Citation Nr: 18146871 Decision Date: 11/01/18 Archive Date: 11/01/18 DOCKET NO. 16-05 851 DATE: November 1, 2018 ORDER Entitlement to service connection for fibromyalgia is denied. Entitlement to service connection for sleep apnea is denied. Entitlement to service connection for a gastrointestinal condition is denied. Entitlement to service connection for colon cancer, to include as due to exposure to Agent Orange is denied. Entitlement to service connection for hiatal hernia is denied. Entitlement to service connection for acid reflux is denied. Entitlement to service connection for erectile dysfunction is denied. Entitlement to service connection for prostate cancer, to include as due to exposure to Agent Orange is denied. Entitlement to service connection for a skin disorder is denied. Entitlement to service connection for neuropathy of the right and left upper extremities, to include as due to exposure to Agent Orange is denied. Entitlement to neuropathy for the right and left lower extremities, to include as due to exposure Agent Orange is denied. Entitlement to service connection for an acquired psychiatric disorder is denied. The severance of service connection for coronary artery disease was proper. FINDINGS OF FACT 1. The Veteran did not serve in Vietnam and is not presumed to have been exposed to herbicides while serving in Thailand. 2. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of fibromyalgia. 3. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of prostate cancer. 4. The preponderance of the evidence is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of sleep apnea. 5. The preponderance of the evidence is against finding that the Veteran has a gastrointestinal disorder due to a disease or injury in service, to include a specific in-service event, injury, or disease. 6. The preponderance of the evidence is against finding that the Veteran has colon cancer due to a disease or injury in service, to include a specific in-service event, injury, or disease. 7. The preponderance of the evidence is against finding that the Veteran has a hiatal hernia disorder due to a disease or injury in service, to include a specific in-service event, injury, or disease. 8. The preponderance of the evidence is against finding that the Veteran has acid reflux due to a disease or injury in service, to include a specific in-service event, injury, or disease. 9. The preponderance of the evidence is against finding that the Veteran has erectile dysfunction due to a disease or injury in service, to include a specific in-service event, injury, or disease. 10. The preponderance of the evidence is against finding that the Veteran has prostate cancer due to a disease or injury in service, to include a specific in-service event, injury, or disease. 11. The preponderance of the evidence is against finding that the Veteran has a skin disorder due to a disease or injury in service, to include a specific in-service event, injury, or disease. 12. The preponderance of the evidence is against finding that the Veteran has neuropathy of the right and left upper extremities due to a disease or injury in service, to include a specific in-service event, injury, or disease. 13. The preponderance of the evidence is against finding that the Veteran has neuropathy of the right and left lower extremities due to a disease or injury in service, to include a specific in-service event, injury, or disease. 14. The preponderance of the evidence is against finding that the Veteran has an acquired psychiatric disorder due to a disease or injury in service, to include a specific in-service event, injury, or disease. 15. In an August 2016 rating decision, the RO proposed to sever service connection for ischemic heart disease on the basis of clear and unmistakable error in the grant of service connection for this disease in the July 2012 rating decision. The accompanying notice informed the Veteran of the 60 day period for the submission of evidence, and of the right to request a hearing. 16. A November 2016 rating decision severed service connection for ischemic heart disease, effective February 1, 2017. 17. The award of service connection for ischemic heart disease was clearly and unmistakably erroneous based on the evidence of record. CONCLUSIONS OF LAW 1. The criteria for service connection for fibromyalgia are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 2. The criteria for service connection for prostate cancer are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. 3. The criteria for service connection for sleep apnea are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 4. The criteria for service connection for a gastrointestinal disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 5. The criteria for service connection for colon cancer are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. 6. The criteria for service connection for hiatal hernia are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 7. The criteria for service connection for acid reflux are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 8. The criteria for service connection for erectile dysfunction are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 9. The criteria for service connection for a skin disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 10. The criteria for service connection for neuropathy of the right and left upper extremities are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 11. The criteria for service connection for neuropathy of the right and left lower extremities are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 12. The criteria for service connection for an acquired psychiatric disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 13. The severance of service connection for ischemic heart disease was proper and service connection may not be restored. 38 U.S.C. § 5112; 38 C.F.R. § 3.105 (d). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1966 to April 1968. Regarding the Veteran’s claimed depression, the Board has recharacterized the issue as a claim for an acquired psychiatric disorder, generally. The Veteran cannot be required to know whether the symptoms he is claiming service connection for are related to depression or another psychiatric disability. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Service Connection The Veteran is seeking service connection for multiple disorders that he alleges are due to his military service pursuant to varying theories of entitlement. Service connection may be granted for any disease 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). Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); 38 C.F.R.§ 3.303. The absence of any one element will result in denial of service connection. Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006). The Board notes that the Veteran has also argued that his claimed disorders of fibromyalgia, gastrointestinal disorders, hiatal hernia, erectile dysfunction, sleep apnea, and acid reflux are secondary to his claimed psychiatric disorder. He also claims that his colon cancer, prostate cancer, skin disorder, and neuropathy of the upper and lower bilateral extremities are due to exposure to Agent Orange. The Board is required to consider all theories of entitlement reasonably raised by the record. See Robinson v. Shinseki, 557 F.3d 1355, 1361 (Fed. Cir. 2009) (the Board is required to weigh all theories of entitlement raised either by the claimant or by the evidence). 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. 439, 448 (1995) (en banc). For the reasons discussed below, the Board finds that service connection is not warranted for a psychiatric disorder. As secondary service connection cannot be granted if the disorder upon which the theory is predicated is not service connected, the Board will address the claims on a direct incurrence basis below. Additionally, absent affirmative evidence to the contrary, there is a presumption of exposure to herbicide agents (to include Agent Orange) for all Veterans who served in Vietnam during the Vietnam Era (the period beginning on January 9, 1962, and ending on May 7, 1975). 38 U.S.C. § 1116 (f) and 38 C.F.R. § 3.307 (a)(6). The presumption also applies to Veterans who served in or near the Korean demilitarized zone between April 1, 1968 and May 7, 1975, as well as to Veterans who served in the Air Force on C-123 aircraft known to have sprayed herbicide agents. Id. Other types of service will result in presumed herbicide agent exposure, including service on or near the perimeter of military bases in Thailand during the Vietnam Era, service where herbicide agents were tested and stored outside of Vietnam, and service by Veterans associated with Department of Defense (DoD) projects to test, destroy, or store herbicide agents in the United States. 38 C.F.R. § 3.309(e). VA procedures for verifying exposure to herbicides in Thailand during the Vietnam Era are detailed in the VA Adjudication Manual, M21-1. The claims file contains a memorandum for the record regarding general herbicide exposure in Thailand during the Vietnam Era from the Veterans Benefits Administration (VBA) in Washington, D.C. VBA reviewed several reports, including the Project CHECO Southeast Asia Report: Base Defense in Thailand, in determining whether veterans who served in Thailand were exposed to herbicides. VBA noted that the Department of Defense (DoD) list of sites where tactical herbicides were used, tested, and stored revealed that limited testing of tactical herbicides were only conducted in Thailand from April 2, 1964 through September 8, 1964, near Pranburi, Thailand. The CHECO Report did not report the use of tactical herbicides on allied bases in Thailand, but it indicated sporadic use of non-tactical (commercial) herbicides within fenced perimeters. Thus, the memorandum noted, if a veteran’s MOS or unit was one that regularly had contact with the base perimeter, there was a greater likelihood of exposure to commercial pesticides, including herbicides. The memorandum also noted that there were no records to show that the same tactical herbicides used in Vietnam were used in Thailand. The memorandum further indicated that there is no presumption of “secondary exposure” to herbicide agents based on being near or working on aircraft that flew over Vietnam or handing of equipment that was once used in Vietnam. The majority of troops in Thailand during the Vietnam Era were stationed at the Royal Thai Air Force Bases (RTAFB) of U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korat, and Don Muang. If a Veteran served on one of those air bases between February 28, 1961 and May 7, 1975 as a security policeman, security patrol dog handler, member of a security police squadron, or otherwise served near the air base perimeter, as shown by his MOS, performance evaluations, or other credible evidence, then herbicide exposure should be acknowledged on a facts-found or direct basis. VBA Manual M21-1, IV.ii.1.H.5.b. VA laws and regulations provide that if a Veteran was exposed to Agent Orange during service, certain listed diseases, are presumptively service-connected. 38 U.S.C. § 1116 (a)(1); 38 C.F.R. § 3.309 (e). Here, the Veteran’s personnel file does not show he had qualifying service in Vietnam. However, the Veteran did serve in Thailand for 16 months, from December 1966 to April 1968, which is outside of the time frame in 1964 when herbicides were used in Thailand. Further, the Veteran’s personnel records do not show he was stationed at one the enumerated bases above and there is no indication in his personnel file that his military occupational specialty, noted to be USASTRATCOM (strategic communications), required him to be on or near the perimeters of military bases. Further, aside from the Veteran’s statements that he was exposed to Agent Orange, he has not set forth any arguments that his military occupational specialty would have placed him on or near the perimeter of a base in Thailand during the Vietnam Era. He has argued that his unofficial duties included the spraying of Agent Orange. However, as the Veteran has not offered any additional evidence to corroborate that statement, the Board finds the Veteran’s personnel records more probative as to what his duties while in the military entailed. As there is no evidence of exposure in Thailand, or any other areas overseas where herbicide exposure is presumed, there is no presumption of exposure. See 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309. Further, the evidence does not support that the Veteran has had direct exposure to herbicide agents in service. Additionally, for veterans who served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 38 C.F.R. 3.307 (a), 3.309(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § 3.303 (b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (the theory of continuity of symptomatology can be used only in cases involving those disabilities specified as chronic under 38 C.F.R. 3.309 (a)). The failure to meet the criteria for a presumption does not, however, preclude a Veteran from establishing entitlement to service connection on a different basis. See 38 U.S.C. § 1113 (b); 38 C.F.R. § 3.303 (d) (the availability of service connection on a presumptive basis does not preclude consideration of service connection on a direct basis); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The Veteran could show that his conditions are otherwise related to service on a direct basis. In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board”). The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C. § 7104 (a). Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran’s demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C. § 5107 (b). When a reasonable doubt arises regarding service origin, such doubt will be resolved in the favor of the claimant. Reasonable doubt is doubt which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102. Finally, the Board acknowledges that, to date, the Veteran has not been provided with VA compensation examinations addressing any of his service connection claims aside from the heart disorder and prostate cancer claims. Regulations provide that VA must afford a veteran a medical examination and/or obtain a medical opinion when it is necessary to make a decision on the claim. 38 C.F.R. § 3.159(c)(4). In service-connection claims, such as is the case here, VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) 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, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006). In this case, examinations are not necessary to adjudicate the Veteran’s service-connection claims. As noted in the discussion below, there is no indication of an injury or other incident in service resulting in his current disorders. Therefore, a remand requesting examinations is not required. 38 C.F.R. § 3.159(c)(4); McLendon, supra. 1. Entitlement to service connection for fibromyalgia, sleep apnea, and prostate cancer The question for the Board is whether the Veteran has current disabilities of fibromyalgia, sleep apnea, and prostate cancer that began during service or are at least as likely as not related to an in-service injury, event, or disease. For the reasons discussed below, the Board concludes that the Veteran does not have current diagnoses of any of the above listed disorders and has not had diagnoses at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The Veteran’s available service treatment records do not include any complaints, treatment, or diagnoses pertaining to fibromyalgia or sleep apnea. With respect to the claim for prostate cancer, the Veteran’s April 1968 separation examination includes a notation of an inflamed prostate gland, but no diagnosis was provided. Concerning specifically the claim for prostate cancer, the April 2014 VA examiner evaluated the Veteran and concluded the Veteran does not have a diagnosis of prostate cancer. Further, despite the existence of numerous treatment records associated with the claims file, neither the VA nor private treatment records show that the Veteran ever received treatment, complained of, or was diagnosed with fibromyalgia, sleep apnea, or prostate cancer during the pendency of this appeal. While the Veteran believes he currently suffers from these disorders, he is not competent to provide diagnoses in this case. The issues are medically complex and require specialized medical education pertaining to bodily systems, as well as the ability to interpret complicated diagnostic medical and laboratory testing, in order to render a diagnosis. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. In sum, the Veteran’s claims fail to meet the first prong of service connection, which is the requirement of a current disability. As the preponderance of the evidence is against the Veteran’s claims of entitlement to service connection for fibromyalgia, sleep apnea, and prostate cancer, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107 (b). As such, the claims must be denied. 2. Entitlement to service connection for colon cancer and neuropathy of the right and left upper and lower extremities The Veteran contends that he suffers from colon cancer and neuropathy of the right and left upper and lower extremities that is the result of his military service and, specifically, due to exposure to Agent Orange. However, as discussed above, the Board finds that the evidence of record does not support a finding that the Veteran was exposed to Agent Orange during service. Even if the record clearly demonstrated that the Veteran was exposed to herbicides during service, colon cancer is not a condition presumptively linked to Agent Orange exposure. 38 C.F.R. §§ 3.307 (a)(6), 3.309(e). While early onset peripheral neuropathy is a condition presumptively linked to Agent Orange exposure, the Veteran has not asserted that it is early onset. In fact, as will be discussed below, the evidence suggests the Veteran’s neuropathy of the bilateral upper and lower extremities is attributable to his treatment for colon cancer. As such, the Veteran is asserting a theory for service connection that does not apply to the facts of this case. 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 was diagnosed with colon cancer, (see November 2010 private treatment record) and bilateral upper and lower extremity neuropathy (see June 2010 private treatment record) the preponderance of the evidence weighs against finding that the Veteran’s colon cancer or neuropathy began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). In this respect, the Veteran’s service treatment records are completely silent regarding any complaints, treatment, or diagnoses for colon cancer or neuropathy during service. Additionally, the first indication of treatment for colon cancer was not until 2007, almost 40 years following separation from service. The Court has indicated that the normal medical findings at the time of separation from service, as well as the absence of any medical records of a diagnosis or treatment for many years after service is probative evidence against the claim. See Mense v. Derwinski, 1 Vet. App. 354, 365 (1991) (affirming the Board where it found that veteran failed to account for the lengthy time period after service for which there was no clinical documentation of low back condition); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (a prolonged period without medical complaint can be considered, along with other factors concerning a claimant’s health and medical treatment during and after military service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability). With respect to the Veteran’s neuropathy, a June 2010 private treatment record specifically noted that the neuropathy is due to the chemotherapy used in treating the Veteran’s colon cancer. Thus, there is simply no evidence of record, aside from the Veteran’s unsubstantiated lay statements, that his colon cancer or neuropathy are due to his military service. While the Veteran believes these disorders are related to an in-service injury, event, or disease, he is not competent to provide a nexus opinion in this case, as the issue of causation require knowledge and interpretation of complicated diagnostic medical and laboratory testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Additionally, while the claims folder does show he has sought treatment for his colon cancer and neuropathy, the claims file does not contain any medical records or etiological opinions linking the Veteran’s disorder to his active service. In sum, there is no evidence, medical or otherwise, to support the Veteran’s assertions. Accordingly, service connection for colon cancer and right and left upper and lower extremity neuropathy is not warranted because the Veteran has not satisfied the nexus requirement of attributing these disorders to his active service. See 38 C.F.R. § 3.303. In reaching the above conclusion, the Board has considered the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claims, that doctrine does not apply. 38 U.S.C. § 5107 (b). The claims of entitlement to service connection for colon cancer and right and left upper and lower extremity neuropathy is denied. 3. Entitlement to service connection for a gastrointestinal disorder, hiatal hernia, acid reflux, erectile dysfunction, skin disorder, and an acquired psychiatric disorder The Veteran seeks service connection for a gastrointestinal disorder, hiatal hernia, acid reflux, erectile dysfunction, skin disorder, and an acquired psychiatric disorder that he alleges are the result of his military service. The question for the Board is whether the Veteran has current disabilities that began during service or are at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has current diagnoses of a gastrointestinal disorder, diagnosed as GERD (see October 2013 private treatment record); hiatal hernia (see October 2013 private treatment record); acid reflux (see October 2013 private treatment record); erectile dysfunction (see November 2009 private treatment record); a skin disorder, diagnosed as folliculitis (see October 2013 private treatment record); and, acquired psychiatric disorders, diagnosed as depression, anxiety, and dysthymic disorder (see March 2011 private treatment record and January 2014 VA treatment record), the preponderance of the evidence weighs against finding that the Veteran’s diagnosed disorders began during service or are otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). In this respect, the Veteran’s service treatment records are completely silent regarding any complaints, treatment, or diagnoses for any of the claimed disorders during service. Additionally, the first indication of treatment for any of the disorders was not until 2009, over 40 years following separation from service. The Court has indicated that the normal medical findings at the time of separation from service, as well as the absence of any medical records of a diagnosis or treatment for many years after service is probative evidence against the claim. See Mense v. Derwinski, 1 Vet. App. 354, 365 (1991) (affirming the Board where it found that veteran failed to account for the lengthy time period after service for which there was no clinical documentation of low back condition); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (a prolonged period without medical complaint can be considered, along with other factors concerning a claimant’s health and medical treatment during and after military service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability). Thus, there is simply no evidence of record, aside from the Veteran’s unsubstantiated lay statements, that any of these disorders are due to his military service. While the Veteran believes his disorders are related to an in-service injury, event, or disease, he is not competent to provide a nexus opinion in this case, as the issue of causation in this case requires knowledge and interpretation of complicated diagnostic medical and laboratory testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Additionally, while the claims folder does show he has sought treatment for these disorders throughout the appeals period, the claims file does not contain any medical records or etiological opinions linking the Veteran’s disorders to his active service. In sum, there is no evidence, medical or otherwise, to support the Veteran’s assertions. Accordingly, service connection for these disorders is not warranted because the Veteran has not satisfied the nexus requirement of attributing each disorder to his active service. See 38 C.F.R. § 3.303. In reaching the above conclusion, the Board has considered the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine does not apply. 38 U.S.C. § 5107 (b). The claims of entitlement to service connection for a gastrointestinal disorder, hiatal hernia, acid reflux, erectile dysfunction, a skin disorder, and an acquired psychiatric disorder are denied. Propriety of Severance of Service Connection The Veteran argues that the severance of service connection for coronary artery disease was erroneous and should be restored. Once service connection has been granted, it can be severed only where the evidence establishes that the grant is clearly and unmistakably erroneous (the burden being on the Government), and only where certain procedural safeguards have been met. 38 C.F.R. § 3.105 (d); Stallworth v. Nicholson, 20 Vet. App. 482, 487 (2006); Daniels v. Gober, 10 Vet. App. 474, 478 (1997). Severance of service connection based on any standard less than that set forth in 38 C.F.R. 3.105 (d) is erroneous as a matter of law. Stallworth, 20 Vet. App. at 488; Graves v. Brown, 6 Vet. App. 166, 170 (1994). Clear and unmistakable error is a very specific and rare kind of error. It is the kind of error, of fact or of law, that, when called to the attention of reviewers, compels the conclusion, to which reasonable minds could not differ, that the results would be manifestly different but for the error. See Fugo v. Brown, 6 Vet. App. 40, 43 (1993). Even when the premise of error is accepted, if it is not absolutely clear that a different result would have ensued, the error complained of cannot be considered clear and unmistakable. Fugo v. Brown, 6 Vet. App. 40, 43-44 (1993), citing Russell v. Principi, 3 Vet. App. 310, 313 (1992). To warrant revision of a decision on the ground of clear and unmistakable error in a severance of service connection case, there must have been an error in the adjudication of the appeal that, had it not been made, would have manifestly changed the outcome, i.e., whether, based on the current evidence of record, a grant of service connection would be clearly and unmistakably erroneous. Stallworth, 20 Vet. App. 482. The same standards apply in a determination of clear and unmistakable error in a prior decision and a determination as to whether a decision granting service connection was the product of clear and unmistakable error for the purpose of severing service connection; however, for the latter case, the reviewable evidence is not limited to that which was before the RO at the time of the challenged rating decision. See Daniels, 10 Vet. App. at 480; see also Allen v. Nicholson, 21 Vet. App. 54, 59 (2007). The severance decision focuses not on whether the original decision was clearly erroneous, but on whether the current evidence establishes that service connection is clearly erroneous. Stallworth, 20 Vet. App. at 488. Based upon the evidence of record, the Board finds that the award of service connection for ischemic heart disease was clearly and unmistakably erroneous. In this case, the RO granted service connection for ischemic heart disease in a July 2012 rating decision, with an initial rating of 10 percent and an effective date of December 13, 2011, the Veteran’s date of claim. The RO granted service connection for this disability on a presumptive basis due to the Veteran’s military service, which they concluded showed service in the Republic of Vietnam. As ischemic heart disease is one of the conditions presumptively linked to Agent Orange exposure. 38 C.F.R. §§ 3.307 (a)(6), 3.309(e). The RO issued a rating decision in April 2013, continuing the initially assigned 10 percent rating. The Veteran filed a notice of disagreement to the rating currently assigned. During the pendency of that appeal for an increased rating, the RO proposed to severe service connection in an August 2016 rating decision. In doing so, the RO found that its July 2012 rating decision was clearly and unmistakably in error for establishing entitlement to service connection, and explained that although the Veteran’s DD Form 214 listed “USARV” as his last duty assignment, which was accepted as proof of having served in the Republic of Vietnam during the presumptive period, the remaining personnel records show only service in Thailand not during a period of time when herbicides were used. The Veteran was given 60 days in which to dispute the proposed severance and provide additional evidence, but the Veteran did not do so. In a November 2016 rating decision, service-connection for ischemic heart disease was severed effective February 1, 2017. The Veteran filed a notice of disagreement with the severance. In considering whether the RO’s initial grant of service connection was clearly erroneous, the Board has considered the requirements for the establishment of service connection, as discussed above. At the time of the initial grant of service connection, the evidence of record consisted of the Veteran’s service treatment and personnel records and VA treatment records providing a diagnosis of coronary artery disease. The initial grant of service connection was based solely on the presumptive regulations for exposure to Agent Orange, which includes ischemic heart disease. To date, the Veteran has not set forth any arguments for service connection on an alternative theory of entitlement. As previously discussed, the Veteran is not entitled to the presumption that he was exposed to Agent Orange during his military service (see above). Therefore, as the initial grant for service connection for coronary artery disease was based solely on his presumed exposure to Agent Orange, it was clearly and unmistakably erroneous and severance was proper. The claim is denied. N. RIPPEL Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Berry, Counsel