Citation Nr: 1304737 Decision Date: 02/08/13 Archive Date: 02/19/13 DOCKET NO. 08-06 041 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas THE ISSUES 1. Entitlement to service connection for residuals of a left eye injury, claimed as traumatic iritis of the left eye. 2. Entitlement to service connection for syncope. 3. Entitlement to service connection for anemia. REPRESENTATION Veteran represented by: Disabled American Veterans ATTORNEY FOR THE BOARD C. Kedem, Counsel INTRODUCTION The Veteran served on active duty from May 1979 to August 2007. This matter comes before the Board of Veterans' Appeals (Board) from an October 2007 rating decision by which the RO, in pertinent part, denied entitlement to service connection for the disabilities enumerated above. In June 2008, the Veteran presented testimony before a Decision Review Officer (DRO) at a hearing held at the RO. The hearing transcript is of record. In June 2011, the Board remanded this case for further evidentiary development. Pursuant to the remand order, updated VA treatment records from the Temple VA Medical Center (VAMC) dated from September 2007 to August 2012 were obtained and the Veteran was afforded with medical examinations for his claimed disorders in September 2011. An addendum medical opinion was provided by the VA eye examiner in November 2011 after review of the claims file. The Veteran's claims were subsequently readjudicated in August 2012. In consideration of the foregoing, and because notice and assistance provisions have been satisfied, the Board finds that the case is now ready for disposition. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998), where the Board's remand instructions were substantially complied with), aff'd, Dyment v. Principi, 287 F.3d 1377 (Fed. Cir. 2002). The Board has reviewed the Veteran's physical claims file, as well as the Veteran's electronic file on the "Virtual VA" system, to ensure a complete review of the evidence in this case. FINDINGS OF FACT 1. The evidence does not reflect current residuals of an in-service left eye injury, and a disability of the left eye is not shown to be causally related to the Veteran's active duty service. 2. The Veteran is not shown to be suffering currently from a syncopal disorder. 3. The Veteran is not shown to be suffering currently from anemia. CONCLUSIONS OF LAW 1. The criteria for service connection for residuals of a left eye injury, claimed as traumatic iritis of the left eye, are not met. 38 U.S.C.A. §§ 1101, 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). 2. The criteria for service connection for syncope are not met. 38 U.S.C.A. §§ 1101, 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). 3. The criteria for service connection for anemia are not met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Standard of Review After the evidence has been assembled, it is the Board's responsibility to evaluate the entire record. 38 U.S.C.A. § 7104(a) (West 2002). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102 (reasonable doubt to be resolved in veteran's favor). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the Court stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Veterans Claims Assistance Act of 2000 (VCAA) VCAA and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). The notice requirements of the VCAA require VA to notify the claimant of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, the VA will attempt to obtain. The Board notes that a "fourth element" of the notice requirement requesting the claimant to provide any evidence in the claimant's possession that pertains to the claim was removed from the language of 38 C.F.R. § 3.159(b)(1). See 73 Fed. Reg. 23,353-356 (April 30, 2008). The United States Court of Appeals for Veterans Claims (Court) issued a decision in the appeal of Dingess v. Nicholson, 19 Vet. App. 473 (2006), which held that the notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service-connection claim, including the degree of disability and the effective date of an award. Those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between a veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. In a timely notice supplied to the Veteran in conjunction with the claim and before service separation, the Veteran received notice regarding what information and evidence is needed to substantiate a claim for service connection as well as what information and evidence must be submitted by the Veteran, what evidence VA would obtain, and of what assistance the VA could provide the Veteran in obtaining this evidence. The notice included provisions for disability ratings and for the effective date of the claim. In March 2007 (i.e., prior to retiring from active service), the Veteran acknowledged in a signed statement that he had been notified of the evidence and information needed to substantiate his claims and had no other information or evidence to provide in support of his claims. Thus, VCAA notice requirements were fully satisfied prior to the initial denial of the Veteran's claims. With regard to the duty to assist, the Board is satisfied that VA has made reasonable efforts to obtain relevant records and evidence. The information and evidence that has been associated with the claims file includes the Veteran's service treatment records, post-service private treatment records, VA treatment records, and the Veteran's statements to include his January 2008 hearing testimony. The Veteran was also afforded with VA medical examinations in connections with the claims. 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159(c)(4). To that end, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that the examinations provided in connection with the issues on appeal are adequate for the purpose of deciding the issues of service connection for residuals of a left eye disability, syncope, and anemia. The examination reports contain sufficient information, to include that supplied by the Veteran, for a determination that the disabilities at issue herein did not have their onset in service, that anemia did not manifest to a compensable degree within one year of service, and that symptoms of the disabilities at issue herein were not continuous since service. The examination reports, together with other evidence of record, also contain sufficient information to conclude that there is no nexus between any left eye disability and service and there is no current disability of anemia or manifested by syncope. For these reasons, the Board finds that VA has fulfilled the duties to notify and assist the Veteran. Law and Regulations Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 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). Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Court has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). Where a veteran who served for ninety days or more during a period of war (or during peacetime service after December 31, 1946) develops certain chronic diseases, such as primary anemia, to a degree of 10 percent or more within one year from separation from service, such diseases may be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 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 as such are not diseases or injuries within the meaning of applicable legislation. 38 C.F.R. § 3.303(c). In the absence of superimposed disease or injury, service connection may not be allowed for refractive error of the eyes, including myopia, presbyopia and astigmatism, even if visual acuity decreased in service, as this is not a disease or injury within the meaning of applicable legislation relating to service connection. 38 C.F.R. §§ 3.303(c), 4.9 (2012); VA Manual M21-MR1, Part III, Subpart IV, Chapter 4, Section B, Para. 10(d). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67 (1997); Layno v. Brown, 6 Vet. App. 465 (1994); Cartwright v. Derwinski, 2 Vet. App. 24 (1991) (although interest may affect the credibility of testimony, it does not affect competency to testify). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465. The Board is charged with the duty to assess the credibility and weight given to evidence. Wensch v. Principi, 15 Vet. App. 362, 367 (2001); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board may weigh the absence of contemporaneous medical evidence against the lay evidence in determining credibility, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the veteran's claims file. Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). The Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). Medical evidence that is speculative, general or inconclusive in nature cannot support a claim. Obert v. Brown, 5 Vet. App. 30, 33 (1993); see also Beausoleil v. Brown, 8 Vet. App. 459, 463 (1996); Libertine v. Brown, 9 Vet. App. 521, 523 (1996). A physician's statement framed in terms such as "may" or "could" is not probative. See Warren v. Brown, 6 Vet. App. 4, 6 (1993). A significant factor to be considered for any opinion is the accuracy of the factual predicate, regardless of whether the information supporting the opinion is obtained by review of medical records or lay reports of injury, symptoms and/or treatment. See Harris v. West, 203 F.3d 1347, 1350-51 (Fed. Cir. 2000) (examiner opinion based on accurate lay history deemed competent medical evidence in support of the claim); Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005) (holding that a medical opinion cannot be disregarded solely on the rationale that the medical opinion was based on history given by the veteran); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. The Board has reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by a veteran or obtained on a veteran's behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Discussion Residuals of a left eye injury, claimed as traumatic iritis of the left eye A July 1984 service treatment record reveals that the Veteran was hit in the left eye and mild traumatic iritis was assessed. In a November 1986 report of medical history, the Veteran denied eye trouble. In an April 1991 report of medical history, the Veteran again denied eye trouble. The Veteran also denied eye trouble in an August 1995 report of medical history. That month, myopia was noted, and the Veteran was given a prescription for glasses. In October 1996, probable vernal conjunctivitis was diagnosed. A June 2002 optometry report revealed only myopia. In April 2004, the Veteran reported loss of vision and indicated that he wore contact lenses or glasses. In May 2004, the Veteran underwent photorefractive keratectomy (PRK) surgery to correct his vision. The service treatment records note an episode of iritis in 2004. A July 2004 medical notation reflects that idiopathic iritis had resolved. A November 2005 screening showed uncorrected distance vision of 20/20. On November and December 2006 post-deployment health assessments, the Veteran expressly denied redness of the eyes with tearing. In a March 2007 post-deployment assessment, the Veteran indicated dimming of vision but denied redness of the eyes with tearing. In a February 2007 report of medical history, the Veteran indicated eye trouble, and the examiner noted periodic blurred left eye vision. In the corresponding medical examination report, an abnormality of the eyes was noted, namely reduced right eye vision. An April 2007 VA eye examination revealed a diagnosis of status-post bilateral PRK with good results, monovision secondary to the foregoing, and a history of limbal folliculitis in 1996 that was felt to be secondary to vernal conjunctivitis. At his January 2008 DRO hearing, the Veteran testified that he started having left eye trouble in approximately 1990, when his left eye was hit by a tree limb. He testified that he had blurred vision and tearing of the left eye since that time and that he still experienced tearing. He indicated that his major complaint regarding the left eye was the excessive production of tears. The Veteran submitted a June 2008 brief medical notation from TG. M.D. indicating left eye epiphora secondary to partial dacryostenosis (i.e., blocked tear duct). In September 2011, the Veteran was afforded with a VA eye examination. At that time, the Veteran reported that his vision, both near and distant, was not as clear as it had been in the past. He also reported blurred vision once or twice a day, which was relieved by rubbing the eyes and taking eye lashes out of the eyes, as well as wearing prescription eye glasses mostly at night. He stated that his current ophthalmologic treatment was artificial tears. After considering the symptomatology described and medical history provided by the Veteran and eye examination results, the examiner diagnosed status post PRK while in the military, monovision (myopia of the right eye), anisometropia of 2 diopters, bilateral pingueculae secondary to sun exposure, asthenopia secondary to anisometropia, dry eyes bilaterally, and presbyopia. In providing a medical opinion, the examiner wrote that she found no ocular pathology of the left eye only. The examiner noted that the Veteran was 20/20 distance with the left eye and needed reading glasses due to presbyopia or loss of accommodative amplitude which was caused by aging, not by military service or injury. The examiner then noted that all of the other conditions found were bilateral and could not be explained by injury to the left eye. The examiner further wrote that there was no evidence of partial blockage of the nasolacrimal duct supposedly found by a private eye physician and, if there were, there would be a higher tear meniscus on the left eye as compared to the right eye. The examiner noted that it was not found. She then noted that when she previously reviewed the Veteran's military medical records, she did not find a diagnosis of iritis and found no signs of iritis in the past and solicited no history consistent with acute iritis. The examiner then added that she asked the Veteran multiple times regarding any concerns pertaining to his eyes and he was very calm and unconcerned with his eyes and realized that he may need glasses due to his age. In a November 2011 addendum to the September 2011 VA eye examination report completed after the examiner reviewed the claims file, the examiner noted an assessment of history of traumatic iritis of the left eye in 1984, which was fully resolved without problems and noting that the Veteran had reported "No" on subsequent reports of medical history in service. The examiner also noted that the Veteran's history of iritis (of the right eye greater than the left) in 2004 showed negative work-up and resolution six weeks after the PRK. She further noted the Veteran's history of chalazion, conjunctivitis affecting the right eye, the PRK surgery in 2004, and the 2008 note from the Veteran's optometrist showing epiphora from partial dacryostenosis without any details or test results and not seen on the current examination. After considering the documentation contained in the claims folder, the examiner wrote that there was no change in the prior assessment or medical opinion except that as noted in the assessment above. She wrote that there were no current sequelae of left eye iritis in 1984 or bilateral iritis in 2004. The examiner further noted that there was no evidence of partial obstruction of the tear drainage system on examination. Eye disorders are generally complex in nature and require advanced medical knowledge in order to diagnose. As such, the Veteran, who has no medical expertise, is not competent to diagnosis eye disorders or comment upon their etiology. Duenas v. Principi, 18 Vet. App. 512, 520 (2004); see also Routen v. Brown, 10 Vet. App. 183, 186 (1997) (holding that a layperson is generally not capable of providing opinions on matters requiring medical knowledge). The Veteran asserts that he has a left eye disability resulting from in-service injury. While the service treatment records do reflect a left eye injury, the injury is not shown to have occurred as a result of being hit by a tree limb, as the Veteran has contended. Rather, a July 1984 record of acute medical care shows that the Veteran was actually hit in the left eye by another individual's hand. As the notation was made at the time of treatment for the injury in service, it is deemed more credible in its report of the circumstances the injury and is afforded more probative value than the Veteran's more recent account of being injured by a tree limb first made many years after service. Regardless, the evidence does not show that a chronic disability resulted as a result of the injury. The Veteran repeatedly checked "No" when asked if he then had or ever had had eye problems when completing service reports of medical history for many years after the 1984 in-service left eye injury, and the record does not reflect any residuals related to the 1984 left eye injury. The competent medical evidence reflects unequivocally that iritis resolved. There has been no diagnosis of iritis after service separation, and the September 2011 VA examiner indicated that there were no sequelae related to the two episodes of in-service iritis in the addendum medical opinion. Although the Veteran testified at the DRO hearing that he started having left eye trouble approximately in 1990 when his left eye was hit by a tree limb, and subsequently had blurred vision and excessive tearing of the left eye during service, his assertion is not deemed credible. As stated above, the injury occurred in 1984, not 1990. The Veteran repeatedly denied having eye trouble on service reports of medical history and post-deployment assessments completed after the 1984 injury. No service medical examiner found that he suffered from any residuals due to the injury, and the September 2011 VA eye examiner found no current residuals. Because the Veteran's hearing testimony is inconsistent with the medical evidence, as well as his own statements made during service after the injury, it is not deemed credible and is afforded no probative weight. The weight of the evidence is against finding that the Veteran has any left eye disability resulting from an injury in service. There being no present left eye injury residuals, service connection for the claimed disability is denied. 38 C.F.R. § 3.303; Shedden, supra; Brammer, supra. The Board also finds no left eye disability manifested by tearing became chronic in service. As stated above, the Veteran explicitly denied tearing and/or eye trouble over many years in service to include on post-deployment forms completed not long before service separation. Furthermore, the Board finds no continuity of symptomatology of left eye tearing between service separation and the present, as no tearing was noted on service separation or on VA examination in April 2007, completed very shortly before the Veteran separated from service and because no tearing was noted until June 2008, almost a year after service separation. Finally, the Board finds no competent and credible evidence of a current left eye disability manifested by tearing that is otherwise related to service. While epiphora was noted in June 2008, the record contains no competent evidence relating it to service. In fact, the September 2011 VA examiner found no sign of obstruction of the tear drainage system on examination and pointed out that the 2008 diagnosis was unsupported by any details or test results. Moreover, the Board notes that the Veteran voiced complaints of dry eyes as opposed to tearing at the September 2011 eye examination. Consequently, as the evidence does not show a chronic left eye disability manifested by tearing in service, no continuity of symptomatology between service separation and the present, and no competent evidence linking such a disability to service, there is no basis upon which to grant service connection for a left eye disability manifested by tearing. See generally 38 C.F.R. § 3.303. To the extent that the Veteran has refractive error of the left eye, no additional disability due to superimposed injury or disease is shown. 38 C.F.R. § 3.303(c). The record reflects no other disability affecting the left eye for which service connection is available that is related to service. The Board notes that the Veteran does suffer from bilateral pingueculae, which has been said to be secondary to sun exposure. It has not, however, been linked to sun exposure in service, and the Veteran has made no argument in this regard. The September 2011 VA eye examiner found no current left eye disability related in any way to the Veteran's period of active service and her medical opinion is afforded great probative weight in resolving the medical question at issue. In short, the Board finds that the probative evidence does not reflect any residual of left eye injury that is related to service and no other left eye disability that is related to service. In making this determination, the Board has considered the provisions of 38 U.S.C.A. § 5107(b), but there is not such a state of approximate balance of the positive evidence with the negative evidence to otherwise warrant a favorable decision. Syncope According to statements of record to include the January 2008 DRO hearing testimony, the Veteran alleges that he suffered from an episode of syncope in service and that he has had occasional episodes of dizziness and lightheadedness since the 1990's. The service treatment records reflect an episode of acute syncope in March 2005 when the Veteran was attending a memorial service for a fallen soldier. On November 2006 post-deployment health assessment, the Veteran expressly denied dizziness, lightheadedness, and fainting. In a March 2007 post-deployment assessment, the Veteran again denied dizziness, fainting, and lightheadedness. In a report of medical history completed in February 2007, the Veteran denied dizziness and fainting spells. The subsequent medical examination report revealed no diagnosis of syncope or symptoms consistent with a syncopal disorder. In April 2007, the Veteran was afforded a VA medical examination. As to syncope, the Veteran reported an episode of dizziness pursuant to which he fainted in 2005. The Veteran denied current problems with syncope. The examiner diagnosed syncope, resolved. A June 2008 private medical notation reveals that the Veteran sought treatment for syncope and that further evaluation was necessary. The Veteran was afforded another VA medical examination in September 2011. The examiner indicated that a review of the record revealed no significant abnormal cardiac findings. The examination report also reveals that the examiner conducted a thorough examination and interview of the Veteran. The examiner found that syncope of unknown etiology had resolved and that there had been no recurrence of syncope since service separation. VA does not generally grant service connection for symptoms alone, without an identified basis for those symptoms. Here, the Veteran has reported episodes of dizziness and lightheadedness since the 1990's, although the evidence is inconsistent regarding the persistence of those symptoms. Indeed, he expressly denied those symptoms in 2006 and 2007, and on VA examination in April 2007, the Veteran denied current problems with syncope. In any event, VA needs to identify an actual disability if service connection for syncope is to be granted. See, e.g., Sanchez-Benitez v. Principi, 259 F.3d 1356 (Fed. Cir. 2001) (holding that symptoms alone, without an underlying disorder, cannot be service connected). The Veteran suffered from an acute episode of syncope in 2005, while still in service. There is no evidence of a chronic syncopal disorder in service and no additional in-service syncopal episodes are documented. Following service, a syncopal disorder was never diagnosed. On VA examination in April 2007, the diagnosis was of syncope, resolved. On VA examination in September 2011, the diagnosis was of syncope resolved, etiology unknown, with no recurrences. Although the Veteran wrote in a November 2007 statement that he had last experienced syncope earlier that month, he made no comment of having had a syncopal episode in 2007 at the September 2011 VA medical examination and, instead, only mentioned having chest pains in 2008 and subsequent testing, which was all negative, when reporting his relevant medical history since service. It stands to reason that the Veteran would have accurately reported his medical history when attending a medical examination for disability compensation purposes as it relates to the claim. The fact that he did not report having a syncopal episode in November 2007 when undergoing medical examination or medical treatment through VA, and has provided no other evidence to support his account of its occurrence, weighs heavily against his credibility as it relates to its occurrence. The Board recognizes that the Veteran is competent to report having fainting episodes (i.e., syncope). However, the account is not deemed credible. There is, in fact, no credible evidence that the Veteran has experienced syncope since service or has suffered from any disability manifested by syncope at any time since filing the claim. Absent a present disability, service connection cannot be granted. See, e.g., Brammer supra. Because no current disability manifested by syncope is shown, service connection for the claimed syncope must be denied. 38 C.F.R. § 3.303; Shedden, supra. In making this determination, the Board has considered the provisions of 38 U.S.C.A. § 5107(b), but there is not such a state of approximate balance of the positive evidence with the negative evidence to otherwise warrant a favorable decision. Anemia The Veteran contends that service connection for anemia is warranted because it was found pursuant to a blood analysis in service in 2004. At that time, in April 2004, the finding was of anemia of unknown etiology. According to his January 2008 hearing testimony, the Veteran's alleged anemia is manifested by such symptoms as fatigue and joint pain. A February 2007 medical examination report did not contain a finding of anemia. On VA examination in April 2007, the Veteran indicated that he was diagnosed with anemia during his over 40 physical in April 2004 and that it resolved on its own. Pursuant to an examination of the Veteran and a review of the claims file to include recent blood work results, the examiner diagnosed anemia, resolved. In September 2011, the Veteran was afforded another VA medical examination. The examiner reviewed the record and indicated in the examination report that the Veteran underwent complete blood counts from December 2009 to August 2011 and that none of the test results indicated anemia. The diagnosis was normal hemaglobin and hemocrit; no anemia since separation from service. The examiner then noted that no current disorder was found. At the outset, the Board observes that the Veteran is not competent to diagnose anemia or to attribute certain symptoms such as fatigue and joint pain to that diagnosis, as anemia is not given to lay observation and requires medical expertise in order to diagnose. Because the Veteran's is not competent to diagnose anemia, the Board accords his representations regarding the presence of anemia no probative value. The competent evidence of record reveals no anemia since 2004 to include no anemia since service separation. Service treatment records include no finding or treatment for anemia after 2004. Also, there has been no competent evidence of anemia since service. As stated above, the September 2011 VA medical examiner specifically noted that the complete blood counts from December 2009 to August 2011 did not once show that the Veteran was anemic. The examiner noted that the Veteran demonstrated normal hemoglobin and hemocrit. After considering the Veteran's reported symptomatology, as well as physical findings on examination and prior laboratory findings, the examiner concluded that the Veteran did not currently have anemia and had not had anemia since service separation. A prerequisite to the granting of service connection is a current disability. Brammer, supra. Because the Veteran does not suffer from anemia and has not since 2004, service connection for anemia is not warranted under any theory of entitlement, namely either directly or on a presumptive basis as a chronic disability. 38 C.F.R. §§ 3.303, 3.307, 3.309(a). Because the weight of the evidence is against the claim, the benefit of the doubt rule does not apply. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; Alemany, supra. ORDER Service connection for residuals of a left eye injury, claimed as traumatic iritis of the left eye, is denied. Service connection for syncope is denied. Service connection for anemia is denied. ______________________________________________ C. Ferguson Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs