Citation Nr: 18155333 Decision Date: 12/04/18 Archive Date: 12/03/18 DOCKET NO. 18-15 772 DATE: December 4, 2018 ORDER Entitlement to service connection for a right knee disorder is denied. Entitlement to service connection for a left knee disorder is denied. Entitlement to service connection for bilateral foot gout is denied. Entitlement to service connection for a back disorder is denied. REMANDED Entitlement to service connection for diabetes mellitus, type II, to include as due to herbicide exposure, is remanded. Entitlement to service connection for coronary artery disease, to include as due to herbicide exposure, is remanded. FINDINGS OF FACT 1. 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. 2. The Veteran’s left knee disorder is not etiologically related to his active service. Left knee arthritis did not manifest within the one-year presumptive period. 3. The Veteran’s bilateral foot gout disorder is not etiologically related to his active service. Bilateral foot arthritis did not manifest within the one-year presumptive period. 4. The Veteran’s back disorder is not etiologically related to his active service. Gout arthritis did not manifest within the one-year presumptive period. CONCLUSIONS OF LAW 1. The criteria for a right knee disorder have not been met. 2. The criteria for a left knee disorder have not been met. 3. The criteria for bilateral foot gout have not been met. 4. The criteria for a back disorder have not been met. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from July 1964 to July 1976. Service Connection 1. Right Knee Disorder The Veteran asserts that he experiences a right knee disorder as a result of his active 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. § 1110 (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. VA records show that the Veteran experiences bilateral knee osteoarthritis. See VA treatment records, November 29, 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 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 a 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 the Veteran experiences bilateral knee osteoarthritis. See VA treatment records, November 29, 2017. The Veteran was diagnosed with osteoarthritis on November 8, 2017. See VA treatment records, November 8, 2017. 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 disorder, which was diagnosed in 2017, 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 diagnosed over 41 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 41 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. The Board acknowledges that the Veteran has not been afforded a VA examination addressing his claimed knee 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). 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 right knee pain results in an impairment of earning capacity. In addition, the Veteran did not complain of right knee pain in service or at separation, and his only documented right knee issues were diagnosed about 41 years after separation from service. As such, Saunders is not applicable to the case currently before the Board. 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. 2. Left Knee Disorder The Veteran asserts that he experiences a left knee disorder as a result of his active 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. VA records show that the Veteran experiences bilateral knee osteoarthritis. See VA treatment records, November 29, 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 left knee disorder, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of the left 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 left knee disorder and 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 experiences bilateral knee osteoarthritis. See VA treatment records, November 29, 2017. The Veteran was diagnosed with osteoarthritis on November 8, 2017. See VA treatment records, November 8, 2017. Based on a review of the evidence, the Board finds that service connection for a left 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 left 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 left 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 left knee disorder, which was diagnosed in 2017, is in any way related to his active service. It is important for the Veteran to understand that no medical professional has tied his left knee disorder to his active service, or to any of his service-connected disabilities. In fact, the left knee issues were diagnosed over 41 years after separation from active service. In addition, the most probative evidence of record shows that the left 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 41 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 left 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. The Board acknowledges that the Veteran has not been afforded a VA examination addressing his claimed knee 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). 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 issues were diagnosed about 41 years after separation from service. 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 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 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. 3. Bilateral Foot Gout The Veteran asserts that he experiences gout as a result of his active 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. VA treatment records show that the Veteran has a diagnosis of chronic gout, and that he complained of left ankle gout and right knee. See VA treatment records, November 29, 2017, November 7, 2017. His private treatment records show a diagnosis of gout. See private treatment records, April 13, 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 gout, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of gout (a type of arthritis) 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 gout and his active service. The Veteran’s STRs do not show that he had a history of gout in active service, and do not show a diagnosis of or treatment for gout. The Veteran’s post-service medical records show that the Veteran experiences gout. See VA treatment records, November 29, 2017, November 7, 2017; private treatment records, April 13, 2016. Based on a review of the evidence, the Board finds that service connection for gout 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 joint 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 joint 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 gout, which appears to have been diagnosed in or around 2016, is in any way related to his active service. It is important for the Veteran to understand that no medical professional has tied his gout to his active service, or to any of his service-connected disabilities. In fact, gout was diagnosed approximately 40 years after separation from active service. In addition, the most probative evidence of record shows that gout 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 gout 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. The Board acknowledges that the Veteran has not been afforded a VA examination addressing his claimed gout 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). 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 gout pain results in an impairment of earning capacity. In addition, the Veteran did not complain of gout pain in service or at separation, and his only documented gout issues were diagnosed about 40 years after separation from service. As such, Saunders is not applicable to the case currently before the Board. Accordingly, service connection for a gout 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 gout, that doctrine does not apply. 38 U.S.C. § 5107 (b) (2012). The claim of entitlement to service connection for gout is denied. 4. Back Disorder The Veteran asserts that he experiences a back disorder, claimed as a lumbar back disorder, as a result of his active 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’s post-service medical records show that the Veteran experiences a back disorder. See VA treatment records, November 29, 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 back disorder, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of a 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 back problems. The Veteran’s post-service medical records show that the Veteran experiences a back disorder. VA treatment records show that the Veteran has a diagnosis of chronic back pain, and that he underwent back surgery (spinal decompression) in July 2011. See VA treatment records, November 29, 2017. The Veteran related that he took Tylenol for his back pain. See VA treatment records, July 11, 2017. His private treatment records show that the Veteran had back surgery for a herniated disc, per history, but that he did not experience any back or joint pain. See private treatment records, April 29, 2014. Based on a review of the evidence, the Board finds that service connection for a 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 back 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 back disorder to his active service, or to any of his service-connected disabilities. 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 decades after separation from service. 38 C.F.R. § 3.309 (a) (2017). The Board also observes that there is no evidence to show that 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. The Board acknowledges that the Veteran has not been afforded a VA examination addressing his claimed back 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). 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 back pain results in an impairment of earning capacity. In addition, the Veteran did not complain of back pain in service or at separation, and his only documented back issues were diagnosed decades after separation from service. As such, Saunders is not applicable to the case currently before the Board. Accordingly, service connection for a 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 back disorder, that doctrine does not apply. 38 U.S.C. § 5107 (b) (2012). The claim of entitlement to service connection for a back disorder is denied. REASONS FOR REMAND 1. Diabetes Mellitus and Coronary Artery Disease In his claim, the Veteran alleged that he was exposed to herbicides, including Agent Orange, in service, which presumptively caused him to develop coronary artery disease and diabetes mellitus, while in service. In a March 2018 statement, the Veteran asserted that he was exposed to Agent Orange during his service in Japan while stationed at 3rd Force Service Regiment (3rd FSR) in Okinawa. The Veteran stated that he was a 3rd and 4th echelon mechanic, and worked on many transport vehicles from Vietnam, which were used to transport Agent Orange in Vietnam. The Veteran stated that he worked at an Agent Orange decontamination station, where he decontaminated vehicles with a steam genie before working on them. He related that the vehicles were covered with dust, dirt, and debris when they arrived in Okinawa from Vietnam, and pressure-washing the vehicles blasted all the dirt, dust, and debris off the vehicles, and into the Veteran’s mouth and nose. See Veteran’s statement, March 13, 2018. The law provides that diseases associated with exposure to certain herbicide agents used in support of military operations in the Republic of Vietnam (Vietnam) during the Vietnam era will be considered to have been incurred in service. 38 U.S.C. § 1116 (a)(1) (2012); 38 C.F.R. § 3.307 (a)(6) (2017). In addition, a veteran who during active military service between April 1, 1968, and August 31, 1971, served in a unit that operated in or near the Korean DMZ in an area in which herbicides are known to have been applied during that period, as determined by the DOD, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to the contrary. 38 C.F.R. § 3.307 (a)(6)(iv) (2017); 76 Fed. Reg. 4,245 - 4,247 (January 25, 2011). However, the presumption of service connection for herbicide-related diseases could also apply if exposure to herbicide agents is shown on a factual basis. In essence, if the veteran did not serve in Vietnam during the Vietnam Era or at the Korean DMZ in a particular unit during the required timeframe, actual exposure to herbicide agents must be verified through appropriate service department or other sources in order for the presumption of service connection for herbicide-related diseases under 38 C.F.R. § 3.309 (e) to be applicable. Exposure to herbicide agents is not presumed in such instances, but the exposure to one of the herbicides listed at 38 C.F.R. § 3.307 (a)(6)(i) can still be established if shown by the facts of the case. Once exposure to herbicide agents has been established by the facts of the case, the presumption of service connection found in 38 C.F.R. § 3.309 (e) for herbicide-related diseases is applicable. VA treatment records confirm that the Veteran has type II diabetes mellitus and coronary artery disease. See VA treatment records, July 11, 2017; private treatment records, September 19, 2016. Therefore, the central question in the present case is whether the evidence establishes on a factual basis that the Veteran was exposed to Agent Orange or other herbicides while serving in Okinawa, Japan, from August 1965 to July 1966. 38 U.S.C. § 1116 (a) (2012); 38 C.F.R. §§ 3.307 (a)(6)(iii), (iv); 3.313(a) (2017). No action has been taken to verify whether this exposure occurred. A remand is necessary to complete the necessary development. In summary, upon remand, the AOJ should follow the appropriate steps in order to attempt to verify exposure to herbicides for the Veteran in Okinawa, Japan from August 1965 to July 1966. See Service Personnel Records (SPRs) for service dates. The matter is REMANDED for the following action: 1. Please attempt to verify exposure to herbicides for the Veteran while stationed with the 3rd FSR in Okinawa, Japan from August 1965 to July 1966, on a factual basis. Please follow the appropriate steps to verify said exposure. The results of these development efforts should be outlined in a memorandum for the record. Please note specifically that the Veteran asserts that he cleaned and power-washed vehicles arriving from Vietnam which were covered in leaves and dirt contaminated by herbicide, and that he inhaled herbicide as a result. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Lech, Counsel