Citation Nr: 1320792 Decision Date: 06/27/13 Archive Date: 07/05/13 DOCKET NO. 03-15 299 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUES 1. Entitlement to service connection for peptic ulcer disease to include as associated with exposure to chlorine. 2. Entitlement to service connection for a skin disorder manifested by blisters and hives to include as associated with exposure to chlorine. 3. Entitlement to service connection for diabetes mellitus to include as associated with exposure to chlorine. 4. Entitlement to service connection for hypertension to include as associated with exposure to chlorine. 5. Entitlement to service connection for a heart disorder, including a heart attack, to include as associated with chlorine and/or exposure to biological hazards (human waste). 6. Entitlement to service connection for a pulmonary disorder to include chronic obstructive pulmonary disease and sleep apnea to include as associated with exposure to chlorine. REPRESENTATION Appellant represented by: Robert W. Gillikin, Attorney at Law WITNESS AT HEARING ON APPEAL The Veteran (Appellant) ATTORNEY FOR THE BOARD C.L. Krasinski, Counsel INTRODUCTION The Veteran, the appellant in this matter, served on active duty from December 1951 to December 1955. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2002 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The RO in Roanoke, Virginia, certified these claims to the Board for appellate review. At the time of certification, the Veteran claimed that the above-listed disorders were related to in-service exposure to mustard gas, or in the case of the claimed heart disorder, either mustard gas or human waste. The Veteran testified in support of these claims during a hearing held at the RO in June 2005 before a Decision Review Officer. In a decision issued in July 2007, the Board denied the appeals for service-connection related to mustard gas exposure and/or exposure to human waste. The Veteran then appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In April 2010, the Court issued a Memorandum Decision vacating the Board's July 2007 decision and remanding the claims to the Board for further proceedings consistent with the Memorandum Decision. In April 2011, the Veteran testified at a personal hearing before the Board, seated in Roanoke, Virginia (Travel Board hearing). At that time, the Veteran indicated that he wished to withdraw his claims for service connection for upper and lower back problems, both claimed as associated with exposure to mustard gas. In a June 2011 Board decision, the claims for service connection for upper and lower back disabilities were dismissed. The Board remanded the remaining issues on appeal for additional development. The Board finds that the agency of original jurisdiction substantially complied with the mandates of the June 2011 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (finding that a remand by the Board confers on the appellant the right to compliance with the remand orders). The Veteran was provided a VA examination in December 2011 and a medical opinion as to the etiology of the claimed disabilities was obtained. For this reason, the Board concludes that there has been substantial compliance with the remand order. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) aff'd, Dyment v. Principi, 287 F.3d 1377 (Fed. Cir. 2002). In evaluating this case, the Board has not only reviewed the Veteran's physical claims file, but has also reviewed the file on the "Virtual VA" system to ensure a complete assessment of the evidence. 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 was exposed to chlorinated wells and human waste during 30 days of active service in 1952. 2. The Veteran does not have a current diagnosed disability of peptic ulcer disease or other ulcer disease. 3. Peptic ulcer disease was not demonstrated during active service or within one year of the Veteran's release from active service. 4. The Veteran does not have a current skin disability manifested by blisters and hives. 5. No injury or disease of the endocrine system or chronic symptoms of diabetes mellitus were manifested during service. 6. The Veteran did not continuously manifest symptoms of diabetes mellitus in the years after service. 7. Diabetes mellitus was not manifested to a degree of ten percent within one year of service separation. 8. The Veteran's diabetes mellitus is not caused by any in-service event, including exposure to chlorine during service and is not related to service. 9. No cardiovascular injury or disease or chronic symptoms of hypertension or a heart or cardiovascular disease were manifested during service. 10. The Veteran did not continuously manifest symptoms of hypertension or a heart or cardiovascular disease in the years after service. 11. Hypertension and a heart or cardiovascular disease were not manifested to a degree of ten percent within one year of service separation. 12. The Veteran's hypertension and heart or cardiovascular disease are not caused by any in-service event, including exposure to chlorine and human waste during service and are not related to service. 13. No injury, disease, or chronic symptoms of a pulmonary or breathing disorder were manifested during service. 14. The Veteran did not manifest recurrent symptoms of a pulmonary or breathing disorder in the years after service. 15. The Veteran's pulmonary and breathing disorder to include chronic obstructive pulmonary disease and sleep apnea are not caused by any in-service event, including exposure to chlorine, during service and are not related to service. CONCLUSIONS OF LAW 1. Peptic ulcer disease, to include claimed as the residual of exposure to chlorine, was not incurred in active military service, nor may such a disability be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 2. A skin disorder to include as manifested by blisters and hives was not incurred in service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2012). 3. Diabetes mellitus, to include claimed as the residual of exposure to chlorine, was not incurred in active military service, nor may such a disability be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 4. Hypertension, to include claimed as the residual of exposure to chlorine, was not incurred in active military service, nor may such a disability be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 5. A heart disorder, to include claimed as the residual of exposure to chlorine and human waste, was not incurred in active military service, nor may such a disability be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 6. A pulmonary and breathing disorder to include chronic obstructive pulmonary disease and sleep apnea claimed as the residual of exposure to chlorine, was not incurred in active military service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations imposes obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). When VA receives a complete or substantially complete application for benefits, it is required to notify the claimant and the representative, if any, of any information and medical or lay evidence that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). VA must (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. The Board finds that the VCAA notice requirements have been satisfied by letters dated in June 2002, July 2004, March 2006, May 2006, June 2009, August 2010, and September 2011. In these letters, VA informed the Veteran of the evidence and information needed to substantiate a claim for service connection and informed the Veteran of which information and evidence he was to provide to VA and which information and evidence VA would attempt to obtain on his behalf. VA informed the Veteran it had to obtain any records held by any federal agency. These letters also informed the Veteran that on his behalf VA would make reasonable efforts to obtain records that were not held by a federal agency, such as records from private doctors and hospitals. Finally, the letters told the Veteran that he could obtain private records himself and submit them to VA. The VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between a veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. The Court held that the VCAA notice must include notice that a disability rating and an effective date of the award of benefits will be assigned if service connection was awarded. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). In the present appeal, the March 2006 and June 2009 letters explained the type of evidence necessary to establish service connection and the type of evidence necessary to establish a disability rating and effective date for the claims on appeal. The claims were readjudicated in the August 2012 Supplemental Statement of the Case, thus curing any lack of timeliness of notice. Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). VA has a duty to assist a veteran in the development of the claim. This duty includes assisting the veteran in the procurement of service treatment records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board notes that the Veteran's service treatment records are not available for review and have been presumed to have been destroyed in the fire at the National Personnel Records Center (NPRC) in 1973. The NPRC reported in April 1997, April 2000, November 2001, and March 2004, that the Veteran's service treatment records had been destroyed in a fire at that facility in 1973. It furnished duty rosters and morning reports. See also the November 2005 RO memorandum. VA will make reasonable efforts to obtain relevant records not in the custody of a Federal department or agency, to include records from private medical care providers. Such reasonable efforts will generally consist of an initial request for the records and, if the records are not received, at least one follow-up request. A follow-up request is not required if a response to the initial request indicates that the records sought do not exist or that a follow-up request for the records would be futile. See 38 C.F.R. § 3.159(c)(1) (2012). In the present case, the evidence shows that the Veteran's service treatment records have been destroyed and any additional efforts to obtain the records would be futile. Destruction of service medical records does not create a heightened benefit of the doubt, but only a heightened duty on the part of VA to consider the applicability of the benefit of the doubt, to assist the claimant in developing the claim, and to explain its decision. Cromer v. Nicholson, 19 Vet App 215 (2005); Russo v. Brown, 9 Vet. App. 46, 51 (1996). The Board has applied the benefit of the doubt and has found that the Veteran was exposed to chlorine wells in service based upon the Veteran's testimony of that in-service event. Where service medical records are missing, VA also has a duty to search alternate sources of service records. Washington v. Nicholson, 19 Vet. App. 362 (2005). The Board finds that VA has met this duty. The NPRC furnished duty rosters and morning reports. The RO obtained service personnel records. The RO notified the Veteran that his service treatment records were missing and that they had obtained the available morning reports. In March 2006 and September 2011 letters, the RO notified the Veteran of alternative forms of evidence to submit in lieu of the missing service treatment records. In January 2003, the Veteran submitted a document, dated September 1954, which included a list of fellow service members from his unit in Greece, some of whom he recalled took him to the hospital when he was overcome by chlorine in 1953 or 1952. In a December 2004 statement, the Veteran indicated that Major Allen FR McKay or 2nd Lieutenant Derald D. Willard, two members of his unit, would be able to verify his exposure to chlorine gas and hospitalization if they were alive. In June 2005 testimony before the RO, the Veteran also stated that his base commander, Major McKee, transported him from the hospital. In a September 2011 letter, the RO/AMC asked the Veteran to provide complete addresses for the service members so that VA could attempt to contact the individuals on the Veteran's behalf. The Veteran did not provide any additional information to the RO or respond to this letter. The Board finds that the RO made reasonable efforts to locate and contact the members of the unit noted by the Veteran and was unable to provide any additional assistance due to the lack of information provided by the Veteran, specifically, the lack of addresses of the identified individuals. The RO also made attempts to obtain the Greek Hospital records identified by the Veteran. In May 2012, the NPRC indicated that they searched for the Greek Hospital records and no records were found. In August 2012, the Veteran was notified that the Greek Hospital records were not located. The RO also made attempts to locate VA treatment records dated in 1954 and 1955 from the Salem VA medical facility. In June 2012, this facility notified VA that no records were located. The Veteran was notified of the results of this search in August 2012. VA treatment records dated from 1996 to 2009 are associated with the claims folder. Private medical records are associated with the claims file. In September 2011, VA contacted the Veteran and asked him to identify health care providers who have treated him for the claimed disabilities. The Veteran did not respond to the letter. In June 2009 and July 2009, the Veteran indicated that he had no additional information or evidence to submit. VA provided an examination in December 2011 to obtain medical evidence as to the nature and likely etiology of the claimed disabilities. The examination is adequate because it was performed by a medical professional based on review of claims file and a solicitation of history and symptomatology from the Veteran, and an examination of the Veteran. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The VA examiner considered the exposure to chlorine in service and provide a medical opinion as to whether the claimed disabilities were related to this exposure in service. Neither the Veteran nor his representative has challenged the adequacy of the examination obtained for these issues. Sickels v. Shinseki, 643 F.3d 1362 (Fed. Cir. 2011) (holding that the Board is entitled to presume the competence of a VA examiner and the adequacy of his opinion). Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion has been met. 38 C.F.R. § 3.159(c)(4). For these reasons, the Board finds that the duties to notify and assist the Veteran have been met, so that no further notice or assistance to the Veteran is required to fulfill VA's duty to assist in the development of the claims. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001). The Board finds that no reasonable possibility exists that any other assistance would aid in substantiating the claims and VA met its duty to assist the Veteran. In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the Court held that 38 C.F.R. § 3.103(c)(2) (2012) requires that the Veterans Law Judge who conducts a hearing fulfill two duties to comply with the above the regulation. These duties consist of (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. Here, during the April 2011 Board hearing, the undersigned Veterans Law Judge noted the elements of service connection that were lacking to substantiate the Veteran's claims, including the need for current disabilities that are shown to be related to service, specifically to the exposure to chlorinated wells and human waste in service. The Veterans Law Judge asked the Veteran questions about in-service chlorine and human waste exposure and elicited additional information about the exposures. The Veterans Law Judge asked L.H., a registered nurse testifying in support of the Veteran's claims, questions about her nexus opinion regarding chlorine exposure including in-service exposure and post service exposure and the effects of the exposures on the claimed disabilities. L.H. testified and presented a medical nexus opinion and medical nexus articles. As the Veteran presented some evidence of nexus of current disability to the in-service events, there is no missing or overlooked evidence. No additional pertinent evidence that might have been overlooked and that might substantiate the claims of service connection was identified by the Veteran or the representative. Therefore, the Board finds that, consistent with Bryant, the undersigned Veterans Law Judge complied with the duties set forth in 38 C.F.R. § 3.103(c)(2). Service Connection Laws and Regulations Service connection will be granted for disability resulting from a disease or injury incurred in or aggravated by military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection requires competent evidence showing, (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, 1167 (Fed. Cir. 2004), citing Hansen v. Principi, 16 Vet. App. 110, 111 (2002); see also Caluza v. Brown, 7 Vet. App. 498 (1995). In this case, cardiovascular disease including hypertension, diabetes mellitus, and peptic ulcer disease are listed among the "chronic diseases" under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.303(b) applies. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a "chronic disease" in service or "continuity of symptoms" after service, the disease shall be presumed to have been incurred in service. For the showing of "chronic" disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of "continuity of symptoms" after service is required for service connection. 38 C.F.R. § 3.303(b). Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases, such as cardiovascular disease including hypertension, diabetes mellitus, and peptic ulcer disease, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 2002); 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. With disability compensation claims, VA adjudicators are directed to assess both medical and lay evidence. As a general matter, a layperson is not capable of opining on matters requiring medical knowledge. See 38 C.F.R. § 3.159(a)(2). In certain circumstances, however, lay evidence may be sufficient to establish a medical diagnosis or nexus. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). In addressing lay evidence and determining its probative value, if any, attention is directed to both competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted"). See Layno v. Brown, 6 Vet. App. 465, 469 (1994). In terms of competency, lay evidence has been found to be competent with regard to a disease with "unique and readily identifiable features" that is "capable of lay observation." See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007) (concerning varicose veins); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (a dislocated shoulder); Charles v. Principi, 16 Vet. App. 370, 374 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398, 405 (1995) (flatfoot). That notwithstanding, a veteran is not competent to provide evidence as to more complex medical questions and, specifically, is not competent to provide an opinion as to etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. See generally Caluza v. Brown, 7 Vet. App. 498 (1995). The Board may weigh the absence of contemporaneous medical evidence against the lay evidence in determining credibility, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006); but see Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000) (evidence of a prolonged period without medical complaint after service can be considered along with other factors in the analysis of a service connection claim). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 7105; 38 C.F.R. §§ 3.102. Service Connection Analysis Initially, the Board notes that the Veteran's service treatment records are not available for review and have been presumed to have been destroyed in the fire at the NPRC in 1973. As the Veteran's service treatment records are unavailable for review, the Board has a heightened duty to explain its findings and conclusions and to consider carefully the benefit-of-the-doubt rule. See O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). The case law does not establish a heightened "benefit of the doubt," only a heightened duty of the Board to consider the applicability of the benefit of the doubt, to assist the claimant in developing the claim, and to explain its decision when the veteran's service records have been destroyed. See Ussery v. Brown, 8 Vet. App. 64 (1995). Similarly, the case law does not lower the legal standard for proving a claim for service connection, but rather increases the Board's obligation to evaluate and discuss in its decision all of the evidence that may be favorable to the veteran. Russo v. Brown, 9 Vet. App. 46 (1996). While it is unfortunate that the Veteran's service treatment records are unavailable, the appeal will be decided upon the evidence of record, and the Board will not draw a negative inference from the absence of service treatment evidence. Review of the record shows that, prior to the April 2010 Court Memorandum Decision, the Veteran contended that he incurred several disorders including peptic ulcer disease, blisters and hives, cardiovascular disease including hypertension, diabetes mellitus, and a breathing or pulmonary disorder due to in-service exposure to mustard gas. At the April 2011 Board personal hearing, notably four years into the claim and after various VCAA notices and rating decision and statement of the case denials, the Veteran explained that he now believes that he developed the claimed disorders due to in-service exposure to chlorine. The Veteran stated that he no longer wished to pursue any claims based on mustard gas exposure as he was certain that exposure to mustard gas could not have caused his current disorders. The