Citation Nr: 18156661 Decision Date: 12/10/18 Archive Date: 12/10/18 DOCKET NO. 16-55 357 DATE: December 10, 2018 ORDER Service connection for fibromyalgia (extreme fatigue and nausea) is denied. New and material evidence has been presented, and the claim for service connection for a right shoulder disability with right side body joint pain is reopened. Service connection for a right shoulder disability with right side body joint pain is denied. Service connection for a left arm disability is denied. Service connection for a right arm disability is denied. Service connection for a neck condition with pain is denied. New and material evidence has been presented, and the claim for service connection for a right knee disability with right side body joint pain is reopened. Service connection for service connection for a right knee disability with right side body joint pain is denied. New and material evidence has been presented, and the claim for service connection for a right ankle disability with right side body joint pain is reopened. Service connection for a left foot disability is denied. Service connection for a right foot disability is denied. Service connection for a bilateral ear condition with pain is denied. Service connection for insomnia with sleep problems is denied. Service connection for abdominal pain and discomfort is denied. Service connection for edema with fluid retention is denied. Service connection for skin irritation of the genitals is denied. Service connection for a disability of the toes (nails) with swelling and fungus is denied. Service connection for diabetes mellitus, type II (DM) is denied. FINDINGS OF FACT 1. The Veteran does not have a current disability manifested by fibromyalgia (extreme fatigue and nausea). 2. In an unappealed rating decision issued in December 2014, the RO denied the Veteran’s claim for service connection for a right shoulder condition. 3. The evidence associated with the claims file subsequent to the December 2014 denial includes evidence that relates to an unestablished fact necessary to substantiate the claim for service connection, is not cumulative or redundant of the evidence previously of record and raises a reasonable possibility of substantiating the claim for service connection for a right shoulder disability with right side body joint pain. 4. A right shoulder disability was not present in service or for years thereafter, and is not etiologically related to service. 5. The Veteran does not have a currently diagnosed left arm disability. 6. The Veteran does not have a currently diagnosed right arm disability. 7. A neck disability was not present in service or for years thereafter, and is not etiologically related to service. 8. In an unappealed rating decision issued in December 2014, the RO denied the Veteran’s claim for service connection for a right knee condition. 9. The evidence associated with the claims file subsequent to the December 2014 denial includes evidence that relates to an unestablished fact necessary to substantiate the claim for service connection, is not cumulative or redundant of the evidence previously of record and raises a reasonable possibility of substantiating the claim for service connection for a right knee disability with right side body joint pain. 10. A right knee disability was not present in service or for years thereafter, and is not etiologically related to service. 11. In an unappealed rating decision issued in December 2014, the RO denied the Veteran’s claim for service connection for a right ankle condition. 12. The evidence associated with the claims file subsequent to the December 2014 denial includes evidence that relates to an unestablished fact necessary to substantiate the claim for service connection, is not cumulative or redundant of the evidence previously of record and raises a reasonable possibility of substantiating the claim for service connection for a right ankle disability with right side body joint pain. 13. The Veteran does not have a currently diagnosed left foot disability. 14. The Veteran does not have a currently diagnosed right foot disability. 15. The Veteran does not have a currently diagnosed bilateral ear condition with pain. 16. A sleep disability was not present in service or for years thereafter, and is not etiologically related to service. 17. The Veteran does not have a chronic disability manifested by abdominal pain and discomfort. 18. A disability manifested by edema with fluid retention was not present in service or for years thereafter, and is not etiologically related to service. 19. The Veteran does not have a currently diagnosed disability manifested by skin irritation of the genitals. 20. The Veteran does not have a currently diagnosed disability of the toes (nails) with swelling and fungus. 21. DM was not present in service or for years thereafter, and is not etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for fibromyalgia (extreme fatigue and nausea) have not been met. 38 U.S.C. §§ 1110 (2012); 38 C.F.R. §§ 3.303, 3.304 (2018). 2. New and material evidence has been received to reopen a claim for service connection for a right shoulder disability with right side body joint pain. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (a) (2018). 3. A right shoulder disability was not incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303 (2018). 4. The criteria for service connection for a left arm disability have not been met. 38 U.S.C. §§ 1110 (2012); 38 C.F.R. §§ 3.303, 3.304 (2018). 5. The criteria for service connection for a right arm disability have not been met. 38 U.S.C. §§ 1110 (2012); 38 C.F.R. §§ 3.303, 3.304 (2018). 6. A neck disability was not incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303 (2018). 7. New and material evidence has been received to reopen a claim for service connection for a right knee disability with right side body joint pain. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (a) (2018). 8. A right knee disability was not incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303 (2018). 9. New and material evidence has been received to reopen a claim for service connection for a right ankle disability with right side body joint pain. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (a) (2018). 10. The criteria for service connection for a left foot disability have not been met. 38 U.S.C. §§ 1110 (2012); 38 C.F.R. §§ 3.303, 3.304 (2018). 11. The criteria for service connection for a right foot disability have not been met. 38 U.S.C. §§ 1110 (2012); 38 C.F.R. §§ 3.303, 3.304 (2018). 12. The criteria for service connection for a bilateral ear condition with pain have not been met. 38 U.S.C. §§ 1110 (2012); 38 C.F.R. §§ 3.303, 3.304 (2018). 13. A sleep disability was not incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303 (2018). 14. The criteria for service connection for a chronic disability manifested by abdominal pain and discomfort have not been met. 38 U.S.C. §§ 1110 (2012); 38 C.F.R. §§ 3.303, 3.304 (2018). 15. A disability manifested by edema with fluid retention was not incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303 (2018). 16. The criteria for service connection for a disability manifested by skin irritation of the genitals have not been met. 38 U.S.C. §§ 1110 (2012); 38 C.F.R. §§ 3.303, 3.304 (2018). 17. The criteria for service connection for a disability of the toes (nails) with swelling and fungus have not been met. 38 U.S.C. §§ 1110 (2012); 38 C.F.R. §§ 3.303, 3.304 (2018). 18. DM was not incurred in or aggravated during active duty, and its incurrence or aggravation during active duty may not be presumed. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 1153 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.306, 3.307, 3.309 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1965 to January 1969, and from February 1969 to August 1971. Claims to Reopen As a general rule, a previously denied claim shall be reopened and reviewed if new and material evidence is presented or secured with respect to that claim. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. When a claimant seeks to reopen a final decision, the first inquiry is whether the evidence obtained after the last disallowance is "new and material." Under 38 C.F.R. § 3.156 (a), new evidence means evidence not previously submitted to agency decision makers. Material evidence means evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). The submission of "new and material" evidence is a jurisdictional prerequisite to the Board's review of such an attempt to reopen a claim. Absent the submission of evidence that is sufficient to reopen the claim, the Board's analysis must cease. See Barnett v. Brown, 83 F.3d 1380, 1384 (Fed. Cir. 1996); Butler v. Brown, 9 Vet. App. 167, 171 (1996); McGinnis v. Brown, 4 Vet. App. 239, 244 (1993). The United States Court of Appeals for Veterans Claims has held that the determination of whether newly submitted evidence raises a reasonable possibility of substantiating the claim, in the final sentence of 38 C.F.R. § 3.156 (a), does not create a third element in the reopening process, but is a component of the question of what is new and material evidence, rather than a separate determination to be made if evidence is new and material. See Shade v. Shinseki, 24 Vet. App.110, 117 (2010) (noting that 38 U.S.C. § 5108 requires only new and material evidence to reopen). Shade further holds that 38 C.F.R. § 3.156 "suggests a standard that would require reopening if newly submitted evidence, combined with VA assistance and considering the other evidence of record, raises a reasonable possibility of substantiating the claim[.]" Id. Further, the Board should not focus solely on whether the evidence remedies the principal reason for denial in the last prior decision, and regulations do not require new and material evidence as to each previously unproven element of a claim. Id. Rather, the Board should focus on whether the evidence, taken together, could at least trigger the duty to assist by providing a medical opinion. Id. See also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Simply stated, the standard is low, but it is a standard that needs to be met. When determining whether a claim should be reopened, the credibility of the newly submitted evidence is generally presumed. Justus v. Principi, 3 Vet. App. 510 (1992). If the evidence is new, but not material, the inquiry ends and the claim cannot be reopened. Smith v. West, 12 Vet. App. 312 (1999). Once evidence is deemed new and material, the Board can proceed to review the claim based on the merits and the entire evidence of record. 1. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a right shoulder disability 2. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a right ankle disability 3. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for a right knee disability In a December 2014 rating decision, the RO denied service connection for right shoulder, right knee and right ankle disabilities. Service connection for a right shoulder disability was denied because the evidence did not show that the currently diagnosed right shoulder disability was related to or caused by service. Service connection for a right knee and right ankle disability was denied because there was no evidence of a currently diagnosed right knee or right ankle disability. The Veteran did not file a timely appeal and the decision became final. Although the Veteran never filed a petition to reopen his claims, in a July 2015 rating decision, the RO reopened and denied the claims for service connection for a right shoulder, right knee and right ankle disability. In December 2015, the Veteran filed a notice of disagreement with the July 2015 rating decision, which the Board has interpreted as a petition to reopen his claims for service connection for a right ankle disability, a right knee disability and a right shoulder disability. Pertinent evidence added to the record since the December 2014 denial includes VA treatment records showing treatment for a right shoulder, right knee and right ankle disability, and the Veteran’s reports of right shoulder pain for over 20 years. The evidence also includes the Veteran’s reports that his right shoulder, right knee and right ankle disabilities developed during his active military service and continued after his discharge. See August 2018 Appellant’s Brief. The Board finds that the VA treatment records and the Veteran’s reports of continuous right shoulder, right knee and right ankle pain since active service are new and not cumulative or redundant of evidence already of record. Furthermore, this newly submitted evidence relates to a fact necessary to substantiate the claims, i.e. whether the Veteran's currently diagnosed right shoulder, right knee and right ankle disabilities were incurred during active service, and raises a reasonable possibility of substantiating the claims. The new VA treatment records and the Veteran’s reports in the August 2018 Appellant’s Brief thereby satisfy the low threshold requirement for new and material evidence; and, the claims are reopened. See Shade v. Shinseki, 24 Vet. App. 110 (2010). Service Connection Service connection may be established for disability resulting from disease or injury incurred in or aggravated by active duty service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Generally, to establish service connection, the evidence must show (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury (or in-service aggravation). Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303 (d) (2018). Under 38 C.F.R. § 3.303 (b), an alternative method of establishing the second and third Shedden/Caluza element is through a demonstration of continuity of symptomatology. Barr v. Nicholson, 21 Vet. App. 303 (2007); see Clyburn v. West, 12 Vet. App. 296, 302 (1999). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post- service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. See Hickson, 12 Vet. App. at 253 (lay evidence of in-service incurrence sufficient in some circumstances for purposes of establishing service connection); 38 C.F.R. § 3.303 (b). The theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic under 38 C.F.R. § 3.309 (a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In relevant part, 38 U.S.C. 1154 (a) requires that VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d at 1337 ("[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence"). "Symptoms, not treatment, are the essence of any evidence of continuity of symptomatology." Wilson v. Derwinski, 2 Vet. App. 16, 19 (1991). Once evidence is determined to be competent, the Board must then determine whether such evidence is also credible. See Layno, supra (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted"). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). With chronic diseases shown as such in service, or within the presumptive period after service, so as to permit a finding of service connection, subsequent manifestation of the same chronic disease at any later date, however remote, are service-connected unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303 (b). § 3.303(b) does not apply to any condition that has not been recognized as chronic under 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests diabetes mellitus, type II to a degree of 10 percent or more within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (2012); 38 C.F.R. § 3.102 (2018); see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. At 54. 1. Service connection for fibromyalgia (extreme fatigue and nausea) Service treatment records do not contain evidence of complaints or treatment for fibromyalgia with extreme fatigue and nausea during active duty or at discharge. The post-service medical evidence of record shows that the Veteran has been diagnosed with multiple joint pain and arthralgia in multiple joints. However, there is no definitive diagnosis of fibromyalgia with extreme fatigue and nausea of record. Whether service connection is claimed on direct, presumptive, or any other basis, a necessary element for establishing such a claim is the existence of a current disability. See Degmetich v. Brown, 104 F.3d 1328 (1997) (holding that section 1110 of the statute requires the existence of a present disability for VA compensation purposes); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). The presence of a disability at the time of filing of a claim or during its pendency warrants a finding that the current disability requirement has been met, even if the disability resolves prior to the Board's adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In this case, while the Veteran has reported suffering from pain in the joints, fatigue and nausea, there is no confirmation in the medical evidence that the Veteran has had a current diagnosis of fibromyalgia with fatigue and nausea since the filing of his claim in October 2014. VA does not generally grant service connection for symptoms alone, without an identified basis for those symptoms. VA needs to identify a disability, not symptoms of a disability. Accordingly, service connection cannot be granted for symptoms of a disability, such as pain, fatigue and nausea. In light of the absence of any competent evidence of fibromyalgia with fatigue and nausea during the pendency of this appeal, this claim must be denied. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Service connection for a right shoulder disability Service treatment records are negative for any evidence of complaints, treatment or a diagnosis related to a right shoulder disability during the Veteran's active military service. VA treatment records show that the Veteran was first diagnosed with a right shoulder disability many years after his discharge. However, these records do not indicate that the Veteran's currently diagnosed right shoulder disability is related to his active military service. The Board also notes that the prolonged period without a diagnosis of a right shoulder disability is probative evidence against the claim. See Maxon v. West, 12 Vet. App. 453, 459 (1999), affirmed sub nom. Maxon v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (ruling that a prolonged period without medical complaint can be considered, along with other factors, as evidence of whether an injury or a disease was incurred in service resulting in any chronic or persistent disability). Most importantly, though, there is no medical opinion of record linking the currently diagnosed right shoulder disability to the Veteran’s service. The Veteran has not provided any competent medical evidence of a nexus between his current right shoulder disability and his active military service. The Veteran alleges that his right shoulder problems first started in service and continued after his discharge. However, to attribute the Veteran's right shoulder disability to military service without objective medical evidence of in-service treatment, or continuity of treatment after service discharge, or a medical opinion providing a nexus, would require excessive speculation. The presumption of service connection for chronic diseases diagnosed within one year following discharge from active duty is also not applicable to this case because the evidence demonstrates that the Veteran's right shoulder arthralgia was diagnosed more than one year after the Veteran's discharge from service. The Board acknowledges the Veteran's assertion that he has a current right shoulder disability, due to events during his active military service. However, while the Veteran is competent to report the observable symptoms of a disability, and in certain situations a lay person may be competent to establish the etiology of a disability; in the present case, the Veteran is not competent to provide a nexus between his currently diagnosed right shoulder disability and his active service or events therein. Such an opinion would require medical expertise as it would require clinical testing and interpretation of clinical findings as well as assessing the relevance of any noted symptomatology. Thus, the Board finds that the Veteran, as a layperson, is not qualified to render an opinion concerning the cause of his right shoulder disability. 38 C.F.R. § 3.159(a)(1), (2) (2018). For the reasons and basis stated above, the Board finds that service connection for a right shoulder disability is not warranted. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 3. Service connection for a left arm disability Service treatment records are negative for any evidence of a left arm disability during active duty or at discharge. The post-service medical evidence of record fails to show that the Veteran has a currently diagnosed left arm disability. Whether service connection is claimed on direct, presumptive, or any other basis, a necessary element for establishing such a claim is the existence of a current disability. See Degmetich v. Brown, 104 F.3d 1328 (1997) (holding that section 1110 of the statute requires the existence of a present disability for VA compensation purposes); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). The presence of a disability at the time of filing of a claim or during its pendency warrants a finding that the current disability requirement has been met, even if the disability resolves prior to the Board's adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In this case, while the Veteran has reported suffering from pain in the left arm, there is no confirmation in the medical evidence that the Veteran has had a current diagnosis of a chronic left arm disability since the filing of his claim in October 2014. VA does not generally grant service connection for symptoms alone, without an identified basis for those symptoms. VA needs to identify a disability, not symptoms of a disability. Accordingly, service connection cannot be granted for symptoms of a disability, such as pain. In light of the absence of any competent evidence of a left arm disability during the pendency of this appeal, this claim must be denied. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 4. Service connection for a right arm disability Service treatment records are negative for any evidence of a right arm disability during active duty or at discharge. The post-service medical evidence of record fails to show that the Veteran has a currently diagnosed right arm disability. Whether service connection is claimed on direct, presumptive, or any other basis, a necessary element for establishing such a claim is the existence of a current disability. See Degmetich v. Brown, 104 F.3d 1328 (1997) (holding that section 1110 of the statute requires the existence of a present disability for VA compensation purposes); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). The presence of a disability at the time of filing of a claim or during its pendency warrants a finding that the current disability requirement has been met, even if the disability resolves prior to the Board's adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In this case, while the Veteran has reported suffering from pain in the right arm, there is no confirmation in the medical evidence that the Veteran has had a current diagnosis of a chronic right arm disability since the filing of his claim in October 2014. VA does not generally grant service connection for symptoms alone, without an identified basis for those symptoms. VA needs to identify a disability, not symptoms of a disability. Accordingly, service connection cannot be granted for symptoms of a disability, such as pain. In light of the absence of any competent evidence of a right arm disability during the pendency of this appeal, this claim must be denied. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. Service connection for a neck condition with pain Service treatment records are negative for any evidence of a neck or cervical spine condition during active duty or at discharge. VA treatment records show complaints of neck pain and tenderness. CTA of head/neck in 2012 showed no acute findings, but 2012 VA treatment records also show degenerative joint disease (DJD) with neck pain. As such, the Board finds that the Veteran has been diagnosed with a neck disability during the current appeal period. VA treatment records show that the Veteran was first diagnosed with a neck disability many years after his discharge. However, these records do not indicate that the Veteran's currently diagnosed neck disability is related to his active military service. The Board also notes that the prolonged period without a diagnosis of a neck disability is probative evidence against the claim. See Maxon v. West, 12 Vet. App. 453, 459 (1999), affirmed sub nom. Maxon v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (ruling that a prolonged period without medical complaint can be considered, along with other factors, as evidence of whether an injury or a disease was incurred in service resulting in any chronic or persistent disability). Most importantly, though, there is no medical opinion of record linking the currently diagnosed neck disability to the Veteran’s service. The Veteran has not provided any competent medical evidence of a nexus between his current neck disability and his active military service. The Veteran alleges that his neck problems first started in service and continued after his discharge. However, to attribute the Veteran's neck disability to military service without objective medical evidence of in-service treatment, or continuity of treatment after service discharge, or a medical opinion providing a nexus, would require excessive speculation. The presumption of service connection for chronic diseases diagnosed within one year following discharge from active duty is also not applicable to this case because the evidence demonstrates that the Veteran's DJD of the neck was diagnosed more than one year after the Veteran's discharge from service. The Board acknowledges the Veteran's assertion that he has a current neck disability, due to events during his active military service. However, while the Veteran is competent to report the observable symptoms of a disability, and in certain situations a lay person may be competent to establish the etiology of a disability; in the present case, the Veteran is not competent to provide a nexus between his currently diagnosed neck disability and his active service or events therein. Such an opinion would require medical expertise as it would require clinical testing and interpretation of clinical findings as well as assessing the relevance of any noted symptomatology. Thus, the Board finds that the Veteran, as a layperson, is not qualified to render an opinion concerning the cause of his neck disability. 38 C.F.R. § 3.159(a)(1), (2) (2018). For the reasons and basis stated above, the Board finds that service connection for a neck disability is not warranted. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 6. Service connection for a right knee disability Service treatment records are negative for any evidence of complaints, treatment or a diagnosis related to a right knee disability during the Veteran's active military service. VA treatment records show that the Veteran was first diagnosed with a right knee disability many years after his discharge. However, these records do not indicate that the Veteran's currently diagnosed right knee disability is related to his active military service. The Board also notes that the prolonged period without a diagnosis of a right shoulder disability is probative evidence against the claim. See Maxon v. West, 12 Vet. App. 453, 459 (1999), affirmed sub nom. Maxon v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (ruling that a prolonged period without medical complaint can be considered, along with other factors, as evidence of whether an injury or a disease was incurred in service resulting in any chronic or persistent disability). Most importantly, though, there is no medical opinion of record linking the currently diagnosed right knee disability to the Veteran’s service. The Veteran has not provided any competent medical evidence of a nexus between his current right knee disability and his active military service. The Veteran alleges that his right knee problems first started in service and continued after his discharge. However, to attribute the Veteran's right knee disability to military service without objective medical evidence of in-service treatment, or continuity of treatment after service discharge, or a medical opinion providing a nexus, would require excessive speculation. The presumption of service connection for chronic diseases diagnosed within one year following discharge from active duty is also not applicable to this case because the evidence demonstrates that the Veteran's right knee arthralgia was diagnosed more than one year after the Veteran's discharge from service. The Board acknowledges the Veteran's assertion that he has a current right knee disability, due to events during his active military service. However, while the Veteran is competent to report the observable symptoms of a disability, and in certain situations a lay person may be competent to establish the etiology of a disability; in the present case, the Veteran is not competent to provide a nexus between his currently diagnosed right knee disability and his active service or events therein. Such an opinion would require medical expertise as it would require clinical testing and interpretation of clinical findings as well as assessing the relevance of any noted symptomatology. Thus, the Board finds that the Veteran, as a layperson, is not qualified to render an opinion concerning the cause of his right knee disability. 38 C.F.R. § 3.159(a)(1), (2) (2018). For the reasons and basis stated above, the Board finds that service connection for a right knee disability is not warranted. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 7. Service connection for a left foot disability Service treatment records are negative for any evidence of a left foot disability during active duty or at discharge. The post-service medical evidence of record fails to show that the Veteran has a currently diagnosed left foot disability. Whether service connection is claimed on direct, presumptive, or any other basis, a necessary element for establishing such a claim is the existence of a current disability. See Degmetich v. Brown, 104 F.3d 1328 (1997) (holding that section 1110 of the statute requires the existence of a present disability for VA compensation purposes); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). The presence of a disability at the time of filing of a claim or during its pendency warrants a finding that the current disability requirement has been met, even if the disability resolves prior to the Board's adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In this case, while the Veteran has reported suffering from pain in the left foot, there is no confirmation in the medical evidence that the Veteran has had a current diagnosis of a chronic left foot disability since the filing of his claim in October 2014. VA does not generally grant service connection for symptoms alone, without an identified basis for those symptoms. VA needs to identify a disability, not symptoms of a disability. Accordingly, service connection cannot be granted for symptoms of a disability, such as pain. In light of the absence of any competent evidence of a left foot disability during the pendency of this appeal, this claim must be denied. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 8. Service connection for a right foot disability Service treatment records are negative for any evidence of a right foot disability during active duty or at discharge. The post-service medical evidence of record fails to show that the Veteran has a currently diagnosed right foot disability. Whether service connection is claimed on direct, presumptive, or any other basis, a necessary element for establishing such a claim is the existence of a current disability. See Degmetich v. Brown, 104 F.3d 1328 (1997) (holding that section 1110 of the statute requires the existence of a present disability for VA compensation purposes); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). The presence of a disability at the time of filing of a claim or during its pendency warrants a finding that the current disability requirement has been met, even if the disability resolves prior to the Board's adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In this case, while the Veteran has reported suffering from pain in the right foot, there is no confirmation in the medical evidence that the Veteran has had a current diagnosis of a chronic right foot disability since the filing of his claim in October 2014. VA does not generally grant service connection for symptoms alone, without an identified basis for those symptoms. VA needs to identify a disability, not symptoms of a disability. Accordingly, service connection cannot be granted for symptoms of a disability, such as pain. In light of the absence of any competent evidence of a right foot disability during the pendency of this appeal, this claim must be denied. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 9. Service connection for a bilateral ear condition with pain Service treatment records are negative for any evidence of a left arm disability during active duty or at discharge. The post-service medical evidence of record fails to show that the Veteran has a currently diagnosed left arm disability. Whether service connection is claimed on direct, presumptive, or any other basis, a necessary element for establishing such a claim is the existence of a current disability. See Degmetich v. Brown, 104 F.3d 1328 (1997) (holding that section 1110 of the statute requires the existence of a present disability for VA compensation purposes); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). The presence of a disability at the time of filing of a claim or during its pendency warrants a finding that the current disability requirement has been met, even if the disability resolves prior to the Board's adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In this case, while the Veteran has reported suffering from pain in the ears, there is no confirmation in the medical evidence that the Veteran has had a current diagnosis of a chronic ear disability since the filing of his claim in October 2014. VA does not generally grant service connection for symptoms alone, without an identified basis for those symptoms. VA needs to identify a disability, not symptoms of a disability. Accordingly, service connection cannot be granted for symptoms of a disability, such as pain. In light of the absence of any competent evidence of a left or right ear disability during the pendency of this appeal, this claim must be denied. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 10. Service connection for a sleep disability, to include insomnia and sleep apnea Service treatment records show treatment for sleeping problems in 1963 and 1968. VA treatment records show that the Veteran has been diagnosed with insomnia and sleep apnea, which were diagnosed many years after his discharge. However, these records do not indicate that the Veteran's currently diagnosed sleep disorder is related to his active military service. The Board also notes that the prolonged period without a diagnosis of a right shoulder disability is probative evidence against the claim. See Maxon v. West, 12 Vet. App. 453, 459 (1999), affirmed sub nom. Maxon v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (ruling that a prolonged period without medical complaint can be considered, along with other factors, as evidence of whether an injury or a disease was incurred in service resulting in any chronic or persistent disability). Most importantly, though, there is no medical opinion of record linking a currently diagnosed sleep disorder (insomnia or sleep apnea) to the Veteran’s service. VA attempted to obtain a medical opinion on the nature and etiology of the claimed insomnia with sleeping problems. However, the Veteran failed to report for a VA examination scheduled in May 2015. Neither the Veteran nor his service representative have presented good cause for his failure to report for the examination, requested another examination or, after receipt of the statement of the case (SOC), argued that the Veteran had not received notice of the May 2015 VA examination. Under these circumstances, the Board finds that the Veteran failed to report for the examination without good cause, and the claim shall be rated based on the evidence of record. 38 C.F.R. §§ 3.655 (a)-(b) (2018). The Veteran has not provided any competent medical evidence of a nexus between his current insomnia and his active military service. The Veteran alleges that his sleeping problems first started in service and continued after his discharge. However, to attribute the Veteran's currently diagnosed insomnia to military service without objective medical evidence of continuity of treatment after service discharge or a medical opinion providing a nexus, would require excessive speculation. The Board acknowledges the Veteran's assertion that he has currently demonstrated insomnia, due to events during his active military service. However, while the Veteran is competent to report the observable symptoms of a disability, and in certain situations a lay person may be competent to establish the etiology of a disability; in the present case, the Veteran is not competent to provide a nexus between his currently diagnosed insomnia and his active service or events therein. Such an opinion would require medical expertise as it would require clinical testing and interpretation of clinical findings as well as assessing the relevance of any noted symptomatology. Thus, the Board finds that the Veteran, as a layperson, is not qualified to render an opinion concerning the cause of his insomnia. 38 C.F.R. § 3.159(a)(1), (2) (2018). For the reasons and basis stated above, the Board finds that service connection for insomnia/sleeping problems is not warranted. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 11. Service connection for abdominal pain and discomfort Service treatment records are negative for any evidence of complaints, treatment or a diagnosis related to abdominal pain and discomfort during the Veteran's active military service. Post-service treatment records show that the Veteran complained of chronic abdominal pain in 2013 and that he had ileostomy placement during surgery for his prostate cancer in April 2015, with abdominal discomfort afterwards. However, there is no medical evidence of record showing a confirmed diagnosis of a chronic disability manifested by abdominal pain and discomfort. Whether service connection is claimed on direct, presumptive, or any other basis, a necessary element for establishing such a claim is the existence of a current disability. See Degmetich v. Brown, 104 F.3d 1328 (1997) (holding that section 1110 of the statute requires the existence of a present disability for VA compensation purposes); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). The presence of a disability at the time of filing of a claim or during its pendency warrants a finding that the current disability requirement has been met, even if the disability resolves prior to the Board's adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In this case, while the Veteran has reported suffering from abdominal pain and discomfort, there is no confirmation in the medical evidence that the Veteran has had a current diagnosis of a chronic abdominal disability since the filing of his claim in October 2014. VA does not generally grant service connection for symptoms alone, without an identified basis for those symptoms. VA needs to identify a disability, not symptoms of a disability. Accordingly, service connection cannot be granted for symptoms of a disability, such as pain. In light of the absence of any competent evidence of a chronic abdominal disability during the pendency of this appeal, this claim must be denied. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 12. Service connection for edema with fluid retention Service treatment records are negative for any evidence of complaints, treatment or a diagnosis related to edema with fluid retention during the Veteran's active military service. VA treatment records show that the Veteran was first diagnosed with edema in the lower extremities many years after his discharge. However, these records do not indicate that the Veteran's currently diagnosed edema is related to his active military service. The Board also notes that the prolonged period without a diagnosis of the claimed disability (abdominal pain and discomfort) is probative evidence against the claim. See Maxon v. West, 12 Vet. App. 453, 459 (1999), affirmed sub nom. Maxon v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (ruling that a prolonged period without medical complaint can be considered, along with other factors, as evidence of whether an injury or a disease was incurred in service resulting in any chronic or persistent disability). Most importantly, though, there is no medical opinion of record linking the currently diagnosed edema of the lower extremities to the Veteran’s service. The Veteran has not provided any competent medical evidence of a nexus between his current edema of the lower extremities and his active military service. As noted above, the Veteran alleges that his edema symptoms first started in service and continued after his discharge. However, to attribute the Veteran's edema of the lower extremities and discomfort to military service without objective medical evidence of in-service treatment, or continuity of treatment after service discharge, or a medical opinion providing a nexus, would require excessive speculation. The Board acknowledges the Veteran's assertion that he has current edema with fluid retention, due to events during his active military service. However, while the Veteran is competent to report the observable symptoms of a disability, and in certain situations a lay person may be competent to establish the etiology of a disability; in the present case, the Veteran is not competent to provide a nexus between his currently diagnosed edema of the lower extremities and his active service or events therein. Such an opinion would require medical expertise as it would require clinical testing and interpretation of clinical findings as well as assessing the relevance of any noted symptomatology. Thus, the Board finds that the Veteran, as a layperson, is not qualified to render an opinion concerning the cause of his edema. 38 C.F.R. § 3.159(a)(1), (2) (2018). For the reasons and basis stated above, the Board finds that service connection for edema of the lower extremities is not warranted. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 13. Service connection for skin irritation of the genitals Service treatment records are negative for any evidence of complaints or treatment for skin irritation of the genitals during active duty or at discharge. The post-service medical evidence of record fails to show that the Veteran has a currently diagnosed disability manifested by skin irritation of the genitals. Whether service connection is claimed on direct, presumptive, or any other basis, a necessary element for establishing such a claim is the existence of a current disability. See Degmetich v. Brown, 104 F.3d 1328 (1997) (holding that section 1110 of the statute requires the existence of a present disability for VA compensation purposes); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). The presence of a disability at the time of filing of a claim or during its pendency warrants a finding that the current disability requirement has been met, even if the disability resolves prior to the Board's adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In this case, while the Veteran has reported suffering from skin irritation in the genital area, there is no confirmation in the medical evidence that the Veteran has had a current diagnosis of a chronic disability manifested by skin irritation of the genitals since the filing of his claim in October 2014. VA does not generally grant service connection for symptoms alone, without an identified basis for those symptoms. VA needs to identify a disability, not symptoms of a disability. Accordingly, service connection cannot be granted for symptoms of a disability, such as skin irritation. In light of the absence of any competent evidence of a disability manifested by skin irritation of the genitals during the pendency of this appeal, this claim must be denied. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 14. Service connection for a disability of the toes (nails) with swelling and fungus Service treatment records are negative for any evidence of a disability of the toes or toenails with swelling and fungus during active duty or at discharge. The post-service medical evidence of record fails to show that the Veteran has a currently diagnosed disability of the toes or toenails with swelling and fungus. Whether service connection is claimed on direct, presumptive, or any other basis, a necessary element for establishing such a claim is the existence of a current disability. See Degmetich v. Brown, 104 F.3d 1328 (1997) (holding that section 1110 of the statute requires the existence of a present disability for VA compensation purposes); see also Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). The presence of a disability at the time of filing of a claim or during its pendency warrants a finding that the current disability requirement has been met, even if the disability resolves prior to the Board's adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In this case, while the Veteran has reported suffering from problems with the toes and toenails, including swelling and fungus, there is no confirmation in the medical evidence that the Veteran has had a current diagnosis of a chronic disability of the toes or toenails manifested by swelling and fungus since the filing of his claim in October 2014. VA does not generally grant service connection for symptoms alone, without an identified basis for those symptoms. VA needs to identify a disability, not symptoms of a disability. Accordingly, service connection cannot be granted for symptoms of a disability, such as swelling. In light of the absence of any competent evidence of a left arm disability during the pendency of this appeal, this claim must be denied. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 15. Service connection for DM Review of the Veteran's service treatment records shows no complaint or manifestation of DM, and no manifestations of DM, were noted at the time of his service separation. Post-service VA treatment records show that the Veteran was first diagnosed with DM many years after his discharge from service. Moreover, the evidence of record does not contain medical evidence that otherwise supports a finding that the currently diagnosed DM is related to the Veteran's active military service. There is also no evidence of DM to a compensable degree within one year of service separation. Accordingly, the Board finds that service connection is not warranted on a direct or presumptive chronic disease basis. Further, the Veteran has not presented evidence of continuity of symptomatology since military service. As noted above, there is no evidence of diabetes until many years after service discharge, and the Veteran does not dispute this fact. With no evidence of diabetes during service, no evidence of post-service continuity of symptomatology, and no evidence of a nexus between present disability and post-service symptomatology, there is no support for a grant of service connection on this basis. As a layperson, the Veteran is certainly competent to report matters within his own personal knowledge, such as the occurrence of an injury or the presence of symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). Moreover, laypersons may, in some circumstances, opine on questions of diagnosis and etiology, such as with respect to simple disabilities capable of being observed. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). However, a lay person without appropriate medical training and expertise simply is not competent to opine on more complex medical questions. See e.g., Jandreau, 492 F.3d at 1377 (holding that a layperson cannot diagnose cancer). Likewise, mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient. Waters, 601 F.3d at 1278. The question of whether the Veteran's DM is etiologically related to his military service is beyond the realm of a layperson's competence, as such involves a complex medical inquiry into biological processes, anatomical relationships, and physiological functioning. Such internal physical processes are not readily observable and are not within the competence of the Veteran in this case, who has not been shown by the evidence of record to have medical training or expertise. As such, lay assertions in this regard have no probative value. For these reasons noted above, the Board finds that a preponderance of the evidence is against the Veteran's claim for service connection and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REMANDED Entitlement to service connection for a right ankle disability is remanded. Entitlement to service connection for an acquired psychiatric disability, to include MDD and an anxiety disorder is remanded. REASONS FOR REMAND 1. Entitlement to service connection for a right ankle disability is remanded. Service treatment records show the Veteran was treated for a right ankle sprain during active duty in September 1966. The post-service medical evidence of record shows that the Veteran has currently diagnosed right ankle arthralgia, which he reports is related to an injury in service. The Veteran is competent to report that he injured his right ankle during active service and that he has continued to experience right ankle pain since his separation from active service. The Veteran's reports provide evidence that a current right ankle disability may be related to service. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). No medical opinion currently of record addresses the etiology of any currently diagnosed right ankle disability. As such, the Board finds that a remand for a VA examination and medical opinion as to the etiology of any current right ankle disability is necessary. See 38 C.F.R. § 4.2 (2018). 2. Entitlement to service connection for an acquired psychiatric disability, to include major depressive disorder (MDD) and an anxiety disorder is remanded. The Veteran contends that he has a current psychiatric disability related to his active military service. He has specifically reported that being assigned to an isolated station during active duty caused him to become depressed, and that his mental health problems have continued since that time. See August 2014 statement from the Veteran and October 2014 notice of disagreement. He also reported that his depression began as a result of witnessing a friend being killed in a car accident in June 1966. See October 2013 VA mental disorders examination report. The Board notes that service treatment records do show that the Veteran reported being upset after witnessing a car accident in which his buddy died. The Veteran was afforded VA mental disorders examinations in October 2013 and October 2014. He was diagnosed with MDD by both examiners. VA treatment records show that the Veteran has also been diagnosed with an anxiety disorder. The October 2013 VA examiner opined that the Veteran’s MDD was not related to his reports of witnessing his friend die in a car accident in service, but the examiner did not discuss whether his diagnosed MDD was related to his reports of isolation during active service. As such, the Board finds the opinion incomplete and therefore, inadequate for evaluation purposes. The October 2014 examiner did not give an opinion at all on the etiology of the Veteran’s MDD. There is no other medical currently of record that addresses the etiology of any currently diagnosed acquired psychiatric disability. As such, the Board finds that a remand for a VA examination and medical opinion as to the etiology of any current acquired psychiatric disability is necessary. See 38 C.F.R. § 4.2 (2018). The matters are REMANDED for the following action: 1. Updated treatment records should be obtained and added to the claims folder/efolder. 2. Following completion of the above, Afford the Veteran an appropriate VA examination to determine the nature and etiology of his psychiatric disorder(s). The claims folder should be made available to the examiner for review in connection with the examination and the examiner should acknowledge such review in the examination report or in an addendum. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any such currently diagnosed psychiatric disorder, including major depressive disorder and an anxiety disorder, was first manifested in service, is causally related to event(s) in service or is otherwise related to service. A complete rationale should be given for all opinions and conclusions expressed, and a discussion of the facts and medical principles involved must be provided. The examiner is advised that the Veteran is competent to report injuries and symptoms and that his reports must be considered in formulating the requested opinion. If his reports are discounted, the examiner should provide a reason for doing so. The examiner is also advised that the absence of evidence in the service treatment records is an insufficient basis, by itself, for a negative opinion. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and whether there is additional evidence that would permit the opinion to be provided. 3. Then, schedule the Veteran with an appropriate clinician for a VA examination to determine the nature and etiology of any currently diagnosed right ankle disability. The examiner should diagnose all right ankle disabilities found. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any currently diagnosed right ankle disability, is etiologically related, in whole or in part, to the Veteran's active service, including his right ankle injury in service. The examiner is advised that the Veteran is competent to report injuries as well as symptoms, and that his reports must be considered in formulating the requested opinion. The examiner is also advised that the absence of evidence in the service treatment records is an insufficient basis, by itself, for a negative opinion. The examiner should provide a rationale for all opinions expressed. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and whether there is additional evidence that would permit the opinion to be provided. (Continued on the next page)   4. After completing the above, and any other development deemed necessary; readjudicate the Veteran's remaining claims based on the entirety of the evidence. If any benefit sought on appeal is not granted, the agency of original jurisdiction should issue a supplemental statement of the case, and the case should then be returned to the Board, if otherwise in order. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD F. Yankey, Counsel