Citation Nr: 18150229 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 16-13 938 DATE: November 14, 2018 ORDER The petition to reopen the claim for service connection for a right knee disorder is denied. Entitlement to service connection for a cervical spine condition is denied. Entitlement to service connection for a back condition is denied. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for tinnitus is denied. Entitlement to service connection for an acquired psychiatric disorder, to include anxiety and depressive disorder is denied. Entitlement to service connection for a stomach condition is denied. Entitlement to service connection for a right shoulder condition is denied. Entitlement to service connection for a left shoulder condition is denied. Entitlement to service connection for a right wrist condition is denied. Entitlement to service connection for tendonitis, left wrist is denied. Entitlement to service connection for chronic fatigue is denied. Entitlement to service connection for sleep apnea is denied. Entitlement to an effective date prior to December 2, 2013, for the award of service connection for degenerative joint disease, left knee is denied. REMANDED Entitlement to a rating in excess of 20 percent for degenerative joint disease, left knee is remanded. FINDINGS OF FACT 1. In an unappealed August 2009 rating decision, the RO denied the Veteran’s claim of entitlement to service connection for a right knee disorder. 2. New and material evidence has not been received since the August 2009 rating decision regarding the claim for a right knee disorder. 3. The Veteran’s cervical spine disorder was not incurred in, or caused by, his military service. 4. The Veteran’s back disorder was not incurred in, or caused by, his military service. 5. The Veteran does not have a current bilateral hearing loss disability for VA compensation purposes. 6. The Veteran’s tinnitus is not linked to disease or injury incurred or aggravated in active service. 7. The Veteran’s acquired psychiatric disorder was not incurred in, or caused by, his military service. 8. The Veteran’s stomach condition was not incurred in, or caused by, his military service. 9. The Veteran does not have a current right shoulder disability linked to disease or injury incurred or aggravated in active service. 10. The Veteran does not have a current left shoulder disability linked to disease or injury incurred or aggravated in active service. 11. The Veteran does not have a current right wrist disability linked to disease or injury incurred or aggravated in active service. 12. The Veteran does not have a current left wrist disability linked to disease or injury incurred or aggravated in active service. 13. The Veteran does not have a current diagnosis of chronic fatigue. 14. The Veteran does not have a current diagnosis of a sleep disorder. 15. On May 12, 2014, the Veteran added a claim of service connection for a left knee disorder to his pending claim of entitlement to service connection filed December 2, 2013. 16. No communication received before December 2, 2013 can be reasonably construed as a claim for service connection for a left knee disorder. CONCLUSIONS OF LAW 1. The August 2009 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. 2. The criteria for reopening the claim for service connection for a right knee disorder have not been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for entitlement to service connection for a cervical spine condition have not been met. 38 U.S.C. §§ 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for entitlement to service connection for a back condition have not been met. 38 U.S.C. §§ 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385. 6. The criteria for entitlement to service connection for tinnitus have not been met. 38 U.S.C. §§ 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 7. The criteria for entitlement to service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 8. The criteria for entitlement to service connection for a stomach condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 9. The criteria for entitlement to service connection for a right shoulder condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 10. The criteria for entitlement to service connection for a left shoulder condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 11. The criteria for entitlement to service connection for a right wrist condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 12. The criteria for entitlement to service connection for a left wrist condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 13. The criteria for entitlement to service connection for chronic fatigue have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 14. The criteria for entitlement to service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 15. The criteria for an effective date earlier than December 2, 2013, for the grant of service connection for left knee degenerative joint disease have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1980 to September 1982. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. A November 2014 rating decision granted service connection for a left knee disorder, rating it as 20 percent disabling; denied entitlement to service connection for a cervical neck condition, back condition, left wrist tendonitis, tinnitus; and denied reopening the Veteran’s claim for service connection a right knee condition. An August 2015 rating decision denied entitlement to service connection for chronic fatigue, sleep apnea, a stomach condition, depression, anxiety, right wrist disorder, right shoulder disorder, left shoulder disorder, and bilateral hearing loss. Concerning the Veteran’s claim for service connection for anxiety and depression, the Board notes that the record reflects various diagnostic impressions. Because the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant’s description of the claim and reported syndromes and all other information of record, the Board finds that it is more appropriate to characterize his mental health claims broadly, as a single claim of entitlement to service connection for an acquired psychiatric disorder. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). New and Material Evidence In general, VA rating decisions that are not timely appealed are final. See 38 U.S.C. § 7105; 38 C.F.R. § 20.302. A finally disallowed claim may be reopened when new and material evidence is presented or secured with respect to that claim. 38 U.S.C. § 5108. New evidence is defined as evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. Such evidence must be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). For the purpose of determining whether new and material evidence has been submitted, the credibility of the evidence is presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The new evidence need not pertain to every unestablished element of a claim to warrant reopening. Rather, VA must consider whether the new evidence, in concert with evidence previously of record, would trigger VA’s duty to provide an examination or opinion under 38 C.F.R. § 3.159(c) were the claim reopened. Shade v. Shinseki, 24 Vet. App. 110, 118 (2010). New and material evidence received within the one-year appeal period of an RO decision prevents that decision from becoming final. 38 C.F.R. § 3.156(b); Bond v. Shinseki, 659 F.3d 1362, 1367-68 (Fed. Cir. 2011); Buie v. Shinseki, 24 Vet. App. 242, 251-52 (2010). Right Knee An August 2009 rating decision denied the Veteran’s claim for service connection for a right knee disorder. The Veteran was notified of the August 2009 rating decision and of his appellate rights by letter dated August 11, 2009. The Veteran did not appeal. As such, the August 2009 rating decision became final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.160(d); 20.302. Since the August 2009 rating decision was issued, additional post-service medical records have been added to the file. These records are new to the file. However, they are not material as they do not speak to the issue of whether the Veteran’s knee disorder may be related to any incident of service. Evidence of a right knee disorder was of record at the time of, and considered in, the August 2009 rating decision. Thus, the new evidence is merely cumulative of the evidence considered in the August 2009 rating decision, and does not relate to an unestablished fact necessary to substantiate the claim. Accordingly, new and material evidence has not been submitted to reopen the claim for a right knee disability. See 38 C.F.R. § 3.156(a). Service Connection Service connection will generally be awarded when a veteran has a 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). Establishing service connection generally requires medical or competent lay evidence of (1) a current disability; (2) incurrence or aggravation of a disease or injury in active service; and (3) a link or nexus between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). For the chronic diseases listed in 38 C.F.R. § 3.309 (a), including tinnitus as an organic disease of the nervous system and arthritis, service connection may alternatively be established with evidence of chronicity of the disease during service or during a presumptive period following service separation, or by showing a continuity of symptoms after service. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015). To establish service connection based on a continuity of symptoms, there must be evidence demonstrating (1) that a condition was “noted” during service; (2) post-service continuity of the same symptoms; and (3) a nexus between the present disability and the continuity of symptoms. Fountain, 27 Vet. at 263-64. When chronicity or continuity of symptoms is shown, direct evidence of a medical nexus or causal link to service is not required to establish service connection. Walker, 708 F.3d at 1338-39. Rather, subsequent manifestations of the same chronic disease at any later date, no matter how remote in time from the period of service, will be service connected unless clearly attributable to causes unrelated to service (“intercurrent” causes). 38 C.F.R. § 3.303(b). In addition, where a veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, there is a presumption of service connection for tinnitus and arthritis if the disease manifested to a degree of 10 percent or more within one year from the date of separation from service, even if there is no evidence of the disease during the service period itself. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). This presumption may be rebutted by affirmative evidence to the contrary. 38 C.F.R. § 3.307 (d). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (providing, in pertinent part, that reasonable doubt will be resolved in favor of the claimant). When the evidence supports the claim or is in relative equipoise, the claim will be granted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); see also Wise v. Shinseki, 26 Vet. App. 517, 532 (2014). If the preponderance of the evidence weighs against the claim, it must be denied. See id.; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 1. Cervical Spine Condition The preponderance of the evidence weighs against service connection for a cervical spine disability. A November 2013 VA x-ray study shows a diagnosis of degenerative disc disease of the cervical spine. Accordingly, a current disability is established. See Holton, 557 F.3d at 1366. The service treatment records (STRs) show that the Veteran was treated for a neck complaint in October 1980. They do not show further neck complaints or treatment. His September 1982 service separation physical noted a normal evaluation of his spine and neck. VA treatment records dated in October 2008 constitute the earliest post-service documentation of a neck condition. These show that the Veteran complained of neck and left shoulder pain after lifting a heavy object. He stated that he did a lot of heavy lifting in his job. He was picking up a mold and felt pain in the back and left side of his neck, radiating to his shoulder. He stated that he has had chronic problems with his neck in the past. He was diagnosed with a cervical strain with spasm. A November 2013 VA x-ray study showed disc degeneration in the Veteran’s cervical spine. A VA examination was performed in December 2016. The examiner opined that it was less likely than not that the Veteran’s degenerative disc disease of the cervical spine was incurred in service or caused by an in-service injury, illness, or event. The examiner explained that, apart from the October 1980 note, the Veteran’s STRs were silent for any other neck complaints during service, and his cervical spine diagnosis was made 30 years following his separation from service. The VA medical opinion is probative, as it was rendered by a medical professional based on review of the record and examination of the Veteran, and supported by an explanation. It weighs against a nexus between the Veteran’s cervical spine disability and his active service. The fact that the evidence does not show neck problems during service apart from the one-time treatment in October 1980, that the Veteran’s neck and spine were evaluated as normal at separation, and that the evidence does not show neck problems for many years following service separation further weighs against a relationship to service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that a proper consideration for the trier of fact is the amount of time that has elapsed since military service, and that evidence of a prolonged period without medical complaint can be considered, along with other factors concerning the Veteran’s health and medical treatment during and after military service, as evidence of whether a condition was incurred in service). Accordingly, the preponderance of the evidence weighs against a link between the Veteran’s cervical spine disability and his active service. Consequently, the criteria for service connection are not satisfied. See 38 C.F.R. § 3.303(a); Holton, 557 F.3d at 1366. To the extent the Veteran has arthritis of the cervical spine, the evidence does not show that it was noted in service, or a chronicity at the time, and does not show a continuity of symptomology following service separation. See 38 C.F.R. § 3.303(b). Accordingly, service connection may not be established for arthritis of the cervical spine based on chronicity or continuity of symptoms. See id. The evidence does not show that arthritis of the cervical spine manifested to a compensable degree within one year of service. Therefore, service connection cannot be granted on a presumptive basis. See 38 C.F.R. §§ 3.303(b), 3.307(a), 3.309(a). Because the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. 5107; 38 C.F.R. § 3.102. 2. Back Condition The preponderance of the evidence weighs against service connection for a back condition. The VA treatment records show diagnose of lumbar spinal stenosis, spondylosis, and degenerative changes. See November 2013 Mental Health Note; December 2013 Consultation Report; August 2014 Primary Care Note. A current disability is established. The STRs do not show complaints or treatment regarding the Veteran’s lumbar spine or back. The September 1982 service separation examination reflects a normal spine evaluation. Moreover, the Veteran has not stated, nor does the record otherwise show, that any event, disease or injury occurred during his active service relevant to the development of a back condition. Therefore, the evidence does not establish an in-service incident. See Davidson, 581 F.3d 1313. In the absence of incurrence of a disease or injury during active service, service connection cannot be established. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(a). As arthritis of the thoracolumbar spine was not noted in service, service connection may not be established based on chronicity during service or a continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). The evidence does not show that the Veteran’s arthritis of the lumbar spine manifested to a compensable degree within one year of service. Therefore, service connection cannot be granted on a presumptive basis. See 38 C.F.R. §§ 3.303(b), 3.307(a), 3.309(a). Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 3. Bilateral Hearing Loss The preponderance of the evidence weighs against service connection for bilateral hearing loss. The Veteran does not have a current hearing loss disability in either ear. For VA compensation purposes, hearing loss is defined as a disability when the auditory puretone threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory puretone thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2017). The threshold for normal hearing is from 0 to 20 decibels; higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The auditory thresholds set forth in § 3.385 establish when hearing loss is severe enough to constitute a disability. Hensley 5 Vet. App. at 159. VA audiological examinations were performed in October 2014 and July 2015. The examination reports show that the Veteran’s puretone thresholds and Maryland CNC speech discrimination scores do not satisfy the criteria for a hearing loss disability for VA compensation purposes. See 38 C.F.R. § 3.385. Specifically, the October 2014 VA audiological examination report reflects puretone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 5 15 20 20 LEFT 0 5 20 35 20 Speech discrimination testing (Maryland CNC) revealed speech recognition ability of 96 percent in the right ear and 94 percent in the left ear. See October 2014 Hearing Loss and Tinnitus DBQ. The July 2015 VA audiological examination report reflects puretone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 15 15 25 25 LEFT 10 10 25 30 25 Speech discrimination testing (Maryland CNC) revealed speech recognition ability of 98 percent in the right ear and 100 percent in the left ear. See July 2015 Hearing Loss and Tinnitus DBQ. Accordingly, although the VA examination reports show some bilateral hearing impairment, as defined in Hensley 5 Vet. App. at 159, they show that the Veteran’s puretone thresholds and speech discrimination scores do not meet the minimum requirements for a disability as defined in 38 C.F.R. § 3.385. To award service connection compensation benefits, a current disability must have existed on or after the date of application for the claimed disability. See 38 U.S.C. § 1110; see also Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (agreeing that the requirement that a claimant have a current disability before service connection may be awarded is satisfied when a claimant has a disability at the time a VA claim is filed or during the pendency of that claim.). As the evidence weighs against a current hearing loss disability in either ear, service connection cannot be established. See id.; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Accordingly, the preponderance of the evidence is against the Veteran’s claim. Consequently, the benefit-of-the-doubt rule does not apply, and service connection for a bilateral hearing loss disability is denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55. 4. Tinnitus The Veteran states that he has tinnitus related to in-service acoustic trauma. See December 2013 Application for Compensation. For the following reasons, the Board finds that service connection is not established. The evidence shows that the Veteran has tinnitus. See October 2014 Hearing Loss and Tinnitus DBQ. Accordingly, the Veteran has a current disability. See Davidson, 581 F.3d 1313. The Veteran’s DD Form 214 reflects that his military occupational specialty (MOS) was rifleman. Accordingly, the Board finds he had exposure to traumatic noise based on the circumstances of his service. A link between the Veteran’s tinnitus and his in-service noise exposure is not established. He underwent a VA examination in October 2014. The examination report notes that the Veteran recurrent bilateral tinnitus, increasing in severity, for the previous 15 to 20 years. Based on review of the record and interview and examination of the Veteran, the examiner opined that it was less likely than not that the Veteran’s tinnitus was caused by or a result of his military noise exposure. The examiner rationalized that the Veteran had normal hearing upon separation from active duty, there were no complaints of tinnitus in his STRs, and tinnitus did not manifest until about 10 years following his discharge. See October 2014 Hearing Loss and Tinnitus DBQ. The October 2014 VA medical opinion is probative, as it represents the conclusion of a medical professional based on review of the record and examination of the Veteran, and is supported by an explanation. It weighs against a nexus between the Veteran’s tinnitus and his period of service, including in-service noise exposure. The VA medical opinion carries more weight than the Veteran’s opinion that his tinnitus is linked to in-service noise exposure. The Veteran did not support his opinion with an explanation, in contrast to the examiner. Moreover, as a medical professional specializing in audiology, the examiner has expertise to make an informed opinion on the issue which the Veteran is not shown to have. Finally, while lay testimony may sometimes be competent evidence regarding the cause of a disability, the Board finds that the issue of whether tinnitus that manifests years after in-service noise exposure may be related to such exposure is not a matter capable of lay observation, as a cause-and-effect relationship cannot be perceived through the senses alone given the lapse in time. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). Therefore, this is a medical determination requiring appropriate expertise. See id.; Layno v. Brown, 6 Vet. App. 465, 469, 470-71 (1994). As the Veteran is a lay person in the field of medicine, and not show to have such expertise, his statement that his tinnitus was caused by noise exposure that occurred years earlier is not competent evidence, and thus is not probative on the issue. See id. Accordingly, the Board accords more weight to the VA medical opinion. In sum, a nexus is not established between the Veteran’s tinnitus and his period of service. Consequently, the criteria for service connection are not satisfied. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(a). The Veteran’s tinnitus was not noted in service. Therefore, service connection may not be established based on chronicity in service or a continuity of symptoms after service. See 38 C.F.R. § 3.303(b). His tinnitus is also not shown to have manifested within one year of service separation. Thus, service connection is not warranted on a presumptive basis. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). Because the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. 5107; 38 C.F.R. § 3.102. 5. Acquired Psychiatric Disorder, to Include Anxiety and Depressive Disorder The preponderance of the evidence weighs against service connection for the Veteran’s acquired psychiatric disorder. The VA treatment records reflect the Veteran has been diagnosed with unspecified depressive disorder. See August 2014 Mental Health Note. Accordingly, he has a current disability. See Davidson, 581 F.3d 1313. The Veteran does not state, nor does the record show, any event, disease or injury that occurred while on active duty relevant to incurrence of a psychiatric disorder. Further, the September 1982 service separation examination reveals a normal psychological evaluation. Therefore, there is no evidence of an in-service incident. See Davidson, 581 F.3d 1313. In the absence of an in-service disease, injury, or event, service connection is not established. See 38 C.F.R. § 3.303(a); Holton, 557 F.3d at 1366 Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102. 6. Stomach Condition The preponderance of the evidence weighs against service connection for a stomach condition. The VA treatment records show that the Veteran has been diagnosed with acid reflux. See August 2016 Discharge Note. The service treatment records do not show that acid reflux manifested in service. The September 1982 service separation examination reveals a normal gastrointestinal evaluation. Moreover, the Veteran does not state, nor does the record show, any event, disease or injury that occurred while on active duty relevant to the development of acid reflux. Therefore, there is no evidence of an in-service incident. See Davidson, 581 F.3d 1313. Accordingly, the criteria for service connection are not satisfied. See 38 C.F.R. § 3.303(a); Holton, 557 F.3d at 1366. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102. 7. Left and Right Shoulder and Wrist Conditions The preponderance of the evidence weighs against service connection for bilateral shoulder and wrist conditions. The Board finds that the evidence does not establish any current right shoulder or left shoulder disabilities, or right wrist or left wrist disabilities for service connection purposes. Several years prior to the May 2015 date of these claims, the VA treatment records show a possible diagnosis of bicipital tendonitis and a diagnosis of left wrist tendonitis. See August 2004 Primary Care Note; February 2009 History and Physical Note (reflecting left wrist tendonitis). Although service connection may be granted for a disability that resolves prior to the adjudication of the claim, McClain, 21 Vet. App. 319, in this case the evidence of record shows that the Veteran did not have a right shoulder, left shoulder, right wrist, or left wrist disability at any time during the pendency of this claim. Accordingly, the preponderance of the evidence weighs against a current disability of the left or right shoulder or left or right wrist. In the absence of a current disability, service connection cannot be established. See Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In the alternative, to the extent the Veteran has current bilateral shoulder or wrist pain that may establish a current disability, the record does not show, and the Veteran has not otherwise identified, an in-service disease or injury or event that may be related to his current conditions. Without evidence of service incurrence or aggravation of a disease or injury, the criteria for service connection are not satisfied. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(a). Because the preponderance of the evidence weighs against the claims, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. 5107; 38 C.F.R. § 3.102. 8. Chronic Fatigue The preponderance of the evidence weighs against service connection for chronic fatigue. The Board finds that the medical evidence does not establish any current chronic fatigue disorders for service connection purposes. The Veteran has never been diagnosed with a chronic fatigue disorder. The competent and credible medical evidence does not show any diagnoses of a fatigue disorder during or prior to the pendency of this claim. While the Veteran is competent to state that he feels tired or fatigued, as a layperson in the field of medicine he does not have the medical expertise to diagnose a chronic fatigue disorder, which is a complex medication determination that cannot be made based on lay observation alone. See Jandreau, 492 F. 3d at 1376-77 (observing that a layperson can be competent to identify conditions that are simple, such as a broken leg, but is not competent to identify more complex conditions such as a form of cancer); Barr, 21 Vet. App. at 309 (holding that lay testimony is competent as to matters capable of lay observation, but not with respect to determinations that are “medical in nature”); Layno, 6 Vet. App.at 469-71 (holding that in order for testimony to be probative of any fact, the witness must be competent to testify as to the facts under consideration, and that lay testimony is not competent to prove that which would require specialized knowledge, training, or medical expertise). In the absence of a current disability, service connection cannot be established. See Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In the alternative, the evidence of record, including the service treatment records, does not show that a disease, injury, or event occurred in service that may be related to the development of a fatigue disorder. The Veteran has not stated that a fatigue condition occurred during service or identified an incident of service that may be related to a current fatigue condition. To the extent the Veteran claims service connection for a fatigue condition secondary to an acquired psychiatric disorder or sleep apnea, service connection for the latter claimed disabilities has been denied in this decision. Thus, service connection on a secondary basis may not be awarded as a matter of law. See 38 C.F.R. § 3.310 (2017). Because the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. 5107; 38 C.F.R. § 3.102. 9. Sleep Apnea Service connection for sleep apnea is not established. The Veteran does not state, and the record does not otherwise show, that he has been diagnosed with sleep apnea. The competent and credible evidence does not show any diagnoses of a sleep disorder. In the absence of a current disability, service connection cannot be established. Because the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. 5107; 38 C.F.R. § 3.102. Earlier Effective Date The Veteran seeks an earlier effective date for the award of service connection for left knee degenerative joint disease. See August 2015 Notice of Disagreement. For the following reasons, the Board finds that an earlier effective date is not warranted. Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. If a claim for disability compensation is received within one year after separation from service, the effective date of entitlement is the day following separation or the date entitlement arose. 38 C.F.R. § 3.400(b)(2). Otherwise, it is the date of receipt of claim or the date entitlement arose, whichever is later. See 38 C.F.R. § 3.400. The Veteran filed a claim for service connection on December 2, 2013, more than one year after his separation from service. In May 2014, he added his claim for service connection for a left knee disorder to his pending claim. See May 2014 Report of General Information. There is no indication in the record of an earlier claim. See 38 C.F.R. §§ 3.150, 3.151, 3.155 (2013) (setting forth the requirements for filing a claim for service connected disability benefits at the time of the Veteran’s December 2013 claim); see also Brannon v. West, 12 Vet. App. 32, 34-5 (1998). The Veteran has not submitted any information or evidence in support of his appeal of the effective date assigned. Accordingly, as a matter of law, an effective date of service connection for a left knee disorder earlier than December 2013 cannot be established. See id. Because the outcome of this issue is determined by the application of law to facts that are not in dispute, the benefit-of-the-doubt rule does not apply. See Sabonis v. West, 6 Vet. App. 426, 430 (1994); see also 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND Entitlement to a rating in excess of 20 percent for degenerative joint disease, left knee is remanded. A new examination must be conducted that complies with Correia v. McDonald, 28 Vet. App. 158 (2016). The U.S. Court of Appeals for Veterans Claims (Court) held that for VA examinations to be adequate for rating musculoskeletal disabilities, they must record range of motion testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of motion of the opposite undamaged joint. Correia, 28 Vet. App. 158 at 169-70 (citing 38 C.F.R. § 4.59). If the examiner is unable to conduct the required testing, or concludes that the required testing is not necessary, he or she should clearly explain why what that is so. Id. at 170. The November 2016 VA examination report provides range of motion results for the left knee and the right knee on passive and active motion, but does not specify whether the testing was conducted in both weight-bearing and nonweight-bearing, as required under Correia. As this is a determination that requires medical judgment, the Board may not make its own independent finding on this issue. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). Accordingly, a new examination should be performed that contains the findings required under Correia. The matter is REMANDED for the following action: 1. Add to the file the Veteran’s outstanding VA treatment records, if any, dating from September 2016 forward. 2. Arrange for a VA examination to assess the current severity of the Veteran’s service-connected left knee disability. All pertinent findings must be recorded in the examination report. The examiner must test the range of motion of the left knee in active motion, passive motion, weight-bearing, and nonweight-bearing, and if possible, also test the range of the right knee. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, the examiner should clearly explain why that is so. If the Veteran endorses flare ups, the examiner must obtain as much information as possible from the Veteran as to the severity, frequency, and duration of flare ups, their effect on functioning, and precipitating and alleviating factors. The examiner must then provide an estimate of additional loss of range of motion, if any, during a flare up or on repeated use over time. If the examiner is unable to provide such an estimate, the examiner must explain why the available information, including the Veteran’s own statements, is not sufficient for that purpose. J. Rutkin Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. M. Stedman, Associate Counsel