Citation Nr: 18140393 Decision Date: 10/03/18 Archive Date: 10/02/18 DOCKET NO. 15-30 897 DATE: October 3, 2018 ORDER Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for a head injury is denied. Entitlement to service connection for a cervical spine disability is denied. Entitlement to service connection for a left upper extremity radiculopathy associated with a cervical spine disability is denied. Entitlement to service connection for a lumbar and thoracic spine disability is denied. Entitlement to service connection for gastrointestinal problems, to include, gastritis and gastroesophageal reflux disorder (GERD), including as due to exposure to environmental hazards in Southwest Asia is denied. Entitlement to service connection for bronchitis, to include as due to exposure to environmental hazards in Southwest Asia is denied. Entitlement to service connection for essential benign tremor, to include as due to exposure to environmental hazards in Southwest Asia is denied. Entitlement to service connection for a dysfunctional bladder, diagnosed as cholecystectomy, to include as due to exposure to environmental hazards in Southwest Asia is denied. Entitlement to service connection for joint pain, claimed as undiagnosed illness due to service in Southwest Asia is denied. Entitlement to service connection for muscle pain, claimed as undiagnosed illness due to service in Southwest Asia is denied. REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to service connection for hypertension and cardiovascular signs, to include as secondary to exposure to environmental hazards in Southwest Asia, is remanded. FINDINGS OF FACT 1. The Veteran was exposed to acoustic trauma while in service. 2. Puretone auditory thresholds do not meet the criteria to establish that the Veteran has a current left or right hearing loss disability for VA compensation purposes. 3. The Veteran’s head injury was noted on his service entrance examination and did not increase in severity during service. 4. The competent and credible evidence, both lay and medical, indicates that the Veteran’s current cervical spine disabilities, to include degenerative disc disease and arthritis: were not incurred in service; symptoms of degenerative arthritis were not chronic in service or manifested to a degree of 10 percent within a year of service separation; and are not otherwise etiologically related to service. 5. The objective medical evidence shows that Veteran’s left upper extremity radiculopathy is associated with his nonservice-connected cervical spine disability. 6. The competent and credible evidence, both lay and medical, indicates that the Veteran’s current thoracic and lumbar spine disabilities, to include lumbar strain; degenerative disc disease; anterolisthesis; and, arthritis: were not incurred in service; symptoms of degenerative arthritis were not chronic in service or manifested to a compensable degree within a year of service separation; and are not otherwise etiologically related to service. 7. The Veteran’s gastrointestinal problems, to include, gastritis and GERD, was not incurred in service, and is not otherwise causally or etiologically related to service. 8. The Veteran’s bronchitis was not incurred in service, and is not otherwise causally or etiologically related to service. 9. The competent and credible evidence, both lay and medical, indicates that the Veteran’s current benign essential tremor was not incurred in service, its symptoms were not chronic in service or manifested to a compensable degree within a year of service separation, and is not otherwise etiologically related to service. 10. The Veteran’s currently diagnosed cholecystectomy was not incurred in service, and is not otherwise causally or etiologically related to service. 11. The competent medical evidence of record does not show that the Veteran experienced a chronic disability of joint and or muscle pain during active duty service, or that such symptoms were otherwise related to his active duty service. CONCLUSIONS OF LAW 1. The criteria to establish service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2017). 2. The criteria to establish service connection for a head injury have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.306 (2017). 3. The criteria for service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 4. The criteria to establish service connection for a left upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2017). 5. The criteria for service connection for a lumbar and thoracic spine disability have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 6. The criteria to establish service connection for gastrointestinal problems, to include, gastritis and GERD have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.317 (2017). 7. The criteria to establish service connection for bronchitis have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.317 (2017). 8. The criteria for service connection for essential benign tremor have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 9. The criteria to establish service connection for a bladder dysfunction disability have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.317 (2017). 10. The criteria to establish service connection for joint pain as due to undiagnosed illness have not been met. 38 U.S.C. 1110, 1117, 1118 (2012); 38 C.F.R. 3.303, 3.317 (2017). 11. The criteria to establish service connection for muscle pain as due to undiagnosed illness have not been met. 38 U.S.C. 1110, 1117, 1118 (2012); 38 C.F.R. 3.303, 3.317 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty from May 1988 to June 1991, to include service in Southwest Asia. In his August 2015 Substantive Appeal (on a VA Form 9), the Veteran requested a Board hearing at his local VA office. The Veteran subsequently requested a hearing via videoconference in a September 2015 submission. In a subsequent December 2016 submission, he stated that he wished to withdraw his request for a Board hearing. Thus, this hearing request is considered to be withdrawn. 38 C.F.R. § 20.704(e) (201). The Board notes that, subsequent to the July 2015 statement of the case, additional evidence was associated with the record. The Veteran waived initial agency of original jurisdiction (AOJ) consideration of this evidence in an August 2018 submission. Therefore, the Board may properly consider such newly received evidence. 38 C.F.R. § 20.1304 (2017). The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Service Connection 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. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). For purposes of applying VA laws, impaired hearing is considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, and 4000 hertz (Hz) is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, and 4000 Hz 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. VA regulations do not preclude service connection for a hearing loss which first met VA’s definition of disability after service. Hensley v. Brown, 5 Vet. App. 155, 159 (1993). Where a current disability due to hearing loss is present, service connection can be granted for a hearing loss disability where the Veteran can establish a nexus between his current hearing loss and a disability or injury he suffered while he was in military service. Godfrey v. Derwinski, 2 Vet. App. 352, 356 (1992). Hearing loss, arthritis, and hypertension are considered a “chronic disease” under 38 C.F.R. § 3.309(a). Therefore, the presumptive service connection provisions under 38 C.F.R. § 3.303(b) for service connection based on “chronic” symptoms in service and “continuous” symptoms since service are applicable. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). For the showing of chronic diseases 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). Service connection may also be established for a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability resulting from undiagnosed illness that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2016, and cannot be attributed to any known clinical diagnosis by history, physical examination, or laboratory tests. 38 U.S.C. § 1117; 38 C.F.R. § 3.317 (a)(1). A qualifying chronic disability means a chronic disability resulting from any of the following (or any combination of the following): (A) An undiagnosed illness; (B) A medically unexplained chronic multi-symptom illness that is defined by a cluster of signs or symptoms, such as chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders (excluding structural gastrointestinal diseases). 38 C.F.R. § 3.317(a)(2)(i). The term medically unexplained chronic multi-symptom illness means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology are not considered medically unexplained. 38 C.F.R. § 3.317 (a)(2)(ii). “Objective indications of chronic disability” include both “signs,” in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Signs or symptoms that may be manifestations of undiagnosed illness or medically unexplained chronic multi-symptom illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders. 38 C.F.R. § 3.317(b). In the case of claims based on undiagnosed illness under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317, unlike those for “direct service connection,” there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004). Further, lay persons are competent to report objective signs of illness. Id. The Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011). This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record. See King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012); Kahana, 24 Vet. App. at 433-34. A claimant bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009). In making its ultimate determination, the Board must give an appellant the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. Id. at 1287 (quoting 38 U.S.C. § 5107 (b)). Bilateral Hearing Loss The Veteran asserts that he has hearing loss, which he attributes to acoustic trauma he sustained in service. The Board notes that the Veteran’s exposure to hazardous noise during service is conceded. After review of the lay and medical evidence of record, the Board finds that the weight of the evidence shows that the Veteran does not have a current right or left hearing loss “disability” as defined by the VA regulatory criteria at 38 C.F.R. § 3.385. Turning to the evidence, in-service audiograms do not show hearing loss for VA purposes. Both his induction and separation examinations show normal hearing for VA purposes, despite a threshold shift in the left ear. The Veteran underwent a VA audiology examination in June 2013, where he reported having difficulty hearing in the present of background noise. Upon examination, puretone thresholds in both the right and left ears revealed normal hearing for VA purposes. Speech discrimination score was 98 percent, bilaterally. The examiner noted that when comparing the enlistment and separation audiograms, there was a significant decrease in hearing at the 2000 and 3000 Hertz frequencies in the left ear, and therefore, the examiner opined that the left ear hearing loss was related to service. However, as noted above, the puretone thresholds in both the right and left ears does not show hearing loss for VA purposes. Namely, the objective testing did not show auditory threshold in any of the frequencies 500, 1000, 2000, 3000, and 4000 hertz that is 40 decibels or greater; or auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, and 4000 Hz are 26 decibels or greater; or speech recognition scores using the Maryland CNC Test are less than 94 percent. Subsequently, in a July 2013 addendum opinion, the VA examiner noted that although the Veteran’s current hearing loss did not meet the VA criteria for service connection, there was a significant decrease in hearing at the 2000 and 3000 Hz in the left ear, and as such, due to this evidence of worsening, opined that the Veteran’s tinnitus was related to service. “Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim.” Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992); McClain v. Nicholson, 21 Vet. App. 319 (2007) (recognizing the disability could arise at any time during the claim); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013) (recognizing disabilities that occur immediately prior to filing of a claim). A hearing loss disability is diagnosed primarily on objective clinical findings and audiometric testing; thus, while the Veteran is competent under the facts of this case to relate symptoms of hearing loss that he experienced at any time, he is not competent to diagnose a hearing loss disability because such diagnosis requires specific medical knowledge and training in audiology and must be supported by objective clinical findings and audiometric testing. The Board recognizes that the Veteran has hearing difficulty, but such does not rise to the level of a “hearing loss” disability for VA purposes. To sum, the dispositive issue is whether the Veteran has hearing loss disability for VA purposes, which the competent medical evidence shows that he does not. Because a bilateral hearing loss disability as defined by the VA regulatory criteria at 38 C.F.R. § 3.385 is not demonstrated in this case, disability benefits are not warranted for bilateral hearing loss. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. In consideration of the foregoing, the Board finds that a preponderance of the lay and medical evidence that is of record weighs against the claim of service connection for bilateral hearing loss and the benefit-of-the-doubt doctrine is therefore not applicable. Head Injury The Veteran generally asserts that he has a head injury that is related to service; however, he provided no information as to any circumstances leading to such injury. Initially, the Board notes that it is unclear whether the Veteran has a diagnosis of a head injury or residuals thereof. The record shows that the Veteran does not have a diagnosis of traumatic brain injury (TBI) or residuals thereof; however, regardless, after a careful review of the lay and medical evidence, the Board finds that the Veteran’s head injury preexisted service and was not aggravated during service. In all cases, a Veteran is presumed to have been sound upon entry into active service, except as to defects, infirmities, or disorders noted at the time of the acceptance, examination, or enrollment, or where clear and unmistakable evidence demonstrates that the condition existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. §§ 1111, 1137; 38 C.F.R. § 3.304(b). In other words, “[w]hen no preexisting condition is noted upon entry into service, the veteran is presumed to have been sound upon entry.” Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). In addition, “the presumption of soundness applies only when a disease or injury not noted upon entry to service manifests in service, and a question arises as to whether it preexisted service.” Gilbert v. Shinseki, 26 Vet. App. 48, 55 (2012). Here, the Veteran’s service treatment records indicate that he was reexamined in August 1988, shortly after he entered active duty, because his record was lost. At the time, in an August 1988 Report of Medical History, the Veteran noted that he had a prior head injury. The medical professional noted that the head injury was as a result of a 1984 motor vehicle accident (MVA) prior to service, where he sustained a concussion. Although the examination itself showed normal results, the Board finds that by the Veteran’s lay assertions his head injury preexisted active duty service, and was noted on his examination. The head injury therefore preexisted service and the evidence must show that there was an increase in the disability during service to trigger the presumption of aggravation. See 38 U.S.C. § 1153; 38 C.F.R. § 3.306. Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. See 38 C.F.R. § 3.306. Temporary or intermittent flare-ups during service of a preexisting injury or disease are not sufficient to be considered “aggravation in service” unless the underlying condition, as contrasted to symptoms, is worsened. Hunt v. Derwinski, 1 Vet. App. 292, 297 (1992); see also Davis v. Principi, 276 F.3d 1341, 1346 (Fed. Cir. 2002) (explaining that, for non-combat veterans, a temporary worsening of symptoms due to flare-ups is not evidence of an increase in disability). The Board finds that the Veteran’s preexisting head injury did not increase in severity during service. Although the Veteran again checked “yes” to sustaining a head injury on his separation examination in May 1991, his service treatment records are otherwise silent to any complaints, treatments, or diagnoses related to a head injury. Because the evidence does not show that the Veteran’s preexisting head injury worsened in service, the presumption of aggravation does not apply and service connection must be denied. Cervical Spine and Associated Left Upper Extremity Radiculopathy The Veteran generally asserts that his cervical spine disabilities and associated left upper extremity radiculopathy are related to a skiing injury he sustained in service. Initially, the Board notes that the Veteran has a current diagnosis of degenerative disc disease with left upper extremity radiculopathy. In addition, there is evidence of arthritis. See e.g., June 2013 VA examination report. The Board next finds that the weight of the lay and medical evidence of record demonstrates that the current cervical spine disabilities and associated left upper extremity radiculopathy were not incurred in service and symptoms of degenerative arthritis of the cervical spine were not chronic in service or manifested within one year of separation. Turning to the evidence, the Veteran’s August 1988 Report of Medical Examination shows normal neck and spine. Additional STRs dated in March 1989 indicate that he reported that he sustained a mild trauma a week earlier when he was skiing where his neck alignment was displaced, but at the time he only complained of back pain and the assessment was back strain. An October 1989 screening note of acute medical care notes that the Veteran complained of sharp pain under the left shoulder for three weeks. The medical professional noted that the pain was not associated with any recent trauma. Additional service treatment records are silent to any complaints, treatment, or diagnoses related to his cervical spine and or left upper extremity radiculopathy, and the Veteran’s May 1991 separation examination showed normal neck and spine. Post-service treatment records prior to 1999 are silent to any complaints, treatments, or diagnoses related to the Veteran’s cervical spine and or associated radiculopathy. Beginning in 1999, the record shows that the Veteran complained of neck pain, at which time he was diagnosed with degenerative disc disease, left upper extremity radiculopathy, and arthritis. As aforementioned, arthritis is a “chronic disease” and as such is subject to presumptive service connection. Here, the Board notes that due to the lack of medical evidence, there is no competent objective evidence to show that the Veteran’s arthritis manifested to a degree of 10 percent within one year after separation from service. Another way to establish service connection for a chronic disease is on a presumptive basis is through continuity of symptomatology. Here, the Board finds the Veteran’s statements regarding continuity of symptomatology are contradicted by the contemporaneous medical and lay evidence, and therefore are not credible. The mere absence of medical records does not contradict a Veteran’s statements about his symptom history. Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). However, if it is determined based upon reliable evidence that there was an extended period of time after service without any manifestations of the claimed condition, then that tends to weigh against a finding of a connection between the disability and service. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). In this case, the Veteran’s recent statements reporting a long history of symptoms of the claimed disability are contradicted by past records in which he appears to have reported all his existing medical conditions without mentioning any problems related to his cervical spine. See AZ v. Shinseki, 731 F.3d 1303, 1318 (Fed. Cir. 2013) (recognizing the widely held view that the absence of an entry in a record may be considered evidence that the fact did not occur if it appears that the fact would have been recorded if present); Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011); Kahana, 24 Vet. App. at 440 (Lance, J., concurring) (citing Fed. R. Evid. 803(7) for the proposition that “the absence of an entry in a record may be evidence against the existence of a fact if such a fact would ordinarily be recorded”). In this case, despite receiving treatment for various orthopedic problems in-service, to include for his service-connected left ankle and left elbow disabilities, it was not until over eight years after discharge that the Veteran complained of neck pain. This long period without problems weighs against the claim. Based upon the language and context of the medical records, the Board finds that the Veteran was reporting all the disabilities/medical conditions/symptoms that he was experiencing at that time. Therefore, his failure to report any complaints of neck pain prior to 1999, is persuasive evidence that he was not then experiencing any relevant problems and outweighs his present recollection to the contrary. Here, the Board is not only relying on the absence of evidence, but also on the contemporaneous, affirmative lay reports of symptoms and history by the Veteran, as well as contemporaneous medical records that specifically show injuries sustained as a result of car accidents prior to service and post-service. To the extent that the Veteran now asserts that his chronic neck disabilities developed during active service, the Board finds that the current assertions made for VA compensation purposes are not credible, because they are contradicted and outweighed by the more contemporaneous lay and medical evidence, including the Veteran’s own statements at service separation. See Harvey v. Brown, 6 Vet. App. 390, 394 (1994) (Board decision properly assigned more probative value to a private hospital record that included lay history that was made for treatment purposes than to subsequent statements made for compensation purposes). In addition, the U.S. Court of Appeals for Veterans Claims, in Savage v. Gober, 10 Vet. App. 488, 496-97 (1997), agreed that in a case where the Veteran failed to present medical nexus evidence relating currently diagnosed arthritis to in-service injury along with lack of evidence of treatments may bear on the credibility of the evidence of continuity. The Board finds that the claim is also not warranted on a direct basis. While the Veteran asserts that his cervical spine disabilities and associated radiculopathy are directly related to service, the Board finds that under the specific facts of this case, including no chronic symptoms in service and no continuous symptoms after service, his lay statements are outweighed by the objective lay and medical evidence of record. Notably, in June 2013, the Veteran underwent a VA examination for his cervical spine, where he reported that he had neck pain since service, where he hurt his neck while skiing. The examiner confirmed diagnoses of degenerative disc disease with left upper extremity radiculopathy and noted that there was evidence of arthritis. After reviewing the claims file and examining the Veteran, the examiner opined that the current disabilities were less likely than not related to service. The examiner explained that the Veteran’s service treatment records show that he had a MVA accident prior to service, no treatment in service, and a normal separation examination. Moreover, the Veteran reported that he had an additional MVA accident post-service, and he was not diagnosed with these disabilities until 1999. The examiner concluded that with no objective substantial evidence in service, history of MVA accident causing concussion prior to service, another accident post-service, and x-rays showing degenerative disc disease more than six years after service are all factors suggestive that the current disabilities are not related to service. Here, while the Veteran is competent to describe any symptoms he experienced at any given time, under the facts of this case, he is not competent to opine as to the etiology of any currently diagnosed cervical spine disabilities and/or left upper extremity radiculopathy, because he is not shown to possess the necessary medical knowledge. In addition, as discussed above, the Board finds his lay assertions as to the onset of his disabilities not credible. The Board is charged with the duty to assess the credibility and weight given to evidence. Wensch v. Principi, 15 Vet. App. 362, 367 (2001). 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. Caluza v. Brown, 7 Vet. App. 498 (1995); Macarubbo v. Gober, 10 Vet. App. 388 (1997); Coburn v. Nicholson, 19 Vet. App. 427, 432 (2006) (Board may reject such statements of the veteran if rebutted by the overall weight of the evidence). A claimant’s inaccurate or less than truthful account of one incident does not automatically invalidate all his statements. However, in the present case, the Veteran’s statements do not reflect merely slight inconsistencies on peripheral matters, but go to the heart of the matter. Given that they are inconsistent, the Board cannot rely on them to establish the onset of the disability. Specifically, as noted above, a review of the Veteran’s service treatment records show that he continuously complained of numerous orthopedic disabilities during service, but at no point complained of any cervical spine injuries or symptoms. In this regard, the June 2013 VA examiner’s opinion is of high probative value. The VA examiner’s opinion was demonstrably fully informed of the pertinent factual premises of the case and provided a fully articulated opinion with supporting reasoned analysis explaining why the Veteran’s cervical spine disabilities and associated left upper extremity radiculopathy did not have its onset during active duty. See Nieves-Rodriguez, 22 Vet. App. 295, 303-304 (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). There is no benefit of the doubt that could be resolved in the Veteran’s favor, since there is no medical evidence to the contrary. The weight of the competent and credible evidence demonstrates no relationship between the current cervical spine disabilities and active duty service, but rather establishes that the currently diagnosed disabilities more likely resulted from pre-service and post-service MVA accidents. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for a cervical spine disability and associated left upper extremity radiculopathy, on direct and presumptive bases, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Lumbar and Thoracic Spine The Veteran asserts that his currently diagnosed lumbar and thoracic spine disabilities are related to his active duty service. Initially, the Board notes that the Veteran has current diagnoses of a lumbar and thoracic spine disabilities. See e.g., June 2013 examination report. The Board next finds that the weight of the lay and medical evidence of record demonstrates that the current lumbar and thoracic spine disabilities were not incurred in service and symptoms of degenerative arthritis of the lumbar spine were not chronic in service or manifested within one year of separation. Turning to the evidence, the Veteran’s the Veteran’s August 1988 Report of Medical Examination shows normal spine. Additional treatment records dated in October 1988 indicate that the Veteran complained of low back pain while lifting furniture, and subsequent treatment notes six-days later indicate that the Veteran complained of low back pain after moving a desk. Thereafter, a March 1989 treatment show that the Veteran complained of back pain for 6-hours, but denied any trauma in the previous 72-hours. He reported that he sustained a mild trauma a week earlier when he was skiing. He stated that his back “locked up” – and “neck alignment displaced,” for which he attempted self-care for one day. The medical professional noted objective evidence of rhomboids on the right side and “spasm – erector spinae muscles with increased tone,” but no swelling or tenderness. The assessment was a strain. Additional service treatment records dated in October 1989 show that the Veteran complained of sharp pain under his left shoulder, but denied any back trauma or back pain in the previous 72-hours. Additional service treatment records are silent to any complaints, treatment, or diagnoses related to the Veteran’s back, his May 1991 separation examination showed normal spine, and the Veteran denied recurring back pain. Post-service treatment records are silent to complaints about any back problems. In June 2013, the Veteran underwent a VA examination for his back, at which time the examiner noted the in-service diagnosis of lumbar strain in 1988, and diagnosed degenerative disc disease of the thoracic and L/S spine with pars defect, as well as anterolisthesis of L5 on S1. The examiner further stated that x-ray showed arthritis in the spine. During the examination, the Veteran reported having daily low back pain, but noted that he was not seen by a medical professional for this problem, and instead self-medicated with Motrin. He further noted that he injured his back moving computers in 2004. After a review of the claims file and examination of the Veteran, the examiner opined that with isolated events in-service, normal separation examination, and long period of no complaints post-service, it was less likely as not that the present back conditions were related to his active duty service. As aforementioned, arthritis is a “chronic disease” and as such is subject to presumptive service connection. Here, the Board notes that due to the lack of medical evidence, there is no competent objective evidence to show that the Veteran’s arthritis manifested to a degree of 10 percent within one year after separation from service. Another way to establish service connection for a chronic disease is on a presumptive basis is through continuity of symptomatology. Here, the Board finds the Veteran’s statements regarding continuity of symptomatology are internally inconsistent and not credible. The Board acknowledges that the is competent to describe symptoms such as back pain he experiences at any given time; however, the Veteran’s lay assertions and the objective medical evidence on record, prior to his post-service accidents and injuries, are silent to complaints of any complaints of back pain. The mere absence of medical records does not contradict a Veteran’s statements about his symptom history. Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). However, if it is determined based upon reliable evidence that there was an extended period of time after service without any manifestations of the claimed condition, then that tends to weigh against a finding of a connection between the disability and service. Maxson v. Gober, supra. In this case, the Veteran’s recent statements reporting a long history of symptoms of the claimed disability are contradicted by past records in which he appears to have reported all his existing medical conditions without mentioning any problems related to his lumbar and or thoracic spine. See AZ v. Shinseki, 731 F.3d 1303, 1318 (Fed. Cir. 2013) (recognizing the widely held view that the absence of an entry in a record may be considered evidence that the fact did not occur if it appears that the fact would have been recorded if present); Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011); Kahana, 24 Vet. App. at 440 (Lance, J., concurring) (citing Fed. R. Evid. 803(7) for the proposition that “the absence of an entry in a record may be evidence against the existence of a fact if such a fact would ordinarily be recorded”). Here, while the Veteran received treatment for other orthopedic problems post-service, he did not complain of back pain, and when he did, he specifically attributed his back injury to moving computers post-service. Therefore, this is persuasive evidence that he was not then experiencing any relevant problems and outweighs his present recollection to the contrary. Here, the Board is not only relying on the absence of evidence, but also on the contemporaneous, affirmative lay reports of symptoms and history by the Veteran, as well as contemporaneous medical records that specifically show injuries sustained as a result of a car accident as well as while moving computers post-service. To the extent that the Veteran now asserts that his chronic lumbar and or thoracic spine disabilities developed during active service, the Board finds that the current assertions made for VA compensation purposes are not credible, because they are contradicted and outweighed by the more contemporaneous lay and medical evidence, including the Veteran’s own statements at service separation. See Harvey v. Brown, 6 Vet. App. 390, 394 (1994) (Board decision properly assigned more probative value to a private hospital record that included lay history that was made for treatment purposes than to subsequent statements made for compensation purposes). In addition, the U.S. Court of Appeals for Veterans Claims, in Savage v. Gober, 10 Vet. App. 488, 496-97 (1997), agreed that in a case where the Veteran failed to present medical nexus evidence relating currently diagnosed arthritis to in-service injury along with lack of evidence of treatments may bear on the credibility of the evidence of continuity. The Board finds that the claim is also not warranted on a direct basis. While the Veteran asserts that his lumbar and or thoracic spine disabilities are directly related to service, the Board finds under the specific facts of this case, including no chronic symptoms in service and no continuous symptoms after service, his lay statements are outweighed by the objective lay and medical evidence of record. While the Veteran is competent to describe symptoms he experiences at any given time, to include pain, based on the record as a whole, that the Veteran is not credible with regard to his statements made for compensation purposes, and under the facts of this case, he is not shown to have the necessary medical knowledge to opine as to the etiology of his currently diagnosed disabilities. As discussed in detail above, to include by the June 2013 VA examiner, the medical record establishes that his in-service complaints of back pain are not related to the currently diagnosed spine disabilities. Notably, the Veteran himself admitted that he injured his back moving computers in 2004, approximately 13-years post-service. The Board is charged with the duty to assess the credibility and weight given to evidence. Wensch v. Principi, supra. 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. Caluza v. Brown, supra; Macarubbo v. Gober, supra; Coburn v. Nicholson, supra. A claimant’s inaccurate or less than truthful account of one incident does not automatically invalidate all his statements. However, in the present case, the Veteran’s statements do not reflect merely slight inconsistencies on peripheral matters, but go to the heart of the matter. Given that they are inconsistent, the Board cannot rely on them to establish the onset of the disability. In this regard, the June 2013 VA examiner’s opinion is of high probative value. The VA examiner’s opinion was demonstrably fully informed of the pertinent factual premises of the case and provided a fully articulated opinion with supporting reasoned analysis explaining why the Veteran’s back disabilities did not have their onset during active duty despite the complaints of back pain in-service. See Nieves-Rodriguez, 22 Vet. App. 295, 303-304 (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). There is no benefit of the doubt that could be resolved in the Veteran’s favor, since there is no medical evidence to the contrary. The weight of the competent and credible evidence demonstrates no relationship between the current lumbar and thoracic spine disabilities and active duty service, but rather establishes that the Veteran’s in-service complaints resolved at service separation, and that he had post-service injuries. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for a lumbar and thoracic spine disabilities, on direct and presumptive bases, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Gastrointestinal Disability, to include Gastritis and GERD The Veteran asserts that he has a gastrointestinal disability, to include gastritis and GERD related to his active duty service, and or alternatively as undiagnosed illness. Initially, the Board notes that the Veteran is currently diagnosed with gastritis and GERD and gastritis. See e.g., June 2013 VA examination report. The Board next finds that the Veteran’s gastrointestinal disabilities are specifically attributed to known disabilities and are not considered an undiagnosed illness or medically unexplained chronic multi-symptom illness. Furthermore, these disabilities were not incurred in-service and are not otherwise casually or etiologically related to service. Turning to the evidence, the Veteran’s service treatment records are silent to any complaints, treatments, or diagnoses of a gastrointestinal disability, to include gastritis and GERD. Post-service private treatment records dated in August 2006 indicate that the Veteran had an upper endoscopy which revealed some red patched in his stomach. A biopsy revealed mild chronic gastritis, with no evidence of bacteria, cancer, or other worrisome processes. The medical professional noted that the finding of mild gastritis was very common and was not clearly associated with abdominal discomfort. The Veteran underwent a VA examination in June 2013, at which time the examiner confirmed that based on the reported symptoms the Veteran had a diagnosis of GERD since 2012. The examiner stated that GERD was a condition caused by mechanical dysfunction of a valve between the stomach and the esophagus. The examiner opined that the Veteran’s GERD was not related to service, because his STRs being silent to any complaints related to GERD as well as GERD not being associated with Gulf War exposures. The examiner also confirmed a diagnosis of gastritis since 2006, but opined that it was also not related to service. The examiner explained that the Veteran did not have any symptoms in-service, and was not diagnosed with gastritis until many years after discharge from active duty. The examiner further noted that the Veteran had a positive history of smoking and alcohol use, which were both risk factors for gastritis. The Veteran did not provide any information as to why he believes his disabilities are related to service, and there is no evidence even suggesting a link between his diagnosed GERD or gastritis and service. Furthermore, no medical professional related his GERD and or gastritis to his active duty service, to include his service in Southwest Asia. In this regard, the June 2013 VA examiner’s opinion is of high probative value. The VA examiner’s opinion was demonstrably fully informed of the pertinent factual premises of the case and provided a fully articulated opinion with supporting reasoned analysis explaining why the Veteran’s GERD and or gastritis did not have their onset during active duty or were otherwise casually or etiologically related to service. See Nieves-Rodriguez, 22 Vet. App. 295, 303-304 (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). There is no benefit of the doubt that could be resolved in the Veteran’s favor, since there is no medical evidence to the contrary. Based on the foregoing, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran’s claimed gastrointestinal disability, to include gastritis and GERD was not incurred in service, is not an undiagnosed illness or medically unexplained chronic multi-symptom illness, and is not otherwise causally or etiologically related to service. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for a gastrointestinal disability, to include gastritis and GERD on a direct or Gulf War Illness basis, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Bronchitis The Veteran’s asserts that he has bronchitis that is related to his active duty service, specifically, his service in Southwest Asia. The Board initially finds that the Veteran has a current diagnosis of bronchitis. See e.g., June 2013 VA examination report. The Board next finds that the Veteran’s bronchitis was not incurred in-service and is not otherwise casually or etiologically related to service. Turning to the evidence, the Veteran’s August 1988 Report of Medical History shows that he underwent a splenectomy prior to service. During service, he was treated occasionally for upper respiratory infections, but on his May 1991 separation examination all systems were normal and he denied any recurrent problems. Post-service treatment records received in February 2008 indicate that the Veteran had a splenectomy and as a result was more susceptible to infectious diseases. In June 2013, the Veteran underwent a VA examination for respiratory disorders, at which time the examiner confirmed a diagnosis of bronchitis. The Veteran stated that he had respiratory symptoms from the Gulf War, and the examiner noted that he was a chronic smoker and had chronic allergies. The examiner further noted that the Veteran continued to smoke post-service, had no history of asthma, and did not require the use of inhalers. After a review of the claims file and examination of the Veteran, the examiner opined that his bronchitis was less likely than not related to service. The examiner explained that the Veteran had upper respiratory infections periodically, with at least one case of bronchitis, but continued to smoke, and with the pattern of symptoms not being extraordinary it was less likely than not related to his active duty service, to include his service in Southwest Asia, but rather more likely related to his chronic smoking. Lastly, the examiner noted that although the Veteran was treated for upper respiratory infections in-service, it was “really not multiple times.” While the Veteran is competent to describe his symptoms at any given time, under the facts of this case, he is not competent to render a medical diagnosis and or opine as to the etiology of his bronchitis, since it requires medical knowledge, which he is not shown to have. The VA examiner’s opinion was demonstrably fully informed of the pertinent factual premises of the case and provided a fully articulated opinion with supporting reasoned analysis explaining why the Veteran’s bronchitis did not have its onset during active duty or was otherwise casually or etiologically related to service. See Nieves-Rodriguez, 22 Vet. App. 295, 303-304 (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). There is no benefit of the doubt that could be resolved in the Veteran’s favor, since there is no medical evidence to the contrary. Moreover, the Veteran’s private treatment records suggest that he was more likely to suffer from infectious disease because of the splenectomy he underwent prior to active duty service. Based on the foregoing, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran’s claimed respiratory disability, to include bronchitis was not incurred in service, is not an undiagnosed illness or medically unexplained chronic multi-symptom illness, and is not otherwise causally or etiologically related to service. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for a respiratory disability, to include bronchitis on a direct or Gulf War Illness basis, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Essential Benign Tremor The Veteran asserts that he has an essential benign tremor that is related to his active duty service, specifically his service in Southwest Asia. Initially, the Board notes that the Veteran is currently diagnosed with essential benign tremor. See e.g., June 2013 VA examination report. The Board next finds that the weight of the lay and medical evidence of record demonstrates that the current essential benign tremor was not incurred in service and symptoms of were not chronic in service or manifested within one year of separation. Turning to the evidence, the Veteran’s service treatment records are silent to any complaints or treatment for symptoms related to essential benign tremor and or diagnosis of essential benign tremor. The Board notes that neither tremors nor manifestations sufficient to identify the disease entity are shown during service. Manifestations must be “noted” in the service records and that is not case in this instance. Therefore, although tremors may constitute an organic disease of the nervous system and therefore is a chronic disease under 38 C.F.R. § 3.309(a), no notations of the disease or any characteristic manifestations were shown in the service records. Additionally, there is no objective medical evidence of tremors until many years after discharge. As such, presumptive service connection is not warranted. The Board finds that service connection is also not warranted on direct basis. Post-service treatment records are silent to any complaints, treatment, or diagnosis of an essential benign tremor until approximately 2010, where he was prescribed Propranolol. In June 2013, the Veteran underwent a VA examination, at which time the examiner confirmed a diagnosis of essential benign tremor and noted its onset was approximately in 2010. After a review of the claims file and examination of the Veteran, the examiner opined that his essential benign tremor was less likely than not related to service, because it was diagnosed many years after service, and there is no evidence that essential tremor can be caused by Gulf War exposures. While the Veteran is competent to describe his symptoms at any given time, under the facts of this case, he is not competent to render a medical diagnosis and or opine as to the etiology of his essential benign tremor, since it requires medical knowledge, which he is not shown to have. The VA examiner’s opinion was demonstrably fully informed of the pertinent factual premises of the case and provided a fully articulated opinion with supporting reasoned analysis explaining why the Veteran’s essential benign tremor did not have its onset during active duty or was otherwise casually or etiologically related to service, to include due to exposure to environmental hazards in Southwest Asia. See Nieves-Rodriguez, 22 Vet. App. 295, 303-304 (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). There is no benefit of the doubt that could be resolved in the Veteran’s favor, since there is no medical evidence to the contrary. Moreover, there is simply no medical or lay evidence suggesting any link between the current diagnosis of essential benign tremor and his active duty service. The weight of the competent and credible evidence demonstrates no relationship between the current essential tremor and active duty service. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for essential benign tremor, on direct and presumptive bases, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Dysfunctional Bladder The Veteran asserts that he has a dysfunctional bladder that is related to his active duty service, specifically his service in Southwest Asia. The Board initially notes that the Veteran is currently diagnosed with cholecystectomy. See e.g., June 2013 VA examination report. The Board next finds that the Veteran’s bladder disability was not incurred in-service and is not otherwise casually or etiologically related to service. Turning to the evidence, the Veteran’s service treatment records are silent to any complaints, treatment, or diagnosis of a bladder disability. Post-service treatment records dated in 2006 show that the Veteran had abdominal pain and a study revealed non-functioning gallbladder, which was removed endoscopically. In June 2013, the Veteran underwent a VA examination, at which time, the examiner confirmed a diagnosis of cholecystectomy. The Veteran reported that post-surgery in 2006, his symptoms improved, but noted soft bowel movements and or diarrhea five to six days per week, which occurred when he ate fatty foods. The examiner noted that the Veteran was not taking any medications, and a review of his medical treatment records showed that he continuously denied a history of diarrhea. After a review of the claims file an examination of the Veteran, the examiner opined that his gallbladder problems were less likely than not related to service, to include service in Southwest Asia. The examiner explained that the Veteran’s symptoms occurred many years after service and diarrhea was common condition post gallbladder surgery. While the Veteran is competent to describe his symptoms at any given time, under the facts of this case, he is not competent to render a medical diagnosis and or opine as to the etiology of any gallbladder disability, since it requires medical knowledge, which he is not shown to have. The VA examiner’s opinion was demonstrably fully informed of the pertinent factual premises of the case and provided a fully articulated opinion with supporting reasoned analysis explaining why the Veteran’s cholecystectomy did not have its onset during active duty or was otherwise casually or etiologically related to service. See Nieves-Rodriguez, 22 Vet. App. 295, 303-304 (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). There is no benefit of the doubt that could be resolved in the Veteran’s favor, since there is no medical evidence to the contrary. Notably, no medical professional linked the Veteran’s gallbladder surgery and or any subsequent diagnoses to his active duty service, to include exposure to environmental hazards in Southwest Asia. Based on the foregoing, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran’s claimed dysfunctional bladder, was not incurred in service and is not otherwise causally or etiologically related to service. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for a dysfunctional bladder disability, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Joint Pain and Muscle Pain as Undiagnosed Illness The Veteran asserts that he has a chronic disability manifested by joint and muscle pain due to his service in Southwest Asia. Subject to various conditions, service connection may be granted for a disability due to undiagnosed illness of a Veteran who served in the Southwest Asia Theater of Operations during the Persian Gulf War. Among the requirements are that there are “objective indications of a chronic disability” resulting from an illness or combination of illnesses manifested by one or more signs or symptoms such as fatigue, signs or symptoms involving the skin, headache, muscle pain, joint pain, neurological signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper and lower), sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. The illness must become manifest during either active service in the Southwest Asia Theater of Operations during the Persian Gulf War or to a degree of 10 percent or more, under the appropriate diagnostic code of 38 C.F.R. Part 4, not later than December 31, 2021. The presumption is applicable if, by history, physical examination, and laboratory tests, the disability cannot be attributed to any known clinical diagnosis. There must be objective signs that are perceptible to an examining physician and other non-medical indicators that are capable of independent verification. There must be a minimum of a six-month period of chronicity. There must be no affirmative evidence that relates the undiagnosed illness to a cause other than being in the Southwest Asia Theater of Operations during the Persian Gulf War. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. If signs or symptoms have been medically attributed to a diagnosed (rather than undiagnosed) illness, the Persian Gulf War presumption of service connection does not apply. VAOPGCPREC 8- 98 (Aug. 3, 1998) (cited at 63 Fed. Reg. 56,703 (Oct. 22, 1998). As noted above, the Veteran’s service records confirm that he served in Southwest Asia and is a Persian Gulf War veteran pursuant to 38 C.F.R. 3.317(e). Turning to the evidence, the Veteran’s service treatment records are silent to any complaints or treatment for joint or muscle pain not attributed to a specific diagnosis. During service, the Veteran complained of back, left elbow, and left ankle pain. His May 1991 separation examination was normal and he denied swollen or painful joints. Post-service treatment records show that the Veteran complained of numerous orthopedic problem; however, all were attributed to a specific body part and diagnosis. During a June 2013 Gulf War General Medical examination, after a review of the claims file and examination of the Veteran, the examiner stated that no undiagnosed illnesses or conditions were found. Specifically, the Veteran’s lay reports of joint and muscle pain were attributed to his service-connected left ankle and elbow disabilities, or his nonservice-connected back and neck disabilities. Accordingly, the Board finds that the Veteran’s joint and muscle pain are specifically attributed to known clinical diagnoses, and as such, there can be no valid claim of service connection on a presumptive basis under 38 C.F.R. § 3.317 or on a direct basis under 38 C.F.R. § 3.303. The Veteran’s appeal for entitlement to service connection for joint and muscle pain, as due to an undiagnosed illness resulting from service in Southwest Asia must be denied. REASONS FOR REMAND The Board finds that a remand is necessary to provide the Veteran with a VA mental health examination and to obtain an addendum medical opinion regarding his hypertension. Regarding the Veteran’s claim for an acquired psychiatric disorder, the Board finds that a new VA examination is necessary to determine the nature and etiology of any currently diagnosed psychiatric disorders. Notably, the Veteran underwent a VA examination for PTSD, at which time the examiner indicated that he did not meet the criteria for PTSD or any other mental disorder. Nevertheless, a review of the claims file shows that he has been diagnosed with depressive neurosis; adjustment disorder with mixed emotional features; personality disorder, not otherwise specified (NOS); and, depressive disorder, NOS. See e.g., VA treatment records dated in October 2011. Accordingly, an addendum opinion is necessary prior to making a decision on the merits. Regarding the claim for service connection for hypertension, the Veteran underwent a VA examination in June 2013, at which time the examiner confirmed a diagnosis since 2005, and opined that it was not related to service or Gulf War exposure, because it was not diagnosed until many years later. While this opinion perhaps explains why presumptive service connection is not warranted, the examiner’s rationale based on direct service connection is incomplete. Notably, the examiner relied simply on the fact that the hypertension was not diagnosed until many years post-service, but did not provide any rationale as to why exposure to environmental hazards in Southwest Asia was not the cause of his hypertension. Thus, an addendum nexus opinion supported by a rationale is necessary. The matter is REMANDED for the following action: 1. Ensure that all outstanding VA treatment records dated since the July 2015 are associated with the claims file. 2. After obtaining all outstanding records, return the claims file, to include a copy of this remand, to the June 2013 examiner for an addendum opinion. If the examiner who drafted the June 2013 report is unavailable, the opinion should be rendered by another appropriate medical professional. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. After complete review of the claims file and examination of the Veteran, the examiner should respond to the following: (a) Identify all currently diagnosed acquired psychiatric disorders. If a psychiatric disorder is not currently shown, the examiner must address the prior diagnoses, noting that they have since resolved and explain any discrepancies. (b) Then, for each currently diagnosed psychiatric disorder, provide an opinion as to whether it more likely than not (50 percent or greater) had its onset during active service or is otherwise related to it. In doing so, please address the Veteran’s lay reports and a “buddy statement” VBMS entry 04/14/2013. The examiner should provide a complete rationale for all opinions. 3. After obtaining all outstanding records, return the claims file, to include a copy of this remand, to the June 2013 examiner for an addendum opinion. If the examiner who drafted the June 2013 report is unavailable, the opinion should be rendered by another appropriate medical professional. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. After a complete review of the claims file, the examiner is asked to respond to the following: Provide an opinion as to whether it more likely than not (50 percent or greater) that the Veteran’s hypertension is related to his active service, specifically his conceded exposure to environmental hazards in Southwest Asia. The examiner should provide a complete rationale for all opinions. 4. Then, readjudicate the claims on appeal. If the benefits on appeal remain denied, furnish the Veteran and his representative with a copy of a supplemental statement of the case and allow an appropriate time for response. Kristy L. Zadora Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Yaffe, Associate Counsel