Citation Nr: 20009768 Decision Date: 02/05/20 Archive Date: 02/05/20 DOCKET NO. 19-01 920 DATE: February 5, 2020 ORDER 1. New and material evidence to reopen the claim for service connection for a psychiatric disorder has been received. 2. New and material evidence to reopen the claim for service connection for a lumbar spine disability has been received. 3. New and material evidence to reopen the claim for service connection for migraine headaches has been received. 4. New and material evidence to reopen the claim for service connection for Klippel-Trenaunay syndrome has been received. 5. Entitlement to service connection for neuropathy of the right lower extremity is denied. 6. Entitlement to service connection for neuropathy of the left lower extremity is denied. 7. Entitlement to service connection for neuropathy of the right upper extremity is denied. 8. Entitlement to service connection for neuropathy of the left upper extremity is granted. 9. Entitlement to service connection for a gastrointestinal disability, to include acid reflux and gastroesophageal reflux disease (GERD), is denied. 10. Entitlement to service connection for a bilateral eye disability is denied. 11. Entitlement to service connection for tinnitus is denied. 12. Entitlement to service connection for arthritis is denied. 13. Entitlement to service connection for gout is denied. 14. Entitlement to service connection for hypercholesterolemia is denied. 15. Entitlement to service connection for chemical burn on the left leg is denied. REMANDED 16. The reopened claim for service connection for a psychiatric disorder is remanded. 17. The reopened claim for service connection for a lumbar spine disability is remanded. 18. The reopened claim for service connection for migraine headaches is remanded. 19. The reopened claim for service connection for Klippel-Trenaunay syndrome is remanded. 20. Entitlement to service connection for obstructive sleep apnea is remanded. 21. Entitlement to service connection for hypertension is remanded. 22. Entitlement to service connection for diabetes mellitus type 2 is remanded. FINDINGS OF FACT 1. In an unappealed June 1995 rating decision, the RO denied service connection for a psychiatric disorder, lumbar spine disability, and migraine headaches based on a finding that the Veteran had not submitted a well-grounded claim for compensation benefits, to include evidence of current disability or evidence that the disability was incurred in service. 2. In an unappealed June 1995 rating decision, the RO denied service connection for Klippel-Trenaunay syndrome based on a finding that the Veteran’s disability preexisted service and was not aggravated by service 3. In a June 2010 rating decision, the RO denied service connection for a psychiatric disorder based on a finding that the Veteran did not have a current disability. The Veteran did not appeal this issue, although he did submit a statement expressing his disagreement with the decisions for other issues. 4. Evidence submitted subsequent to the June 1995 rating decision that denied service connection for a lumbar spine disability, migraine headaches, and Klippel-Trenaunay syndrome is not cumulative or redundant of evidence previously of record, relates to unestablished facts necessary to substantiate the claims, and raises a reasonable possibility of substantiating the claims for service connection for a lumbar spine disability, migraine headaches, and Klippel-Trenaunay syndrome. 5. Evidence submitted subsequent to the June 2010 rating decision that denied service connection for a psychiatric disorder is not cumulative or redundant of evidence previously of record, relates to unestablished facts necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim for service connection for a psychiatric disorder. 6. Neuropathy of the right lower extremity did not have its onset in service, was not manifested to a compensable degree within one year of service discharge, and is not otherwise related to service. 7. Neuropathy of the left lower extremity did not have its onset in service, was not manifested to a compensable degree within one year of service discharge, and is not otherwise related to service. 8. The preponderance of the evidence of record is against finding that the Veteran has had neuropathy of the right upper extremity at any time during or approximate to the pendency of the claim. 9. The preponderance of the evidence of record is against finding that the Veteran has had neuropathy of the left upper extremity at any time during or approximate to the pendency of the claim. 10. The preponderance of the evidence is against finding that the Veteran’s gastrointestinal disability, to include acid reflux and GERD, was incurred in or otherwise related to service. 11. The preponderance of the evidence is against finding that the Veteran’s eye disability was incurred in or is otherwise related to service. 12. Tinnitus did not have its onset in service, was not manifested to a compensable degree within one year of service discharge, and is not otherwise related to service. 13. Arthritis did not have its onset in service, was not manifested to a compensable degree within one year of service discharge, and is not otherwise related to service. 14. The preponderance of the evidence is against finding that the Veteran’s gout has its onset in service, was manifested to a compensable degree within one year of service discharge, or is otherwise related to service. 15. Hypercholesterolemia is a laboratory finding and not a disability for which service connection may be granted. 16. The preponderance of the evidence of record is against finding that the Veteran has had a chemical burn on the left leg at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. The June 1995 rating decision denying service connection for a psychiatric disorder, for a lumbar spine disability, migraine headaches, and Klippel-Trenaunay syndrome is final. 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. 2. The June 2010 rating decision denying service connection for a psychiatric disorder is final. 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. 3. The criteria for reopening the claims for service connection for a psychiatric disorder, for a lumbar spine disability, migraine headaches, and Klippel-Trenaunay syndrome, on the basis of new and material evidence have been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 4. The criteria for service connection for neuropathy of the right lower extremity are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a). 5. The criteria for service connection for neuropathy of the left lower extremity are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a). 6. The criteria for service connection for neuropathy of the right upper extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 7. The criteria for service connection for neuropathy of the left upper extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 8. The criteria for service connection for gastrointestinal disability, to include acid reflux and GERD are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 9. The criteria for service connection for a bilateral eye disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 10. The criteria for service connection for tinnitus are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a). 11. The criteria for service connection for arthritis are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a). 12. The criteria for service connection for gout are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a). 13. The criteria for service connection for hypercholesterolemia are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 14. The criteria for service connection for chemical burn on the left leg are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from September 1992 to October 1994. New and Material Evidence If a claim for service connection has been previously denied and that decision became final, the claim can be reopened and reconsidered only if new and material evidence is presented with respect to that claim. 38 U.S.C. § 5108. New evidence is defined as existing evidence not previously submitted to agency decisionmakers, while material evidence is defined as existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. 38 C.F.R. § 3.156(a). 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. Only evidence presented since the last final denial on any basis (whether by the Board or RO, and whether upon the merits of the case or upon a previous adjudication that no new and material evidence had been presented) will be evaluated in the context of the entire record. The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low. Moreover, in determining whether this low threshold is met, consideration need not be limited to whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but also whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the VA’s duty to assist or through consideration of an alternative theory of entitlement. For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed. Regardless of the AOJ’s actions, given the previous unappealed denial of the claim on appeal, the Board has a legal duty under 38 U.S.C. §§ 5108 and 7105 to address the question of whether new and material evidence has been received to reopen the claims for service connection. This matter goes to the Board’s jurisdiction to reach the underlying claims and adjudicate the claim on a de novo basis. 1. New and material evidence to reopen the claim for service connection for a psychiatric disorder The claim for service connection for a psychiatric disorder (then claimed as “stress”) was initially denied in a June 1995 rating decision based on a finding that the Veteran had not submitted a well-grounded claim for benefits, to include evidence of current disability or evidence that the Veteran’s disability was incurred in service. The Veteran was notified of this determination in a June 1995 letter, which included information about the Veteran’s appeal rights. The Veteran did not appeal this decision. The Veteran has not contended that this rating decision is not final as to this issue. Thus, the June 1995 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. The claim for service connection for a psychiatric disorder (then claimed as “anxiety”) was next denied in a June 2010 rating decision based on a finding that the Veteran did not have a current disability. The Veteran was notified of this determination in a June 2010 letter, which included information about the Veteran’s appeal rights. The Veteran did not appeal this issue, although he submitted a statement expressing his disagreement with the decisions for other issues. The Veteran has not contended that this rating decision is not final as to this issue. Thus, the June 2010 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. The pertinent evidence of record at the time of the June 2010 rating decision included the Veteran’s DD Form 214, service treatment records (STRs), and a VA examination. The Veteran now seeks to reopen his claim of service connection for a psychiatric disorder on the submission of new and material evidence. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Thus, the Board has reviewed the entire record, with particular attention to the additional evidence received since the last final decision in June 2010. After reviewing the record, the Board finds that the additional evidence received is new and material within the meaning of 38 C.F.R. § 3.156. A review of the record shows that in an October 2018 private disability and benefits questionnaire (DBQ), Dr. Heather Henderson-Galligan diagnosed the Veteran with unspecified depressive disorder and opined that the Veteran’s disability is related to service. This evidence is new, because it has not been previously submitted. This evidence is also material because it pertains to the bases for the prior denial, that is, that the Veteran did not have a diagnosis of a psychiatric disorder, and raises a reasonable possibility of substantiating the claims. In this regard, for the purpose of establishing whether new and material evidence has been received, the credibility of the evidence is to be presumed. For these reasons, the Board finds that new and material evidence has been received to reopen the claim of entitlement for service connection for a psychiatric disorder. See 38 C.F.R. § 3.156(a). The reopened claim for service connection for a psychiatric is remanded, as discussed below. 2. New and material evidence to reopen the claim for service connection for a lumbar spine disability 3. New and material evidence to reopen the claim for service connection for migraine headaches The claims for service connection for a lumbar spine disability and for migraine headaches was initially denied in a June 1995 rating decision based on a finding that the Veteran had not submitted a well-grounded claim for benefits, to include evidence of current disabilities or evidence that the Veteran’s disabilities were incurred in service. The Veteran was notified of this determination in a June 1995 letter, which included information about the Veteran’s appeal rights. The Veteran did not appeal this decision. The Veteran has not contended that this rating decision is not final as to this issue. Thus, the June 1995 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. The pertinent evidence of record at the time of the June 1995 rating decision included the Veteran’s DD Form 214, STRs, and a VA examination. The Veteran now seeks to reopen his claims of service connection for a lumbar spine disability and for migraine headaches on the submission of new and material evidence. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Thus, the Board has reviewed the entire record, with particular attention to the additional evidence received since the last final decision in June 1995. After reviewing the record, the Board finds that the additional evidence received is new and material within the meaning of 38 C.F.R. § 3.156. A review of the record shows that numerous VA treatment records document symptoms of a lumbar spine disability and migraine headaches. For example, VA treatment records from March 2017 and May 2017 note diagnoses of lumbago and degeneration of lumbar or lumbosacral intervertebral disc. In an April 2019 private opinion, Dr. Homer Skaggs diagnosed the Veteran with migraine headaches and opined that they were related to service. This evidence is new, because it has not been previously submitted. This evidence is also material because it pertains to the bases for the prior denial, that is, that the Veteran did not have diagnoses for his disabilities, and raises a reasonable possibility of substantiating the claim. In this regard, for the purpose of establishing whether new and material evidence has been received, the credibility of the evidence is to be presumed. For these reasons, the Board finds that new and material evidence has been received to reopen the claims of entitlement for service connection for a lumbar spine disability and for migraine headaches. See 38 C.F.R. § 3.156(a). The reopened claim for service connection for a lumbar spine disability and for migraine headaches are remanded, as discussed below. 4. New and material evidence to reopen the claim for service connection for Klippel-Trenaunay syndrome The claim for service connection for Klippel-Trenaunay syndrome was initially denied in a June 1995 rating decision based on a finding that the Veteran’s disability preexisted service and was not aggravated by service. The Veteran was notified of this determination in a June 1995 letter, which included information about the Veteran’s appeal rights. The Veteran did not appeal this decision. The Veteran has not contended that this rating decision is not final as to this issue. Thus, the June 1995 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. The claim for service connection for a psychiatric disorder (then claimed as “anxiety”) was next denied in a June 2010 rating decision based on a finding that the Veteran had not submitted evidence that Klippel-Trenaunay syndrome was aggravated by service. The Veteran was notified of this determination in a June 2010 letter, which included information about the Veteran’s appeal rights. The Veteran did not appeal this decision. The Veteran has not contended that this rating decision is not final as to this issue. Thus, the June 2010 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. The pertinent evidence of record at the time of the June 2010 rating decision included the Veteran’s DD Form 214, service treatment records (STRs), and a VA examination. The Veteran now seeks to reopen his claim of service connection for Klippel-Trenaunay syndrome on the submission of new and material evidence. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Thus, the Board has reviewed the entire record, with particular attention to the additional evidence received since the last final decision in June 2010. After reviewing the record, the Board finds that the additional evidence received is new and material within the meaning of 38 C.F.R. § 3.156. A review of the record shows that in an April 2019 private opinion, Dr. Skaggs opined that the Veteran’s Klippel-Trenaunay syndrome was aggravated by service. This evidence is new, because it has not been previously submitted. This evidence is also material because it pertains to the bases for the prior denial, that is, that the Veteran’s Klippel-Trenaunay syndrome was not aggravated by service, and raises a reasonable possibility of substantiating the claims. In this regard, for the purpose of establishing whether new and material evidence has been received, the credibility of the evidence is to be presumed. For these reasons, the Board finds that new and material evidence has been received to reopen the claim of entitlement for service connection for an acquired Klippel-Trenaunay syndrome. See 38 C.F.R. § 3.156(a). The reopened issue of service connection for Klippel-Trenaunay syndrome is remanded, as discussed below. 5. Entitlement to service connection for neuropathy of the right lower extremity 6. Entitlement to service connection for neuropathy of the left lower extremity These issues shall be discussed jointly as neuropathy of the bilateral lower extremities The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for neuropathy of the bilateral lower extremities on a direct or presumptive basis. The reasons follow. The Veteran has been diagnosed with neuropathy of the bilateral lower extremities, and thus there is evidence of a current disability, and the Veteran meets first element of a service-connection claim. As to an in-service disease or injury, the evidence does not support a finding of a disease or injury in service. The STRs do not document complaints, symptoms, diagnosis, or treatment for neuropathy of the bilateral lower extremities. The records show vascular and muscular complaints related to the Veteran’s bilateral lower extremities throughout service. For example, in a November 1992 record the Veteran complained of pain and was found to have mild strain of the bilateral upper legs and was evaluated for vascular problems in his lower extremities throughout 1993. However, as these records showed that the Veteran’s symptoms were either muscular or vascular in nature, they do not support a finding of complaints or injury related to neuropathy of the bilateral lower extremities. In a Report of Medical History from January 1993, the Veteran denied a history of neuritis, lameness, and paralysis, which tends to show that he was not experiencing neuropathy of the bilateral lower extremities in service. Accordingly, the preponderance of the evidence is against a finding of complaints or symptoms related to neuropathy of the bilateral lower extremities during service, and the in-service disease or injury element is not met. As to evidence of a nexus between the current disability and service, the Board finds that the preponderance of the evidence is against such a nexus. For example, the Veteran was first diagnosed with neuropathy of the bilateral lower extremities in a January 2016 VA treatment record, which is approximately 10 years following service discharge, and tends to establish that neuropathy of the bilateral lower extremities did not have its onset in service. Although the Veteran claims that his neuropathy of the bilateral lower extremities is related to service, he is not medically trained, and is therefore not qualified to competently opine about medical etiology. In certain instances, lay testimony may be competent to establish medical etiology or nexus. However, the diagnosis of neuropathy of the bilateral lower extremities requires specialized training for determinations as to diagnosis and causation, and is therefore, not susceptible to lay opinions on etiology. The origin or cause of the Veteran’s neuropathy of the bilateral lower extremities is not a simple question that can be determined based on mere personal observation by a lay person, the Veteran’s lay assertion is not competent to establish a nexus. Therefore, as the evidence does not support a relationship between neuropathy of the bilateral lower extremities and service, the nexus element is not met. As to presumptive service connection for a chronic disease, the Board finds that the Veteran did not incur an event, injury, or disease related to his current neuropathy of the bilateral lower extremities in service and that his neuropathy of the bilateral lower extremities did not manifest during service or within one year of separation from service. Furthermore, the evidence of record does not demonstrate that the Veteran’s symptoms have been continuous since separation from service in October 1994. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). There were no complaints, diagnosis, or treatment for this disorder for approximately 22 years following service discharge until the Veteran was diagnosed with neuropathy of the bilateral lower extremities in January 2016. The absence of post-service complaints, findings, diagnosis, or treatment for approximately 22 years after service is one factor that tends to weigh against a finding of continuous symptoms since separation from service. The Board may weigh the absence of contemporaneous medical evidence as one factor in determining credibility of lay evidence. A prolonged period without medical complaint can be considered, along with other factors, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability. In sum, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for neuropathy of the bilateral lower extremities. The benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107(b) is not applicable, as there is no approximate balance of evidence. 7. Entitlement to service connection for neuropathy of the right upper extremity 8. Entitlement to service connection for neuropathy of the left upper extremity These issues shall be discussed jointly as neuropathy of the bilateral upper extremities The question for the Board in this case 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 or is caused or aggravated by a service-connected disability. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. In order for service connection to be established, there needs to be competent evidence of a current disability. The Board concludes that the Veteran does not have a current diagnosis of neuropathy of the bilateral upper extremities and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b), 38 C.F.R. § 3.303(a), (d). Despite consistent treatment from July 1999 to April 2019, neither VA nor private treatment records contain a diagnosis of neuropathy of the bilateral upper extremities. The Board notes that in numerous VA treatments beginning in 2017, the Veteran was evaluated for neuropathy of the bilateral lower extremities, but not for his upper extremities. The Board finds that if the Veteran experienced symptoms of neuropathy of the bilateral upper extremities, he would have mentioned them during these treatments. While the Veteran believes he has a current diagnosis of neuropathy of the bilateral upper extremities, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Consequently, the Board gives more probative weight to the competent medical evidence. The Board concludes that the Veteran does not have a current diagnosis of neuropathy of the bilateral upper extremities, to include pain that causes functional impairment that affects earning capacity, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b), 38 C.F.R. § 3.303(a), (d). For example, of record are medical records from July 1999 to April 2019, and these records do not contain a diagnosis of neuropathy of the bilateral upper extremities, to include pain that causes functional impairment that affects earning capacity. These records cover 20 year period, and the lack of documentation of neuropathy of the bilateral upper extremities, to include pain, is evidence against the claim for service connection for neuropathy of the bilateral upper extremities. In sum, without competent evidence of a current disability, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for neuropathy of the bilateral upper extremities, and the claim is denied. 9. Entitlement to service connection for a gastrointestinal disability, to include acid reflux and GERD The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for a gastrointestinal disability, to include acid reflux and GERD. The reasons follow. The Veteran has been diagnosed with a gastrointestinal disability, and thus there is evidence of a current disability, and the Veteran meets first element of a service-connection claim. As to an in-service disease or injury, the evidence does not support a finding of a disease or injury in service. The STRs do not document complaints, symptoms, diagnosis, or treatment for a gastrointestinal disability. In a Report of Medical History from January 1993, the Veteran denied history of frequent indigestion and stomach, liver, or intestinal trouble, which tends to show that he was not experiencing a gastrointestinal disability in service. Accordingly, the preponderance of the evidence is against a finding of complaints or symptoms related to a gastrointestinal disability during service, and the in-service disease or injury element is not met. As to evidence of a nexus between the current disability and service, the Board finds that the preponderance of the evidence is against such a nexus. For example, the Veteran was first diagnosed with a gastrointestinal disability in a December 2006 VA treatment record, which is approximately 12 years following service discharge, and tends to establish that a gastrointestinal disability did not have its onset in service. Although the Veteran claims that his gastrointestinal disability is related to service, he is not medically trained, and is therefore not qualified to competently opine about medical etiology. In certain instances, lay testimony may be competent to establish medical etiology or nexus. However, the diagnosis of a gastrointestinal disability requires specialized training for determinations as to diagnosis and causation, and is therefore, not susceptible to lay opinions on etiology. The origin or cause of the Veteran’s gastrointestinal disability is not a simple question that can be determined based on mere personal observation by a lay person, the Veteran’s lay assertion is not competent to establish a nexus. Therefore, as the evidence does not support a relationship between a gastrointestinal disability and service, the nexus element is not met. In sum, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for a gastrointestinal disability. The benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107(b) is not applicable, as there is no approximate balance of evidence. 10. Entitlement to service connection for a bilateral eye disability The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for a bilateral eye disability. The reasons follow. The Veteran has been diagnosed with a bilateral eye disability, and thus there is evidence of a current disability, and the Veteran meets first element of a service-connection claim. For example, the Veteran has been diagnosed with chronic dry eye syndrome. As to an in-service disease or injury, the evidence does not support a finding of a disease or injury in service. The STRs do not document complaints, symptoms, diagnosis, or treatment for a bilateral eye disability. In a Report of Medical History from January 1993, the Veteran denied history of eye trouble, which tends to show that he was not experiencing a bilateral eye disability in service. Accordingly, the preponderance of the evidence is against a finding of complaints or symptoms related to a bilateral eye disability during service, and the in-service disease or injury element is not met. As to evidence of a nexus between the current disability and service, the Board finds that the preponderance of the evidence is against such a nexus. For example, the Veteran was first diagnosed with a bilateral eye disability in a March 2010 VA treatment record, which is approximately 16 years following service discharge, and tends to establish that a bilateral eye disability did not have its onset in service. Although the Veteran claims that his eye disability is related to service, he is not medically trained, and is therefore not qualified to competently opine about medical etiology. In certain instances, lay testimony may be competent to establish medical etiology or nexus. However, the diagnosis of a bilateral eye disability requires specialized training for determinations as to diagnosis and causation, and is therefore, not susceptible to lay opinions on etiology. The origin or cause of the Veteran’s eye disability is not a simple question that can be determined based on mere personal observation by a lay person, the Veteran’s lay assertion is not competent to establish a nexus. Therefore, as the evidence does not support a relationship between a bilateral eye disability and service, the nexus element is not met. In sum, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for a bilateral eye disability. The benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107(b) is not applicable, as there is no approximate balance of evidence. 11. Entitlement to service connection for tinnitus The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for tinnitus on a direct or presumptive basis. The reasons follow. The Veteran has been diagnosed with tinnitus, and thus there is evidence of a current disability, and the Veteran meets first element of a service-connection claim. As to an in-service disease or injury, the evidence does not support a finding of a disease or injury in service. The STRs do not document complaints, symptoms, diagnosis, or treatment for tinnitus. In a Report of Medical History from January 1993, the Veteran denied history of ear, nose or throat trouble, which tends to show that he was not experiencing tinnitus in service. Accordingly, the preponderance of the evidence is against a finding of complaints or symptoms related to tinnitus during service, and the in-service disease or injury element is not met. As to evidence of a nexus between the current disability and service, the Board finds that the preponderance of the evidence is against such a nexus. For example, although the Veteran claimed that his tinnitus symptoms were continuous with service, the Veteran denied tinnitus in a September 2012 VA treatment record, which is approximately 18 years following service discharge, and tends to establish that tinnitus did not have its onset in service. In a February 2015 VA examination, the examiner opined that that the Veteran’s tinnitus was less likely than not related to or otherwise incurred in service, explaining that the Veteran’s service records did not support tinnitus, as his audiology examination results had not change from enlistment to the time of the February 2015 VA examination. This opinion establishes that tinnitus is not related to service. Although the Veteran claims that his tinnitus is related to service, he is not medically trained, and is therefore not qualified to competently opine about medical etiology. In certain instances, lay testimony may be competent to establish medical etiology or nexus. However, the diagnosis of tinnitus requires specialized training for determinations as to diagnosis and causation, and is therefore, not susceptible to lay opinions on etiology. The origin or cause of the Veteran’s tinnitus is not a simple question that can be determined based on mere personal observation by a lay person, the Veteran’s lay assertion is not competent to establish a nexus. Therefore, as the evidence does not support a relationship between tinnitus and service, the nexus element is not met. As to presumptive service connection for a chronic disease, the Board finds that the Veteran did not incur an event, injury, or disease related to his current tinnitus in service and that his tinnitus did not manifest during service or within one year of separation from service. Furthermore, the evidence of record does not demonstrate that the Veteran’s symptoms have been continuous since separation from service in October 1994. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). There were no complaints, diagnosis, or treatment for this disorder for approximately 20 years following service discharge until the Veteran was first filed a claim for benefits in December 2014. The absence of post-service complaints, findings, diagnosis, or treatment for approximately 20 years after service is one factor that tends to weigh against a finding of continuous symptoms since separation from service. The Board may weigh the absence of contemporaneous medical evidence as one factor in determining credibility of lay evidence. A prolonged period without medical complaint can be considered, along with other factors, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability. In sum, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for tinnitus. The benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107(b) is not applicable, as there is no approximate balance of evidence. 12. Entitlement to service connection for arthritis The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for arthritis on a direct or presumptive basis. The reasons follow. The Veteran has been diagnosed with arthritis, and thus there is evidence of a current disability, and the Veteran meets first element of a service-connection claim. As to an in-service disease or injury, the evidence does not support a finding of a disease or injury in service. The STRs do not document complaints, symptoms, diagnosis, or treatment for arthritis. In a Report of Medical History from January 1993, the Veteran denied history of arthritis. In Dental Health Questionnaires from September 1992, August 1993, and July 1994, the Veteran denied a history of arthritis. This evidence tends to show that he was not experiencing arthritis in service. Accordingly, the preponderance of the evidence is against a finding of complaints or symptoms related to arthritis during service, and the in-service disease or injury element is not met. As to evidence of a nexus between the current disability and service, the Board finds that the preponderance of the evidence is against such a nexus. For example, the Veteran was first diagnosed with arthritis in a December 2011 VA treatment record, which is approximately 17 years following service discharge, and tends to establish that arthritis did not have its onset in service. Although the Veteran claims that his arthritis is related to service, he is not medically trained, and is therefore not qualified to competently opine about medical etiology. In certain instances, lay testimony may be competent to establish medical etiology or nexus. However, the diagnosis of arthritis requires specialized training for determinations as to diagnosis and causation, and is therefore, not susceptible to lay opinions on etiology. The origin or cause of the Veteran’s arthritis is not a simple question that can be determined based on mere personal observation by a lay person, the Veteran’s lay assertion is not competent to establish a nexus. Therefore, as the evidence does not support a relationship between arthritis and service, the nexus element is not met. As to presumptive service connection for a chronic disease, the Board finds that the Veteran did not incur an event, injury, or disease related to his current arthritis in service and that his arthritis did not manifest during service or within one year of separation from service. Furthermore, the evidence of record does not demonstrate that the Veteran’s symptoms have been continuous since separation from service in October 1994. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). There were no complaints, diagnosis, or treatment for this disorder for approximately 17 years following service discharge until the Veteran was diagnosed with arthritis. The absence of post-service complaints, findings, diagnosis, or treatment for approximately 17 years after service is one factor that tends to weigh against a finding of continuous symptoms since separation from service. The Board may weigh the absence of contemporaneous medical evidence as one factor in determining credibility of lay evidence. A prolonged period without medical complaint can be considered, along with other factors, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability. In sum, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for arthritis. The benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107(b) is not applicable, as there is no approximate balance of evidence. 13. Entitlement to service connection for gout The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for gout on a direct or presumptive basis. The reasons follow. The Veteran has been diagnosed with gout, and thus there is evidence of a current disability, and the Veteran meets first element of a service-connection claim. As to an in-service disease or injury, the evidence does not support a finding of a disease or injury in service. The STRs do not document complaints, symptoms, diagnosis, or treatment for gout. In a Report of Medical History from January 1993, the Veteran denied history of arthritis. In Dental Health Questionnaires from September 1992, August 1993, and July 1994, the Veteran denied a history of arthritis. This evidence tends to show that he was not experiencing gout in service. Accordingly, the preponderance of the evidence is against a finding of complaints or symptoms related to gout during service, and the in-service disease or injury element is not met. As to evidence of a nexus between the current disability and service, the Board finds that the preponderance of the evidence is against such a nexus. For example, the Veteran was first diagnosed with gout in a December 2011 VA treatment record, which is approximately 17 years following service discharge, and tends to establish that gout did not have its onset in service. Although the Veteran claims that his gout is related to service, he is not medically trained, and is therefore not qualified to competently opine about medical etiology. In certain instances, lay testimony may be competent to establish medical etiology or nexus. However, the diagnosis of gout requires specialized training for determinations as to diagnosis and causation, and is therefore, not susceptible to lay opinions on etiology. The origin or cause of the Veteran’s gout is not a simple question that can be determined based on mere personal observation by a lay person, the Veteran’s lay assertion is not competent to establish a nexus. Therefore, as the evidence does not support a relationship between gout and service, the nexus element is not met. As to presumptive service connection for a chronic disease, the Board finds that the Veteran did not incur an event, injury, or disease related to his current gout in service and that his gout did not manifest during service or within one year of separation from service. Furthermore, the evidence of record does not demonstrate that the Veteran’s symptoms have been continuous since separation from service in October 1994. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). There were no complaints, diagnosis, or treatment for this disorder for approximately 17 years following service discharge until the Veteran was diagnosed with gout. The absence of post-service complaints, findings, diagnosis, or treatment for approximately 17 years after service is one factor that tends to weigh against a finding of continuous symptoms since separation from service. The Board may weigh the absence of contemporaneous medical evidence as one factor in determining credibility of lay evidence. A prolonged period without medical complaint can be considered, along with other factors, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability. In sum, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for gout. The benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107(b) is not applicable, as there is no approximate balance of evidence. 14. Entitlement to service connection for hypercholesterolemia The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for hypercholesterolemia. The reasons follow. The Veteran maintains that he has hypercholesterolemia, or high cholesterol, as a result of service. The term “disability,” as used for VA purposes, refers to impairment of earning capacity and Congress specifically limits entitlement to service connection for diseases or injuries that have resulted in a disability. See 38 U.S.C. § 1110. In this case, there is no evidence showing that the Veteran’s hypercholesterolemia has resulted in a disability. Hypercholesterolemia, in and of itself, is a laboratory finding. It is not a disease, injury, or disability for VA compensation purposes, even though it may be considered a risk factor in the development of certain diseases. See 61 Fed. Reg. 20,440, 20,445 (May 7, 1996) (providing that 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.). The record in this case contains no evidence suggesting that hypercholesterolemia causes the Veteran any impairment of earning capacity. Although hypercholesterolemia may be evidence of underlying disability or may later cause disability, service connection may not be granted for the laboratory finding itself. Again, there is no dispute that the Veteran has hypercholesterolemia, the law simply does not provide benefits for elevated laboratory findings without a disability, so the claim must be denied. 15. Entitlement to service connection for chemical burn on the left leg In a June 2010 rating decision, the RO denied service connection for chemical burn of the left leg. In a June 2010 submission, the Veteran submitted a VA Form 21-4138 in which he stated that he disagreed with the decision with respect to the denial of service connection for chemical burn on the left leg. However, no Statement of the Case (SOC) was issued, and VA did not otherwise acknowledge the Veteran’s notice of disagreement. Accordingly, the June 2010 rating decision is not final with respect to this issue, the claim remains open, and an analysis of whether new and material evidence has been submitted is not warranted. The question for the Board in this case 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 or is caused or aggravated by a service-connected disability. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. In order for service connection to be established, there needs to be competent evidence of a current disability. The Board concludes that the Veteran does not have a current diagnosis of chemical burn on the left leg and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b), 38 C.F.R. § 3.303(a), (d). Despite consistent treatment from July 1999 to April 2019, VA treatment records do not contain a diagnosis of chemical burn on the left leg. For example, in a June 1999, the Veteran was evaluated for a rash on his left ankle, but did not mention a chemical burn on his left leg, and VA treatment records from September 2013 show treatment for a left ankle rash, but the treatment was for a temporary duration. The Board finds that a left ankle scar or rash is not encompassed by the Veteran’s claim of a chemical burn scar on his left leg. While the Veteran believes he has a current diagnosis of chemical burn on the left leg, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Consequently, the Board gives more probative weight to the competent medical evidence. The Board concludes that the Veteran does not have a current diagnosis of chemical burn on the left leg, to include pain that causes functional impairment that affects earning capacity, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b), 38 C.F.R. § 3.303(a), (d). For example, of record are medical records from July 1999 to April 2019, and these records do not contain a diagnosis of chemical burn on the left leg, to include pain that causes functional impairment that affects earning capacity. These records cover 20 year period, and the lack of documentation of chemical burn on the left leg, to include pain, is evidence against the claim for service connection for chemical burn on the left leg. In sum, without competent evidence of a current disability, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for chemical burn on the left leg, and the claim is denied. REASONS FOR REMAND While further delay is regrettable, additional development is warranted before the Veteran's claims may be decided. 16. The reopened claim for service connection for a psychiatric disorder is remanded. In an October 2018 private opinion, Dr. Henderson-Galligan opined that the Veteran’s unspecified depressive disorder began in service and opined that it was aggravated by physical issues. Dr. Henderson-Gallian also stated that due to the complex overlap of endorsed symptoms, it is inconceivable to differentiate specific causation for the Veteran’s disability. The Board finds Dr. Henderson-Galligan’s opinion inadequate for several reasons. For example, although Dr. Henderson-Galligan opines that the Veteran’s psychiatric disorder began in service, this contention is not supported by the Veteran’s service records, which are absent for any psychiatric complaints. Instead, the examiner relies on the Veteran’s reported date of onset, which is not supported by the record. Additionally, although Dr. Henderson-Galligan states that the Veteran’s psychiatric disorder is aggravated beyond its normal progression by the Veteran’s physical conditions, she does not state which conditions cause this aggravation, or the baseline status of the disability prior to aggravation. Finally, Dr. Henderson-Galligan provides conflicting causes for the etiology, and states that it is not possible to ascertain the etiology of the Veteran’s psychiatric disorder. Although the Board has reopened the claim for service connection for a psychiatric disorder, the agency of original jurisdiction has not decided this claim on the merits. 17. The reopened claim for service connection for a lumbar spine disability is remanded. Although the Board has reopened the claim for service connection for a lumbar spine disability, the agency of original jurisdiction has not decided this claim on the merits.   18. The reopened claim for service connection for migraine headaches is remanded. In an April 2019 private medical record, Dr. Skaggs opined that the Veteran’s migraine headaches are caused by service, caused by his psychiatric disorder, and aggravated by his psychiatric disorder. However, this opinion is contradictory, as it assigns multiple alternate etiologies for the same disability. As such, the Board finds that this opinion is inadequate. Although the Board has reopened the claim for service connection for migraine headaches, the agency of original jurisdiction has not decided this claim on the merits. 19. The reopened claim for service connection for Klippel-Trenaunay syndrome is remanded. In an April 2019 private medical record, Dr. Skaggs opined that the Veteran’s Klippel-Trenaunay syndrome was aggravated beyond its normal progression by his service. However, Dr. Skaggs did not provide an opinion as to the baseline level of aggravation prior to aggravation. As such, the Board finds that this opinion is inadequate. Although the Board has reopened the claim for service connection for Klippel-Trenaunay syndrome, the agency of original jurisdiction has not decided this claim on the merits. 20. Entitlement to service connection for obstructive sleep apnea is remanded. In an April 2019 private medical record, Dr. Skaggs opined that the Veteran’s obstructive sleep apnea was caused by service and aggravated by his psychiatric disorder. This claim is inextricably intertwined with the development in connection with the claim for entitlement to service connection for a psychiatric disorder. Thus, consideration of this claim is deferred. 21. Entitlement to service connection for hypertension is remanded. In a June 2010 rating decision, the RO denied service connection for hypertension. In a June 2010 submission, the Veteran submitted a VA Form 21-4138 in which he stated that he disagreed with the decision with respect to the denial of service connection for hypertension. However, no SOC was issued, and VA did not otherwise acknowledge the Veteran’s notice of disagreement. Accordingly, the June 2010 rating decision is not final with respect to this issue, the claim remains open, and an analysis of whether new and material evidence has been submitted is not warranted. In an April 2019 private medical record, Dr. Skaggs opined that the Veteran’s hypertension was caused by service, caused by his psychiatric disorder, and/or aggravated by his psychiatric disorder. This claim is inextricably intertwined with the development in connection with the claim for entitlement to service connection for a psychiatric disorder. Thus, consideration of this claim is deferred. 22. Entitlement to service connection for diabetes mellitus type 2 is remanded. In an April 2019 private medical record, Dr. Skaggs opined that the Veteran’s diabetes mellitus type 2 was caused by hypertension because of the shared risk factors and mutual excerebration because of a shared etiological component. This claim is inextricably intertwined with the development in connection with the claim for entitlement to service connection for a psychiatric disorder. Thus, consideration of this claim is deferred. The matters are REMANDED for the following action: 1. The AOJ should consider the reopened claims for service connection for a psychiatric disorder, a lumbar spine disability, migraine headaches, Klippel-Trenaunay syndrome on the merits. 2. Undertake any additional development deemed necessary. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Husain, Associate 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.