Citation Nr: 18158839 Decision Date: 12/18/18 Archive Date: 12/17/18 DOCKET NO. 16-27 110 DATE: December 18, 2018 ORDER 1. The application to reopen the claim for entitlement to service connection for degenerative arthritis of the lumbar spine, also claimed as chronic mid-back pain with benign hemangioma, low back pain, a fracture of the mid-back with a tumor, and degenerative disc disease of the spine, (thoracolumbar spine disability) is denied. 2. The application to reopen the claim for entitlement to service connection for mild foraminal stenosis at C6-C7, also claimed as neck disease, cervical radiculopathy, spondylosis, and stenosis, (cervical spine disability) is denied. 3. The application to reopen the claim for entitlement to service connection for right ankle pain, also claimed as joint pain, (right ankle disability) to include as secondary to the Veteran’s thoracolumbar spine disability, cervical spine disability, or bilateral foot disability, is granted. 4. The application to reopen the claim for entitlement to service connection for left ankle sprain, also claimed as joint pain, (left ankle disability) to include as secondary to a thoracolumbar spine disability, cervical spine disability, or bilateral foot disability, is granted. 5. The application to reopen the claim for entitlement to service connection for right knee joint pain, (right knee disability) to include as secondary to a thoracolumbar spine disability, cervical spine disability, or bilateral foot disability, is granted. 6. The application to reopen the claim for entitlement to service connection for tendonitis of the left knee, also claimed as left knee strain and joint pain, (left knee disability) to include as secondary to a thoracolumbar spine disability, cervical spine disability, or bilateral foot disability, is granted. 7. The application to reopen the claim for entitlement to service connection for emphysema is denied. 8. The application to reopen the claim for entitlement to service connection for left wrist carpal tunnel syndrome, claimed as nerve compression and joint pain, (left wrist carpal tunnel syndrome) is denied. 9. The application to reopen the claim for entitlement to service connection for right wrist carpal tunnel syndrome, claimed as nerve compression and joint pain, (right wrist carpal tunnel syndrome) is denied. 10. The application to reopen the claim for entitlement to service connection for left cubital syndrome, claimed as nerve compression, (left cubital syndrome) is denied. 11. Entitlement to service connection for a respiratory disability, to include sinusitis, asthma, and granulomatous disease, is denied. 12. Entitlement to service connection for a gall bladder disability is denied. 13. Entitlement to service connection for a liver disability, to include fatty liver, (liver disability) is denied. 14. Entitlement to service connection for nausea and digestive disabilities, to include hernia hiatal, gastrointestinal reflux disease, nutcracker esophagus, stomach pain, and nausea, (digestive disabilities) is denied. 15. Entitlement to service connection for peripheral neuropathy of the left upper extremity, to include as secondary to a thoracolumbar or cervical spine disability, is denied. 16. Entitlement to service connection for radiculopathy of the left lower extremity, to include as secondary to a thoracolumbar or cervical spine disability, is denied. 17. Entitlement to service connection for a right ankle disability, to include as secondary to a thoracolumbar spine disability, is denied. 18. Entitlement to service connection for a left ankle disability, to include as secondary to a thoracolumbar spine disability, is denied. 19. Entitlement to service connection for a right knee disability, to include as secondary to a thoracolumbar spine disability, cervical spine disability, or bilateral foot disability, is denied. 20. Entitlement to service connection for a left knee disability, to include as secondary to a thoracolumbar spine disability, cervical spine disability, or bilateral foot disability, is denied. REMANDED 21. Entitlement to service connection for peripheral neuropathy of the right upper extremity, to include as secondary to a thoracolumbar or cervical spine disability, is remanded. 22. Entitlement to service connection for peripheral neuropathy of the left lower extremity, to include as secondary to a thoracolumbar or cervical spine disability, is remanded. FINDINGS OF FACT 1. In a September 2004 rating decision, entitlement to service connection for a thoracolumbar spine disability was denied. The Veteran was notified of the decisions and his right to appeal. The Veteran appealed the September 2004 rating decision but ultimately withdrew his appeal in December 2008, and the September 2004 rating decision became final. 2. Evidence submitted since the September 2004 rating decision does not relate to an unestablished fact necessary to substantiate the claim for entitlement to service connection for a thoracolumbar spine disability. 3. In a June 2004 rating decision, entitlement to service connection for a cervical spine disability was denied. The Veteran was notified of the decision and his right to appeal. The Veteran filed a timely appeal of the June 2004 rating decision but ultimately withdrew his appeal in December 2008, and the June 2004 rating decision became final. 4. Evidence submitted since the June 2004 rating decision does not relate to an unestablished fact necessary to substantiate the claim for entitlement to service connection for a cervical spine disability. 5. In a June 2004 rating decision, entitlement to service connection for a right ankle disability was denied. The Veteran was notified of this decision and his right to appeal. The Veteran filed a timely appeal of the decision but ultimately withdrew his appeal in December 2008, and the June 2004 rating decision became final. 6. Evidence submitted since the June 2004 rating decision relates to an unestablished fact necessary to substantiate the claim for entitlement to service connection for a right ankle disability. 7. In a June 2004 rating decision, entitlement to service connection for a left ankle disability was denied. The Veteran was notified of this decision and his right to appeal. The Veteran filed a timely appeal of the decision but ultimately withdrew his appeal in December 2008, and the June 2004 rating decision became final. 8. Evidence submitted since the June 2004 rating decision relates to an unestablished fact necessary to substantiate the claim for entitlement to service connection for a left ankle disability. 9. In a June 2004 rating decision, entitlement to service connection for a right knee disability was denied. The Veteran was notified of this decision and his right to appeal. The Veteran filed a timely appeal of the decision but ultimately withdrew his appeal in December 2008, and the June 2004 rating decision became final 10. Evidence submitted since the June 2004 rating decision relates to an unestablished fact necessary to substantiate the claim for entitlement to service connection for a right knee disability. 11. In a June 2004 rating decision, entitlement to service connection for a left knee disability was denied. The Veteran was notified of this decision and his right to appeal. The Veteran filed a timely appeal of the decision but ultimately withdrew his appeal in December 2008, and the June 2004 rating decision became final. 12. Evidence submitted since the June 2004 rating decision relates to an unestablished fact necessary to substantiate the claim for entitlement to service connection for a left knee disability. 13. In a November 2005 rating decision, entitlement to service connection for emphysema was denied. The Veteran was notified of the decision and his right to appeal. The Veteran appealed the November 2005 rating decision but ultimately failed to perfect the appeal, and the November 2005 rating decision became final. 14. Evidence submitted since the November 2005 rating decision does not relate to an unestablished fact necessary to substantiate the claim for entitlement to service connection for emphysema. 15. In an April 2008 rating decision, entitlement to service connection for left wrist carpal tunnel syndrome was denied. The Veteran was notified of the decision and his right to appeal. The Veteran appealed the April 2008 rating decision but ultimately failed to perfect the appeal, and the April 2008 rating decision became final. 16. Evidence submitted since the April 2008 rating decision does not relate to an unestablished fact necessary to substantiate the claim for entitlement to service connection for left wrist carpal tunnel syndrome. 17. In an April 2008 rating decision, entitlement to service connection for right wrist carpal tunnel syndrome was denied. The Veteran was notified of the decision and his right to appeal. The Veteran appealed the April 2008 rating decision but ultimately failed to perfect the appeal, and the April 2008 rating decision became final. 18. Evidence submitted since the April 2008 rating decision does not relate to an unestablished fact necessary to substantiate the claim for entitlement to service connection for right wrist carpal tunnel syndrome. 19. In an April 2008 rating decision, entitlement to service connection for left cubital syndrome was denied. The Veteran was notified of the decision and his right to appeal. The Veteran appealed the April 2008 rating decision but ultimately failed to perfect the appeal, and the April 2008 rating decision became final. 20. Evidence submitted since the April 2008 rating decision does not relate to an unestablished fact necessary to substantiate the claim for entitlement to service connection for left cubital syndrome. 21. The Veteran’s respiratory disability, including sinusitis, asthma, and granulomatous disease, did not have an onset in service, were not manifested to a compensable degree within one year of service discharge, and were not otherwise related to service, including the Veteran’s service in Southwest Asia. 22. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis or symptomatology of a chronic undiagnosed gall bladder disability. 23. The preponderance of the evidence is against finding that a liver disability began during active service; is otherwise related to an in-service injury, event, or disease; or was caused by the Veteran’s service in Southwest Asia. 24. The preponderance of the evidence is against finding that the Veteran’s digestive disabilities began during active service; is otherwise related to an in-service injury, event, or disease; or was caused by the Veteran’s service in Southwest Asia. 25. The Veteran does not have a diagnosis of peripheral neuropathy of the left upper extremity, the Veteran’s symptoms of numbness are associated with other diagnosed disabilities, and the Veteran’s symptoms are not related to the Veteran’s service in Southwest Asia. 26. The preponderance of the evidence is against finding that the Veteran’s radiculopathy of the left lower extremity began during active service; is otherwise related to an in-service incident injury, event or disease; or was caused by the Veteran’s service in Southwest Asia. 27. The Veteran’s right ankle disability is neither proximately due to nor aggravated beyond its natural progression by a service-connected disability; is not otherwise related to an in-service injury, event, disease; and was not caused by Veteran’s service in Southwest Asia. 28. The Veteran’s left ankle disability is neither proximately due to nor aggravated beyond its natural progression by a service-connected disability; is not otherwise related to an in-service injury, event, disease; and was not caused by the Veteran’s service in Southwest Asia. 29. The Veteran’s right knee disability is neither proximately due to nor aggravated beyond its natural progression by a service-connected disability; is not otherwise related to an in-service injury, event, disease; and was not caused by the Veteran’s service in Southwest Asia. 30. The Veteran’s left knee disability is neither proximately due to nor aggravated beyond its natural progression by a service-connected disability; is not otherwise related to an in-service injury, event, disease; and was not caused by the Veteran’s service in Southwest Asia. CONCLUSIONS OF LAW 1. The September 2004 rating decision denying service connection for a thoracolumbar spine disability is final. New and material evidence has not been received to reopen the claim for entitlement to service connection for a thoracolumbar spine disability. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. §§ 3.156(a), 20.1103 (2017). 2. The June 2004 rating decision denying service connection for a cervical spine disability is final. New and material evidence has not been received to reopen the claim for entitlement to service connection for a cervical spine disability. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. §§ 3.156(a), 20.1103 (2017). 3. The June 2004 rating decision denying service connection for a right ankle disability is final. New and material evidence has been received to reopen the claim for entitlement to service connection for a right ankle disability. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. §§ 3.156(a), 20.1103 (2017). 4. The June 2004 rating decision denying service connection for a left ankle disability is final. New and material evidence has been received to reopen the claim for entitlement to service connection for a left ankle disability. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. §§ 3.156(a), 20.1103 (2017). 5. The June 2004 rating decision denying service connection for a right knee disability is final. New and material evidence has been received to reopen the claim for entitlement to service connection for a right knee disability. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. §§ 3.156(a), 20.1103 (2017). 6. The June 2004 rating decision denying service connection for a left knee disability is final. New and material evidence has been received to reopen the claim for entitlement to service connection for a left knee disability. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. §§ 3.156(a), 20.1103 (2017). 7. The November 2005 rating decision denying service connection for emphysema is final. New and material evidence has not been received to reopen the claim for entitlement to service connection for emphysema. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. §§ 3.156(a), 20.1103 (2017). 8. The April 2008 rating decision denying service connection for left wrist carpal tunnel syndrome is final. New and material evidence has not been received to reopen the claim for entitlement to service connection for left wrist carpal tunnel syndrome. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. §§ 3.156(a), 20.1103 (2017). 9. The April 2008 rating decision denying service connection for right wrist carpal tunnel syndrome is final. New and material evidence has not been received to reopen the claim for entitlement to service connection for right wrist carpal tunnel syndrome. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. §§ 3.156(a), 20.1103 (2017). 10. The April 2008 rating decision denying service connection for left cubital syndrome is final. New and material evidence has not been received to reopen the claim for entitlement to service connection for left cubital syndrome. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. §§ 3.156(a), 20.1103 (2017). 11. The criteria for entitlement to service connection for a respiratory disability, to include sinusitis, asthma, and granulomatous disease, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1117, 1137, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a)–(b), (d), 3.304, 3.307, 3.309(a), 3.317 (2017). 12. The criteria for entitlement to service connection for a gall bladder disability have not been met. 38 U.S.C. §§ 1110, 1117, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.317 (2017). 13. The criteria for entitlement to service connection for a liver disability have not been met. 38 U.S.C. §§ 1110, 1117, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.317 (2017). 14. The criteria for entitlement to service connection for digestive disabilities have not been met. 38 U.S.C. §§ 1110, 1117, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.317 (2017). 15. The criteria for entitlement to service connection for peripheral neuropathy of the left upper extremity, to include as secondary to a thoracolumbar or cervical spine disability, have not been met. 38 U.S.C. §§ 1110, 1117, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.310(a), 3.317 (2017). 16. The criteria for entitlement to service connection for radiculopathy of the left lower extremity, to include as secondary to a thoracolumbar or cervical spine disability, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1117, 1137, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.304, 3.307, 3.309, 3.310(a), 3.317 (2017). 17. The criteria for entitlement to service connection for a right ankle disability, to include as secondary to a thoracolumbar spine disability, have not been met. 38 U.S.C. §§ 1110, 1117, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.310(a), 3.317 (2017). 18. The criteria for entitlement to service connection for a left ankle disability, to include as secondary to a thoracolumbar spine disability, have not been met. 38 U.S.C. §§ 1110, 1117, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.310(a), 3.317 (2017). 19. The criteria for entitlement to service connection for a right knee disability, to include as secondary to a thoracolumbar spine disability, cervical spine disability, or bilateral foot disability, have not been met. 38 U.S.C. §§ 1110, 1117, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.310(a), 3.317 (2017). 20. The criteria for entitlement to service connection for a left knee disability, to include as secondary to a thoracolumbar spine disability, cervical spine disability, or bilateral foot disability, have not been met. 38 U.S.C. §§ 1110, 1117, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.310(a), 3.317 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1989 to November 1993 and from April 1995 to May 1995. In October 2018, the Veteran submitted a Motion to Advance on the Docket due to financial hardship. The Board grants the Veteran’s motion to Advance on Docket due to financial hardship. New and Material Evidence Prior unappealed decisions of the RO are final. 38 U.S.C. §§ 7105(c); 38 C.F.R. §§ 20.1103. The Board does not have jurisdiction to consider a claim that has become final before it determines that new and material evidence has been presented, irrespective of what the regional office (RO) may have determined with respect to new and material evidence. If, however, new and material evidence is presented or secured with respect to a claim which has been disallowed, VA shall reopen the claim and review the former disposition of the claim. New evidence means existing evidence not previously submitted to agency decision makers. 38 C.F.R. § 3.156(a). Material evidence means existing evidence that, by itself or 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. Id. New and material evidence need not be received as to each previously unproven element of a claim in order to justify reopening thereof; the threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is “low.” Shade v. Shinseki, 24 Vet. App. 110, 117–20 (2010). 1. Whether new and material evidence has been submitted to reopen the claim for entitlement to service connection for a thoracolumbar spine disability The Veteran’s claim for service connection for a thoracolumbar spine disability was previously considered and denied by the RO in a September 2004 rating decision as the Veteran’s thoracolumbar spine disability was not found to have a nexus to his active duty service and the Veteran’s service treatment records (STRs) did not document treatment for a thoracolumbar spine disability in service. The Veteran was notified of that decision and of his appellate rights. The Veteran filed a notice of disagreement with the RO’s September 2004 rating decision, and a statement of the case (SOC) was issued in May 2005. The Veteran submitted a Form 9 in July 2005 and additional SOCs were issued in September and October 2005. Finally, in December 2008, the RO issued a supplemental statement of the case (SSOC). Shortly after the issuance of the December 2008 SSOC, the Veteran submitted a statement in December 2008 indicating that he wished to withdraw all the issues on appeal other than his claims for entitlement to service connection for depression and stress. As the Veteran withdrew his appeal for entitlement to service connection for a thoracolumbar spine disability in December 2008, the Board finds the September 2004 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. In November 2013 the Veteran filed an application to reopen his claim for a thoracolumbar spine disability. In a November 2013 rating decision, the RO reopened the Veteran’s claim for entitlement to service connection for a thoracolumbar spine disability but denied service connection. However, the Board is not bound by the RO’s determination that the Veteran’s claim be reopened. Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). Since the September 2004 rating decision, the Veteran has continued to report chronic pain in his thoracolumbar spine that he contends had its onset in service. However, this evidence is not new as the Veteran had reported chronic pain in his thoracolumbar spine at the time of the September 2004 rating decision. The Veteran’s VA treatment records also note ongoing degradation of the Veteran’s thoracolumbar spine disability. However, this evidence is not material as the existence of a current thoracolumbar spine disability is not in dispute, and therefore, this evidence does not relate to an unestablished fact necessary to substantiate the Veteran’s claim. Accordingly, the Board finds that new and material evidence has not been received to reopen the claim for service connection for a thoracolumbar spine disability, and the application to reopen the previously-denied claim is denied. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 2. Whether new and material evidence has been submitted to reopen the claim for entitlement to service connection for a cervical spine disability The Veteran’s claim for service connection for a cervical spine disability was previously considered and denied by the RO in a June 2004 rating decision as the Veteran’s cervical spine disability was not found to have a nexus to his active duty service, despite STRs indicating an in-service motor vehicle accident in July 1992. The Veteran was notified of that decision and of his appellate rights. The Veteran filed a notice of disagreement with the RO’s June 2004 rating decision, and a SOC was issued in May 2005. The Veteran submitted a Form 9 in July 2005 and additional SOCs were issued in September and October 2005. Finally, in December 2008, the RO issued a SSOC. Shortly after the issuance of the December 2008 SSOC, the Veteran submitted a statement in December 2012 indicating that he wished to withdraw all the issues on appeal other than his claims for entitlement to service connection for depression and stress. As the Veteran withdrew his appeal for entitlement to service connection for a cervical spine disability in December 2008, the Board finds the June 2004 rating decision is In June 2012 the Veteran filed an application to reopen his claim for a cervical spine disability. In an October 2013 rating decision, the RO reopened the Veteran’s claim for entitlement to service connection for a cervical spine disability but denied service connection. However, the Board is not bound by the RO’s determination that the Veteran’s claim be reopened. Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). Since the June 2004 rating decision, the Veteran has continued to report chronic pain in his cervical spine that he contends had its onset in service after a motor vehicle accident. However, this evidence is not new as the Veteran had reported chronic pain in his cervical spine due to a motor vehicle accident at the time of the June 2004 rating decision. The Veteran’s VA treatment records also note an ongoing diagnosis of disc protrusions and bulges, canal stenosis, and fibromatosis in the Veteran’s cervical spine. However, this evidence is not material as the existence of a current thoracolumbar spine disability is not in dispute, and therefore, this evidence does not relate to an unestablished fact necessary to substantiate the Veteran’s claim. Accordingly, the Board finds that new and material evidence has not been received to reopen the claim for service connection for a cervical spine disability. Therefore, the application to reopen the previously-denied claim is denied. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. The Board acknowledges that the Veteran has asserted, since the June 2004 rating decision, that his cervical spine disability is secondary to his thoracolumbar spine disability. However, as the Veteran has not been granted service connection for a thoracolumbar spine disability, service connection cannot be granted on this basis, and this additional claim does not warrant reopening the Veteran’s claim for entitlement to service connection for a cervical spine disability. 3. – 5. Whether new and material evidence has been submitted to reopen the claims for entitlement to service connection for a right and left ankle disability and a right knee disability The Veteran’s claims for entitlement to service connection for a right and left ankle disability and a right knee disability were previously considered and denied by the RO in a June 2004 rating decision as the Veteran did not have a current diagnosis of a bilateral ankle or right knee disability and the Veteran had not exhibited symptoms for six continuous months. The Veteran was notified of that decision and of his appellate rights. The Veteran filed a notice of disagreement in June 2004, and a SOC was issued in May 2005. Additional SOCs were issued in September and October 2005. A final SSOC was issued in December 2008. In December 2008, the Veteran submitted a statement indicating that he wished to withdraw all the issues on appeal other than his claims for entitlement to service connection for depression and stress. As the Veteran withdrew his appeal for entitlement to service connection for his right and left ankle disability and right knee disability in December 2008, the Board finds the June 2004 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. In June 2012, the Veteran requested to reopen his claim for entitlement to service connection for right and left ankle disability and right knee disability. The RO denied service connection for the Veteran’s right and left ankle and right knee disabilities in June 2004 because the Veteran did not have a currently diagnosed disability in the right or left ankle or right knee. Furthermore, the Veteran had not shown that his undiagnosed illness had persisted for a period of six months. Since the June 2004 rating decision, the Veteran has consistently reported joint pain in his right and left ankle and right knee, which suggests chronicity for a period of at least six months. The Board finds this evidence is new and material as it relates to one of the reasons for the June 2004 denial of service connection for a right and left ankle disability and right knee disability and raises a reasonable possibility of substantiating the Veteran’s claim. Accordingly, the claims for entitlement to service connection for a right and left ankle disability and right knee disability are reopened. 6. Whether new and material evidence has been submitted to reopen the claim for entitlement to service connection for a left knee disability The Veteran’s claim for entitlement to service connection for a left knee disability was previously considered and denied by the RO in a June 2004 rating decision as the Veteran did not have a current diagnosis of a left knee disability. The Veteran was notified of that decision and of his appellate rights. The Veteran filed a notice of disagreement in June 2004, and a SOC was issued in May 2005. Additional SOCs were issued in September and October 2005. A final SSOC was issued in December 2008. In December 2008, the Veteran submitted a statement indicating that he wished to withdraw all the issues on appeal other than his claims for entitlement to service connection for depression and stress. As the Veteran withdrew his appeal for entitlement to service connection for a left knee disability in December 2008, the Board finds the June 2004 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. In June 2012, the Veteran requested to reopen his claim for entitlement to service connection for a left knee disability. The RO denied service connection for a left knee disability in June 2004 as the Veteran did not have a current disability in his left knee. Since the June 2004 rating decision, the Veteran received a VA examination in November 2014. At that examination, the VA examiner diagnosed the Veteran with left knee tendonitis, which had an onset in 2006. The Board finds this evidence is new and material as it relates to one of the reasons for the June 2004 denial of service connection for a left knee disability and raises a reasonable possibility of substantiating the Veteran’s claim. Accordingly, the claim is reopened. 7. Whether new and material evidence has been submitted to reopen the claim for entitlement to service connection for respiratory conditions, to include emphysema and asthma The Veteran’s claim for service connection for emphysema was previously considered and denied by the RO in a November 2005 rating decision as the Veteran’s current emphysema was not found to have had its onset during the Veteran’s active duty service. The Veteran was notified of that decision and of his appellate rights. The Veteran filed a notice of disagreement with the RO’s November 2005 rating decision, and a SOC was issued in July 2007. The Veteran did not a submit a Form 9, and the Board finds the November 2005 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. In May 2014, the Veteran filed an application to reopen his claim for emphysema. In a November 2014 rating decision, the RO reopened the Veteran’s claim for entitlement to service connection for emphysema but denied service connection. However, the Board is not bound by the RO’s determination that the Veteran’s claim be reopened. Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). Since the November 2005 rating decision, a VA general medical examination in July 2006 noted that the Veteran’s emphysema had progressed. However, this evidence is not material as the existence of a diagnosis of emphysema is not in dispute, and therefore, the evidence does not relate to an unestablished fact necessary to substantiate the Veteran’s claim. Accordingly, the Board finds that new and material evidence has not been received to reopen the claim for service connection for a thoracolumbar spine disability. Therefore, the application to reopen the previously-denied claim is denied. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. The Board notes that the Veteran asserts that his emphysema, and other respiratory disabilities, are caused by his service in Southwest Asia. However, as the Veteran has a diagnosed disability, the provisions of 38 C.F.R. § 3.317 do not apply. 8. – 9. Whether new and material evidence has been submitted to reopen the claim for entitlement to service connection for left and right wrist carpal tunnel syndrome The Veteran’s claim for service connection for left and right wrist carpal tunnel syndrome was previously considered and denied by the RO in an April 2008 rating decision as the Veteran had a current diagnosis of carpal tunnel that did not arise within one year of discharge from service and, despite a fracture to his right wrist in service, the preponderance of the evidence was against a finding that the Veteran’s right and left wrist carpal tunnel syndrome occurred in or was caused or aggravated by his active duty service. The Veteran was notified of that decision and of his appellate rights. The Veteran filed a notice of disagreement with the RO’s April 2008 rating decision, and a SOC was issued in December 2008. The Veteran did not a submit a Form 9, and the Board finds the April 2008 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. In June 2012, the Veteran filed an application to reopen his claim for right and left carpal tunnel syndrome. In an October 2013 rating decision, the RO reopened the Veteran’s claim for entitlement to service connection for right and left carpal tunnel syndrome but denied service connection. However, the Board is not bound by the RO’s determination that the Veteran’s claim be reopened. Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). Since the April 2008 rating decision, the Veteran’s VA treatment records continue to show a diagnosis of and treatment for bilateral carpal tunnel syndrome. However, this evidence is not new or material as the existence of a diagnosis of bilateral carpal tunnel syndrome is not in dispute. Therefore, the evidence does not relate to an unestablished fact necessary to substantiate the Veteran’s claim. Accordingly, the Board finds that new and material evidence has not been received to reopen the claim for service connection for right and left carpal tunnel syndrome. Therefore, the application to reopen the previously-denied claim is denied. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 10. Whether new and material evidence has been submitted to reopen the claim for entitlement to service connection for left cubital syndrome The Veteran’s claim for service connection for left cubital syndrome was previously considered and denied by the RO in an April 2008 rating decision as the Veteran had a current diagnosis of left cubital syndrome that did not arise within one year of discharge from service and the preponderance of the evidence was against a finding that the Veteran’s left cubital syndrome occurred in or was caused or aggravated by his active duty service. The Veteran was notified of that decision and of his appellate rights. The Veteran filed a notice of disagreement with the RO’s April 2008 rating decision, and a SOC was issued in December 2008. The Veteran did not a submit a Form 9, and the Board finds the April 2008 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. In June 2012, the Veteran filed an application to reopen his claim for left cubital syndrome. In an October 2013 rating decision, the RO reopened the Veteran’s claim for entitlement to service connection for left cubital syndrome but denied service connection. However, the Board is not bound by the RO’s determination that the Veteran’s claim be reopened. Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). Since the April 2008 rating decision, the Veteran’s VA treatment records continue to show a diagnosis of and treatment for left cubital syndrome. However, this evidence is not new or material as the existence of a diagnosis of cubital syndrome is not in dispute. Therefore, the evidence does not relate to an unestablished fact necessary to substantiate the Veteran’s claim. Accordingly, the Board finds that new and material evidence has not been received to reopen the claim for service connection for left cubital syndrome. Therefore, the application to reopen the previously-denied claim is denied. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. In this case, the disorders at issue include some which constitute a “chronic disease” listed under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.303(b) applies. Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. For the showing of “chronic” disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of “continuity of symptoms” after service is required for service connection. 38 C.F.R. § 3.303(b). Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. Service connection is also warranted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(b). In addition, the Board notes that the Veteran served in the Southwest Asia theater of operations in support of Operation Desert Storm/Desert Shield. 38 C.F.R. § 3.317(e). Under those provisions, service connection may be established for objective indications of a chronic disability resulting from an undiagnosed illness or illnesses, provided that such disability (1) became manifest in service on active duty in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War or to a degree of 10 percent or more not later than December 31, 2021; and (2) by history, physical examination, and laboratory tests cannot be attributed to a known clinical diagnosis. To fulfill the requirement of chronicity, the illness must have persisted for six months. 38 U.S.C. § 1117; 38 C.F.R. 3.317. The Board must analyze the credibility and probative value of the evidence, account for the evidence it finds persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the Veteran. This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record. A lay person is competent to report to the onset and continuity of his symptomatology. Moreover, lay evidence may be competent and sufficient evidence of a diagnosis or nexus if (1) the particular condition at issue is the type of condition that is within the competence or common knowledge of a lay person, (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, 1376–77 (Fed. Cir. 2007). The Board must determine on a case-by-case basis whether a particular condition is the type of condition that is within the competence of a lay person. A veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. In making its ultimate determination, the Board must give a veteran the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. 11. Entitlement to service connection for a respiratory disability, to include sinusitis, asthma, and granulomatous disease The Board notes that the RO initially characterized the Veteran’s respiratory claims as an initial claim for entitlement to service connection to a respiratory condition, including granulomatous disease, and as a claim to reopen a claim for entitlement to service connection for respiratory conditions, to include emphysema and asthma. The Board has recharacterized the issue as a claim to reopen a claim for entitlement to service connection for emphysema and an initial claim for entitlement to service connection for a respiratory disability, to include sinusitis, asthma, and granulomatous disease, as the RO’s November 2005 rating decision clearly only denied service connection for emphysema, not asthma, and therefore, the Veteran’s claim for asthma has not previously been considered and denied by the RO and new and material evidence is not needed for that claim. The Veteran asserts that his respiratory symptoms are caused by his service in Southwest Asia. The Board notes that the Veteran has multiple respiratory diagnoses including sinusitis, emphysema, asthma, and granulomatous disease. As the Veteran has numerous diagnoses for his symptoms, service connection based on 38 C.F.R. § 3.117 and the Veteran’s service in Southwest Asia is not warranted. However, the Board will still analyze whether service connection can be granted for the Veteran’s respiratory disabilities on another basis. The Board concludes that, while the Veteran has a diagnosis of granulomatous disease, which is a chronic disease under 38 C.F.R. § 3.309(a), it was not chronic in service or manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. VA treatment records show the Veteran was not diagnosed with granulomatous disease until February 2014, nearly 20 years after his separation from service and many years outside of the applicable presumptive period. Service connection for granulomatous disease and the Veteran’s other respiratory disabilities, including asthma and sinusitis, may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s respiratory disabilities and an in-service injury, event or disease. The Veteran’s STRs from July 1991 and July 1992 note that the Veteran’s lungs were clear. Furthermore, on a dental health questionnaire from April 1993, the Veteran specifically checked that he did not have and had not had emphysema, asthma, a persistent cough, hay fever, or sinus problems. Additionally, at the Veteran’s separation examinations for his first and second periods of service, conducted in October 1993 and April 1995, respectively, the Veteran specifically denied ever having or having then chronic or frequent colds, sinusitis, hay fever, asthma, shortness of breath, pain or pressure in the chest, or chronic cough. When asked on the form if he had ever had an illness or injury other than those already noted on the form, the Veteran checked no. Additionally, clinical evaluations of the Veteran’s sinuses, lungs, and chest were all normal. These facts tend to establish that the Veteran did not have a respiratory disability in service, as he specifically denied such symptomatology and clinical evaluations were normal. The Board finds the facts documented in the STRs are more probative than the Veteran’s lay statements suggesting a respiratory disability with an onset in service, as the STRs were created contemporaneously with the time period in question, and the Board finds no reason to question their accuracy. The Veteran’s current statements were made decades after his discharge from active duty service, and the Board finds his current statements have less probative value than the contemporaneous STRs. Consequently, entitlement to service connection for a respiratory disability, to include sinusitis, asthma, and granulomatous disease, is denied. 12. Entitlement to service connection for a gall bladder disability The first question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of a gall bladder disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. At a February 2013 VA general medical examination, it was noted that the Veteran did not have a diagnosis of a gall bladder or pancreas disability. The Veteran also asserts that he has a gall bladder disability caused by his service in Southwest Asia. The Board acknowledges that the Veteran does not have a diagnosis related to his gall bladder. However, the preponderance of the evidence in the Veteran’s claims file does not document that the Veteran has unexplained symptomatology associated with his gall bladder. Additionally, the Veteran’s March 2013 VA treatment records specifically noted that the Veteran did not have gall bladder wall thickening. Finally, at a Gulf War VA examination, conducted in November 2014, the VA examiner opined that the Veteran does not have conditions that are at least as likely as not associated with his service in Southwest Asia and Gulf War syndrome as the Veteran has not reported symptomatology until 2006, 13 years after his discharge from service and 15 years after his service in Southwest Asia. The examiner further opined that literature related to Gulf War syndrome does not endorse such a long latency period. Absent a chronic disability persisting for at least six months, service connection for an undiagnosed illness due to service in Southwest Asia is not warranted. While the Veteran believes he has a gall bladder disability associated with his service in Southwest Asia, he is not competent to provide a diagnosis or a nexus opinion in this case. Consequently, the Board gives more probative weight to the competent medical evidence, which does not support a current diagnosis of a gall bladder disability or a chronic undiagnosed gall bladder illness associated with the Veteran’s service in Southwest Asia. Service connection for a gall bladder disability is denied. 13. Entitlement to service connection for a liver disability The Veteran asserts that his liver disability is caused by his service in Southwest Asia. The Board notes that the Veteran has a diagnosis related to his liver, including February 2014 VA treatment records that document a benign liver cyst in his right lobe and January 2015 VA treatment records documenting an ongoing problem of steatosis of the liver. As the Veteran has a diagnosis for his liver symptoms, service connection based on 38 C.F.R. § 3.117 and the Veteran’s service in Southwest Asia is not warranted. However, the Board will still analyze whether service connection can be granted for the Veteran’s liver disability on another basis. The remaining question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of a benign liver cyst and liver steatosis, the preponderance of the evidence is against finding that they began during active service or are otherwise related to an in-service injury, event, or disease. The preponderance of the evidence in the Veteran’s STRs do not document treatment for or symptoms of a liver disability. Additionally, at the Veteran’s separation examinations for his first and second periods of service, conducted in October 1993 and April 1995 respectively, the Veteran specifically denied ever having or having then “stomach, liver, or intestinal trouble.” When asked on the form if he had ever had an illness or injury other than those already noted on the form, the Veteran checked no. Additionally, clinical evaluation of the abdomen and viscera was normal. These facts tend to establish that the Veteran did not have a liver disability in service, as he specifically denied such symptomatology, and a clinical evaluation was normal. The Board finds the facts documented in the STRs are more probative than the Veteran’s lay statements suggesting a liver disability with an onset in service, as the STRs were created contemporaneously with the time period in question, and the Board finds no reason to question their accuracy. The Veteran’s current statements were made decades after his discharge from active duty service, and the Board finds his current statements have less probative value than the contemporaneous STRs. Consequently, entitlement to service connection for a liver disability is denied. 14. Entitlement to service connection for digestive disabilities The Board notes that the RO required new and material evidence prior to reopening, and ultimately denying, the Veteran’s claim. The Veteran first filed a claim for symptoms of nausea, which was denied in June 2004. The Veteran filed a claim for specific digestive disabilities in June 2012, including hiatal hernia, difficulty swallowing, and stomach pain. The Veteran later went on to note that he had a diagnosis of gastrointestinal reflux disease and nutcracker’s esophagus. The Board finds this to be a new and distinct claim for various digestive disabilities, and therefore, new and material evidence is not required to reopen the Veteran’s claim. The Veteran’s claims file includes numerous diagnoses of digestive disabilities. In October 2003, VA treatment records document the Veteran tested positive for gastrointestinal reflux disease. VA treatment records from April 2006 document a diagnosis of a hiatal hernia. In July 2006, a VA general medical exam also noted a diagnosis of helicobacter pylori. December 2012 VA treatment records note that the Veteran has pain in his esophagus due to nutcracker esophagus associated with difficulty swallowing. VA treatment records also document regular reports of diarrhea and consistent medication associated with the Veteran’s digestive diagnoses. The Veteran asserts that his digestive disabilities are caused by his service in Southwest Asia. The Board notes that the Veteran, as noted above, has multiple diagnoses for his symptoms. As the Veteran has a diagnosis for his symptoms, service connection based on 38 C.F.R. § 3.117 and the Veteran’s service in Southwest Asia is not warranted. However, the Board will still analyze whether service connection can be granted for the Veteran’s digestive disabilities on another basis. Service connection for digestive disabilities may still be granted on a direct basis; however, the preponderance of the evidence is against finding that the Veteran’s digestive disabilities had their onset in service. VA treatment records do not document symptoms of a digestive disability until approximately 2003, many years after the Veteran’s discharge from service. Furthermore, the preponderance of the evidence in the Veteran’s STRs do not document treatment for or symptoms of digestive abnormalities during the Veteran’s active duty service. Significantly, at the Veteran’s separation examinations for his first and second periods of service, conducted in October 1993 and April 1995 respectively, the Veteran specifically denied ever having or having then “frequent indigestion,” “rupture or hernia,” or “stomach, liver, or intestinal trouble.” When asked on the form if he had ever had an illness or injury other than those already noted on the form, the Veteran checked no. Additionally, clinical examination of the abdomen and viscera was normal. These facts tend to establish that the Veteran did not have radiculopathy of the left lower extremity in service, as he specifically denied such symptomatology and a clinical evaluation was normal. The Board finds the facts documented in the STRs and VA treatment records to be more probative than the Veteran’s lay statements suggesting digestive symptoms since his discharge from active duty service as the STRs were created contemporaneously with the time period in question, and the Board finds no reason to question their accuracy. The Veteran’s current statements were made decades after his discharge from active duty service, and the Board finds his current statements have less probative value than the contemporaneous STRs. Consequently, entitlement to service connection for the Veteran’s various digestive disabilities are denied. 15. Entitlement to service connection for peripheral neuropathy of the left upper extremity, to include as secondary to a thoracolumbar or cervical spine disability The Veteran asserts that the numbness and tingling in his left upper extremity is caused by his service in Southwest Asia. The Board notes that the Veteran does not have a diagnosis of peripheral neuropathy of the left upper extremity. However, the Veteran’s symptoms of numbness and tingling in his left upper extremity are frequently described as originating in his median motor and ulnar motor nerves, which are associated with the Veteran’s diagnoses of bilateral carpal tunnel syndrome and cubital syndrome as documented in the Veteran’s December 2005 VA nerve conduction study. As the Veteran has a diagnosis for his symptoms, service connection based on 38 C.F.R. § 3.117 and the Veteran’s service in Southwest Asia is not warranted. Additionally, service connection for peripheral neuropathy of the left upper extremity is not warranted on a direct basis as the Veteran does not have a diagnosis of peripheral neuropathy of the left upper extremity outside of bilateral carpal tunnel syndrome and cubital syndrome, which are addressed above. While the Veteran believes he has a current diagnosis of peripheral neuropathy of the left upper extremity he is not competent to provide a diagnosis in this case as the issue is medically complex. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Absent a current diagnosis, service connection on a direct basis is denied. 16. Entitlement to service connection for radiculopathy of the left lower extremity, to include as secondary to a thoracolumbar or cervical spine disability At a VA examination in November 2014, the Veteran was diagnosed with mild radiculopathy of the sciatic nerve in the left lower extremity. The Veteran asserts that the numbness and radiculopathy in his left lower extremity is caused by his service in Southwest Asia. The Board notes that the Veteran, as noted above, has a diagnosis of mild radiculopathy in the left lower extremity. As the Veteran has a diagnosis for his symptoms, service connection based on 38 C.F.R. § 3.117 and the Veteran’s service in Southwest Asia is not warranted. However, the Board will still analyze whether service connection can be granted for the Veteran’s radiculopathy of the left lower extremity on another basis. The Veteran has also asserted that his radiculopathy is caused or aggravated by his thoracolumbar and/or cervical spine disabilities. As noted above, the Veteran’s claims for service connection for a thoracolumbar and cervical spine disability were not reopened. The Veteran is not service connected for these disabilities. As the Veteran is not service connected for a thoracolumbar or cervical spine disability, the Veteran’s radiculopathy of the left lower extremity cannot be service connected on a secondary basis. The Board also concludes that, while the Veteran has radiculopathy of the left lower extremity, which is a chronic disease under 38 C.F.R. § 3.309(a), it was not chronic in service or manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. VA treatment records show the Veteran was not diagnosed with radiculopathy of the left lower extremity until November 2014, nearly 20 years after the Veteran’s separation from service and many years outside of the applicable presumptive period. Furthermore, VA treatment records specifically note that the Veteran did not exhibit symptoms of radiculopathy in his lower extremities in July 2006, and the Veteran did not begin reporting radiculopathy in the lower extremities on a consistent basis in his VA treatment records until July 2007. Service connection for radiculopathy of the left lower extremity may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s radiculopathy of the left lower extremity and an in-service injury, event, or disease. VA treatment records do not document complaints of radiculopathy in the left lower extremity until July 2007, and the Veteran was not diagnosed with radiculopathy of the left lower extremity until November 2014, many years after the Veteran’s discharge from service. VA treatment records prior to July 2006 specifically document that the Veteran did not experiences symptoms of radiculopathy in his lower extremities. The preponderance of the evidence in the Veteran’s STRs do not document treatment for or symptoms of radiculopathy in the left lower extremity. Additionally, at the Veteran’s separation examinations for his first and second periods of service, conducted in October 1993 and April 1995 respectively, the Veteran specifically denied ever having or having then lameness, paralysis, or any other issues with his lower extremities. When asked on the form if he had ever had an illness or injury other than those already noted on the form, the Veteran checked no. Additionally, clinical evaluations of the lower extremities and the neurological system were both normal. These facts tend to establish that the Veteran did not have radiculopathy of the left lower extremity in service, as he specifically denied such symptomatology and clinical evaluations of the lower extremities and neurological system were both normal. The Board finds the facts documented in the STRs and VA treatment records to be more probative than the Veteran’s lay statements suggesting radiculopathy of the left lower extremity with an onset in service, as the STRs were created contemporaneously with the time period in question, and the Board finds no reason to question their accuracy. The Veteran’s current statements were made decades after his discharge from active duty service, and the Board finds his current statements have less probative value than the contemporaneous STRs. Consequently, entitlement to service connection for radiculopathy of the left lower extremity is denied. 17. – 19. Entitlement to service connection for a right and left ankle disabilities, to include as secondary to a thoracolumbar spine disability, and a right knee disability, to include as secondary to a thoracolumbar spine disability, cervical spine disability, and bilateral foot disability The Veteran asserts that the joint pain in his right and left ankle and right knee is caused by his service in Southwest Asia. The Board notes that the preponderance of the evidence is against a finding that the Veteran has a diagnosis of a disability in the right or left ankle or right knee. Additionally, the Board notes that the Veteran has credibly reported chronic joint pain in his right and left ankle and right knee since he initially filed his claim for service connection for these disabilities in May 2003. However, the Board finds that the medical opinion provided by the November 2014 VA medical examiner to be most probative, as the Veteran is not competent to provide a nexus opinion between his service and his current joint pain. The VA examiner noted that though the Veteran was reporting chronic pain in the right and left ankle and right knee, there was no objective evidence of a loss of range of motion or functional impact due to the Veteran’s pain. The examiner further opined that the Veteran’s conditions were not at least as likely as not caused by his service in Southwest Asia as the Veteran’s symptoms did not begin until many years after his service in Southwest Asia, noting that literature for Gulf War syndrome does not endorse such a long latency period. As the more probative evidence of record is against a finding that the Veteran’s chronic joint pain in his right and left ankle and right knee are not at least as likely as not caused by the Veteran’s service in Southwest Asia, service connection on the basis of a chronic disability due to an undiagnosed illness is not warranted. The Board has also considered whether service connection can be awarded on a direct or secondary basis. However, the Board concludes that the Veteran does not have a current diagnosis of a current disability in his right or left ankle or right knee and has not had one at any time during the pendency of the claim or recent to the filing of the claim. While the Veteran believes he has current diagnoses of disabilities involving his bilateral ankle and right knee, and experiences continuous pain, he is not competent to provide a diagnosis in this case as the issues are medically complex. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent evidence, and absent a current diagnosis, service connection on a direct and secondary basis is not warranted. 20. Entitlement to service connection for a left knee disability, to include as secondary to a thoracolumbar spine disability, cervical spine disability, or bilateral foot disability At a VA examination in November 2014, the Veteran was diagnosed with tendonitis of the left knee with an onset in 2006. The Veteran asserts that the joint pain in his left knee is caused by his service in Southwest Asia. The Board notes that the Veteran has a diagnosis of tendonitis in the left knee. As the Veteran has a diagnosis for his symptoms, service connection based on 38 C.F.R. § 3.117 and the Veteran’s service in Southwest Asia is not warranted. However, the Board will still analyze whether service connection can be granted for the Veteran’s left knee disability on another basis. The Veteran has also asserted that his left knee disability is caused or aggravated by his thoracolumbar and/or cervical spine disabilities or a bilateral foot disability. As noted above, the Veteran’s claims for entitlement to service connection for a thoracolumbar and cervical spine disability were not reopened, and therefore, the Veteran is not service connected for these disabilities. Additionally, the Board notes that the Veteran’s claims for entitlement to service connection for bilateral pes planus and foot pain have been denied. As the Veteran is not service connected for a thoracolumbar or cervical spine disability or a bilateral foot disability the Veteran’s left knee disability cannot be service connected on a secondary basis. The Board acknowledges that the Veteran is service connected for a fracture of the right third metatarsal. However, the preponderance of the evidence of record does not document, and the Veteran does not provide a rationale to suggest, that the residuals of this disability caused or aggravated the Veteran’s left knee disability. Finally, the Board will address whether the Veteran meets the criteria for direct service connection for a left knee disability. The Board acknowledges that the Veteran twisted his knee in March 1992 while in service. However, the preponderance of the evidence is against a finding that the Veteran’s left knee injury in service was permanent or chronic. At the Veteran’s separation examinations for his first and second periods of service, conducted in October 1993 and April 1995 respectively, the Veteran specifically denied ever having or having then “swollen or painful joints,” “arthritis, rheumatism, or bursitis,” “bone, joint, or other deformity,” or “‘trick’ or locked knee.” When asked on the form if he had ever had an illness or injury other than those already noted on the form, the Veteran checked no. Additionally, clinical evaluation of the lower extremities was normal. These facts tend to establish that the Veteran did not have a chronic or permanent disability in his left knee while in service, as he specifically denied such symptomatology and clinical evaluation of his lower extremities was normal. The Board finds the facts documented in the STRs and VA treatment records to be more probative than the Veteran’s lay statements suggesting he has had pain in his left knee since discharge from service, as the STRs were created contemporaneously with the time period in question, and the Board finds no reason to question their accuracy. The Veteran’s current statements were made many years after his discharge from active duty service, and the Board finds his current statements have less probative value than the contemporaneous STRs. Consequently, entitlement to service connection for radiculopathy of the left lower extremity is denied. REASONS FOR REMAND 21– 22. Entitlement to service connection for peripheral neuropathy of the right upper extremity and left lower extremity, to include as secondary to a thoracolumbar or cervical spine disability Entitlement to service connection for peripheral neuropathy of the right upper extremity and left lower extremity were initially denied in an October 2013 rating decision. The Veteran filed a notice of disagreement, specifically expressing an intent to disagree with the RO’s October 2013 decision denying entitlement to service connection for peripheral neuropathy of the right upper extremity and left lower extremity. In May 2014, the RO contacted the Veteran to clarify the issues the Veteran intended to appeal. In his response, the Veteran reported that he intended to appeal the denial of entitlement to service connection for peripheral neuropathy of the right upper extremity and left lower extremity. In a November 2014 rating decision, the RO again denied the Veteran’s claims for peripheral neuropathy of the right upper extremity and left lower extremity after finding new and material evidence had been submitted to reopen the claims. The Board notes that new and material evidence was not necessary as the Veteran had timely filed a notice of disagreement to the RO’s initial rating decision in October 2013 for the Veteran’s claims for entitlement to service connection for peripheral neuropathy of the right upper extremity and left lower extremity. Following the November 2014 rating decision, the Veteran again filed a notice of disagreement, submitted in February 2015, specifically indicating that he disagreed with the RO’s denial of entitlement to service connection for peripheral neuropathy of the right upper extremity. The Veteran seems to note that he intends to disagree and withdraw a claim for peripheral neuropathy of the left lower extremity in his notice of disagreement. However, given the discrepancy in the Veteran’s intent in the February 2015 notice of disagreement and the Veteran’s clear intent to disagree in his October 2013 notice of disagreement, the Board finds that the Veteran more likely than not intended to appeal the issue of entitlement to service connection for peripheral neuropathy of the left lower extremity. In June 2016, the RO issued an SOC that did not include the issues of entitlement to service connection for peripheral neuropathy of the right upper extremity and left lower extremity, despite the Veteran including the issue on both his October 2013 and February 2015 notices of disagreement. Furthermore, on the Veteran’s June 2016 Form 9, the Veteran reported that he wanted to appeal the issue of peripheral neuropathy of the right upper extremity. A remand is required for the AOJ to issue a SOC. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240–41 (1999). The matters are REMANDED for the following action: Send the Veteran and his representative a SOC that addresses the issues remanded by the Board. If the Veteran perfects an appeal as it relates to the issues of entitlement to service connection for peripheral neuropathy of the right upper extremity and left lower extremity, the issues should be returned to the Board for further appellate consideration.   A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Keninger, Associate Counsel