Citation Nr: 18154557 Decision Date: 11/30/18 Archive Date: 11/30/18 DOCKET NO. 15-22 994 DATE: November 30, 2018 ORDER Entitlement to service connection for a right shoulder disorder is denied. Entitlement to service connection for a left shoulder disorder is denied. Entitlement to service connection for a neck disorder is denied. Entitlement to service connection for a low back disorder is denied. Entitlement to service connection for an upper back disorder is denied. Entitlement to service connection for a left knee disorder, is denied. Entitlement to service connection for a right knee condition is denied. Entitlement to service connection for a bilateral foot disorder is denied. Entitlement to service connection for a bilateral eye disorder is denied. Entitlement to service connection for a sleep disorder, to include sleep apnea, is denied. REMANDED Entitlement to a compensable rating for migraine headaches is remanded. FINDINGS OF FACT 1. The Veteran’s right shoulder disorder is not etiologically related to his active service. Right shoulder arthritis did not manifest within the one-year presumptive period. 2. The competent evidence of record shows that the Veteran does not have a current diagnosis of a left shoulder disorder which could be attributable to his active service. 3. The Veteran’s neck disorder is not etiologically related to his active service. Neck arthritis did not manifest within the one-year presumptive period. 4. The Veteran’s low back disorder is not etiologically related to his active service. Back arthritis did not manifest within the one-year presumptive period. 5. The Veteran’s upper back disorder is not etiologically related to his active service. Back arthritis did not manifest within the one-year presumptive period. 6. The Veteran’s right knee disorder is not etiologically related to his active service. Right knee arthritis did not manifest within the one-year presumptive period. 7. The competent evidence of record (the best evidence) shows that the Veteran does not have a current diagnosis of a left knee disorder which could be attributable to his active service. 8. The Veteran’s bilateral foot disorder is not etiologically related to his active service. Arthritis did not manifest within the one-year presumptive period. 9. The Veteran’s bilateral eye disorder is not etiologically related to his active service. 10. The Veteran’s sleep disorder is not etiologically related to his active service. disorder CONCLUSIONS OF LAW 1. The criteria for service connection for a right shoulder disorder have not been met. 2. The criteria for service connection for a left shoulder disorder have not been met. 3. The criteria for service connection for a neck disorder have not been met. 4. The criteria for service connection for a low back disorder have not been met. 5. The criteria for service connection for an upper back disorder have not been met. 6. The criteria for service connection for a right knee disorder have not been met. 7. The criteria for service connection for a left knee disorder have not been met. 8. The criteria for a bilateral foot disorder have not been met. 9. The criteria for service connection for a bilateral eye disorder have not been met. 10. The criteria for service connection for a sleep disorder have not been met. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from August 1973 to August 1975. The Veteran and his spouse testified before the undersigned Veterans Law Judge (VLJ) in a June 2018 videoconference hearing. A transcript of the hearing is of record. The United States Court of Appeals for Veterans Claims (Court) set aside a previous Board decision on issue of entitlement to service connection for traumatic injury to the hands in May 2018. In the same order, the Court remanded that issue. As such, the issue will be addressed in a separate decision. Service Connection 1. Right Shoulder Disorder The Veteran asserts that he experiences a right shoulder disorder, which is related to his active service. Specifically, the Veteran argues that he injured his shoulder working as a mechanic while in service. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). For veterans with 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases, including arthritis, 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. §§ 1112, 1113 (2012); 38 C.F.R. §§ 3.307, 3.309 (2017). Pursuant to 38 C.F.R. § 3.303 (b), where a chronic disease such as arthritis is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected. If a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303 (b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101 (3) or 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 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 diagnosed with acute anterior tear of the right shoulder, an injury which he sustained in 2011. See VA examination, January 2013. The Veteran also experiences right shoulder arthritis. See VA treatment records, December 31, 2013. As such, the first element of service connection, a current diagnosis, has been met. The Board concludes that, while the Veteran has a current diagnosis of a right shoulder disorder, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of the right shoulder disorder began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d) (2017). In sum, while the Veteran’s claim meets prong (1) a current disability, it fails at prongs (2) and (3), as there is no in-service occurrence and there is no nexus between the Veteran’s current right shoulder disorder and his active service. The Veteran’s STRs do not show that he had a history of right shoulder issues in active service, and do not show a diagnosis of or treatment for a right shoulder disorder. The Veteran’s post-service medical records show that he reported having right shoulder pain for two years. See VA treatment records, November 17, 2011. He sustained an acute anterior tear of the right shoulder in 2012, and underwent physical therapy for it. See VA examination, January 2013; VA treatment records, July 26, 2013. The Veteran also experiences right shoulder arthritis. See VA treatment records, December 31, 2013. None of the medical records speak to the disorder’s etiology vis-à-vis the Veteran’s active service. The Veteran underwent a VA examination for his shoulder in January 2013. The examiner noted that the Veteran was diagnosed with acute anterior tear of the right shoulder, an injury which he sustained in 2012. The examiner opined that the Veteran had no right shoulder problems in service, and that there was no evidence of shoulder problems until 2011. The examiner stated that the right shoulder injury was less likely as not related to the Veteran’s active service, as working as a mechanic for two years would not cause a shoulder disability. See VA examination, January 2013. Based on a review of the evidence, the Board finds that service connection for a right shoulder disorder is not warranted. In reaching this determination, the Board has also considered the lay assertions of record, including the contentions of the Veteran in support of a medical nexus. As a lay person, the Veteran is competent to report observable symptoms, such as having right shoulder pain. See Washington v. Nicholson, 21 Vet. App. 191, 195 (2007) (holding that, “[a]s a layperson, an appellant is competent to provide information regarding visible, or otherwise observable symptoms of disability”); see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (Lay testimony is competent to establish the presence of observable symptomatology); Layno v. Brown, 6 Vet. App. 465 (1994). Lay evidence may be competent on a variety of matters concerning the nature and cause of disability. Jandreau, 492 F.3d at 1377 n.4. While the Veteran is competent to report having experienced symptoms of right shoulder pain, he is not competent to provide a diagnosis in this case or determine that these symptoms are somehow related to his active service or any service-connected disabilities. This issue is medically complex, as it requires specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the medical evidence in this case. Crucially, the evidence of record does not show that the Veteran’s right shoulder disorder, which was diagnosed in 2012 (and was an acute tear), is in any way related to his active service. It is important for the Veteran to understand that no medical professional has tied his right shoulder disorder to his active service, or to any of his service-connected disabilities. In fact, the right shoulder issues were deemed a direct result of the Veteran experiencing an acute injury in 2012, over 37 years after separation from active service. In addition, the most probative evidence of record shows that the right shoulder disorder did not have its onset during service or for many years thereafter. The diagnosed arthritis did not manifest within one year of separation from service, but rather about 37 years after separation from service. 38 C.F.R. § 3.309 (a) (2017). The Board also observes that there is no evidence to show that right shoulder arthritis existed or was “noted” in service. Thus, the provisions of 38 C.F.R. § 3.303 (b) pertaining to chronicity or continuity of symptomatology are not for application. Accordingly, service connection for a right shoulder disorder is not warranted because the Veteran has not satisfied the second and third requirements of service connection, i.e., an in-service incident and a nexus. See 38 C.F.R. § 3.303 (2017); see again Gilpin, 155 F.3d at 1353; Brammer, 3 Vet. App. at 225. 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 of entitlement to service connection for a right shoulder disorder, that doctrine does not apply. 38 U.S.C. § 5107 (b) (2012). The claim of entitlement to service connection for a right shoulder disorder is denied. 2. Left Shoulder Disorder The Veteran asserts that he experiences a left shoulder disorder, which is related to his active service. Specifically, the Veteran argues that he injured his shoulder working as a mechanic while in service. As an alternative theory, the Veteran asserts that his left shoulder disorder is related to his right shoulder disorder. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). 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. After a review of the record, the Board finds that there is no competent, credible, and probative evidence that would establish that the Veteran experiences a left shoulder disorder that is etiologically related to his active service. The Veteran’s STRs do not show that he had a history of left shoulder issues in active service, and do not show a diagnosis of or treatment for a left shoulder disorder. The Veteran’s post-service medical records show that the Veteran underwent a left shoulder surgery at some point in the past for rotator cuff pathology. See VA treatment records, April 30, 2012. The surgery took place when the Veteran was 37 years old. See VA treatment records, October 22, 2012. The Veteran reported left shoulder pain. See VA treatment records, September 6, 2013. He stated that his range of motion in the left shoulder was good, and that he wished that his right shoulder range of motion was the same as his left. See VA treatment records, July 26, 2013. The Veteran reported shoulder pain related to a left rib injury (the notes failed to specify which shoulder hurt him). See VA treatment records, December 12, 2013. No other treatment records speak to any left shoulder complaints or issues. The Veteran underwent a VA examination for his shoulders in January 2013. The examiner noted that the Veteran was diagnosed with acute anterior tear of the right shoulder, and no left shoulder injuries. The examiner opined that the Veteran had no shoulder problems in service, and that there was no evidence of shoulder problems until 2011 (when he injured his right shoulder). The examiner stated that the left shoulder injury was less likely as not related to the Veteran’s active service, as working as a mechanic for two years would not cause a shoulder disability and the Veteran did not have any left shoulder issues. See VA examination, January 2013. Regarding the first element of service connection (i.e. a current disability), importantly, the Veteran’s medical records do not show a diagnosis of a current left shoulder disorder. While the Veteran did undergo a left shoulder surgery when he was 37, per his history, that issue was resolved. All treatment records in evidence are completely silent for a current left shoulder disorder diagnosis. The January 2013 VA examiner found that the Veteran did not experience a left shoulder disorder. As such, the Veteran’s claim for entitlement to service connection for a left shoulder disorder fails. The best evidence of record shows that the Veteran does not have a current diagnosis of a left shoulder disorder. In the absence of proof of a present disorder (and, if so, of a nexus between that disorder and the active military service), there can be no valid claims for service connection. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). This principle has been repeatedly reaffirmed by the Federal Circuit, which has stated that “a Veteran seeking disability benefits must establish... the existence of a disability [and] a connection between the Veteran’s service and the disability.” Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). The Board has considered whether the Veteran experienced a left shoulder disorder at any time during the pendency of this appeal. Service connection may be granted if there is a disability at some point during the claim even if it later resolves or becomes asymptomatic. McClain v. Nicholson, 21 Vet. App. 319 (2007). In this case, there is no evidence of a left shoulder disorder at any time during the pendency of this appeal. The Veteran also has not identified or submitted any competent evidence, to include a diagnosis of the disorder, or a medical nexus, relating his claimed disorder to active service. The Board has considered the Veteran’s lay statements in support of his claim. In multiple statements, the Veteran related that he believed that he experienced a left shoulder disorder that was related to his service. Although laypersons are competent to provide opinions on some medical issues, as to the specific issues in this case, diagnosing a left shoulder disorder, this issue falls outside the realm of common knowledge of a layperson. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (laypersons not competent to diagnose cancer). As a layperson, the Veteran has not been shown to possess the medical expertise to diagnose a left shoulder disorder and its etiology. The claims file does not contain any medical examinations diagnosing the Veteran with a left shoulder disorder, or linking his self-reported symptoms to his active service. In sum, there is no evidence, medical or otherwise, to support the Veteran’s statements. Thus, as previously stated, the medical evidence of record is only against the Veteran’s service connection claim. Finally, the Board is cognizant of the recent ruling in Saunders v. Wilkie, which found that pain alone can constitute a disability. 886 F.3d 1356, 1368 (Fed. Cir. 2018). However, in contrast to Saunders, the Veteran has not demonstrated that his left shoulder pain results in an impairment of earning capacity. In addition, the Veteran did not complain of left shoulder pain in service or at separation, and his only documented left shoulder issue occurred when the Veteran was 37 and went away after surgical treatment (was acute). As such, Saunders is not applicable to the case currently before the Board. Accordingly, service connection for a left shoulder disorder is not warranted because the Veteran has not satisfied the first requirement of service connection, i.e., a current diagnosis of a disability. See 38 C.F.R. § 3.303 (2017); see again Gilpin, 155 F.3d at 1353; Brammer, 3 Vet. App. at 225. 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 of entitlement to service connection for a left shoulder disorder, that doctrine does not apply. 38 U.S.C. § 5107 (b) (2012). The claim of entitlement to service connection for a left shoulder disorder is denied. 3. Neck Disorder The Veteran asserts that he experiences a neck disorder, which is related to his active service. Specifically, the Veteran argues that he injured his neck working as a mechanic while in service. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). For veterans with 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases, including arthritis, 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. §§ 1112, 1113 (2012); 38 C.F.R. §§ 3.307, 3.309 (2017). Pursuant to 38 C.F.R. § 3.303 (b), where a chronic disease such as arthritis is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected. If a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303 (b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101 (3) or 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 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 diagnosed with degenerative joint disorder (DJD) of the neck. See VA treatment records, October 14, 2011. As such, the first element of service connection, a current diagnosis, has been met. The Board concludes that, while the Veteran has a current diagnosis of a neck disorder, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of the neck disorder began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d) (2017). In sum, while the Veteran’s claim meets prong (1) a current disability, it fails at prongs (2) and (3), as there is no in-service occurrence and there is no nexus between the Veteran’s current neck disorder and his active service. The Veteran’s STRs do not show that he had a history of neck issues in active service, and do not show a diagnosis of or treatment for a neck disorder. The Veteran’s post-service medical records show that he reported having neck pain. See VA treatment records, December 7, 2011; June 16, 2012. None of the medical records speak to the disorder’s etiology vis-à-vis the Veteran’s active service. The Veteran underwent a VA examination for his neck in January 2013. The examiner noted that the Veteran had no neck complaints in service. The examiner stated that any neck problems were less likely as not related to the Veteran’s active service, as working as a mechanic for two years would not cause a neck disability. See VA examination, January 2013. The examiner opined that the Veteran experienced age-related degenerative disc disease. See VA examination, January 2013, in VBMS. Based on a review of the evidence, the Board finds that service connection for a neck disorder is not warranted. In reaching this determination, the Board has also considered the lay assertions of record, including the contentions of the Veteran in support of a medical nexus. As a lay person, the Veteran is competent to report observable symptoms, such as having neck pain. See Washington v. Nicholson, 21 Vet. App. 191, 195 (2007) (holding that, “[a]s a layperson, an appellant is competent to provide information regarding visible, or otherwise observable symptoms of disability”); see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (Lay testimony is competent to establish the presence of observable symptomatology); Layno v. Brown, 6 Vet. App. 465 (1994). Lay evidence may be competent on a variety of matters concerning the nature and cause of disability. Jandreau, 492 F.3d at 1377 n.4. While the Veteran is competent to report having experienced symptoms of neck pain, he is not competent to provide a diagnosis in this case or determine that these symptoms are somehow related to his active service or any service-connected disabilities. This issue is medically complex, as it requires specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the medical evidence in this case. Crucially, the evidence of record does not show that the Veteran’s neck disorder, which was diagnosed in 2011, is in any way related to his active service. It is important for the Veteran to understand that no medical professional has tied his neck disorder to his active service, or to any of his service-connected disabilities. In fact, the neck issues were first noted in 2011, over 36 years after separation from active service. In addition, the most probative evidence of record shows that the neck disorder did not have its onset during service or for many years thereafter. The diagnosed arthritis did not manifest within one year of separation from service, but rather about 36 years after separation from service. 38 C.F.R. § 3.309 (a) (2017). The Board also observes that there is no evidence to show that neck arthritis existed or was “noted” in service. Thus, the provisions of 38 C.F.R. § 3.303 (b) pertaining to chronicity or continuity of symptomatology are not for application. Accordingly, service connection for a neck disorder is not warranted because the Veteran has not satisfied the second and third requirements of service connection, i.e., an in-service incident and a nexus. See 38 C.F.R. § 3.303 (2017); see again Gilpin, 155 F.3d at 1353; Brammer, 3 Vet. App. at 225. 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 of entitlement to service connection for a neck disorder, that doctrine does not apply. 38 U.S.C. § 5107 (b) (2012). The claim of entitlement to service connection for a neck disorder is denied. 4. Low Back Disorder The Veteran asserts that he experiences a low back disorder, which is related to his active service. Specifically, the Veteran argues that he injured his low back working as a mechanic while in service. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). For veterans with 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases, including arthritis, 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. §§ 1112, 1113 (2012); 38 C.F.R. §§ 3.307, 3.309 (2017). Pursuant to 38 C.F.R. § 3.303 (b), where a chronic disease such as arthritis is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected. If a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303 (b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101 (3) or 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 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 diagnosed with DJD of the back. See VA treatment records, October 14, 2011. As such, the first element of service connection, a current diagnosis, has been met. The Board concludes that, while the Veteran has a current diagnosis of a back disorder, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of the back disorder began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d) (2017). In sum, while the Veteran’s claim meets prong (1) a current disability, it fails at prongs (2) and (3), as there is no in-service occurrence and there is no nexus between the Veteran’s current back disorder and his active service. The Veteran’s STRs do not show that he had a history of back issues in active service, and do not show a diagnosis of or treatment for a back disorder. The Veteran’s post-service medical records show that he reported having back pain. See VA treatment records, June 5, 2013; October 20, 2014; January 12, 2015; April 6, 2017. He also experienced skin cysts on his back, which were removed, but this is not the disorder that the Veteran is claiming service connection for, it was clearly an acute issue. See VA treatment records, May 15, 2014. None of the medical records speak to the disorder’s etiology vis-à-vis the Veteran’s active service. The Veteran underwent a VA examination for his back in January 2013. The examiner noted that the Veteran had no back complaints in service. The examiner stated that any back problems were less likely as not related to the Veteran’s active service, as working as a mechanic for two years would not cause a back disability. See VA examination, January 2013. The examiner opined that the Veteran experienced age-related degenerative disc disease. See VA examination, January 2013, in VBMS. Based on a review of the evidence, the Board finds that service connection for a low back disorder is not warranted. In reaching this determination, the Board has also considered the lay assertions of record, including the contentions of the Veteran in support of a medical nexus. As a lay person, the Veteran is competent to report observable symptoms, such as having back pain. See Washington v. Nicholson, 21 Vet. App. 191, 195 (2007) (holding that, “[a]s a layperson, an appellant is competent to provide information regarding visible, or otherwise observable symptoms of disability”); see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (Lay testimony is competent to establish the presence of observable symptomatology); Layno v. Brown, 6 Vet. App. 465 (1994). Lay evidence may be competent on a variety of matters concerning the nature and cause of disability. Jandreau, 492 F.3d at 1377 n.4. While the Veteran is competent to report having experienced symptoms of back pain, he is not competent to provide a diagnosis in this case or determine that these symptoms are somehow related to his active service or any service-connected disabilities. This issue is medically complex, as it requires specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the medical evidence in this case. Crucially, the evidence of record does not show that the Veteran’s low back disorder, which was diagnosed in 2011, is in any way related to his active service. It is important for the Veteran to understand that no medical professional has tied his low back disorder to his active service, or to any of his service-connected disabilities. In fact, the back issues were first noted in 2011, over 36 years after separation from active service. In addition, the most probative evidence of record shows that the back disorder did not have its onset during service or for many years thereafter. The diagnosed arthritis did not manifest within one year of separation from service, but rather about 36 years after separation from service. 38 C.F.R. § 3.309 (a) (2017). The Board also observes that there is no evidence to show that low back arthritis existed or was “noted” in service. Thus, the provisions of 38 C.F.R. § 3.303 (b) pertaining to chronicity or continuity of symptomatology are not for application. Accordingly, service connection for a low back disorder is not warranted because the Veteran has not satisfied the second and third requirements of service connection, i.e., an in-service incident and a nexus. See 38 C.F.R. § 3.303 (2017); see again Gilpin, 155 F.3d at 1353; Brammer, 3 Vet. App. at 225. 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 of entitlement to service connection for a low back disorder, that doctrine does not apply. 38 U.S.C. § 5107 (b) (2012). The claim of entitlement to service connection for a low back disorder is denied. 5. Upper Back Disorder The Veteran asserts that he experiences an upper back disorder, which is related to his active service. Specifically, the Veteran argues that he injured his upper back working as a mechanic while in service. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). For veterans with 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases, including arthritis, 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. §§ 1112, 1113 (2012); 38 C.F.R. §§ 3.307, 3.309 (2017). Pursuant to 38 C.F.R. § 3.303 (b), where a chronic disease such as arthritis is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected. If a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303 (b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101 (3) or 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 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 diagnosed with DJD of the back. See VA treatment records, October 14, 2011. As such, the first element of service connection, a current diagnosis, has been met. The Board concludes that, while the Veteran has a current diagnosis of a back disorder, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of the back disorder began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d) (2017). In sum, while the Veteran’s claim meets prong (1) a current disability, it fails at prongs (2) and (3), as there is no in-service occurrence and there is no nexus between the Veteran’s current back disorder and his active service. The Veteran’s STRs do not show that he had a history of back issues in active service, and do not show a diagnosis of or treatment for a back disorder. The Veteran’s post-service medical records show that he reported having back pain. See VA treatment records, June 5, 2013; October 20, 2014; January 12, 2015; April 6, 2017. He also experienced skin cysts on his back, which were removed, but this is not the disorder that the Veteran is claiming service connection for, it was clearly an acute issue. See VA treatment records, May 15, 2014. None of the medical records speak to the disorder’s etiology vis-à-vis the Veteran’s active service. The Veteran underwent a VA examination for his back in January 2013. The examiner noted that the Veteran had no back complaints in service. The examiner stated that any back problems were less likely as not related to the Veteran’s active service, as working as a mechanic for two years would not cause a back disability. See VA examination, January 2013. The examiner opined that the Veteran experienced age-related degenerative disc disease. See VA examination, January 2013, in VBMS. Based on a review of the evidence, the Board finds that service connection for an upper back disorder is not warranted. In reaching this determination, the Board has also considered the lay assertions of record, including the contentions of the Veteran in support of a medical nexus. As a lay person, the Veteran is competent to report observable symptoms, such as having back pain. See Washington v. Nicholson, 21 Vet. App. 191, 195 (2007) (holding that, “[a]s a layperson, an appellant is competent to provide information regarding visible, or otherwise observable symptoms of disability”); see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (Lay testimony is competent to establish the presence of observable symptomatology); Layno v. Brown, 6 Vet. App. 465 (1994). Lay evidence may be competent on a variety of matters concerning the nature and cause of disability. Jandreau, 492 F.3d at 1377 n.4. While the Veteran is competent to report having experienced symptoms of back pain, he is not competent to provide a diagnosis in this case or determine that these symptoms are somehow related to his active service or any service-connected disabilities. This issue is medically complex, as it requires specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the medical evidence in this case. Crucially, the evidence of record does not show that the Veteran’s upper back disorder, which was diagnosed in 2011, is in any way related to his active service. It is important for the Veteran to understand that no medical professional has tied his upper back disorder to his active service, or to any of his service-connected disabilities. In fact, the back issues were first noted in 2011, over 36 years after separation from active service. In addition, the most probative evidence of record shows that the back disorder did not have its onset during service or for many years thereafter. The diagnosed arthritis did not manifest within one year of separation from service, but rather about 36 years after separation from service. 38 C.F.R. § 3.309 (a) (2017). The Board also observes that there is no evidence to show that upper back arthritis existed or was “noted” in service. Thus, the provisions of 38 C.F.R. § 3.303 (b) pertaining to chronicity or continuity of symptomatology are not for application. Accordingly, service connection for an upper back disorder is not warranted because the Veteran has not satisfied the second and third requirements of service connection, i.e., an in-service incident and a nexus. See 38 C.F.R. § 3.303 (2017); see again Gilpin, 155 F.3d at 1353; Brammer, 3 Vet. App. at 225. 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 of entitlement to service connection for an upper back disorder, that doctrine does not apply. 38 U.S.C. § 5107 (b) (2012). The claim of entitlement to service connection for an upper back disorder is denied. 6. Right Knee Disorder The Veteran asserts that he experiences a right knee disorder, which is related to his active service. Specifically, the Veteran argues that he injured his right knee working as a mechanic while in service. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). For veterans with 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases, including arthritis, 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. §§ 1112, 1113 (2012); 38 C.F.R. §§ 3.307, 3.309 (2017). Pursuant to 38 C.F.R. § 3.303 (b), where a chronic disease such as arthritis is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected. If a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303 (b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101 (3) or 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 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 diagnosed with DJD of the right knee. See VA treatment records, September 11, 2015. As such, the first element of service connection, a current diagnosis, has been met. The Board concludes that, while the Veteran has a current diagnosis of a right knee disorder, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of the right knee disorder began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d) (2017). In sum, while the Veteran’s claim meets prong (1) a current disability, it fails at prongs (2) and (3), as there is no in-service occurrence and there is no nexus between the Veteran’s current right knee disorder and his active service. The Veteran’s STRs do not show that he had a history of right knee issues in active service, and do not show a diagnosis of or treatment for a right knee disorder. The Veteran’s post-service medical records show that he reported having right knee pain. See VA treatment records, September 6, 2013; December 31, 2013; January 12, 2015; April 6, 2017. None of the medical records speak to the disorder’s etiology vis-à-vis the Veteran’s active service. The Veteran underwent a VA examination for his right knee in January 2013. The examiner noted that the Veteran had no right knee complaints in service or right after service. The examiner stated that a knee disorder was less likely as not related to the Veteran’s active service, as working as a mechanic for two years would not cause a knee disability. See VA examination, January 2013. The examiner opined that the Veteran had normal bilateral knees. See VA examination, January 2013, in VBMS. Based on a review of the evidence, the Board finds that service connection for a right knee disorder is not warranted. In reaching this determination, the Board has also considered the lay assertions of record, including the contentions of the Veteran in support of a medical nexus. As a lay person, the Veteran is competent to report observable symptoms, such as having right knee pain. See Washington v. Nicholson, 21 Vet. App. 191, 195 (2007) (holding that, “[a]s a layperson, an appellant is competent to provide information regarding visible, or otherwise observable symptoms of disability”); see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (Lay testimony is competent to establish the presence of observable symptomatology); Layno v. Brown, 6 Vet. App. 465 (1994). Lay evidence may be competent on a variety of matters concerning the nature and cause of disability. Jandreau, 492 F.3d at 1377 n.4. While the Veteran is competent to report having experienced symptoms of right knee pain, he is not competent to provide a diagnosis in this case or determine that these symptoms are somehow related to his active service or any service-connected disabilities. This issue is medically complex, as it requires specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the medical evidence in this case. Crucially, the evidence of record does not show that the Veteran’s right knee, which was diagnosed in 2015, is in any way related to his active service. It is important for the Veteran to understand that no medical professional has tied his right knee disorder to his active service, or to any of his service-connected disabilities. In fact, the right knee issues were first noted in 2015, over 40 years after separation from active service. In addition, the most probative evidence of record shows that the right knee disorder did not have its onset during service or for many years thereafter. The diagnosed arthritis did not manifest within one year of separation from service, but rather about 40 years after separation from service. 38 C.F.R. § 3.309 (a) (2017). The Board also observes that there is no evidence to show that right knee arthritis existed or was “noted” in service. Thus, the provisions of 38 C.F.R. § 3.303 (b) pertaining to chronicity or continuity of symptomatology are not for application. Accordingly, service connection for a right knee disorder is not warranted because the Veteran has not satisfied the second and third requirements of service connection, i.e., an in-service incident and a nexus. See 38 C.F.R. § 3.303 (2017); see again Gilpin, 155 F.3d at 1353; Brammer, 3 Vet. App. at 225. 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 of entitlement to service connection for a right knee disorder, that doctrine does not apply. 38 U.S.C. § 5107 (b) (2012). The claim of entitlement to service connection for a right knee disorder is denied. 7. Left Knee Disorder The Veteran asserts that he experiences a left knee disorder, which is related to his active service. Specifically, the Veteran argues that he injured his right knee working as a mechanic while in service. As an alternative theory, the Veteran asserts that his left knee disorder is related to his right knee disorder. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). 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. After a review of the record, the Board finds that there is no competent, credible, and probative evidence that would establish that the Veteran experiences a left knee disorder that is etiologically related to his active service. The Veteran’s STRs do not show that he had a history of left knee issues in active service, and do not show a diagnosis of or treatment for a left knee disorder. The Veteran’s post-service medical records show that the Veteran complained of knee pain that was not specified as to whether it was on the left or the right on one occasion. See VA treatment records, September 6, 2013. The other reports concern right knee pain and right knee issues only. No other treatment records speak to any left knee complaints or issues. The Veteran underwent a VA examination for his left knee in January 2013. The examiner noted that the Veteran had no left knee complaints in service or right after service. The examiner stated that a knee disorder was less likely as not related to the Veteran’s active service, as working as a mechanic for two years would not cause a knee disability. See VA examination, January 2013. The examiner opined that the Veteran had normal bilateral knees. See VA examination, January 2013, in VBMS. Regarding the first element of service connection, a current disability, importantly, the Veteran’s medical records do not show a diagnosis of a current left knee disorder. All treatment records in evidence are completely silent for a current left knee disorder diagnosis. The January 2013 VA examiner found that the Veteran did not experience a left knee disorder. As such, the Veteran’s claim for entitlement to service connection for a left knee disorder fails. The best evidence of record shows that the Veteran does not have a current diagnosis of a left knee disorder. In the absence of proof of a present disorder (and, if so, of a nexus between that disorder and the active military service), there can be no valid claims for service connection. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). This principle has been repeatedly reaffirmed by the Federal Circuit, which has stated that “a Veteran seeking disability benefits must establish... the existence of a disability [and] a connection between the Veteran’s service and the disability.” Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). The Board has considered whether the Veteran experienced a left knee disorder at any time during the pendency of this appeal. Service connection may be granted if there is a disability at some point during the claim even if it later resolves or becomes asymptomatic. McClain v. Nicholson, 21 Vet. App. 319 (2007). In this case, there is no evidence of a left knee disorder at any time during the pendency of this appeal. The Veteran also has not identified or submitted any competent evidence, to include a diagnosis of the disorder, or a medical nexus, relating his claimed disorder to active service. The Board has considered the Veteran’s lay statements in support of his claim. In multiple statements, the Veteran related that he believed that he experienced a left knee disorder that was related to his service. Although laypersons are competent to provide opinions on some medical issues, as to the specific issues in this case, diagnosing a left knee disorder, this issue falls outside the realm of common knowledge of a layperson. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (laypersons not competent to diagnose cancer). As a layperson, the Veteran has not been shown to possess the medical expertise to diagnose a left knee disorder and its etiology. The claims file does not contain any medical examinations diagnosing the Veteran with a left knee disorder, or linking his self-reported symptoms to his active service. In sum, there is no evidence, medical or otherwise, to support the Veteran’s statements. Thus, as previously stated, the medical evidence of record is only against the Veteran’s service connection claim. Finally, the Board is cognizant of the recent ruling in Saunders v. Wilkie, which found that pain alone can constitute a disability. 886 F.3d 1356, 1368 (Fed. Cir. 2018). However, in contrast to Saunders, the Veteran has not demonstrated that his left knee pain results in an impairment of earning capacity. In addition, the Veteran did not complain of left knee pain in service or at separation, and his only documented left knee issue occurred when the Veteran reported knee pain. As such, Saunders is not applicable to the case currently before the Board. Accordingly, service connection for a left knee disorder is not warranted because the Veteran has not satisfied the first requirement of service connection, i.e., a current diagnosis of a disability. See 38 C.F.R. § 3.303 (2017); see again Gilpin, 155 F.3d at 1353; Brammer, 3 Vet. App. at 225. In short, there is nothing to service-connect, as the Veteran does not have a diagnosed left knee disorder. 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 of entitlement to service connection for a left knee disorder, that doctrine does not apply. 38 U.S.C. § 5107 (b) (2012). The claim of entitlement to service connection for a left knee disorder is denied. 8. Bilateral Foot Disorder The Veteran asserts that he experiences a bilateral foot disorder, which is related to his active service. Specifically, the Veteran argues that he injured his feet working as a mechanic while in service. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). For veterans with 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases, including arthritis, 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. §§ 1112, 1113 (2012); 38 C.F.R. §§ 3.307, 3.309 (2017). Pursuant to 38 C.F.R. § 3.303 (b), where a chronic disease such as arthritis is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected. If a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303 (b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101 (3) or 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 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 diagnosed with minimal degenerative arthritis of the feet. See VA treatment records, January 31, 2013. As such, the first element of service connection, a current diagnosis, has been met. The Board concludes that, while the Veteran has a current diagnosis of a bilateral foot disorder, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of the bilateral foot disorder began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d) (2017). In sum, while the Veteran’s claim meets prong (1) a current disability, it fails at prongs (2) and (3), as there is no in-service occurrence and there is no nexus between the Veteran’s current bilateral foot disorder and his active service. The Veteran’s STRs do not show that he had a history of bilateral foot issues in active service, and do not show a diagnosis of or treatment for a bilateral foot disorder. The Veteran’s post-service medical records show that he reported having foot pain. See VA treatment records, January 31, 2013; March 1, 2016. None of the medical records speak to the disorder’s etiology vis-à-vis the Veteran’s active service. The Veteran underwent a VA examination for his feet in January 2013. The examiner noted that the Veteran had no foot complaints in service or right after service. The examiner related that the Veteran had arthritis of the first metatarsophalangeal joint (the big toe). See VA examination, January 2013, VBMS. The examiner stated that a bilateral foot disorder was less likely as not related to the Veteran’s active service, as working as a mechanic for two years would not cause a foot disability. See VA examination, January 2013. Based on a review of the evidence, the Board finds that service connection for a bilateral foot disorder is not warranted. In reaching this determination, the Board has also considered the lay assertions of record, including the contentions of the Veteran in support of a medical nexus. As a lay person, the Veteran is competent to report observable symptoms, such as having foot pain. See Washington v. Nicholson, 21 Vet. App. 191, 195 (2007) (holding that, “[a]s a layperson, an appellant is competent to provide information regarding visible, or otherwise observable symptoms of disability”); see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (Lay testimony is competent to establish the presence of observable symptomatology); Layno v. Brown, 6 Vet. App. 465 (1994). Lay evidence may be competent on a variety of matters concerning the nature and cause of disability. Jandreau, 492 F.3d at 1377 n.4. While the Veteran is competent to report having experienced symptoms of foot pain, he is not competent to provide a diagnosis in this case or determine that these symptoms are somehow related to his active service or any service-connected disabilities. This issue is medically complex, as it requires specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the medical evidence in this case. Crucially, the evidence of record does not show that the Veteran’s bilateral knee, which was diagnosed in 2013, is in any way related to his active service. It is important for the Veteran to understand that no medical professional has tied his foot disorder to his active service, or to any of his service-connected disabilities. In fact, the right knee issues were first noted in 2013, over 38 years after separation from active service. In addition, the most probative evidence of record shows that the bilateral foot disorder did not have its onset during service or for many years thereafter. The diagnosed arthritis did not manifest within one year of separation from service, but rather about 38 years after separation from service. 38 C.F.R. § 3.309 (a) (2017). The Board also observes that there is no evidence to show that foot arthritis existed or was “noted” in service. Thus, the provisions of 38 C.F.R. § 3.303 (b) pertaining to chronicity or continuity of symptomatology are not for application. Accordingly, service connection for a bilateral foot disorder is not warranted because the Veteran has not satisfied the second and third requirements of service connection, i.e., an in-service incident and a nexus. See 38 C.F.R. § 3.303 (2017); see again Gilpin, 155 F.3d at 1353; Brammer, 3 Vet. App. at 225. 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 of entitlement to service connection for a bilateral foot disorder, that doctrine does not apply. 38 U.S.C. § 5107 (b) (2012). The claim of entitlement to service connection for a bilateral foot disorder is denied. 9. Bilateral Eye Disorder The Veteran asserts that he experiences a bilateral eye disorder which is related to his active service. Specifically, the Veteran asserts that he injured his eyes while working as a mechanic, as liquids dripped into his eyes and he was not issued eye protection. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). 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 diagnosed with dry eye syndrome, cataracts, and ocular allergies. See VA treatment records, April 6, 2017; September 22, 2017. As such, the first element of service connection, a current diagnosis, has been met. The Board concludes that, while the Veteran has a current diagnosis of a bilateral eye disorder, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of the bilateral eye disorder began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d) (2017). In sum, while the Veteran’s claim meets prong (1) a current disability, it fails at prongs (2) and (3), as there is no in-service occurrence and there is no nexus between the Veteran’s current bilateral eye disorder and his active service. The Veteran’s STRs do not show that he had a history of eye issues in active service, and do not show a diagnosis of or treatment for an eye disorder. The Veteran’s post-service medical records show that he reported having eye issues. See VA treatment records, April 6, 2017; September 22, 2017. The Veteran reported no eye problems in March 2016. See VA treatment records, March 21, 2016. None of the medical records speak to the disorder’s etiology vis-à-vis the Veteran’s active service. Based on a review of the evidence, the Board finds that service connection for an eye disorder is not warranted. In reaching this determination, the Board has also considered the lay assertions of record, including the contentions of the Veteran in support of a medical nexus. As a lay person, the Veteran is competent to report observable symptoms, such as having dry eyes. See Washington v. Nicholson, 21 Vet. App. 191, 195 (2007) (holding that, “[a]s a layperson, an appellant is competent to provide information regarding visible, or otherwise observable symptoms of disability”); see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (Lay testimony is competent to establish the presence of observable symptomatology); Layno v. Brown, 6 Vet. App. 465 (1994). Lay evidence may be competent on a variety of matters concerning the nature and cause of disability. Jandreau, 492 F.3d at 1377 n.4. While the Veteran is competent to report having experienced eye symptoms, he is not competent to provide a diagnosis in this case or determine that these symptoms are somehow related to his active service or any service-connected disabilities. This issue is medically complex, as it requires specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the medical evidence in this case. Crucially, the evidence of record does not show that the Veteran’s eye disorder is in any way related to his active service. It is important for the Veteran to understand that no medical professional has tied his eye disorder to his active service, or to any of his service-connected disabilities. The Board acknowledges that the Veteran has not been afforded a VA examination addressing his claimed eye disorder and its relationship to his active service. No such examination is required, as the only evidence that the Veteran’s claimed disability is related to his military service are his own conclusory generalized lay statements, which are unsupported by even speculative medical evidence. See Waters v. Shinseki, 601 F.3d 1274, 1277 (Fed. Cir. 2010); Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010). Accordingly, service connection for a bilateral eye disorder is not warranted because the Veteran has not satisfied the second and third requirements of service connection, i.e., an in-service incident and a nexus. See 38 C.F.R. § 3.303 (2017); see again Gilpin, 155 F.3d at 1353; Brammer, 3 Vet. App. at 225. 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 of entitlement to service connection for a bilateral eye disorder, that doctrine does not apply. 38 U.S.C. § 5107 (b) (2012). The claim of entitlement to service connection for a bilateral eye disorder is denied. 10. Sleep Disorder The Veteran asserts that he experiences a sleep disorder which is related to his active service. Specifically, the Veteran asserts that he snores. As an alternative theory, the Veteran asserts that his sleep disorder is secondary to his service-connected migraine headaches. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2017). 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 diagnosed with insomnia. See VA treatment records, January 12, 2015; February 16, 2016. As such, the first element of service connection, a current diagnosis, has been met. The Board concludes that, while the Veteran has a current diagnosis of a sleep disorder, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of the sleep disorder began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d) (2017). In sum, while the Veteran’s claim meets prong (1) a current disability, it fails at prongs (2) and (3), as there is no in-service occurrence and there is no nexus between the Veteran’s current sleep disorder and his active service. The Veteran’s STRs do not show that he had a history of sleep issues in active service, and do not show a diagnosis of or treatment for a sleep disorder. The Veteran’s post-service medical records show that he reported having sleep problems. See VA treatment records, January 12, 2015; February 16, 2016. The Veteran also reported that he slept better. He was noted not to have a sleep apnea diagnosis. See VA treatment records, October 3, 2016; May 2, 2016. None of the medical records speak to the disorder’s etiology vis-à-vis the Veteran’s active service. The Veteran underwent a VA sleep examination for his feet in February 2013. The examiner noted that the Veteran had no sleep complaints in service, but that the Veteran related that his insomnia started in basic training (about 40 years ago). The examiner stated that the Veteran did not have any symptoms of sleep apnea, and experienced insomnia. The examiner stated that insomnia was less likely as not related to the Veteran’s active service, as the Veteran did not report any sleep issues in service, and his current insomnia was treated successfully with sleep aids, which the Veteran started taking a few years ago. The examiner added that migraine headaches did not cause chronic insomnia. The examiner also opined that migraines did not cause sleep apnea, that the Veteran was never told that he had sleep apnea, and there was no evidence of sleep apnea either now or in service. See VA examination, February 2013. Based on a review of the evidence, the Board finds that service connection for a sleep disorder is not warranted. In reaching this determination, the Board has also considered the lay assertions of record, including the contentions of the Veteran in support of a medical nexus. As a lay person, the Veteran is competent to report observable symptoms, such as having problems falling asleep. See Washington v. Nicholson, 21 Vet. App. 191, 195 (2007) (holding that, “[a]s a layperson, an appellant is competent to provide information regarding visible, or otherwise observable symptoms of disability”); see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (Lay testimony is competent to establish the presence of observable symptomatology); Layno v. Brown, 6 Vet. App. 465 (1994). Lay evidence may be competent on a variety of matters concerning the nature and cause of disability. Jandreau, 492 F.3d at 1377 n.4. While the Veteran is competent to report having experienced symptoms of sleep problems, he is not competent to provide a diagnosis in this case or determine that these symptoms are somehow related to his active service or any service-connected disabilities. This issue is medically complex, as it requires specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the medical evidence in this case. Crucially, the evidence of record does not show that the Veteran’s sleep disorder, which was diagnosed many years after separation from service, is in any way related to his active service. It is important for the Veteran to understand that no medical professional has tied his sleep disorder to his active service, or to any of his service-connected disabilities. Accordingly, service connection for a sleep disorder is not warranted because the Veteran has not satisfied the second and third requirements of service connection, i.e., an in-service incident and a nexus. See 38 C.F.R. § 3.303 (2017); see again Gilpin, 155 F.3d at 1353; Brammer, 3 Vet. App. at 225. 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 of entitlement to service connection for a sleep disorder, that doctrine does not apply. 38 U.S.C. § 5107 (b) (2012). The claim of entitlement to service connection for a sleep disorder is denied. REASONS FOR REMAND 1. Headaches At the June 2018 hearing before the Board, the Veteran’s spouse asserted, and the Veteran confirmed, that the Veteran’s headache disability has worsened since the last DBQ examination, which took place in August 2012. See hearing transcript, June 2018. As such, the Veteran must be scheduled for a new VA examination to assess the current severity of his headache disability. Snuffer v. Gober, 10 Vet. App. 400 (1997) (noting that a Veteran is entitled to a new VA examination where there is evidence that the condition has worsened since the last examination). Additionally, current treatment records should be identified and obtained. The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Schedule the Veteran for a VA headache examination to determine the current level of severity of all impairment resulting from his headaches. The claims file must be made available, and reviewed by the examiner. Any indicated studies must be performed. The examiner should provide all information required for rating purposes. The examiner must review the claims file and note that review in the examination report. The examiner must provide the rationale for all opinions expressed. If the examiner is unable to provide the required opinions, the examiner should explain why that is. The examiner should provide opinions on the following: Please identify all headache pathology found to be present. Conduct all indicated tests and studies. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Lech, Counsel