Citation Nr: 1305000 Decision Date: 02/11/13 Archive Date: 02/21/13 DOCKET NO. 06-13 800 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Indianapolis, Indiana THE ISSUES 1. Entitlement to service connection for gastrointestinal problems, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness. 2. Entitlement to service connection for sleep apnea, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness. 3. Entitlement to service connection for skin rash, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness. 4. Entitlement to service connection for headaches, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness. REPRESENTATION Veteran represented by: The American Legion ATTORNEY FOR THE BOARD J.A. Flynn, Associate Counsel INTRODUCTION The Veteran served on active duty in the United States Army from October 1986 to February 1993. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2005 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Indianapolis, Indiana that, in relevant part, denied the Veteran's claims set forth above. In his April 2006 substantive appeal, the Veteran requested a hearing before the Board at a local regional office. In February 2007, the Veteran withdrew this request in writing and, since that time, he has not requested an additional hearing before the Board. The Veteran's request for a hearing is therefore considered withdrawn. See 38 C.F.R. § 20.704 (2012). This matter has previously been before the Board, most recently in April 2012, when it remanded the case to develop the medical evidence of record and ensure that the RO had taken appropriate steps to ensure both the completeness of the Veteran's claims file and that VA had the Veteran's correct address on file. Specifically with regard to the medical evidence of record, the Board instructed the RO to attempt to obtain additional medical records and to provide the Veteran with VA examinations of his conditions. As will be discussed in further detail below, the RO uploaded pertinent medical records to the Veteran's Virtual VA e-folder, and the Veteran was provided with examinations of his conditions in August 2012. As an initial matter, the Board notes that when its remand orders are not complied with, it errs as a matter of law when it fails to ensure compliance. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In the instant case, the Board finds that there has been effective compliance with the Board's remand instructions. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (noting that Stegall requires substantial compliance with remand orders, rather than absolute compliance.) As the Board noted in its April 2012 Remand, in January 2012, the Veteran's representative raised the issue of entitlement to an effective date prior to July 5, 2006, for the grant of service connection for myalgia and myositis, claimed as muscle and joint pain, including based on clear and unmistakable error in the May 2007 rating decision. This issue, however, has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over it and it is referred to the AOJ for appropriate action. FINDINGS OF FACT 1. The Veteran served in the Southwest Asia Theater of Operations during the Persian Gulf War. 2. The Veteran's gastrointestinal problems are a known clinical diagnosis and are not attributable to undiagnosed illness or an unexplained chronic multisymptom illness or otherwise related to the Veteran's active duty service. 3. The Veteran's sleep apnea is a known clinical diagnosis and is not attributable to undiagnosed illness or an unexplained chronic multisymptom illness or otherwise related to the Veteran's active duty service. 4. A known clinical diagnosis, acne, is assigned for the Veteran's claimed skin rash, and no skin disorder is attributable to an undiagnosed illness or an unexplained chronic multisymptom illness or otherwise related to the Veteran's active duty service. 5. The Veteran's headaches are a known clinical diagnosis and are not attributable to undiagnosed illness or an unexplained chronic multisymptom illness or otherwise related to the Veteran's active duty service. CONCLUSIONS OF LAW 1. The Veteran does not have gastrointestinal problems as the result of disease or injury incurred in or aggravated by active military service, and such condition may not be presumed to have been due to an undiagnosed illness or an unexplained chronic multisymptom illness incurred in service. See 38 U.S.C.A. §§ 1110, 1117, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.317 (2012). 2. The Veteran does not have sleep apnea as the result of disease or injury incurred in or aggravated by active military service, and it may not be presumed to have been due to an undiagnosed illness or an unexplained chronic multisymptom illness incurred in service. See 38 U.S.C.A. §§ 1110, 1117, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.317 (2012). 3. The Veteran does not have a skin rash as the result of disease or injury incurred in or aggravated by active military service, and it may not be presumed to have been due to an undiagnosed illness or an unexplained chronic multisymptom illness incurred in service. See 38 U.S.C.A. §§ 1110, 1117, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.317 (2012). 4. The Veteran does not have headaches as the result of disease or injury incurred in or aggravated by active military service, and such condition may not be presumed to have been incurred in service or presumed as due to an undiagnosed illness or an unexplained chronic multisymptom illness incurred in service. See 38 U.S.C.A. §§ 1110, 1117, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.317 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board has thoroughly reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim decided herein. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the veteran). The Board must assess the credibility and weight of all 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 claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Duty to Notify and Assist The Board has given consideration to the VCAA, which includes an enhanced duty on the part of VA to notify a veteran of the information and evidence necessary to substantiate claims for VA benefits. See 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2012); 38 C.F.R. § 3.159 (2012). The VCAA also redefines the obligations of VA with respect to its statutory duty to assist veterans in the development of their claims. See 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. See 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b) (2012); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. This notice must be provided prior to an initial unfavorable decision on a claim by the agency of original jurisdiction. See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). In addition, the notice requirements of the VCAA apply to all five elements of a service-connection claim, including: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. See Dingess v. Nicholson, 19 Vet. App. 473 (2006). Further, this notice must include information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. See id. at 486. Determinations concerning prejudicial error and harmless error should be made on a case-by-case basis. See Shinseki v. Sanders, 129 S.Ct. 1696 (2009). In the instant case, correspondence dated December 2004, March 2006, and May 2007 notified the Veteran of information and evidence necessary to substantiate the claim; information and evidence that VA would seek to provide; and information and evidence that the Veteran was expected to provide. The Veteran filed his claim prior to the Court's 2006 decision in Dingess, and as such, he was not provided with full Dingess notice at the time of the initial December 2004 VCAA letter. Instead, in March 2006, pursuant to the Court's holding in Dingess, the Veteran was provided with notice regarding the degree of disability and effective date. Additionally, since the time of the March 2006 Dingess notice, the Veteran has been provided with several readjudications of his claim, and the Board finds that there has been no prejudice to the Veteran requiring additional notice. The Board finds that the notice provisions of the VCAA have been fulfilled, and that no further notice is necessary. With respect to the duty to assist, VA has done everything reasonably possible to assist the Veteran with respect to his claim for benefits in accordance with 38 U.S.C.A. § 5103A (West 2002) and 38 C.F.R. § 3.159(c) (2012). Service treatment records have been associated with the claims file. All identified and available post-service treatment records have been secured, which include VA treatment records. Additionally, the Veteran was provided with VA examination. The examination reports indicate that the examiners reviewed the Veteran's claim file, past medical history, recorded his current complaints, conducted an appropriate evaluation, and rendered an appropriate diagnosis and opinion consistent with the remainder of the evidence of record. The Board, therefore, concludes that this examination report is adequate for the purposes of rendering a decision in the instant appeal. See 38 C.F.R. § 4.2 (2012); see also Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Neither the Veteran nor his representative has contended otherwise. There is no indication in the record that any additional evidence, relevant to the issues decided herein, is available and not part of the claims file. See 38 C.F.R. § 3.159(c)(4). The records satisfy 38 C.F.R. § 3.326. In this regard, the Board notes that the Veteran's service medical records could not be obtained from the National Personnel Records Center (NPRC). The Veteran's claims file indicates that these records are not available, since the Veteran's original claims file was lost. In May 2012, pursuant to the Board's April 2012 Remand directive, the NPRC confirmed that all available service treatment records had been provided for the Veteran. The Board recognizes its heightened duty to explain its findings and conclusions and to consider benefit of the doubt and corroborative testimony such as buddy statements in cases in which records are unavailable. See O'Hare v. Derwinski, 1 Vet. App. 365 (1991). Additionally, as will be discussed in further detail below, the Veteran has not specifically alleged that he received treatment for any of the above disabilities in service. Accordingly, the Board finds that the lack of service treatment records is minimally prejudicial to the Veteran in the instant case. In summary, the Board finds that "it is difficult to discern what additional guidance VA could have provided to the Veteran regarding what further evidence he should submit to substantiate his claim." Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004); see also Livesay v. Principi, 15 Vet. App. 165, 178 (2001) (en banc) (observing that "the VCAA is a reason to remand many, many claims, but it is not an excuse to remand all claims."); Reyes v. Brown, 7 Vet. App. 113, 116 (1994); Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (both observing circumstances as to when a remand would not result in any significant benefit to the claimant). Presumptive Service Connection, Qualifying Chronic Disability Service connection may be warranted for a Persian Gulf Veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2011. See 38 U.S.C.A. § 1117 (West 2002 & Supp. 2012); 38 C.F.R. § 3.317 (2012). Unlike service connection on a direct basis as discussed below, the provisions of 38 U.S.C.A. § 1117 and 38 C.F.R. § 3.317 do not require competent medical nexus of a link between the qualifying chronic disability and military service. Service connection is presumed unless there is affirmative evidence to the contrary. See 38 C.F.R. § 3.317(c) (2012); Gutierrez v. Principi, 19 Vet. App. 1 (2004). The term "Persian Gulf Veteran" means a veteran who, during the Persian Gulf War, served on active military, naval, or air service in the Southwest Asia theater of operations, which includes Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. See 38 C.F.R. § 3.317(d) (2012). For purposes of § 3.317, there are three types of qualifying chronic disabilities: (1) an undiagnosed illness; (2) a medically unexplained chronic multi-symptom illness; and (3) a diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C.A. § 1117(d) warrants a presumption of service connection. 38 C.F.R. § 3.317(a)(2) (2012). An undiagnosed illness is defined as a condition that by history, physical examination, and laboratory tests cannot be attributed to a known clinical diagnosis. Further, laypersons are competent to report objective signs of illness. See Gutierrez v. Principi, 19 Vet. App. 1 (2004). A medically unexplained chronic multi-symptom illness is one defined by a cluster of signs or symptoms, and specifically includes chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome. A medically unexplained chronic multi-symptom illness means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. See 38 C.F.R. § 3.317(a)(2). There are currently no diagnosed illnesses that have been determined by the Secretary to warrant a presumption of service connection under 38 C.F.R. § 3.317(a)(2)(C) (2012). Objective indications of chronic disability include both signs, in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. See 38 C.F.R. § 3.317(a)(3) (2012). Signs or symptoms that may be manifestations of undiagnosed illness or medically unexplained chronic multi-symptom illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders. See 38 C.F.R. § 3.317(b) (2012). For purposes of § 3.317, disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a six-month period will be considered chronic. The six-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. See 38 C.F.R. § 3.317(a)(4) (2012). Compensation shall not be paid under § 3.317 if there is affirmative evidence that an undiagnosed illness was not incurred during active military service in the Southwest Asia theater of operations during the Persian Gulf War; if there is affirmative evidence that an undiagnosed illness was caused by a supervening condition or event that occurred between the Veteran's most recent departure from active duty in the Southwest Asia theater of operations during the Persian Gulf War and the onset of the illness; or if there is affirmative evidence that the illness is the result of the Veteran's own willful misconduct or the abuse of alcohol or drugs. See 38 C.F.R. § 3.317(c) (2012). The Veteran's personnel records indicate that the Veteran served in Southwest Asia during the Persian Gulf War, and he received the Southwest Asia Service Medal with three bronze stars. Thus, the Board finds that the Veteran is a Persian Gulf Veteran for the purposes of 38 U.S.C.A. § 1117 and 38 C.F.R. § 3.317, and he could thus potentially qualify for service connection under 38 C.F.R. § 3.317. As the Board noted in its May 2010 Remand, however, the Veteran's claimed symptoms have been associated with the known diagnoses of GERD, migraine headaches, obstructive sleep apnea, and acne. As such, the Veteran's claimed conditions are not undiagnosed illnesses or indicators of unexplained multisymptom illness, and they may not be presumed related to the Veteran's service under provisions applicable to undiagnosed illness or unexplained chronic multisymptom illness. See 38 C.F.R. § 3.317 (2012). Although the Board does not doubt the sincerity of the Veteran's belief that he may have disabilities due to undiagnosed illnesses related to his service in Southwest Asia, as a lay person without the appropriate medical training or expertise, he is not competent to provide a probative opinion on a complex medical matter such as the diagnosis or etiology of a current disability, undiagnosed illness, or medically unexplained chronic multi-symptom illness. The Veteran's medical records, including the opinions of the August 2012 VA examiner, clearly arrive at medical conclusions contrary to the Veteran's claims, specifically attributing the Veteran's claimed symptoms to known clinical diagnoses that are not qualifying illnesses. See 38 C.F.R. § 3.317 (2012). The Board relies on the medical treatment providers' opinions in this case as they are based on objective evidence, their medical expertise, and the Veteran's assertions. In short, the Board finds that the Veteran's claimed symptoms have been fully attributed to clinical diagnoses that are not qualifying chronic disabilities under § 1117. Thus, the theory that the Veteran has undiagnosed illnesses or a medically unexplained chronic multi-symptom illness or qualifying chronic disability manifested by symptoms that are related to the Veteran's service in Southwest Asia does not have merit. For all the foregoing reasons, the Board finds that, to the extent that the Veteran's claims for service connection are adjudicated under 38 C.F.R. § 3.317, the claims must be denied. However, 38 C.F.R. § 3.317 is not the only basis for reviewing service connection, and the Board must consider other possible theories for service connection. Direct Service Connection In cases in which a Veteran applies for service connection under 38 C.F.R. § 3.317 but is found to have a disability attributable to a known diagnosis, further consideration under the direct service connection provisions of 38 U.S.C.A. § 1110 is warranted. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Service connection may be awarded for a "chronic" condition when a disease defined by statute or regulation as a chronic disease manifests itself and is identified as such in service (or within the presumption period under 38 C.F.R. § 3.307), and the Veteran presently has the same condition. There is a presumption, under 38 U.S.C.A. § 1101, that certain organic disorders of the nervous system manifested to a compensable degree within one year following a Veteran's service discharge are service-connected. No presumption is applicable to GERD or sleep apnea. No presumption is applicable to a skin disorder, except with respect to exposure to herbicide agents, and that presumption is not applicable in this case, as the Veteran has no Vietnam service and does not allege exposure to herbicides. Service connection may be granted for disability or injury incurred in or aggravated by active military service. See 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease initially diagnosed after service, when the evidence establishes that the disease was incurred in service. 38 U.S.C.A. § 1113(b) (West 2002); 38 C.F.R. § 3.303(d) (2012); Cosman v. Principi, 3 Vet. App. 503, 505 (1992). The disease entity for which service connection is sought must be chronic rather than acute and transitory in nature. For the showing of chronic disease in service, a combination of manifestations must exist sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic. Continuity of symptomatology is required when the condition noted during service is not shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b) (2012). To establish service connection for the Veteran's claimed disorder, there must be (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 current disability. Hickson v. West, 12 Vet. App. 247 (1999). As noted above, the first Hickson element has been met with respect to each of the Veteran's claimed conditions, that is, he has been diagnosed with GERD, sleep apnea, acne, and headaches. With respect to the third Hickson element, the relationship, if any, between the Veteran's disability and his military service, is essentially medical in nature. The Board is prohibited from exercising its own independent judgment to resolve medical questions. Colvin v. Derwinski, 1 Vet. App. 171 (1991). 1. Claim for service connection for GERD With respect to the Veteran's claim for service connection for GERD, the Veteran was provided with a VA examination in August 2012. After a physical examination of the Veteran and review of the Veteran's claims file, the examiner explained the mechanism by which GERD occurs and noted that risk factors for GERD include obesity, hiatal hernia, smoking, diabetes, delayed stomach emptying, and diet. The examiner noted that the Veteran was first diagnosed with GERD in 2005, and he first began taking medication in treatment of his GERD in 2006. The examiner noted that the claims file does not suggest that the Veteran was treated for GERD during his military service. The examiner observed no chronicity of care for GERD during the period which elapsed between the Veteran's 1993 separation from service and the 2005 medical treatment. Accordingly, the examiner found it to be less likely than not that the Veteran's GERD was related to the Veteran's active duty service. The medical opinion is more persuasive than the Veteran's statements. The medical opinion places the preponderance of the evidence against the claim. 2. Claim for service connection for sleep apnea With respect to the Veteran's claim for service connection for sleep apnea, the Veteran claimed in an April 2008 examination that he first experienced symptoms associated with sleep apnea in 1995. While the Board acknowledges the competency of the Veteran to make such an observation, the Board finds that it is not supported by the medical evidence of record; indeed, there are no medical records diagnosing the Veteran with sleep apnea until 2005. The Board therefore affords the Veteran's allegation of a 1995 onset of sleep apnea with little probative weight. The Board further notes that, since the Veteran's service separation was in 1993 and the onset of symptoms, as reported by the Veteran, was in 1995, the Veteran's report does not establish continuity and chronicity of symptoms beginning during the Veteran's service or proximate thereto. The Board further notes that sleep apnea is not identified by statute or regulation as a chronic disease for which service connection may be presumed if the disorder is manifested within the presumptive period. The Veteran was provided with a VA examination of his sleep apnea in August 2012. After a physical examination of the Veteran and review of the Veteran's claims file, the examiner noted the mechanism by which sleep apnea occurs and noted that risk factors include a lower jaw that is short compared to the upper jaw, certain shapes of the palate or airway that cause the airway to be narrower or collapse more easily, large tonsils and adenoids, large neck or collar size, a large tongue, and obesity. The examiner observed no complaints of sleep apnea in the record until 2005, at which time the Veteran was diagnosed with sleep apnea following a sleep study. The Veteran then began receiving treatment for this condition in 2006. The examiner observed no chronicity of care for sleep apnea between separation from service and 2005. Accordingly, the Veteran found it to be less likely than not that the Veteran's sleep apnea was related to the Veteran's active duty service. The medical opinion is more persuasive than the Veteran's statements. The medical opinion places the preponderance of the evidence against the claim. 3. Claim for service connection for a skin disorder With respect to the Veteran's claim for service connection for a skin condition, the Veteran was provided with a VA examination in August 2012. After a physical examination of the Veteran and review of the Veteran's claims file, the examiner noted that the Veteran reported that he started having acne breakouts during his military service in 1992. The examiner observed no records suggesting that the Veteran received care for acne in service, and no records suggesting that the Veteran began receiving treatment for acne soon after his separation from service. Instead, the Veteran was first examined for intermittent acne breakouts in 2005. The examiner observed no chronicity of care for acne between separation from service and 2005. Accordingly, the Veteran found it to be less likely than not that the Veteran's skin condition was related to the Veteran's active duty service. The medical opinion is more persuasive than the Veteran's statements. The medical opinion places the preponderance of the evidence against the claim. 4. Claim for service connection for headaches With respect to the Veteran's claim for service connection for headaches, an April 2008 examination largely addressing miscellaneous neurological disorders noted that the date of onset for the Veteran's headaches was "unclear." The examiner noted that the Veteran stated that he got headaches "frequently after the war," and he remembered experiencing headaches while in service. The examiner indicated that it would be purely speculative to opine regarding the etiology of the headaches, but he also noted that migraines are usually idiopathic or genetic. In a separate April 2008 examination, the Veteran claimed that he first experienced symptoms associated with headaches in 1995 or since returning from deployment during active service. While the Board acknowledges the competency of the Veteran to make such an observation of the date of onset of his headaches, the Board finds that such observation is not supported by the medical evidence of record; indeed, there are no medical records diagnosing the Veteran with headaches until 2005. The Board therefore affords the Veteran's allegation of a 1995 or earlier onset of headaches with little probative weight. The Veteran was provided with a VA examination of his headaches in August 2012. After a physical examination of the Veteran and review of the Veteran's claims file, the examiner noted that the Veteran's claims file contained no documentation of treatment for or complaints of headaches in service. Instead, the Veteran was first examined for headaches in 2005. The Veteran reported that he was stared on an anti-inflammatory medication to treat his headaches in 2006, but he quit taking the medication and currently took only over-the-counter aspirin as needed. The examiner observed no chronicity of care for acne between separation from service and 2005. Accordingly, the Veteran found it to be less likely than not that the Veteran's headaches were related to the Veteran's active duty service. The medical opinion is more persuasive than the Veteran's statements. The medical opinion places the preponderance of the evidence against the claim. Summary Upon review of this evidence, the Board finds that VA examiners have consistently been unable to link the Veteran's claimed disabilities with his active duty service. To the extent that the Veteran himself believes that his disabilities are related to his military service, the Board notes that the Veteran is competent to provide testimony concerning factual matters of which he has first-hand knowledge (that is, experiencing physical symptoms associated with each of his claimed disabilities). See Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). Further, under certain circumstances, lay statements may support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability, or symptoms of disability, susceptible of lay observation. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Indeed, VA provided the Veteran with examinations based on the competency of these observations. A layperson is generally not deemed competent, however, to opine on a matter that requires medical knowledge, such as the determination of etiology of a chronic disability which is not susceptible to lay observation. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Board has reviewed the Veteran's VA treatment records for any suggestion that his current disabilities are related to military service and has found none. Accordingly, with no support in the medical evidence of record that the Veteran's disabilities are related to his military service, the Board places little probative weight on the Veteran's lay opinion regarding the etiology of his condition. The Board notes that certain neurologic disorders, if manifesting within one year following service, may be presumed service-connected. However, the evidence shows that the Veteran's claimed headaches did not manifest to a level which required medical attention within one year following his service discharge. This evidence demonstrates that headaches were no manifested to a compensable degree within one year following separation from service. In reaching these conclusions, the Board finds that the preponderance of the evidence is against the claims for direct service connection and for service connection under § 1117 for a disability manifested by gastrointestinal problems, sleep apnea, skin rash, and headaches. Therefore, the claims must be denied. See 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102 (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). .+ (CONTINUED NEXT PAGE) ORDER Service connection for gastrointestinal problems, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness, is denied. Service connection for sleep apnea, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness, is denied. Service connection for skin rash, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness, is denied. Service connection for headaches, to include as due to an undiagnosed illness or an unexplained chronic multisymptom illness, is denied. ____________________________________________ TRESA M. SCHLECHT Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs