Citation Nr: 18146699 Decision Date: 11/01/18 Archive Date: 10/31/18 DOCKET NO. 11-05 749 DATE: November 1, 2018 ORDER Entitlement to service connection for a back disability due to disc bulges and herniation with degenerative problems, claimed as herniated discs (evaluated under DC 5237), is denied. Entitlement to service connection for a neck condition due to neck bulging (also claimed as cervical area pain and disc bulging), is denied. Entitlement to service connection for a bilateral hip condition due to bulging discs and herniation with degeneration problems, is denied. Entitlement to service connection for a disorder manifested by bilateral knee pain is denied. Entitlement to service connection for a disorder manifested by bilateral ankle pain is denied. Entitlement to service connection for peripheral neuropathy, left upper extremity, is denied. Entitlement to service connection for peripheral neuropathy, right upper extremity, is denied. Entitlement to service connection for peripheral neuropathy, left lower extremity, is denied. Entitlement to service connection for peripheral neuropathy, right lower extremity, is denied. Entitlement to service connection for radiculopathy, left upper extremity, is denied. Entitlement to service connection for radiculopathy, right upper extremity, is denied. Entitlement to service connection for radiculopathy, left lower extremity, is denied Entitlement to service connection for radiculopathy, right lower extremity, is denied. Entitlement to service connection for a nervous disorder, to include loss of memory and concentration problems, is denied. REMANDED Entitlement to service connection for basal cell carcinoma (also claimed as skin cancer), to include as caused by exposure to an herbicide agent, is remanded. Entitlement to service connection for removal of lesions due to basal cell carcinoma with scar is remanded. FINDINGS OF FACT 1. The Veteran served in the Republic of Vietnam during the Vietnam era. 2. The Veteran’s degenerative arthritis of the lumbar spine and intervertebral disc syndrome did not manifest during service or within one year following service and are not attributable to service. 3. The Veteran’s bulging discs of the cervical spine and degenerative disc disease of the cervical spine did not manifest during service or within one year following service and are not attributable to service. 4. The Veteran’s bilateral hip strain did not manifest during service, is not attributable to service, and is not caused or permanently worsened by a service-connected disease or injury. 5. The Veteran’s bilateral knee strain did not manifest during service, is not attributable to service, and is not caused or permanently worsened by a service-connected disease or injury. 6. The Veteran’s lateral collateral ligament strain of the bilateral ankles did not manifest during service, is not attributable to service, and is not caused or permanently worsened by a service-connected disease or injury. 7. The Veteran’s peripheral neuropathy, left upper extremity, did not manifest during service, is not attributable to service, and is not caused or permanently worsened by a service-connected disease or injury. An organic disease of the nervous system was not manifested in service or within one year following service. 8. The Veteran’s peripheral neuropathy, right upper extremity, did not manifest during service, is not attributable to service, and is not caused or permanently worsened by a service-connected disease or injury. An organic disease of the nervous system was not manifested in service or within one year following service. 9. The Veteran’s peripheral neuropathy, left lower extremity, did not manifest during service, is not attributable to service, and is not caused or permanently worsened by a service-connected disease or injury. An organic disease of the nervous system was not manifested in service or within one year following service. 10. The Veteran’s peripheral neuropathy, right lower extremity, did not manifest during service, is not attributable to service, and is not caused or permanently worsened by a service-connected disease or injury. An organic disease of the nervous system was not manifested in service or within one year following service. 11. The Veteran’s radiculopathy, left upper extremity, did not manifest during service, is not attributable to service, and is not caused or permanently worsened by a service-connected disease or injury. An organic disease of the nervous system was not manifested in service or within one year following service. 12. The Veteran’s radiculopathy, right upper extremity, did not manifest during service, is not attributable to service, and is not caused or permanently worsened by a service-connected disease or injury. An organic disease of the nervous system was not manifested in service or within one year following service. 13. The Veteran’s radiculopathy, left lower extremity, did not manifest during service, is not attributable to service, and is not caused or permanently worsened by a service-connected disease or injury. An organic disease of the nervous system was not manifested in service or within one year following service. 14. The Veteran’s radiculopathy, right lower extremity, did not manifest during service, is not attributable to service, and is not caused or permanently worsened by a service-connected disease or injury. An organic disease of the nervous system was not manifested in service or within one year following service. 15. The Veteran does not have an acquired psychiatric disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for lumbar degenerative arthritis of the spine and intervertebral disc syndrome have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for bulging discs of the cervical spine and degenerative disc disease of the cervical spine have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. The criteria for entitlement to service connection for bilateral hip strain have not been met. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.310. 4. The criteria for entitlement to service connection for bilateral knee strain have not been met. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.310. 5. The criteria for entitlement to service connection for lateral collateral ligament strain of the bilateral ankles have not been met. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.310. 6. The criteria for entitlement to service connection for peripheral neuropathy, left upper extremity, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5103, 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310. 7. The criteria for entitlement to service connection for peripheral neuropathy, right upper extremity, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5103, 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310. 8. The criteria for entitlement to service connection for peripheral neuropathy, left lower extremity, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5103, 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310. 9. The criteria for entitlement to service connection for peripheral neuropathy, right lower extremity, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5103, 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310. 10. The criteria for entitlement to service connection for radiculopathy, left upper extremity, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5103, 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310. 11. The criteria for entitlement to service connection for radiculopathy, right upper extremity, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5103, 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310. 12. The criteria for entitlement to service connection for radiculopathy, left lower extremity, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5103, 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310. 13. The criteria for entitlement to service connection for radiculopathy, right lower extremity, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5103, 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310. 14. The criteria for entitlement to service connection for a nervous disorder, to include loss of memory and concentration problems, have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 5103, 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1964 to March 1966. This matter is before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of January 2010 and October 2010. It was remanded by the Board in October 2017. Service Connection Service connection will be granted for a current disability that 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). Generally, service connection requires a present disability, an in-service incurrence or aggravation of a disease or injury, and a nexus 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). Service connection may be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be granted on a secondary basis for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service-connected. 38 C.F.R. § 3.310(b). Secondary service connection generally requires a current disability, a service-connected disability, a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509 (1998). For a veteran who served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for certain chronic diseases if the chronic disease is shown as such during service or within one year of discharge from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.303(b), 3.307, 3.309. When the fact of chronicity in service is not adequately supported, a continuity of symptomatology since service is an alternative means of establishing service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). The claimant will be given the benefit of the doubt as to any issue material to the determination of a matter when there is an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 1. Entitlement to service connection for back disability due to disc bulges and herniation with degenerative problems, claimed as herniated discs [evaluated under DC 5237]. 2. Entitlement to service connection for neck condition due to neck bulging (also claimed as cervical area pain and disc bulging). The Veteran reports that he injured his back during service from a fall from a truck and from moving heavy equipment, sacks of cement, ammunition, and other material. See Veteran’s filing of October 2018. The service treatment records do not reference back or neck symptoms. The March 1966 separation examination report revealed clinical evaluation of the Veteran was normal with respect to “spine, other musculoskeletal.” The Veteran reported no back or neck symptoms at separation and expressly denied bone, joint, or other deformity, as well as arthritis or rheumatism. A VA examination report of January 1971 included a finding of a normal musculoskeletal system. A February 2010 letter from Dr. N. O. V., references the Veteran’s report of injuring his back from falling from a truck and lifting heavy material during service. The doctor opined that the Veteran’s lumbar spine and cervical spine disabilities are due to the in-service injuries described by the Veteran. No rationale was offered other than, implicitly, the Veteran’s reported history. The Veteran underwent VA examinations of his back and neck (cervical spine) in December 2017. The examination report references a 2006 diagnosis of degenerative arthritis of the spine and a 2017 diagnosis of intervertebral disc syndrome (IVDS). An August 2013 MRI of the cervical spine was interpreted as revealing central bulging discs at C3-C4 through C5-C6 and degenerative disc disease of the cervical spine. Thus, the Veteran has current back and neck disabilities. The VA examiner offered negative nexus opinion as to the back and neck on the grounds that: the service treatment records contain no complaints, treatment, report, or diagnosis of any back or neck injury or pain; and bulging discs and lumbar spondylosis are shown by imaging records of February 2006, 40 years after the Veteran’s service separation. Neck symptoms were found to have had their onset in the “2000’s.” The examiner specifically noted that consideration was given to the Veteran’s report of back injury during service caused by heavy lifting. The VA examiner also noted the February 2010 opinion of Dr. N. O. V. indicating that the Veteran’s back and neck disabilities are related to active duty service, but the opinion was discounted on the basis that no objective evidence of back or neck injury was found in the service treatment records and that the Veteran had had normal exams after active duty service. The Veteran believes that his back and neck disabilities had their onset in service, and he is competent to report his experienced symptoms. 38 C.F.R. § 3.159(a); Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, the Board does not find the Veteran to be credible in that he has not been consistent in his report of symptoms. See Caluza v. Brown, 7 Vet. App. 498, 511-12 (1995). He made no back or neck complaints to clinicians when he was found to have a normal spine at service separation in 1966 and upon VA examination in 1971. Although lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran’s lay statements. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Here the Board finds the lack of any indication of back or neck symptoms during service and for years following service to weigh against the Veteran’s assertion of an in-service onset. The Veteran, as a layperson, is not competent to diagnose a disability such as arthritis or IVDS or to offer a nexus opinion. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). The VA examiner, who by training is competent to offer an opinion as to a nexus between disability and service, concluded upon consideration of the Veteran’s entire history that the current back and neck disabilities are likely not related to his service. The opinion of the VA examiner, being based upon a thorough examination of the Veteran and an analysis of the relevant history, is given considerable weight in this case. See Bloom v. West, 12 Vet. App. 185, 187 (1999). Evidence favorable to the Veteran is the February 2010 record of Dr. N. O. V. The Board assigns less weight to the doctor’s opinion than to that of the VA examiner, because the former is based entirely on the Veteran’s reported history, and the Board has found the Veteran not to be credible. See Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005). Furthermore, unlike the VA examiner, the private opinion gives no indication that consideration was given to the Veteran’s normal spine at service separation in 1966 and later in 1971 and the fact that the Veteran then reported no relevant symptoms. Service connection cannot be presumed for the chronic disease of arthritis in this case, because arthritis did not manifest during service or within one year of service separation. Nor were there credible in-service symptoms for which the fact of chronicity may be legitimately questioned and upon which a continuity-of-symptomatology theory of service connection might be developed. 38 C.F.R. § 3.303(b). The benefit of the doubt doctrine is inapplicable, because the preponderance of the evidence is against the claim. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 3. Entitlement to service connection for hips condition due to bulging discs and herniation with degeneration problem. 4. Entitlement to service connection for bilateral knee pain. 5. Entitlement to service connection for bilateral ankle pain. The Veteran seeks service connection for disabilities of the hips, knees, and ankles. The service treatment records note no relevant symptoms, and the Veteran had a normal separation examination in March 1966. He reported no hip, knee, or ankle symptoms at that time and specifically denied having, or having had, a trick or locked knee, deformity of a bone or joint, arthritis or rheumatism, or foot trouble. The Veteran underwent VA examinations of his hips, knees, and ankles in December 2017. Bilateral hip strain, lateral collateral ligament strain of the bilateral ankles, and bilateral knee strain were diagnosed. The VA examiner placed the onset of the hip and ankle disabilities in the “2000’s.” The onset of the knee disability was dated to 2014. As to all three bilateral disabilities, the nexus opinion was negative on the grounds that the service treatment records are completely silent for any complaints, treatments, diagnoses, or other evidence of hip, knee, or ankle pain or conditions. The examiner specifically noted that consideration was given to the Veteran’s report of injury to the hips, knees, and ankles caused by jumping from trucks and ships during service. With respect to possible secondary service connection, the VA examiner noted that, although the Veteran and Dr. N. O. V. associate the Veteran’s disabilities of the hips, knees, and ankles with his back and neck disabilities, the latter disabilities have been determined not to be related to a disease or injury during service. No medical opinion of record associates the Veteran’s disabilities of the hips, knees, or ankles with service. A February 2010 letter of Dr. N. O. V. offers the conclusory opinion that the Veteran’s disabilities of the hips, knees, and ankles are a consequence of his neck and back disabilities. No rationale is given. As the Board has determined that the Veteran is not entitled to service connection for the latter disabilities, the second element of Wallin is not met, and service connection on a secondary basis is not warranted. The Veteran, as a layperson, is competent to report his experienced symptoms. 38 C.F.R. § 3.159(a); Layno v. Brown, 6 Vet. App. 465, 470 (1994). He is not competent, however, to diagnose hip, knee, or ankle strain or to offer a nexus opinion. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). The VA examiner, who by training is competent to offer an opinion as to a nexus between such disability and service, concluded upon consideration of the Veteran’s entire history that the current disabilities are likely not related to his service. The opinion of the VA examiner, being based upon a thorough examination of the Veteran and an analysis of the relevant history, is given considerable weight in this case. See Bloom v. West, 12 Vet. App. 185, 187 (1999). To the extent that the Veteran can competently report recurrent symptoms since service, the Board does not find the Veteran to be credible in that he has not been consistent in his reporting. See Caluza v. Brown, 7 Vet. App. 498, 511-12 (1995). He made no hip, knee, or ankle complaint to clinicians when he was found to have a normal musculoskeletal system at service separation and in 1971. Although lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran’s lay statements. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Here the Board finds the lack of any indication of hip, knee, or ankle symptoms during service and for years following service to weigh against the Veteran’s assertion of an in-service onset. In this case, the Board accords more probative weight to the negative nexus opinion of the VA examiner than to the February 2010 record of Dr. N. O. V., because the VA examiner provided a rationale that reflected full consideration of the Veteran’s medical history. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The December 2017 VA examiner considered the February 2010 letter of Dr. N. O. V. but discounted it on the basis that she had not considered the lack of any hip, knee, or ankle injury during service and at separation. The benefit of the doubt doctrine is inapplicable, because the preponderance of the evidence is against the claim. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 6. Entitlement to service connection for peripheral neuropathy, left upper extremity. 7. Entitlement to service connection for peripheral neuropathy, right upper extremity. 8. Entitlement to service connection for peripheral neuropathy, left lower extremity. 9. Entitlement to service connection for peripheral neuropathy, right lower extremity. 10. Entitlement to service connection for radiculopathy, left upper extremity. 11. Entitlement to service connection for radiculopathy, right upper extremity. 12. Entitlement to service connection for radiculopathy, left lower extremity. 13. Entitlement to service connection for radiculopathy, right lower extremity. The Veteran underwent VA examinations for his back and neck in December 2017. It was determined that he has radiculopathy of the right and left upper extremities and right and left lower extremities, which involves nerve roots of the sacral, lumbar, and cervical spine. No evidence suggests, and the Veteran does not argue, that his peripheral neuropathy and radiculopathy were directly caused by a disease or injury during service. The Veteran argues for secondary service connection on the basis that his neuropathy and radiculopathy are caused or aggravated by other disabilities for which service connection is sought, namely for disabilities of the back, neck, hips, knees, and ankles. A February 2010 letter of Dr. N. O. V. states her opinion that the Veteran’s neuropathy and radiculopathy are caused by his disabilities of the back, neck, hips, knees, and ankles. No rationale is offered. The December 2017 VA examiner offered a negative opinion as to possible secondary service connection on the grounds that the Veteran’s back, neck, hip, knee, and ankle disabilities are not related to an injury or disease in service. The positive opinion of Dr. N. O. V. was considered by the examiner. The VA examiner determined that the Veteran’s bilateral upper and lower neurological symptoms are caused by disabilities of the back and neck. The Board has determined that the Veteran is not entitled to service connection for those disabilities, nor for those of the hips, knees, and ankles. Therefore, the second element of Wallin is not met, and service connection on a secondary basis is not warranted. Early-onset peripheral neuropathy is listed among the diseases that may be presumed to be related to exposure to herbicides, absent affirmative evidence to the contrary. 38 C.F.R. § 3.309(e). Although the Veteran served in the Republic of Vietnam and is presumed, pursuant to 38 U.S.C. § 1116, to have been exposed to an herbicide agent, all the evidence associates the Veteran’s peripheral neuropathy with his back and neck injuries. No evidence suggests that he has early onset peripheral neuropathy. Therefore, service connection based on herbicide exposure is not warranted. Nor may service connection by presumed for a listed chronic disease (organic disease of the nervous system), as the Veteran’s medical history does not indicate a manifestation of peripheral neuropathy or radiculopathy of the upper or lower extremities during service or within one year of separation. The benefit of the doubt doctrine is inapplicable because the preponderance of the evidence is against the claim. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 14. Entitlement to service connection for a nervous disorder, to include loss of memory and concentration problems. The Veteran seeks service connection for a nervous disorder. See filing of October 2009. The claim includes any acquired psychiatric disability indicated by the record. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Veteran alleges current symptoms of nervousness, compulsive movements, insomnia, nightmares, anxiety, depression, eating disorder, panic attacks, memory loss, imbalance, and weight loss. Upon VA examination, he reported variously that his psychiatric symptoms began in 2016, 2012, 1997, and 1966. See VA examination report of December 2017. He maintains that he could not donate blood to his terminally ill mother because of his service-connected hepatitis, and that this inability caused him to become depressed. See Veteran’s filing of October 2018. Service treatment records document no psychiatric symptoms. For the separation examination of March 1966, the Veteran was found to be normal with respect to “psychiatric,” and he reported no such symptoms. On the form, he specifically denied frequent trouble sleeping, nightmares, depression or excessive worry, and nervous trouble of any sort. VA treatment records note anxiety as a problem dating from November 2007. The November 2007 record, upon which the listing of the anxiety problem is based, does not diagnose anxiety as a psychiatric disorder. Rather, it merely indicates that the Veteran complained of “feeling nervous all the time” and that he denied any depression. VA treatment records of 2009 note that the Veteran was prescribed Buspirone for anxiety. There is also a March 2010 assessment of “anxiety/with insomnia started in Trazodone.” Again, there is no psychiatric diagnosis, as opposed to an “assessment.” A February 2010 letter of Dr. N. O. V. indicates that, as a consequence of the Veteran’s restricted activity and social functioning due to his hepatitis, back disability, knee disability, ankle disability, and neck disability, he presents decreased interest and pleasure in most activities, frustration, anxiety, irritability, loss of memory, concentration problems, and fatigue or low energy. Generally, a diagnosis of a mental disorder must conform to the criteria of the Fifth Edition of the Diagnostic and Statistical Manual (DSM-5). 38 C.F.R. § 4.125(a). For claims that were initially certified for appeal to the Board, the Court of Appeals for Veterans Claims (CAVC), or the U.S. Court of Appeals for the Federal Circuit prior to August 4, 2014, the DSM-IV will apply. For all applications for benefits received by VA or pending before the agency of original jurisdiction on or after August 4, 2014, the DSM-5 will apply. 38 C.F.R. § 4.125; 79 Fed. Reg. 45,093, 45,094-096 (Aug. 4, 2014); 80 Fed. Reg. 14,308 (Mar. 19, 2015) (final). Because the Veteran’s claim was certified to Board in April 2016, the DSM-5 applies in this case. The Veteran underwent a VA examination for mental disorders in December 2017. The examiner determined that the Veteran did not meet the full diagnostic criteria for a mental health diagnosis under the DSM-5 or DSM-IV. The examiner acknowledged the Veteran’s report of nervousness, compulsive movements, insomnia, nightmares, anxiety, depression, eating disorder, panic attacks, memory loss, imbalance, and weight loss. However, upon evaluation of mental status and cognitive functioning, the examiner concluded that the Veteran does not have, and has not had, a psychiatric disability. Specifically, his psychomotor activity, appearance, behavior, affect, speech, thought process, thought content, orientation, and attention were normal. Concentration was relatively conserved. Recent and remote memory were conserved. Short memory was found to be deteriorated on the basis that the Veteran did not recall any words that had been previously mentioned in the Mini Mental State Examination (MMSE). The Board may appropriately favor the opinion of one competent medical authority over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). It is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes probative value to a medical opinion. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008). In this case, the Board accords more weight to the opinion of the December 2017 VA examiner than to the February 2010 of Dr. N. O. V. and the VA treatment record of November 2007 referenced above. The VA examiner showed an understanding of the complete record to date and offered a reasonable explanation for the Veteran’s reported symptoms, including those noted by earlier clinicians. The VA opinion is supported by the record and shows knowledge and skill in analyzing the relevant data. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). The VA examiner acknowledged both the VA treatment records showing anxiety and the February 2010 private physician’s statement that attributed the Veteran’s anxiety, memory loss, concentration, and other symptoms to other disabilities, including service-connected hepatitis. The examiner noted that no record, including the prescription of Buspirone to treat anxiety, made a diagnosis based on the DSM criteria. The examiner considered the symptoms noted by Dr. N. O. V. to be the Veteran’s emotional response to physical discomfort and needs rather than symptoms meeting the full diagnostic criteria according to the DSM. Specifically, in the VA examiner’s opinion, the Veteran’s single symptom of feeling nervous in 2007 did not justify the diagnosis of a psychiatric disorder, and none was made in the record. The Board has considered the Veteran’s statements. See appellate briefs of July and October 2017; VA examination report of December 2017. As a layperson, he is competent to report his experienced symptoms. See Layno v. Brown, 6 Vet. App. 465 (1994). VA must decide on a case by case basis whether a particular condition is of the type which may be diagnosed by a layperson. See Kahana v. Shinseki, 24 Vet. App 428 (2011). The Board finds in this case that a layperson lacks the competence to diagnose his or her own psychiatric disorder, including depression. The Veteran is service-connected for hepatitis. See rating decision of April 1971. Secondary service connection is not warranted on the basis of the February 2010 letter of Dr. N. O. V. which noted that the Veteran’s frustration, anxiety, and other symptoms were partly a consequence of his restricted activity and social functioning due to hepatitis. Because the Veteran does not have a psychiatric disability, neither direct nor secondary service connection is possible. Furthermore, because Dr. N. O. V. did not offer a rationale for her positive opinion, it has no probative value. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). To the extent that the opinion as to secondary causation implicitly relies on the Veteran’s reported history, Dr. N. O. V.’s medical opinion may be rejected because the Veteran is not credible. See Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005). As noted above, he has not consistently reported the onset of his symptoms or consistently attributed them to service-connected disability. See Caluza v. Brown, 7 Vet. App. 498, 511-12 (1995), aff’d per curiam, 78 F.3d. 604 (Fed. Cir. 1996). Service connection requires a current disability. See Degmetich v. Brown, 104 F. 3d 1328, 1333 (1997). Here the preponderance of the competent evidence of record is against finding that the Veteran has an acquired psychiatric disorder. The first elements of Shedden and Wallin have not been met. Therefore, the claim must be denied on both a direct basis and a secondary basis, and further discussion of other elements of service connection is unnecessary. REASONS FOR REMAND Entitlement to service connection for basal cell carcinoma (also claimed as skin cancer), to include as caused by exposure to an herbicide agent. Entitlement to service connection for scars resulting from removal of lesions due to basal cell carcinoma The Veteran is currently diagnosed with basal cell carcinoma. See VA examination report of December 2017. He attributes his skin cancer to herbicide exposure during Vietnam service. His DD Form 214 confirms service in Vietnam. He also argues that the disability was caused by prolonged daytime exposure to sunlight while stationed in Vietnam for seven months. See Veteran’s filing of October 2018. A February 2010 letter of Dr. N. O. V. opines that the Veteran’s skin cancer is due to his exposure to herbicides during service. No rationale is offered for the opinion other than that “it is well known that Vietnam veterans [were] exposed to Agent Orange which is associated to multiple conditions among them skin cancer.” The Veteran underwent a VA examination for skin diseases in December 2017. The examiner offered a negative nexus opinion on the grounds that 1) the service treatment records indicate no evidence of basal cell carcinoma during service, and 2) basal cell carcinoma is not one of the conditions for which service connection based on herbicide exposure may be presumed. The examiner also offered the conclusory statement that “there is not enough evidence to support a connection between the condition and service.” The Veteran is presumed to have been exposed to herbicides during service, as the record demonstrates that he served in the Republic of Vietnam during the Vietnam Era. 38 C.F.R. § 3.307(a)(6)(iii). As noted by the VA examiner, skin cancer is not listed as a presumptive disease associated with exposure to herbicides. 38 C.F.R. § 3.309(e). The presumption for diseases associated with herbicide exposure does not preclude a claimant from establishing service connection with proof of actual causation. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Therefore, the Board will remand for a VA opinion as to the likelihood that the Veteran’s basal cell carcinoma is related to his conceded herbicide exposure. Medical opinion is also needed as to the Veteran’s argument that sunlight exposure while in Vietnam caused his basal cell carcinoma. The Veteran’s claim of entitlement to service connection for scars resulting from removal of lesions due to basal cell carcinoma will also be remanded as inextricably intertwined with the service-connection claim relating to basal cell carcinoma. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain all relevant treatment records relating to the remanded issues to the extent possible. All records/responses received must be associated with the electronic claims folder. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his basal cell carcinoma and scar(s) associated with removal of lesions due to basal cell carcinoma. The examiner must opine as to whether the cancer is at least as likely as not related to an in-service injury, event, or disease, to include presumed in-service herbicide exposure, and exposure to sunlight during service. For purposes of the examination, the examiner is to presume that the Veteran is credible in his report of his sunlight exposure from 6:00 AM to 6:00 PM for 7 months during service (see Veteran’s October 2018 statement in claims file). In the examination instructions, inform the examiner that the fact that a legal presumption of service connection has not been established for a particular disorder is not dispositive of the issue of a nexus between current disability and service. In this case, consideration must still be given to the likelihood that the Veteran’s presumed herbicide exposure actually caused his basal cell carcinoma, regardless of whether basal cell carcinoma is listed in VA regulations as a “presumed” herbicide disease. (Continued on the next page)   The examiner should provide a full rationale for all opinions. If the requested opinion cannot be provided without resort to mere speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Steven D. Najarian, Counsel