Citation Nr: 1318430 Decision Date: 06/06/13 Archive Date: 06/11/13 DOCKET NO. 11-13 909 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUES 1. Entitlement to service connection for type 2 diabetes mellitus. 2. Entitlement to service connection for retinopathy (claimed as blindness), including as secondary to type 2 diabetes mellitus. 3. Entitlement to service connection for open-angle glaucoma (claimed as blindness), including as secondary to type 2 diabetes mellitus. 4. Entitlement to service connection for cataracts (claimed as blindness), including as secondary to type 2 diabetes mellitus. 5. Entitlement to service connection for congestive heart failure (claimed as heart trouble), including as secondary to type 2 diabetes mellitus. 6. Entitlement to service connection for posttraumatic stress disorder (PTSD), including as secondary to type 2 diabetes mellitus. 7. Entitlement to special monthly compensation based on the need for aid and attendance. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD M. Young, Counsel INTRODUCTION The Veteran had active duty service from June 1955 to June 1958. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2010 rating decision by a Regional Office (RO) of the Department of Veterans Affairs (VA) that denied service connection for the matters on appeal. Notice of disagreement as to all the matters on appeal, was received in June 2010. A statement of the case (SOC) was issued in March 2011; and a Substantive Appeal was received in May 2011. In March 2013, the Veteran had a Travel Board hearing before the undersigned Veterans Law Judge; a copy of the hearing transcript is associated with the claims folder. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT 1. The Veteran did not have service in the Republic of Vietnam. He had service in Korea near the demilitarized zone (DMZ); he was not exposed to herbicides while on active duty in Korea; exposure to herbicides, including Agent Orange while on active duty cannot be presumed. 2. Type 2 diabetes mellitus was not shown in service, was not manifested to a compensable degree within one year of separation from active service, and is not otherwise related to the Veteran's active service, (to include presumptive provisions of § 3.309). 3. Retinopathy, open-angle glaucoma, cataracts, and congestive heart failure were not manifested during the Veteran's active duty service or for many years thereafter, nor are they otherwise causally related to such service or a service-connected disability. 4. There is no credible supporting evidence that the claimed in-service stressors occurred. 5. There are no provisions for awarding special monthly compensation based on the need of aid and attendance when the Veteran is not service-connected for any disability. CONCLUSIONS OF LAW 1. Type 2 diabetes mellitus was not incurred in or aggravated by active duty service nor may it be presumed to be related to active duty service. 38 U.S.C.A. §§ 1131, 1137, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2012). 2. Retinopathy was not incurred in or aggravated by active duty service, and is not related to a service-connected disability. 38 U.S.C.A. §§ 1131, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.303, 3.310 (2012). 3. Open-Angle glaucoma was not incurred in or aggravated by active duty service, and is not related to a service-connected disability. 38 U.S.C.A. §§ 1131, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.303, 3.310 (2012). 4. Cataracts were not incurred in or aggravated by active duty service, and are not related to a service-connected disability. 38 U.S.C.A. §§ 1131, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.303, 3.310 (2012). 5. Congestive heart failure was not incurred in or aggravated by active duty service, may not be presumed to be related to active duty service and is not related to a service-connected disability. 38 U.S.C.A. §§ 1131, 1137, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310 (2012). 6. PTSD was not incurred in or aggravated by active duty service, and is not related to a service-connected disability. 38 U.S.C.A. §§ 1131, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.303, 3.310 (2012). 7. The criteria for entitlement to special monthly compensation based on the need for aid and attendance have not been met. 38 U.S.C.A. § 1114 (West 2002 & Supp. 2012); 38 C.F.R. § 3.350 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 (VCAA) Under the VCAA, codified at 38 U.S.C.A. 5100, 5102, 5103, 5103A, 5106, 5107 and 5126; see also 38 C.F.R. § 3.102, 3.156(a), and 3.326(a), VA has a duty to notify the claimant of any information and evidence needed to substantiate and complete a claim, and of what part of that evidence is to be provided by the claimant and what part VA will attempt to obtain for the claimant. 38 U.S.C.A. § 5103(a); 38 C.F.R.§ 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). Duty to Notify The record shows that in a November 2009 VCAA letter, the Veteran was informed of the information and evidence necessary to warrant entitlement to the benefit sought on appeal. The Veteran was also advised of the types of evidence VA would assist him in obtaining as well as his own responsibilities with regard to identifying relevant evidence. See Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). The United States Court of Appeals for Veterans Claims' (Court) decision in Pelegrini v. Principi, 18 Vet. App. 112 (2004) held, in part, that a VCAA notice as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable agency of original jurisdiction decision on a claim for VA benefits. The notice requirements apply to all five elements of a service connection claim: 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. Dingess v. Nicholson, 19 Vet. App. 473 (2006). In this case, the RO provided VCAA notice to the Veteran in November 2009, which was prior to the May 2010 rating decision. That letter explained the evidence necessary to substantiate the Veteran's claims, the evidence VA was responsible for providing, the evidence he was responsible for providing, and informed the Veteran of disability rating and effective date criteria. See Id. In sum, the Veteran has received all essential notice, has had a meaningful opportunity to participate in the development of his claims, and is not prejudiced by any technical notice deficiency along the way. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). In any event, the Veteran has not demonstrated any prejudice with regard to the content of the notice. See Shinseki v. Sanders, 129 S. Ct. 1696 (2009) (reversing prior case law imposing a presumption of prejudice on any notice deficiency, and clarifying that the burden of showing that an error is harmful, or prejudicial, normally falls upon the party challenging the agency's determination); Mayfield v. Nicholson, 444 F.3d 1328, 1333-34 (Fed. Cir. 2006). Duty to Assist The Board finds that there has been compliance with the assistance provisions set forth in the law and regulations. The Board notes that the Veteran's service treatment records and medical reports, with the exception of his April 1958 discharge medical examination report, are unavailable. The RO requested his service medical records from the National Personnel Records Center (NPRC), and was notified that the records were fire-related and that there are no Surgeon General Office records available. VA and private treatment records have been obtained and are associated with the claims file. Service personnel records consisting of DD Form 214 and a June 1958 "Extract" identifying the Veteran therein. The RO requested the Veteran's records from the Social Security Administration (SSA), and was notified that his medical records had been destroyed. SSA indicated that such records do not exist; and further efforts to obtain them would be futile. While SSA did not provide a copy of the SSA decision and other administrative documents associated with the Veteran's disability claim, the Board finds that such decision is not relevant to his diabetes or the disabilities claimed as secondary to diabetes. See Golz v. Shinseki, 590 F.3d 1317, 1320-21 (Fed. Cir. 2010) ("When an SSA decision pertains to a completely unrelated medical condition and the Veteran makes no specific allegations that would give rise to a reasonable belief that the medical records may nonetheless pertain to the injury for which the Veteran seeks benefits, relevance is not established."). In addition a March 2010 memorandum noted that the information required to corroborate stressful events in service was insufficient to send to the U.S. Army and Joint Services Records Research Center (JSRRC). The Veteran's Virtual VA file has been reviewed, there were no pertinent medical records found. The Board finds that the record as it stands includes adequate competent evidence to allow the Board to decide the case and no further action is necessary. See generally 38 C.F.R. § 3.159(c)(4). No additional pertinent evidence has been identified by the claimant. In disability compensation (service connection) claims, VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for VA to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). For reasons explained in the analysis section of this decision, the Board finds that VA examinations (with nexus opinions) are not necessary. Given these facts, it appears that all available records have been obtained. There is no further assistance that would be reasonably likely to assist the Veteran in substantiating his claims. 38 U.S.C.A. § 5103A(a)(2). For the foregoing reasons, the Board therefore finds that VA has satisfied its duty to notify and the duty to assist pursuant to the VCAA. See 38 U.S.C.A. §§ 5102 and 5103; 38 C.F.R. §§ 3.159(b), 20.1102; Pelegrini, 18 Vet. App. 112; Quartuccio, 16 Vet. App. 183; Dingess, 19 Vet. App. 473. Service Connection The Board acknowledges that in a case in which a Veteran's service records are unavailable through no fault of his own, there is a heightened obligation for VA to assist in the development of the claim and to provide reasons or bases for any adverse decision rendered without such records. See O'Hare v. Derwinski, 1 Vet. App. 365 (1991), see also Moore v. Derwinski, 1 Vet. App. 401 (1991) (holding that the heightened duty to assist a Veteran in developing facts pertaining to his claim in a case in which service treatment records are presumed destroyed includes the obligation to search for alternative medical records). Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1131. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). Moreover, under 38 C.F.R. § 3.303(b), the second and third elements of Shedden and Caluza may be established through a demonstration of continuity of symptomatology. Barr v. Nicholson, 21 Vet. App. 303 (2007). Also, in the context of, for example, diabetes mellitus, such disorder may also be presumed to have been incurred in service if shown to have manifested to a compensable degree within one year after the date of separation from service. 38 U.S.C.A. §§ 1101, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Secondary service connection is warranted where a disability is proximately due to, or the result of, or aggravated by a service-connected disease or injury. Establishing service connection on a secondary basis requires: (1) Competent evidence (a medical diagnosis) of a current disability (for which secondary service connection is sought); (2) evidence of a service connected disability; and (3) competent evidence that the current disability was either (a) caused or (aggravated) by the service connected disability. 38 C.F.R. § 3.310 (a); see also Allen v. Brown, 7 Vet. App. 439 (1995). When there is an approximate balance of positive and negative 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(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, 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 fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Board has reviewed all evidence in the claims file, and in the Veteran's "Virtual VA" electronic claims file, with an emphasis on the evidence relevant to these appeals. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The Board will summarize the relevant evidence as appropriate and the Board's analysis will focus on what the evidence shows, or fails to show, as to the claims. Type 2 Diabetes Mellitus The Veteran claims entitlement to type 2 diabetes mellitus, which he asserts he was treated for on active duty in Korea in 1956; at a hospital near Tongduchon, South Korea and the 7th Division. He stated that Dr. K. Young [sic] diagnosed him with diabetes at that time. He has also claimed entitlement to service connection for retinopathy, open-angle glaucoma, cataracts, congestive heart failure and PTSD, as secondary to his diabetes mellitus. In addition, he claims entitlement to special monthly compensation based on the need for aid and attendance based on legal blindness and his granddaughter assisting him with his care. As noted, the Veteran's service treatment records and other medical records were destroyed in a fire at the records center in 1973. The Veteran has asserted that he was diagnosed and treated for diabetes in service. The only record of a medical nature related to the Veteran's service, and available in the claims file, is his April 1958 discharge medical examination (Report of Medical Examination). That document does not show complaints, treatment, or a diagnosis of diabetes mellitus; nor does it show abnormal blood sugar levels or typical symptoms associated with diabetes mellitus. According to the Report of Medical Examination his clinical evaluation at discharge was normal, including his endocrine system. In addition, laboratory findings for "sugar" were negative. The examining physician noted there were no defects or diagnoses. In a June 1958 "Physical Statement Upon Separation" the Veteran indicated that there had been no change in his physical condition since his last final-type physical examination in April 1958, with no exceptions. The Board finds that the medical examination report at the time of the Veteran's discharge from service, and the Veteran's report (in June 1958) that his physical condition had not changed since the April 1958 discharge examination to be highly probative evidence in this case. The Board finds that these records reflect that the Veteran reported no symptoms specific to diabetes during service, there were no symptoms of diabetes manifested during service and the Veteran was not diagnosed with diabetes during his active duty service. Consequently, service connection for type 2 diabetes mellitus on the basis that it became manifest in service and persisted, is not warranted. Postservice medical reports show that in February 1979 the Veteran was admitted to the hospital for removal of an "AO" plate and a varus osteotomy. He did not mention diabetes when he reported his prior medical history; nor was it noted on physical examination. An April 1997 VA follow-up treatment report noted that the Veteran presented for a routine eye examination and that he was newly diagnosed with diabetes mellitus one week prior. At his Travel Board hearing the Veteran testified that after discharge from service he worked for a private regional medical center and there (in the emergency department) received treatment for his diabetes. The claims file contains copies of reports from that private regional medical center (where the Veteran was employed), which in pertinent part shows a June 1998 emergency department report that notes the Veteran is diabetic. In addition, a June 2001 emergency physician record notes a history of non-insulin dependent diabetes. VA primary care physician reports dated in August 1999 and December 2002 provide assessments of adult-onset diabetes mellitus. VA primary care physician notes dated in August 2006, December 2006, November 2007, and May 2008 assess the Veteran with diabetes mellitus type 2. In a June 2008 private nephrology consultation report, it was noted that the Veteran reported with an approximately 12-year history of diabetes mellitus and receives all of his medications from VA. The diagnosis, in pertinent part, was diabetes mellitus with renal manifestations. While the evidence supports a finding that the Veteran has a current diagnosis of type 2 diabetes mellitus there is no evidence of a nexus between the claimed disorder and service. Further, the Board emphasizes the multi-year gap between discharge from active duty service in 1958 and the first indication of the disorder in 1997 (newly diagnosed diabetes mellitus). While the Veteran has testified that he was diagnosed and treated for diabetes in service, the probative evidence of record does not support any such contention. The Board finds that the Veteran's statements that he was diagnosed with and treated for diabetes in service and continuity of his diabetes are simply not credible. Continuity has not been established here, neither through the competent evidence nor through the Veteran's statements. It is noteworthy that in 1979 when the Veteran was admitted to the hospital he did not report having diabetes. Furthermore, he did not file a claim for service connection for diabetes for many years after service (2009), which suggests that he did not believe that his diabetes was service-related for many years. The record indicates that he was aware of the process of filing VA claims as he filed a VA claim in the early 1980's. At his hearing the Veteran indicated that during service he was near the Korean DMZ. This is significant because effective February 24, 2011, VA amended its adjudication regulations to extend a presumption of herbicide exposure to certain Veterans who served in Korea. Specifically, VA added a new paragraph (a)(6)(iv) to 38 C.F.R. § 3.307 that reads as follows: A Veteran who, during active military, naval, or air service, served between April 1, 1968, and August 31, 1971, in a unit that, as determined by the Department of Defense, operated in or near the Korean DMZ in an area in which herbicides are known to have been applied during that period, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. See 76 Fed. Reg. 4245 (Jan. 25, 2011). If a Veteran was exposed to an herbicide agent (to include Agent Orange) during active military service, certain diseases, including type 2 diabetes (also known as Type 2 diabetes mellitus or adult-onset diabetes), shall be service-connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even if there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). As the Veteran's military service was from June 1955 to June 1958 and his service in Korea was sometime in 1956, this new provision is not applicable to his case. As an additional matter, diabetes mellitus was not shown within one year of the Veteran's release from active duty. Therefore, service connection is also not warranted on a presumptive basis. 38 C.F.R. §§ 3.307, 3.309. The Board finds that the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for type 2 diabetes mellitus. Consequently, the benefit-of-the-doubt rule does not apply, and service connection for type 2 diabetes mellitus is not warranted. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. Retinopathy, Open-angle Glaucoma, Cataracts, Congestive Heart Failure, and PTSD Regarding these claims, the Veteran has primarily asserted that these disorders occurred secondary to diabetes (discussed below). However, he is not precluded from establishing service connection with proof of actual direct causation as due to active duty service. See Combee v. Brown, 34 F.3d 1039, 1041-42 (Fed. Cir. 1994). Here, the Board finds that service connection is not warranted for retinopathy, open-angle glaucoma, cataracts, congestive heart failure, and PTSD on a direct basis. As noted, the Veteran's service treatment records and other medical records were destroyed in a fire at the records center in 1973. The only record of a medical nature related to the Veteran's service is his April 1958 discharge Report of Medical Examination. That document does not show complaints, treatment, or a diagnosis of any of the claimed disorders. His clinical evaluation at discharge was normal, including his eyes (generally), ophthalmoscopic, pupils and ocular motility; his visual acuity was 20/20 in both eyes; his heart and vascular system and his psychiatric evaluation were normal. The examining physician noted there were no defects or diagnoses. In his June 1958 "Physical Statement Upon Separation" the Veteran indicated that there had been no change in his physical condition since his last final-type physical examination in April 1958, with no exceptions. The Board finds that the medical examination report at the time of the Veteran's discharge from service, and the Veteran's report (in June 1958) that his physical condition had not changed since the April 1958 discharge examination to be highly probative evidence in this case. The Board finds that these records reflect that the Veteran reported no symptoms specific to the claimed disorders during service, there were no symptoms of any of the disorders manifested during service and the Veteran was not diagnosed with any of the claimed disorders during his active duty service. Consequently, service connection for retinopathy, open-angle glaucoma, cataracts, congestive heart failure, and PTSD on the basis that they became manifests in service and persisted, are not warranted. Post-service, on March 2001 VA optometry outpatient clinic report, the Veteran's assessment was proliferative diabetic retinopathy (PDR) status post extensive panretinal photocoagulation (PRP), each eye, large tractional fibrotic band, right eye lifted into the right vitreous with hemorrhage on the tractional band, right eye, multiple macular cysts, left eye, vision 20/200 left eye, mild cataracts, each eye, and large cup-to-disc (C/D), left eye. On April 2003 VA optometry outpatient clinic note, the Veteran reported that he had cataract surgery on the right eye last year. He stated that he has a cataract on the left but he is not ready for surgery. He stated that he is blind in the right eye (he can only see a little light from his right eye). The assessments were PDR status post extensive PRP, each eye, macular scar, right eye, maculopathy, left eye, optic atrophy, right eye, mild cataract, left eye, and questionable aphakic, right eye, status post cataract surgery, right eye. Private treatment records dated in July 2005, January 2006, August 2006, February 2007, November 2007, August 2008, and March 2009, show diagnoses of PDR, each eye, chronic open-angle glaucoma, each eye, left senile nuclear sclerotic cataract, and right aphakia, acquired. Private treatment records dated from March 2007 to November 2009 show impressions of congestive heart failure. A June 2008 nephrology consultation report shows a past history of blindness in the right eye secondary to diabetes mellitus. Private treatment records dated in September 2009 and February 2010 show diagnoses of diabetes mellitus, type 2 with ophthalmic complications, controlled, PDR, each eye, chronic open-angle glaucoma, each eye, and right aphakia, acquired. While this evidence reflects that the Veteran has been diagnosed with retinopathy, glaucoma, cataracts and congestive heart failure, it does not show that any of the claimed disorders are due to the Veteran's active duty service. The evidence shows that the first findings of the claimed retinopathy and cataracts were in 2001, approximately 43 years after the Veteran's discharge from active military service. Open-angle glaucoma was first shown in 2005, approximately 47 years after his discharge from active military service; and congestive heart failure was first shown in 2007, approximately 49 years after his discharge from active military service. The Board notes that the evidence of record reveals that there was a prolonged period without medical complaint or treatment for the claimed disorders, and the amount of time which has elapsed since military service can be considered as evidence against the claims. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). As the claimed disorders were not shown during service or for years thereafter, service connection can only be granted if there is some competent evidence linking the current disorder to service. Here, there is no such competent evidence; and as noted above, the Veteran does not contend that retinopathy, open-angle glaucoma, cataracts, and congestive heart failure are related to his active military service, but are secondary to the claimed type 2 diabetes mellitus. Since the preponderance of the evidence is against the Veteran's claims of entitlement to service connection for retinopathy, open-angle glaucoma, cataracts, and congestive heart failure, the benefit-of-the-doubt doctrine is inapplicable in the final analysis, and the claims must be denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. With further regard to the claim for PTSD, the evidence does not show that the Veteran has been diagnosed with PTSD or any psychiatric disorder related to his period of service. Specifically, service connection for PTSD requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a nexus between current symptomatology and the claimed stressor in-service. 38 C.F.R. § 3.304(f). In a December 2009 statement in support of his claim for PTSD, the Veteran noted the he was constantly under attack from the enemy while serving in Korea. He stated that while building bridges numerous soldiers were killed or wounded in action from hostile fire. He noted that he has flashbacks on a regular basis of being back in the war. Upon review of the Veteran's alleged in-service stressors, the RO determined that such stressor information was not sufficient to forward to the Joint Services Records Research Center (JSRRC). The Veteran was requested to submitted additional information to assist with verifying the claimed stressors. In December 2009 the RO received a response from the Veteran, but the information received was not sufficient to forward to JSRRC. The RO therefore determined that the information required to corroborate the Veteran's alleged stressful events in service were insufficient to send to JSRRC and insufficient to allow for meaningful research of the National Archives. A diagnosis of PTSD for VA compensation purposes must be based on a corroborated stressor. It is noted that the Veteran's service began several months after the Korean conflict ended, and the Veteran has otherwise not furnished sufficient detail to allow verification of the stressors that he has claimed. Service Connection as Secondary to Diabetes Mellitus The Board addresses the Veteran's claim that his retinopathy, open-angle glaucoma, cataracts, congestive heart failure, and PTSD, are related to his diabetes mellitus. In general, service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Any additional impairment of earning capacity resulting from an already service-connected condition, regardless whether the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id. However, for the reasons discussed above, service connection for the Veteran's diabetes mellitus is not warranted, and he is currently not service-connected for any disability. Therefore, service connection for retinopathy, open-angle glaucoma, cataracts, congestive heart failure, and PTSD as secondary to his diabetes mellitus, is not warranted. The Board has also considered the statements made by the Veteran relating his diabetes mellitus and retinopathy, open-angle glaucoma, cataracts, congestive heart failure, and PTSD to his active service and to a service-connected disability. The Federal Circuit has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Davidson v. Shinseki, 581 F.3d 1313 (Fed Cir. 2009) (quoting Jandreau v. Nicholson,, 492 F.3d 1372 (Fed. Cir. 2007). In this case, however, the Veteran is not competent to provide testimony regarding the etiology of his diabetes mellitus and retinopathy, open-angle glaucoma, cataracts, congestive heart failure, and PTSD. See Id. at 1377. Because these disorders are diagnosed by unique and readily identifiable features, they do not involve a simple identification that a layperson is competent to make. Therefore, the unsubstantiated statements regarding the claimed etiology of the Veteran's diabetes mellitus and retinopathy, open-angle glaucoma, cataracts, congestive heart failure, and PTSD are found to lack competency. In light of the above discussion, the Board concludes that the preponderance of the evidence is against the claims for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Special Monthly Compensation The Veteran has claimed that he is blind in both eyes and requires the assistance of his granddaughter, and is therefore entitled to special monthly compensation based on the need for aid and attendance. Special monthly compensation is payable if, as the result of service-connected disability, the Veteran has an anatomical loss or loss of use of both feet, or of one hand and one foot; has blindness in both eyes with visual acuity of 5/200 or less; is permanently bedridden; or is so helpless as to be in need of regular aid and attendance of another person. 38 U.S.C.A. § 1114 (l); 38 C.F.R. § 3.350(b). (This is different from special monthly pension, which would be based on all disabilities rather than only those that are service-connected. See 38 C.F.R. § 3.351). Entitlement to special monthly compensation is only warranted in cases where service connection has been established. In this case, the Veteran is not service-connected for any disability, and is therefore not entitled to special monthly compensation. As the law and not the evidence are dispositive the appeal is denied due to the absence of legal merit. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Consequently, the Veteran's claim of entitlement to special monthly compensation based on the need for aid and attendance must be denied as a matter of law. ORDER The appeal is denied as to all issues. ____________________________________________ ALAN S. PEEVY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs