Citation Nr: 18145726 Decision Date: 10/30/18 Archive Date: 10/29/18 DOCKET NO. 09-31 745 DATE: October 30, 2018 ORDER Entitlement to service connection for tinnitus is granted. Entitlement to service connection for a lumbar spine disability to include herniated discs at L4-5 is denied. Entitlement to service connection for bilateral lower extremity radiculopathy is denied. Entitlement to service connection for reflex sympathetic dystrophy is denied. Entitlement to service connection for kidney stones is denied. Entitlement to service connection for a psychiatric disorder to include depression and anxiety is denied. Entitlement to service connection for arthritis of the shoulders is denied. Entitlement to service connection for a liver disorder to include cirrhosis is denied. REMANDED Entitlement to a total disability evaluation based upon individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. It is as likely as not that the Veteran’s current tinnitus is related to active service. 2. A lumbar spine disability to include disc disease was not manifested in active service, is not related to disease or injury or other event in active service, and first manifested many years after active service after post service injuries. 3. Bilateral lower extremity radiculopathy was not manifested in active service, was first manifested many years after service separation, is not related to disease or injury or other event in active service, and is not caused by or aggravated by a service-connected disability. 4. Reflex sympathetic dystrophy was not manifested in active service, was first manifested many years after service separation, is not related to disease or injury or other event in active service, and is not caused by or aggravated by a service-connected disability. 5. A bilateral shoulder disability to include arthritis was not manifested in active service, was first manifested many years after service separation, is not related to disease or injury or other event in active service, and is not caused by or aggravated by a service-connected disability. 6. A liver disability to include cirrhosis was not manifested in active service, was first manifested many years after service separation, is not related to disease or injury or other event in active service, and is not caused by or aggravated by a service-connected disability. 7. Kidney stones were not manifested in active service, are not related to disease or injury or other event in active service, and are not caused by or aggravated by a service-connected disability. 8. A psychiatric disorder to include depression and anxiety was not manifested in active service, is not related to disease or injury or other event in active service, and is not caused by or aggravated by a service-connected disability. CONCLUSIONS OF LAW 1. By extending the benefit of the doubt to the Veteran, the criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). 2. The criteria for service connection for a lumbar spine disability to include disc disease have not been met. 38 U.S.C. §§ 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). 3. The criteria for service connection for bilateral lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2018). 4. The criteria for service connection for reflex sympathetic dystrophy have not been met. 38 U.S.C. §§ 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2018). 5. The criteria for service connection for a bilateral shoulder disability to include arthritis have not been met. 38 U.S.C. §§ 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2018). 6. The criteria for service connection for a liver disability to include cirrhosis have not been met. 38 U.S.C. §§ 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2018). 7. The criteria for service connection for kidney stones have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2018). 8. The criteria for service connection for a psychiatric disorder to include depression and anxiety have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1987 to March 1990. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions dated in August 2008 and February 2009 of the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. This matter was remanded to the RO in July 2013 and September 2016. The Veteran appeared before the Board at a video conference hearing in June 2016. In August 2016, the Veteran submitted a waiver of agency of original jurisdiction (AOJ) consideration of new evidence pursuant to 38 C.F.R. § 20.1304 (2018). 1. Service Connection Service connection will be granted for disability resulting from a disease or injury incurred in or aggravated by military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection requires competent evidence showing, (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004), citing Hansen v. Principi, 16 Vet. App. 110, 111 (2002); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Where a veteran served ninety days or more of active service, and certain chronic diseases, to include degenerative arthritis, disc disease, an organic disease of the nervous system to include tinnitus, and cirrhosis of the liver, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). 38 C.F.R. § 3.303 (b) applies to the “chronic diseases” under 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Under 38 C.F.R. § 3.310 (a), service connection may be granted for disability that is proximately due to or the result of a service-connected disease or injury. That regulation permits service connection not only for disability caused by service-connected disability, but for the degree of disability resulting from aggravation to a nonservice-connected disability by a service-connected disability. See 38 C.F.R. § 3.310 (2017); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). Pursuant to § 3.310(a) of VA regulations, service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. at 448. Once the evidence has been assembled, it is the Board’s responsibility to evaluate the evidence. 38 U.S.C. § 7104 (a). The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.102, 4.3. 2. Entitlement to service connection for tinnitus is granted. The Veteran contends that he incurred tinnitus as a result of noise exposure in active service. At the hearing before the Board in June 2016, the Veteran stated that he worked on the flight line and he worked on loud equipment and around jet engines, diesel engines, compressors, and air tools. He stated that he worked in enclosed spaces such as hangers. The Veteran stated that he began to notice ringing in the ears soon after service and he would notice it in quiet areas. The Board finds that the Veteran is competent to describe being exposed to loud noise, such as that caused by a flight line and equipment and tools. See Falzone v. Brown, 8 Vet. App. 398, 403 (1995). The Veteran’s lay statements are found to be credible as they have been consistent and are confirmed by the circumstances of his service. Service records indicate that when the Veteran served in the Air Force and he worked on the flight line and maintained aerospace ground equipment. An in-service July 1987 Occupational Health Exam indicates that the Veteran worked in a shop that repaired, serviced, and cleaned all non-powered aerospace ground equipment (AGE). It was noted that the majority of the noise exposure occurred on the flight line while operating AGE’s. The service treatment records show that the Veteran was given periodic hearing tests to monitor his hearing and he wore hearing protection. For these reasons, the in-service injury of acoustic trauma to both ears is established. Resolving reasonable doubt in the Veteran’s favor, the Board finds that the criteria for service connection for tinnitus have been met. The March 2017 VA audiological examination and medical opinion determined that it was at least as likely as not that the Veteran’s recurrent tinnitus was caused by and the result of the military noise exposure. The VA audiologist indicated that the rationale for the conclusion was the nature of the Veteran’s duties and his description of tinnitus for over 30 years. The Board finds that the evidence supports a grant of service connection for tinnitus. The Veteran provided competent and credible lay evidence of the noise exposure in active service and that he began to experience tinnitus soon after service. The VA medical opinion relates the tinnitus to the military noise exposure. There is evidence which weighs against the claim. The service treatment records do not document complaints or treatment of tinnitus. Resolving reasonable doubt in the Veteran’s favor, the Board finds that the criteria for service connection for tinnitus have been met. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The claim of service connection for tinnitus is granted. 3. Entitlement to service connection for a lumbar spine disability to include disc disease is denied. The Veteran contends that his low back disability began in active service. At the hearing before the Board in June 2016, the Veteran stated that he worked as a mechanic in active service and he did maintenance on ground support equipment. The Veteran stated that he could not recall making any complaints about his back in active service other than the initial time on November 23, 1987, when he complained about lower back pain and pain in his hip. The Veteran indicated that he did not seek any other treatment for the back in service and he did not have pain or issues with his back at that time. The Veteran started that his back disability developed over time and he did not seek treatment for the back disability for a long time after service. He stated that he was young and he would take Tylenol and go back to work. Regarding the history of several post-service injuries concerning the back, the Veteran stated that usually he would do something that would aggravate the injury, and if he bent over too long or was lifting or if he was doing a similar kind of job after the military, it would aggravate what he had previously. 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, while the Veteran has current diagnosis of a lumbar spine disability, the preponderance of the evidence weighs against finding that the lumbar spine disability began during service or is otherwise related to an in-service injury, event, or disease. The March 2017 VA examination report shows diagnoses of lumbar degenerative disc disease, spinal cord stimulator implantation, and associated residual pain of lower extremities. The Board finds the weight of the competent and credible evidence shows that the current lumbar spine disability first manifested many years after active service, is caused by post service injuries, and is not related to disease or injury or other event in active service. Service enlistment exam dated in October 1986 indicates that examination of the spine was normal. A November 1987 primary care service treatment record indicates that the Veteran sought medical treatment for lower back pain. It was noted that the Veteran had left hip pain when laying down too long. Examination revealed no tenderness of the low back or hip. A back disability was not detected. A March 1989 report of medical history indicates that the Veteran denied having recurrent back pain. He stated that he was presently in excellent health. Examination of the spine was normal. The examination report indicates that the examinee denies and review of the medical records fail to reveal any significant medical or surgical history since the last exam in October 1986. A service record dated in February 1990 indicates that the Veteran elected not to have an exam in conjunction with his scheduled separation. The Medical Group determined that a physical for separation was not required. The Veteran separated from active service in March 1990. The Board notes that a February 2002 private medical record indicates that the Veteran underwent evaluation to establish primary care. It was noted that he was asymptomatic and denied any active complaints. He reported having a prior medical history of sciatica; the diagnosis was made approximately five years ago but was never investigated with imaging studies. The Veteran reported that he would occasionally develop paresthesias in the lower limbs. The assessment was unremarkable physical exam. The first evidence of a diagnosis of a lumbar spine disability is in 2003. An October 2003 report of an initial evaluation for rehabilitation indicates that the Veteran reported that he injured his back at work. He stated that at the time, he was supporting sixty to seventy pounds with his right arm and was working with his left arm. He stated that he experienced pain in the left leg with tingling to the left foot and pain across the low back. The pain increased with standing or walking for 15 minutes and sitting for 30 minutes. He stated that he was currently on light duty with lifting limited to under 20 pounds and limited bending and twisting. The Veteran reported having a prior medical history of a back injury in 1998 otherwise he had a negative history. The assessment was lumbar strain. An October 2004 C. Pain Management Center record provides information as to the September 2003 back injury. The record indicates that the Veteran reported that he was injured on the job on September 25, 2003. He was working for Delta Airlines as a mechanic and he was putting in a starter in a vehicle. He reached behind him to get a wrench while holding the starter up. He felt a pinch in his back and by the end of the shift, he had pain into his left foot. He saw his family physician and he was placed on Flexeril and Darvocet. An October 2003 treatment record indicates that the assessment was chronic lower back pain with episodic exacerbation due to heavy object lifting at work. MRI showed mild disc protrusion of L4/L5 with slight encroachment on the left transversal root on the left lateral canal. The physician noted no significant changes seen since 2002. At that point, conservative treatment was recommended. A December 2003 lumbar spine x-ray report shows an impression of severe, acute low back pain, annular tear chronic L4-5, no evidence of neurological compression, and multi-level degenerative changes. A December 2003 consultation report indicates that the Veteran reported a couple of back injuries: in 1998 or 1999, he was working and had temporary back pain that went down his leg. He was treated with muscle relaxers and it went away. He reported having a second injury in 2002 and he had back pain and leg pain on the left and he was treated with physical therapy and it went away. The Veteran reported having an injury in September or so when he was reaching up with his left hand and had a sudden onset of pain in the back on the left that went into the buttocks and down the leg to some degree. The Veteran saw his primary care doctor and then saw another doctor at his company’s behest. He underwent two epidural injections and after the second epidural in December, he had increased pain that radiated to the buttocks and into the groin. A December 2003 consult report shows an assessment of severe lower back pain secondary to a work related injury many months ago with history of steroid injection in the lumbar intervertebral disk; the last injection was December 2, 2003. There was a MRI finding of a prominent bulge of the degenerative L4-L5. A January 2004 hospital admission report indicates that the Veteran was admitted for treatment/rehab of low back disability. The diagnosis was degenerative disc disease at L4-5 with annular tear and right lower extremity pain of unknown etiology. Medications were adjusted and gave him fairly good pain relief. There was a question of hepatitis which was suspected to have been medication induced. There was a consideration as to whether the Veteran had reflex sympathetic dystrophy but a bone scan in January 2004 was not suggestive of reflex sympathetic dystrophy. The Veteran was seen by a psychiatrist; he had depression but no evidence of major depression or conversion reaction. It was noted that overall, the Veteran stated that his pain was currently 60 percent improved compared to pre-rehab admission and the reason for this was probably multifactorial including his participation in rehabilitation, medication adjustment, and perhaps sympathetic blocks. The Veteran was afforded a VA examination and a medical opinion was obtained in March 2017. The diagnosis was lumbar degenerative disc disease, spinal cord stimulator implantation with associated residual pain of lower extremities, and bilateral lower extremity radiculopathy. The VA examiner stated that the currently diagnosed condition of lumbar degenerative disc disease, spinal cord stimulator implantation with associated residual pain of lower extremities, and bilateral lower extremity radiculopathy are less likely than not (less than 50 percent probability) had its onset during active service or within one year thereafter, or are otherwise etiologically related to such service. The VA examiner indicated that while there may be service treatment records from November 1989 that indicate a complaint of back pain, no chronic diagnosis is established. The VA examiner noted that the separation physical examination is negative for documentation of ongoing and chronic back pain. The VA examiner indicated that the Veteran has a significant occupational history of back injuries following separation from the military. The VA examiner noted that while the lay statement is appreciated describing back pain during military service, the significant injuries that occurred following separation from the military cannot be overlooked. It would be too speculative to conclude that the significant chronic spine condition that occurred following separation from the military is directly attributable to military service based on the available documentation. There is no competent evidence of record showing a diagnosis of degenerative disc disease or arthritis of the spine compensable to 10 percent within one year from service separation. Thus, presumptive service connection pursuant to C.F.R. § 3.307(a) is not warranted. The Board also finds that the weight of the competent and credible evidence shows that the Veteran did not experience chronic and continuous symptoms of a low back disability in active service or since service separation. The Board finds that the more probative evidence shows that the current lumbar spine disability did not manifest in service and is not related to the injury or symptoms in active service but was caused by the post service injuries. The service treatment records document one instance of low back pain and treatment. The Veteran denied having recurrent back pain on subsequent exam in March 1989 and examination of the spine was normal. He waived his right to a separation exam in February 1990. The record shows that the Veteran first sought medical treatment for a back disability many years after service separation when he injured his back. The more probative evidence, the March 2017 VA examination report and opinion, establishes that the current lumbar spine disability is not related to the symptoms in active service. Thus, service connection for lumbar spine degenerative disc disease or arthritis on a presumptive basis under 38 C.F.R. § 3.303 (b) is not warranted. The Board finds that the March 2017 VA medical opinion is probative because the VA examiner reviewed the Veteran’s claims file and medical history, considered the Veteran’s lay statements, and provided a rationale for the opinion. The VA examiner specifically considered the treatment in active service and post service. The Board finds that the opinion is based upon sufficient facts and data and that this opinion is probative. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board notes that the VA examiner inadvertently reported the date of the back injury in service as November 1989 instead of November 1987; while the VA examiner reported the incorrect date, the other information from this medical record was reported correctly and the Board finds that the information in the service treatment records support the VA examiner’s medical conclusion. The Board finds that the service treatment records including the March 1989 examination report and the Veteran’s statements made in February 1990 waiving a separation exam are more probative than the Veteran’s lay statements and lay statements by his family members made almost 17 years after service in connection with his claim for compensation benefits. The lay and medical evidence generated at the time of the Veteran’s period of service is highly probative. These records and statements are contemporaneous with the Veteran’s period of service. These records contain information that is inherently more reliable than information recorded at a later time, in this case, information recorded 17 years after the event in question. The March 1989 examination report and report of medical history shows that the Veteran did not have recurrent back pain and the exam of the spine was normal. The Veteran’s statements made in February 1990 waiving a separation exam show that the Veteran believed he was in excellent health. This evidence supports a finding that the Veteran did not have a low back disability at that time. These records were generated contemporaneously with the Veteran’s service, and therefore are felt to have greater probative value than assertions made more than 17 years after service and in conjunction with a claim for VA benefits. Curry v. Brown, 7 Vet. App. at 68 (noting that contemporaneous evidence has greater probative value than history as reported by a veteran). The Board accords greater probative weight to the official service records and the Veteran’s own lay statements made during active service. The Board acknowledges that the Veteran is competent to report his symptoms and observations during the appeal period, and the Board finds these reports are credible. However, for the reasons discussed above, the Board accords greater probative weight to the official service records and the Veteran’s own lay statements made during active service. The Veteran has also related the lumbar spine disability to active service and he stated that the symptoms began in active service and have continued since then. Although lay persons are competent to describe observable symptoms and provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, an opinion as to the etiology and onset of a lumbar spine disability to include disc disease falls outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Some medical issues require specialized training for a determination as to diagnosis and causation, and such issues are therefore not susceptible of lay opinions on etiology. Neither the Veteran nor his representative has produced a medical opinion or identified medical evidence that establishes a medical nexus between the lumbar spine disability and active service. Further, as noted above, the VA examiner concluded that the lumbar spine disability was not manifested in active service and is not related to the symptoms in service. As such, the medical findings and opinion of the VA examiner warrant greater probative weight than the Veteran’s lay contentions. The Veteran submitted a July 2016 statement from his private neurologist in support of his claim. The private neurologist indicated that the Veteran had reported that he first had back difficulties and an injury in active service in 1987. The private neurologist noted that he did not review any records from 1987. The private neurologist noted that he saw the Veteran in 2004 and the Veteran had seen at least five physicians for the recurrent back problems since 1987. The Board finds that the medical opinion by the private neurologist to have limited probative value and this opinion is outweighed by the VA medical opinion. The Board does not question the private neurologist’s competence and expertise as a medical doctor. However, the opinion is not sufficient to establish a nexus between the current lumbar spine disability and active service. The private neurologist notes that the Veteran had a back injury in 1987 but also indicates that he did not see any records for the 1987 injury. The private neurologist notes that the Veteran had back symptoms from 1987 to 2004 but does not provide any detailed information as to the symptoms for this time period. The private neurologist does not address the significant post service back injuries. On the other hand, the March 2017 VA examiner reviewed the in-service records as well as the post service medical evidence. The VA examiner provided a more detailed and reasoned opinion as to the onset of the back injury. As such, the medical findings and opinion of the VA examiner warrant greater probative weight than the opinion by the private neurologist. Accordingly, on this record, the evidence is found to preponderate against the claim for service connection for a lumbar spine disability to include disc disease. Therefore, service connection is denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 4. Entitlement to service connection for bilateral lower extremity radiculopathy, reflex sympathetic dystrophy, kidney stones, depression/anxiety, arthritis of the shoulders, and a liver disorder to include cirrhosis is denied. The Veteran contends that he has bilateral lower extremity radiculopathy, reflex sympathetic dystrophy, kidney stones, depression/anxiety, arthritis of the shoulders, and a liver disorder to include cirrhosis as a result of the lumbar spine disability and the medications he takes to treat that disability. However, as service connection for a lumbar spine disability is being denied by this decision, service connection for bilateral lower extremity radiculopathy, reflex sympathetic dystrophy, kidney stones, depression/anxiety, arthritis of the shoulders, and a liver disorder on a secondary basis must be denied as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (where the law and not the evidence is dispositive, the Board should deny the claim on the ground of lack of legal merit). As to service connection on a direct basis for bilateral lower extremity radiculopathy, reflex sympathetic dystrophy, kidney stones, depression/anxiety, arthritis of the shoulders, and a liver disorder, the Board finds that the weight of the competent and credible evidence establishes that these disabilities first manifested over a decade after service and are not related to active service. The Veteran has not contended, and the medical evidence does not reflect, that the Veteran has bilateral lower extremity radiculopathy, reflex sympathetic dystrophy, kidney stones, depression/anxiety, arthritis of the shoulders, and a liver disorder related to active service. There is no evidence of bilateral lower extremity radiculopathy, reflex sympathetic dystrophy, kidney stones, depression/anxiety, arthritis of the shoulders, and a liver disorder in active service. See the October 1986 enlistment examination report, the March 1989 examination report, and the February 1990 election to waive the separation exam. The weight of the competent and credible evidence establishes that these disabilities first manifested decades after service and are caused by or the result of the lumbar spine disability and medical treatment for the lumbar spine disability. With respect to negative evidence, the fact that there were no records of any complaints, treatment, or diagnosis of these disabilities for many years after service separation weighs against the claim. See Maxson, 230 F.3d at 1333. The Board also finds that the Veteran did not experience continuous symptoms of bilateral lower extremity radiculopathy, reflex sympathetic dystrophy, kidney stones, depression/anxiety, arthritis of the shoulders, and a liver disorder in active service or since service separation until the disorders were diagnosed over a decade after service. Thus, presumptive service connection under the provisions of 38 C.F.R. § 3.303 (b) and § 3.307(a) is not warranted. Moreover, there is no indication of an association between the bilateral lower extremity radiculopathy, reflex sympathetic dystrophy, kidney stones, depression/anxiety, arthritis of the shoulders, and a liver disorder, and any documented event or incident of service. A VA medical opinion and examination were not provided to address the theory that these disorders are related to active service or a service-connected disability. The Federal Circuit Court of Appeals (Federal Circuit) has recognized that there is not a duty to provide an examination in every case. See Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). Rather, the Secretary’s obligation under 38 U.S.C. § 5103A (d) to provide the Veteran with a medical examination or to obtain a medical opinion is not triggered unless there is an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability. See McLendon v. Nicholson, 20 Vet. App.79, 81 (2006). As discussed, there is no probative evidence of an in-service symptoms or diagnosis. The Veteran does not identify an in-service injury or event that led to the claimed disorders. There is no lay or medical evidence of the disabilities in active service. There is no indication of an association between the disabilities and injury, event, or disease in active service or a service-connected disability. The record in this case is negative for any indication, other than the Veteran’s own general assertions, that the disabilities are associated to service or a service-connected disability. As noted above, the Veteran, as a layperson, is not competent to provide a medical opinion as to the etiology of a disease. There is sufficient competent medical evidence on file for VA to make a decision on this claim. As such, VA’s duty to provide an examination is not triggered. In light of the above, the Board finds that the preponderance of the evidence is against a finding that the bilateral lower extremity radiculopathy, reflex sympathetic dystrophy, kidney stones, depression/anxiety, arthritis of the shoulders, and a liver disorder are related to active service or are due to or aggravated by a service-connected disability. As the preponderance of the evidence is against the Veteran’s claims, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Gilbert; supra. The claims are denied. REASONS FOR REMAND The Board finds that a remand is required for readjudication of the TDIU claim in the first instance in light of the Board’s grant of service connection for tinnitus. Due process requires that the first adjudication must be made by the agency of original jurisdiction. Bernard v. Brown, 4 Vet. App. 384, 392-94 (1993). (Continued on the next page)   The matter is REMANDED for the following action: Readjudicate the issue of entitlement to a TDIU. If any benefit sought on appeal remains denied, the Veteran and representative should be provided a Supplemental Statement of the Case. An appropriate period of time should be allowed for response before the case is returned to the Board. THOMAS H. O'SHAY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C.L. Krasinski, Counsel