War service is more probative than the remote assertions of the Veteran. The lack of continuity of treatment may bear in a merits determination on the credibility of the evidence of continuity of symptoms by lay parties. Savage v. Gober, 10 Vet. App. 488, 496 (1997). In sum, the Board is left with no documented complaints or findings of a diagnosed psychiatric disorder in service, documented subjective complaints of psychiatric symtoms in December 1992, but no evidence of psychiatric treatment until approximately five or six years after his Persian Gulf service and, importantly, no medical opinion to support the Veteran's claim. Under these circumstances, the Board is unable to find that there is a state of equipoise of the positive evidence and negative evidence. The preponderance of the evidence now of record is against the Veteran's claim of service connection for a psychiatric disability. B. GERD and Hiatal Hernia The Veteran also seeks service connection for GERD and a hiatal hernia, including as due to an undiagnosed illness. In his March 2004 NOD, the Veteran said that he had reflux since the Gulf War and noted his treatment by VA in the 1990s for the disorder. He believed the reflux was a symptom of Gulf War Syndrome but was unaware he had a hiatal hernia until he received the February 2004 rating decision. An October 2003 VA examination report includes the Veteran's complaints of diarrhea while in the Persian Gulf and frequent soft stools in recent years. He had reflux with a normal appetite. Objectively, the Veteran was 70 1/2 inches tall, weighed 281 pounds, and did not appear chronically or acutely ill. His abdomen was soft, protuberant, and nontender. There was no succession splash audible in the epigastrum and bowel sounds were distant. The diagnoses included reflux esophagitis, history with a small hiatal hernia, and minimal esophageal reflux. In June 2012, a VA examiner diagnosed the Veteran with a congenital hiatal hernia and GERD. In order to establish service connection for his claimed disability due to an undiagnosed illness, the legal criteria provide, in pertinent part, that the illness or symptoms not be attributable to any known clinical diagnosis by history, physical examination, and/or laboratory tests. 38 C.F.R. § 3.317. While acknowledging the Veteran's complaints of gastrointestinal symtoms since serving in the Gulf War, such symptom has been attributed to a congenital hiatal hernia and GERD, and thus service connection for GERD and a congenital hiatal hernia due to an undiagnosed condition is not warranted. The Board has also considered the Veteran's claim of entitlement to service connection for GERD and a hiatal hernia under a direct theory of entitlement. Service treatment records reflect the Veteran's complaint of nausea and vomiting with occasional diarrhea assessed as a possible cold in January 1986. In December 1986, October 1987, and April 1991, gastroenteritis was diagnosed. In March 1989, he complained of nausea and diarrhea. Post service, the December 1992 VA treatment records show that the Veteran reported a clinical diagnosis of "hiatal hernia". July 1993 VA outpatient records include the Veteran's complaints of stomach pain and heartburn for two weeks, and indicate that he believed he might have a hiatal hernia. Reflux esophagitis and pelvic ulcer disease were diagnosed Private medical records show that, in October 2001, the Veteran was treated for gastric upset and an upper gastrointestinal examination revealed mild to moderate GERD. In February 2002, he was treated for right upper abdominal pain of unclear cause. In May 2002, he was noted to have GERD. In October 2003, the VA examiner diagnosed the Veteran with reflux esophagitis, history with a small hiatal hernia and minimal esophageal reflux. Results of an upper gastrointestinal (UGI) series performed by VA in December 2003 showed a small hiatal hernia with minimal reflux to the distal esophagus. October 2004 VA outpatient records note the Veteran's complaint of epigastric distress and that he had GERD. It was also noted that the Veteran had a severe anxiety component and needed a mental health referral but refused and became angry/violent when it was mentioned. According to the June 2012 VA examination report, the examiner reviewed the Veteran's medical records and performed a clinical evaluation. The examiner indicated that the Veteran complained of GERD that had its onset in 1993 and a hiatal hernia, a congenital condition that started in December 1992. The Veteran said he was not seen for this in service. The VA examiner said that there was no on-going treatment for GERD or hiatal hernia in service. The Veteran currently complained of having reflux. It was noted that the Veteran did not report for blood and other laboratory tests scheduled with his VA examination. The diagnosis was congenital hiatal hernia that was not caused or aggravated by military service and GERD. The VA examiner said that it was less likely than not (less than 50 percent probability) that the Veteran's congenital hernia or GERD were incurred in or caused by active military service. The VA examiner explained that the Veteran was not seen in an on-going fashion in service for GERD or a hiatal hernia. He was occasionally seen for gastroenteritis with nausea and vomiting with occasional diarrhea. There was no pattern of illness causing later problems. He was not diagnosed with GERD until after service. The Veteran's nausea, vomiting, and occasional diarrhea were not caused by his congenital hiatal hernia or GERD. Initially, as to the Veteran's congenital hiatal hernia, the record is totally devoid of any super imposed injury or disease in service that caused a resultant hiatal hernia disability. See 38 C.F.R. § 3.303(c). In fact, the June 2012 VA examiner specifically stated that the Veteran was not seen in service in an on-going fashion for hiatal hernia or GERD. Thus, service connection for a congenital hiatal hernia is not warranted. Further, there is no medical evidence reflecting complaints of GERD prior to July 1993, more than 1 year after his separation from active service in the Persian Gulf. The Board finds an absence of any subjective complaints of GERD for over year after separation from his Persian Gulf service or of persistent symptoms of GERD between service-discharge and 1993 and an absence of any objective evidence of gastrointestinal complaints for over 1 year after discharge from his Persian Gulf service. More significantly, in June 2012, a VA examiner opined that it was less likely than not (less than 50 percent probability) that the Veteran's congenital hernia or GERD were incurred in or caused by active military service. The examiner provided a clear rationale to support his opinion. The VA examiner explained that the Veteran was not seen in an on-going fashion in service for GERD or a hiatal hernia. The Veteran was occasionally seen for gastroenteritis with nausea and vomiting with occasional diarrhea but there was no pattern of illness causing later problems. The VA examiner said that the Veteran was not diagnosed with GERD until after service and his nausea, vomiting, and occasional diarrhea were not caused by his congenital hiatal hernia or GERD. There is no medical opinion of record to contradict the VA examiner's conclusion. The Board accepts the June 2012 VA examiner's opinion as being the most probative medical evidence on the subject, as such was based on a review of all historical records, and contains detailed rationale for the medical conclusion that the Veteran's GERD and congenital hernia were not incurred in or aggravated by his active military service. See Boggs v. West, 11 Vet. App. 334 (1998). The Board has considered the Veteran's contention that a relationship exists between his GERD and his period of service in the Persian Gulf. In adjudicating this claim, the Board must assess the Veteran's competence and credibility. See Buchanan v. Nicholson, 451 F.3d at 1331; Washington v. Nicholson, 19 Vet. App. at 368-69. See also Barr v. Nicholson, 21 Vet. App. at 303; 38 C.F.R. § 3.159(a)(2). In this capacity, the Board finds that, while the Veteran is competent to attest to his symptomatology related to his GERD, however, he is not competent to provide an opinion that his GERD is due to service, to include his service in the Persian Gulf, as he does not have the requisite medical expertise. GERD was not noted during his period of service in the Persian Gulf and despite his contentions that he had experienced GERD since such service, he told a VA clinic physician in July 1993 examiner that GERD had begun approximately two weeks prior, not right after his Persian Gulf service. The Board finds the Veteran's statements offered to a medical examiner for purposes of receiving medical treatment to be more credible, than statements offered later in support of his claim for compensation. The Veteran's contentions are outweighed by the subjective complaints documented in post-service treatment records that his GERD began over one year after separation from his Gulf War service and a medical opinion that his GERD was less likely than not incurred in or caused by active military service. The negative clinical and documentary evidence post service for over one year after his Gulf War service is more probative than the remote assertions of the Veteran. The lack of continuity of treatment may bear in a merits determination on the credibility of the evidence of continuity of symptoms by lay parties. Savage v. Gober, 10 Vet. App. at 496. In sum, the Board is left with no documented complaints or findings of GERD in service, no documented subjective complaints of GERD for over one year after his discharge from Persian Gulf service, no documented objective findings of GERD until more than one year after his service in the Persian Gulf, and a VA medical opinion to the effect that his GERD was less likely than not incurred in or caused by active military service. Under these circumstances, the Board is unable to find that there is a state of equipoise of the positive evidence and negative evidence. The preponderance of the evidence now of record is against the Veteran's claim of service connection for GERD and hiatal hernia. C. A Disorder Manifested by Low Back Pain In his March 2004 NOD, the Veteran said that no claim was submitted for lower back pain, although he complained of it at least once while in service. Service treatment records reveal that the Veteran was treated for low back pain on several occasions. Results of x-rays of his lumbar spine performed in November 1986 and April 1988 were normal. In September 1990, mechanical back pain was noted. Post service, the December 1992 VA medical records includes the Veteran's reported history of having low back syndrome subject to exacerbation due to physical activity. On examination at that time, there was tenderness at L-5 and S1 with full range of motion. Subsequent VA and non-VA medical records and examination reports, dated to 2012, are not referable to complaints of a low back disorder. During the October 2003 VA examination, the Veteran did not complain of having a low back disorder. Objectively, he walked with a relatively normal gait and posture and was able to undress and dress himself without assistance or without a display of discomfort. There was no malalignment of the axial skeleton. The Veteran had normal flexibility of the back through all corresponding physiological arcs. He was able to squat to full range and stand on his toes and heels. A low back disorder was not diagnosed. In the absence of proof of a current disability of a low back disorder, there can be no valid claim. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. at 225. Congress has specifically limited entitlement to service connection to cases where such incidents have resulted in a disability. Brammer, 3 Vet. App. at 225. In the absence of any competent evidence of a low back disorder, the Board must conclude the Veteran does not currently suffer from such a disability. Without a diagnosed low back disorder, the Board must deny the Veteran's claim. See Degmetich v. Brown, 104 F.3d at 1333 (holding that the existence of a current disability is the cornerstone of a claim for VA disability compensation). Without a diagnosed chronic disability associated with the Veteran's spinal system, there can be no valid claim of service connection. Thus, the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply, and the claim of service connection for a low back disorder must be denied. See Gilbert v. Derwinski, 1 Vet. App at 49. D. A Disorder Manifested by Numbness and Tingling of the Arms The Veteran also seeks service connection for a disability manifested by numbness and tingling of the arms. In his March 2004 NOD, the Veteran asserted that his numbness in his arms and face were neurological symtoms that could be caused by Gulf War Syndrome. He said he had the problem for some time. During his October 2003 VA examination, the Veteran said he had numbness and tingling on the left side and was told it was from hyperventilating. Objectively, a neurologic abnormality was not noted. The examiner diagnosed episodic peripheral neuropathy of the left upper extremity with no motor weakness (and the examiner could not exclude the possibility of a hyperventilation syndrome). In order to establish service connection for his claimed disability due to an undiagnosed illness, the legal criteria provide, in pertinent part, that the illness or symptoms not be attributable to any known clinical diagnosis by history, physical examination, and/or laboratory tests. 38 C.F.R. § 3.317. While acknowledging the Veteran's complaints of left upper extremity numbness and tingling since serving in the Gulf War, such symptom has been attributed to an episodic peripheral neuropathy and the possibility of a hyperventilation syndrome and thus service connection for numbness and tingling of the arms due to an undiagnosed condition is not warranted. The Board has also considered the Veteran's claim of entitlement to service connection for numbness and tingling of the arms under a direct theory of entitlement. Service treatment records are not referable to complaints or diagnosis of, or treatment for, numbness and tingling of the Veteran's arms. June 1994 VA outpatient records include the Veteran's complaints that the fingers of his left arm were going to sleep for the past three days. Private medical records, dated from 2000 to 2002, include the Veteran's complaint of left arm and hand numbness. The October 2003 VA examiner did not report any clinical findings associated with the Veteran's upper extremities. Diagnoses included episodic peripheral neuropathy of the left upper extremity with no motor weakness (and could not exclude the possibility of a hyperventilation syndrome). December 2003 VA radiology reports include the Veteran's complaint of left shoulder tenderness and pain and neck pain and numbness of the left hand. Results of x-rays of his left shoulder were normal. October 2004 VA medical records reveal that Veteran complained of arm pain that seemed chronic and was resolved. The Veteran became agitated when the clinic physician would not prescribe antibiotics and also seemed paranoid. There is no medical evidence reflecting complaints of numbness and tingling in the Veteran's left arm prior to June 1994; that constitutes a 2 year period after his separation from active service in the Persian Gulf. The Board finds an absence of any subjective complaints of upper extremity numbness and tingling for 2 years after separation from his Persian Gulf service or of persistent symptoms of numbness and tingling between service-discharge and 1994. The lack of any evidence of continuing numbness and tingling from his period of active duty that ended in May 1992, and the initial findings and complaints of numbness and tingling in 1994 weighs against the claim. A prolonged period without medical complaint can be considered, along with other factors concerning the claimant's health and medical treatment during and after military service, as evidence of whether a disability was incurred in service or whether an injury, if any, resulted in any chronic or persistent disability which still exists currently. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). The Board has considered the Veteran's contention that a relationship exists between his upper extremity numbness and tingling and his period of service in the Persian Gulf. In adjudicating this claim, the Board must assess the Veteran's competence and credibility. See Buchanan v. Nicholson, 451 F.3d at 1331; Washington v. Nicholson, 19 Vet. App. at 368-69. See also Barr v. Nicholson, 21 Vet. App. at 303; 38 C.F.R. § 3.159(a)(2). In this capacity, the Board finds that while the Veteran is competent to attest to his symptomatology related to his upper extremity numbness and tingling, however, he is not competent to provide an opinion that his upper extremity numbness and tingling are due to service, to include his service in the Persian Gulf, as he does not have the requisite medical expertise. Upper extremity numbness and tingling were not noted during his period of service in the Persian Gulf and despite his contentions that he had experienced upper extremity numbness and tingling since such service, he told a VA clinic examiner in June 1994 that such numbness and tingling had begun approximately three days prior, not right after his Persian Gulf service. The Board finds the Veteran's statements offered to a medical examiner for purposes of receiving medical treatment to be more credible, than statements offered later in support of his claim for compensation. The Veteran's contentions are outweighed by the subjective complaints documented in post-service treatment records that his upper extremity numbness and tingling began approximately two years after separation from his Gulf War service and a medical opinion that his left upper extremity numbness and tingling was due to episodic peripheral neuropathy (and the possibility of a hyperventilation syndrome could not be excluded). The negative clinical and documentary evidence post service for approximately two years after his Gulf War service is more probative than the remote assertions of the Veteran. Savage v. Gober, 10 Vet. App. at 496. In sum, the Board is left with no documented complaints or findings of upper extremity numbness and tingling in service, no documented subjective complaints of upper extremity numbness and tingling until approximately two years after his Persian Gulf service, no documented objective findings of left upper extremity numbness and tingling until approximately two years after his service in the Persian Gulf, and a VA medical opinion to the effect that his left upper extremity tingling and numbness was due to episodic peripheral neuropathy, that was also no shown in service. Under these circumstances, the Board is unable to find that there is a state of equipoise of the positive evidence and negative evidence. The preponderance of the evidence now of record is against the Veteran's claim of service connection for a disorder manifested by numbness and tingling of the arms. E. A Disorder Manifested by Facial Numbness The Veteran also seeks service connection for a disorder manifested by facial numbness. In his March 2004 NOD, he said he had numbness and tingling in his face that he believed was caused by Gulf War Syndrome. Service treatment records are not referable to complaints or diagnosis of, or treatment for, facial numbness. Post service, October 2004 VA medical records include the Veteran's complaints of tingling lips that was resolved. In the absence of proof of a current disability of a facial numbness disorder, there can be no valid claim. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. at 225. Congress has specifically limited entitlement to service connection to cases where such incidents have resulted in a disability. Brammer, 3 Vet. App. at 225. In the absence of any competent evidence of a facial numbness disorder, the Board must conclude the Veteran does not currently suffer from such a disability. Without a diagnosed facial numbness disorder, the Board must deny the Veteran's claim. See Degmetich v. Brown, 104 F.3d at 1333. The Board has considered the Veteran's contention that he has a facial numbness disorder that is related to his service. In adjudicating this claim, the Board must assess the Veteran's competence and credibility. See Buchanan v. Nicholson, 451 F.3d at 1331; Washington v. Nicholson, 19 Vet. App. at 368-69. See also Barr v. Nicholson, 21 Vet. App. at 303; 38 C.F.R. § 3.159(a)(2). In this capacity, the Board finds the Veteran is competent to attest to his symptomatology that he believes is associated with a facial numbness disability; however, a diagnosis of a facial numbness disability is not the type of disability that can be identified simply by lay observation, it requires a diagnosis by a medical professional. Thus, he is not competent to diagnose a facial numbness disability, as he does not have the requisite medical expertise. There is no indication in the medical records that he has a diagnosed facial numbness disability. The Veteran's contentions of a chronic disability are outweighed by the objective findings which require medical expertise. Without a diagnosed chronic disability associated with the neurologic system, there can be no valid claim of service connection. Thus, the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply, and the claim of service connection for a disorder manifested by facial numbness must be denied. See Gilbert v. Derwinski, 1 Vet. App at 49. F. A Disorder Manifested by Tremor The Veteran also seeks service connection for a disorder manifested by tremor. In his March 2004 NOD, the Veteran said he had neurological symtoms that he believed were associated with Gulf War Syndrome. Service treatment records are not referable to complaints or diagnosis of, or treatment for tremor. Post service, the VA and non VA medical records and examination reports, dated from 1992 to 2012, are not referable to complaints of, or treatment for, a disorder manifested by a tremor. When examined by VA in October 2003, the Veteran did not report having a disability manifested by tremor. Objectively, the VA examiner reported no tremors or fasciculations. In the absence of proof of a current disability of a tremor disorder, there can be no valid claim. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. at 225. Congress has specifically limited entitlement to service connection to cases where such incidents have resulted in a disability. Brammer, 3 Vet. App. at 225. In the absence of any competent evidence of a tremor disorder, the Board must conclude the Veteran does not currently suffer from such a disability. Without a diagnosed tremor disorder, the Board must deny the Veteran's claim. See Degmetich v. Brown, 104 F.3d at 1333. The Board has considered the Veteran's contention that he has a tremor disorder that is related to his service. In adjudicating this claim, the Board must assess the Veteran's competence and credibility. See Buchanan v. Nicholson, 451 F.3d at 1331; Washington v. Nicholson, 19 Vet. App. at 368-69. See also Barr v. Nicholson, 21 Vet. App. at 303; 38 C.F.R. § 3.159(a)(2). In this capacity, the Board finds the Veteran is competent to attest to his symptomatology that he believes is associated with a tremor disability; however, a diagnosis of a tremor disability is not the type of disability that can be identified simply by lay observation, it requires a diagnosis by a medical professional. Thus, he is not competent to diagnose a tremor disability, as he does not have the requisite medical expertise. There is no indication in the medical records that he has a diagnosed tremor disability. In fact, the October 2003 VA examiner expressly reported no clinical finding of tremor. The Veteran's contentions of a chronic disability are outweighed by the objective findings which require medical expertise. Without a diagnosed chronic disability associated with the neurologic system, there can be no valid claim of service connection. Thus, the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply, and the claim of service connection for a disorder manifested by a tremor must be denied. See Gilbert v. Derwinski, 1 Vet. App at 49. G. A Disorder Manifested by Blurred Vision The Veteran further seeks service connection for a disability manifested by blurred vision. In his March 2004 NOD, he noted that he recently experienced blurred vision that could indicate some other illness. Service treatment records are not referable to complaints of blurred vision. Post service, a May 1992 VA outpatient record indicates that the Veteran complained of having a headache and saw spots before his eyes. On clinical evaluation, an eye disorder was not noted. Headaches were diagnosed. A March 1993 VA medical record reflects that the Veteran was evaluated for a headache and denied having blurred vision. Private medical records, dated in October 2002, include the Veteran's complaint of a black spot in his right eye. He also reported being dizzy and lightheaded. His blood pressure was within normal limits and a diagnosed disability was not reported. In November 2002, he reported having blurred vision, headaches, left arm and hand numbness, and dizziness. A June 2003 private medical record contains the Veteran's complaints of blurred vision, nervousness, and dizziness. During the October 2003 VA examination, the Veteran said that he got "a little blurred vision". Objectively, his blood pressure was normal and examination of his eyes revealed that sclera was not icteric and conjunctiva was not pale. There were normal exttraocular movements. A November 2003 VA eye examination report reflects that the Veteran's visual acuity was 20/20 in each eye and an eye disease or disorder was not found. In the absence of proof of a current disability of a vision disorder, there can be no valid claim. Boyer v. West, 210 F.3d at 1353; Brammer v. Derwinski, 3 Vet. App. at 225. In the absence of any competent evidence of an eye disorder, the Board must conclude the Veteran does not currently suffer from such a disability. Without a diagnosed eye disorder, the Board must deny the Veteran's claim. See Degmetich v. Brown, 104 F.3d at 1333. The Board accepts the November 2003 VA examiner's opinion as being the most probative medical evidence on the subject, as such was based on a review of all historical records and clinical evaluation for the medical conclusion that the Veteran does not currently suffer from an eye disease or disorder. See Boggs v. West, 11 Vet. App. at 334. The Board has considered the Veteran's contention that he has a vision disorder that is related to his service. In adjudicating this claim, the Board must assess the Veteran's competence and credibility. See Buchanan v. Nicholson, 451 F.3d at 1331; Washington v. Nicholson, 19 Vet. App. at 368-69. See also Barr v. Nicholson, 21 Vet. App. at 303; 38 C.F.R. § 3.159(a)(2). In this capacity, the Board finds the Veteran is competent to attest to his symptomatology that he believes is associated with a vision disability, however, a diagnosis of an eye disease disability is not the type of disability that can be identified simply by lay observation, it requires a diagnosis by a medical professional. Thus, he is not competent to diagnose an eye disease disability, as he does not have the requisite medical expertise. As detailed, the November 2003 VA examiner found no eye disease, and there is otherwise no indication in the medical records that he has a diagnosed vision disability. The Veteran's contentions of a chronic disability are outweighed by the objective findings which require medical expertise. Without a diagnosed chronic disability associated with the eyes, there can be no valid claim of service connection. Thus, the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply, and the claim of service connection for a disorder manifested by blurred vision must be denied. See Gilbert v. Derwinski, 1 Vet. App at 49. H. A Disorder Manifested by Dizziness The Veteran also seeks service connection for a disorder manifested by dizziness. In his March 2004 NOD, he reported that his dizziness was more recent but could indicate some other illness. He noted that results of cardiac tests were normal. Service treatment records are not referable to complaints of dizziness other than in April 1991 when he was treated for gastroenteritis. Post service, an October 2001 private medical record reflects the Veteran's complaint of dizziness and chest tightness for the past month. February 2002 private medical records show that he reported being lightheaded and dizzy, and having chest pain, that were thought possibly the result of a panic disorder. A May 2002 private medical record includes complaints of dizziness and shortness of breath associated with anxiety attacks. In October and November 2002, the Veteran complained of headaches, blurred vision, and dizziness. A June 2003 private medical record includes the Veteran's complaints of dizziness, nervousness, and blurred vision. The October 2003 VA examination report is not referable to complaints of dizziness, or diagnosis of a disorder manifested by dizziness. Objectively, the Veteran's blood pressure was within normal limits. He ambulated with a normal gait and there were no reported findings associated with dizziness. In the absence of proof of a current disability of a disorder manifested by dizziness, there can be no valid claim. Boyer v. West, 210 F.3d at 1353; Brammer v. Derwinski, 3 Vet. App. at 225. In the absence of any competent evidence of a disorder manifested by dizziness, the Board must conclude the Veteran does not currently suffer from such a disability. Without a diagnosed disorder manifested by dizziness, the Board must deny the Veteran's claim. See Degmetich v. Brown, 104 F.3d at 1328. The Board has considered the Veteran's contention that he has a disorder manifested by dizziness that is related to his service. In adjudicating this claim, the Board must assess the Veteran's competence and credibility. See Buchanan v. Nicholson, 451 F.3d at 1331; Washington v. Nicholson, 19 Vet. App. at 368-69. See also Barr v. Nicholson, 21 Vet. App. at 303; 38 C.F.R. § 3.159(a)(2). In this capacity, the Board finds the Veteran is competent to attest to his symptomatology that he believes is associated with a disorder manifested by dizziness; however, a diagnosis of a dizziness disability is not the type of disability that can be identified simply by lay observation, it requires a diagnosis by a medical professional. Thus, he is not competent to diagnose a dizziness disability, as he does not have the requisite medical expertise. There is no indication in the medical records that he currently has a diagnosed disorder manifested by dizziness. The Veteran's contentions of a chronic disability are outweighed by the objective findings which require medical expertise. Without a diagnosed chronic disability associated with dizziness, there can be no valid claim of service connection. Thus, the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply, and the claim of service connection for a disorder manifested by dizziness must be denied. See Gilbert v. Derwinski, 1 Vet. App at 49. I. A Disorder Manifested by Fatigue The Veteran also seeks service connection for a disorder manifested by fatigue. In his March 2004 NOD, the Veteran said he had a well documented history that included fatigue and that he reported this symptom every time he saw a physician. Service treatment records are not referable to complaints or diagnosis of, or treatment for, a disorder manifested by fatigue. Post service complaints of fatigue have been associated with a known clinical diagnosis of sleep apnea rendered in December 2003 and March 2004 VA medical records. The Veteran's complaints of fatigue are addressed in his claim for service connection for sleep apnea and sleep disturbance, discussed infra. J. A Disorder Manifested by Chest Pain The Veteran further seeks service connection for a disorder manifested by chest pain. During the October 2003 VA examination, the Veteran reported having chest pain for about two years that was localized in the left upper breast area. He said he was evaluated by a cardiologist and results of a stress test were normal. He was given medicine for his pain that lasted about thirty minutes. Objectively, the Veteran's cardiovascular system showed the cardiac rhythm was regular with no murmur, gallops or clicks. The point of maximum impulse could not be located on inspection and palpation because of a thick chest wall. The diagnoses included mild costochondritis of the left upper chest area (the VA examiner noted that, on palpating that area, the Veteran flinched slightly, and this was a localized costochondritis that was not related to organic heart disease). In order to establish service connection for his claimed disability due to an undiagnosed illness, the legal criteria provide, in pertinent part, that the illness or symptoms not be attributable to any known clinical diagnosis by history, physical examination, and/or laboratory tests. 38 C.F.R. § 3.317. While acknowledging the Veteran's complaints of chest pain symtoms since serving in the Gulf War, such symptoms have been attributed most recently to a known clinical diagnosis of costochondritis. The Board has also considered the Veteran's claim of entitlement to service connection for a chest pain disability under a direct theory of entitlement. Service treatment records are not referable to complaints or diagnosis of, or treatment for, a disorder manifested by chest pain. Post service, results of a chest x-ray taken by VA in October 1992 revealed no cardiac disease. A November 1993 VA outpatient record includes the Veteran's complaint of chest pain. Results of an x-ray taken at the time to rule out pneumonia showed calcified pulmonary granulomas. Results of an electrocardiogram (EKG) taken at the time were considered normal. A September 2001 private chest-x-ray report includes an impression of old granulomatous disease. The February 2002 private medical records include the Veteran's complaint of being lightheaded and dizzy, and having chest pain. His symtoms were thought possibly a result of a panic disorder. In June and November 2003, the Veteran was seen in a private emergency room for complaints that included chest pain. In June 2003, he was diagnosed with chest pain and anxiety. During the October 2003 VA examination, the Veteran reported having chest pain for about two years that was localized in the left upper breast area. He said he was evaluated by a cardiologist and results of a stress test were normal. He was given medicine for his pain that lasted about thirty minutes. Objectively, the Veteran's cardiovascular system showed the cardiac rhythm was regular with no murmur, gallops or clicks. The point of maximum impulse could not be located on inspection and palpation because of a thick chest wall. The diagnoses included mild costochondritis of the left upper chest area (the VA examiner noted that, on palpating that area, the Veteran flinched slightly, and this was a localized costochondritis that was not related to organic heart disease). The November 2003 private hospital records note the Veteran's past history of multiple visits to the emergency department for chest pains and extensive workups tailored for cardiac disorders, that yielded negative results. It was further noted that his multiple visits prompted the suggestion that he might need to see a psychiatrist about them. Upon evaluation, his musculoskeletal pain was thought to be the cause of the Veteran's complaints. He was diagnosed with atypical chest pain and chest wall pain. December 2003 VA medical records show that the Veteran reported having shortness of breath and left anterior chest pain suggestive of costochondritis. Results of pulmonary function tests performed at that time revealed findings suggestive of mild airflow limitation. Results of a chest x-ray taken at that time revealed no evidence of congestive failure and no acute chest disease. Results of an EKG were normal and results of x-ray of the Veteran's left shoulder taken at the time revealed no fracture, dislocation or other bony or joint pathology. October 2004 VA medical records include the Veteran's complaint of chest pain that seemed chronic and resolved. It was noted that the Veteran seemed paranoid and was agitated that the clinic examiner would not prescribe antibiotics. There is no medical evidence reflecting complaints of a chest pain disorder prior to November 1993; over two years after the Veteran's period of Gulf War service in 1991 and over 1 year after his separation from active service. The Board finds an absence of any subjective complaints of chest pain disability for more than one year after separation from his Persian Gulf service or of persistent symptoms of chest pain disability between service-discharge and 1993. The lack of any evidence of continuing chest pain disability for over one year between his period of active duty that ended in May 1992, and the initial findings and complaints of chest pain disability weighs against the claim. See Maxson v. Gober, 230 F.3d at 1330. The Board has considered the Veteran's contention that a relationship exists between his chest pain disability and his period of service in the Persian Gulf. In adjudicating this claim, the Board must assess the Veteran's competence and credibility. See Buchanan v. Nicholson, 451 F.3d at 1331; Washington v. Nicholson, 19 Vet. App. at 368- 69. In Barr v. Nicholson, 21 Vet. App. at 303, the Court emphasized that lay testimony is competent if it is limited to matters that the witness has actually observed and is within the realm of the witnesses' personal knowledge. See also 38 C.F.R. § 3.159(a)(2). In this capacity, the Board finds that while the Veteran is competent to attest to his symptomatology related to his chest pain disability, however, he is not competent to provide an opinion that he has a chest pain disorder due to service, to include his service in the Persian Gulf, as he does not have the requisite medical expertise. A chest pain disorder was not diagnosed during the Veteran's period of service in the Persian Gulf and complaints of chest pain were not noted until late 1993, more than one year after his discharge from active service. There was no suggestion that chest pain began in service and the Veteran's contentions are outweighed by the subjective complaints documented in post-service treatment records that his chest pain symtoms began over one year after separation from his Gulf War service. The negative clinical and documentary evidence post service for over one year after his Gulf War service is more probative than the remote assertions of the Veteran. The lack of continuity of treatment may bear in a merits determination on the credibility of the evidence of continuity of symptoms by lay parties. Savage v. Gober, 10 Vet. App. at 496. In sum, the Board is left with no documented complaints or findings of a diagnosed chest pain disorder in service, no documented subjective complaints of chest pain symtoms until approximately two years after his Persian Gulf service, and no documented objective findings of chest pain symtoms until approximately 2 years after his discharge from service in the Persian Gulf, Under these circumstances, the Board is unable to find that there is a state of equipoise of the positive evidence and negative evidence. The preponderance of the evidence now of record is against the Veteran's claim of service connection for a disorder manifested by chest pain. K. A Disorder Manifested by Shortness of Breath The Veteran also claims service connection for a disorder manifested by shortness of breath. Private medical records dated in September 2001 show that the Veteran was treated for asthma with bronchitis. A May 2002 private medical record indicates that he was seen for follow up of an emergency room visit when he had dizziness and shortness of breath that the physician thought was similar to prior anxiety attacks. In September 2002, he was treated for pneumonia. In February 2003, he was noted to have chest pain related to reactive airway disease. In June 2003, the Veteran complained of breathing difficulty. June and November 2003 chest x-rays revealed evidence of prior granulomatous disease. In order to establish service connection for his claimed disability due to an undiagnosed illness, the legal criteria provide, in pertinent part, that the illness or symptoms not be attributable to any known clinical diagnosis by history, physical examination, and/or laboratory tests. 38 C.F.R. § 3.317. While acknowledging the Veteran's complaints of shortness of breath symtoms since serving in the Gulf War, such symptoms have been attributed to asthma with bronchitis, reactive airway disease, and prior granulomatous disease, and thus service connection for a disability manifested by shortness of breath due to an undiagnosed condition is not warranted. The Board has also considered the Veteran's claim of entitlement to service connection for a disorder manifested by shortness of breath under a direct theory of entitlement. Service treatment records show that, in November 1985, the Veteran was treated for complaints of congestion in his chest. Objectively, there was slight wheezing noted in his left lung and he was assessed with having a cold and possible allergy. In December 1987, he was treated for an upper respiratory infection and, in January 1989, a possible upper respiratory virus was noted. In November 1990, the Veteran was treated for an upper respiratory infection with a need to rule out strep. Post service, private medical records show that, in September 2001, the Veteran was seen in a hospital emergency room for complaints of chest pain for approximately one week. He had some dyspnea. Upon evaluation, the diagnosis was asthma with bronchitis. Results of a chest x-ray taken at the time revealed old granulomatous disease. A September 2002 private medical record indicates that the Veteran was treated for pneumonia. Private medical records, dated in February 2003, reveal that the Veteran was treated for chest pain possibly related to reactive airway disease and, in March 2003, for chest pain that he attributed to his running out of medication, Prilosec. Results of an echocardiogram and exercise stress test performed in April 2003 were normal. June 2003 private hospital records show that, on June 24th, the Veteran was seen in the emergency room with an episode of feeling short of breath while driving. He started to cough and came to the hospital. It was noted that he was seen multiple times in the past for chest pain and breathing difficulty. He felt fine during the interview. He smoked one or two packs of cigarettes a day depending on his anxiety level and was very anxious recently. He had a history of asthma and used an albuterol inhaler at home. The Veteran said he often had episodes of feeling short of breath and breathing heavily and denied syncope. He felt dizzy and light-headed when breathing heavily. Upon evaluation, the diagnosis was cough and chest wall pain. He was advised to stop smoking and seek outpatient treatment for anxiety management. Results of chest x-rays performed in June and November 2003 revealed evidence of prior granulomatous disease. The October 2003 VA examination report indicates that the Veteran reported having shortness of breath for about two years, when he slept and when he was awake. He said it sometimes just happened, although he felt better in the past three months. Objectively, examination of his respiratory system revealed no cough or expectoration and no tachypnea or hyperpnea. On percussion, his lungs were resonant. On auscultation, breath sounds were vesicular without rales or ronchi. A disorder manifested by shortness of breath was not diagnosed. November 2003 private medical records indicate that the Veteran was treated for atypical chest pain, chest wall pain, and anxiety. The records note a past medical history of asthma. December 2003 VA medical records show that the Veteran reported having shortness of breath and left anterior chest pain suggestive of costochondritis. Results of pulmonary function tests performed at that time revealed findings suggestive of mild airflow limitation. October 2004 VA medical records include the Veteran's complaints of wheezing that seem to have resolved. He became agitated when the clinic physician would not prescribe antibiotics and seemed paranoid. It was noted that the Veteran needed a mental health referral but refused and became angry and violent when that was mentioned. There is no medical evidence reflecting complaints of shortness of breath prior to 2001, at least 9 years after the Veteran's separation from active service in the Persian Gulf. The Board finds an absence of any subjective complaints of shortness of breath for nearly 9 years after separation from his Persian Gulf service. The lack of any evidence of shortness of breath symtoms for many years between his period of active duty, and the initial findings and complaints of asthma and reactive airway disease weighs against the claim. See Maxson v. Gober, 230 F.3d at 1330. The Board has considered the Veteran's contention that a relationship exists between his shortness of breath and his period of service in the Persian Gulf. In adjudicating this claim, the Board must assess the Veteran's competence and credibility. See Buchanan v. Nicholson, 451 F.3d at 1331; Washington v. Nicholson, 19 Vet. App. at 368-69. See also Barr v. Nicholson, 21 Vet. App. at 303; 38 C.F.R. § 3.159(a)(2). In this capacity, the Board finds that while the Veteran is competent to attest to his symptomatology related to his shortness of breath, however, he is not competent to provide an opinion that his shortness of breath is due to service, to include his service in the Persian Gulf, as he does not have the requisite medical expertise. Shortness of breath was not noted during his period of service in the Persian Gulf and despite his contentions that he had experienced shortness of breath since such service, he told a private examiner in September 2001 that such chest pain and dyspnea had begun approximately one week prior, not right after his Persian Gulf service. The Board finds the Veteran's statements offered to a medical examiner for purposes of receiving medical treatment to be more credible, than statements offered later in support of his claim for compensation. The Veteran's contentions are outweighed by the subjective complaints documented in post-service treatment records that his shortness of breath began approximately 9 years after separation from his Gulf War service, and no medical evidence that his asthma and reactive airway disease were incurred in active service. The negative clinical and documentary evidence post service for approximately 9 years after his Gulf War service is more probative than the remote assertions of the Veteran. The lack of continuity of treatment may bear in a merits determination on the credibility of the evidence of continuity of symptoms by lay parties. Savage v. Gober, 10 Vet. App. at 496. In sum, the Board is left with no documented complaints or findings of shortness of breath in service, no documented subjective complaints of shortness of breath until approximately 9 years after his Persian Gulf service, and no documented objective findings of asthma until 2001 until approximately 9 years after his service in the Persian Gulf. Under these circumstances, the Board is unable to find that there is a state of equipoise of the positive evidence and negative evidence. The preponderance of the evidence now of record is against the Veteran's claim of service connection for a disorder manifested by shortness of breath. L. A Disorder Manifested by Obstructive Sleep Apnea and Sleep Disturbance The Veteran seeks service connection for obstructive sleep apnea and sleep disturbance. In his March 2004 NOD, he said he repeatedly told treating physicians of his fatigue. The October 2003 VA examination report indicates that the Veteran underwent a sleep study a year earlier that was positive. A December 2003 VA medical record shows that results of a sleep study were compatible with moderately severe obstructive sleep apnea. A March 2004 VA medical record includes an impression of moderately severe obstructive sleep apnea. In order to establish service connection for his claimed disability due to an undiagnosed illness, the legal criteria provide, in pertinent part, that the illness or symptoms not be attributable to any known clinical diagnosis by history, physical examination, and/or laboratory tests. 38 C.F.R. § 3.317. While acknowledging the Veteran's complaints of sleep disturbance and fatigue since serving in the Gulf War, such symptoms have been attributed to obstructive sleep apnea and, thus, service connection for sleep apnea and sleep disturbance due to an undiagnosed condition is not warranted. The Board has also considered the Veteran's claims of entitlement to service connection for sleep apnea and sleep disturbance under a direct theory of entitlement. Service treatment records are devoid of any complaints or diagnosis of fatigue, sleep disturbance or, for that matter, any complaints related to sleep apnea. Post service, the December 1992 VA medical record does not reflect symptoms of fatigue. Private medical records show that, in September 2002, the Veteran said he was diagnosed with sleep apnea but did not follow up for treatment. In October 2003, the Veteran told the VA examiner that he was evaluated for sleep apnea the previous year and findings were positive. The March 2004 VA medical record reflects a diagnosis of moderately severe obstructive sleep apnea. In October 2004, records indicate that the Veteran needed a referral to his primary care physician for management of sleep apnea. There is no medical evidence reflecting complaints of sleep apnea prior to September 2002 that constitutes a 10 year period after his separation from active service in the Persian Gulf. The Board finds an absence of any subjective complaints of sleep apnea for nearly 10 years after separation from his Persian Gulf service or of persistent symptoms of sleep difficulty between service-discharge and 2002, and an absence of any objective evidence of sleep difficulty for more than 10 years after discharge from his Persian Gulf service. The lack of any evidence of continuing sleep disturbance for many years between his period of active duty, and the initial findings and complaints of sleep apnea weighs against the claim. See Maxson v. Gober, 230 F.3d at 1330. The Board has considered the Veteran's contention that a relationship exists between his sleep apnea and his period of service in the Persian Gulf. In adjudicating this claim, the Board must assess the Veteran's competence and credibility. See Buchanan v. Nicholson, 451 F.3d at 1331; Washington v. Nicholson, 19 Vet. App. at 368- 69. See also Barr v. Nicholson, 21 Vet. App. at 303; 38 C.F.R. § 3.159(a)(2). In this capacity, the Board finds that while the Veteran is competent to attest to his symptomatology related to his sleep apnea, fatigue, and sleep disturbance, however, he is not competent to provide an opinion that his sleep disturbance, fatigue, and sleep apnea are due to service, to include his service in the Persian Gulf, as he does not have the requisite medical expertise. Neither sleep apnea nor sleep disturbance or fatigue were noted during his period of service in the Persian Gulf and despite his contentions that he had experienced sleep disturbance and fatigue since such service, he did not mention having sleep disturbance and fatigue to an examining physician until 2002. The Veteran's contentions are outweighed by the subjective complaints documented in post-service treatment records that his sleep disturbance began approximately 10 years after separation from his Gulf War service. The negative clinical and documentary evidence post service for approximately 10 years after his Gulf War service is more probative than the remote assertions of the Veteran. Savage v. Gober, 10 Vet. App. at 496. In sum, the Board is left with no documented complaints or findings of sleep disturbance, fatigue, or sleep apnea in service, no documented subjective complaints of sleep disturbance until approximately 10 years after his Persian Gulf service, no documented objective findings of sleep apnea until approximately 10 years after his service in the Persian Gulf, and VA medical records to the effect that his fatigue and sleep disturbance is due to sleep apnea, that was also not shown in service. Under these circumstances, the Board is unable to find that there is a state of equipoise of the positive evidence and negative evidence. The preponderance of the evidence now of record is against the Veteran's claim of service connection for fatigue, sleep apnea, and sleep disturbance. M. A Neck Disorder The Veteran also seeks service connection for a neck disorder During the October 2003 VA examination, the Veteran reported neck pain and the examiner noted that the Veteran had mild hypertrophic degenerative osteophytosis of the cervical spine at C5-C6, by x-ray. In order to establish service connection for his claimed disability due to an undiagnosed illness, the legal criteria provide, in pertinent part, that the illness or symptoms not be attributable to any known clinical diagnosis by history, physical examination, and/or laboratory tests. 38 C.F.R. § 3.317. While acknowledging the Veteran's complaints of neck pain since serving in the Gulf War, such symptom has been attributed to mild hypertrophic degenerative osteophytosis of the cervical spine at C5-C6 and, thus, service connection for a neck disorder due to an undiagnosed condition is not warranted. The Board has also considered the Veteran's claim of entitlement to service connection for a neck disorder under a direct theory of entitlement. Service medical records show that, in December 1985, the Veteran complained of neck pain and was assessed with a stiff neck. In October 1988, he was assessed as having a possible pinched nerve and a stiff neck. An October 1989 periodic examination report is not referable to a neck disorder. Post service, the December 1992 VA medical records include the Veteran's complaint of cervical spine and neck pain. Results of x-rays of the Veteran's cervical spine performed by VA in June 1994 revealed no abnormality. April 2003 private medical records show that the Veteran complained of neck pain and was assessed as having cervical paresthesia. The October 2003 VA examiner said that x-rays showed mild hypertrophic degenerative osteophytosis of the cervical spine at C5, C6. November 2003 private medical records indicate that the Veteran complained of shoulder and neck pain and was assessed with atypical chest pain and chest wall pain. Results of x-rays of the Veteran's cervical spine taken by VA in December 2003 include mild hypertrophic degenerative spurring at the anterior margin of the C5-6 disk and otherwise normal cervical spine films. Although the Veteran reported having cervical spine and neck pain in December 1992, results of x-rays of his cervical spine taken in June 1994 were normal and there is no medical evidence reflecting subsequent complaints of a neck disorder prior to April 2003 that is an 11 year period after his separation from active service in the Persian Gulf. The Board finds an absence of any subjective complaints of neck problems for over 11 years after separation from his Persian Gulf service or of persistent symptoms of neck problems between service-discharge and 2003, and an absence of any objective evidence of neck problems for over 11 years after discharge from his Persian Gulf service. The lack of any evidence of continuing neck problems for many years between his period of active duty, and the initial findings and complaints of neck problems weighs against the claim. See Maxson v. Gober, 230 F.3d at 1330. The Board has considered the Veteran's contention that a relationship exists between his neck problems and his period of service in the Persian Gulf. In adjudicating this claim, the Board must assess the Veteran's competence and credibility. See Buchanan v. Nicholson, 451 F.3d at 1331; Washington v. Nicholson, 19 Vet. App. at 368- 69. See also Barr v. Nicholson, 21 Vet. App. at 303; 38 C.F.R. § 3.159(a)(2). In this capacity, the Board finds that while the Veteran is competent to attest to his symptomatology related to his neck problems; however, he is not competent to provide an opinion that his neck problems are due to service, to include his service in the Persian Gulf, as he does not have the requisite medical expertise. Neck problems were not noted during his period of service in the Persian Gulf and medical findings that show that his neck problems are associated with mild hypertrophic degenerative osteophytosis of the cervical spine at C5, C6 diagnosed in 2003. The negative clinical and documentary evidence post service for approximately 11 years after his Gulf War service is more probative than the remote assertions of the Veteran. The lack of continuity of treatment may bear in a merits determination on the credibility of the evidence of continuity of symptoms by lay parties. Savage v. Gober, 10 Vet. App. at 488. In sum, the Board is left with no documented complaints or findings of neck problems in service, no documented subjective complaints of neck problems until approximately 11 years after his Persian Gulf service, no documented objective findings of neck problems until approximately 11 years after his service in the Persian Gulf, and VA medical records to the effect that his neck problems are associated with mild hypertrophic degenerative osteophytosis of the cervical spine at C5, C6, that was also not shown in service. Under these circumstances, the Board is unable to find that there is a state of equipoise of the positive evidence and negative evidence. The preponderance of the evidence now of record is against the Veteran's claim of service connection for a neck disorder. Undiagnosed Disability While complaints of low back pain, tremor, blurred vision and dizziness have not been attributed to known diagnoses, they have not been manifested by objective signs or symptoms that are manifested to a compensable degree. Other than complaints, physical examinations have been normal and the criteria for being an undiagnosed disability have not been met. All Claimed Disorders While the Veteran maintains that he has a psychiatric disorder, sleep apnea, GERD and hiatal hernia, disorders manifested by low back pain, numbness and tingling of the arms and face, tremor, blurred vision, dizziness, fatigue, chest pain, shortness of breath, fatigue and sleep disturbance, and a neck disorder, as a lay person he has not been shown to be capable of making medical conclusions, thus, his statements regarding diagnoses and causation are not competent. 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). Although the Veteran is competent in certain situations to provide a diagnosis of a simple condition such as a dry skin on his hands, he is not competent to provide evidence as to more complex medical questions, as is the case here. See Woehlaert v. Nicholson, 21 Vet. App. at 456. A clear preponderance of the objective and probative medical evidence of record is against the Veteran's claims for service connection for a psychiatric disorder, sleep apnea GERD and hiatal hernia, disorders manifested by low back pain, numbness and tingling of the arms and face, tremor, blurred vision, dizziness, fatigue, chest pain, shortness of breath, fatigue and sleep disturbance, and a neck disorder, and his claims must be denied. The benefit-of-doubt rule does not apply when the Board finds that a preponderance of the evidence is against the claims. Ortiz v. Principi, 274 F. 3d 1361, 1365 (Fed. Cir. 2001) CONTINUED ON NEXT PAGE ORDER Service connection for a psychiatric disorder variously claimed as depression, anxiety, panic attacks, bipolar disorder, and personality disorder, including as a qualifying chronic disability under 38 C.F.R. § 3.317, is denied. Service connection for GERD and hiatal hernia, including as a qualifying chronic disability under 38 C.F.R. § 3.317, is denied. Service connection for a disorder manifested by low back and neck pain, including as a qualifying chronic disability under 38 C.F.R. § 3.317, is denied. Service connection for a disorder manifested by numbness and tingling of the arms and face, including as a qualifying chronic disability under 38 C.F.R. § 3.317, is denied. Service connection for a disorder manifested by dizziness, blurred vision, and tremor, including as a qualifying chronic disability under 38 C.F.R. § 3.317, is denied. Service connection for a disorder manifested by chest pain, including as a qualifying chronic disability under 38 C.F.R. § 3.317, is denied. Service connection for a disorder manifested by shortness of breath, including as a qualifying chronic disability under 38 C.F.R. § 3.317, is denied. Service connection for fatigue, obstructive sleep apnea, and sleep disturbance, including as a qualifying chronic disability under 38 C.F.R. § 3.317, is denied. ____________________________________________ THOMAS J. DANNAHER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs