Citation Nr: 19144167 Decision Date: 06/07/19 Archive Date: 06/06/19 DOCKET NO. 16-05 589 DATE: June 7, 2019 ORDER Service connection for rhinitis, claimed as sinusitis, is granted. Service connection for a back disability is denied. Service connection for a cardiovascular disability is denied. Service connection for hypertension is denied. Service connection for diabetes mellitus is denied. Service connection for nerve damage to the bilateral upper extremities is denied. Service connection for nerve damage to the bilateral lower extremities is denied. FINDINGS OF FACT 1. Rhinitis was diagnosed during active service and the Veteran has continued to experience symptoms of rhinitis since service separation. 2. Symptoms of a back disability, cardiovascular disability, hypertension, diabetes mellitus, and nerve damage to the bilateral upper and lower extremities were not continuous or recurrent in service or since service separation; arthritis, hypertension, and diabetes mellitus did not manifest to a compensable degree within one year of active service; hyperlipidemia is not a disability; and there is no medical nexus between the claimed back disability, cardiovascular disability, hypertension, diabetes mellitus, or nerve damage to the bilateral upper and lower extremities and active service. CONCLUSIONS OF LAW 1. The criteria for service connection for rhinitis have been met. 38 U.S.C. §§ 101, 1101, 1131, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 2. The criteria for service connection for a back disability have not been met. 38 U.S.C. §§ 101, 1101, 1112, 1113, 1131, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309. 3. The criteria for service connection for a cardiovascular disability have not been met. 38 U.S.C. §§ 101, 1101, 1131, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 4. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 101, 1101, 1112, 1113, 1131, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309. 5. The criteria for service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 101, 1101, 1112, 1113, 1131, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309. 6. The criteria for service connection for nerve damage to the bilateral upper extremities have not been met. 38 U.S.C. §§ 101, 1101, 1131, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 7. The criteria for service connection for nerve damage to the bilateral lower extremities have not been met. 38 U.S.C. §§ 101, 1101, 1131, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from October 1978 to October 1981. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) competent evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) competent evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The United States Court of Appeals for Veterans Claims (Court) has held that “Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim.” Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). Where a veteran who served for ninety days or more during a period of war (or during peacetime service after December 31, 1946) develops certain chronic diseases, such as arthritis, cardiovascular disability, hypertension, or diabetes mellitus, to a degree of 10 percent or more within one year from separation from service, such diseases may be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. In this case, the medical evidence of record demonstrates current diagnoses of lumbar spine arthritis, hypertension, and diabetes. Where the veteran asserts entitlement to service connection for a chronic disease but there is insufficient evidence of a diagnosis in service, service connection may be established under 38 C.F.R. § 3.303(b) by demonstrating a continuity of symptomatology since service or diagnosis within the presumptive period after service, but only if the chronic disease is listed under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331, 1338-39 (Fed. Cir. 2013); 38 C.F.R. § 3.307 (service connection authorized for chronic diseases diagnosed within the presumptive period). However, for the reasons set forth below, the Veteran was not diagnosed with arthritis, hypertension, or diabetes within one year of separation from service, nor has there been continuity of symptomatology of those disorders. With specific regard to continuity of symptomatology, 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, such as arthritis, hypertension, or diabetes, 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). The remaining conditions at issue are not among the “chronic diseases” listed under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.309(b) (requiring continuity of a condition after service if chronicity is not found in service) does not apply to those disorders. See Walker, 708 F.3d 1331. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Allergic rhinitis As noted on the title page of this decision, the Veteran claimed service connection for sinusitis, and the claim has been developed as such. However, in Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the Court found that when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. “Although the RO has no duty to read the mind of the claimant, the RO should construe a claim based on the reasonable expectations of the non-expert, self-represented claimant, and the evidence developed in processing that claim.” Clemons, 23 Vet. App. at 5. Thus, pursuant to the holding in Clemons, the Board has construed the Veteran’s claim of service connection for sinusitis to include a claim of service connection for rhinitis, as the symptoms of those disorders are similar, and both are evaluated under the Schedule of Ratings for Diseases of the Nose and Throat. 38 C.F.R. § 4.97, Diagnostic Codes 6510 – 6514, 6522. The Veteran’s service treatment records show that he was diagnosed with rhinitis during active service. In March 1980, mirror and speculum examination of the nose revealed fiery red, friable mucosa and a hypertrophied inferior turbinate on the right with almost complete airway obstruction. He was given a nasal spray. In April 1980, the Veteran reported daily epistaxis for one month. On examination, there was a slightly deviated septum with compensating hypertrophy of the right inferior turbinate and a fissure on the anterior left side. The diagnosis was epistaxis of unknown etiology. He was given saline spray. A June 1980 treatment note records a diagnosis of rhinitis. Following separation from active service, an August 2008 treatment note indicates that the Veteran requested refills of Nasonex nasal spray, and that he was given samples of same. In February 2009, the Veteran reported a 2 to 3-day history of nasal congestion, discharge, sore throat, ear congestion, and dry cough. On examination, he had post nasal drip and mild maxillary tenderness. He was diagnosed with sinusitis, hypertension, and diabetes, and was prescribed nasal spray. In November 2012, the Veteran reported nasal stuffiness. Examination of the nose was normal, but the clinician assessed allergic rhinitis, acute, minor. In June 2013, the Veteran complained of head and chest congestion, sinus drainage, and cough. It was noted he had problems with allergic rhinitis. The clinician assessed sinusitis, acute, moderate; allergic rhinitis, acute, moderate; and bronchitis. In June 2013, the Veteran submitted a Sinusitis/Rhinitis Disability Benefits Questionnaire completed by his private physician, Dr. G. The doctor diagnosed chronic sinusitis, first diagnosed in May 2013, and allergic rhinitis, first diagnosed in November 2012, and again in January and June 2013. The doctor indicated that symptoms of chronic sinusitis included episodes of sinusitis, headaches, and pain and tenderness of the affected sinus. Dr. G. did not offer a nexus opinion. In March 2014, the Veteran was afforded a VA sinusitis/rhinitis examination. The VA examiner noted that the Veteran was diagnosed with allergic rhinitis in 2012, and that he was claiming service connection for chronic sinusitis secondary to rhinitis treated while on active duty. The Veteran reported that he had a runny nose, postnasal drip, sore throat, and shortness of breath while on active duty, and that he was treated with Flonase; he now complained of similar symptoms on a daily basis and was treated with flunisolide. A CT was performed which showed no significant inflammatory paranasal sinus disease or obstructive sinonasal polyposis; and minimal inflammatory mucosal changes within the dependent right maxillary sinus. The VA examiner opined that the claimed sinusitis was not related to the Veteran’s rhinitis, reasoning that the CT of the sinuses showed minimal inflammatory mucosal changes, but no thickening to indicate chronic sinusitis; therefore, the examiner was unable to offer a favorable nexus opinion in the absence of a diagnosis of sinusitis. Private treatment records show that the Veteran was diagnosed with acute bronchitis and sinusitis in July 2015, and VA treatment records show ongoing treatment for allergic rhinitis. While the 2014 VA examiner opined that the Veteran’s sinusitis was not chronic based on the CT scan, the Veteran’s private treatment records show occasional episodes of sinusitis, and his post-service records show ongoing treatment for recurrent allergic rhinitis. The VA examiner did not address whether the Veteran’s rhinitis was related to active service. Moreover, the Veteran was diagnosed with rhinitis during active service based on symptoms similar to those he experienced after service separation. Resolving reasonable doubt in his favor, the Board finds an in-service diagnosis of allergic rhinitis, and continuity of symptomatology with regard to rhinitis symptoms. Thus, service connection for allergic rhinitis is granted. Back disability, cardiovascular disability, hypertension, diabetes, and nerve damage to the bilateral upper and lower extremities The Veteran contends that he has a back disability, cardiovascular disability, hypertension, diabetes, and nerve damage to the bilateral upper and lower extremities that began during or are related to his active service. For the reasons discussed below, the Board finds that there is no medical nexus between the current back disability, cardiovascular disability, hypertension, diabetes, or nerve damage to the bilateral upper and lower extremities and active service. Therefore, service connection for the claimed disabilities is not warranted. At the outset, the Board notes that VA regulations specify that the term hypertension means that the diastolic blood pressure is predominantly 90 mm or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160 mm or greater with a diastolic blood pressure of less than 90 mm. 38 C.F.R. § 4.104, Diagnostic Code 7101. In addition, VA regulations specify that hypertension must be confirmed by readings taken two or more times on at least three different days. Id., Note (1). Reviewing the most relevant evidence of record, the Veteran’s blood pressure readings were 118/60 at the June 1978 enlistment examination, 120/80 in April 1979, 102/70 in May 1979, 110/70 in June 1979, and 110/78 in July 1979. In January 1980, his blood pressure was measured at 150/100, and he was diagnosed with rule out hypertension. Blood pressure readings over the next 2 days were 136/94 and 142/94. A hypertension consultation was ordered. Several days later, blood pressure was recorded at 142/99, and an ECG was within normal limits. Blood pressure was recorded at 118/70 in March 1980, 128/88 in May 1980, 122/84 in June 1980, and 118/76 in September 1980. In October 1980, the Veteran reported for a re-check for supposed hypertension. The doctor noted that he had been normo-tensive by blood pressure in medical records except for isolated blood pressure of January 1980 with diastolic pressure in the 90s. Currently, his sitting blood pressure was recorded at 138/88 and 124/80, and standing was at 132/86 and 120/76. The clinician diagnosed doubtful hypertension. With regard to the claimed back and cardiovascular disabilities, diabetes mellitus, and nerve damage to the extremities, service treatment records are negative for any reports, signs, symptoms, findings, treatment, or diagnoses of the claimed disabilities. In May 1980, on a dental health questionnaire, the Veteran indicated a history of heart murmur, but no finding of a heart murmur is recorded by any clinician in his treatment records, and as noted above, an ECG was normal. Following separation from active service, at an August 1983 quad examination for Reserve service and a January 1987 enlistment examination for National Guard service, clinical evaluations of the heart, vascular system, endocrine system, upper and lower extremities, feet, spine, and neurologic system were marked as normal. The Veteran denied pain or pressure in his chest, palpitation or pounding heart, heart trouble, high blood pressure, arthritis, recurrent back pain, foot trouble, and neuritis on his Report of Medical History at both examinations. In 1983, blood glucose level was 100 mg/dL and marked as negative, and blood pressure was 118/64. In 1987, blood pressure was 110/70. In May 1989, a fasting glucose test was 81 mg/dL, where expected range was 60 to 115 mg/dL. In November 2005, the Veteran denied chest pain, shortness of breath, dyspnea on exertion, palpitations, and paresthesias. Blood pressure was 132/78. Heart rate and rhythm were normal without murmurs, rubs, or gallops. In May 2006, blood pressure was 136/82. Heart had regular rate and rhythm without murmurs, rubs, or gallops. Neurologic examination was grossly intact. In May 2007, blood pressure was 160/98 and was noted to be elevated. Heart had regular rate and rhythm with no murmurs, rubs, or gallops. The clinician recommended blood pressure checks and told the Veteran to return if blood pressure was elevated over 136 and 86. Later in May 2007, the Veteran reported for follow-up of elevated blood sugar levels and it was noted that he also had hypertension. He denied chest pain, shortness of breath, dyspnea on exertion, palpitations, and paresthesias. Blood pressure was 174/100. Heart had regular rate and rhythm without murmurs, rubs, or gallops. Neurological examination was grossly intact. The diagnoses were hypertension and new onset diabetes. Private and VA treatment records show ongoing follow-up for hypertension and diabetes. In May 2011, the Veteran reported pain in his buttocks bilaterally with minimal if any back pain. He denied lower leg pain, paresthesias, and weakness. A lumbar spine x-ray showed moderate facet joint osteoarthritis. The diagnosis was bilateral buttock pain with questionable etiology. The following month, the Veteran reported low back pain radiating into his left leg. In August 2012, the Veteran reported a recent fall during which he slipped on some grease and fell off of the top of a truck. He had 2 broken ribs on the left side and continued to have low back and bilateral leg pain. He reported no back pain until 9 days prior when he fell. The diagnoses were neuropathy of the lumbosacral plexus, and pain in the lower extremities. The following day he began a series of L4-L5 steroid injections for lumbar radiculopathy. In November 2012, the Veteran sought treatment at a private practice for the first time. A history of hypertension, diabetes, hyperlipidemia, and scoliosis were noted. He reported that he had had a fall while at work in August 2012 and reported chronic low back pain with pain and discomfort into both lower extremities. He had seen a cardiologist with catheter in the past indicating nonobstructive plaques and medical management was recommended. Review of systems indicated no palpitations, no arrhythmia, no numbness, and no paresthesia. Physical examination revealed heart rate and rhythm normal without murmurs, and reflexes normal. There was lumbar spine tenderness. The clinician diagnosed hypertension, back pain with radiation, coronary atherosclerosis - nonobstructive plaques, diabetes mellitus, dyslipidemia, and scoliosis. A separate treatment note from the same date indicates that the Veteran reported palpitations, chest discomfort, and shortness of breath with activities and exertion, and that he had an abnormal EKG that showed tachycardia. He stated that the symptoms had begun in the last month. An ECG was performed and showed sinus tachycardia. The clinician ordered an echocardiogram, stress test, and 24-hour Holter monitor. A stress test indicated that mildly reversible ischemia in the inferolateral wall could not be excluded by the study and a normal LVEF at 54 percent. A later November 2012 treatment note indicates that diabetes was diagnosed approximately three years prior, and that he had experienced low back pain for approximately three years. In January 2013, the Veteran reported pain in his back, neck, legs, and arms, and that he had a back injury related to work. On examination, he had back stiffness and reduced range of motion, as well as paresthesia of the lower extremities. Straight leg raising was positive on the left side only. Neurologic examination of the upper and lower extremities was normal, including light touch sensation. The diagnosis was chronic pain in the bilateral upper and lower extremities. A May 2013 treatment note indicates that a coronary angiography had been performed in March 2010 which showed moderate stenoses in LAD and RCA with 50 percent stenosis and ejection fraction of 55 percent. The clinician discussed the option of an invasive heart catheter and angiogram, but the Veteran wished to try medical management for the time being. In June 2013, the Veteran submitted a Diabetes Mellitus Disability Benefits Questionnaire completed by a private physician. The doctor stated that diabetes mellitus was diagnosed in November 2012, and that the Veteran was taking oral hypoglycemic agents and insulin. The doctor also stated that that Veteran had a cardiac condition and hypertension as a result of his diabetes but did not provide any rationale for this opinion. In December 2013, the Veteran reported for a diabetes check of his feet and was diagnosed with diabetic neuropathy, having reported burning, numbness, and tingling constantly. In March 2014, the Veteran was afforded a VA hypertension examination. The Veteran reported that he had been diagnosed with hypertension during active service, was treated with Benicar, and had continuous treatment since his initial diagnosis. The VA examiner opined that the Veteran’s hypertension was not related to active service, noting his blood pressure readings during active service and the impression of doubtful hypertension in October 1980, and concluding that he was unable to determine the exact date of diagnosis of hypertension as his medical records dated back to 2005 and no earlier. The examiner noted that the service treatment records were insufficient to support of diagnosis of hypertension, and, therefore, he was unable to establish a nexus between active service and hypertension. An April 2014 lumbar spine x-ray showed mild scoliosis and minimal degenerative changes. An August 2014 VA treatment note indicates a diagnosis of probable diabetic neuropathy, for which he was started on medication. A May 2015 VA treatment note indicates that the Veteran reported that he had diabetes for five years. A December 2015 private treatment note indicates a diagnosis of coronary artery disease 5 to 6 years prior. In February 2016, a left heart catheterization revealed severe and uncontrolled ischemic angina, precordial chest pain, unstable angina ACS, and abnormal cardiac stress test with ischemic defect in the inferior wall and inferolateral wall. A CABG was recommended and performed several days later, with a post-operative diagnosis of unstable angina, three-vessel coronary artery disease. An undated Summary of Care from the Veteran’s private treatment records indicate that his diabetes and hypertension were diagnosed in May 2007. After a review of all the evidence of record, lay and medical, the Board finds that there is no relationship between the Veteran’s back disability, cardiovascular disability, hypertension, diabetes, and nerve damage to the bilateral upper and lower extremities and his military service, including no credible evidence of continuous or recurrent symptoms of the claimed disabilities during active service, continuous or recurrent symptomatology of the claimed disabilities following service separation, or competent medical evidence establishing a link between the current disabilities and active service. Therefore, the Board finds that a preponderance of the evidence that is of record weighs against the claim for service connection for a back disability, cardiovascular disability, hypertension, diabetes, and nerve damage to the bilateral upper and lower extremities, and outweighs the Veteran’s more recent contentions regarding in-service continuous or recurrent symptoms and continuous or recurrent post-service symptoms. First, the Board notes that the Veteran has been diagnosed with hyperlipidemia, and that the current appeal for service connection for a cardiovascular disability has been developed as a claim for service connection for hyperlipidemia. Hyperlipidemia is a laboratory finding and is not a disability in and of itself for which VA compensation benefits are payable. See 61 Fed. Reg. 20,440, 20,445 (May 7, 1996) (Diagnoses of hyperlipidemia, elevated triglycerides, and elevated cholesterol are actually laboratory results and are not, in and of themselves, disabilities. They are, therefore, not appropriate entities for the rating schedule). Service connection may not be granted for a laboratory finding, standing alone, and for the reasons discussed below, service connection is not warranted for the Veteran’s other cardiovascular conditions. In that regard, the evidence weighs against a finding of continuous or recurrent symptoms of the claimed disabilities during active service. As noted above, service treatment records are negative for any signs, reports, findings, symptoms, or diagnoses of back or cardiovascular disabilities, diabetes, and nerve damage to the extremities. Moreover, while the Veteran’s diastolic pressure was elevated during active service in January 1980, as noted by the clinician who evaluated him in October 1980, his blood pressure was normal after that, as recorded in March, May, June, September, and October 1980. Moreover, the October 1980 treatment note indicates that it was doubtful that the Veteran had hypertension. Therefore, the Board finds that to the extent that the Veteran had an isolated period of elevated blood pressure readings in January 1980, his blood pressure returned to normal prior to separation, and the weight of the evidence demonstrates that symptoms of hypertension were not continuous or recurrent during active service. Next, the preponderance of the evidence demonstrates that arthritis, a cardiovascular disability, hypertension, and diabetes mellitus did not manifest to a compensable degree within one year of service separation. The preponderance of the evidence demonstrates no back arthritis, cardiovascular disability, hypertension, or diabetes symptoms during the one-year period after service, and no diagnosis or findings of arthritis, cardiovascular disability, hypertension, or diabetes of any severity during the one-year post-service presumptive period. Indeed, the evidence does not demonstrate diagnoses of back arthritis until 2011, coronary artery disease in or about 2010, and diagnoses of hypertension and diabetes mellitus in or about May 2007. For these reasons, the Board finds that arthritis, hypertension, coronary artery disease, and diabetes mellitus did not manifest to a compensable degree within one year of service separation; therefore, the presumptive provisions for these conditions are not applicable in this case. 38 C.F.R. §§ 3.307, 3.309. The Board next finds that the preponderance of the evidence demonstrates that symptoms of a back disability, cardiovascular disability, hypertension, diabetes, and nerve damage to the bilateral upper and lower extremities were not continuous or recurrent since separation from active service in October 1981. The first post-service documentation of back problems was in 2011, cardiovascular symptoms in 2010, hypertension and diabetes in 2007, and nerve damage to the extremities in 2011, as described above. The absence of post-service complaints, findings, diagnosis, or treatment for the claimed disabilities for more than 25 years after service separation is one factor that tends to weigh against a finding of continuous or recurrent symptoms of the claimed disabilities after service separation. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (the lack of contemporaneous medical records is one fact the Board can consider and weigh against the other evidence, although the lack of such medical records does not, in and of itself, render the lay evidence not credible). Additional evidence demonstrating that symptoms of the claimed disabilities were not continuous or recurrent since service separation includes the August 1983 quad examination report and January 1987 National Guard enlistment examination report at which clinical evaluations of the heart, vascular system, endocrine system, upper and lower extremities, feet, spine, and neurologic system were marked as normal, and at which the Veteran denied pain or pressure in his chest, palpitation or pounding heart, heart trouble, high blood pressure, arthritis, recurrent back pain, foot trouble, and neuritis on his Report of Medical History. Blood pressure was also normal at both examinations. In addition, in November 2005, the Veteran denied chest pain, shortness of breath, dyspnea on exertion, palpitations, and paresthesias, and heart examination was normal, as described above. Neurologic examination was intact in May 2006 and May 2007. The May 2007 treatment note discussed above also specifically indicates that the Veteran’s diabetes was “new onset.” Moreover, subsequent treatment notes, such as in August 2008, November 2012, and May 2015, indicate the Veteran reported inception of diabetes no earlier than 2007. Private treatment notes from 2007 also indicate a progression from an assessment of “elevated blood pressure” to “hypertension” in May 2007, with treatment notes in 2005 and 2006 being negative for any indication of high blood pressure. The undated Summary of Care from the same physician also indicates that diabetes and hypertension were diagnosed in May 2007. In August 2009, October 2009, February 2010, June 2010, October 2010, and January 2011, the Veteran denied chest pain, shortness of breath, dyspnea on exertion, palpitations, and paresthesias. In August 2012, following the Veteran’s post-service back injury, he reported experiencing no back pain prior to that fall. Finally, the December 2015 treatment note indicates a diagnosis of coronary artery disease 5 to 6 years prior. These statements by the Veteran and findings by his treating clinicians provide highly probative evidence against a finding of continuous symptoms of the claimed disabilities since active service. With regard to the Veteran’s more recent assertions made in the context of the current disability claim of continuous or recurrent back disability, cardiovascular disability, hypertension, diabetes, and nerve damage symptoms since service, the Board finds that, while the Veteran is competent to report the onset of symptoms of the claimed disabilities, these more recent assertions are outweighed by the other, more contemporaneous, lay and medical evidence of record, both in service and after service, and are not reliable. See Charles v. Principi, 16 Vet. App. 370 (2002). The Board finds that the Veteran’s assertions of continuous or recurrent symptoms of the claimed disabilities after service are not accurate because they are outweighed by other evidence of record that includes the more contemporaneous service treatment records, which are negative for back, cardiovascular, diabetes, and nerve damage symptoms, and show that the elevated blood pressure readings in January 1980 resolved prior to separation; the negative August 1983 Reserve and January 1987 National Guard examination reports; the Veteran’s denial of cardiovascular and neurological symptoms in November 2005, August 2009, October 2009, February 2010, June 2010, October 2010, and January 2011; the normal neurologic examinations in May 2006 and May 2007; the diagnosis of “new onset” diabetes in May 2007; the undated Summary of Care from the same physician indicating diagnoses of diabetes and hypertension in May 2007; the statements made by the Veteran in August 2008, November 2012, and May 2015 placing inception of diabetes in 2007 or later; the Veteran’s statement regarding inception of back pain since his post-service fall in August 2012; the December 2015 note indicating inception of cardiovascular disease 5 to 6 years prior; and the lack of any medical documentation of reports or treatment for any of the claimed disabilities until more than 25 years after service separation. As such, the Board does not find that the evidence sufficiently supports continuous or recurrent symptomatology of the claimed disabilities since service so as to warrant a grant of service connection. Finally, the Board finds that the weight of the competent medical evidence weighs against a finding of a medical nexus between the current back disability, cardiovascular disability, hypertension, diabetes, and nerve damage to the extremities and active service. In this regard, the Board finds that the 2014 VA hypertension nexus opinion, discussed above, is the most probative evidence of record. The VA opinion is competent and probative medical evidence because it is factually accurate and is supported by adequate rationale. The VA examiner interviewed and examined the Veteran, was informed of the pertinent evidence, reviewed the Veteran’s claims file, and fully articulated the opinion in the report. There are no contrary competent medical opinions of record. The Board acknowledges the Veteran’s belief that his back disability, cardiovascular disability, hypertension, diabetes, and nerve damage to the extremities are related to his active service. However, his statements alone do not establish a medical nexus. Indeed, while the Veteran is competent to provide evidence regarding matters that can be perceived by the senses, he is not shown to be competent to render medical opinions on questions of etiology. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology). As such, as a layperson, he is without the appropriate medical training and expertise to offer an opinion on a medical matter, including the diagnosis, etiology, or causation of a specific disability. The question of diagnosis and causation, in this case, involves complex medical issues that the Veteran is not competent to address. Jandreau. (Continued on the next page)   For these reasons, the claims must be denied. Because the preponderance of the evidence is against the claims, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Cynthia M. Bruce Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Sherrard, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.