Citation Nr: 18140172 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 15-02 469 DATE: October 2, 2018 ORDER As new and material evidence has been received, the previously denied claim of entitlement to service connection for a low back disorder is reopened. As new and material evidence has been received, the previously denied claim of entitlement to service connection for a thyroid disorder is reopened. As new and material evidence has been received, the previously denied claim of entitlement to service connection for difficulty swallowing is reopened. As new and material evidence has been received, the previously denied claim of entitlement to service connection for osteoarthritis is reopened. As new and material evidence has been received, the previously denied claim of entitlement to service connection for an acquired psychiatric disorder is reopened. As new and material evidence has been received, the previously denied claim of entitlement to service connection for an eye disorder is reopened. Entitlement to service connection for a low back disorder is denied. Entitlement to swelling of bilateral leg and joints is denied. Entitlement to service connection for rheumatoid arthritis is denied. Entitlement to service connection for ischemic heart disease is denied. Entitlement to service connection for chloracne is denied. REMANDED Entitlement to service connection for parathyroid adenoma, also claimed as neck nodule and thyroid disorder, is remanded. Entitlement to service connection for dysphagia, claimed as difficulty swallowing, is remanded. Entitlement to service connection for osteoarthritis is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include major depressive disorder, bipolar disorder and posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for an eye disorder is remanded. Entitlement to service connection for an upper respiratory disorder, to include allergies, is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for erectile dysfunction is remanded. Entitlement to service connection for diabetes mellitus is remanded. Entitlement to service connection for bilateral carpal tunnel syndrome is remanded. Entitlement to service connection for peripheral neuropathy is remanded. Entitlement to a compensable rating for acne scarring on the cheeks and back, furuncle and atopic dermatitis is remanded. FINDINGS OF FACT 1. A February 2014 rating decision denied entitlement to service connection for low back disorder because new and material evidence had not been submitted; the Veteran failed to file a notice of disagreement to initiate an appeal from this decision and new and material evidence was not received within one year. 2. Additional evidence received since the February 2014 rating decision is not cumulative or redundant of the evidence of record at the time of that decision, relates to an unestablished fact necessary to substantiate the claim for service connection for a low back disorder and raises a reasonable possibility of substantiating the claim. 3. A January 2013 rating decision denied entitlement to service connection for a thyroid disorder because there was no evidence of radiation exposure; the Veteran failed to file a notice of disagreement to initiate an appeal from this decision and new and material evidence was not received within one year. 4. Additional evidence received since the January 2013 rating decision is not cumulative or redundant of the evidence of record at the time of that decision, relates to an unestablished fact necessary to substantiate the claim for service connection for a thyroid disorder and raises a reasonable possibility of substantiating the claim. 5. A January 2013 rating decision denied entitlement to service connection for difficulty swallowing because there was no evidence of a current diagnosis; the Veteran failed to file a notice of disagreement to initiate an appeal from this decision and new and material evidence was not received within one year. 6. Additional evidence received since the January 2013 rating decision is not cumulative or redundant of the evidence of record at the time of that decision, relates to an unestablished fact necessary to substantiate the claim for service connection for difficulty swallowing and raises a reasonable possibility of substantiating the claim. 7. A November 2010 rating decision denied entitlement to service connection for osteoarthritis (of the spine) because there was no evidence of a current diagnosis; the Veteran failed to file a notice of disagreement to initiate an appeal from this decision and new and material evidence was not received within one year. 8. Additional evidence received since the November 2010 rating decision is not cumulative or redundant of the evidence of record at the time of that decision, relates to an unestablished fact necessary to substantiate the claim for service connection for osteoarthritis and raises a reasonable possibility of substantiating the claim. 9. A January 2013 rating decision denied entitlement to service connection for an acquired psychiatric disorder, to include depression and PTSD, because there was no link to service; the Veteran failed to file a notice of disagreement to initiate an appeal from this decision and new and material evidence was not received within one year. 10. Additional evidence received since the January 2013 rating decision is not cumulative or redundant of the evidence of record at the time of that decision, relates to an unestablished fact necessary to substantiate the claim for service connection for an acquired psychiatric disorder, to include major depressive disorder, bipolar disorder and PTSD, and raises a reasonable possibility of substantiating the claim. 11. A July 1986 rating decision denied entitlement to service connection for an eye disorder because the Veteran’s myopia was considered a refractive error; the Veteran failed to file a notice of disagreement to initiate an appeal from this decision and new and material evidence was not received within one year. 12. Additional evidence received since July 1986 rating decision is not cumulative or redundant of the evidence of record at the time of that decision, relates to an unestablished fact necessary to substantiate the claim for service connection for an eye disorder and raises a reasonable possibility of substantiating the claim. 13. The Veteran’s low back disorder did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, event, or disease. 14. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of swelling of the bilateral leg and joints that is separate and apart from his service-connected bilateral knee disabilities. 15. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of rheumatoid arthritis. 16. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of ischemic heart disease. 17. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of chloracne. CONCLUSIONS OF LAW 1. The February 2014 rating decision that denied a claim for service connection for a low back disorder is final. 38 U.S.C. 7105 (c); 38. C.F.R. 3.104, 20.302, 20.1103. 2. The additional evidence received since the February 2014 rating decision is new and material, and the claim for service connection for a low back disorder is reopened. 38 U.S.C. 5108; 38 C.F.R. 3.156. 3. The January 2013 rating decision that denied a claim for service connection for a thyroid disorder is final. 38 U.S.C. 7105 (c); 38. C.F.R. 3.104, 20.302, 20.1103. 4. The additional evidence received since the January 2013 rating decision is new and material, and the claim for service connection for a thyroid disorder is reopened. 38 U.S.C. 5108; 38 C.F.R. 3.156. 5. The January 2013 rating decision that denied a claim for service connection for difficulty swallowing is final. 38 U.S.C. 7105 (c); 38. C.F.R. 3.104, 20.302, 20.1103. 6. The additional evidence received since the January 2013 rating decision is new and material, and the claim for service connection for dysphagia, claimed as difficulty swallowing, is reopened. 38 U.S.C. 5108; 38 C.F.R. 3.156. 7. The November 2010 rating decision that denied a claim for service connection for osteoarthritis of the spine is final. 38 U.S.C. 7105 (c); 38. C.F.R. 3.104, 20.302, 20.1103. 8. The additional evidence received since the November 2010 rating decision is new and material, and the claim for service connection for osteoarthritis is reopened. 38 U.S.C. 5108; 38 C.F.R. 3.156. 9. The January 2013 rating decision that denied a claim for service connection for an acquired psychiatric disorder, to include depression and PTSD, is final. 38 U.S.C. 7105 (c); 38. C.F.R. 3.104, 20.302, 20.1103. 10. The additional evidence received since the January 2013 rating decision is new and material, and the claim for service connection for an acquired psychiatric disorder, to include major depressive disorder, bipolar disorder and PTSD, is reopened. 38 U.S.C. 5108; 38 C.F.R. 3.156. 11. The July 1986 rating decision that denied a claim for service connection for an eye disorder is final. 38 U.S.C. 7105 (c); 38. C.F.R. 3.104, 20.302, 20.1103. 12. The additional evidence received since the July 1986 rating decision is new and material, and the claim for service connection for an eye disorder, is reopened. 38 U.S.C. 5108; 38 C.F.R. 3.156. 13. The criteria for service connection for a low back disorder are not met. 38 U.S.C. §§ 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). 14. The criteria for service connection for swelling of the bilateral leg and joints are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 15. The criteria for service connection for rheumatoid arthritis are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 16. The criteria for service connection for ischemic heart disease are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 17. The criteria for service connection for chloracne are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1981 to September 1984. He also had active duty for training (ACDUTRA) from September 1987 to February 1988 with the Army National Guard. As some of the issues in the statement of the case appeared to be duplicative, for clarification purposes, the Board has characterized the issues as set forth above. Moreover, in light of a May 2017 private evaluation showing diagnosis of PTSD, the Board has expanded the issue of service connection for an acquired psychiatric disorder to include PTSD pursuant to Clemons v. Shinseki, 23 Vet. App. 1 (2009). In August 2018, the Board sent a letter to the Veteran requesting clarification as to whether he wanted a Board hearing. Although the Veteran initially responded that he wanted a Board video conference hearing; subsequently, the Veteran, through his representative, withdrew his hearing request. Additional evidence, including VA clinical records, has been associated with the record that has not been considered by the Agency of Original Jurisdiction (AOJ). However, in June 2018, the Veteran waived his right to send the case back to the AOJ for consideration of this evidence. As such, the Board may properly consider this evidence. In numerous statements of record, the Veteran, through his representative, has argued that service connection for diabetes should be awarded as presumptively due to herbicide exposure at Redstone Arsenal, Alabama. Essentially, they assert that herbicide exposure was conceded as the Veteran was granted acne scarring due to Agent Orange. However, review of the January 2013 rating decision that granted service connection for acne scarring shows that such disorder was awarded as directly being related to service. The decision continued that since exposure to herbicides had not been confirmed, this association had not been established. Nevertheless, as discussed further below in the remand section, the Board finds that further development is needed with respect to the Veteran’s claimed exposure to herbicides. In July 2018, the AOJ issued a statement of the case with respect to the issues of service connection for sleep apnea and cervical disorder. However, the Veteran failed to file a substantive appeal. As such, these matters are no longer on appeal. New and Material Evidence Rating actions are final and binding based on evidence on file at the time the claimant is notified of the decision and may not be revised on the same factual basis except by a duly constituted appellate authority. 38 C.F.R. 3.104 (a). The claimant has one year from notification of an RO decision to initiate an appeal by filing a notice of disagreement with the decision, and the decision becomes final if an appeal is not perfected within the allowed time period. 38 U.S.C. 7105 (b) and (c); 38 C.F.R. 3.160 (d), 20.200, 20.201, 20.202, and 20.302(a). If new and material evidence is received during an applicable appellate period following a RO decision (1 year for a rating decision and 60 days for a statement of the case) or prior to an appellate (Board) decision (if an appeal was timely filed), the new and material evidence will be considered as having been filed in connection with the claim that was pending at the beginning of the appeal period. 38 C.F.R. 3.156 (b). Thus, under 38 C.F.R. 3.156 (b), “VA must evaluate submissions received during the relevant [appeal] period and determine whether they contain new evidence relevant to a pending claim, whether or not the relevant submission might otherwise support a new claim.” Bond v. Shinseki, 659 F.3d 1362, 1367-68 (Fed. Cir. 2011). “[N]ew and material evidence” under 38 C.F.R. 3.156 (b) has the same meaning as “new and material evidence” as defined in 38 C.F.R. 3.156 (a). See Young v. Shinseki, 22 Vet. App. 461, 468 (2011). Generally, a claim which has been denied in an unappealed Board decision or an unappealed RO decision may not thereafter be reopened and allowed. 38 U.S.C. 7104 (b), 7105(c). The exception to this rule is 38 U.S.C. 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. New evidence means evidence not previously submitted. Material evidence means existing evidence that by itself or when considered with previous evidence relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of last final decision, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. 3.156 (a). In Shade v. Shinseki, 24 Vet. App 110 (2010), the United States Court of Appeals for Veterans Claims (Court) interpreted the language of 38 C.F.R. 3.156 (a) as creating a low threshold, and viewed the phrase “raises a reasonable possibility of substantiating the claim” as “enabling rather than precluding reopening.” The Court emphasized that the regulation is designed to be consistent with 38 C.F.R. 3.159 (c)(4), which “does not require new and material evidence as to each previously unproven element of a claim.” The Court further held it would be illogical to require that a claimant submit medical nexus evidence when he has provided new and material evidence as to another missing element, as it would “force the Veteran to provide medical nexus evidence to reopen his claim so that he could be provided with a medical nexus examination by VA.” For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence, although not its weight, is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). Low Back Disorder The Veteran is seeking to reopen his claim for service connection for a low back disorder. Service connection for a low back disorder was initially denied in a November 2010 rating decision because the Veteran’s current disability was not related to service. The RO again denied the claim in a January 2013 rating decision. Most recently, the RO denied the claim in February 2014 because new and material evidence had not been submitted. Although the Veteran submitted a notice of disagreement in November 2014, the Veteran did not indicate a desire to appeal this issue. Moreover, VA clinical records during this period are duplicative of prior treatment records. In sum, the Veteran did not initiate an appeal from this determination and new and material evidence was not received within one year. Under these circumstances, the Board must find that the February 2014 rating decision became final with respect to this issue. 38 U.S.C. 7105 (c); 38. C.F.R. 3.104, 20.302, 20.1103. Since the February 2014 rating decision, additional evidence has been associated with the record, including statements from the Veteran, additional VA clinical records and a May 2017 private opinion. Importantly, the May 2017 private examiner opined that the Veteran’s low back disorder was more probable than not secondary to his military service. Accordingly, the evidence received since the February 2014 rating decision is new and material as it is not redundant of evidence already of record in February 2014, and relates to the unestablished fact of whether the Veteran’s low back disorder may be related to service. See 38 C.F.R. 3.156 (a). As such, the issue of entitlement to service connection for a low back disorder is reopened. 38 U.S.C. 5108. Thyroid Disorder The Veteran is seeking to reopen his claim for service connection for a thyroid disorder. Service connection for a thyroid disorder was initially denied in a January 2013 rating decision because there was no evidence that the Veteran was exposed to radiation in service. Importantly, the Veteran did not initiate an appeal from this determination and new and material evidence was not received within one year. Under these circumstances, the Board must find that the January 2013 rating decision became final. 38 U.S.C. 7105 (c); 38. C.F.R. 3.104, 20.302, 20.1103. Since the January 2013 rating decision, additional evidence has been associated with the record, including statements from the Veteran, additional VA clinical records and a May 2017 private opinion. Again, the May 2017 private examiner opined that the Veteran’s thyroid disorder was more probable than not secondary to his military service. Accordingly, the evidence received since the January 2013 rating decision is new and material as it is not redundant of evidence already of record in January 2013, and relates to the unestablished fact of whether the Veteran’s thyroid disorder may be related to service. See 38 C.F.R. 3.156 (a). As such, the issue of entitlement to service connection for a thyroid disorder is reopened. 38 U.S.C. 5108. Difficulty Swallowing The Veteran is seeking to reopen his claim for service connection for difficulty swallowing. Service connection for difficulty swallowing was initially denied in a January 2013 rating decision because there was no evidence of a current diagnosis. Importantly, the Veteran did not initiate an appeal from this determination and new and material evidence was not received within one year. Under these circumstances, the Board must find that the January 2013 rating decision became final. 38 U.S.C. 7105 (c); 38. C.F.R. 3.104, 20.302, 20.1103. Since the January 2013 rating decision, additional evidence has been associated with the record, including statements from the Veteran, additional VA clinical records and a May 2017 private opinion. Importantly, the Veteran has continued to report difficulty swallowing, which would appear to be indicative of a current disability. Accordingly, the evidence received since the January 2013 rating decision is new and material as it is not redundant of evidence already of record in January 2013, and relates to the unestablished fact of whether the Veteran’s difficulty swallowing may be related to service. See 38 C.F.R. 3.156 (a). As such, the issue of entitlement to service connection for dysphagia, claimed as difficulty swallowing, is reopened. 38 U.S.C. 5108. Osteoarthritis The Veteran is seeking to reopen his claim for service connection for osteoarthritis. Service connection for osteoarthritis (of the spine) was initially denied in a November 2010 rating decision because there was no evidence of a current diagnosis. Importantly, the Veteran did not initiate an appeal from this determination and new and material evidence was not received within one year. Under these circumstances, the Board must find that the January 2013 rating decision became final. 38 U.S.C. 7105 (c); 38. C.F.R. 3.104, 20.302, 20.1103. Since the November 2010 rating decision, additional evidence has been associated with the record, including statements from the Veteran, additional VA clinical records and a May 2017 private opinion. The May 2017 private examiner diagnosed osteoarthritis of the shoulders, elbows and wrists and opined that the Veteran’s severe musculoskeletal disease were more probable than not secondary to his military service. Accordingly, the evidence received since the November 2010 rating decision is new and material as it is not redundant of evidence already of record in November 2010, and relates to the unestablished fact of whether the Veteran’s osteoarthritis may be related to service. See 38 C.F.R. 3.156 (a). As such, the issue of entitlement to service connection for osteoarthritis is reopened. 38 U.S.C. 5108.   Psychiatric Disorder The Veteran is seeking to reopen his claim for service connection for an acquired psychiatric disorder, to include depression and PTSD. Service connection for depression was initially denied in a November 2010 rating decision because there was no evidence that such disability was incurred or caused by service. The RO again denied the claim in for depression as well as PTSD in January 2013 because there was no evidence that a psychiatric disorder was incurred during service. Most recently, the RO denied the claims in the February 2014 rating decision, which was appealed to the Board. Importantly, the Veteran did not initiate an appeal from this determination and new and material evidence was not received within one year. Under these circumstances, the Board must find that the January 2013 rating decision became final. 38 U.S.C. 7105 (c); 38. C.F.R. 3.104, 20.302, 20.1103. Since the January 2013 rating decision, additional evidence has been associated with the record, including statements from the Veteran, additional VA clinical records and a May 2017 private opinion. Again, the May 2017 private examiner opined that the Veteran’s psychiatric disorders, including PTSD, were more probable than not secondary to his military service. Accordingly, the evidence received since the January 2013 rating decision is new and material as it is not redundant of evidence already of record in January 2013, and relates to the unestablished fact of whether the Veteran’s acquired psychiatric disorder may be related to service. See 38 C.F.R. 3.156 (a). As such, the issue of entitlement to service connection for an acquired psychiatric disorder, to include major depressive disorder, bipolar disorder and PTSD, is reopened. 38 U.S.C. 5108. Eye Disorder The Veteran is seeking to reopen his claim for service connection for an eye disorder. Service connection for an eye disorder was initially denied in a July 1986 rating decision because the only eye disorder was myopia, which is considered a refractive error. Importantly, the Veteran did not initiate an appeal from this determination and new and material evidence was not received within one year. Under these circumstances, the Board must find that the January 2013 rating decision became final. 38 U.S.C. 7105 (c); 38. C.F.R. 3.104, 20.302, 20.1103. Since the July 1986 rating decision, additional evidence has been associated with the record, including statements from the Veteran, additional VA clinical records and a May 2017 private opinion. Importantly, an October 2011 clinical record showed a diagnosis of nasal pterygium of the right eye, which is not considered a refractive error. Accordingly, given the new diagnosis, the evidence received since the July 1986 rating decision is new and material as it is not redundant of evidence already of record in July 1986, and relates to the unestablished fact of whether the Veteran’s eye disorder may be related to service. See 38 C.F.R. 3.156 (a). As such, the issue of entitlement to service connection for eye disorder is reopened. 38 U.S.C. 5108. Service Connection A Veteran is a person who served in the active military, naval, or air service and who was discharged or released under conditions other “than dishonorable.” 38 C.F.R. § 3.1 (d). The term “active military, naval, or air service” includes: (1) active duty; (2) any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty; and (3) any period of inactive duty for training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in the line of duty. 38 U.S.C. § 101 (24); 38 C.F.R. § 3.6 (a). Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Low Back Disorder The Veteran contends that his low back disorder is due to service. He has asserted that he injured his back while in night training carrying boxes of ammunition. He has also asserted that his back disorder is due to prolonged squatting and kneeling on uneven surfaces. The Veteran also asserted that he was exposed to radiation while dealing with explosive and nuclear bombs. Certain chronic diseases will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). The Board notes that the advantages of these evidentiary presumptions do not extend to those who claim service connection based on a period of ACDUTRA or INACDUTRA. McManaway v. West, 13 Vet. App. 60, 67 (citing Paulson v. Brown, 7 Vet. App. at 469-70, for the proposition that, “if a claim relates to period of [ACDUTRA], a disability must have manifested itself during that period; otherwise, the period does not qualify as active military service and claimant does not achieve Veteran status for purposes of that claim”); Biggins v. Derwinski, 1 Vet. App. 474, 478 (1991); Smith v. Shinseki, 24 Vet. App. 40, 47 (2010). Nevertheless, the question for the Board is whether the Veteran has a chronic disease that manifested to a compensable degree during his period of active service or within the applicable presumptive period, or whether continuity of symptomatology has existed since the Veteran’s period of active service. The Board concludes that, while the Veteran has arthritis of the lumbar spine, which is a chronic disease under 38 U.S.C. § 1101(3)/38 C.F.R. § 3.309(a), it was not chronic in service or manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. VA clinical treatment records show the Veteran was not treated for low back pain until approximately August 2000. He was diagnosed with discogenic disease approximately in November 2006, over 18 years after his separation from service and 17 years outside of the applicable presumptive period. While the Veteran is competent to report experiencing symptoms of back pain in service, the Board finds the reports of continuity of symptomatology not credible. The Veteran’s reports are internally inconsistent with his reports in contemporaneous treatment records, which show that in August 2000, he reported the onset of back pain to be two days. Moreover, a September 2010 record showed a history of back since 2005, outside of the presumptive period. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Significantly, at the November 2010 VA examination, the Veteran did not recall when he was evaluated for the first time for low back pain or when he first came to VA for treatment, but indicated that he took some of his aunt’s pain medication. Further, while the Veteran asserts that the reported symptoms were manifestations of his low back disorder, he is not competent to determine that these symptoms were manifestations of arthritis. The issue is medically complex, as it requires specialized medical knowledge of the interaction between multiple organ systems in the body/the ability to interpret complicated diagnostic medical testing]. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Board gives more probative weight to competent medical evidence, which establishes that these symptoms began many years after service. The November 2010 VA examiner determined that the chronicity of low back pain was not established. Service connection for the Veteran’s low back disorder may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s low back disorder and an in-service injury, event or disease during active duty or ACDUTRA. 38 U.S.C. § 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The November 2010 VA examiner opined that the Veteran’s low back disorder was less likely as not related to an in-service injury, event, or disease. The examiner rationalized that although there was evidence of treatment of low back pain in September 1983 and complaints of recurrent back pain in September 1984, there was no evidence of treatment up to several years after service point out that the condition in service was acute and transitory and resolved with military treatment given at that time. The examiner noted that the Veteran was diagnosed for the first time with discogenic disease of the lumbar spine in November 2006, several years after service. The Board recognizes that the May 2017 private examiner found that the Veteran’s low back disorder was more probable than not secondary to his military service. However, in contrast to the VA examiner, the private examiner did not offer any sort of rationale for his opinion. See Neives-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). As such, the November 2010 VA examiner’s opinion has more probative value. Again, while the Veteran believes his low back is related to an in-service injury, event, or disease, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the November 2010 VA examination. In conclusion, based on the analysis above, the preponderance of the evidence is against the Veteran’s claim for a low back disorder. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107(b). Swelling of Bilateral Leg and Joints The Veteran is also seeking service connection for swelling of the bilateral leg and joints. The Veteran has generally asserted that this disability is due to service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of swelling of the bilateral leg and joints, which is distinct from his service connected right and left knee degenerative arthritis, at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The May 2015 VA examination shows that the Veteran reported recurrent swelling of joints and legs, which he developed about 10 to 15 years ago. X-rays of the knees showed bilateral small joint effusions. After examining the Veteran and reviewing the record, the examiner diagnosed bilateral degenerative arthritis of both knees and right shin splints. When asked to opine on the Veteran’s swelling of legs and joints, the examiner found that the Veteran’s current bilateral knee pain with diagnosis of degenerative arthritis was at least as likely as not related to complaints in service. Subsequently, service connection for arthritis of both knees was awarded. The examination shows that the Veteran’s symptoms were attributed to his service-connected bilateral knees. Moreover, VA clinical records also do not show that the Veteran has a diagnosis of swelling of the legs and joints that is separate and apart from his service-connected knee disabilities. The Board recognizes that VA clinical records show complaints of ankle pain and swelling. However, service connection for right and left ankle disabilities was previously denied in the February 2014 rating decision. The Veteran did not appeal this determination with respect to these disabilities and thus, any disorders of the ankles are not currently on appeal. In sum, the medical evidence is silent with respect to any diagnosis of a separate disability manifested by swelling of the legs and joints. In turn, the Veteran’s symptoms are already contemplated in his 10 percent each disability ratings for his service-connected right and left knee disorders. In fact, the rating criteria for the knees contemplate such functional impairment. See 38 C.F.R. § 4.7`1a, Diagnostic Codes 5256-5261. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating an appellant’s service-connected disabilities. 38 C.F.R. § 4.14. Therefore, to assign an additional rating based on the same symptomatology would be tantamount to pyramiding. 38 C.F.R. § 4.14; see also Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994) (it is possible for an appellant to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition). While the Veteran believes he has a current diagnosis of swelling of the legs and joint that is separate from his service-connected bilateral knee disorders, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. In conclusion, based on the analysis above, the preponderance of the evidence is against the Veteran’s claim for swelling of bilateral leg and joints. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107(b). Rheumatoid Arthritis, Ischemic Heart Disease, and Chloracne The Veteran contends that these disabilities are due to exposure to herbicides, radiation and/or other contaminants while stationed at Redstone Arsenal while on ACDUTRA. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of rheumatoid arthritis, ischemic heart disease and chloracne and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). Importantly, the May 2017 private examiner evaluated the Veteran and while diagnosing hypertensive cardiovascular disease, there was no diagnosis of ischemic heart disease. Likewise, while the examiner diagnosed osteoarthritis of various joints, he did not diagnose rheumatoid arthritis. Importantly, VA and private clinical records are also silent with respect to any diagnoses of rheumatoid arthritis and ischemic heart disease. A May 2015 VA rheumatoid factor test was normal. Moreover, the January 2013 VA examiner evaluated the Veteran and determined that, while he suffered from other skin disorders, he did not have a diagnosis of chloracne. Subsequently, private and VA clinical records are also silent with respect to any diagnoses of these disorders. The Board notes that the Veteran has not been afforded an examination in connection with his claims for rheumatoid arthritis and ischemic heart disease; however, the Board finds that such is not necessary with respect to these issues. Specifically, in this case, there is no competent medical evidence of a current diagnosis or persistent or recurrent symptoms. Thus, the Board finds that a VA examination and/or opinion is not necessary to decide the claims for service connection. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). While the Veteran believes he has a current diagnosis of rheumatoid arthritis, ischemic heart disease and chloracne, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. In conclusion, based on the analysis above, the preponderance of the evidence is against the Veteran’s claim for rheumatoid arthritis, ischemic heart disease and chloracne. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107(b). REASONS FOR REMAND Entitlement to service connection for parathyroid adenoma, also claimed as neck nodule and thyroid disorder, dysphagia, claimed as difficulty swallowing, osteoarthritis, an acquired psychiatric disorder, to include major depressive disorder, bipolar disorder and PTSD, eye disorder, upper respiratory disorder, to include allergies, hypertension erectile dysfunction, diabetes mellitus, bilateral carpal tunnel syndrome and peripheral neuropathy are remanded. The Veteran asserts that his disorders are due to exposure to herbicides, radiation and other contaminants while stationed at Redstone Arsenal during ACDUTRA. In support of his claim, the Veteran has submitted publications concerning contaminants in the ground as well as radiation exposure at Redstone Arsenal and Agent Orange being stored at Redstone Arsenal in the past and seeping into the soil. The Veteran’s personnel records show that his primary military occupational specialty was a munitions material management. He has also submitted a radiation risk activity sheet outlining his exposure due to working underground with nuclear weapons. In light of the Veteran’s contentions, the Board finds that further development is necessary to confirm whether the Veteran was exposed to herbicides, radiation and other contaminants while stationed at Redstone Arsenal. The Veteran has asserted that he has thyroid nodular disease, which is a radiogenic disease. A VA x-ray appears to show a thyroid nodule. The record does not contain sufficient evidence regarding the Veteran’s asserted radiation exposure. Accordingly, VA should develop the Veteran’s claim as directed under 38 C.F.R. § 3.311. Moreover, the Board finds that further development is necessary to determine whether the Veteran was exposed to herbicides and other contaminants in the soil while stationed at Redstone Arsenal. Further, the Veteran also submitted a stressor statement in July 2014 describing a field accident where another soldier was shot between September to December 1981. A remand is required to allow VA to attempt to corroborate the Veteran’s reported stressor. Moreover, the Veteran has not been afforded a VA examination to address any of these issues. As discussed above, the May 2017 private examiner linked all of the Veteran’s disability to his