Citation Nr: 20021359 Decision Date: 03/25/20 Archive Date: 03/25/20 DOCKET NO. 16-25 958 DATE: March 25, 2020 ORDER 1. Entitlement to service connection for hypertension is denied. 2. Entitlement to service connection for a lumbar spine disability is denied. 3. Entitlement to service connection for a bilateral eye disability, to include glaucoma and cortical cataracts, is denied. 4. Entitlement to service connection for a right ear hearing loss disability is denied. 5. Entitlement to service connection for peripheral neuropathy of the left upper extremity is denied. 6. Entitlement to service connection for peripheral neuropathy of the right upper extremity is denied. 7. Entitlement to service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD), is denied. 8. Entitlement to service connection for an upper front teeth disability is denied. FINDINGS OF FACT 1. Hypertension 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. 2. A lumbar spine 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. 3. The preponderance of the evidence is against finding that the Veteran’s bilateral eye disability, to include glaucoma and cortical cataracts, was incurred in or otherwise related to service. 4. The preponderance of the evidence of record is against finding that the Veteran has had for a right ear hearing loss disability at any time during or approximate to the pendency of the claim. 5. The preponderance of the evidence of record is against finding that the Veteran has had for peripheral neuropathy of the left upper extremity at any time during or approximate to the pendency of the claim. 6. The preponderance of the evidence of record is against finding that the Veteran has had for peripheral neuropathy of the right upper extremity at any time during or approximate to the pendency of the claim. 7. The preponderance of the evidence of record is against finding that the Veteran has had for a psychiatric disorder, to include PTSD, at any time during or approximate to the pendency of the claim. 8. The Veteran does not have a current dental disability due to trauma or injury incurred during active service, and he does not meet the requirements for service connection for the limited purpose of receiving VA outpatient dental treatment. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension have not been 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). 2. The criteria for service connection for a lumbar spine disability have not been 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). 3. The criteria for service connection for a bilateral eye disability, to include glaucoma and cortical cataracts, have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for service connection for a right ear hearing loss disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 5. The criteria for service connection for peripheral neuropathy of the left upper extremity have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 6. The criteria for service connection for peripheral neuropathy of the right upper extremity have not been 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 a psychiatric disorder, to include PTSD, have not been 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 a dental disability, for purposes of both compensation and VA outpatient treatment, have not been met. 38 U.S.C. §§ 1110, 1131, 1721, 5107; 38 C.F.R. §§ 3.102, 3.306, 3.381, 4.150, 17.161. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from June 1960 to June 1964 and the Army from November 1964 to October 1967. The Veteran testified at a video conference hearing before the undersigned Veterans Law Judge in December 2018. A transcript of the hearing was prepared and associated with the claims file. At the December 2018 Board hearing, the undersigned Veterans Law Judge left the record open for 60 days, to allow the Veteran and his representative to submit any additional evidence within their possession. In January 2019 the Veteran submitted additional relevant evidence with respect to his claims. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a 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. Service connection may 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). Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases, such as hypertension, arthritis, and sensorineural hearing loss, which is an organic diseases of the nervous system, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 38 C.F.R. §§ 3.309(a). 1. Entitlement to service connection for hypertension At the December 2018 Board hearing, the Veteran’s representative contended that the Veteran’s hypertension was proximately due to, or aggravated by, his service-connected diabetes mellitus type 2. The Veteran stated that he was either diagnosed with hypertension shortly before leaving service or immediately after leaving service, although he could not recall exactly, and that he has continuously been taking medication to treat the hypertension. The Veteran requested consideration of both direct and secondary theories of entitlement. 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 hypertension on a direct, secondary, or presumptive basis. The reasons follow. The Veteran has been diagnosed with hypertension, 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 service treatment records (STRs) show that the Veteran was found to have elevated blood pressure readings during his October 1964 Report of Medical Examination. The Veteran was found to have normal blood pressure readings in Reports of Medical Examination from March 1967 and July 1967, which was at separation. In the July 1967 Report of Medical History, the Veteran denied a history of low or high blood pressure. As the Veteran had a high blood pressure reading in October 1964, the evidence supports a finding of complaints or symptoms related to hypertension during service, and the in-service disease or injury element is 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 hypertension in 2003, as reported by him at the August 2013 VA examination, which is approximately 36 years following service discharge, and tends to establish that hypertension did not have its onset in service. With regard to the Veteran’s contention that he was diagnosed with hypertension during service or immediately after service, and has taken medication since that time, the Board notes that the record does not support this contention. Additionally, the Veteran stated at the August 2013 VA examination that he originally was diagnosed with hypertension in 2003. However, this contradicts the Veteran’s December 2018 Board hearing testimony, where he stated that he was during or immediately after service. As the Veteran has provided contradictory statements with regard to the onset of hypertension, the Board finds that the Veteran’s overall credibility has been negatively impacted. The Veteran also contends that his hypertension is proximately due to, or aggravated by, either service-connected diabetes mellitus type 2 or his non service-connected eye disability. The Veteran has not submitted evidence to support this contention, and such contention is not supported by the record. Although the Veteran claims that hypertension is related to service or to a service-connected disability, the Veteran 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 hypertension 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 hypertension 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 hypertension and service or to a service-connected disability, 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 hypertension in service and that his hypertension 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 1967. 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 36 years following service discharge until the Veteran was diagnosed with hypertension in 2003. The absence of post-service complaints, findings, diagnosis, or treatment for approximately 36 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 hypertension. 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. 2. Entitlement to service connection for a lumbar spine disability At the December 2018 Board hearing, the Veteran testified that he injured his back in a tank accident during service. The Veteran stated that he additionally injured his back in a karate training accident during service. The Veteran also stated that he received treatment for his injury during service, including x-rays. The Veteran testified that he believes his injury was aggravated by age. 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 lumbar spine disability on a direct or presumptive basis. The reasons follow. The Veteran has been diagnosed with a lumbar spine 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 low back sprain/strain with underlying degenerative arthritis. As to an in-service disease or injury, the STRs show that the Veteran suffered a back injury during hand-to-hand combat training in April 1964. The Veteran continued to complain of back pain after this incident, seeking treatment in March 1966, April 1966, and April 1967. In April 1966, x-ray results of the Veteran’s back showed normal findings. Accordingly, the evidence supports a finding of complaints or symptoms related to a lumbar spine disability during service, and the in-service disease or injury element is 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, after the complaints of pain in service, the Veteran was found to have clinically normal evaluations of his spine in Reports of Medical Examination from March 1967 and at separation in July 1967. In a Report of Medical History from July 1967, the Veteran stated that he had a history of recurrent back pain, noting that he injured his back in 1966, but no longer had a problem. This shows that by the time the Veteran was separating from service, he had not developed a chronic lumbar spine disability. This is further supported by the fact that the evidence of record shows that the Veteran first complained of back symptoms in a September 2011 private treatment record from the Campbell Family Practice, which is approximately 44 years following service discharge, and tends to establish that a lumbar spine disability did not have its onset in service. Supporting this date of onset is the fact that records from the same private treatment facility, dating back to March 2009, do not support complaints or diagnosis of a lumbar spine disability. In an October 2013 VA opinion, the examiner opined that that the Veteran’s lumbar spine disability was less likely than not related to or otherwise incurred in service, explaining that a strain or sprain is a soft tissue injury that is expected to resolve within one year without long term residuals or sequelae. The examiner stated that soft tissue injuries of the lumbar spine do not cause, contribute to, or enhance the progression of lumbar degenerative arthritis. The VA examiner concluded that the most likely cause of the Veteran’s arthritis is advancing age. This opinion establishes that a lumbar spine disability is not related to the in-service lumbar spine complaints. The Board accords high probative value to this opinion, as the examiner had reviewed the file and provided a rationale for the conclusion reached. Although the Veteran claims that a lumbar spine disability is related to service, the Veteran 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 lumbar spine 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 lumbar spine 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 lumbar spine disability 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 a lumbar spine disability in service and that his lumbar spine disability 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 1967. 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 44 years following service discharge until the Veteran complained of symptoms related to a lumbar spine disability in September 2011. The absence of post-service complaints, findings, diagnosis, or treatment for approximately 44 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 a lumbar spine 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. 3. Entitlement to service connection for a bilateral eye disability, to include glaucoma and cortical cataracts At the December 2018 Board hearing, the Veteran’s representative contended that the Veteran’s eye disability is proximately due to, or aggravated by, his service-connected diabetes mellitus type 2. The Veteran alternatively contended that his eye disability is secondary to hypertension. 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, in the August 2013 VA examination, the Veteran was diagnosed with cortical cataracts and chronic open angle glaucoma. The Board notes that the Veteran has also been diagnosed with refractive errors. However, defects of form or structure of the eye that are of congenital or developmental origin may not be considered as disabilities or service connected on the basis of incurrence or aggravation beyond natural progress during service. Refractive errors are due to anomalies in the shape and conformation of the eye structures and generally of congenital or developmental origin for example - astigmatism, myopia, hyperopia, and presbyopia. Therefore, the effect of uncomplicated refractive errors must be excluded in considering impairment of vision from the standpoint of service connection and evaluation. Thus, to the extent that the Veteran has been diagnosed with a refractive error, service connection for this disability cannot be granted. 38 C.F.R. §§ 3.303(c), 4.9. 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. The STRs show that the Veteran was found to have clinically normal evaluations of his eyes in Reports of Medical Examination from March 1967 and at separation in July 1967. In a Report of Medical History from July 1967, the Veteran denied history of eye trouble, which tends to show that he was not experiencing a bilateral eye disability in service. The Veteran was found to have convergence insufficiency in a June 1965 record and astigmatism a March 1967 record. These records noted these findings in the context of a vision examination, and, as such, are refractive errors, which do not support evidence of a bilateral eye disability. 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 the August 2013 VA examination, which is approximately 46 years following service discharge, and tends to establish that a bilateral eye disability did not have its onset in service. The Veteran contends that his eye disability is proximately due to, or aggravated by, either service-connected diabetes mellitus type 2 or his non service-connected hypertension. The Veteran has not submitted evidence to support this contention, and such contention is not supported by the record. The Veteran has not been diagnosed with diabetic retinopathy. Although the Veteran claims that a bilateral eye disability is related to service or to a service-connected disability, the Veteran 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 bilateral 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 or to a service-connected disability, 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. 4. Entitlement to service connection for a right ear hearing loss disability At the December 2018 Board hearing, the Veteran contended that he is entitled to service connection for a right ear hearing loss disability due to his service-connected left ear hearing loss disability. The Veteran stated that he incurred a right ear hearing loss disability due to working around tanks while they were firing 45 caliber cartridges during service in Wildflecken, Germany, which resulted in significant noise exposure. The Veteran stated that private medical examiners diagnosed the Veteran with a right ear hearing loss disability, but was unsure if records were available to verify his disability. 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 a right ear hearing loss disability 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). On a VA audiological evaluation in August 2013, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 5 20 25 30 Speech audiometry revealed speech recognition ability of 100 percent in the right ear. Although the August 2013 VA examination found that the Veteran had sensorineural hearing loss in the 500 to 5000 Hertz range, the Board finds that the Veteran’s right ear hearing loss at a level that is not considered to be a disability for VA purposes. Specific to claims for service connection, impaired hearing is considered a disability for VA purposes when the auditory threshold in any of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of these frequencies are 26 or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. In evaluating claims of service connection for hearing loss disability, it is observed that the threshold for normal hearing is from zero to 20 decibels, with higher threshold levels indicating some degree of hearing loss. For the purpose of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of these frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Here, the Veteran’s August 2013 VA audiogram does not support that the Veteran has an auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz at 40 decibels or greater, or that a measurement of auditory thresholds for at least three of these frequencies that was 26 decibels or greater. Furthermore, in a March 2017 VA treatment record, the Veteran denied symptoms of a hearing loss disability. Although the Veteran contends he has been diagnosed with a right ear hearing loss disability by a private treatment facility, the record does not support such a diagnosis. Accordingly, the evidence does not support a right ear hearing loss disability for VA purposes. Service connection is predicated on the existence of a current disability for VA purposes. At present, there is no competent evidence of record that establishes the existence of right ear hearing loss disability under the clear requirement of 38 C.F.R. § 3.385. The United States Court of Appeals for Veterans Claims has specifically upheld the validity of 38 C.F.R. § 3.385 to define hearing loss for VA compensation purposes. Laypersons are sometimes competent to provide opinions regarding etiology and diagnosis. In this case, the Board finds that the specific audiological results shown on examination are more probative evidence as to whether the Veteran manifests a right ear hearing loss disability for VA purposes. While the Veteran believes he has a current diagnosis of a right ear hearing loss disability, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Consequently, the Board gives more probative weight to the competent medical evidence. As noted above, the Veteran has been diagnosed with right ear sensorineural hearing loss, which, as noted above, is a “chronic disease” where service connection may be warranted if it manifests to a compensable degree within one year following discharge from service. However, it must be noted that there is no competent evidence that the Veteran incurred a right ear hearing loss “disability” to a compensable degree within one year of separation from service. The fact that a veteran has an organic disease of the nervous system during or after service is not determinative unless that disease results in “disability.” For hearing loss purposes, VA has defined a hearing loss “disability’ as a condition that meets the provisions of 38 C.F.R. § 3.385. Because the Veteran’s right ear hearing loss does not meet those criteria, he cannot be awarded service connection for a right ear hearing loss “disability.” The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. §§ 1110, 1131. Evidence must show that the Veteran currently has the disability for which benefits are being claimed. Because the evidence shows that the Veteran does not have a right ear hearing loss disability during the pendency of the appeal, the Board finds that service connection for a right ear hearing loss disability is not warranted. 5. Entitlement to service connection for peripheral neuropathy of the left upper extremity 6. Entitlement to service connection for peripheral neuropathy of the right upper extremity At the December 2018 Board hearing, the Veteran testified that he has a diagnosis of peripheral neuropathy of the bilateral upper extremities, noting that he believed it was related to his service-connected peripheral neuropathy of the bilateral lower extremities. The Veteran stated that he experiences symptoms his upper extremities that correspond to the symptoms of peripheral neuropathy in his lower extremities. He relayed that he was exposed to extreme cold weather during service in Baumholder, Germany, and that he believed this may be the cause of his peripheral neuropathy. The Board notes that the Veteran is shown to have service in Vietnam, therefore is presumptively assumed to have been exposed to herbicide agents during service. 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 peripheral 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). The reasons for this determination follow. The August 2013 VA examiner evaluated the Veteran and determined that he did not have a diagnosis of peripheral neuropathy of the bilateral upper extremities, and separately noted that there is no objective evidence supporting a diagnosis of peripheral neuropathy of the hands. Further, despite consistent treatment from January 1968 to January 2019, neither private nor VA treatment records contain a diagnosis of peripheral neuropathy of the bilateral upper extremities. For example, in a March 2006 private treatment record, Dr. Kathleen Eberle found that the Veteran had normal diagnostic findings for motor conduction studies in his left median and ulnar nerves, and normal sensory conduction studies of the left medial antebrachial, superficial radial, median and ulnar nerves. Dr. Eberle concluded that there is no electric evidence of peripheral neuropathy in the Veteran’s left upper extremity. These records establish that the Veteran was found not to have a diagnosis of peripheral neuropathy of the bilateral upper extremities. While the Veteran believes he has a current diagnosis of peripheral 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 peripheral neuropathy of the bilateral upper extremities, to include pain or symptoms that cause 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 January 1968 to January 2019, and these records do not contain a diagnosis of peripheral neuropathy of the bilateral upper extremities, to include pain that causes functional impairment that affects earning capacity. These records cover 51 year period, and the lack of documentation of peripheral neuropathy of the bilateral upper extremities, to include pain, is evidence against the claim for service connection for peripheral 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 peripheral neuropathy of the bilateral upper extremities, and the claim is denied. 7. Entitlement to service connection for a psychiatric disorder, to include PTSD At the December 2018 Board hearing, the Veteran stated that he experiences symptoms of nightmares, anxiety, and depression. The Veteran stated that during service, he witnessed numerous injuries and dead bodies that continue to haunt him until today. The Veteran recounted discussing his troubled thoughts with other individuals during service. He testified that other service members had similar thoughts and feelings, which they openly expressed during service. 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 a psychiatric disorder 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). The reasons for this determination follow. The August 2013 VA examiner evaluated the Veteran and determined that the Veteran did not have a diagnosis of any psychiatric disorder. The VA examiner also noted that the Veteran did not have a diagnosis of PTSD under DSM-IV criteria. Further, despite consistent treatment from January 1968 to January 2019, neither private nor VA treatment records contain a diagnosis of a psychiatric disorder. For example, in private treatment records from the Lajja Neurology Association, in May 2017, June 2017, October 2017, and April 2018, it was noted that the Veteran denied symptoms of anxiety, an eating disorder, loss of appetite, and stressors. In a VA treatment record from April 2014, after a negative PTSD screen, the examiner noted that the Veteran had no mental health condition requiring further intervention. The Veteran was found to have another negative PTSD screen in a July 2017 VA treatment record. While the Veteran believes he has a current diagnosis of a psychiatric disorder, 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 a psychiatric disorder, to include pain or symptoms that cause 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 January 1968 to January 2019, and these records do not contain a diagnosis of a psychiatric disorder, to include pain that causes functional impairment that affects earning capacity. These records cover a 51-year period, and the lack of documentation of a psychiatric disorder, including PTSD, to include pain, is evidence against the claim for service connection for a psychiatric disorder. 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 a psychiatric disorder, and the claim is denied. 8. Entitlement to service connection for an upper front teeth disability At the December 2018 Board hearing, the Veteran testified that he suffered an injury to his front teeth during the above mentioned tank accident that resulted in a back injury. The Veteran stated that this incident resulted in cracked teeth, which were not fixed until after service. The Veteran also stated that the injury took place approximately in 1966, during service in Germany. Dental disorders are treated differently than other medical disorders in the VA benefits system. Compensation is only available for certain types of dental and oral conditions, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla. To warrant compensation for a dental disability, as opposed to treatment only, the evidence must show that a trauma has caused a loss of substance of the body of the maxilla or mandible resulting in a loss of teeth, or that disease (such as osteomyelitis, but not periodontal disease) has caused a loss of substance of the body of the maxilla or mandible resulting in a loss of teeth. Absent a demonstration of dental trauma, service connection may be considered solely for the purpose of determining entitlement to dental examinations or outpatient dental treatment. In that case, treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease will be considered service-connected solely for the purpose of establishing eligibility for outpatient dental treatment in accordance with 38 C.F.R. § 17.161. See 38 C.F.R. § 3.381. First, the Board finds that the Veteran does not have a compensable dental disorder for VA compensation purposes. The STRs show that the Veteran’s July 1967 separation examination report documents a normal clinical evaluation of the Veteran’s mouth and throat and nose, however the examining physician noted that a “Type 2” dental examination revealed injury to teeth #9 and #10. Although the evidence shows that the Veteran had abnormal tooth findings at separation in July 1976, the record does not show that the Veteran had loss of teeth caused by bone loss due to service trauma or disease such as osteomyelitis. The record does not support that a service trauma has caused a loss of substance of the body of the maxilla or mandible resulting in a loss of teeth, or that disease (such as osteomyelitis, but not periodontal disease) has caused a loss of substance of the body of the maxilla or mandible resulting in a loss of teeth. As such, the Board finds that the preponderance of evidence weighs against a finding of a current dental disability eligible for service connection for VA compensation purposes. Notwithstanding the above, the Veteran may be entitled to service connection for the purpose of receiving VA outpatient dental treatment if he is eligible under one of various categories. 38 U.S.C. § 1712; 38 C.F.R. § 17.161. The Board notes that entitlement to service connection for the purpose of receiving VA outpatient dental treatment was previously denied in rating decisions from May 1968 and March 1997. Class I VA outpatient treatment is available for veterans with an adjudicated compensable service-connected dental condition. In this case, as noted above, the evidence does not show that the Veteran has an adjudicated service-connected compensable dental condition; therefore, entitlement to Class I dental treatment is not warranted. Class II eligibility for any treatment reasonably necessary for the one-time correction of a service-connected noncompensable condition is available for veterans discharged under conditions other than dishonorable from active service of 90 days or more in the Persian Gulf War on or after October 1, 1981, provided the veteran made application for such treatment within 180 days after such discharge or release, the veteran’s DD Form 214 does not bear a certification that the veteran was provided, within the 90-day period immediately before such discharge or release, a complete dental examination (including dental x-rays) and all appropriate dental treatment indicated by the examination to be needed, and a VA dental examination was completed within six months after discharge or release, unless delayed through no fault of the veteran. Significantly, the Veteran is not eligible for Class II dental treatment because he separated from service in July 1967, and thus does not have qualifying service during the Persian Gulf War on or after October 1, 1981. The Board has also considered whether the Veteran is eligible for any of the additional classes of outpatient VA dental treatment. Veterans having a service-connected noncompensable dental condition determined to be the result of combat wounds or other service trauma will be eligible for VA dental care on a Class II(a) basis. Notably, the term “service trauma” does not include the intended effects of therapy or restorative dental care and treatment provided during a veteran’s military service. 38 C.F.R. § 3.306(b)(1). Although the Board has considered the lay evidence of record, the Board finds that the record does not support evidence of an in-service dental trauma or injury. As such, the Veteran does not meet eligibility requirements for Class II(a) dental treatment. Class II(b) or (c) eligibility extends to veterans having a service-connected noncompensable dental condition who were detained or interned as prisoners of war. In this case, the Veteran’s personnel records, including his DD Forms 214 from his two periods of service, do not reflect that he was a prisoner of war, and he has not asserted such a contention. Thus, he does not meet the criteria for Class II(b) or(c) dental treatment. Other categories of eligibility include those veterans having a dental condition clinically determined to be complicating a medical condition currently being treated by VA, veterans whose service-connected disabilities are rated as totally disabling, and some veterans who are Chapter 31 vocational rehabilitation trainees. However, none of these categories are applicable in this case. In sum, the preponderance of evidence does not show that the Veteran meets any of the categories of eligibility for VA outpatient dental treatment. As such, there is no reasonable doubt to resolve, and the claim is denied. 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.