Citation Nr: 18126628 Decision Date: 08/16/18 Archive Date: 08/15/18 DOCKET NO. 15-31 804 DATE: August 16, 2018 ORDER New and material evidence having been received sufficient to reopen the claim for service connection for diabetes mellitus type II, the appeal is granted to this extent. Entitlement to service connection for diabetes mellitus, type II is denied. Entitlement to service connection for atrial fibrillation is denied. Entitlement to service connection for hypertension is denied. FINDINGS OF FACT 1. A July 2010 rating decision denied service connection for diabetes mellitus, type II on the basis that there was no evidence of diabetes mellitus, type II symptoms or diagnosis in active service, the Veteran was not exposed to herbicides in active service, and there is no relationship between the diabetes mellitus, type II and active service. 2. Evidence received since the July 2010 decision is new, and, in conjunction with previously considered evidence, relates to an unestablished fact that is necessary to substantiate the claim for service connection for diabetes mellitus, type II. 3. The Veteran did not serve in country or on the inland waterways of the Republic of the Vietnam during the Vietnam era but served in the blue waters off the coast of Vietnam. 4. The Veteran was not exposed to herbicides in service. 5. No disease or chronic symptoms of diabetes mellitus, type II was manifested during service or was continuously manifested in the years after service; diabetes mellitus, type II was not manifested to a degree of ten percent within one year of service separation; diabetes mellitus, type II was diagnosed many years after service, and there is no competent evidence that establishes that the diabetes mellitus, type II is related to disease or injury in service. 6. No disease or chronic symptoms of hypertension or atrial fibrillation was manifested during service or was continuously manifested in the years after service; hypertension and atrial fibrillation were not manifested to a degree of ten percent within one year of service separation; and there is no competent evidence that establishes that hypertension and atrial fibrillation are related to disease or injury in service. CONCLUSIONS OF LAW 1. The evidence received subsequent to the July 2010 rating decision is new and material and the claim for service connection for diabetes mellitus, type II is reopened. 38 U.S.C. §§ 5108, 7104(b), 7105(c) (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 (2018). 2. The criteria for service connection for diabetes mellitus, type II are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1116 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2018). 3. The criteria for service connection for hypertension and atrial fibrillation are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1116 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from March 1971 to March 1973. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an April 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. The April 2014 rating decision reopened the claim for service connection for diabetes mellitus, type II and adjudicated the claim on the merits. New and Material Evidence Rating actions from which an appeal is not perfected become final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. The governing regulations provide that an appeal consists of a timely filed notice of disagreement in writing, and after a statement of the case has been furnished, a timely filed substantive appeal. 38 C.F.R. § 20.200. In order to reopen a claim which has been denied by a final decision, new and material evidence must be received. 38 U.S.C. § 5108. New and material evidence means evidence not previously submitted to agency decision makers; which relates, either by itself or when considered with previous evidence of record, to an unestablished fact necessary to substantiate the claim; which is 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 which raises a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). To reopen a previously disallowed claim, new and material evidence must be presented or secured since the last final disallowance of the claim on any basis, including on the basis that there was no new and material evidence to reopen the claim since a prior final disallowance. See Evans v. Brown, 9 Vet. App. 273, 285 (1996). For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed. See Justus v. Principi, 3 Vet. App. 510, 513 (1992) (in determining whether evidence is new and material, “credibility” of newly presented evidence is to be presumed unless evidence is inherently incredible or beyond competence of witness). The July 2010 RO rating decision denied service connection for diabetes mellitus, type II on the basis that there was no evidence of service in-country in Vietnam and that there was no evidence of symptoms or diagnosis of diabetes mellitus type II in active service or a nexus to active service. The evidence of record at the time of the July 2010 decision consisted of the Veteran’s service treatment records and service personnel records; a February 2010 medical statement showing a diagnosis of diabetes mellitus, type II; a November 2008 private medical record showing a history of diabetes mellitus for 8 years; and a November 2009 PIES response indicating that no conclusive proof of in-country Vietnam service was found. The Veteran was notified of the July 2010 rating decision, but he did not file a timely appeal, and no new and material evidence was received within a year of that decision. Therefore, the July 2010 decision is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104(a), 3.156(b), 3.160(d), 20.302, 20.1103. In September 2013, the Veteran applied to reopen the previously denied claim for service connection for diabetes mellitus, type II. The additional evidence received in support of the claim includes the Veteran’s statements dated in June 2014 and August 2015. In the statements, the Veteran alleges that, while serving on USS Midway, he was exposed to Agent Orange in the drinking and bathing water supply on the ship, and he was exposed to planes that were sprayed by chemicals. The Board concludes there is sufficient evidentiary basis to reopen the Veteran’s claim on appeal. The Veteran’s statements are new since this evidence is neither cumulative nor redundant of the evidence that was of record in July 2010. This evidence is also material because this medical evidence tends to show that the Veteran may have been exposed to herbicides while serving aboard USS Midway. This evidence relates to an unestablished fact necessary to substantiate the claim which is evidence of exposure to herbicides in active service. Thus, the Board finds that this evidence is new and material and the claim for service connection is reopened. Service Connection In order to establish service connection, the facts, as shown by evidence, must demonstrate that a disease or injury resulting in current disability was incurred during service or, if pre-existing active service, was aggravated therein. 38 U.S.C. § 1110. Service connection may also be granted for a disability initially diagnosed after service when all of the evidence shows it to have been incurred in service. 38 C.F.R. § 3.303 (d) (2018). Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Where a veteran served ninety days or more of active service, and certain chronic diseases, such as diabetes mellitus or cardiovascular disease, 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; 38 C.F.R. §§ 3.307, 3.309(a). In this case, diabetes mellitus and cardiovascular disease are listed among the “chronic diseases” under 38 C.F.R. § 3.309 (a); therefore, 38 C.F.R. § 3.303(b) applies. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Presumptive service connection on the basis of herbicide exposure is provided for specified diseases manifested to a degree of 10 percent within a specified period in a Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975. 38 U.S.C. § 1116 (a). If a Veteran was exposed to a herbicide agent during active military, naval, or air service, the following diseases shall be service-connected if the requirements of 38 U.S.C. § 1116, 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113; 38 C.F.R. § 3.307(d) are also satisfied: chloracne or other acneform disease consistent with chloracne, non-Hodgkin’s lymphoma, soft tissue sarcoma, Hodgkin’s disease, porphyria cutanea tarda (PCT), multiple myeloma, acute and subacute peripheral neuropathy, prostate cancer, cancers of the lung, bronchus, larynx, trachea, Type II (adult-onset) diabetes mellitus, chronic lymphocytic leukemia, AL amyloidosis, Parkinson’s disease, ischemic heart disease, and B-cell leukemias, such as hairy cell leukemia. 38 C.F.R. § 3.309(e). The diseases listed at 38 C.F.R. § 3.309(e) shall have become manifest to a degree of 10 percent or more any time after service, except that chloracne and porphyria cutanea tarda and acute and subacute peripheral neuropathy shall have become manifest to a degree of 10 percent or more within a year after the last date on which the Veteran was exposed to an herbicide agent during active military, naval, or air service. 38 C.F.R. § 3.307(a)(6)(ii). VA’s Secretary has determined that a presumption of service connection based on exposure to herbicides used in the Republic of Vietnam during the Vietnam era is not warranted for any condition for which the Secretary has not specifically determined a presumption of service connection is warranted. See 68 Fed. Reg. 27,630 (May 20, 2003). In this regard, the Board observes that VA has issued several notices in which it was determined that a presumption of service connection based upon exposure to herbicides used in Vietnam should not be extended to certain specific disorders, based upon extensive scientific research. See, e.g., Notices, 68 Fed. Reg. 27,630-41 (2003); 64 Fed. Reg. 59,232-243 (1999); 61 Fed. Reg. 57,586-589 (1996). However, the Federal Circuit has determined that an appellant is not precluded from establishing service connection with proof of actual direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). Once the evidence has been assembled, it is the Board’s responsibility to evaluate the evidence. 38 U.S.C. § 7104(a). 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 a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.102, 4.3. The Veteran asserts that he was exposed to Agent Orange while serving aboard USS Midway during the Vietnam War. In December 2009, the National Personnel Records Center (NPRC) confirmed that USS Midway was in the official waters of the Republic of Vietnam in 1971 from May 17 to June 9, June 29 to July 20, July 31 to August 17, September 26 to October 11, and May 1 to June 1; in 1972 from June 11 to July 7, July 16 to August 13, August 23 to September 10, September 19 to October 12, October 23 to November 23, December 3 to December 22, and December 31; and in 1973 from January 4 to January 24, and February 3 to February 9. The NPRC stated that there was no conclusive proof that the Veteran had in-country service. The Veteran’s service personnel records verify that he served aboard the ship during these times. In statements dated in June 2014 and August 2015, the Veteran alleged, while serving on USS Midway, that he was exposed to Agent Orange in the drinking and bathing water supply on the ship and that he was exposed to planes that were sprayed by chemicals. There is no assertion that the Veteran was stationed in the Republic of Vietnam, or had official duty there, and his service personnel records do not reflect any such duty. While the Veteran was awarded the Vietnam Service Medal and the Vietnam Campaign Medal, these medals recognize service aboard USS Midway and participation in military operations, but not necessarily duty or visitation within the Republic of Vietnam. See Manual of Military Decorations and Awards (Department of Defense Manual 1348.33-V3, November 2010). The Veteran contends that the presumption of herbicide exposure should extend to Veterans who served aboard navy ships that were in the official waters of the Republic of Vietnam. Service in the Republic of Vietnam includes service in the brown water offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. 38 C.F.R. § 3.313. This presumption does not apply to veterans who served exclusively offshore in ocean-going ships, i.e., the “blue water” Navy. See 38 C.F.R. § 3.313(a); VAOPGCPREC 27-97 (Mere service on a deep-water naval vessel in waters off the shore of the Republic of Vietnam does not constitute “Service in the Republic of Vietnam” for purposes of 38 U.S.C. § 1116 (2012). Haas v. Peake, 525 F.3d 1168, 1197 (Fed. Cir. 2008) (upholding VA’s statutory interpretation excluding the “blue water” Navy from presumptive herbicide exposure). In February 2016, in response to a decision by the United States Court of Appeals for Veterans Claims in Gray v. McDonald, 27 Vet. App. 313 (2015), VA released updated guidance about which bodies of water in Vietnam constitute inland waterways and thus which service members are to be presumed to have been exposed to herbicides as a result of service in Vietnam. VA further updated its Adjudication Manual, M21-1MR. The applicable provisions of the M21-1 Manual, specifically those provisions defining inland waterways and offshore waters and designating some of the specific locations determined to be within those categories, were modified. The manual reaffirmed that the presumption of exposure to Agent Orange requires evidence establishing duty or visitation within the Republic of Vietnam, and that service on offshore waters does not establish a presumption of exposure to Agent Orange. The current manual specifically provides that: Inland waterways are fresh water rivers, streams, and canals, and similar waterways. Because these waterways are distinct from ocean waters and related coastal features, service on these waterways is service in the Republic of Vietnam. VA considers inland waterways to end at their mouth or junction to other offshore water features, as described below. For rivers and other waterways ending on the coastline, the end of the inland waterway will be determined by drawing straight lines across the opening in the landmass leading to the open ocean or other offshore water feature, such as a bay or inlet. For the Mekong and other rivers with prominent deltas, the end of the inland waterway will be determined by drawing a straight line across each opening in the landmass leading to the open ocean. VBA Manual M21-1, IV.ii.1.H.2.a. Inland waterway service is also referred to as “brown-water” Navy service. Id. By contrast, “off shore waters” are defined as the high seas and any coastal or other water feature, such as a bay, inlet, or harbor, containing salty or brackish water and subject to regular tidal influence. This includes salty and brackish waters situated between rivers and the open ocean. VBA Manual M21-1, IV.ii.1.H.2.b. Service in offshore waters is also referred to as “blue-water” Navy service. While the M21-1 Manual is not binding on the Board, it is instructive on the definition of inland waterways and offshore waters for the purposes of entitlement to presumptive service connection. See 38 C.F.R. § 19.5; VBA Manual M21-1, IV.ii.1.H.2. The Board rejects the Veteran’s argument that he was exposed to herbicides while serving aboard USS Midway. According to Haas, service in the official waters off the coast of Vietnam does not constitute “service in the Republic of Vietnam.” See VAOPGCPREC 27-97 (O.G.C. Prec.27-97); Haas v. Peake, 525 F.3d 1168 (Fed. Cir. 2008) (holding that the Court had erred in rejecting VA’s interpretation of § 3.307(a)(6)(iii) as requiring a service member’s presence at some point on the landmass or inland waters of Vietnam in order to benefit from the regulation’s presumption). See 38 C.F.R. §§ 3.307(a), 3.313(a) (2015). Instead, service in the Republic of Vietnam requires visitation (i.e. setting foot) in Vietnam or service in the inland waters of Vietnam. Id. The Board also relies on guidance from the VA Adjudication Procedure Manual and a training letter issued in September 2010 by the Compensation and Pension Service, and a VBA Fast Letter 10-37 (September 10, 2010). According to the February 5, 2016 amendments to the VBA Manual M21-1, IV.ii.1.H.2.a, offshore waters are the high seas and any coastal or other water feature, such as a bay, inlet, or harbor, containing salty or brackish water and subject to regular tidal influence. This includes salty and brackish waters situated between rivers and the open ocean. VBA Manual M21-1, IV.ii.1.H.2.b. See also Training Letter 10-06, Adjudicating Disability Claims Based on Herbicide Exposure from U.S. Navy and Coast Guard Veterans of the Vietnam Era (September 9, 2010). This guidance suggested that a blue water veteran must show that he stepped foot on the land mass of Vietnam to warrant the presumption of herbicide exposure under Haas. In addition to these amendments to the M21-1, the VA herbicide exposure ship list was also updated on the same day to reflect the M21-1 amendments. The amended background section of the document, entitled Navy and Coast Guard Ships Associated with Service in Vietnam and Exposure to Herbicide Agents states as follows: According to 38 C.F.R. § 3.307 (a)(6)(iii), eligibility for the presumption of Agent Orange exposure requires that a Veteran’s military service involved “duty or visitation in the Republic of Vietnam” between January 9, 1962 and May 7, 1975. This includes service within the country of Vietnam itself or aboard a ship that operated on the inland waterways of Vietnam. However, this does not include service aboard a large ocean-going ship that operated only on the offshore waters of Vietnam, unless evidence shows that a Veteran went ashore. Inland waterways include rivers, canals, estuaries, and deltas. They do not include open deep-water bays and harbors such as those at Da Nang Harbor, Qui Nhon Bay Harbor, Nha Trang Harbor, Cam Ranh Bay Harbor, Vung Tau Harbor, or Ganh Rai Bay. These are considered to be part of the offshore waters of Vietnam because of their deep-water anchorage capabilities and open access to the South China Sea. Veterans whose military records confirm they served aboard the ships on VA’s list of U.S. Navy and Coast Guard ships associated with military service in Vietnam and possible exposure to Agent Orange qualify for presumption of herbicide exposure. http://www.publichealth.va.gov/exposures/agentorange/shiplist/list.asp. USS Midway is not on this list. The Board finds that the weight of the evidence establishes that USS Midway was an offshore “blue water” vessel during the time period the Veteran was aboard the ship. The weight of the competent and credible evidence shows that the Veteran did not have service in the Republic Vietnam or the inland waterways of the Republic of Vietnam or another location where exposure to herbicides can be presumed, and the service records do not otherwise show exposure to herbicide agents. 38 C.F.R. § 3.307 (a)(6)(iii) (2018). As it is not shown that the Veteran had service in the Republic of Vietnam, the presumption of exposure to herbicides does not apply to his claim of service connection for diabetes mellitus type II. 38 U.S.C. § 1116(f). As the Veteran is not presumed to have been exposed to herbicides, the presumption of service connection under 38 U.S.C. § 1116(a)(1) for these disorders does not apply. Although neither the presumption of exposure to herbicides nor the presumption of service connection due to such exposure applies to the claim for the reasons articulated, the Veteran may still establish service connection by evidence of actual exposure to herbicides and by evidence that such exposure caused the disability. 38 C.F.R. § 3.303(d); Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). The Veteran asserts that he was exposed to herbicides through the drinking and bathing water on USS Midway and by exposure to the planes. In determining the regulatory definition of service in the Republic of Vietnam, VA carefully considered all the potential exposure mechanisms advanced by the Veteran. See Definition of Service in the Republic of Vietnam, 73 Fed. Reg. 20566 (April 16, 2008). Specifically, VA noted that: It is conceivable that some veterans of offshore service incurred exposure under some circumstances due, for example, to airborne drift, groundwater runoff, and the proximity of individual boats to the Vietnam coast. For purposes of the presumption of exposure, however, there is no apparent basis for concluding that any such risk was similar in kind or degree to the risk attending service within the land borders of the Republic of Vietnam. More significantly, because ‘‘offshore service’’ encompasses a wide range of service remote from land and thus from areas of actual herbicide use, there is no reason to believe that any risk of herbicide exposure would be similarly pervasive among veterans of offshore service as among veterans of service within the land borders of Vietnam. Id. at 20569. The Secretary has determined that the evidence available at this time does not support establishing a presumption of exposure to herbicides for Blue Water Navy Vietnam Veterans. The Secretary’s decision is based on careful review of a May 2011 Institute of Medicine (IOM) of the National Academy of Sciences report entitled “Blue Water Navy Vietnam Veterans and Agent Orange Exposure.” This report was completed at the request of VA. The IOM reviewed a wide range of data sources and concluded that there is insufficient evidence to determine whether Blue Water Navy Veterans were exposed to Agent Orange-associated herbicides during the Vietnam War. The Board finds that the Veteran’s own assertions that he was exposed to herbicides while stationed aboard USS Midway to have no probative value. While he is competent to describe an observable event such as having a substance touch his skin or using water or seeing a liquid substance, the Board finds that he has not shown that he has the requisite expertise to identify a chemical substance. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010) (holding that a layperson’s assertions indicating exposure to gases or chemicals during service are not considered to be sufficient evidence alone to establish actual exposure). Lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his or her personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical or scientific expertise. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). There is no evidence of record that the Veteran has the expertise to identify the substances he may have been exposed to without scientific training or the use of scientific testing to identify a substance he came into contact with. Thus, his statements that he was exposed to Agent Orange are not competent and have no probative value. The Veteran’s contentions that he was exposed to herbicides through drinking water have already been considered by the Secretary of VA in creating the “bright line” rule against presumptive exposure to deep water vessels. In Haas, supra, a blue water Veteran, who served on USS MOUNT KATMAI, supplemented his argument with studies which attempted to show a direct connection between the spraying of Agent Orange on the mainland of Vietnam to the development of Agent Orange-related diseases in service members who served on the ships offshore. In particular, the claimant in Haas attempted to rely on a 2002 Australian Research Study. Although the Federal Circuit passed no judgment on the validity of studies, such as the Australian study, it did highlight the VA’s rulemaking with respect to this Australian study: VA scientists and experts have noted many problems with the study that caution against reliance on the study to change our long-held position regarding veterans who served off shore. First, as the authors of the Australian study themselves noted, there was substantial uncertainty in their assumptions regarding the concentration of dioxin that may have been present in estuarine waters during the Vietnam War. Second, even with the concentrating effect found in the Australian study, the levels of exposure estimated in this study are not at all comparable to the exposures experienced by veterans who served on land where herbicides were applied. Third, it is not clear that U.S. ships used distilled drinking water drawn from or near estuarine sources, or if they did, whether the distillation process was similar to that used by the Australian Navy. Crucially, based on this analysis, the VA stated that “‘we do not intend to revise our long-held interpretation of ‘service in Vietnam.’“ See Haas, 525 F.3d at 1194 (citing 73 Fed. Reg. 20,566, 20,568 (Apr. 16, 2008)). Accordingly, the Board defers to the Secretary’s reasonable interpretation regarding the reliability and soundness of the various scientific studies purporting to establish actual herbicide exposure to blue water Vietnam Veterans. Thus, the Veteran’s claim of service connection for diabetes mellitus does not fall within the purview of 38 U.S.C.§ 1116; 38 C.F.R. § 3.307 and the weight of the evidence establishes that he was not exposed to herbicides during active service. Accordingly, the Board finds that the weight of the competent and credible evidence establishes that the diabetes mellitus, type II first manifested in about 2000, over 25 years after service. See the November 2008 treatment record. With respect to negative evidence, the fact that there were no records of any complaints, treatment, or diagnosis of diabetes mellitus, type II for over 25 years after service separation weighs against the claim. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (A prolonged period without medical complaint can be considered, along with other factors concerning a claimant’s health and medical treatment during and after military service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability). Thus, the lack of any evidence of diabetes mellitus, type II symptoms or findings for over two decades between the period of active service and manifestation of this disease is itself evidence which tends to show that this disease did not have its onset in service or for years thereafter. There is also no evidence of diabetes mellitus, type II in service or for many years thereafter. Separation examination in January 1973 indicates that examination of the endocrine system was normal. There is no evidence of symptoms, complaints or diagnoses of diabetes mellitus, type II in active service. There is no competent evidence of a diagnosis of diabetes mellitus, type II within one year after service separation in March 1973. The Board also finds that the Veteran did not experience continuous symptoms of diabetes mellitus, type II in service or since service separation. There is no competent evidence of symptoms of this disorder since separation from service until the time of the diagnoses in about 2000. Thus, presumptive service connection under the provisions of 38 C.F.R. § 3.303 (b) and § 3.307(a) is not warranted. There is no competent evidence to establish a nexus between the diabetes mellitus, type II and any documented event or incident of service. There is no competent and credible medical evidence that links the claimed disease to service. The Veteran’s own assertions that the claimed diabetes mellitus, type II is related to service to include in service herbicide exposure are afforded no probative weight in the absence of evidence that he has the expertise to render opinions about medical matters. Although lay persons are competent to provide opinions on some medical issues, the specific disability in this case, diabetes mellitus, falls outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Diagnosing diabetes mellitus requires specialized training and medical diagnostic testing for a determination as to diagnosis and causation, and is not susceptible of lay opinions on etiology. There is no evidence that the Veteran has medical expertise. Furthermore, he has not submitted any credible evidence to corroborate the assertion that he was actually exposed to herbicides in service, and if so, the circumstance of that exposure. Therefore, the Board finds that his lay statements of record cannot be accepted as competent evidence sufficient to establish service connection for diabetes mellitus, type II. His lay statements are not sufficient to establish exposure to herbicides in service and are not competent to diagnose diabetes mellitus and relate it to any event, injury, or disease during service. In light of the above, the Board finds that the preponderance of the evidence is against a finding that the diabetes mellitus, type II is related to service. As the preponderance of the evidence is against the Veteran’s claim, the benefit of the doubt rule is not applicable. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). The claim for service connection for diabetes mellitus, type II on a direct and presumptive basis is denied. The Board also finds that a preponderance of the lay and medical evidence that is of record weighs against the claim for service connection for hypertension and atrial fibrillation. As discussed in detail above, the weight of the evidence establishes that the Veteran did not serve in country in Vietnam. Further, hypertension and atrial fibrillation are not presumptive diseases under 38 U.S.C. § 1116. 38 C.F.R. § 3.309(e), Note 3. Consequently, the Veteran’s claims of service connection for hypertension and atrial fibrillation do not fall within the purview of 38 U.S.C.§ 1116; 38 C.F.R. § 3.307, and the weight of the evidence establishes that the Veteran was not exposed to herbicides during active service. The Board finds that the weight of the competent and credible evidence establishes that the Veteran’s hypertension and atrial fibrillation first manifested many years after service separation, and are not caused by or otherwise related to his active military service. Review of the record shows that during the Veteran’s period of service, there were no findings of symptoms or diagnosis of a heart disorder. The Veteran did not have hypertension or atrial fibrillation upon entrance examination. The January 1973 separation examination report indicates that examination of the heart and chest was normal. Chest X rays were negative. The Veteran separated from service in March 1973. The Veteran reported that he now had hypertension and atrial fibrillation in a September 2013 statement. He did not identify or submit competent evidence of a current diagnosis. Indeed, there is no competent evidence of a diagnosis of hypertension or atrial fibrillation within one year after service separation in March 1973. Thus, presumptive service connection under the provisions of 38 C.F.R. § 3.307 (a) is not warranted. The Board also finds that the weight of the competent and credible evidence shows that the Veteran did not experience chronic and continuous symptoms of hypertension and atrial fibrillation in service or since service separation. There is no lay or medical evidence of chronic symptoms hypertension or atrial fibrillation in active service or in the years after service separation. The Board finds that the service medical evidence and post service medical evidence show a lack of complaints, treatment, or diagnosis of hypertension and atrial fibrillation for many years after service. Thus, presumptive service connection under the provisions of 38 C.F.R. § 3.303(b) is not warranted. Moreover, there is no competent evidence to establish a nexus between the hypertension or atrial fibrillation and any documented event or incident of service. There is no competent and credible medical evidence that links the claimed diseases to service. The Veteran’s own assertions that the hypertension or atrial fibrillation are related to service to include herbicide exposure in service are afforded no probative weight in the absence of evidence that he has the expertise to render opinions about medical matters. See Kahana, supra; Jandreau, supra. Diagnosing heart disease requires specialized training and medical diagnostic testing for a determination as to diagnosis and causation, and is not susceptible of lay opinions on etiology. There is no evidence that the Veteran has medical expertise. Therefore, the Board finds that his lay statements of record cannot be accepted as competent evidence sufficient to establish service connection for heart disease. In light of the above, the Board finds that the preponderance of the evidence is against a finding that the hypertension and atrial fibrillation are related to service. As the preponderance of the evidence is against the Veteran’s claims, the benefit of the doubt rule is not applicable. 38 U.S.C. § 5107(b); Gilbert, supra. The claims for service connection for hypertension and atrial fibrillation on a direct and presumptive basis are denied. VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5103, 5103A (2012); 38 C.F.R. § 3.159 (2017). The Veteran filed the claims through VA’s fully developed claim program. The Board finds that the content requirements of a duty-to-assist notice letter have been fully satisfied as the Veteran was provided all of the relevant notice requirements in his September 2013 VA 21-526 EZ Fully Developed Claim forms (EZ Claim). He has had representation throughout the entire appeal period. Therefore, additional notice is not required. A VA medical opinion and examination were not provided for the issues on appeal. The Federal Circuit Court of Appeals (Federal Circuit) has recognized that there is not a duty to provide an examination in every case. See Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). Rather, the Secretary’s obligation under 38 U.S.C. § 5103A(d) to provide the Veteran with a medical examination or to obtain a medical opinion is not triggered unless there is an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability. See McLendon v. Nicholson, 20 Vet. App.79, 81 (2006). The record in this case is negative for any indication that the diabetes mellitus, type II; hypertension; or atrial fibrillation are associated to service. The record in this case is negative for any indication, other than the Veteran’s own general assertion, that the claimed disabilities are related to active service. The Veteran did not provide lay or medical evidence of the disabilities in active service or symptoms or disease in active service. The service treatment records do not document diabetes mellitus, type II; hypertension; or atrial fibrillation. Exposure to herbicides in service and in-country service in Vietnam are not established. The Veteran’s sole assertion that he wants service connection for diabetes mellitus, type II; hypertension; or atrial fibrillation are insufficient to trigger VA’s duty to provide an examination with an opinion. There is no evidence of the claimed disabilities in active service or any indication of an association to service. There is sufficient competent evidence on file for the Board to make a decision on the claims. As such, VA’s duty to provide an examination with an opinion is not triggered. See Waters, 601 F.3d 1274. VA has fulfilled its obligation to assist the Veteran in developing these claims. Neither the Veteran nor his representative has identified any deficiency in VA’s notice or assistance duties. 38 U.S.C. §§ 5103, 5103A (2012); 38 C.F.R. § 3.159 (2017); Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (“the Board’s (CONTINUED ON NEXT PAGE) obligation to read filings in a liberal manner does not require the Board...to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist). THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C.L. Krasinski, Counsel