service. However, he failed to proffer a rationale for this opinion. However, in light of the Veteran’s contentions and the May 2017 opinion, the Veteran should be afforded a VA examination(s) etiological opinion(s). Lastly, in light of the need to remand these matters, VA treatment records from September 2017 to the present should be obtained. Moreover, the AOJ should also take necessary steps to obtain authorization and request any additional private records for the remaining disabilities on appeal. Entitlement to a compensable rating for acne scarring on the cheeks and back, furuncle and atopic dermatitis is remanded. In an August 2017 statement, the Veteran asserted that his service-connected skin disability has increased in severity since the Veteran was last examined by VA in February 2014. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of his service-connected skin disorder. The matters are REMANDED for the following action: 1. Obtain VA treatment records from September 2017 to the present. Take necessary steps to obtain authorization and request any additional private records for the remaining disabilities on appeal. 2. Attempt to corroborate the Veteran’s in-service stressors, including a field accident where another soldier was shot between September to December 1981. If more details are needed, contact the Veteran to request the information. 3. Develop the Veteran’s assertion that he was exposed to radiation from working with nuclear weapons at Redstone Arsenal. If evidence of possible exposure to radiation or ionizing radiation is found, obtain a dose assessment and an opinion. If more details are needed, contact the Veteran to request the information. If there is still insufficient information to verify exposure to radiation, issue a Formal Finding outlining the steps taken to assist the Veteran and notify the Veteran of VA’s inability to verify the in-service herbicide agent exposure. 4. Attempt to verify the Veteran’s asserted in-service exposure to herbicide agents and other contaminants in the soil at Redstone Arsenal. If more details are needed, contact the Veteran to request the information. If there is still insufficient information to verify exposure to herbicide agents, issue a Formal Finding outlining the steps taken to assist the Veteran and notify the Veteran of VA's inability to verify the in-service herbicide agent exposure. 5. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any parathyroid adenoma, also claimed as neck nodule and thyroid disorder, dysphagia, claimed as difficulty swallowing, osteoarthritis, eye disorder, upper respiratory disorder, to include allergies, hypertension, erectile dysfunction, diabetes mellitus, bilateral carpal tunnel syndrome and peripheral neuropathy. The examiner(s) should clearly delineate all diagnosed disorders. The examiner(s) must opine whether each diagnosed disorder is at least as likely as not related to an in-service injury, event, or disease, to include exposure to contaminants while stationed at Redstone Arsenal. With respect to osteoarthritis of the joints, hypertension, diabetes mellitus, bilateral carpal tunnel syndrome and peripheral neuropathy, the examiner should opine whether it at least as likely as not that such disorder (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. If the Veteran’s herbicide exposure is confirmed, with the exception of diabetes mellitus, the examiner should opine whether it is at least as likely as not that any diagnosed disorder is related to in-service herbicide agent exposure. If the Veteran’s radiation exposure is confirmed, with the exception of any diagnosed parathyroid adenoma or non-malignant thyroid nodular disease, the examiner should opine whether it is at least as likely as not that any diagnosed disorder is related to ionizing radiation. With respect to the any eye disorder, the examiner should clearly delineate all eye/vision disorders. With respect to any diagnosed acquired vision/eye disorder that is not considered a refractive error, the examiner should opine whether it is at least as likely as not that such disorder manifested during service or is otherwise related to any incident of service; and with respect to any diagnosed refractive error, including myopia, whether it is at least as likely as not that any such disorder has been aggravated beyond its natural progression or subject to a superimposed disease due to the Veteran’s active service. 6. After the Veteran’s reported stressors have been developed, schedule the Veteran for a psychiatric examination to determine the nature and etiology of any posttraumatic stress disorder (PTSD). If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not related to a verified in-service stressor. If any other acquired psychiatric disorders are diagnosed, the examiner must opine whether each diagnosed disorder is at least as likely as not related to an in-service injury, event, or disease. 7. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected for acne scarring on the cheeks and back, furuncle and atopic dermatitis. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner should describe the effect of the Veteran’s skin   disability on any occupational functioning and activities of daily living. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J.N. Moats