Citation Nr: 18151947 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 15-15 307 DATE: November 20, 2018 ORDER New and material evidence having not been received, the application to reopen the previously denied claim of entitlement to service connection for hypertension, to include as due to service in the Southwest Asia Theater of Operations, is denied, and the claim is not reopened. New and material evidence having not been received, the application to reopen the previously denied claim of entitlement to service connection for type 2 diabetes mellitus, to include as due to toxic herbicide exposure, is denied, and the claim is not reopened. Entitlement to service connection for erectile dysfunction, to include as due to type 2 diabetes mellitus, is denied. Entitlement to service connection for diabetic neuropathy of all four extremities, to include as due to type 2 diabetes mellitus and toxic herbicide exposure, is denied. Entitlement to service connection for chronic fatigue syndrome, to include as due to service in the Southwest Asia Theater of Operations, is denied. Entitlement to service connection for muscle fatigue, to include as due to service in the Southwest Asia Theater of Operations, is denied. Entitlement to service connection for asthma is denied. Entitlement to service connection for headaches, to include as due to service in the Southwest Asia Theater of Operations, is denied. Entitlement to service connection for a visual disability, to include ocular hypertension, diabetic retinopathy, and a visual field defect, is denied. Entitlement to service connection for a heart condition, to include hypertensive heart disease and paroxysmal atrial fibrillation, to also include as due to toxic herbicide exposure, is denied. REMANDED Entitlement to service connection for sleep apnea, to include as due to service in the Southwest Asia Theater of Operations, is remanded. Entitlement to service connection for a gastrointestinal disorder, to include irritable bowel syndrome, to include as due to service in the Southwest Asia Theater of Operations, is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), major depression, and an anxiety disorder, to also include as due to service in the Southwest Asia Theater of Operations, is remanded. FINDINGS OF FACT 1. In October 2008, service connection for hypertension and type 2 diabetes mellitus was denied; a notice of disagreement and/or new and material evidence was not received within one year of notice of that decision. 2. The evidence added to the record since the October 2008 decision does not relate to an unestablished fact necessary to substantiate the claim of entitlement to service connection for hypertension or type 2 diabetes mellitus. 3. The Veteran was not exposed to toxic herbicides during military service. 4. The preponderance of the evidence is against finding that the Veteran’s erectile dysfunction and diabetic neuropathy are related to an in-service injury, event, or disease; the Veteran is not service-connected for diabetes. 5. 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 chronic fatigue syndrome or muscle fatigue. 6. The preponderance of the evidence is against finding that the Veteran’s asthma, headaches, visual disability, and heart condition began during active service, or are otherwise related to an in-service injury, event, or disease. CONCLUSIONS OF LAW 1. The October 2008 decision that denied the Veteran’s claim for entitlement to service connection for hypertension is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 2. As the evidence received subsequent to the October 2008 decision is not new and material, the requirements to reopen the claim for entitlement to service connection for hypertension, to include as due to service in the Southwest Asia Theater of Operations, are not met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.102, 3.156. 3. The October 2008 decision that denied the Veteran’s claim for entitlement to service connection for type 2 diabetes mellitus is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 4. As the evidence received subsequent to the October 2008 decision is not new and material, the requirements to reopen the claim for entitlement to service connection for type 2 diabetes mellitus, to include as due to toxic herbicide exposure, are not met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.102, 3.156. 5. The criteria for entitlement to service connection for erectile dysfunction, to include as due to type 2 diabetes mellitus, have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 6. The criteria for entitlement to service connection for diabetic neuropathy of all four extremities, to include as due to type 2 diabetes mellitus and toxic herbicide exposure, have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309, 3.310. 7. The criteria for entitlement to service connection for chronic fatigue syndrome, to include as due to service in the Southwest Asia Theater of Operations, have not been met. 38 U.S.C. §§ 1110, 1111, 1117, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.317(a), (b). 8. The criteria for entitlement to service connection for muscle fatigue, to include as due to service in the Southwest Asia Theater of Operations, have not been met. 38 U.S.C. §§ 1110, 1111, 1117, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.317(a), (b). 9. The criteria for entitlement to service connection for asthma have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 10. The criteria for entitlement to service connection for headaches, to include as due to service in the Southwest Asia Theater of Operations, have not been met. 38 U.S.C. §§ 1110, 1111, 1117, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.317(a), (b). 11. The criteria for entitlement to service connection for a visual disability, to include ocular hypertension, diabetic retinopathy, and a visual field defect, have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 12. The criteria for entitlement to service connection for a heart condition, to include hypertensive heart disease and paroxysmal atrial fibrillation, to also include as due to toxic herbicide exposure, have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1981 to May 1982, January 1985 to May 1985, and from January 1991 to July 1991, while serving in the Army National Guard. He served in the Southwest Asia Theater of Operations. This case comes before the Board of Veterans’ Appeals (Board) on appeal from August 2014 and June 2015 rating decisions by the Department of Veterans Affairs (VA). The Board has expanded the Veteran’s claims on appeal to encompass all similar disorders. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (the scope of a disability claim includes any disability that may reasonably be encompassed by the claimant’s description of the claim, reported symptoms, and the other information of record). New and Material Evidence In order for evidence to be sufficient to reopen a previously disallowed claim, it must be both new and material. If the evidence is new, but not material, the inquiry ends and the claim cannot be reopened. See Smith v. West, 12 Vet. App. 312, 314 (1999); Manio v. Derwinski, 1 Vet. App. 140 (1991). Under the relevant regulation, “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. If it finds that the submitted evidence is new and material, VA may then proceed to evaluate the merits of the claim on the basis of all evidence of record, but only after ensuring that the duty to assist the veteran in developing the facts necessary for the claim has been satisfied. See Elkins v. West, 12 Vet. App. 209 (1999); but see 38 U.S.C. § 5103A (eliminates the concept of a well-grounded claim). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low, and consideration is not limited to whether the newly submitted evidence relates specifically to the reason the claim was last denied. Rather, consideration should include whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the Secretary’s duty to assist or through consideration of an alternative theory of entitlement. See Shade v. Shinseki, 24 Vet. App. 110, 117-18 (2010). 1. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for hypertension, to include as due to service in the Southwest Asia Theater of Operations 2. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for type 2 diabetes mellitus, to include as due to toxic herbicide exposure The Veteran is seeking service connection for the previously-denied claims involving hypertension and type 2 diabetes mellitus. As the two claims share the same background, they will be discussed together. Based on the additional evidence added to the record since the previous final denial of the Veteran’s claims, the Board finds that new and material evidence has not been added to the record. The Veteran’s service connection claims for hypertension and diabetes were denied in an October 2008 rating decision. A review of that rating decision reveals that at the time, VA declined to grant service connection for either disorder because he was diagnosed with both of them several years after discharge. Specifically, he was diagnosed with hypertension in September 2000 and he was diagnosed with diabetes in January 2000. There were no mentions of symptoms pertaining to diabetes and only a single notation of a high blood pressure reading in the Veteran’s service treatment records. He did not appeal that decision within one year, nor did he submit any new and material evidence within a year of receiving it. See Buie v. Shinseki, 24 Vet. App. 242 (2011). This represents the last final denial of the claims. Since the last final denial, new medical records have been added to the claims file. With respect to the Veteran’s diabetes, medical records show continued treatment for the disorder. Despite the addition of treatment records, there remains no new and material evidence. The new evidence does not act to support the possibility that his diabetes manifested during active service or is in anyway related to active service. Additionally, the Veteran has asserted that he was exposed to toxic herbicides during his basic training and additional trainings in Fort McClellan, Alabama. However, in a June 2018 response, the Department of Defense stated that it has not identified Fort McClellan as a location where Agent Orange was used, tested, or stored. Agent Orange was developed for combat operations in Vietnam and was used in Vietnam from 1962 to early 1971. Fort McClellan was not on the Agent Orange shipping supply line. Moreover, all use of Agent Orange by the military was terminated in 1971, ten years prior to the Veteran’s claimed exposure. Any herbicide use observed or associated with the Veteran was only of the commercial variety. As the Veteran’s theory of entitlement has been thoroughly analyzed and denied by the Department of Defense, the Board finds that no material evidence has been presented with respect to the Veteran’s diabetes claim. As for the Veteran’s hypertension, the Veteran asserted, without more, that his disorder was due to his service in Southwest Asia. In an August 2014 VA examination, the examiner opined that the Veteran’s hypertension was not caused by or a result of a specific exposure event experienced by the Veteran during service in Southwest Asia. There was no medical literature to support an etiological link. Instead, the examiner stated that the Veteran’s hypertension was likely due to his age, family factors, and obesity. Also, there were no indications that the condition existed during active service. Although the Veteran cited his service in Southwest Asia as the cause for his diabetes, the mere offering of an alternative theory of entitlement does not constitute new and material evidence sufficient to reopen a previously-denied claim. See, e.g., Roebuck v. Nicholson, 20 Vet. App. 307 (2006). Furthermore, although the VA examination report is new evidence, it cannot serve to reopen the Veteran’s claim as the conclusions addressing his current diagnosis are unfavorable. See Villalobos v. Principi, 3 Vet. App. 450 (1992). Consequently, the Board concludes that the Veteran has not submitted both new and material evidence with respect to his claims of service connection for hypertension and type 2 diabetes mellitus. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). Certain chronic diseases are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Moreover, for such chronic diseases, an alternative method of establishing the second and third Shedden/Caluza element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a); see 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2014). Additionally, evidence of continuous symptoms since active duty is a factor for consideration as to whether a causal relationship exists between an in-service injury or incident and the current disorder as is contemplated under 38 C.F.R. § 3.303(a). VA must give due consideration to all pertinent medical and lay evidence in a case where a veteran is seeking service connection. 38 U.S.C. § 1154(a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the veteran. 38 U.S.C. § 5107(b). Under 38 U.S.C. § 1117(a)(1), compensation is warranted for a Persian Gulf Veteran who exhibits objective indications of a “qualifying chronic disability” that became manifest during service on active duty in the Armed Forces in the Southwest Asia Theater of operations during the Persian Gulf War, or to a degree of 10 percent during the presumptive period prescribed by the Secretary. Effective October 16, 2012, VA extended the presumptive period in 38 C.F.R. § 3.317(a)(1)(i) through December 31, 2016 (for qualifying chronic disabilities that become manifest to a degree of 10 percent or more after active duty in the Southwest Asia Theater of operations). See 77 Fed. Reg. 63225 (2012). Furthermore, the chronic disability must not be attributed to any known clinical disease by history, physical examination, or laboratory tests. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a), (b). The Board notes that Congress revised 38 U.S.C. § 1117, effective March 1, 2002. In the revised statute, the term “chronic disability” was changed to “qualifying chronic disability,” and the definition of “qualifying chronic disability” was expanded to include (a) undiagnosed illness, (b) a medically unexplained chronic multi-symptom illness that is defined by a cluster of signs or symptoms, or (c) any diagnosed illness that the Secretary determines, in regulations, warrants a presumption of service connection. Signs or symptoms which may be manifestations of undiagnosed illness or medically unexplained chronic multi-symptom illness include, but are not limited to: (1) fatigue, (2) unexplained rashes or other dermatological signs or symptoms, (3) headache, (4) muscle pain, (5) joint pain, (6) neurological signs and symptoms, (7) neuropsychological signs or symptoms, (8) signs or symptoms involving the upper or lower respiratory system, (9) sleep disturbances, (10) gastrointestinal signs or symptoms, (11) cardiovascular signs or symptoms, (12) abnormal weight loss, and (13) menstrual disorders. 38 C.F.R. § 3.317(b). 3. Entitlement to service connection for erectile dysfunction, to include as due to type 2 diabetes mellitus 4. Entitlement to service connection for diabetic neuropathy of all four extremities, to include as due to type 2 diabetes mellitus and toxic herbicide exposure The Veteran contends that he suffers from erectile dysfunction and diabetic neuropathy. He has attributed his disorders to his diabetes and his asserted toxic herbicide exposure. Initially, the Board notes that as the Veteran is not service-connected for type 2 diabetes mellitus, secondary service connection as a result of that disorder is unavailable for the Veteran’s erectile dysfunction and diabetic neuropathy. Additionally, as noted in the discussion in the section above addressing type 2 diabetes mellitus, the Veteran has not been exposed to toxic herbicides. Therefore, that avenue of service connection is also unavailable to the Veteran. Nevertheless, the Board will still evaluate whether direct service connection is warranted for the Veteran’s erectile dysfunction and diabetic neuropathy. 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 finds that the Veteran is competent to assert that he has erectile dysfunction. However, it is unclear whether the Veteran has a current disability with respect to his neuropathy claim. The Veteran was not provided with a VA examination for his claims. However, the Board finds that a VA examination is not required here because competent evidence has not been presented indicating that the existence of a disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s active service. Additionally, there is no evidence to show that the claimed disabilities occurred in service or are associated with service. See McClendon v. Nicholson, 20 Vet App. 79 (2006). Regardless, the Board concludes that, even if the Veteran has a diagnosis of erectile dysfunction and peripheral neuropathy, the preponderance of the evidence is against finding that the disabilities began during active 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). Service treatment records for active duty service do not reflect complaints of, treatment for, or a diagnosis related to these conditions. Significantly, his final active duty separation examination was absent of any complaints of or observed symptoms related to any of these conditions. In fact, the post-service evidence does not reflect symptoms related to the disorders for many years after the Veteran last left active duty service in July 1991. The first indication of erectile dysfunction was in May 2006 when the Veteran was referred from the Diabetes Education Program to the Sexuality and Health Clinic. At the time, the Veteran complained of a progressive loss of erection and changes in the frequency of sexual activity in the past year. With regards to his claimed neuropathy, the earliest reference to possible neuropathy would be in May 2004, when a diagnosis of possible focal neuropathy was posited by a medical provider. As none of these disorders started during service or continued since the time of service, continuity is not established based on the clinical evidence. The Veteran himself has not specifically asserted that he has suffered from erectile dysfunction and neuropathy since military service. Instead, the Veteran asserts that the disorders are a result of his type 2 diabetes mellitus and claimed toxic herbicide exposure during service. However, as noted above, the Veteran is ineligible for secondary service connection. Moreover, the Board notes that the Veteran submitted claims for other VA benefits prior to claiming the issues on appeal. Thus, the Veteran was aware of the VA benefits system, and had the Veteran been experiencing these conditions since service, it is intuitive that he would have submitted claims for the disorders at that time. The Board notes that there are no treatment records establishing that the Veteran’s disorders, which first manifested several years after the end of active service, are related to active duty, nor has any physician asserted that such a relationship exists. Without any basis to suggest that the Veteran’s disorders are related to military service, the Board finds that the weight of the competent evidence does not attribute the erectile dysfunction and peripheral neuropathy to military service despite his contentions to the contrary. In reaching the above conclusion, the Board also considered the doctrine of reasonable doubt. 38 U.S.C. § 5107(b). However, as the most probative evidence is against the claim, the doctrine is not applicable in this case. See also, e.g., Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 5. Entitlement to service connection for muscle fatigue, to include as due to service in the Southwest Asia Theater of Operations 6. Entitlement to service connection for chronic fatigue syndrome, to include as due to service in the Southwest Asia Theater of Operations The Veteran contends that he suffers from muscle fatigue and chronic fatigue syndrome as due to his service in Southwest Asia. 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 the Veteran does not have a current diagnosis of muscle fatigue or chronic fatigue syndrome, and has not had one 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). With respect to muscle fatigue, during an April 2015 VA examination, the examiner noted the Veteran’s assertion that he had developed muscle pain at both the thigh and distal muscle of his leg. Specifically, the Veteran described a pin/needle sensation all over the legs during ambulation and when he is exposed to sunlight. Nevertheless, the examiner noted no specific muscle injury. Muscle strength testing was completely normal and there were no signs or symptoms attributable to any muscle injury. Importantly, despite the Veteran’s complaints of pain, there was no functional impairment noted. As a result, the examiner concluded that the Veteran did not have a current muscle disorder. With respect to chronic fatigue syndrome, the Veteran underwent a VA examination in June 2015. The Veteran had not been previously diagnosed with chronic fatigue syndrome. The examiner concluded that the Veteran does not meet the criteria for the diagnosis of chronic fatigue syndrome. His service treatment and VA records were silent for any diagnosis and there was an absence of medical evidence of chronic fatigue. Critically, he did not meet the criteria of debilitating fatigue severe enough to reduce daily activities to less than 50 percent of the usual level for at least six months. In addition, the Veteran has other conditions that mimic the claimed condition such as a psychiatric disorder, obesity, anemia, angina pectoris, and diabetes. While the Veteran believes he has a current diagnosis of muscle fatigue and chronic fatigue syndrome, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Moreover, while the Veteran may be competent to report having pain or soreness in a certain region, the evidentiary record does not reflect any resulting disability or functional impairment. See Saunders v. Wilkie, No. 886 F.3d. 1356 (Fed. Cir. 2018) (indicating that the term “disability” refers to the functional impairment of earning capacity, rather than the underlying cause of the impairment, and pain alone may be a functional impairment). Consequently, the Board finds that service connection is not warranted for muscle fatigue and chronic fatigue syndrome. 7. Entitlement to service connection for asthma 8. Entitlement to service connection for headaches, to include as due to service in the Southwest Asia Theater of Operations 9. Entitlement to service connection for a visual disability, to include ocular hypertension, diabetic retinopathy, and a visual field defect 10. Entitlement to service connection for a heart condition, to include hypertensive heart disease and paroxysmal atrial fibrillation, to also include as due to toxic herbicide exposure The Veteran contends that he suffers from asthma, headaches, a visual disability, and a heart condition. He has specifically attributed his headaches to his service in Southwest Asia. He has attributed his heart condition to his exposure to toxic herbicide exposure. As noted in the discussion in the section above addressing type 2 diabetes mellitus, the Veteran has not been exposed to toxic herbicides. Therefore, that avenue of service connection is unavailable to the Veteran with regards to his heart condition. Nevertheless, the Board will still evaluate whether direct service connection is warranted. 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 Veteran was not provided with a VA examination for his asthma and visual disability claims. However, the Board finds that a VA examination is not required here because competent evidence has not been presented indicating that the existence of a disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s active service. Additionally, there is no evidence to show that the claimed disabilities occurred in service or are associated with service. See McClendon v. Nicholson, 20 Vet App. 79 (2006). The Board concludes that the preponderance of the evidence is against finding that the Veteran’s asthma, headaches, visual disability, and heart condition began during active 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). Service treatment records for active duty service do not reflect complaints of, treatment for, or a diagnosis related to these conditions. Significantly, his final active duty separation examination was absent of any complaints of or observed symptoms related to any of these conditions. In fact, the post-service evidence does not reflect symptoms related to the disorders for many years after the Veteran last left active duty service in July 1991. The first indication of asthma is a June 2009 VA treatment record. He first complained of headaches in November 2014. As for his visual disability, he was diagnosed with an altered cup to disc ratio in February 2003. He was diagnosed with ocular hypertension in June 2011. He was later diagnosed with diabetic retinopathy in May 2014. He was also diagnosed with a visual field defect in January 2016. The Veteran was also diagnosed with refractive error of the eye, but this is not a disability for VA compensation purposes. See 38 C.F.R. § 4.9. With regards to his heart disorder, he was diagnosed with hypertensive heart disease in August 2014 and paroxysmal atrial fibrillation in October 2013. As none of these disorders started during service or continued since the time of service, continuity is not established based on the clinical evidence. The Veteran has not specifically asserted that he has suffered from these disabilities since service. The Board notes that it is possible that his ocular hypertension is from his hypertension and that his diabetic retinopathy is from his diabetes. However, as neither disorder is service-connected, the Veteran is ineligible for secondary service connection. Moreover, the Board notes that the Veteran submitted claims for other VA benefits prior to claiming the issues on appeal. Thus, the Veteran was aware of the VA benefits system, and had the Veteran been experiencing these conditions since service, it is intuitive that he would have submitted claims for the disorders at that time. The Board notes that there are no treatment records establishing that the Veteran’s disorders, which first manifested several years after the end of active service, are related to active duty, nor has any physician asserted that such a relationship exists. Moreover, with regards to his headaches disability, the Veteran underwent a VA examination in June 2015. The examiner noted a diagnosis of tension headaches. The examiner then opined that the Veteran’s tension headaches are less likely than not related to service, to include any specific exposure event during service in Southwest Asia. The examiner stated that the evidence demonstrates that the Veteran began complaining about headaches in November 2014, more than 20 years after being released from active duty. The Veteran also underwent a VA examination for his heart disorder in August 2014. The examiner noted that the Veteran had hypertension since 2000 as well as noted the Veteran’s current diagnoses of hypertensive heart disease and paroxysmal atrial fibrillation. The examiner opined that the Veteran’s heart condition is not caused by or a result of a specific exposure event experienced by the Veteran during service in Southwest Asia. The examiner stated that the medical literature does not support an etiologic link between heart disease and exposure to fumes, dust, and smoke. There is also no indication that his heart condition is related to military service because there is no indication of the condition during military service. Instead, the Veteran’s heart condition is likely due to chronic hypertension, which is likely due to increased age, family factors, and obesity. Without any basis to suggest that the Veteran’s disorders are related to military service, the Board finds that the weight of the competent evidence does not attribute the asthma, headaches, visual disability, and heart condition to military service despite his contentions to the contrary. In reaching the above conclusion, the Board also considered the doctrine of reasonable doubt. 38 U.S.C. § 5107(b). However, as the most probative evidence is against the claim, the doctrine is not applicable in this case. See also, e.g., Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for sleep apnea, to include as due to service in the Southwest Asia Theater of Operations, is remanded. The Veteran is seeking service connection for sleep apnea. He underwent a VA examination for sleep apnea in August 2014. During that examination, the examiner noted an initial diagnosis of sleep apnea in November 2008 with complaints possibly pertaining to sleep apnea beginning in 2003. However, a medical provider noted an impression of obstructive sleep apnea in July 1993, which was a full ten years prior to when the examiner stated that the Veteran first complained to his primary care provider regarding symptoms of sleep apnea. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. See 38 U.S.C. 5103(d); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As the medical opinion relied on incorrect facts, the opinion is inadequate. Therefore, the Board will remand the claim for an addendum medical opinion. 2. Entitlement to service connection for a gastrointestinal disorder, to include irritable bowel syndrome, to include as due to service in the Southwest Asia Theater of Operations, is remanded. The Veteran is seeking service connection for a gastrointestinal disorder. He underwent a VA examination for stomach conditions in June 2015. During that examination, the examiner concluded that the Veteran has no current disability. Instead, the examiner only noted that the Veteran had episodes of constipation. However, the Veteran’s treatment records contain multiple diagnoses that could be relevant. In March 2011, he was diagnosed with diverticulosis. In November 2013, he was diagnosed with a carcinoid tumor. Finally, in January 2014, an endoscopy revealed duodenitis and gastritis. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. See 38 U.S.C. 5103(d); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As the medical opinion failed to mention the previous gastrointestinal diagnoses, the opinion is inadequate. Therefore, the Board will remand the claim for an addendum medical opinion. 3. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, major depression, and an anxiety disorder, to also include as due to service in the Southwest Asia Theater of Operations, is remanded. The Veteran is seeking service connection for an acquired psychiatric disorder. He has been diagnosed with multiple psychiatric disorders. The Veteran’s claim hinges on showing a connection between his current psychiatric disorders and his military service. Importantly, a November 2015 VA treatment record notes that the Veteran has received ambulatory psychiatric treatment on and off since his return from the Persian Gulf. VA should communicate with the Veteran in an attempt to locate and obtain all pertinent records. VA should also ask the Veteran to provide any possible corroboration, whether documents or statements, that show psychiatric treatment soon after his separation from active duty service. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s sleep apnea is at least as likely as not related to military service. The examiner should comment on the significance, if any, of the impression of obstructive sleep apnea made by a medical provider in July 1993. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s gastrointestinal disorder is at least as likely as not related to military service. The examiner should comment on the Veteran’s previous diagnoses of diverticulosis, a carcinoid tumor, duodenitis, and gastritis. 3. Ask the Veteran to complete any necessary forms to obtain any outstanding treatment records pertaining to his psychiatric treatment soon after his separation from active duty. VA should also ask the Veteran to provide any possible corroboration, whether documents or statements, that show psychiatric treatment soon after his separation from active duty service. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Borman, Associate Counsel