Citation Nr: 1322368 Decision Date: 07/12/13 Archive Date: 07/18/13 DOCKET NO. 09-37 190 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for right ear hearing loss. 2. Entitlement to service connection for bilateral knee disorder. 3. Entitlement to service connection for bilateral cataracts, to include as secondary to service-connected diabetes mellitus, type II. 4. Entitlement to service connection for night sweats. 5. Entitlement to service connection for memory loss. 6. Entitlement to service connection for bilateral hip joint pain. 7. Entitlement to service connection for bilateral ankle joint pain. 8. Entitlement to service connection for bilateral foot joint pain. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD D. Whitehead, Counsel INTRODUCTION The Veteran served on active duty from May 1967 to May 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. At the time of the March 2012 Board Remand, the issue on appeal also included a claim for service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD). Service connection for PTSD was granted in an October 2012 rating decision. The time period during which to file a notice of disagreement as to the disability rating assigned has not yet expired, and the Veteran has not disagreed with the assigned evaluation or effective date. Therefore, that matter of service connection for PTSD has been resolved and is not in appellate status. See generally Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (holding that where an appealed claim for service connection is granted during the pendency of the appeal, a second notice of disagreement must thereafter be timely filed to initiate appellate review of "downstream" issues such as the compensation level assigned for the disability or the effective date of service connection). The issues of service connection for bilateral hip, ankle, and foot pain are remanded to the RO via the Appeals Management Center in Washington, DC. FINDINGS OF FACT 1. The medical evidence does not show a right hearing disability for VA purposes. 2. The probative evidence does not show a current bilateral knee disorder, to include osteoarthritis, is related to the Veteran's military service. 3. The probative evidence does not show that an eye disorder, to include bilateral cataracts, is related to the Veteran's military service or to a service-connected disorder. 4. The evidence of record shows that the Veteran's reports of night sweats and memory loss are not a separate disorder, but are symptoms of his service-connected PTSD. CONCLUSIONS OF LAW 1. Hearing loss in the right ear was not incurred in the Veteran's active duty service, nor may it be presumed to have been so incurred. 38 U.S.C.A. §§ 1110, 1112, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 2. A bilateral knee disorder was not incurred in the Veteran's active duty service, nor may osteoarthritis of the knees be presumed to have been so incurred. 38 U.S.C.A. §§ 1110, 1112, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 3. An eye disorder, to include bilateral cataracts, were not incurred in service and are not proximately due to or aggravated by a service-connected disability. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.310 (2012). 4. The criteria for service connection for night sweats and memory, as separate and distinct disorders, have not been met. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. § 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VA's Duty to Notify and Assist VA has a duty to notify the claimant what information or evidence is needed in order to substantiate the claim and it must assist the claimant by making reasonable efforts to get the evidence needed. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). The Board finds that VA's duty to notify was satisfied by letters sent to the Veteran in April and May of 2008 and in a September 2009 statement of the case. These letters and the September 2009 statement of the case addressed all of the notice elements with regards to the Veteran's claims. Although the September 2009 statement of the case was issued following the initial adjudication of the case, the Veteran's claims were readjudicated, with the most recent adjudication occurring by way of an October 2012 supplemental statement of the case. Nothing more is required. The duty to assist has also been met in this case. The service treatment records are in the claims file. All identified post-military medical records have been obtained and associated with the file. In the March 2012 remand, the Board directed the RO to contact the Veteran and clarify whether he received disability and/or retirement benefits from the Social Security Administration (SSA) and to obtain his SSA records if he does indeed receive disability benefits. The record show that the RO contacted the Veteran in April 2012, at which time he reported that he receives SSA retirement benefits and is not in receipt of any benefits for disability purposes. See Stegall v. West, 11 Vet. App. 268 (1998). There is no indication of any outstanding relevant evidence not currently of record. VA examinations with respect to the issues on appeal were completed in December 2008 and June 2012. 38 C.F.R. § 3.159(c)(4). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that the VA opinions obtained in this case are adequate, as they are predicated on a full reading of the service treatment records and VA medical records in the Veteran's claims file. The opinions consider all of the pertinent evidence of record and the statements of the Veteran and are supported by the other evidence of record. This opinion was based upon a physical examination of the Veteran, a review of his claims file, and the examiner provided a rationale for the conclusion reached. See Barr, 21 Vet. App. at 312. Moreover, the Veteran has neither advanced an argument that the examination was deficient in any respect, nor that he was prejudiced thereby. Id. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion with respect to the issues on appeal has been met. 38 C.F.R. § 3.159(c)(4). Legal Criteria for Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C.A. §§ 1110. 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). To establish service connection for a disability resulting from a disease or injury incurred in service, or to establish service connection based on aggravation in service of a disease or injury which pre-existed service, there must be (1) competent evidence of the current existence of the disability for which service connection is being claimed; (2) competent evidence of incurrence or aggravation of a disease or injury in active service; and (3) competent evidence of a nexus or connection between the current disability and the disease or injury incurred or aggravated in service. Horn v. Shinseki, 25 Vet. App. 231, 236 (2010); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept. 14, 2009); cf. Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)). In many cases, medical evidence is required to meet the requirement that the evidence be "competent". However, when a condition 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. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Service connection for certain chronic diseases, to include arthritis and sensorineural hearing loss, may be established on a presumptive basis by showing that the disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C.A. §§ 1101, 1112 (West 2002); 38 C.F.R. §§ 3.307(a)(3), 3.309(a). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of that disease during the period of service. 38 C.F.R. § 3.307(a). For claims for service connection for hearing loss or impairment, VA has specifically defined what is meant by a "disability" for the purposes of service connection. 38 C.F.R. § 3.385. "[I]mpaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent." 38 C.F.R. § 3.385. Service connection for a current hearing loss "disability" is not precluded where hearing was within normal audiometric testing limits at separation from service. Id. When audiometric test results do not meet the regulatory requirements for establishing a "disability" at the time of the Veteran's separation, the Veteran may nevertheless establish service connection for a current hearing disability by submitting competent evidence that the current disability is the result of disease or injury in service. Id. Although all the evidence has been reviewed, only the most relevant and salient evidence is discussed below. See Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Right Ear Hearing Loss The Veteran claims entitlement to service connection for hearing loss in the right ear. He attributes the claimed right ear hearing loss to military noise exposure from guns and weapons during his service in Vietnam. He claims that his ear drum was damaged while on active duty. Service connection for a left ear hearing disability was granted by a rating decision in September 2009 due to in-service noise exposure. Service treatment records have been reviewed and are negative for reported symptomatology or diagnoses related to a hearing loss disorder. On a January 1967 pre-induction report of medical history, the Veteran denied ever having running ears or any ear, nose, or throat trouble. A January 1967 pre-induction report of medical examination shows the Veteran's ears were normal. On the associated audiological examination, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 4000 RIGHT 15 (30) 5 (15) 5 (15) 15 (10) (Note: The January 1967 audiometric test results were reported in standards set forth by the American Standards Association (ASA). The ASA results are the figures on the left of each column and are not in parentheses. Since November 1, 1967, those standards have been set by the International Standards Organization (ISO)-American National Standards Institute (ANSI). In order to facilitate data comparison, the ASA standards have been converted to ISO-ANSI standards and are represented by the figures in parentheses.). The Veteran's hearing was again assessed during his active duty service in March 1968, at which time he continued to deny having any ear, nose, or throat trouble. The March 1968 audiological examination revealed that pure tone thresholds, in decibels, for the right ear were as follows: HERTZ 500 1000 2000 4000 RIGHT 5 5 5 20 A May 1969 separation report of medical examination shows that the clinical examination of the Veteran's ears was normal. On the May 1969 separation report of medical history, the Veteran again denied ever having any ear, nose, or throat trouble. On the audiological examination, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 4000 RIGHT 10 0 0 10 The Veteran's audiometric test results do not show that right ear hearing levels meet the criteria for a hearing loss disability under VA regulations at any time during his military service, to include on service separation. See 38 C.F.R. § 3.385. A May 2008 record from the Veteran's private physician shows a diagnosis of sudden hearing loss; this record does not include the results of any audiometric test results or specify which ear was affected. Post-military VA medical records do not show evidence of a right ear hearing loss disability as defined by VA regulations. Id. During a December 2008 VA audiology examination, the Veteran reported experiencing noise exposure while on active duty from gun fire during his service in Vietnam. He also reported noise exposure due to his post-service occupation as a machinist, during which he reported using ear plugs. Although the Veteran claimed to have sustained damage to his eardrum during his Vietnam service, the physical examination in December 2008 revealed a normal right ear, with normal tympanometry and acoustic reflex testing. On the audiological examination, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 5 10 25 25 The clinical test results failed to show a right ear hearing loss disability for VA purposes. 38 C.F.R. § 3.385. The examiner concluded that the Veteran's right ear hearing was normal. Based on the evidence of record, the Board finds that service connection for hearing loss in the right ear is not warranted. Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In this case, there is no audiological evidence dated in service or after the Veteran's separation from the military showing that he has a right ear hearing disability for VA purposes. 38 C.F.R. § 3.385. In the absence of proof of a present disability there can be no valid claim. See Brammer, 3 Vet. App. at 225; see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) For all the foregoing reasons, the claim for service connection for hearing loss in the right ear must be denied. The evidence in this case is not so evenly balanced so as to allow application of the benefit-of-the-doubt rule as required by law and VA regulations. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Bilateral Knee Disorder The Veteran claims that he currently has a bilateral knee disorder due to his military service. He attributes his joint pain to his service as a wire team chief, which required constant standing on utility poles in steel wireman's stirrups. He claims that his current joint problems are due to the pressure of his total weight while on the stirrups and using a safety belt. Service personnel records reflect the Veteran's service in the United States Army from May 1967 to May 1969. His DD 214 lists his military occupational specialty as a wire team chief. Service treatment records document his reports of right knee symptomatology. The January 1967 pre-induction report of medical examination shows that the clinical examination of the lower extremities and skin was normal. A September 1967 service treatment record includes the Veteran's report of right knee pain and his history of an old right knee injury caused by a nail laceration to the knee. The physical examination revealed tenderness, with pressure applied to the patella. Service treatment records dated in February 1968 reflect the Veteran's additional report of experiencing right knee stiffness and pain since 1950, when he sustained a deep laceration on a rusty nail over the anterior aspect of his knee. An x-ray examination completed that month revealed a small calcific density in the lateral margin of the right knee. During a physical examination completed at that time, the Veteran voiced no complaints with initial manipulation of the patella. The examiner noted, however, that when the Veteran's attention was directed toward it, he reported having pain. The examiner determined that the orthopedic examination was normal. A February 1968 medical report shows that physical and x-ray examinations revealed no abnormality of the knee joint. The attending orthopedic surgeon determined that the Veteran was fit for active duty, and that there was no indication that a physical profile was needed at that time. Subsequent service treatment records are void of any reports or diagnoses related to either the right or the left knee. A March 1968 report of medical examination and associated report of medical history are negative for clinical findings or reported symptomatology relevant to the knees. A May 1969 separation examination shows that the Veteran's lower extremities were normal; on the associated report of medical history, the Veteran denied ever having a trick or locked knee; bone joint, or other deformity; arthritis or rheumatism; or lameness. Private treatment records dated after the Veteran's service discharge reveal a diagnosis of osteoarthritis of the knee in January 2007. There is no indication from these records as to which knee joint was affected. In a statement received in May 2008, the Veteran's wife reported that the Veteran developed problems in his joints with his legs after he returned from Vietnam. She reported that in December 2005, he felt that he could no longer work because of increasing pain in his arms and legs. A June 2012 VA joints examination report reflects the Veteran's report of increasing pain in his legs and arms and a history of "joint pain all over," with no specific reference to his knees. In reviewing the Veteran's service treatment records, the examiner noted the Veteran's report of a childhood injury to the right knee, and that he had no difficulty with his knee when he entered the military or when completing basic training. The Veteran did not report any specific in-service injury to his knee, but he stated that he was "attacked" twice during his service in Vietnam, which involved incoming shell fire. The examiner noted that the Veteran was a poor historian, and he stated that it was difficult to obtain a history of the Veteran's symptoms following his discharge, although the Veteran reported that he began to have knee pain ninety days after his separation from the military. The physical examination revealed a diagnosis of bilateral osteoarthritis of the knees. The examiner noted that the Veteran's service treatment records showed an assessment of a right knee injury, with no mention of left knee complaints. The examiner noted that the in-service x-ray showed no abnormality. The examiner opined that the Veteran's current bilateral knee disorder was not related to the right knee pain in 1968, and further found that his bilateral knee disorder was not due to his military service. Having reviewed the foregoing, the Board finds that the preponderance of the evidence is against the claim for service connection for a bilateral knee disorder. Accordingly, the claim must be denied. Initially, the Board notes the Veteran's in-service reports of a sustaining a deep laceration to his right knee prior to his military service. However, the Veteran was not diagnosed with any right knee disorders at the time of his enlistment, or at any other time during his military service. Given this, the presumption of sound condition has not been rebutted and the Veteran is presumed to have been sound at the time of enlistment. See 38 U.S.C.A. § 1111 (West 2002); 38 C.F.R. § 3.304(b)(1) (2012); Paulson v. Brown, 7 Vet. App. 466, 470 (1995); Crowe v. Brown, 7 Vet. App. 238, 246 (1995). The Veteran attributes his current right and left knee osteoarthritis to the physical demands caused by his military service as a wire team chief. The Veteran's statements are competent evidence of his inservice duties and symptomatology because this requires only personal knowledge as it comes to him through his senses. See 38 U.S.C.A. § 1154(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). In this case, the Veteran's service treatment records document his report of right knee pain while on active duty. While some symptoms of the disorder, such as pain, may be reported by a layperson, the diagnosis and etiology of the disorder require medical training. The Veteran does not have the medical expertise to provide an opinion regarding its etiology. Thus, the Veteran's lay assertions as to the etiology of his current bilateral knee osteoarthritis are not probative or sufficient in this instance. Id. There is no probative evidence that the Veteran had chronic right and/or left knee disabilities as a result of his military service, to include any knee symptomatology documented in his service treatment records. In this regard, the Board finds the Veteran's May 1969 separation report of medical examination to be highly probative as to his condition at the time directly prior to his release from active duty, as it was generated with the specific purpose of ascertaining the Veteran's then-physical condition, as opposed to his current assertion which is inconsistent with the evidence of record and proffered in an attempt to secure VA compensation benefits. Caluza v. Brown, 7 Vet. App. 498, 506 (1995) (finding that in weighing the credibility, VA may consider inconsistent statements, internal inconsistency, and consistency with other evidence of record). The May 1969 separation physical examination report is entirely negative for any clinical findings relevant to or a diagnosis of a right or left knee disorder and therefore weighs heavily against the claim. Moreover, the medical evidence does not show any evidence of a diagnosed right and left knee disorder until 2007. This diagnosis was rendered over thirty years after his discharge from active duty service. Evidence of a prolonged period without medical complaint and the amount of time that elapsed since active duty service can be considered as evidence against a claim. Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (holding that VA did not err in denying service connection when the veteran failed to provide evidence which demonstrated continuity of symptomatology, and failed to account for the lengthy time period for which there is no clinical documentation of his low back condition). The Board finds the VA medical opinion is highly probative and compelling evidence against the Veteran's claim that his current right and left knee disorders were incurred in or are related to his military service. See Nieves-Rodriguez, 22 Vet. App. 295, 299-301 (2008); see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). There is no competent medical evidence of record to rebut the opinion against the claim or otherwise diminish its probative weight. See Wray v. Brown, 7 Vet. App. 488, 492-93 (1995). To the extent that the Veteran is able to observe continuity of bilateral knee symptoms, his opinion is outweighed by the competent medical evidence. The weight of the competent and probative evidence is against a finding that the Veteran's right and left knee osteoarthritis is related to service. Moreover, the evidence does not show that right and left knee osteoarthritis was diagnosed within a year of his discharge from the military, and therefore, presumptive service connection is not warranted in this case. See 38 C.F.R. §§ 3.307, 3.309. Accordingly, while the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit of the doubt doctrine is inapplicable where, as here, the preponderance of the evidence is against the claim. Gilbert, 1 Vet. App. at 53-56. Accordingly, service connection for a bilateral knee disorder is not warranted. Bilateral Cataracts Here, the Veteran asserts that his bilateral cataracts are caused or aggravated by his service-connected diabetes mellitus, type II. Service connection may be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Service connection is in effect for diabetes mellitus type II. The Veteran does not claim, nor does the evidence show that an eye disorder, to include his bilateral cataracts began in or are related to his military service. Service treatment records show that assessments in January 1967, May 1967, March 1968, and May 1969 revealed that his uncorrected vision was 20/20, bilaterally. These records are negative for a diagnosis of cataracts or reports of vision problems. In a physician's statement submitted in May 2008, the Veteran's private physician, Dr. N., reported a diagnosis of diabetes mellitus, type II, and that there were no complications that were directly due to his diabetes. Also in May 2008, the Veteran's private physician, Dr. G.W., reported a diagnosis of diabetes mellitus, with no complications that were directly due to diabetes mellitus and specifically noted that there were no eye disorder findings. In June 2012, a VA examination revealed a diagnosis of diabetes mellitus, without ophthalmic manifestations for either eye. The examiner noted that there were no signs of retinopathy or diabetic macular edema. The examiner also rendered a diagnoses of mild nuclear sclerotic cataracts in each eye, that were not visually significant and were of an average appearance for age. Additional diagnoses included refractive error/presbyopia, dry eye symptoms, and small optic nerve head cup and crowded disc for both eyes. The examiner opined that none of these disorders were caused or aggravated by the Veteran's service-connected diabetes mellitus. The examiner concluded that the Veteran's cataracts were age related and were not caused or aggravated by his diabetes mellitus. The VA examiner explained that age is the greatest risk factor for cataracts, or lens opacity, and that the disorder was caused by aging of the crystalline lens. According to the examiner, each person would develop cataract as they age, with the rate and severity of this development influenced by family history, smoking history, unprotected exposure to ultraviolet light over a lifetime. The examiner further explained that cataracts associated with diabetes mellitus were typically found in diabetes mellitus, Type I, and are cortical opacities known as "snowflake" cataracts. With respect to the evidence showing that the Veteran is currently diagnosed with refractive error/presbyopia for both eyes, which are not a disability for VA purposes. See 38 C.F.R. § 3.303(c), 4.9 (2012); McNeely v. Principi, 3 Vet. App. 357, 364 (1992). The evidence of record does not indicate, nor does the Veteran claim, that an eye disorder, to include cataracts, began during his military service or is related to his military service. Thus, service connection on a direct basis is not warranted. The June 2012 VA examiner thoroughly reviewed the claims file, after which she essentially opined that the Veteran's bilateral cataracts, dry eye symptoms, optic nerve head cup, and crowded discs were not caused or aggravated by his diabetes mellitus. Specifically for the claimed cataracts disorder, the examiner concluded that this disorder was age related and was not caused or aggravated by his service-connected diabetes mellitus. The VA examiner's opinions were based on the evidence of record, the clinical examination, and the Veteran's statements, and are supported by sound medical rationale, and provide highly probative and compelling evidence against the Veteran's claim that an eye disorder, to include bilateral cataracts, are secondary to any of his service-connected diabetes mellitus. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (indicating "[i]t is the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion"); Wray v. Brown, 7 Vet. App. 488, 493 (1995). The Veteran's private physicians, Drs. N. and G.W., similarly opined that the Veteran did not have any complications, to include any eye findings, directly due to his diabetes. The Veteran has not provided any competent medical evidence to rebut the opinions against the claim for secondary service connection or submitted objective evidence that otherwise diminishes its probative weight. See Wray v. Brown, 7 Vet. App. 488, 492-93 (1995). The Veteran's statements are competent evidence to report the symptomatology associated with the claimed disorder, as this information comes to him through his senses. While some symptoms of a cataract disorder, such as blurred vision, may be reported by a layperson, the diagnosis and etiology of the claimed disorder requires medical training. The Veteran simply does not have the medical expertise to provide an opinion regarding the etiology of this disorder. Thus, the Veteran's lay assertions as to the etiology of the claimed disorder are not probative or sufficient in this instance. See Jandreau, 492 F.3d 1372 (Fed. Cir. 2007). In summary, the Board finds that the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for an eye disorder, to include bilateral cataracts. Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit of the doubt doctrine is inapplicable where, as here, the preponderance of the evidence is against the claim. See Gilbert, 1 Vet. App. at 53-56. Accordingly, service connection for an eye disorder, to include bilateral cataracts, is not warranted. Night Sweats and Memory Loss Claims The issues currently on appeal include claims for service connection for night sweats and memory loss, which the Veteran attributes to his service-connected PTSD. In statements submitted in May 2008, in support of his now-granted claim for service connection for PTSD, the Veteran described experiencing nightmares of his Vietnam service after which he would wake up sweating. On his April 2009 notice of disagreement and September 2009 VA Form 9, he also characterized his PTSD claim as including night sweats and memory loss. In a May 2008 statement, the Veteran's wife described her observations as to his psychiatric symptoms. She reported that the Veteran would wake up sweating, screaming, and crying at times due to nightmares. VA psychiatric treatment records in 2008 show the Veteran's service-connected psychiatric symptoms included nightmares, waking up sweating, and moderate difficulty remembering stressful experiences from the past. During a VA PTSD examination completed in June 2012, the Veteran reported having nightmares. Additional VA and private medical records associated with the claims file do not include any reports of night sweats or memory loss symptoms in any context other than the Veteran's report of his psychiatric symptoms. The evidence does not show that this claimed symptomatology are separate and distinct disorders, rather than symptoms of PTSD, nor does the Veteran claim otherwise. These symptoms have already been considered by the RO in assigning the current 30 percent disability rating for his service-connected PTSD disability. 38 C.F.R. § 4.14 (2012). "In the absence of proof of present disability there can be no valid claim." Brammer, 3 Vet. App. at 225. With no evidence of night sweats and memory loss disorders, separate and distinct from PTSD, service connection for night sweats and memory loss is not warranted. ORDER Service connection for right ear hearing loss is denied. Service connection for a bilateral knee disorder, to include osteoarthritis, is denied. Service connection for an eye disorder disorder, to include bilateral cataracts, is denied. Service connection for night sweats and memory loss disorders, separate and distinct from PTSD is denied. REMAND The Veteran claims that he currently has bilateral hip joint, bilateral ankle joint, and bilateral foot joint disorders due to his military service. He essentially attributes his current joint problems to the physical demands caused by his military occupational specialty as a wire team chief. He claims that this military occupational specialty required him to constantly stand on utility poles while wearing wireman's stirrups, and that the pressure of his total weight while wearing the stirrups and the safety belt caused his current joint conditions. The medical evidence of record currently does not show definitive diagnoses with regards to the Veteran's bilateral hips, ankles, or feet. However, on a January 2007 private treatment record, the Veteran's health history was noted to include rheumatoid arthritis. An April 2008 VA treatment record additionally shows the Veteran's report of experiencing "joint pain all over." To date, the Veteran has not been afforded a VA examination with respect to his claims for service connection for bilateral hip, ankle, and feet disorders. While the medical records suggest that a diagnosis of rheumatoid arthritis, the exact nature and etiology of any current condition affecting his bilateral hips, ankles, and feet is unclear. Assistance by VA includes providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on a claim. 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159(c)(4). When medical evidence is inadequate, VA must supplement the record by seeking an advisory opinion or ordering a medical examination. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Hatlestad v. Derwinski, 3 Vet. App. 213 (1992). Given the medical evidence indicating a diagnosis of rheumatoid arthritis, along with the Veteran's competent lay statements regarding the nature of his military service and his current orthopedic symptoms, the Veteran must be afforded a VA examination to determine whether the claimed disorders are attributable to his military service. Colvin, 1 Vet. App. 171. Accordingly, the case is remanded for the following action: 1. The RO must contact the Veteran and afford him the opportunity to identify or submit any additional pertinent evidence in support of his claims. Based on his response, the RO must attempt to procure copies of all records which have not previously been obtained from identified treatment sources. All attempts to secure this evidence must be documented in the claims file by the RO. If, after making reasonable efforts to obtain named records the RO is unable to secure same, the RO must notify the Veteran and (a) identify the specific records the RO is unable to obtain; (b) briefly explain the efforts that the RO made to obtain those records; (c) describe any further action to be taken by the RO with respect to the claim; and (d) that he is ultimately responsible for providing the evidence. The Veteran and his representative must then be given an opportunity to respond. 2. After all outstanding records have been associated with the claims file, the Veteran must be afforded the appropriate VA examination to determine whether any hip, ankle, and/or foot disorder found is related to his military service. All pertinent symptomatology and findings must be reported in detail. Any indicated diagnostic tests and studies must be accomplished. The claims file and all records on Virtual VA must be made available to the examiner, and the examiner must specify in the examination report that the claims file and Virtual VA records have been reviewed. The examiner must specify the dates encompassed by the Virtual VA records that were reviewed. Based on the clinical examination, a review of the evidence of record, and with consideration of the Veteran's statements, the examiner must state whether any diagnosed hip, ankle, and foot disorder is related to the Veteran's active duty service, to include as due to the physical demands of his military occupational specialty as a wire team chief. In providing the requested opinions, the examiner must consider the January 2007 private medical record indicating a history of rheumatoid arthritis. A complete rationale for all opinions must be provided. If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the examiner must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. The report prepared must be typed. 3. The Veteran must be notified that it is his responsibility to report for the examination scheduled, and to cooperate in the development of the claims. The consequences for failure to report for a VA examination without good cause may include denial of the claims. 38 C.F.R. §§ 3.158, 3.655 (2012). In the event that the Veteran does not report for a scheduled examination, documentation must be obtained and associated with the Veteran's claims file that shows that notice scheduling the examination was sent to his last known address. Documentation must be also be obtained and associated with the Veteran's claims file demonstrating any notice that was sent was returned as undeliverable. 4. The examination report must be reviewed to insure that it is in complete compliance with the directives of this remand. If the report is deficient in any manner, implement corrective procedures at once. 5. After completing the above actions, and any other development as may be indicated by any response received as a consequence of the actions taken in the paragraphs above, readjudicate the claims. If any benefit sought on appeal remains denied, the Veteran and his representative must be furnished a supplemental statement of the case and be given the opportunity to respond thereto. The appeal must then be returned to the Board for appellate review. No action is required by the Veteran until he receives further notice; however, he may present additional evidence or argument while the case is in remand status at the RO. Kutscherousky v. West, 12 Vet. App. 369 (1999). ______________________________________________ JOY A. MCDONALD Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs