Citation Nr: 1319643 Decision Date: 06/18/13 Archive Date: 06/27/13 DOCKET NO. 10-02 605 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Entitlement to service connection for sarcoidosis. 2. Entitlement to service connection for chronic obstructive pulmonary disease (COPD). 3. Entitlement to service connection for depression. REPRESENTATION Appellant represented by: Military Order of the Purple Heart of the U.S.A. ATTORNEY FOR THE BOARD A. Barone, Counsel INTRODUCTION The Veteran served on active duty from May 1953 to May 1957. This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from a January 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California, which denied the benefits sought on appeal. This case was previously before the Board in December 2011, when it was remanded for additional development. Following the December 2011 remand, this case returned to the Board and the Board obtained a VHA medical opinion in March 2013 to address medical questions at issue. 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's sarcoidosis was not manifested during the Veteran's active duty service nor within a year thereafter, nor is sarcoidosis otherwise related to service, including any alleged exposure to asbestos. 2. Service connection for sarcoidosis is not in effect, thus the Veteran's claim for service connection for COPD on a secondary basis must be denied as a matter of law. 3. The Veteran's respiratory disability, diagnosed as COPD, was not manifested during the Veteran's active duty service or for many years thereafter, nor is COPD otherwise related to service, including any alleged exposure to asbestos, nor is COPD etiologically linked to any service-connected disability. 4. Service connection for sarcoidosis or for COPD is not in effect, thus the Veteran's claim for service connection for depression on a secondary basis must be denied as a matter of law. 5. The Veteran's psychiatric disability, claimed as depression, was not manifested during the Veteran's active duty service or for many years thereafter, nor is any psychiatric disability otherwise related to service or etiologically linked to any service-connected disability. CONCLUSIONS OF LAW 1. Sarcoidosis was not incurred in or aggravated by service, nor has sarcoidosis been proximately caused or aggravated by any service-connected disability. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2012). 2. Respiratory disability, diagnosed as COPD, was not incurred in or aggravated by the Veteran's active duty service, nor has any respiratory disability been proximately caused or aggravated by any service-connected disability. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.310 (2012). 3. An acquired psychiatric disability, to include depression, was not incurred in or aggravated by service, nor has any acquired psychiatric disability been proximately caused or aggravated by any service-connected disability. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 (VCAA) As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the United States Department of Veterans Affairs (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; 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a). Duty to Notify Upon receipt of a complete or substantially complete application, VA must notify the claimant of the information and evidence not of record that is necessary to substantiate a claim, which information and evidence VA will obtain, and which information and evidence the claimant is expected to provide. 38 U.S.C.A. § 5103(a). 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). The notice must be provided to a claimant before the initial unfavorable adjudication by the RO. Pelegrini v. Principi, 18 Vet. App. 112 (2004). The notice requirements may be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). The RO provided the appellant notice by a letter in September 2008; such notice was prior to the initial unfavorable adjudication of the claim in connection with the January 2009 RO rating decision. In aggregate, the notification complied with the specificity requirements of Dingess v. Nicholson, 19 Vet. App. 473 (2006) identifying the five elements of a service connection claim; and Quartuccio v. Principi, 16 Vet. App. 183 (2002), identifying the evidence necessary to substantiate a claim and the relative duties of VA and the claimant to obtain evidence. The Veteran has received all essential notice, has had a meaningful opportunity to participate in the development of his claim, 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 attacking the agency's determination). See also Mayfield v. Nicholson, 444 F.3d 1328, 1333-34 (Fed. Cir. 2006). Duty to Assist VA has obtained service treatment records; obtained private and VA post-service treatment records (or negative responses from identified private medical sources); assisted the Veteran in obtaining evidence; and afforded the Veteran VA examinations on the sarcoidosis and COPD issues prior to obtaining an adequate VHA medical expert advisory opinion on these issues in March 2013. The Board finds that the March 2013 VHA medical expert advisory opinion presents a thorough and complete discussion of the pertinent history, medical principles, key contentions, and significant evidence. The March 2013 VHA medical expert advisory opinion addresses the essential medical questions with expert determinations informed by review of the claims file such that the opinion presents adequate and probative evidence on the sarcoidosis and COPD issues. The record in this case includes what appears to be a complete or reasonably complete set of service treatment records. The Board notes that during the RO's attempt to develop additional service records pertinent to confirming alleged asbestos exposure, the October 2008 National Personnel Records Center (NPRC) response to a request for information indicated that no additional service treatment records were found for the Veteran and that the Veteran's service records may have been destroyed in a fire at that facility. The Board notes that the question of confirming the Veteran's alleged in-service exposure to asbestos has become moot because the development of a March 2013 VHA expert medical advisory opinion (discussed in detail below) has produced uncontradicted medical evidence that none of the Veteran's claimed disabilities can be considered medically linked to any hypothetical asbestos exposure even if such occurred. Determining exposure to asbestos during service is only significant to the appeal to the extent that such asbestos exposure could serve as the basis of establishing a link between a claimed disability and military service. 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 these 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 medical records are presumed destroyed includes the obligation to search for alternative medical records). In this case, the Board notes that the set of service treatment records available for review appear largely complete (with numerous records including service entrance and separation medical examination reports). The Board also notes that the Veteran's contentions and testimony do not otherwise indicate that he recalls receiving medical treatment for sarcoidosis, COPD, or depression during service; the Veteran has described that sarcoidosis was first diagnosed after service and that the other disabilities later developed consequent to sarcoidosis. Again, the Board also notes that the question of whether the Veteran was exposed to asbestos during service has lost significance following the development of the uncontradicted medical evidence of the March 2013 VHA medical advisory opinion explaining that the Veteran's claimed disabilities are not of a nature that can be linked to any hypothetical asbestos exposure even if such exposure occurred. Thus, there is no reason to obtain additional service personnel records and no suggestion of any missing pertinent documentation in the Veteran's service treatment records. Importantly, the Veteran's discharge examination has been associated with the claims file. Thus, the Board finds that the RO has met its heightened duty to assist in the instant case. The Board has carefully considered whether the March 2013 VHA medical expert advisory opinion is adequate. The Board finds that the March 2013 VHA medical expert advisory opinion is probative evidence adequately addressing the medical questions featured in the sarcoidosis and COPD issues on appeal. The evidence of record is now sufficiently developed to support informed appellate review. The March 2013 VHA medical expert advisory opinion presents a detailed explanation of rationale presenting a persuasive basis for the conclusions, and the presented analysis cites the pertinent facts of record, the Veteran's contentions, the pertinent prior evidence, and applicable medical principles informed by review of medical literature. In light of the above, the Board finds the March 2013 VHA medical expert advisory opinion to be adequate and probative evidence concerning the medical questions of whether the Veteran's sarcoidosis and COPD on appeal have been caused by his military service or service-connected disability. The Board additionally observes that the Veteran has expressed an objection to the consideration of etiology opinions developed by VA in this case without direct current examination of the Veteran; the Veteran expressed such an objection in his January 2013 written statement. However, medical etiology opinions informed by review of the pertinent documented medical history and application of medical principles concerning undisputed current diagnoses (sarcoidosis and COPD in this case) can constitute probative evidence without a direct medical inspection of the Veteran; the essential questions addressed by the VA medical etiology opinion developed in this case concern the etiology of the Veteran's already-established diagnoses, not any dispute that may be informed by current examination findings. The Board finds that the Veteran's objection provides no persuasive basis for discounting the probative value of the March 2013 VHA medical opinion. With regard to issue of entitlement to service connection for depression being decided herein, the Board finds that a VA medical examination (with nexus opinion) is not required in order to make a final adjudication. See McLendon v. Nicholson, 20 Vet. App. 79 (2006), states, that in disability compensation (service connection) claims, VA must provide a medical examination [for a nexus opinion, as applicable] 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. The Board finds that the standards set forth in McLendon are not met with regard to the depression issue on appeal in this case. There is no credible evidence of an event, injury, or disease during service or within a presumptive period to satisfy the second McLendon requirement. As discussed below, the evidence in this case establishes that the Veteran had a pre-service "anxiety reaction" diagnosis which was not aggravated during service (nor even noted as existing at the time of the Veteran's separation from service) and there is otherwise no suggestion of in-service psychiatric symptomatology including in the service treatment records and in the Veteran's testimony. The Veteran's contentions describe his claimed depression as a consequence of post-service manifestations of sarcoidosis and COPD, not as a pathology with onset during military service. The Veteran is not shown to have had any pertinent manifestations of depression during service or for many years thereafter. Finally, no further development is necessary with regard to the Veteran's claim that his depression is secondary to his sarcoidosis or COPD; service connection may not be granted on this basis in view of the fact that service connection for sarcoidosis and COPD is denied. As such, VA examination in connection with the depression issue is not necessary. Review of the claims file shows substantial compliance with the directives of the Board's December 2011 remand directives. In this regard, the Board notes that the recently developed March 2013 VHA medical advisory opinion provides competent evidence (discussed in more detail below) that none of the Veteran's claimed disabilities can be medically linked to any hypothetical asbestos exposure; any question of developing evidence to determine whether the Veteran was exposed to asbestos during military service is therefore rendered moot (determining exposure to asbestos during service is only significant to the appeal to the extent that such asbestos exposure could serve as the basis of establishing a link between a claimed disability and military service). The Board otherwise notes that the claims file now contains all available pertinent records from the tuberculosis clinic in Cuyahoga County described in the Board's December 2011 remand; a written statement from the Veteran dated in December 2011 indicates that there are no additional pertinent medical records known to be available. Proper RO-level readjudication of the issues was completed as evidenced by the November 2012 supplemental statement of the case. All known and available records relevant to the issues on appeal have been obtained and associated with the Veteran's claims file; the Veteran has not contended otherwise. VA has complied with the notice and assistance requirements and the Veteran is not prejudiced by a decision on the appellate issue at this time. In light of the above, the Board concludes 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. Analysis The issue before the Board involves a claim of entitlement to service connection. Applicable law provides that service connection will be granted if it is shown that the veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury or disease in line of duty, in the active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Additionally, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, such as sarcoidosis and psychoses, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection is warranted for a disability which is proximately due to, or the result of, a service-connected disease or injury. 38 C.F.R. § 3.310. The Court has also held that service connection can be granted for a disability that is aggravated by a service-connected disability and that compensation can be paid for any additional impairment resulting from the service-connected disorder. Allen v. Brown, 7 Vet. App. 439 (1995). VA law provides that a veteran is presumed to be in sound condition, except for defects, infirmities or disorders noted when examined, accepted, and enrolled for service, or where clear and unmistakable evidence establishes that an injury or disease existed prior to service and was not aggravated by service. 38 U.S.C.A. §§ 1111, 1132, 1137. The presumption of soundness attaches only where there has been an induction examination during which the disability about which the veteran later complains was not detected. See Bagby v. Derwinski, 1 Vet.App. 225, 227 (1991). The regulations provide expressly that the term "noted" denotes "[o]nly such conditions as are recorded in examination reports," 38 C.F.R. § 3.304(b), and that "[h]istory of preservice existence of conditions recorded at the time of examination does not constitute a notation of such conditions." Id at (b)(1). The law further provides that the burden to show no aggravation of a pre-existing disease or disorder during service is an onerous one that lies with the government. See Cotant v. Principi, 17 Vet. App. 116, 131 (2003); Kinnaman v. Principi, 4 Vet. App. 20, 27 (1993). Importantly, the VA Office of the General Counsel determined that VA must show by clear and unmistakable evidence that there is a pre-existing disease or disorder and that it was not aggravated during service. See VAOPGCPREC 3-03 (July 16, 2003). The claimant is not required to show that the disease or injury increased in severity during service before VA's duty under the second prong of this rebuttal standard attaches. Id. The Board must follow the precedent opinions of the General Counsel. 38 U.S.C.A. § 7104(c). Also pertinent is the decision of the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) in Wagner v. Principi, 370 F.3d 1089 (Fed.Cir. 2004), issued on June 1, 2004, summarizing the effect of 38 U.S.C.A. § 1111 on claims for service-connected disability: When no preexisting condition is noted upon entry into service, the veteran is presumed to have been sound upon entry. The burden then falls on the government to rebut the presumption of soundness by clear and unmistakable evidence that the veteran's disability was both preexisting and not aggravated by service. The government may show a lack of aggravation by establishing that there was no increase in disability during service or that any "increase in disability [was] due to the natural progress of the" preexisting condition. 38 U.S.C.A. § 1153. If this burden is met, then the veteran is not entitled to service-connected benefits. However, if the government fails to rebut the presumption of soundness under section 1111, the veteran's claim is one for service connection. This means that no deduction for the degree of disability existing at the time of entrance will be made if a rating is awarded. See 38 C.F.R. § 3.322. On the other hand, if a preexisting disorder is noted upon entry into service, the veteran cannot bring a claim for service connection for that disorder, but the veteran may bring a claim for service-connected aggravation of that disorder. In that case section 1153 applies and the burden falls on the veteran to establish aggravation. See Jensen v. Brown, 19 F.3d 1413, 1417 (Fed.Cir. 1994). If the presumption of aggravation under section 1153 arises, the burden shifts to the government to show a lack of aggravation by establishing "that the increase in disability is due to the natural progress of the disease." 38 U.S.C. § 1153; see also 38 C.F.R. § 3.306; Jensen, 19 F.3d at 1417. Wagner, 370 F. 3d at 1096. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Board determinations with respect to the weight and credibility of evidence are factual determinations going to the probative value of the evidence. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). A veteran is competent to describe symptoms that he experienced in service or at any time after service when the symptoms he perceived, that is, experienced, were directly through the senses. 38 C.F.R. § 3.159 (competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience; lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person.); Layno, 6 Vet. App. at 469-71 (lay testimony is competent as to symptoms of an injury or illness, which are within the realm of one's personal knowledge; personal knowledge is that which comes to the witness through the use of the senses; lay testimony is competent only so long as it is within the knowledge and personal observations of the witness, but lay testimony is not competent to prove a particular injury or illness); see Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation). The absence of contemporaneous medical evidence is a factor in determining credibility of lay evidence, but lay evidence does not lack credibility merely because it is unaccompanied by contemporaneous medical evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim); Barr, 21 Vet. App. 303 ("Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms"). In determining whether statements submitted by a veteran are credible, the Board may consider internal consistency, facial plausibility, consistency with other evidence, and statements made during treatment. Caluza v. Brown, 7 Vet. App. 498 (1995). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Also, a veteran as a lay person is competent to offer an opinion on a simple medical condition. Davidson v. Shinseki, 581 F. 3d 1313, 1316 (Fed. Cir. 2009) (citing Jandreau). VA must consider the competency of the lay evidence and cannot outright reject such evidence on the basis that such evidence can never establish a medical diagnosis or nexus; however, this does not mean that lay evidence is necessarily always sufficient to identify a medical diagnosis, but rather only that it is sufficient in those cases where the lay person is competent and does not otherwise require specialized medical training and expertise to do so, i.e., the Board must determine whether the claimed disability is a type of disability for which a layperson is competent to provide etiology or nexus evidence. See Davidson, 581 F. 3d at 1316 (recognizing that, under 38 U.S.C.A. § 1154(a), lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition; he is reporting a contemporaneous medical diagnosis; or lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). The Board further notes that it has reviewed all of the evidence in the Veteran's claims file and in "Virtual VA" (VA's electronic data storage system), with an emphasis on the evidence relevant to the matter on appeal. 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) (VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence as appropriate and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as to the claim. Sarcoidosis and COPD The Veteran claims entitlement to service connection for sarcoidosis and COPD, contending that these pathologies are causally related to in-service chemical exposures and/or may have had in-service onset. If service connection is established for sarcoidosis on a direct basis, the Veteran contends that service connection for COPD is warranted on a secondary basis as etiologically linked to the sarcoidosis. The Veteran's April 1953 service entrance medical examination report shows that a pre-service history of seasonal hay fever and symptoms of mild asthma was noted upon entrance. The Board finds, however, that no chronic disability of the lungs nor any other symptom of sarcoidosis or COPD was noted at entrance. In this regard, the noted seasonal hay fever does not appear to indicate a chronic disability of the lungs. Significantly, the noted symptoms of mild asthma were followed up upon with a medical determination that the Veteran did not actually have asthma; a July 1953 service treatment record shows that the Veteran was medically studied for bronchial asthma concerns and "told he was not asthmatic." The Board finds that the service treatment records do not show notation of any actual pre-service sarcoidosis, COPD, or pertinent chronic lung disability. Accordingly, the Board finds that the Veteran must be presumed to have been in sound health with regard to sarcoidosis, COPD, or pertinent chronic lung disability. This finding is in the Veteran's favor (a finding of pre-existing pertinent disability limits the extent to which any in-service manifestation of a claimed disability would warrant a grant of service connection). The Board shall now proceed considering whether service connection is warranted for sarcoidosis or COPD with the presumption that the Veteran's health was sound in pertinent respects at the time of his entrance to service. The Veteran's service treatment records document multiple instances of hay fever manifestations, but no indication of pertinent sarcoidosis, COPD, or chronic lung disability. The Veteran's March 1957 service separation medical examination report shows that the Veteran was found to be clinically normal with regard to his lungs and chest; no pertinent abnormalities were found nor were any suggestions of sarcoidosis, COPD, or chronic lung disability noted. (The Board finds no suggestion of record that the 'enucleated tonsils' abnormality noted at separation was pertinent to sarcoidosis, COPD, or chronic lung disability.) The Board finds that the service treatment records, as a whole, reflect that the Veteran had no symptoms or diagnosis of sarcoidosis, COPD, or chronic lung disability during military service. In May 1957, the Veteran filed a claim for service-connected disability benefits on the basis of disabilities he believed at that time to have been incurred during service. The Veteran specifically claimed entitlement to service connection for ear infections and for prostatitis. August 1957 VA medical examination reports show that a medical determination was made that the Veteran did not have asthma and that he did have a history of hay fever allergies/rhinitis; the Veteran reported at that time that he had no recent history of pertinent symptoms. The Board finds that the evidence shows that the Veteran did not have any detected or manifested onset of sarcoidosis, COPD, or chronic lung disability as of August 1957. In multiple statements (including a July 2008 statement), the Veteran has testified that his sarcoidosis was detected through a chest X-ray at a Cleveland, Ohio, tuberculosis clinic in 1958. Although significant efforts have been undertaken to develop documentation of the described 1958 diagnosis, no documentation of record corroborates this testimony (including the records obtained from the identified pertinent clinic). Significantly, the Cuyahoga County Clinic records obtained and included in the claims-file include a June 1969 medical notation indicating "initial onset sarcoidosis 3-1/2 years ago." This evidence indicates that medical professionals involved in providing the Veteran's medical care and evaluation of sarcoidosis in 1969 believed that the sarcoidosis had its initial onset in approximately 1965 or 1966. The Board considers it reasonable to assume that the trained medical professionals would correctly note the timing of onset of sarcoidosis and, furthermore, that the noted chronology would be informed by the Veteran's own recollection of his medical history. The Board notes that the records from the Cuyahoga County Clinic contemporaneously document finding "probable sarcoidosis" in November 1965, indicating that sarcoidosis had not been previously diagnosed; this appears to be consistent with the June 1969 record indicating onset of sarcoidosis in approximately 1965. The Board finds that the contemporaneous medical documentation from the 1960s strongly suggests that the Veteran's sarcoidosis had initial onset in 1965. Subsequent medical records include repeated confirmations of sarcoidosis diagnoses over the period of decades leading to the present time. A June 1998 private medical record describes that the Veteran's sarcoidosis was of probably at least twenty-five years duration, but no further particular findings regarding chronology or etiology are presented in the treatment records. Private treatment reports show findings consistent with COPD with onset many years after the sarcoidosis diagnosis; a July 1999 private treatment report shows that the Veteran's chest x-ray was consistent with COPD and sarcoidosis. In July 2008, the Veteran filed a claim of entitlement to service connection for sarcoidosis (claimed as due to in-service asbestos exposure / various chemical exposures during service as a hydraulic mechanic) and COPD (claimed as due to sarcoidosis). An August 2008 private doctor's statement describes having treated the Veteran for 17 years (since 1991) and notes that the Veteran has lung disease which "may be due to environmental, chemical, or asbestos exposure, or sarcoidosis." This statement does not identify any probability of any etiological link between military service and a claimed disability; the Board finds that the medical statement does not provide any basis for a grant of service connection in this case and does not meaningfully support the claim (aside from further confirming the existence of the claimed lung disease and sarcoidosis). The August 2008 medical statement merely identifies several possible causes for the Veteran's lung disease without any indication of the probability that such disease is linked to military service. Service connection may not be based on a resort to speculation or mere possibility. See 38 C.F.R. § 3.102. An October 2008 private medical statement indicates that the Veteran had been "followed in this office since 1981" and has "chronic sarcoidosis initially diagnosed in 1958." A December 2008 VA examination report diagnoses sarcoidosis and COPD without offering a pertinent etiology opinion; the December 2008 VA examination report indicates that the sarcoidosis had onset in 1957 without identifying any basis for this detail (aside from interview of the Veteran regarding his recollections). A recitation of the Veteran's own account of his pertinent medical history is not accorded significant probative weight; there must be some objective, competent or at least contemporaneous evidence to corroborate a layperson's report of diagnostic medical history under these circumstances. A bare transcription of lay history, unenhanced by additional comment by the transcriber, does not become competent medical evidence merely because the transcriber is a health care professional. See LeShore v. Brown, 8 Vet. App. 406, 409 (1995). A November 2012 VA medical opinion is also of record, but the Board finds that the etiology opinion presented is not adequate to be considered probative evidence in this case. The November 2012 VA medical opinion finds that although it is "possible" that the Veteran's sarcoidosis had onset in 1958, the Veteran's sarcoidosis is unlikely related to military service; the November 2012 VA medical opinion provides no conclusion supportive of the Veteran's claim. The Board does not consider the negative medical opinion probative because the examiner's discussion of rationale merely discusses the lack of contemporaneous documentation of the Veteran's claimed 1958 onset of sarcoidosis; the November 2012 VA medical opinion does not discuss the medical principles or other pertinent facts of this case in connection with evaluating the probability that the claimed current disabilities may be etiologically related to the Veteran's service. As the Board's finding that the November 2012 VA medical opinion lacks probative value is a finding in the Veteran's favor (as the discounted opinion does not support the Veteran's claim), the Board need not further discuss the November 2012 VA medical opinion. For the purpose of obtaining a probative medical opinion addressing the critical medical questions with regard to the sarcoidosis and COPD issues, the Board requested a VHA medical advisory opinion in February 2013. The resultant March 2013 VHA medical advisory opinion weighs significantly against the Veteran's claims. The Board finds the conclusions of the March 2013 VHA medical advisory opinion to be highly probative evidence as it has been authored by a competent medical expert presenting the pertinent medical opinions with adequate discussions of rationale informed by medical principles and review of the claims-file. The March 2013 VHA medical advisory opinion states that "[i]t is more likely than not and within a reasonable degree of medical certainty that exposure to any of the listed exposures (napalm, asbestos, unspecified chemicals, hydraulic fuel, metal dust, carbon dust and brake dust) did not result in his diagnosis of Sarcoidosis nor did they result in any other respiratory illness." The expert notes that the nature and extent of such exposures are unclear from the subjective reports that are the exclusive source of information regarding such exposures, notes that dangerous dosages of exposure are unlikely given that "he was never treated for an exposure to toxic levels of any of the substances" in active service and he was not "exposed to any of them for long enough to result in any respiratory disorder." Significantly, the expert explains that "exposure to asbestos, brake dust, metal dust, hydraulic fuel, napalm, carbon dust, abrasives and unspecified chemicals ... are NOT KNOWN causes of sarcoidosis. There is no biologically plausible mechanism to explain how exposure to any one of these substances can cause sarcoidosis." The expert goes on to further explain the rationale for the negative opinion by citing that "there is no credible medical literature (strength of association or consistency) that supports the opinion that exposure to any of these substances produces sarcoidosis." The expert finds that the contended link between such an exposure and sarcoidosis "is NOT compatible with any existing theory or knowledge." The expert concludes that it is apparent that the Veteran had sarcoidosis in the 1960s, but that the "diagnosis of sarcoidosis is unrelated to actual or potential exposure to any of the listed substances during active duty" because his case "does not meet the minimal criteria needed to establish a causal relationship between exposure to these substances and the development of sarcoidosis." The March 2013 VHA expert identifies the specific medical conditions that have been medically accepted as linked to asbestos exposure, and explains that there is no evidence that the Veteran has any of the identified asbestos-linked conditions. The expert further clarifies that "asbestos exposure is not known to cause sarcoidosis." The March 2013 VHA expert opinion goes on to also address questions pertinent to the etiology of the Veteran's COPD. The expert states that "none of the listed exposures (napalm, asbestos, hydraulic fuel, unspecified chemicals, abrasives, metal dust, carbon dust or brake dust) is known to produce COPD...." The expert notes that additionally, "there is no diagnostic evidence of COPD in his military records." Acknowledging the service treatment records' references to hay fever and asthma concerns, the expert explains that "[h]is season symptoms and normal radiographic studies during this time period [in service] are inconsistent with persons who suffer from COPD." The expert notes that the Veteran was never treated for COPD, never had an abnormal chest X-ray during service, was merely treated for seasonal allergies and rhinitis, and at the time of his "separation examination in March of 1957 [he] reported no respiratory symptoms and his chest x ray at that time was normal." On these bases, the expert repeatedly concludes that "it is more likely than not and within a reasonable degree of medical certainty that COPD did not pre-exist his military service and was not aggravated or develop[ed] during his military service." The March 2013 VHA expert also discusses that the Veteran's most significant risk factors for COPD include his history of smoking cigarettes, but "COPD manifests itself in smokers following 10 years of active smoking about a pack a day. The records indicate that he quit smoking in 1963 following a 14 year history. In 1957, he had not smoked long enough to develop COPD from tobacco smoke." The VHA expert otherwise goes on to indicate that the Veteran's sarcoidosis was the major contributing cause of the ongoing lung function decline and his current symptoms. The Board finds that the probative March 2013 VHA medical advisory opinion adequately explains a persuasive conclusion that the Veteran's sarcoidosis and COPD are not etiologically linked to his military service, to include the claimed in-service exposures. The Board observes that the VHA expert's report cites Cuyahoga County Clinic records showing evidence of sarcoidosis as dated in 1963, whereas the Board reads those same records as actually dated in 1965. The VHA expert's interpretation of those records are more favorable to the Veteran (placing the earliest evidence of onset of sarcoidosis nearer to his period of military service), so there is no diminishment of the probative value of the negative etiology opinion presented by the March 2013 VHA medical advisory opinion. The Board notes that the Veteran's contentions have included references to his belief that he was exposed to asbestos during service. The Board has given consideration to whether the claimed disabilities on appeal may be linked to asbestos exposure on the basis of the evidence of record. The Board notes that there is no specific statutory guidance with regard to asbestos-related claims, nor has the Secretary promulgated any regulations in regard to such claims. However, VA has issued a circular on asbestos-related diseases. DVB Circular 21-88-8, Asbestos-Related Diseases (May 11, 1988) (DVB Circular) provides guidelines for considering compensation claims based on exposure to asbestos. The information and instructions from the DVB Circular have been included in a VA Adjudication Procedure Manual, M21-1 (M21-1), Part VI, 7.21. The United States Court of Appeals for Veterans Claims (Court) has held that VA must analyze an appellant's claim to entitlement to service connection for asbestosis or asbestos-related disabilities under the administrative protocols under these guidelines. Ennis v. Brown, 4 Vet. App, 523, 527 (1993); McGinty v. Brown, 4 Vet. App. 428, 432 (1993). The guidelines provide that the latency period for asbestos-related diseases varies from 10-45 years or more between first exposure and development of disease. M21-1, part VI, para. 7.21(b)(1) and (2). It is noted that an asbestos-related disease can develop from brief exposure to asbestos or as a bystander. The guidelines identify the nature of some asbestos-related diseases. The most common disease is interstitial pulmonary fibrosis (asbestosis). Asbestos fibers may also produce pleural effusions and fibrosis, pleural plaques, mesotheliomas of the pleura and peritoneum, lung cancer, and cancers of the gastrointestinal tract. See M21-1, part VI, para. 7.21(a)(1). The Veteran acknowledges that the Veteran is competent to offer statements regarding his exposure to asbestos. See McGinty v. Brown, 4 Vet. App. 428, 432 (1993) (The veteran is competent to testify as to the facts of his asbestos exposure). However, assuming for the sake of argument that the Veteran was in fact exposed to asbestos during service, whether the Veteran has any particular disability related to such exposure is medical in nature. In this case, there is absolutely no apparent basis for suggesting any relationship between the claimed sarcoidosis or COPD and the alleged asbestos exposure, nor does any competent evidence of record suggest the possibility of any such relationship. The March 2013 VHA medical advisory opinion specifically addresses the asbestos contention and explains that none of the Veteran's claimed disabilities may be linked to any hypothetical asbestos exposure. Thus, the Board finds that service connection on the basis of alleged exposure to asbestos is not warranted for any claimed disability on appeal at this time. The Board finds that the probative evidence of record weighs against finding any in-service onset of sarcoidosis, COPD, or any current chronic lung disability; the Board finds that the probative evidence of record weighs against finding any other manner of etiological link between any such disability and military service. Depression The Veteran claims entitlement to service connection for depression, contending that he has depression as a result of the sarcoidosis and COPD for which he has also sought to establish service connection. The Veteran's claim of entitlement to service connection for depression essentially features the theory that the claimed depression is a consequence of sarcoidosis and/or COPD. However, service connection is not warranted for sarcoidosis or COPD in this case. As discussed elsewhere in this Board decision, the Board has determined that service connection is not warranted for sarcoidosis or COPD. Thus, service-connection for the claimed depression secondary to sarcoidosis or COPD is barred as a matter of law. 38 C.F.R. § 3.310(a); Sabonis v. Brown, 6 Vet.App. 426 (1994). The Veteran's express contentions have exclusively indicated that his claimed depression has been a consequence of the sarcoidosis and COPD, and he has testified that his sarcoidosis and COPD were diagnosed after service. There is no clear testimony indicating that the Veteran recalls experiencing symptoms of depression during service. Nevertheless, to afford full consideration of all possible bases for service connection raised by the record, the Board notes that the Veteran's service treatment records refer to concerns involving "mild anxiety reaction" during service. The Veteran's April 1953 service entrance examination report shows that the Veteran had a clinically noted psychiatric abnormality, identified as "mild anxiety reaction." Service treatment records from June and July 1953 contain references to the anxiety reaction diagnosis and indicate that attention was paid to determining if the Veteran could be cleared for duty. It appears that such clearance was obtained, as the Veteran served until May 1957 with no additional suggestion of psychiatric symptoms or diagnosis during service. Significantly, the Veteran's March 1957 service separation medical examination report shows that the Veteran was found to be clinically normal with regard to psychiatric examination. The Board finds that the presumption of soundness does not apply in this case with regard to the psychiatric symptoms and diagnosis associated with mild anxiety reaction; the Veteran's in-service mild anxiety reaction was a psychiatric pathology clearly noted in his service entrance examination. As a preexisting anxiety reaction diagnosis was noted upon entry into service, service connection for the anxiety reaction diagnosis may only be established on the basis of service-connected aggravation of that disorder. However, the March 1957 service separation examination shows no psychiatric abnormalities at that time (the Veteran was found to be clinically normal with regard to psychiatric examination) and there is otherwise no evidence or testimony indicating any in-service worsening of psychiatric symptoms or in-service aggravation of the severity of a pre-existing psychiatric diagnosis. Neither depression nor any other psychiatric disability (aside from anxiety reaction) was noted on the Veteran's April 1953 service entrance examination report; the presumption of soundness would apply with regard to depression or any psychiatric diagnosis other than anxiety reaction. The Board's analysis in this case would then regard any shown in-service manifestation or diagnosis of psychiatric disability (other than anxiety reaction) as having initial onset during service, and proceed to consider whether any current chronic psychiatric disability is etiologically linked to the in-service psychiatric disability. However, there is no evidence of any manifestation or diagnosis of any psychiatric disability (aside from anxiety reaction) during the Veteran's military service. The only suggestion of in-service psychiatric symptoms or diagnosis is notes expressly concerning pre-existing anxiety reaction; the Veteran's March 1957 service separation examination report shows that he was clinically normal on psychiatric evaluation at that time, and the Veteran has not presented any evidence or testimony indicating in-service onset of depression or other psychiatric disability. The Veteran has presented the claim of entitlement to service connection for depression clearly on the basis of such disability being secondary to sarcoidosis or COPD; the Veteran has not contended that direct service connection is warranted on the basis of alleging any in-service onset of the claimed psychiatric disability. Therefore there is no basis for granting service connection for depression or any psychiatric disability on a direct basis in this case. The Board finds that the evidence does not support any basis for granting the claim of entitlement to service connection for depression. The preponderance of the evidence is against finding any etiological link to service for depression, as there is no indication of any in-service psychiatric pathology aside from anxiety reaction shown to have pre-existed service and not been aggravated by service. The Veteran's theory of entitlement to service connection for depression as secondary to sarcoidosis or COPD must be denied as a matter of law. Conclusion The Board finds that the preponderance of the evidence is against the claims of entitlement to service connection for sarcoidosis, COPD, and depression. In reaching this decision, the Board has reviewed the entirety of the evidence of record but finds that there is no other evidence of record which probatively contradicts the findings presented in the most probative evidence discussed above with regard to the issues on appeal. The Board acknowledges that the claims file contains a quantity of other documents, but none of the information in these records substantially supports the Veteran's claims or otherwise contradicts the evidence deemed to be most probative in the discussion above. Here, the evidence weighs against finding that any of the claimed disabilities is etiologically linked to military service or linked to any other claimed service-connected disability. The Veteran has been afforded VA examinations and a VHA medical expert advisory opinion to ensure adequate competent medical evidence addressing the sarcoidosis and COPD claims. As discussed above, the criteria for requiring a VA examination was not met with regard to the depression issue; there is no indication of record that the Veteran had onset of depression during service or proximately thereafter, and the Veteran's contended basis for service connection for depression requires that his sarcoidosis or COPD be service connected. The evidence now presents adequate medical information and opinion in connection with these claims; the March 2013 VHA expert provided clear findings and opinions with persuasive discussions of rationale weighing against the sarcoidosis and COPD claims on all pertinent bases. The VHA expert's pertinent findings and opinions address, with persuasive rationale, the pertinent facts and evidence of record; the Board finds that the March 2013 VHA medical advisory opinion is the most probative evidence of record on these issues. The Board acknowledges that service connection may indeed be granted when a chronic disease or disability is not present in service, but there is evidence of continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). In this case, however, the most persuasive evidence persuasively establishes that the Veteran had no symptom complaints attributable to sarcoidosis, COPD, or depression during service or proximately following service. He had no pertinent symptom complaints nor medical indication of any of these claimed disabilities when he filed a claim for disability benefits in May 1957 nor at the time of his August 1957 VA examination. The Veteran has not testified that he had any continuity of symptoms of depression from service or proximately thereafter, and the most probative evidence of record indicates no continuity of symptoms attributable to sarcoidosis or COPD from service or proximately thereafter. To the extent that the Veteran's statements present testimony indicating a continuity of such symptomatology since service or proximately thereafter, the Board finds that such testimony is not credible in this regard as it is contradicted by contemporaneous documentation of medical reports and the Veteran's own accounting of disability symptoms during service and proximately thereafter. The evidence in this case does not show continuity of symptomatology associated with a chronic disability for the purposes of application of 38 C.F.R. § 3.303(b). The Board acknowledges the Veteran's belief that his disabilities on appeal are related to his military service. However, there is no evidence of record showing that the Veteran has the specialized medical education, training, and experience necessary to render a competent medical opinion as to the diagnosis and etiology of a disability. The Board finds that questions of identifying the specific etiology of complex internal pathologies such as sarcoidosis, COPD, or depression are medical questions requiring specialized knowledge and expertise; such questions are not generally resolvable through information available to lay senses. Consequently, the Veteran's own assertions as to diagnosis and etiology of these disabilities have no probative value. Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C.A. § 1153(a); 38 C.F.R. §§ 3.303(a), 3.159(a); see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). See also Robinson v. Shinseki, 312 Fed. Appx. 336 (Fed. Cir. 2009) (non-precedential) (confirming that, in some cases, lay evidence will be competent and credible evidence of etiology). However, a determination concerning diagnosis of a specific disease or a determination concerning the possibility of a causal relationship between two different disease pathologies or between a chemical exposure and a chronic disability requires specialized training, and may therefore not be established by lay opinions on etiology. As the preponderance of the evidence is against the Veteran's claims of entitlement to service connection in this case, the benefit-of-the-doubt rule does not apply and this claims are denied. See 38 U.S.C.A. § 5107. ORDER The appeal is denied as to all issues. ____________________________________________ ALAN S. PEEVY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs