Citation Nr: 1318143 Decision Date: 06/04/13 Archive Date: 06/11/13 DOCKET NO. 08-03 271 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Denver, Colorado THE ISSUES 1. Entitlement to service connection for a sleep disorder, to include sleep apnea and narcolepsy. 2. Entitlement to service connection for a low back disc disability, to include as secondary to sleep apnea. 3. Entitlement to service connection for right inguinal hernia repair. 4. Entitlement to service connection for prostatitis. 5. Entitlement to service connection for myositis, claimed as chest pain and breathing problems. 6. Entitlement to service connection for depression. REPRESENTATION Appellant represented by: Military Order of the Purple Heart of the U.S.A. WITNESS AT HEARING ON APPEAL Veteran and spouse ATTORNEY FOR THE BOARD H.J. Baucom, Associate Counsel INTRODUCTION The Veteran had active service from September 1974 to August 1977. This matter comes before the Board of Veterans' Appeals (Board) from a January 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. In August 2009 a Board hearing was held at the RO in Denver, Colorado before the undersigned; the transcript is of record. The Board has not only reviewed the Veteran's physical claims file but also the Veteran's file on the "Virtual VA" system to insure a total review of the evidence. In July 2012 the Board remanded the issues for further development which has been completed. FINDINGS OF FACT 1. A sleep disorder, to include sleep apnea and narcolepsy, was not first manifest during service, or within a year after discharge from service, and the medical evidence of record does not show that a sleep disorder, to include sleep apnea and narcolepsy, is related to any disease or injury incurred in or aggravated by service. 2. A low back disc disability was not first manifest during service, or within a year after discharge from service, and the medical evidence of record does not show that a low back disability is related to any disease or injury incurred in or aggravated by service or to any other service connected disability. 3. A right inguinal hernia was not first manifest during service, or within a year after discharge from service, and the medical evidence of record does not show that a right inguinal hernia is related to any disease or injury incurred in or aggravated by service. 4. Prostatitis was not first manifest during service, or within a year after discharge from service, and the medical evidence of record does not show that prostatitis is related to any disease or injury incurred in or aggravated by service. 5. Myositis, claimed as chest pain and breathing problems, was not first manifest during service, or within a year after discharge from service, and the medical evidence of record does not show that myositis, claimed as chest pain and breathing problems, is related to any disease or injury incurred in or aggravated by service. 6. Depression was not first manifest during service, or within a year after discharge from service, and the medical evidence of record does not show that depression is related to any disease or injury incurred in or aggravated by service. CONCLUSIONS OF LAW 1. The criteria for service connection for sleep disorder, to include sleep apnea and narcolepsy have not been met. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). 2. The criteria for service connection for a low back disc disability, to include as secondary to sleep apnea have not been met. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2012). 3. The criteria for service connection for right inguinal hernia repair have not been met. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). 4. The criteria for service connection for prostatitis have not been met. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). 5. The criteria for service connection for myositis, claimed as chest pain and breathing problems, have not been met. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). 6. The criteria for service connection for depression have not been met. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Notice and Assistance VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2011). A September 2006 letter satisfied the duty to notify provisions. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b) (1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). This letter notified the Veteran of regulations pertinent to the establishment of an effective date and of the disability rating. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). August 2010 and July 2012 letters informed the Veteran of the additional development following the Board remand. The Veteran testified that he received treatment at Denver Health Hospital and the record contains treatment records from Denver Health Hospital. A June 2011 letter from Dr. RH at Denver Health Hospital reported he was currently receiving treatment there however; the Veteran did not authorize VA to attempt to obtain any additional treatment records. 38 U.S.C.A. § 5103A, 38 C.F.R. § 3.159. The Veteran's service treatment records, VA medical treatment records, and private treatment records have been obtained. Although there was a formal finding of unavailability of records of the Veteran's Social Security Administration(SSA) disability determination, and the records considered in that determination, copies of such were received from the Veteran. 38 C.F.R. § 3.159 (c) (2). The Board has reviewed the Veteran's "Virtual VA" file. Two VA examinations were conducted in September 2012; the Veteran has not argued, and the record does not reflect, that these examinations were inadequate for rating purposes. 38 C.F.R. § 3.159(c)(4); Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). The examinations were adequate as the examiners reviewed the record, evaluated the Veteran and provided an opinion with supporting rationale as to the cause of the Veteran's current disabilities. There is no indication in the record that any additional evidence, relevant to the issues decided, is available and not part of the claims file. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). As there is no indication that any failure on the part of VA to provide additional notice or assistance reasonably affects the outcome of the case, the Board finds that any such failure is harmless. See Mayfield v. Nicholson, 20 Vet. App. 537 (2006); see also Dingess/Hartman, 19 Vet. App. at 486; Shinseki v. Sanders/Simmons, 129 S. Ct. 1696 (2009). Analysis Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). To establish service connection, there must be a competent diagnosis of a current disability; medical or, in certain cases, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. Hickson v. West, 12 Vet. App. 247, 252 (1999); see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The nexus between service and the current disability can be satisfied by competent evidence of continuity of symptomatology and evidence of a nexus between the present disability and the symptomatology. See Voerth v. West, 13 Vet. App. 117 (1999); Savage v. Gober, 10 Vet. App. 488, 495 (1997). Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is 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 facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In the prior July 2012 Board decision, the credibility of the evidence, including the Veteran's lay statements, was presumed for the purpose of establishing whether new and material evidence has been received. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The claims have been reopened and are herein evaluated on the merits, therefore the presumption of credibility afforded for assessing new and material evidence no longer applies. When addressing a claim on the merits, the Board has an obligation to evaluate the credibility of evidence and to assign probative weight to competent evidence. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (recognizing the Board's "authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other items of evidence"). 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. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. Sleep Disorder The Veteran contends that his current sleep disorder, which includes sleep apnea and narcolepsy, began in service. The Veteran testified that in service he was assigned to North American Aerospace Defense Command (NORAD) and worked the mid shift from 11pm to 7 am. He also testified that there were lockdowns while they ran drills for two to three weeks. The Veteran contends that the shift work messed up his sleep which caused his sleep apnea and narcolepsy. Service treatment records are absent for any complaints or treatment for fatigue, sleep problems, snoring, hypersomnolence (excessive sleepiness), or any symptoms of narcolepsy. However, in a December 2005 buddy statement, one of the Veteran's fellow airman and neighbor reported that the Veteran had complained of sleep issues in 1975 or 1976. The statement is competent as it is reporting a lay observation, the Veteran's complaints, and is found to be credible. This statement only establishes that the Veteran complained of sleep problems during service. It does not establish that those in-service sleep complaints are in anyway related to his current sleep disorders. Post service private treatment records show that the Veteran was diagnosed with sleep apnea in 1989. In a November 1993 sleep disorder consultation the Veteran noted his problems with daytime sleepiness beginning in 1988. In 1993 the Veteran was found to be disabled by the SSA based in part upon his narcolepsy. In September 2012 a VA examiner evaluated the Veteran and reviewed the record. The examiner noted the lack of in service medical visits related to any sleep difficulties. The examiner opined that it is less likely as not that the Veteran's sleep disorder, including both sleep apnea and narcolepsy, is related to his military service. The examiner explained that his opinion is based on the fact that although the Veteran reports symptoms of hypersomnolence during active duty, he was never seen for this condition during active duty which would suggest that any sleepiness during active duty was minor and not related to a disease. The examiner also explained that were the Veteran's sleep disorders due to diseases that had their onset during service, it is not likely that it would have taken the Veteran more than ten years to seek treatment for the symptoms, noting that the Veteran reported first experiencing daytime sleepiness in 1988, eleven years post service. Lay statements have also been considered. In a September 2009 letter the Veteran's wife reported that she knew that the Veteran started developing sleep problems because of all the nights he worked in the NORAD cave. She reported that he worked nights for his entire Air Force career and over the years his sleep problems got worse. The Veteran also contends that his sleep disorders began in service. As a general matter the Board must consider whether a veteran's particular disability is the type of disability for which lay evidence is competent. Kahana v. Shinseki, 24 Vet. App. 428, 433, n. 4 (2011). Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435, as to the specific issue in this case, whether the Veteran's in service sleep problems are related to his current sleep disorders of sleep apnea and narcolepsy, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). Testimony as to such underlying pathology is testimony as to an internal medical process that extends beyond an immediately observable cause-and-effect relationship that is of the type that the courts have found to be beyond the competence of lay witnesses. Jandreau, 492 F.3d at 1377, n. 4 ("sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer"); Kahana v. Shinseki, 24 Vet. App. 428, 433, n. 4 (noting impropriety of the Board categorically discounting lay testimony and requiring the Board to determine, on a case by case basis, whether a veteran's particular disability is the type of disability for which lay evidence is competent). The Veteran and his wife are competent to report lay observations such as her observation that the Veteran had sleep issues during service, and his reported symptoms that he experienced such as daytime sleepiness and fatigue, as these are subjective and observable symptoms. The Board finds the Veteran's statements that he was tired and sleepy when he worked the night shift to be competent and credible. Although the Veteran and his wife are competent and credible to state that the Veteran had sleep difficulties in service, they are not competent to state that those sleep difficulties were manifestations of the current sleep disorders of sleep apnea and narcolepsy. The Board finds that the etiology of sleep disorders, to include apnea and narcolepsy, is outside the realm of common knowledge of a lay person. Therefore the Veteran and his wife's opinions as to when his current sleep disorders began are of limited probative value. The medical professional who evaluated the Veteran and reviewed the records determined that the Veteran's in service sleep difficulties were not early manifestations of sleep apnea and narcolepsy, his current sleep disorders, as he would not have waited over ten years to seek treatment for these types of sleep disorders. The lay opinions are outweighed by the competent medical opinion of record which concluded that the Veteran's sleep disorders are not related to service and provided a supporting rationale. The preponderance of the evidence is against the claim; there is no doubt to be resolved. Service connection for a sleep disorder, to include sleep apnea and narcolepsy, is not warranted. Low Back Disability The Veteran initially claimed that his back disability was secondary to his sleep apnea. However, as sleep apnea is not service connected, there is no basis for secondary service connection. The Veteran contends that his current back disability began in service. The Veteran testified that he experienced back pain in service after doing heavy lifting. He testified that he sought treatment from a medic who gave him pain medicine and told him to lie down. Service treatment records are absent for any complaints of or treatment for a back disability at any time. However, in a September 2009 letter the Veteran's wife reported that the Veteran had hurt his back in service. The Veteran's reported history of when his back pain began is inconsistent. The Veteran testified as to in service treatment however there are no records of any such treatment. The Veteran testified that post service he was treated for his back in 1981 or 1982 however there are no records for any back treatment in the 1980s. The Veteran provided the same history of post service treatment in the 1980s to the September 2012 VA examiner. Recent VA treatment records note that the Veteran has reported both a history of low back pain since 1976, and in a separate note, a history of back pain since before 1987. In a SSA form the Veteran reported having lower back pain with numbness as a result of a car accident in the summer of 1995. The September 2012 VA examiner evaluated the Veteran, reviewed the claims file and concluded that it was less likely than not that a back disability incurred in or was caused by service. The examiner explained that there was no indication in the claims file that the Veteran had any back condition during active duty. In addition the Veteran told the examiner that he was not seen for back problems by medical providers until at least three to four years after service. The examiner found that this delay suggested that any of the Veteran's reported symptoms of back discomfort during active service were minor and not severe enough to cause his present back condition. Lay statements from the Veteran and his wife have been considered. They report that he injured his back in service and was treated for it. The Board finds that the Veteran is competent to report that he experienced back pain in service as it is a subjective observation that he has experienced through his five senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Veteran's wife is competent to report that he complained of back pain, or that she observed him to be in pain, as these are both lay observations. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 as to the specific issue in this case, whether the Veteran's in service back pain is related to his current back disability, falls outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1377. While the Veteran is competent to report symptoms that he experiences, such as back pain, he is not competent to provide a medical opinion as to the etiology of his back disability. Although the Veteran is competent to report when he started to experience back pain, as this is a subjective observation, the Board finds his current claim, that the same back pain began in service, to be not credible and contradicted by his own varying reports of back pain starting in the 1976 or 1980s, or 1995. As he is found to be not credible, the Veteran's opinion is of little probative value and is outweighed by the competent medical opinion of record which concluded that the Veteran's back disability did not begin in service and even if he did experience some back pain in service it was not severe enough to be the cause of his current back disability. The preponderance of the evidence is against the claim; there is no doubt to be resolved. Service connection for a back disability is not warranted. Right Inguinal Hernia and Prostatitis The Veteran contends that he has a right inguinal hernia due to service. The Veteran testified that he thought he had a hernia and a flare up of prostatitis in service but he was not sure. Service treatment records are absent for any complaints of groin pain or any prostate or urinary conditions. At the September 2012 VA examination the Veteran reported that he thought his prostatitis was due to mental stress in service. In March 1999 the Veteran was treated for complaints of right groin pain for the past six months. Examination and testing found there to be no evidence of a hernia. In May 1999 the Veteran sought treatment for right groin pain, reporting that the pain began in August 1998. Although the Veteran testified at the Board hearing that he had surgery in 1981 for his hernia, there are no records from any surgery; the Veteran did not report a history of hernia surgery when seeking treatment for groin pain in 1999, and none of the physicians noted any evidence of any prior hernia surgery despite an extensive workup, which included a surgery consult, in 1999. The September 2012 VA examiner opined that the Veteran's right inguina hernia did not develop until many years after active duty, and there is no evidence of an inguinal hernia during active duty. The examiner concluded that the Veteran's right inguinal hernia was less likely than not incurred in or caused by service. The examiner explained that there was no medical literature that would suggest that heavy lifting would cause the onset of an inguinal hernia 25 years later. The September 2012 VA examiner opined that the Veteran's prostate condition did not develop until many years after active duty. The examiner also noted that while the Veteran has been diagnosed with prostatitis in the remote past, however, the prostatitis has resolved and he now has symptoms due to enlarged prostate from BPH (benign prostate hypertrophy). The examiner noted that there is no medical evidence of any urinary or prostate condition during active duty. Addressing the Veteran's contentions, the examiner explained that there is no medical literature which would suggest that prostate conditions develop due to emotional stress or heavy lifting. The examiner also found that the Veteran's report of no present prostate discomfort and not ever taking antibiotics for the prostate, suggests that the Veteran has not had prostatitis symptoms for many years. Lay statements from the Veteran have been considered. The Veteran testified he thought that his right inguinal hernia started in service but he wasn't sure. The Board finds that the Veteran would be competent to report experiencing groin pain in service or observing a bulge beneath his skin, because those are subjective observations that he could experience through his five senses. Kahana v. Shinseki, 24 Vet. App. 428, 433, n. 4 (2011). However, this is not what he reported. The Veteran only testified that he thought that his inguinal hernia began in service, not that he actually experienced groin pain or any other symptom of inguinal hernia in service. Furthermore his statement that his hernia began in service is contradicted by his contemporaneous report in 1999 that his groin pain began in 1998. Contemporaneous evidence has greater probative value than history as reported by a Veteran. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) Similarly the Board finds that while the Veteran would be competent to report experiencing prostate pain or taking antibiotics in service, as these are subject to lay observation, Kahana v. Shinseki, 24 Vet. App. 428, 433, n. 4 (2011), he did not make any such reports. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, the issue in this case, whether the Veteran's inguinal hernia or prostatitis began in service or are related to service, falls outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1377. The Veteran is not competent to provide a medical opinion as to the etiology of his right inguinal hernia and prostatitis. He is not competent to opine that mental stress caused prostatitis, as this is outside the realm of common knowledge as there is no observable cause and effect. The Veteran's opinion is of no probative value and is outweighed by the competent medical opinion of record which concluded that the Veteran's right inguinal hernia and prostatitis did not begin in service. The preponderance of the evidence is against the claim; there is no doubt to be resolved. Service connection for a right inguinal hernia and prostatitis is not warranted. Myositis The Veteran testified that he was treated in service for complaints of chest pain. Service treatment records reflect multiple complaints of chest pain. In December 1975 the Veteran was seen twice for reports of right chest pain which were diagnosed as musculoskeletal or neuritis-myositis. In July 1976 the Veteran was seen three times for right chest pain diagnosed as costochondritis (chest wall pain) and pectoral myositis (muscle inflammation). Post service, in December 1991 private treatment records show treatment for chest pain on the left side following a May 1991 work place injury when he lifted a large and bulky computer weighing 75-80 pounds up a flight of stairs. The Veteran reported seeing a cardiologist and pulmonologist with nothing of any significance found. He also reported that a bone scan and CT scan were negative. The September 2012 VA examiner opined that the Veteran's myositis was less likely than not incurred in or caused by service. The examiner stated that although the Veteran was seen on several occasions during active duty for chest wall pain, the pain was in the right chest wall and not the left chest wall, the location of his current chest wall pain. The examiner found that the Veteran's left chest wall pain began in 1991 following a work place injury. Lay statements have been considered. The Veteran contends that his myositis began in service. The Veteran is competent to report symptoms that he experiences through his five senses, such as chest pain during service, as pain is a subjective observation. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 433, n. 4 (2011), as to the specific issue in this case, whether the Veteran's current left wall myositis began in service or is related to his in service complaints of right wall myositis, falls outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1377. The Veteran's opinion on etiology is of little probative value and is outweighed by the competent medical opinion of record which concluded that the Veteran's myositis did not begin in service. The preponderance of the evidence is against the claim; there is no doubt to be resolved. Service connection for myositis is not warranted. Depression The Veteran contends that his depression began in service. He testified that he experienced panic attacks in service during lock downs at NORAD. Service treatment records do not contain any reports of mental health treatment or counseling in service. The Veteran testified that he left service because he couldn't handle his current position and was offered an alternative position as a cook but he did not want to take it. In May 1994 a substance abuse psychologist found that the Veteran had depression as a result of his cocaine use and that he was now taking medication for depression. In an August 2002 private psychological consult done in conjunction with SSA development, the Veteran reported experiencing depression during his time in the Air Force. He reported that he worked inside of a mountain where he was locked up in a cave, and that he has nightmares from his experience. At a September 2012 VA psychiatric examination the Veteran denied receiving treatment for anxiety and depression during service when asked about his prior reports of such treatment in VA records. At the VA examination the Veteran reported that his work was "top secret" and that events took place at NORAD which caused him to become upset, anxious and depressed but he is not allowed to discuss these events. He also reported that he was afraid to ask for treatment at the time. Although the Veteran described having anxiety and recollection of challenging experiences at NORAD the examiner reported that he could not explain what any of these experiences are other than he had a difficult schedule and he may have been involved in drills where he was locked into the mountain for 30 days. The Veteran did not report persistent detachment, numbing, hypervigilance or avoidance of military subjects associated with any of these vague events. He did report almost going into bankruptcy and having his home foreclosed on at various times in the past several years. The examiner noted that it is unclear when the Veteran started abusing cocaine but in either the mid 1980s to mid 1990s the Veteran sought mental health and substance treatment and is now receiving treatment with psychotropic medication-although no counseling or substance treatment. The examiner found that the Veteran has had some trauma after service based on financial problems, possible foreclosure and bankruptcy. The examiner noted that the Veteran continues to report some anxiety and depression. Based on a thorough evaluation of the Veteran and the record, the examiner opined that the Veteran's current mental conditions are less likely as not associated with events that the Veteran experienced during military service and are as likely as not associated with post-military, marital, financial and job stressors. The Veteran's lay statements have been considered. The Board finds that the Veteran is competent to report symptoms that he experiences, such as anxiousness and nervousness, as those are subjective observations of things he experiences through his five senses. The Veteran is competent to report continuous symptoms of depression since service however is found to be not credible, and unsupported by the record. He did not report experiencing any symptoms of a mental health or psychiatric disorder until he sought treatment for cocaine abuse in the 1990s. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that a lengthy period without medical complaints about a condition can be considered as a factor in resolving a claim) The Board also finds that the Veteran is not competent to diagnose depression, or opine as to when depression began, or opine that any current depression is due to working in a cave 40 years prior, as this requires medical expertise and would fall outside the realm of common knowledge of a lay person. There is no observable cause and effect between working in a cave in service, and depression 40 years later. See Jandreau, 492 F.3d at 1377. The Veteran's opinion is of little probative value and is outweighed by the competent medical opinion of record which affirmatively found that the Veteran's depression was not related to service. There is no evidence of a link between the Veteran's current depression and service. The weight of the competent medical evidence is against the claim. The preponderance of the evidence is against the claim; there is no doubt to be resolved. Service connection for depression is not warranted. ORDER Service connection for a sleep disorder, to include sleep apnea and narcolepsy, is denied. Service connection for a low back disc disability, to include as secondary to sleep apnea, is denied. Service connection for right inguinal hernia repair is denied. Service connection for prostatitis is denied. Service connection for myositis, claimed as chest pain and breathing problems, is denied. Service connection for depression is denied. ____________________________________________ MICHELLE L. KANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs