Citation Nr: 18146612 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 16-22 068 DATE: October 31, 2018 ORDER Reconsideration of a previously denied claim of entitlement to service connection for type II diabetes mellitus is granted. Reconsideration of a previously denied claim of entitlement to service connection for neuropathy of the right hand is granted. Reconsideration of a previously denied claim of entitlement to service connection for neuropathy of the left hand is granted. The claim of entitlement to service connection for type II diabetes mellitus is denied. The claim of entitlement to service connection for coronary artery disease (CAD) is denied. The claim of entitlement to service connection for neuropathy of the right hand, as secondary to type II diabetes mellitus, is denied. The claim of entitlement to service connection for neuropathy of the left hand, as secondary to type II diabetes mellitus, is denied. The claim of entitlement to service connection for neuropathy of the right foot, as secondary to type II diabetes mellitus, is denied. The claim of entitlement to service connection for neuropathy of the left foot, as secondary to type II diabetes mellitus, is denied. FINDINGS OF FACT 1. A June 2008 rating decision denied service connection for type II diabetes mellitus and neuropathy of the hands; although notified of the denials in a letter that same month, the Veteran did not initiate an appeal. 2. New evidence associated with the claims file since the June 2008 denials of service connection for type II diabetes mellitus and neuropathy of the hands includes relevant official service department records not previously considered. 3. Type II diabetes mellitus and CAD are among the diseases for which VA’s Secretary has recognized that there exists an etiological relationship with herbicide exposure. 4. The Veteran did not serve on active duty in the Republic of Vietnam during the Vietnam era, and may not be presumed to have been exposed to herbicides, to include Agent Orange, during service. 5. Although further efforts have been expended to attempt to verify herbicide exposure, objective, persuasive evidence does not establish that the Veteran was actually exposed to Agent Orange during his period of service in Thailand, as alleged; in fact, the objective evidence on this point weighs against a finding of actual exposure. 6. Type II diabetes mellitus and CAD were not shown in service or for many years thereafter, and there is no persuasive medical evidence or opinion establishing a relationship between these disabilities and service. 7. As service connection for type II diabetes mellitus has not been established, there is no legal basis to award service connection, on a secondary basis, for peripheral neuropathy of the right hand, peripheral neuropathy of the left hand, peripheral neuropathy of the right foot, or peripheral neuropathy of the left foot. CONCLUSIONS OF LAW 1. As pertinent evidence received since the June 2008 denials of service connection for type II diabetes mellitus and neuropathy of the hands includes official service department records not previously considered, the criteria for reconsideration of the claims for service connection for type II diabetes mellitus, neuropathy of the right hand, and neuropathy of the left hand are met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. 2. The criteria for service connection for type II diabetes mellitus are not met. 38 U.S.C. §§ 1110, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 3. The criteria for service connection for CAD are not met. 38 U.S.C. §§ 1110, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 4. The criteria for service connection for peripheral neuropathy of the right hand, as secondary to type II diabetes mellitus, are not met. 38 U.S.C. §§ 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.310. 5. The criteria for service connection for peripheral neuropathy of the left hand, as secondary to type II diabetes mellitus, are not met. 38 U.S.C. §§ 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.310. 6. The criteria for service connection for peripheral neuropathy of the right foot, as secondary to type II diabetes mellitus, are not met. 38 U.S.C. §§ 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.310. 7. The criteria for service connection for peripheral neuropathy of the left foot, as secondary to type II diabetes mellitus, are not met. 38 U.S.C. §§ 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1967 to July 1969. This appeal to the Board of Veterans’ Appeals (Board) arose from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado. In a December 2012 rating decision, the RO, inter alia, reopened but denied on the merits the Veteran’s claims for service connection for type II diabetes mellitus and for neuropathy of the hands, and denied his claims for service connection for CAD and for neuropathy of the feet. Following the receipt of additional evidence, in a September 2013 rating decision, the RO confirmed and continued the previous denials of service connection for diabetes, neuropathy of the hands (recharacterized as right hand neuropathy and left hand neuropathy), CAD, and neuropathy of the feet hands (recharacterized as right foot neuropathy and left foot neuropathy). In September 2014, the Veteran filed a notice of disagreement (NOD). A statement of the case (SOC) was issued in March 2016, and the Veteran filed a substantive appeal (via a VA Form 9, Appeal to the Board of Veterans’ Appeals) in May 2016. In June 2017, the Veteran testified during a Board video-conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. For reasons made clear below, the Board finds that the diabetes, neuropathy of the right hand, and neuropathy of the left hand claims, initially adjudicated as requests to reopen, are more appropriately characterized as requests for reconsideration, consistent with the provisions of 38 C.F.R. § 3.156(c). Moreover, given the favorable disposition of these reconsideration requests, as discussed below, the appeal also has been expanded to include these underlying de novo claims for service connection. Also, this appeal has been advanced on the Board’s docket, pursuant to 38 U.S.C. § 7107(a)(2) and 38 C.F.R. § 20.900(c). Analysis At the outset, the Board has determined that all notification and development actions needed to fairly adjudicate each claim herein decided have been accomplished and that there is, thus, no prejudice to the Veteran in the Board proceeding to a decision on these claims, at this juncture. As indicated above, and explained below, as the Board is granting the requests for reconsideration, any further due process discussion regarding this aspect of the appeal is not warranted. As for the underlying service connection claims for type II diabetes mellitus, right hand neuropathy, and left hand neuropathy, as well the service connection claims for CAD, right foot neuropathy, and left foot neuropathy, April 2012 pre-rating letters provided notice to the Veteran regarding the information and evidence needed to substantiate his service connection claims. The evidence received and considered in connection with these claims include the Veteran’s service treatment records (STRs), VA treatment records, private treatment records, service personnel records, the transcript of the June 2017 Board hearing, as well as written statements provided by the Veteran and his representative, on his behalf. Notably, the Veteran has not identified, and the record does not otherwise indicate, any additional existing evidence necessary for a fair adjudication of the claims that has not been obtained. Although the Veteran has not been afforded a VA examination and no medical opinion has been obtained in connection with either claims as explained below, no such examination or opinions in connection with either claim is required. See 38 C.F.R. § 3.159(d); see also Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010) (discussing the limits of the duty-to-assist in furnishing a VA medical examination). 1. Reconsideration The Veteran’s claims for service connection for type II diabetes mellitus, right hand neuropathy, and left hand neuropathy were initially denied by the RO in a June 2008 rating decision. The pertinent evidence then of record consisted of the Veteran’s STRs, DD Form 214, and private treatment records. The RO noted that the requisite service in Vietnam to establish service connection based on a relationship to herbicide exposure had not been shown, and that there was no evidence of exposure to herbicides in any other period of service. On these bases, the RO denied the claims. Although notified that his claims for service connection for diabetes and neuropathy of the hands were denied in a June 2008 letter, the Veteran did not initiate an appeal. Moreover, no additional evidence was received within the one-year appeal period following notification of the denials. See 38 C.F.R. § 3.156(b). Typically, this fact would render the decision final as to the evidence then of record, and not subject to revision on the same factual basis. See 38 U.S.C. § 7105(b); 38 C.F.R. §§ 3.104, 20.302, 20.1103. Under such circumstances, VA could only reopen and review such claims if new and material evidence is submitted by or on behalf of the Veteran. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). However, at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim, notwithstanding the requirement that new and material evidence must first be received. 38 C.F.R. § 3.156(c). In this case, additional evidence was associated with the claims file following the prior denials—specifically, in June 2012, the Veteran’s service personnel records were associated with the claims file. These records are relevant to the Veteran’s claims, as they concern where he was stationed during service as well as his job duties in service and relate to his assertion that he was exposed to agent orange during his service in Thailand. These records existed at the time of the initial denials, but were not associated with the claims file or considered by the RO at that time. As such, pursuant to 38 C.F.R. § 3.156(c), the receipt of these additional service records requires reconsideration of the claims for service connection for diabetes, right hand neuropathy, and left hand neuropathy—which, effectively, renders the initial denial non-final. Hence, there is no basis for analysis of the claims for service connection for diabetes, right hand neuropathy, and left hand neuropathy as requests to reopen under 38 C.F.R. § 3.156(a). 2. Service Connection The Veteran contends that he currently has type II diabetes mellitus and CAD that are each related to service—specifically, Agent Orange exposure while stationed in Thailand. In this regard, he claims that he was exposed to Agent Orange while stationed in Sattahip, when he took prisoners to the Udorn Royal Thai Air Force Base (RTAFB) at least four times, when he ate dinner weekly and retrieved supplies at the U-Tapao RTAFB, and when travelling throughout the region on various assignments. Additionally, the Veteran contends that he currently has peripheral neuropathy of both hands and both feet that are related to his diabetes. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease was incurred in active service. 38 C.F.R. § 3.303(d). Generally, to establish service connection, there must be competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) an etiological relationship between the present disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). See also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The determination as to whether elements are met is based on an analysis of all the evidence of record and the evaluation of its competency, credibility and probative value. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Baldwin v. West, 13 Vet. App. 1, 8 (1999). Certain chronic diseases, such as diabetes mellitus and CAD, shall be presumed to have been incurred in service if manifested to a compensable degree within a prescribed period post-service (one year for diabetes mellitus and CAD), even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. With chronic disease shown as such in service (or within the presumptive period under 38 C.F.R. § 3.307) to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributed to intercurrent causes. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is questioned. When the fact of chronicity in service is not adequately supported, then the showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). The United States Court of Appeals for the Federal Circuit has clarified that the provisions of 38 C.F.R. § 3.303(b) pertaining to the award of service connection based on continuity of symptomatology (in lieu of a medical nexus opinion) apply to chronic diseases as defined in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). As noted, such diseases include diabetes mellitus and CAD. If a veteran was exposed to herbicide agents (to include Agent Orange) during service, certain listed diseases, including type II diabetes mellitus and CAD, are presumptively service-connected. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.309(e). A veteran who “served in the Republic of Vietnam” between January 9, 1962 and May 7, 1975 is presumed to have been exposed during such service to herbicide agents. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). VA has interpreted the applicable regulation to mean that the presumption of service connection applies to those service members who physically set foot in Vietnam. See Haas v. Peake, 544 F.3d 1306, 1308 (Fed. Cir. 2008). However, VA now recognizes that tactical or tactical-like herbicides were used on the fenced-in perimeters of military bases in Thailand. See Veterans Benefits Administration (VBA) C&P Service Bulletin (May 2010). Thus, under certain circumstances, VA has determined that exposure to herbicide agents will be conceded for veterans whose duties placed them at or near the perimeters of Thailand military bases during the Vietnam era (February 28, 1961 to May 7, 1975), allowing for presumptive service connection of the diseases associated with herbicide exposure. See VA Adjudication Procedures Manual (M21-1), pt. IV, subpt. ii, ch. 1, sec. H.5.b. (Mar. 27, 2018). VA based this determination on evidence contained in a declassified Vietnam era Department of Defense document titled “Project CHECO Southeast Asia Report: Base Defense in Thailand.” Specifically, if a veteran served in the Air Force at certain RTAFBs (i.e., U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korat or Don Muang) as an Air Force security policeman, security patrol dog handler, member of the security police squadron, or otherwise near the base perimeter as shown by evidence of daily work duties, performance evaluation reports, or other credible evidence, herbicide exposure is to be conceded on a direct/fact-founds basis. See M21-1, pt. IV, subpt. ii, ch. 1, sec. H.5.b. Herbicide exposure will also be conceded on a direct/fact-founds basis for Army veterans who served on RTAFBs in Thailand if the veteran provides a statement that he was involved in perimeter security duty, and there is additional credible evidence supporting this statement. See id. Additionally, if the veteran served at a U.S. Army Base as a member of a military police unit or with a military police occupational specialty, herbicide exposure is to be conceded on a direct/facts-found basis if the veteran states that his duty placed him at or near the base perimeter. See id. Notwithstanding the presumption, service connection for a disability claimed as due to exposure to herbicide agents may be established by showing that a disorder resulting in disability was in fact causally linked to such exposure. See Brock v. Brown, 10 Vet. App. 155, 162-64 (1997); Combee v. Brown, 34 F.3d 1039, 1044 (Fed. Cir. 1994), citing 38 U.S.C. §§ 1113(b) and 1116 and 38 C.F.R. § 3.303. Service connection may also be established on a secondary basis for disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires competent evidence showing (1) the existence of a current disability, and (2) that the current disability either (a) was caused by or (b) is aggravated by a service-connected disability. See 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439 (1995). In adjudicating a claim for VA benefits, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-6 (1990). Considering the record in light of the above noted legal authority, the Board finds that service connection for CAD and diabetes must be denied. Post-service private and VA treatment rerecords, to include a December 2011 private treatment record from Poudre Valley Medical Group, show that the Veteran has been diagnosed with type II diabetes mellitus and CAD. Hence, for purposes of these claims, the current disability requirement is met. The remaining questions, however, are whether each disability was incurred in service, may be presumed to have been incurred in service, or was otherwise medically related to in-service injury or disease. First, addressing the Veteran’s alleged in-service Agent Orange exposure, the Veteran’s DD Form 214 shows that he served in the Army from September 1967 to July 1969, and that he received the National Defense Service Medal, the Vietnam Campaign Medal, and the Vietnam Service Medal. In addition, his service personnel records show that he had service in Thailand from July 1968 to July 1969, and that his military occupational specialty was wheeled vehicle mechanic. Although the Veteran clearly served during the Vietnam era, there is no indication that he had Vietnam service within the meaning of 38 U.S.C. § 1116(f) and 38 C.F.R. § 3.307(a)(6) (warranting a presumption of herbicides exposure). His service records do not reflect such service. Here, the evidence does not reflect in-country service, nor has the Veteran asserted having served in Vietnam. Rather, as noted above, his sole contention has been that he as exposed to herbicides while serving in Thailand. However, in this case, there simply is no persuasive evidence to support a finding of exposure to herbicide agents, to include Agent Orange, in Thailand. Notably, as a layperson, the Veteran is competent to report on matters observed or within his personal knowledge, and thus is competent to relate his experiences, movements, and occupational duties. See, e.g., Layno v. Brown, 6 Vet. App. 465, 470 (1994), and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993)). Even assuming, without deciding, that such lay assertions might provide some evidence of herbicide exposure in an appropriate case, such is not the case here. Although the Veteran’s service personnel records show that he served in Thailand during the Vietnam era, and the Veteran has asserted that he went to the U-Tapao RTAFB for dinner and to pick up supplies, as well as the Udorn RTAFB to deliver prisoners, the Veteran has not alleged, and his service records do not indicate, that he served in the Air Force, let alone that he was stationed at a RTAFB or even served as a security policeman, security patrol dog handler, member of the security police squadron, or otherwise near the air base perimeter. In addition, as Army personnel, the Veteran has not alleged, and his service records do not indicate, that he was involved in perimeter security duty while serving on a RTAFB. Moreover, the Veteran has not alleged, and his service records do not indicate, that he was a member of a military police unit or had a military police occupational specialty, or that his duty placed him at or near the base perimeter, while serving at the Army base in Sattahip. Furthermore, as noted above, the Veteran’s service personnel records reflect that he served as wheeled vehicle mechanic while in Thailand. Additionally, although the Veteran claimed during the June 2017 Board hearing that he saw a mist in the air whenever he went to the U-Tapao RTAFB, which he now presumes to have been from the spraying of Agent Orange, he also testified that nobody, including himself, knew what it was. Moreover, in this case, further efforts have been expended in attempting to resolve the question of whether the Veteran had actual in-service herbicide exposure, and, collectively, the results of such searches weigh against a finding of actual exposure. In this regard, a February 2008 response from a request submitted though the Personnel Information Exchange System (PIES), indicated no records of exposure to herbicides. In addition, a November 2012 memorandum from the U.S. Army and Joint Service Records Research Center (JSRRC) reflected a formal finding that the Veteran’s exposure to Agent Orange in Thailand could not be confirmed, and any further attempts to prove such was considered futile. The memorandum specifically considered the Veteran’s assertion that he was exposed to Agent Orange while serving in Thailand, noting his statements that he was based out of Sattahip, that he took prisoners to the Udorn RTAFB at least four times, that he ate dinner weekly and retrieved supplies at the U-Tapao RTAFB, and that he travelled throughout the region on various assignments. As, on these facts, neither presumed nor actual in-service exposure to herbicides, to include Agent Orange, is warranted or shown, the precise dates of the Veteran’s service in Thailand is not dispositive of the question of his exposure to herbicides, the merits of the claims. Accordingly, the Board has, like the RO, considered the claims for service connection for diabetes and CAD under other theories of entitlement. The Board also finds, however, that no other legal theory provides a basis for awards of service connection for these disabilities at issue. Here, the Veteran’s STRs reflect no complaints, findings, or diagnoses pertinent to diabetes mellitus or CAD. Also, no abnormalities with respect to such conditions were noted in the July 1969 service separation report of medical history or examination report. Moreover, the Veteran has not contended that his diabetes or CAD was present during service. In fact, during the June 2017 Board hearing, the Veteran’s representative stated that the Veteran’s diabetes symptoms began four years ago, and that his heart problems began about 10 to 11 years ago. Later during that hearing, the Veteran testified that his diabetes symptoms instead began 40 years ago, which is still over seven years after the Veteran separated from service. Significantly, the Veteran concurrently confirmed that such symptoms began after service. Moreover, the post-service clinical evidence documents the first clinical diagnosis of CAD in August 2008. See August 2008 Poudre Valley Medical Group Treatment Record. With regard to diabetes, while an April 2007 private treatment record from Poudre Valley Medical Group is the first clinical evidence of a diagnosis of diabetes, subsequent records from Poudre Valley Medical Group indicate that the Veteran was first diagnosed with diabetes in 2004. The Veteran also testified as such during the June 2017 Board hearing. Notwithstanding, a June 2010 VA treatment record notes that the Veteran reported that he might have first been diagnosed with diabetes in 2001, but that the exact date was unknown, and subsequent VA treatment records note that the Veteran reported being first diagnosed with diabetes in 1995. In any case, and despite the inconsistency of the Veteran’s reports, all the above-mentioned diagnoses are clearly well beyond the one-year post-discharge period for establishing service connection for diabetes or CAD on a presumptive basis. See 38 C.F.R. §§ 3.307. 3.309. Further, the lack of any evidence or assertions of symptoms during service which have continued to the present day preponderates against awarding service connection on the basis of chronicity and continuity of symptomatology. See 38 C.F.R. § 3.303(b). Finally, there is no medical evidence or opinion whatsoever even suggesting that there exists a medical nexus between current diabetes or CAD and service, and, on these facts, further medical development of these claims to obtain any such opinions is not required. Generally, VA will provide a medical examination or obtain a medical opinion if the evidence indicates the existence of a current disability or persistent or recurrent symptoms of a disability that may be associated with an event, injury, or disease in service, but the record does not contain sufficient medical evidence to decide the claim. 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Here, while diabetes and CAD during the Veteran’s lifetime has been demonstrated, there is no persuasive evidence to indicate that either disability may be associated with an event, injury, or disease in service. As previously discussed, the Veteran himself does not contend that he experienced any symptoms related to these disabilities during service or for many years thereafter. Additionally, there is no medical or other persuasive evidence which suggests that the Veteran’s diabetes or CAD is related to his service. Moreover, in the absence of evidence of an in-service disease or injury—to include presumed or actual herbicide exposure—a remand of either claim to obtain opinions as to the etiology of the claimed disability would, in essence, place the examining clinician in the role of a fact finder. However, this is the Board’s responsibility. In other words, any medical opinion which provided a nexus between the Veteran’s diabetes or CAD and his service would necessarily be based solely on the Veteran’s current uncorroborated assertions regarding what occurred in service advanced in support of this claim (i.e., that he was exposed to Agent Orange). A medical opinion premised on an unsubstantiated account of a claimant has no probative value. See, e.g., Reonal v. Brown, 5 Vet. App. 458, 461 (1993); Swann v. Brown, 5 Vet. App. 229 (1993). Simply stated, obtaining a medical opinion under the circumstances presented here would be a useless act. The duty to assist is not invoked where “no reasonable possibility exists that such assistance would aid in substantiating the claim.” See, e.g., Charles v. Principi, 16 Vet. App. 370, 374-75 (2002); 38 U.S.C. § 5103(a)(2). Therefore, VA has no obligation to obtain any medical opinions commenting upon the etiology of the Veteran’s diabetes and CAD. See 38 U.S.C. § 5103A(d); 3.159(c)(4); McLendon, 20 Vet. App. at 83. Furthermore, as for any direct assertions by the Veteran and his representative that there exists a medical relationship between the Veteran’s current diabetes or CAD and service, the Board finds that no such assertions provide persuasive evidence in support of these claims. The matter of the medical etiology of these disabilities is one within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). Although lay persons are competent to provide opinions on some medical issues (see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011)), here, the matters of the etiology of the Veteran’s diabetes and CAD are complex medical matters that fall outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377, n. 4 (Fed. Cir. 2007) (providing that lay persons are not competent to diagnose cancer). As the Veteran and his representative are not shown to be other than laypersons without appropriate training and expertise, neither is competent to render a probative (i.e., persuasive) opinion on the complex medical matters upon which these claims turn. Id. Hence, in this case, lay assertions of medical nexus have no probative value. For all the forgoing reasons, the claims for service connection for diabetes and CAD must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the doubt doctrine; however, as no competent, probative evidence supports required elements of the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, supra. With respect to the secondary service connection claims for right hand neuropathy, left hand neuropathy, right foot neuropathy, and left foot neuropathy, as service connection for diabetes mellitus is not established, secondary service connection for each of these disabilities must be denied as a matter of law. See 38 C.F.R. § 3.310; Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). JACQUELINE E. MONROE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Rothstein, Associate Counsel