Veteran's representative, when asked, specifically stated that the Veteran was abandoning the mustard gas theory of entitlement. Notably, the Veteran does not now assert that mustard gas exposure caused any of his current disorders and has, in fact, specifically rejected that theory of entitlement; there is also no treatment evidence of record to suggest this as a possible theory of entitlement. See Robinson v. Mansfield, 21 Vet. App. 545, 553 (2008) (VA must consider the possible theories of entitlement raised by the claimant or the evidence of record). At the April 2011 Board personal hearing, the Veteran stated that he believed that all of his claimed disorders were caused by in-service exposure to chlorine. The Veteran testified that he dug water wells during service and, subsequently, chlorinated the wells with chlorine, thereby exposing himself to high doses of chlorine. He stated that he was exposed to the chlorinated wells for approximately 30 days. The Veteran stated that he went to the Greek Hospital after being overwhelmed by the chlorine gas. He also asserted that he was exposed to human waste during service and this caused his heart disease. He contends that bacteria from the human waste ate away his heart valves. The Veteran is competent to report an observable event such as digging a well and to report observable symptoms such as a blister. See also Jandreau; supra. The Board finds that the Veteran's statements have limited credibility and therefore, limited probative value, because the Veteran first made these statements over 50 years after service separation and these statements are inconsistent with his previous statements. The Veteran had previously asserted that his claimed disabilities were caused by exposure to mustard gas, not chlorine. In support of the Veteran's claim, at the April 2011 Board hearing, L.H., a registered nurse, testified that chlorine exposure could result in the disorders caused by the Veteran. She also stated that post-service chlorine exposure could create the same results. L.H. also submitted additional research materials to the Board in support of her testimony. See also the April 2011 statement from L.H. Service Connection for Peptic Ulcer Disease and a Skin Disorder The Board finds the weight of the competent and credible evidence shows that the Veteran does not have a current diagnosed disability of peptic ulcer disease or a skin disability manifested by blisters and hives. The Veteran has provided lay evidence of symptoms of blisters and hives and he reported having gastrointestinal symptoms in service and in the past. The Board notes that the Veteran is competent to report observable symptoms such as pains or a blister; however, the Veteran is not competent to render a clinical diagnosis of a specific type of disease process such as peptic ulcer disease without the requisite medical training and expertise. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Rendering a diagnosis of a disease such as peptic ulcer disease falls outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) ("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"). The Court has held that a lay person, such as the Veteran, may be capable of diagnosing physically observable non-complex disorders, such as a skin disorder. McCartt v. West, 12 Vet. App. 164, 167-68 (1999) (implying that allegations of a skin disorder of boils, blotches, rash, soreness, and itching since service was the type of condition lending itself to lay observation and could satisfy the nexus requirement). Essentially, when a disorder may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. In such cases, the Board is within its province to weigh that testimony and to make a credibility determination as to whether that evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. Barr v. Nicholson, 21 Vet. App. 303 (2007). This, in the present case, a skin disorder manifested by hives and blisters, such as the one the Veteran has repeatedly described, is something he is competent to report. The Board must then assess the credibility of the Veteran's statements. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Having reviewed the Veteran's numerous statements, the Board finds them to be credible as they have been consistent. However, the medical evidence does not establish a diagnosis of peptic ulcer disease or a clinical diagnosis pertinent to the skin. The Veteran was afforded a VA examination in December 2011. Physical examination revealed no evidence of a benign or malignant neoplasm or metastases. The Veteran denied having a skin disease. The Board finds the December 2011 VA examination report to have great evidentiary weight as the opinion reflects a comprehensive and reasoned review of the entire evidentiary record. The VA examiner reviewed the claims folder, considered the Veteran's medical history, and examined the Veteran before rendering the medical opinion. Factors for assessing the probative value of a medical opinion are the examiner's access to the claims file and the thoroughness and detail of the opinion. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Prejean v. West, 13 Vet. App. 444, 448-9 (2000). The medical opinion is based on sufficient facts and data. In Nieves-Rodriguez, 22 Vet. App. 295, the Court held that guiding factors in evaluating the probity of a medical opinion are whether the opinion was based on sufficient facts or data, whether the opinion was the product of reliable principles and methods, and whether the medical professional applied the principles and methods reliably to the facts of the case. For these reasons, the Board has assigned great probative weight to the opinion of the VA physician and finds that it outweighs the lay theories and lay statements of the Veteran and establishes that the Veteran does not have a current skin disability. The December 2011 VA examination report indicates that there was no evidence of a stomach or duodenum disorder. The Veteran denied having any stomach or duodenum symptoms. For the same reasons as above, the Board finds the December 2011 VA examination report to have great evidentiary weight as the opinion reflects a comprehensive and reasoned review of the entire evidentiary record. The VA examiner reviewed the claims folder, considered the Veteran's medical history, and examined the Veteran before rendering the medical opinion. See Hernandez-Toyens; supra; see also Prejean; supra. The medical opinion is based on sufficient facts and data. See Nieves-Rodriguez; supra. For these reasons, the Board has assigned great probative weight to the opinion of the VA physician and finds that it outweighs the lay theories and lay statements of the Veteran and establishes that the Veteran does not have current peptic ulcer disease. There is medical evidence that the Veteran had a history of ulcers in the past. In May 1973, the Veteran was treated for postoperative anal stenosis following a hemorrhoidectomy several months earlier. In December 1979, the Veteran underwent an exploratory laparotomy with duodenotomy and excision of the polyp of the duodenum. It was indicated that he had had peptic ulcer disease as a child. In the medical history portion of the report, the Veteran was noted to have had no serious medical illnesses. It was indicated that he had had an appendectomy in 1937 and a hemorrhoidectomy in 1974. At an August 1995 VA examination, the Veteran stated that he had stomach pains in 1952 or 1953 during service. He reported that he had an upper GI series performed at that time which revealed ulcers. He noted that he was put on a mild diet and that the ulcers healed. He indicated that a second upper GI was done which showed that the ulcers had healed. It was noted that in 1964 the Veteran had an upper GI performed which showed ulcers and he was again placed on a controlled diet. The Veteran also stated that he underwent a partial gastrectomy in 1980. He indicated that he had no further treatment and that he occasionally took Maalox for his infrequent stomach pain. The medical evidence of record does not show a current diagnosis of peptic ulcer disease or other ulcer disease. A November 2003 private hospital record indicates that examination of the abdomen was within normal limits. A November 2008 VA treatment record indicates that the Veteran denied having an ulcer. The VA treatment records do not show a diagnosis of an ulcer. The weight of the evidence shows that the Veteran does not currently have peptic ulcer disease or other clinical diagnosis of ulcer disease. The weight of the evidence shows that the Veteran did not have a diagnosis of peptic ulcer disease or other ulcer disease within one year of service separation in December 1955. There is competent evidence that the Veteran has had blisters and hives in the past. At the June 2005 hearing, the Veteran testified that he was treated for blisters near his rectum by two private physicians beginning in 1963. He stated that neither of the physicians knew what caused the blisters. He noted that the polyps he had removed were really blisters and were described as polyps for insurance purposes. The weight of the evidence shows that the Veteran does not have a clinical diagnosis of a skin disability or symptoms of blisters or hives. The December 2011 VA examination report indicates that the Veteran denied having a current skin disease. The medical evidence of record does not show a current diagnosis of a skin disorder to include a disorder manifested by blisters and hives. The Court has held that Congress specifically limited entitlement to service connected benefits to cases where there is a current disability. "In the absence of proof of a present disability, there can be no valid claim." Brammer, 3 Vet. App. at 225. Without competent evidence of a diagnosed disability, service connection for the disorder cannot be awarded. See Brammer; supra; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004) (holding that service connection requires a showing of current disability); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998) (holding that a grant of service connection requires that there be a showing of disability at the time of the claim, as opposed to sometime in the distant past). The more probative evidence of record shows that the Veteran did not have peptic ulcer disease or a skin disability at any point during the claim or appeal period. McClain v. Nicholson, 21 Vet. App. 319 (2007). Accordingly, on this record, the evidence is found to preponderate against the claim that the Veteran has peptic ulcer disease or other ulcer disease or a skin disability to include manifested by hives and blisters including that was incurred in or is related to service. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. Service Connection for Diabetes Mellitus, Hypertension, Heart Disorder, and Pulmonary/Breathing Disorder The Veteran contends that all of his claimed disorders were caused by in-service exposure to chlorine. The Veteran testified that he dug water wells during service and, subsequently, chlorinated the wells with chlorine, thereby exposing himself to high doses of chlorine. He stated that he went to the Greek Hospital after being overwhelmed by the chlorine gas. He also asserted that he was exposed to human waste during service and he believes this caused his heart disease. See the April 2011 Board personal hearing transcript. Based upon a review of all the lay and medical evidence, the Board finds the weight of the competent and credible evidence shows that the diabetes mellitus, hypertension, heart disorder, and pulmonary disorder did not manifest in service or to a compensable degree within one year of service separation and are not otherwise related to active service. The Board finds the weight of the competent and credible evidence shows that the Veteran did not have chronic symptoms of diabetes mellitus, hypertension, heart disorder, or pulmonary disorder in service or continuous symptoms after service. The Veteran is competent to report an observable event such as digging a well and to report observable symptoms such as pain or difficulty breathing. See Jandreau; supra. However, the Board finds that the Veteran's statements have limited credibility and, therefore, limited probative value, because the Veteran first made these statements over 50 years after service separation, and these statements are inconsistent with his previous statements concerning the etiology of his claimed disabilities. As noted, the Veteran first alleged in 2001 that all of his claimed disabilities were caused by exposure to mustard gas in service. Only years later into the VA claims and after service connection denials by VA did the Veteran abandon the mustard gas exposure theory and present the chlorinated wells and human waste theories and stories of in-service exposure. Thus, the Board finds that the Veteran's statements are sufficient to establish that he was exposed to chlorine in service, although the statements have limited credibility and probative value and do not establish the onset of the claimed disabilities in service or chronic symptoms in service, or continuous post service symptoms. The Board further finds that the Veteran is not competent to render an opinion as to the extent of any injuries he may have incurred as a result of the exposure to chlorine. As noted, the Veteran, as a layperson, may report any observable symptoms he experienced having and after the exposure but without medical training, he does not have the expertise to diagnose any disorder or disease years after service and related to the exposure. The Board finds that the weight of the competent and credible evidence establishes that the Veteran did not have chronic symptoms, diagnosis, or treatment of diabetes mellitus, hypertension, or a heart disorder during active service; therefore, the criteria for presumptive service connection under 38 C.F.R. § 3.303(b) based on in-service chronic symptoms are not met. The Board finds that there is equipoise as to whether the Veteran had symptoms of shortness of breath in service soon after exposure to chlorine; however, a pulmonary disorder was not diagnosed and the Veteran does not report there was a diagnosis, and the evidence does not support a finding of chronic symptoms for the remainder of service. The service treatment records are not available and have been destroyed. The morning reports show that the Veteran was excused from duty on various days but the reasons for the excused duty are not noted. The Veteran himself reports that he was treated at the Greek Hospital in service after the chlorine exposure; however, records from the Greek hospital have not been located. The Board further notes that records from the Veteran's reported treatment at the VA facility in Salem in 1954 and 1955 have not been located. Resolving reasonable doubt in the Veteran's favor, the Board finds that the Veteran was exposed to chlorine and human waste in service and he was treated at a hospital in service and he had symptoms of shortness of breath; however, these symptoms were not chronic or recurrent during service. The Board finds that the weight of the competent and credible evidence establishes that the Veteran did not sustain an injury or disease of the cardiovascular system or the endocrine system during service and he did not experience chronic in service or continuous post service symptoms of hypertension, heart disease, diabetes mellitus, or a pulmonary disorder. See 38 C.F.R. § 3.303(b). In addition to the credible lay evidence, the medical evidence of record does not establish chronic symptoms in service or continuous symptoms after service. The Veteran did not submit any lay evidence of chronic symptoms in service or continuously since service. In statements made in support of his claims and in testimony at the hearing before the RO in June 2005 and at the hearing before the Board in April 2011, the Veteran stated that the claimed disabilities began many years after service separation. In the July 1995 claim for compensation benefits, the Veteran stated that he had shortness of breath in 1952 and was treated for one week. He reported that he had a heart condition since 1990 and diabetes since 1991. An August 1995 VA examination report indicates that the Veteran reported that he first noticed tightness in his chest in 1985; he reported that he was in the hospital for one week and there was no diagnosis. He reported having shortness of breath and chest tightness three months later. He currently had no current cardio symptoms or complaints. The Veteran reported that he had breathing problems in service in 1952 but he was better when he was stationed in Germany. He reported that he currently had shortness of breath with exertion. The examiner noted that shortness of breath was expected because of the Veteran's weight. The diagnoses were no current cardio complaints, shortness of breath with exertion with a normal chest x-ray, adult onset diabetes mellitus, and hypertension. Therefore, presumptive service connection pursuant to 38 C.F.R. § 3.303(b) for continuous post service symptoms is not warranted. At the hearing before the RO in June 2005, the Veteran reported having symptoms of diarrhea, vomiting, and a weak stomach in service. He did not report having symptoms due to a heart disorder, hypertension, a pulmonary disorder, or diabetes mellitus. The Veteran stated that he did not have breathing problems until several years after service separation. At the hearing before the Board in April 2011, the Veteran stated that he had a breathing problem after his service in Crete; he had breathing problems in 1954. He stated that he sought treatment at VA in 1958 for breathing problems. The Board finds that the weight of the competent and credible evidence establishes that the claimed disabilities did not manifest within one year of service separation and first manifested many years after service separation in December 1955. Therefore, presumptive service connection pursuant to 38 C.F.R. § 3.309(a) for a chronic disease manifested to 10 percent within one year from service separation is not warranted. Regarding the claimed heart disorder and hypertension, the competent evidence shows that the Veteran first had cardio symptoms 20 years after service separation. A June 1987 C. Hospital record indicates that the Veteran had a diagnosis of hypertension. The Veteran was admitted with complaints of chest pain and pressure over the chest. The diagnosis was chest pain of unknown etiology. The records noted that the Veteran had a similar episode one year prior. The diagnosis was ruled out myocardial infarction and hypertension. The August 1995 VA examination report shows a diagnosis of hypertension and indicated that the Veteran had no current cardio complaints. Chest x-ray examination was normal. A June 1996 VA treatment record shows diagnoses of coronary artery disease, status post myocardial infarction, and hypertension. The record notes that the Veteran reported having on and off chest pain since his myocardial infarction. A December 2011 VA examination report indicates that the Veteran had diagnoses of congestive heart failure, hypertension and mild cardiomegaly. The examiner noted that the Veteran was unable to recall how long he had elevated blood pressure readings. Regarding the claimed diabetes mellitus, the competent evidence shows that this disorder first manifested over 30 years after service separation. An August 1995 VA examination report shows a diagnosis of adult onset diabetes mellitus. A September 1995 VA treatment record shows a diagnosis of diabetes mellitus. Regarding the claimed pulmonary disorder to include chronic obstructive pulmonary disease and sleep apnea, the competent evidence shows that the Veteran reported having symptoms of shortness of breath in service in 1952, in 1958, and in 1995. The August 1995 VA examination report indicates that the Veteran reported having shortness of breath on exertion. Chest x-ray examination was normal and the diagnosis was shortness of breath with exertion. A July 2003 VA treatment record indicates that the Veteran reported having shortness of breath with everything. An August 2003 VA treatment record notes that the Veteran had chest pain, angina like, continuing variably. The examiner noted that it could be due to restrictive lung disease and sleep apnea. November 2003 records from B. Hospital indicate that the Veteran complained of intermittent problems with coughing and wheezing. The Veteran indicated that he had shortness of breath the past 3 or 4 weeks and he had an increase in severity. The diagnosis, in pertinent part, was exacerbation of chronic obstructive pulmonary disease. A December 2011 VA examination report shows a diagnosis of chronic obstructive pulmonary disease. It was noted that a 2011 chest computed tomography scan showed chronic fibrotic changes and pulmonary function tests in March 2006 shoed a mild obstructive pattern without response to a bronchodilator. It was noted that the Veteran reported being winded since 2005. At the June 2005 hearing, the Veteran testified that his breathing problems did not start until several years after separation from service. The weight of the competent and credible evidence establishes that hypertension, a heart disorder, and diabetes mellitus did not manifest to a compensable (10 percent) degree within a year of service separation. The Veteran separated from service in December 1955. There is no medical evidence or other competent evidence of record of record dated from a year from December 1955 which establishes that any of these disorders manifested to a degree of ten percent. The Veteran did not provide any lay evidence of the symptoms of these claimed disorders for this time period. The weight of the competent and credible evidence establishes that the Veteran's hypertension, heart disorder, and diabetes mellitus first manifested over 20 years after service separation. The weight of the competent and credible evidence establishes that the Veteran's current pulmonary disorder manifested by chronic obstructive pulmonary disease and sleep apnea did not manifest in service but first manifested over 20 years after service separation. Therefore, presumptive service connection pursuant to 38 C.F.R. § 3.307 and 38 C.F.R. § 3.309(a) is not warranted. The weight of the competent and credible evidence establishes that the Veteran did not experience continuous symptoms of hypertension, a heart disorder, and diabetes mellitus since service separation. As noted above, the Veteran did not provide lay statements that he had continuous symptoms since service. He presented lay statements that the symptoms of chest pain or tightness and shortness of breath began many years after service and were intermittent. The Board also finds that the weight of the competent and credible evidence shows that the Veteran did not experience recurrent symptoms of a pulmonary disorder in service or since service separation but that such symptoms first began approximately 30 years after service separation. The Veteran has not presented any competent evidence of recurrent or continuing pulmonary symptoms since separation from service. Finally, the Board finds that the weight of the evidence demonstrates that hypertension, a heart disorder, diabetes mellitus, and a pulmonary disorder are not caused by any in-service event or injury and are not medically related to service, to include the exposure to chlorine or human waste in service. The Veteran was afforded a VA examination in December 2011. The VA examiner reviewed the claims folder, considered the Veteran's reported medical history, examined the Veteran, and offered an opinion as to the etiology of the claimed disorders. The diagnoses were diabetes mellitus, hypertension, congestive heart failure, obstructive sleep apnea, and chronic obstructive pulmonary disease. The VA examiner in December 2011 opined that it was less likely than not that any of these disorders were incurred in or caused by the claimed in-service injury, event, or illness. The examiner indicated that the rationale for the medical opinion was based upon the claims folder, medical records, medical history, physical examination of the Veteran and review of NIH.com and E.P.A. medical literature online. The examiner indicated that chlorine gas is a pulmonary irritant with intermediate water solubility that causes acute damage in the upper and lower respiratory tract. The examiner explained that chronic exposure to chlorine gas or mist may result in decreases in pulmonary function, inflammation of the bronchi, dermatitis, conjunctivitis, upper respiratory tract abnormalities, and nasal ulceration; that symptoms may be delayed for one to two days and the symptoms similar to those of acute viral infections of the upper respiratory tract may also occur, and inhalation causes a transitory constriction of the respiratory tract which lessens on prolonged exposure. The VA examiner in December 2011 noted that the prescribed treatment recommended by peer review medical literature conflicted with the treatment provided to the Veteran during an acute exposure, according to the Veteran's statements. The treatment recommended is decontamination and supplemental oxygen. The examiner indicated that the up to date literature does not support the Veteran's claimed conditions as caused primarily by acute exposure to chlorinating wells in active service. The VA examiner in December 2011 noted that the Veteran's claimed conditions surfaced in response to the Veteran's aging process and were exaggerated by his comorbid conditions. The examiner indicates that the statement by L.H., the registered nurse, was reviewed and indicated that there was no supporting documentation to date to support the assertions. The Board finds the December 2011 VA medical opinion to have great evidentiary weight as the opinion reflects a comprehensive and reasoned review of the entire evidentiary record. The VA examiner reviewed the claims folder and the Veteran's medical history and examined the Veteran before rendering the medical opinion. The examiner considered the registered nurse's opinion. The VA examiner reported the research and medical findings concerning chlorine exposure and considered such findings when rendering the medical opinion. Factors for assessing the probative value of a medical opinion are the examiner's access to the claims file and the thoroughness and detail of the opinion. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Prejean v. West, 13 Vet. App. 444, 448-9 (2000). The medical opinion is based on sufficient facts and data. In Nieves-Rodriguez, 22 Vet. App. 295, the Court held that guiding factors in evaluating the probity of a medical opinion are whether the opinion was based on sufficient facts or data, whether the opinion was the product of reliable principles and methods, and whether the medical professional applied the principles and methods reliably to the facts of the case. The evidence weighing in favor of the Veteran's claim includes private medical opinion by L.H., a registered nurse. In an April 2011 statement, L.H. stated that chlorine exposure could result in the disorders caused by the Veteran, although she also stated that post-service chlorine exposure could create the same results. L.H. also submitted additional research materials to the Board in support of her testimony. The medical articles associated with the record essentially indicate that drinking and bathing in chlorinated water cause a variety of adverse health effects including heart disease. The Board finds that L.H.'s statement is not sufficient evidence to establish that the claimed disabilities were caused by the chlorine exposure in service. L.H.'s statement is inconclusive because she states that there "could" be a relationship between the claimed disabilities and the chlorine exposure in service. She does not render an opinion that the chlorine exposure in service as likely as not caused the claimed disabilities in the Veteran's case. The Court has held that medical opinions that are speculative, general, or inconclusive in nature cannot support a claim. See Obert v. Brown, 5 Vet. App. 30, 33 (1993); Bloom v. West, 12 Vet. App. 185, 187 (1999). A physician's statement framed in terms such as "may" or "could" is not probative. See Warren v. Brown, 6 Vet. App. 4, 6 (1993). L.H. further testified that post-service chlorine exposure could also have led to the same results as the in-service chlorine exposure. L.H. essentially testified that post-service chlorine exposure could have led to the claimed disabilities, an opinion that, although produced by the L.H. ostensible in support of the claim, actually weighs against the claim because the Veteran had a few chlorine exposures in service but had over 60 years of post-service exposure to chlorinated water from drinking and bathing. The medical articles concerning chlorine exposure are also generic in suggesting a relationship. The medical articles do not address the specific facts in the Veteran's case or his specific contention that he was exposed to chlorine when chlorinating wells in service in the 1950s and this exposure led to the claimed diseases 20 to 30 years later. The articles address the use of chlorinated water for drinking and bathing for many years, not an isolated incident of chlorine exposure. In this case, the 60 year history of drinking and bathing in chlorinated water is much more significant than four years of exposure in service. The medical articles do not address the facts or circumstances of the Veteran's case and do not provide any plausible causal relationship between the Veteran's claimed diseases and his chlorine exposure in service. This information is not only insufficient to establish the element of medical nexus evidence but, in this case, where the Veteran had some chorine exposures during four years of service but had a 60 year history of post-service drinking and bathing in chlorinated water, which is 15 times the amount of in-service exposure, even has a tendency to show that the post-service exposure was the more likely cause of the disorders. See Sacks v. West, 11 Vet. App. 314 (1998). See also Wallin v. West, 11 Vet. App. 509, 513 (1998) (treatise evidence cannot simply provide speculative generic statements not relevant to the veteran's claim, but "standing alone," must include "generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion" (citing Sacks, 11 Vet. App. at 317; see also Stadin v. Brown, 8 Vet. App. 280, 284 (1995). The Board finds the December 2011 VA medical opinion to have greater evidentiary weight than the statement by L.H., the registered nurse, and the medical article. The December 2011 VA medical opinion reflects a comprehensive and reasoned review of the entire evidentiary record. The VA examiner reviewed the claims folder and the Veteran's medical history and examined the Veteran before rendering the medical opinion. The examiner addressed the specific facts and contentions in the Veteran's case and provided reasons and bases for the rationale. The Veteran himself has attempted to relate his hypertension, heart disease, diabetes mellitus, and pulmonary disorder to his active service and to the in-service exposure to chlorine and human waste. As noted, the Veteran, as a lay person, is competent to describe observable symptoms such as pain or difficulty breathing. Although lay persons are competent to provide opinions on some medical issues, see Kahana, 24 Vet. App. at 435, as to the specific issue in this case, an opinion as to the etiology and onset of hypertension, heart disease, diabetes mellitus, and a pulmonary disorder falls outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1377 n.4 (lay persons not competent to diagnose cancer). Some medical issues require specialized training for a determination as to diagnosis and causation; therefore such issues are not susceptible of lay opinions on etiology. Lay testimony on the question of relating the current hypertension, heart disease, diabetes mellitus, and the pulmonary disorder to service is not competent in the present case because the Veteran is not competent to state that these disabilities were incurred in service. See Davidson v. Shinseki, 581 F.3d 1313, 316 (Fed. Cir. 2009); Kahana (lay witnesses are competent to opine as to some matters of diagnosis and etiology, and the Board must determine on a case by case basis whether a veteran's particular disability is the type of disability for which lay evidence is competent). Such diagnoses require clinical or diagnostic testing such as clinical blood pressure readings, chest x-ray examination, electrocardiogram, glucose testing, or pulmonary function tests, and these tests are not found within the record during or immediately following his service period. Additionally, an opinion of etiology would require knowledge of the complexities of the cardiovascular, endocrine, and pulmonary systems and the various causes of unobservable hypertension, heart disease, diabetes mellitus and pulmonary disease, and would involve objective clinical testing that the Veteran is not competent to perform. The Veteran also asserts that he has a heart disability due to exposure to human waste and biohazards during his period of service. At the hearing before the Board in April 2011, the Veteran indicated that he was exposed to human waste during service and this caused his heart disease. He contends that bacteria from the human waste ate away his heart valves. The Veteran has attempted to relate his cardiovascular disease to his active service and the claimed exposures. As noted, the Veteran, as a lay person, is competent to describe observable symptoms and firsthand events such as being exposed to human waste. Although lay persons are competent to provide opinions on some medical issues, see Kahana at 435, as to the specific issue in this case, an opinion as to whether exposure to human waste and biohazards caused cardiovascular disease falls outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1377 n.4 (lay persons not competent to diagnose cancer). Some medical issues require specialized training for a determination as to diagnosis and causation, and such issues are therefore not susceptible of lay opinions on etiology. Additionally, an opinion of etiology would require knowledge of the complexities of the cardiovascular system and the various causes of cardiovascular disease. The Veteran has not submitted evidence that he has such knowledge, expertise, or training. There is no competent medical evidence of record indicating that the current heart disability or cardiovascular disease were caused or aggravated by the claimed exposure to human waste and biohazards. The record contains many medical treatment notations regarding the cardiovascular disease but at no time did a physician or other medical professional express an opinion regarding a link between the current cardiovascular disease and the claimed exposures in service. For the reasons and bases discussed above, the Board finds that a preponderance of the lay and medical evidence that is of record weighs against the claim for service connection for hypertension, a heart disability, diabetes mellitus, and a pulmonary disorder, including as a presumptive disease and on a direct basis, and the claims must be denied. Because the preponderance of the evidence is against the claims, the benefit of the doubt doctrine is not for application. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. ORDER Service connection for peptic ulcer disease, to include as associated with exposure to chlorine, is denied. Service connection for a skin disability to include as manifested by blisters and hives and to include as associated with exposure to chlorine is denied. Service connection for diabetes mellitus, to include as associated with exposure to chlorine, is denied. Service connection for hypertension to include as associated with exposure to chlorine is denied. Service connection for a heart disorder to include as associated with exposure to chlorine, is denied. Service connection for a pulmonary and breathing disorder to include as associated with exposure to chlorine is denied. ____________________________________________ J. PARKER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs