Citation Nr: 20037576 Decision Date: 06/02/20 Archive Date: 06/02/20 DOCKET NO. 20-15 555 DATE: June 2, 2020 ORDER A 70 percent rating, and no higher, for posttraumatic stress disorder (PTSD) is granted. A compensable rating for right ear hearing loss disability is denied. A 20 percent rating, and no higher, for left ankle strain is granted A rating in excess of 10 percent for left hand ulnar neuropathy is denied. Service connection for left wrist disability is denied. Service connection for right eardrum partial perforation is denied. Service connection for right hand disability is denied. Service connection for vertigo is denied. FINDINGS OF FACT 1. The severity, frequency, and duration of the Veteran’s PTSD symptoms more closely approximate occupational and social impairment with deficiencies in most areas; total occupational and social impairment is not demonstrated or approximated. 2. Veteran’s right ear hearing loss has been manifested by hearing acuity of no worse than Level I in the right ear. 3. The Veteran’s left ankle strain is manifested by marked limited motion of the ankle considering the degree of impairment during flare ups. 4. The Veteran’s left hand ulnar neuropathy is manifested by not more than mild incomplete paralysis of the left (minor) ulnar nerve; moderate incomplete paralysis is not shown or approximated. 5. The Veteran does not have a current left wrist disability. 6. The Veteran does not have current right eardrum partial perforation. 7. The Veteran does not have a current right hand disability. 8. The Veteran does not have current vertigo. CONCLUSIONS OF LAW 1. The criteria for a disability rating of 70 percent for PTSD and no higher are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. 2. The criteria for a compensable rating for right ear hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100. 3. The criteria for a disability rating of 20 percent and no higher for left ankle strain have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5271. 4. The criteria for a disability rating in excess of 10 percent for left hand ulnar neuropathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.124a, DC 8516. 5. The criteria for service connection for left wrist disability are not met. 38 U.S.C. §§ 1101, 1112, 1113, 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a). 6. The criteria for service connection for right eardrum partial perforation are not met. 38 U.S.C. §§ 1101, 1112, 1113, 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for right hand disability are not met. 38 U.S.C. §§ 1101, 1112, 1113, 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a). 8. The criteria for service connection for vertigo are not met. 38 U.S.C. §§ 1101, 1112, 1113, 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who had active service from June 2002 to June 2006 in the Marine Corps and from July 2006 to February 2018 in the Army, appeals a January 2018 rating decision. The DD-214 is of record. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity resulting from disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for the higher evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as “staged” ratings.” Fenderson v. West, 12 Vet. App. 119, 126-127 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). When assessing the severity of a musculoskeletal disability that is at least partly rated on the basis of limitation of motion, VA must also consider the extent that the Veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when his symptoms are most prevalent (“flare-ups”) due to the extent of his pain (and painful motion), weakness, premature or excess fatigability, and incoordination-assuming these factors are not already contemplated by the governing rating criteria. DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995); see also 38 C.F.R. §§ 4.40, 4.45, 4.59. 1. PTSD The Veteran seeks a rating in excess of 50 percent for PTSD, arguing his symptoms include obsessional rituals which warrant a 70 percent rating. He notes he is unable to participate in and enjoy most activities due to irrational, compulsive and obsessive impulses since his deployment that resulted in PTSD. The Board agrees that the Veteran’s PTSD warrants a rating of 70 percent. However, the preponderance of the evidence is against finding that the criteria for a rating in excess of 70 percent are met any time relevant to the claim. PTSD is rated under Diagnostic Code 9411 using the General Rating Formula for Mental Disorders (General Formula). 38 C.F.R. § 4.130. A 70 percent disability rating, warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. VA examination for PTSD in January 2018 includes the examiner’s assessment that PTSD caused occupational and social impairment with reduced reliability and productivity which is the criteria for a 50 percent rating. Occupational and social impairment with deficiencies in most areas, and total occupational and social impairment, were found not present. Notably absent symptoms included inability to establish and maintain effective relationships, suicidal ideation, obsessional rituals which interfere with routine activities, impaired impulse control, such as unprovoked irritability with periods of violence, spatial disorientation, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, neglect of personal appearance and hygiene, intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene or disorientation to time or place. Other symptoms present included hypervigilance reported, appetite high and history of comfort eating, avoidance, intrusions, nightmares and night sweats. An April 2020 Disability Benefits Questionnaire (DBQ) from non-VA psychologist Wende J. Anderson, Psy.D., reflects that the Veteran indeed does manifest the aforementioned criteria for a 70 percent rating to include obsessional rituals and impaired impulse control. Dr. Anderson found deficiencies in most areas but not total occupational and social impairment. She noted that he reported attempting suicide twice via medication during his second deployment in Iraq but that he had not attempted suicide since. She observed he had had suicidal thoughts and thoughts of death and homicide but had not thought of suicide since 2017. Current homicidal or suicidal ideation was denied. She concluded that the Veteran did not meet the criteria for involuntary hospitalization. Significantly, she had observed earlier in the exam that he did not present a persistent danger of hurting self or others. She referenced his history, noting occupational difficulties that began in the Army (his second period of service) and reportedly lead to General Discharge Under Honorable Conditions based on misconduct. Road rage, gesturing, aggressive driving and inability to get along with coworkers and subordinates were reported. There is sufficient evidence to conclude that PTSD resulted in deficiencies in most areas at all times relevant to the claim. A 70 percent rating is granted. As to a higher rating, a 100 percent rating is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The "such symptoms as" language means "for example," and does not represent an exhaustive list of symptoms that must be found before granting the rating of that category. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). The list of examples provides guidance as to the severity of symptoms contemplated for each rating. Id. However, this fact does not make the provided list of symptoms irrelevant. See Vasquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). The Veteran must still demonstrate either the particular symptoms associated with the rating sought, or other symptoms of similar severity, frequency, and duration. Id. at 117. The criteria for a rating in excess of 70 percent are not met or approximated at any time. Neither of the mental health examiners find total occupational and social impairment. Rather, they specifically note total occupational and social impairment is not present. Neither the examination nor the treatment record indicates gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. In fact, a June 2019 PTSD medication follow-up indicates his medication adjustment is helping. He had been on a cruise to Mexico with family, was taking online college courses and enjoying family time to include watching the Celtics, Patriots and Bruins, as well as hiking and eating healthy. While impairment is indeed demonstrated, total occupational and social impairment due to PTSD has not been shown or approximated. The Board assigns significant probative weight to the 2018 VA and the 2020 non-VA assessments of the well-informed mental health providers on this matter, as they are in agreement and are made by trained professionals. Simply put, none of the mental health opinions of record reflect that the Veteran has manifested the symptoms associated with total occupational and social impairment defined above. The Veteran’s assertions to the contrary have been weighed and appreciated but the issue of the degree of mental health impairment is medically complex. Because of this, the Board concludes that the medical opinions are more probative as to degree of impairment and symptoms. Based on a careful review of all the evidence, the Board finds that during the entirety of the pendency of the claim, a rating for PTSD in excess of 70 percent is not warranted. The Board has considered all psychiatric symptoms in reaching the above conclusions. See Mittleider v. West, 11 Vet. App. 181, 182 (1998). In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence such claim in excess of 70 percent. Therefore, the benefit of the doubt doctrine is not applicable in the instant appeal, and his claim must be denied. 38 C.F.R. §§ 4.3, 4.7. 2. Right ear hearing loss The Veteran seeks a compensable rating for right ear hearing loss, urging he has difficulty hearing on the right side. The rating criteria for hearing loss are set forth under 38 C.F.R. § 4.85, Diagnostic Code 6100. In evaluating service-connected hearing loss, disability ratings are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are performed. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Regulations specify that an examination for hearing impairment for VA purposes must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test. 38 C.F.R. § 4.85. Evaluations of bilateral hearing loss range from noncompensable to 100 percent based on an organic impairment of hearing acuity, as measured by controlled speech discrimination tests in conjunction with the average hearing threshold, as measured by puretone audiometric tests in the frequencies of 1000, 2000, 3000 and 4000 cycles per second. The rating schedule establishes 11 auditory acuity Levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. VA audiological evaluations are conducted using a controlled speech discrimination test together with the results of puretone audiometry tests. The vertical line in Table VI (printed in 38 C.F.R. § 4.85) represents nine categories of the percentage of discrimination based on a controlled speech discrimination test. The horizontal columns in Table VI represent nine categories of decibel loss based on the puretone audiometry test. The numeric designation of impaired hearing (Levels I through XI) is determined for each ear by intersecting the vertical row appropriate for the percentage of discrimination and the horizontal column appropriate to the puretone decibel loss. The percentage evaluation is found from Table VII (in 38 C.F.R. § 4.85 and the statement of the case) by intersecting the vertical column appropriate for the numeric designation for the ear having the better hearing acuity and the horizontal row appropriate for the numeric designation for the level for the ear having the poorer hearing acuity. For example, if the better ear had a numeric designation of Level "V" and the poorer ear had a numeric designation of Level "VII" the percentage evaluation is 30 percent. See 38 C. F. R. § 4.85. If impaired hearing is service-connected in only one ear, in order to determine the percentage evaluation from Table VII, the non-service-connected ear will be assigned a Roman Numeral designation for hearing impairment of I. Id. Regulations also provide that in cases of exceptional hearing loss, i.e., when the puretone threshold at each of the four specified frequencies (1,000, 2,000, 3,000 and 4,000 hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86 (a). The provisions of 38 C.F.R. § 4.86 (b) further provide that when the puretone threshold is 30 decibels or less at 1,000 hertz and 70 decibels or more at 2,000, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or VIa, whichever results in the higher numeral. That numeral will then be evaluated to the next higher Roman numeral. The Veteran does not demonstrate an exceptional hearing loss pattern. The Veteran received a VA audiological examination in January 2018. The results were as follows: HERTZ 1000, 2000, 3000, 4000, Average RIGHT 30, 20, 30, 30, 27.5 Speech recognition was 96 percent, as measured by the Maryland CNC test. Puretone testing was deemed valid and CNC testing was deemed appropriate. These results correspond to a Level I for the right ear. As the left ear is not service-connected, it is assigned a Level I. Combined, these results correspond to a 0 percent rating. There are no medical records that are inconsistent with this current level of hearing. Accordingly, the Board finds that the Veteran's right ear hearing loss does not warrant a compensable rating. The assignment of disability ratings for hearing impairment are derived by a mechanical application of the numeric designations assigned after audiometric evaluations are rendered. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The Veteran is competent to report that he has difficulty hearing on the right side and his statements are generally reasonable. That fact is recognized by the grant of service connection. However, the Veteran's lay opinion as to the extent of the disability is far less probative than the results of the objective examinations prepared by skilled professionals. Furthermore, the only basis to assign a rating based upon hearing loss is the result of the objective testing. The preponderance of the evidence is against a compensable rating for the Veteran's right ear hearing loss. As such, the benefit-of-the-doubt doctrine is inapplicable. For these reasons, the benefit sought on appeal is denied. 3. Left ankle strain The Veteran seeks an increased rating for this disability, rated 10 percent disabling under DC 5271 for moderate limited motion of the ankle under the Schedule of Ratings – musculoskeletal system. 38 C.F.R. §§ 4.71a. The question for the Board is whether he meets or approximates the criteria for a higher rating for the left ankle. The Board finds that the evidence is evenly balanced as to whether he indeed does approximate the criteria for a 20 percent rating, for the following reasons. Under DC 5271, a 20 percent evaluation is warranted for marked limitation of motion of the ankle. Under DC 5270, ankylosis of the ankle in plantar flexion, less than 30 degrees, also warrants a 20 percent rating. A 30 percent evaluation is warranted for ankylosis in plantar flexion, between 30 and 40, or in dorsiflexion, between 0 and 10 degrees. 38 C.F.R. § 4.71a. VA left ankle examination in January 2018 reflects that the current condition is chronic left ankle pain from surgery. There is no ankylosis of the left ankle. Dorsiflexion was initially 0 to 15 out of 20 degrees and plantar flexion was 0 to 40 out of 45 degrees. Range of motion itself does not contribute to a functional loss but pain was noted to cause functional loss. There was pain with weight bearing. Pain and lack of endurance reduced range of motion after 3 repetitions to plantar flexion 0-35, dorsiflexion 0 to 10. The Veteran reported flare-ups described as pain and stiffness making it difficult to walk or run for prolong periods of time. The examiner stated pain and lack of endurance during flare-ups reduced range of motion to plantar flexion 0-25, dorsiflexion 0 to 5. He assessed the impact on the ability to work as ankle stiffness, pain, difficulty with prolong walking or climbing stairs. The VA treatment records dated during the appeal period do not show significant treatment for the left ankle. A March 2020 evaluation from non-VA chiropractor Dr. Robert Amis, Jr., Diagnostic Consultant, reflects dorsiflexion to 5 degrees and plantar flexion to 25 degrees. He stated his examination was consistent with ankle instability and dysfunction. Dr. Amis indicated he examined and interviewed the Veteran but did not indicate he reviewed the record. The Board finds that the 2018 VA ankle examination shows that the Veteran’s ankle disability approximates the criteria for a 20 percent rating under DC 5271 when consideration is given to the impact of his flare-ups. The Veteran’s description of pain and limited motion, combined with the assessment of the VA examiner, is sufficient to support a finding of marked limitation of the ankle. No higher rating is warranted; the examiner specifically found no ankylosis. The Board finds the examiner’s assessment to be highly probative as to the degree of disability. It is consistent with the treatment record and was made based in part on the Veteran’s descriptions of symptoms and flare-ups. A 20 percent rating and no higher adequately represents any functional impairment attributable to the disability. See 38 C.F.R. §§ 4.41, 4.10. The criteria for the 20 percent rating are approximated throughout the appeal period when all the evidence is considered. See 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability has been resolved in the Veteran’s favor. See 38 C.F.R. § 4.3. 4. Left hand ulnar neuropathy The Veteran seeks an increased rating for this disability, rated 10 percent disabling under DC 8516 for mild incomplete paralysis of the minor arm ulnar nerve under the Schedule of Ratings – Diseases of the peripheral nerves. 38 C.F.R. § 4.124a. He states the rating should be 20 percent because there were two separate injuries 7 years apart. Ratings under DC 8516 for the ulnar nerve include a 30 percent rating for major and a 20 percent rating for minor moderate incomplete paralysis; a 40 percent rating for the major arm and a 30 percent rating for the minor arm when there is severe incomplete paralysis and a 60 percent rating for the major arm and a 50 percent rating for the minor arm when there is complete paralysis. Complete paralysis of this nerve is demonstrated by the griffin claw deformity, due to flexor contraction of ring and little fingers, atrophy very marked in dorsal interspace and thenar and hypothenar eminences; loss of extension of ring and little fingers cannot spread the fingers (or reverse), cannot adduct the thumb; flexion of wrist weakened. The record reflects that the Veteran is right-handed and that the nerve involved is the ulnar nerve. See, e.g., January 2018 VA peripheral nerves DBQ. The question for the Board is whether he meets or approximates the criteria for a higher rating for the left hand ulnar neuropathy. The Board finds that the preponderance of the evidence is against so finding, for the following reasons. Historically, there was left hand ulnar nerve damage, also claimed as left hand 3rd digit numbness and disfigurement, related to service. As noted by the VA examiner in January 2018, the date of onset of the symptoms is 2005, reportedly after injury during service. At the January 2018 VA examination, the following was noted: mild left upper extremity intermittent pain, paresthesias and/or dysesthesias and numbness. Reflexes were normal. Sensory was decreased as to the left upper extremity hand and fingers at the C6-8 distribution. Muscle strength testing was all normal. There was no muscle atrophy. There were no trophic changes. The examiner found there was mild incomplete paralysis of the left ulnar nerve. The impact of this peripheral neuropathy on the claimant's ability to work was weakened movement of the finger especially during repetitive typing or using hand tools. Inasmuch as the Veteran reported there was left hand 3rd digit numbness and disfigurement, there was no diagnosis because there was no pathology to render a diagnosis. The report from Dr. Amis indicates that the Veteran injured his left hand in 2009 while in Iraq. He noted left hand pain and assessed a grip strength on the left of ‘43 ft. lbs: 62% functional deficit’. The Board has considered the guidance established in sections 4.120, 4.123, and 4.124. We also note the report of decreased grip strength. However, the VA examiner established that strength was normal, except for a finger. Sensation was decreased, but there was no atrophy or trophic changes. Here, the Veteran's consistent complaints support not more than sustained mild incomplete paralysis of the left ulnar nerve. Neither the treatment record nor Dr. Amis’ report suggests a higher degree of incomplete paralysis. There is no competent support for a higher rating for this disability. The VA examination reflects the assessment of mild incomplete paralysis as to the ulnar nerve, as specifically opposed to moderate or severe incomplete or complete paralysis. We conclude that the assessed functional impact is commensurate with what would be expected of mild incomplete paralysis of this nerve. In sum, the primary disability is sensory with minimal change in strength of a finger. Overall, the impairment is no more than mild. The findings do not exceed the criteria for mild incomplete paralysis and they in no way approximate a higher rating. We find that the observations of the skilled VA examiner in January 2018, who assessed mild incomplete paralysis, are far more probative and more credible as to the degree of disability than the lay evidence, to the extent that the Veteran vaguely argues there is a higher level of impairment than that representative of mild incomplete paralysis. In conclusion, a rating in excess of 10 percent for left hand ulnar neuropathy is denied. Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service or for aggravation of a preexisting injury suffered or disease contracted in line of duty. 38 U.S.C. §§ 1110, 1131. In general, 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. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). 5. Left wrist disability 6. Right eardrum partial perforation 7. Right hand disability 8. Vertigo The Veteran contends that he has these conditions due to service. He claims (1) there is left wrist disability separate and apart from ulnar nerve disability (2) he partially perforated his right eardrum in Iraq in March 2007 and still has injury, (3) he injured his right hand at Cherry Point in 2005 and still has injury, and (4) he has vertigo as a result of injury in Iraq in 2007. The issue for the Board is whether the Veteran has, or had at anytime during the period of his claim, left wrist or right hand disability, right eardrum partial perforation or vertigo that began during service or is at least as likely as not related to service. The Board concludes that the Veteran does not have any of these disabilities and did not have them at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The preponderance of the evidence is against a finding of current disability as to left wrist or right hand disability, right eardrum partial perforation or vertigo. Significantly, the Veteran was afforded VA examination in January 2018 as to each of these claims and each VA examiner who reviewed the claims folder and medical records, examined and interviewed the Veteran, found no current disability as to the disability at issue. First, as to left wrist, the VA wrist conditions DBQ reflects there is no diagnosis because there is no pathology to render a diagnosis as to the left wrist. All findings and ranges of motion were normal. The examiner declined to check off any potential diagnoses related to the wrist as being present. No pain was noted on the exam. The only positive finding was that the Veteran reported flare ups of the left wrist can be described as pain and stiffness with difficulty holding heavy items. Parenthetically, it is noted that in the left hand peripheral nerves exam, the examined stated inasmuch as the Veteran reported there was left hand 3rd digit numbness and disfigurement, there was no diagnosis because there was no pathology to render a diagnosis. Second, as to the right hand, the VA hand and finger conditions DBQ reflects there is no diagnosis because there is no pathology to render a diagnosis as to the right hand. All findings and ranges of motion were normal. The examiner declined to check off any potential diagnoses related to the right hand as being present. No pain was noted on the exam. The only positive finding was that the Veteran reported flare ups of the right hand that can be described as pain and stiffness with difficulty grabbing items. Here, we find the medical findings are far more probative as to whether there is disability. We find that there is no disability and in the absence of disabili8ty there can be no valid claim, whether considered under sections 1110, 1131 or 1117. All laws require the presence of disability. Third and fourth, as to right eardrum and vertigo, the VA ear conditions DBQ (including vestibular and infections conditions) reflects there is no diagnosis as to the ear or peripheral vestibular condition. The examiner acknowledged the Veteran’s date of onset of symptoms for these conditions as in service in 2007, and noted that dizziness began at that time and has reportedly remained. The examination was normal in every respect, however. The examiner found no diagnosis as to either the right eardrum/tympanic membrane or vertigo, because there was no pathology to render a diagnosis. All findings were recorded as normal and the examiner declined to check off any potential diagnoses. Dr. Amis includes a diagnosis of left wrist pain and dysfunction and right hand pain more likely than not related to service in his report. The treatment record does not show any diagnosed left wrist disorder, right hand disorder, right eardrum disorder or vertigo. The January 2018 VA examiners’ opinions that there is no current disability as to each of these conditions is based on a review of the medical record, all the evidence, and the examiner’s expertise. The VA opinions are well-supported and acknowledge the Veteran’s theories as to symptom onset in service. The 2018 VA opinions are thus highly probative. While the Veteran is competent to assert what his perceptions of his conditions are, such an assertion is of minimal probative weight in determining whether there is current disability in view of the VA examiner’s well-supported opinion to the contrary. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the Board considers evidence to be more probative if it includes clear conclusions and supporting data with a reasoned analysis connecting the data and conclusions). Thus, the Board finds the 2018 VA examiners’ conclusions more probative than the Veteran’s lay statements as to current disability. The Board adopts the 2018 VA opinions for their reasons and bases, noting that the examiner has fairly considered the material evidence of record. Wray v. Brown, 7 Vet. App. 488 (1995). Furthermore, the Board finds the VA opinions more probative as to the issue of current disability than the opinion of Dr. Amis as to the left wrist and right hand. Here, the VA examiner performed a detailed review of the record, made a systematic review of the potential positive findings and found that there were no identifiable manifestations to support a finding of current disability as to either the left wrist or right hand. Due to the absence of competent proof of a present disability due to disease or residual of injury as to these claims, there is no valid claim for service connection. Congress has specifically limited entitlement to service connection to cases where such incidents have resulted in a disability at any point during the claim or appeal period. Brammer v. Derwinski, 3 Vet. App. 223 (1992). The existence of disability due to disease or injury is not subject to lay observation. It requires knowledge of complicated diagnostic medical testing. Although he is competent to report his perceived symptoms, the Veteran as a lay person was not competent to diagnose these conditions because this requires medical expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Furthermore, there are no Jandreau type exceptions in this case. Hence, the opinion of the Veteran is not competent in this case. The preponderance of the   evidence is against a finding of current disability as to each of these claims, the benefit-of-the-doubt doctrine does not apply, and the claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Since he served in the Gulf, we have considered the Gulf War law and regulations. However, the VA examinations were normal. A normal examination is inconsistent with a finding of disability (impairment) whether un-diagnosed or diagnosed. The statement of Dr. Amis fails to establish actual disability and is not credible. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. RIPPEL 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.