Citation Nr: 20021133 Decision Date: 03/24/20 Archive Date: 03/24/20 DOCKET NO. 06-33 476 DATE: March 24, 2020 ORDER Entitlement to service connection for hypertension including as secondary to service-connected disability is denied. Entitlement to compensation under the provisions of U.S.C. § 1151 for hypertension is denied. Entitlement to service connection for a heart disability claimed as a fast heart is denied. Entitlement to service connection for hyperthyroidism including as secondary to service-connected disability is denied. Entitlement to compensation under the provisions of U.S.C. § 1151 for hyperthyroidism is denied. FINDINGS OF FACT 1. A heart disability is not currently manifest and did not manifest at any point during the appeal period. 2. Hypertension did not manifest in service and is not attributable to service, and did not manifest to a compensable degree within one year of discharge from service. 3. Hypertension is not caused or aggravated by service-connected disease or injury. 4. There is no additional disability of hypertension that was the result of carelessness, negligence, lack of proper skill, error in judgment or other instance of fault on the part of VA, nor was it due to an event not reasonably foreseeable. 5. Hyperthyroidism did not manifest in service or within one year of separation and is not attributable to service. 6. Hyperthyroidism is not caused or aggravated by service-connected disease or injury. 7. There is no additional disability of hyperthyroidism that was the result of carelessness, negligence, lack of proper skill, error in judgment or other instance of fault on the part of VA, nor was it due to an event not reasonably foreseeable. CONCLUSIONS OF LAW 1. A heart disability was not incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.304. 2. Hypertension was not incurred in or aggravated by service and it may not be presumed to have been incurred therein. 38 U.S.C. §§ 1112, 1113, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. Hypertension is not proximately due to or the result of (causation or aggravation) a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310. 4. The criteria for compensation pursuant to the provisions of 38 U.S.C. § 1151 for hypertension have not been met. 38 U.S.C. §§ 1151, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.361. 5. Hyperthyroidism was not incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.304. 6. Hyperthyroidism is not proximately due to or the result of (causation or aggravation) a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310. 7. The criteria for compensation pursuant to the provisions of 38 U.S.C. § 1151 for hyperthyroidism have not been met. 38 U.S.C. §§ 1151, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.361. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1975 to November 1979. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a December 2005 and August 2006 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). In August 2008, the Board denied the claims of service connection for hypertension, hyperthyroidism, and a heart disability. The Veteran appealed to the United States Court of Appeals for Veterans Claims (“Court”). In November 2009, the Court issued an Order and a Memorandum Decision that vacated the Board’s August 2008 decision. The Memorandum Decision noted that the Secretary of VA did not make adequate efforts to tailor the duty to assist the Veteran as to providing him examinations while he was incarcerated. In July 2010, and September 2014, the Board remanded the claims for additional development. In an April 2015 decision, the Board again remanded the claims on appeal and specifically ordered that the agency of original jurisdiction (AOJ) address the claims of hypertension and hyperthyroidism under 38 U.S.C. § 1151, noting that these were inextricably intertwined with the claims for service connection on appeal. The claims on appeal were again remanded in May 2017 for further evidentiary development. The claims have been returned to the Board. Review of the completed development reveals that, at the very least, substantial compliance with the remand directives was obtained. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Service Connection Pertinent legal criteria Veterans are entitled to compensation from VA if they develop a disability “resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty.” 38 U.S.C. § 1110 (wartime service), 1131 (peacetime service). To establish a right to compensation for a present disability, a veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service”-the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). For certain chronic disorders, including hypertension, service connection may be granted if the disease becomes manifest to a compensable degree within one year following separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. With chronic disease shown as such in service (or within the presumptive period under § 3.307) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected unless clearly attributable to intercurrent causes. This rule does not mean that any manifestation of joint pain, any abnormality of heart action or heart sounds, any urinary findings of casts, or any cough, in service will permit service connection of arthritis, disease of the heart, nephritis, or pulmonary disease, first shown as a clear-cut clinical entity, at some later date. 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, as distinguished from merely isolated findings or a diagnosis including the word “Chronic.” When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). The Veteran has not claimed that his disabilities on appeal are the result of combat with the enemy. Therefore, the combat provisions of 38 U.S.C. § 1154 are not for consideration. Service connection is also warranted for disability which is proximately due to or the result of a service-connected disease or injury. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice connected disease or injury will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. The rating activity will determine the baseline and current levels of severity under the Schedule for Rating Disabilities (38 C.F.R. Part 4) and determine the extent of aggravation by deducting the baseline level of severity, as well as any increase in severity due to the natural progress of the disease, from the current level. 38 C.F.R. § 3.310(b). For secondary service connection to be granted, generally there must be (1) evidence of a current disability; (2) evidence of a service-connected disease or injury; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). After the evidence is assembled, it is the Board’s responsibility to evaluate the entire record. See 38 U.S.C. § 7104(a). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Heart disability The Veteran contends that he has a heart disability, characterized as rapid heartbeat, that is related to his service. The evidence of record establishes that the Veteran does not have a current heart disability. In this regard, in September 2019, the Veteran was afforded a VA examination to determine the nature and etiology of his claimed heart disability. After examination of the Veteran, the VA examiner declined to diagnose the Veteran with a heart disability that was separate from any symptoms that were associated with the Veteran’s hyperthyroidism which, as indicated above, is a separate claim for service connection that the Veteran has claimed. Indeed, the examiner reported that the Veteran’s report and signs of tachycardia was an appropriate response to hyperthyroidism which was now resolved without residuals and did not represent a pathologic cardiac condition. In this case, the Board finds that the most probative evidence weighs against finding that the criteria have been met for a current heart disability. In this regard, the Board finds it highly probative that the VA examiner opined that the Veteran does not have a heart disability. The Board further notes that there is no competent medical evidence contrary to the VA examination report indicating that the Veteran’s history of tachycardia was a symptom of his hyperthyroidism that did not result in a heart disability. The Board has considered the Veteran’s statements indicating that he has a heart disability. The Veteran is competent to provide evidence of that which he experiences, including his symptomatology and medical history. Layno v. Brown, 6 Vet. App. 465, 469 (1994). In addition, lay evidence can be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition; (2) the layperson is reporting a contemporaneous medical diagnosis; or, (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007)); Kahana v. Shinseki, 24 Vet. App. 428, 433, n.4 (2011). However, competence must be distinguished from probative weight. Although the Veteran is competent to relate what he experiences through the senses, the lay evidence is lacking in detail to support the conclusion that there is a current heart disability. The Veteran’s lay assertions are therefore afforded less probative weight, and less credibility than the opinion of the 2019 VA examiner. In this instance, the Board concludes that the most probative evidence establishes that the Veteran does not have a heart disability. The existence of a current disability is the cornerstone of a claim for VA disability benefits. See Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997). Therefore, in the absence of current disability, there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In this case, there is no disability that resulted from a disease or injury. Under the circumstances, the Veteran has not met the regulatory requirements to establish service connection for a heart disability under any theory of entitlement and service connection must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. Here, however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Hypertension The Veteran contends that he has hypertension that is related to his service or is alternatively secondary to his service-connected hepatitis B. Direct and presumptive service connection The Board notes that the Veteran has been diagnosed with hypertension. See, e.g., a VA examination report dated September 2019. To the extent that the Veteran contends that his hypertension is related to service, the Board finds that the objective evidence outweighs this contention. Crucially, the Veteran’s service treatment records indicate no suggestion of treatment for or complaints of symptoms related to hypertension. Indeed, the earliest indication of hypertension dating back to service is the notation in the September 2019 VA examination report with onset in 1999. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) [contemporaneous evidence has greater probative value than history as reported by the veteran]. This is more than 15 years after the Veteran’s discharge from service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (explaining that the Board may consider "evidence of a prolonged period without medical complaint," along with other factors in resolving a claim). The Board observes that lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person (e.g. any evidence not requiring that the proponent has specialized education, training, or experience). 38 C.F.R. § 3.159(a)(2). As such, the Veteran can competently testify about symptoms he experienced in service. However, competency must be distinguished from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Layno v. Brown, 6 Vet. App. 465, 469 (1994). In the present case, the Board finds that the Veteran’s history of hypertension since service is outweighed by the objective evidence of record in light of the lack of any post service identification until 1999 as well as the available service treatment records which indicate normal findings with regard to the Veteran’s blood pressure. Therefore, to the extent that the Veteran contends that his hypertension manifested during service, this lay evidence is at odds with the remainder of the record, which reflects normal findings during service. As such, the Veteran’s statements are lacking probative value. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) [VA cannot ignore a veteran’s testimony simply because the veteran is an interested party; personal interest may, however, affect the credibility of the evidence]. In short, there is no credible evidence of an in-service manifestation of hypertension. To the extent that the Veteran asserts that his hypertension is related to service, the Board finds that the Veteran’s statements regarding this disability being incurred in service is not credible given the objective evidence of record to include the service treatment records and the post service medical records. The Board also notes that while the Veteran currently evidences hypertension, in as much as the service treatment records reveal normal findings, he did not have characteristic manifestations sufficient to identify the chronic disease entity during service or within one year of separation. 38 C.F.R. § 3.303(b). The Veteran has not contended otherwise. Secondary service connection The competent evidence establishes that the Veteran has hypertension. See, e.g., the September 2019 VA examination report. Additionally, the Veteran is currently service-connected for hepatitis B. The Board has carefully evaluated the evidence and, for reasons stated immediately below, finds that a preponderance of the competent and probative evidence of record is against a finding that the Veteran’s current hypertension is due to or aggravated by his service-connected hepatitis B and service connection is therefore not warranted on a secondary basis. The Veteran was provided a VA examination for his hypertension in September 2019. After examination of the Veteran and consideration of the Veteran’s medical history, the examiner diagnosed the Veteran with hypertension and opined that it is less likely than not that the hypertension is caused or aggravated by the service-connected hepatitis B. The examiner’s rationale for her conclusion was based on her finding that there was no evidence the Veteran’s hepatitis B had any effect on the Veteran’s blood pressure. She indicated that the Veteran’s hepatitis B had resolved i.e. the Veteran no longer carried the result, and therefore the current diagnosis of hypertension could not have been affected by the hepatitis B infection he had in service. Moreover, the Veteran’s hypertension was well controlled on monotherapy of low dose amlodipine which was expected at is age. The September 2019 VA examination was based upon thorough consideration and analysis of the Veteran’s pertinent medical history. See Bloom v. West, 12 Vet. App. 185, 187 (1999) [the probative value of a physician’s statement is dependent, in part, upon the extent to which it reflects “clinical data or other rationale to support his opinion”]. The Board observes that the Veteran has submitted medical articles detailing the effects of hepatitis B and hypertension. The Board notes that medical treatise evidence can, in some circumstances, constitute competent medical evidence. See Wallin v. West, 11 Vet. App. 509, 514 (1998); see also 38 C.F.R. § 3.159(a)(1) [competent medical evidence may include statements contained in authoritative writings such as medical and scientific articles and research reports and analyses]. However, the articles submitted by the Veteran are of a general nature and do not contain any information or analysis specific to the Veteran’s case. Additionally, the Court has held that medical evidence, which is speculative, general, or inconclusive in nature cannot support a claim. See Jones v. Shinseki, 23 Vet. App. 382, 390 (2010); Beausoleil v. Brown, 8 Vet. App. 459, 463 (1996); Libertine v. Brown, 9 Vet. App. 521, 523 (1996). As discussed above, the September 2019 VA examiner reviewed the Veteran’s medical history, considered his complaints, and conducted an examination of the Veteran, and thereafter concluded that the Veteran’s current hypertension is not caused or aggravated by the hepatitis B. The Board has therefore placed great probative value on the findings of the VA examiner. As such, the articles submitted by the Veteran are of little or no probative value, and, to the extent that there is any probative value, are greatly outweighed by the examiner’s opinion. The Board observes that the Veteran has indicated his hypertension is secondary to his hepatitis B. The Board notes that the Veteran is competent to report that he has been diagnosed with hypertension. However, to the extent the Veteran proffers this information as a positive nexus between his hypertension and hepatitis B, the Board finds that such an opinion is outweighed by the evidence of record, in particular the September 2019 VA medical opinion which was based on thorough review of the Veteran’s pertinent medical history and medical condition and supported by adequate rationales. Therefore, this lay evidence is accorded little probative value. Here, the preponderance of the evidence is against the claim and there is no doubt to be resolved. For the reasons and bases expressed above, the Board finds that the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for hypertension, to include as secondary to service-connected disease or injury. The benefit sought on appeal are accordingly denied. Hyperthyroidism The Veteran contends that he has hyperthyroidism that is related to service or is alternatively secondary to the service-connected hepatitis B. Direct service connection The Board notes that the Veteran has been diagnosed with hyperthyroidism. See, e.g., a VA examination report dated September 2019. To the extent that the Veteran contends that his hyperthyroidism is related to service, the Board finds that the objective evidence outweighs this contention. Crucially, the Veteran’s service treatment records indicate no suggestion of treatment for or complaints of symptoms related to hyperthyroidism. Indeed, the earliest indication of hyperthyroidism dating back to service is the notation in the September 2019 VA examination report with onset in 1996. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) [contemporaneous evidence has greater probative value than history as reported by the veteran]. This is more than 15 years after the Veteran’s discharge from service. In the present case, the Board finds that the Veteran’s history of hyperthyroidism since service is outweighed by the objective evidence of record in light of the lack of any post service identification until 1996 as well as the available service treatment records which indicate normal findings with regard to the Veteran’s hyperthyroidism. See Maxson, 230 F.3d at 1333 (Fed. Cir. 2000). Therefore, to the extent that the Veteran contends that his hyperthyroidism manifested during service, this lay evidence is at odds with the remainder of the record, which reflects normal findings during service. As such, the Veteran’s statements are lacking probative value. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) [VA cannot ignore a veteran’s testimony simply because the veteran is an interested party; personal interest may, however, affect the credibility of the evidence]. In short, there is no credible evidence of an in-service manifestation of hyperthyroidism. To the extent that the Veteran asserts that his hyperthyroidism is related to service, the Board finds that the Veteran’s statements regarding this disability being incurred in service is not credible given the objective evidence of record to include the service treatment records and the post service medical records. Secondary service connection The competent evidence establishes that the Veteran has hyperthyroidism. See, e.g., the September 2019 VA examination report. Additionally, the Veteran is currently service-connected for hepatitis B. The Board has carefully evaluated the evidence and, for reasons stated immediately below, finds that a preponderance of the competent and probative evidence of record is against a finding that the Veteran’s current hyperthyroidism is due to or aggravated by his service-connected hepatitis B and service connection is therefore not warranted on a secondary basis. Specifically, the Veteran was provided a VA examination for his hyperthyroidism in September 2019. After examination of the Veteran and consideration of the Veteran’s medical history, the examiner diagnosed the Veteran with hyperthyroidism and opined that it is less likely than not that the hyperthyroidism is caused or aggravated by the service-connected hepatitis B. The examiner’s rationale for her conclusion was based on her finding that the Veteran’s hepatitis B shortly resolved after infection in service and there was no evidence after his service period that he ever had any chronic hepatitis infection as evidenced by serially normal LFTs on laboratory testing from his period of incarceration which was from 1996 to 2014. In addition, the Veteran was treated with antilipid medications during incarceration, a relative contraindication if he had any active liver disease. The examiner further noted it is unlikely that he would have been prescribed those medications of his hepatitis B was an active infection. As such, there is no indication that the Veteran was actively infected with hepatitis B at the same time as he was diagnosed with hyperthyroidism which was in 1996. The September 2019 VA examination was based upon thorough consideration and analysis of the Veteran’s pertinent medical history. See Bloom, supra. The Board observes that the Veteran has submitted medical articles detailing the effects of hepatitis B and hyperthyroidism. The Board notes that medical treatise evidence can, in some circumstances, constitute competent medical evidence. See Wallin, supra. However, the articles submitted by the Veteran are of a general nature and do not contain any information or analysis specific to the Veteran’s case. Additionally, the United States Court of Appeals for Veterans Claims (Court) has held that medical evidence, which is speculative, general, or inconclusive in nature cannot support a claim. See Jones, Beausoleil, and Libertine, all supra. As discussed in detail above, the September 2019 VA examiner reviewed the Veteran’s medical history, considered his complaints, and conducted an examination of the Veteran, and thereafter concluded that the Veteran’s current hyperthyroidism is not caused or aggravated by the hepatitis B. The Board has therefore placed great probative value on the findings of the VA examiner. As such, the articles submitted by the Veteran are of little or no probative value, and, to the extent that there is any probative value, are greatly outweighed by the examiner’s opinion. The Board observes that the Veteran has indicated his hyperthyroidism is secondary to his hepatitis B. The Board notes that the Veteran is competent to report that he has been diagnosed with hyperthyroidism. However, to the extent the Veteran proffers this information as a positive nexus between his hyperthyroidism and hepatitis B, the Board finds that such an opinion is outweighed by the evidence of record, in particular the September 2019 VA medical opinion which was based on thorough review of the Veteran’s pertinent medical history and medical condition and supported by adequate rationales. Therefore, this lay evidence is accorded little probative value. For the reasons and bases expressed above, the Board finds that the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for hyperthyroidism, to include as secondary to service-connected disease or injury. The benefit sought on appeal are accordingly denied. § 1151 Hypertension and hyperthyroidism The Veteran asserts that the care he received for hepatitis B through VA was careless and negligent, and caused his hypertension and hyperthyroidism to develop or worsen. He argues that he is entitled to VA compensation benefits under 38 U.S.C. § 1151 on these grounds. A Veteran may be awarded compensation for additional disability, not the result of his willful misconduct, if the disability was caused by hospital care, medical or surgical treatment, or examination furnished the Veteran under any law administered by VA, either by a VA employee or in a VA facility as defined in 38 U.S.C. § 1701(3)(A), and the proximate cause of the disability was (1) carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing the hospital care, medical or surgical treatment, or examination, or (2) an event not reasonably foreseeable. 38 U.S.C. § 1151; 38 C.F.R. § 3.361. The Board finds that the weighs against the Veteran’s claim that VA care for his hepatitis caused his hypertension and hyperthyroidism to develop or worsen. In this regard, a VA opinion was obtained as to this matter in January 2020. The VA examiner noted that the Veteran was incarcerated from 1996 to 2013 and that the Veteran was diagnosed with hyperthyroidism in the late 1990s. Pertinently, there was no evidence that the VA was involved in his care during this time. Further, he restored to normal thyroid function with normal TSH values. Moreover, his elevated blood pressure was a consequence of the high thyroid state and resolved when the thyroid function was restored to normal. The 2020 examiner stated that based upon these findings that the VA did not cause or worsen the hypertension or hypothyroidism, and there was no additional disability that resulted from VA care. The Board notes that there are no contrary medical opinions of record. The Board must assess the credibility and weight to be given the evidence. The January 2020 VA opinion is credible and deserving of significant probative weight. It is based on a thorough discussion of the Veteran’s history and demonstrates the examiner’s substantial knowledge and skill in analyzing the data, relevant factors noted in Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). The Board finds that the January 2020 opinion is the most persuasive evidence on the question of whether there is additional hypertension and hyperthyroidism disabilities due to VA care for hepatitis, and it weighs against the claims. Simply put, the record contains no reliable evidence which tends to substantiate the Veteran’s contentions that he suffered additional disability due the VA care he received that was due to carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA or an event not reasonably foreseeable. The Veteran is not competent to provide such an opinion because an opinion as to this would be medically complex in nature as it would involve analysis of medical reports and the standard of care at that time. See Jandreau. Also, determinations as to whether a physician’s diagnosis, treatment or procedures for arriving at a diagnosis or course of treatment conform to ordinary standards of medical care generally present matters outside the ordinary knowledge of laypersons and therefore must be shown by medical evidence. See OGCPREC 05-01. The Board finds that this is the case in these claims. Accordingly, the most probative evidence in this case is the January 2020 VA opinion, which reflects that there was not additional disability that was the result of carelessness, negligence, lack of proper skill, error in judgment or other instance of fault on the part of VA, or was it due to an event not reasonably foreseeable. The Board is aware that the Veteran is competent to relate that which he has been told by an examiner. However, the Board finds the actual records are far more probative and more credible than the lay recounting. Although some of the lay statements may fall within the realm of competence, such statements are outweighed by the reasoned and comprehensive medical opinion evidence. Notably, the Veteran has never argued that he was treated without informed consent. 38 C.F.R. § 3.361(d)(1)(ii). The record does not otherwise reflect that the Veteran was unable to provide informed consent. Accordingly, the Board finds that benefits are not warranted on this basis. For the foregoing reasons, the preponderance of the evidence is against the claims for compensation under the provisions of 38 U.S.C. § 1151 for hypertension and hyperthyroidism. The benefit-of-the-doubt doctrine is therefore not for application, and the claims must be denied. See 38 U.S.C. § 5107(b). Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.326(a); see also Dingess v. Nicholson, 19 Vet. App. 473 (2006). The Veteran has not raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s 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 a duty to assist argument). P. M. Johnson Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Nadia Kamal, 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.