Citation Nr: 20048065 Decision Date: 07/17/20 Archive Date: 07/17/20 DOCKET NO. 20-20 537 DATE: July 17, 2020 ORDER New and material evidence having not been received, the claim of entitlement to service connection for an acquired psychiatric disability, claimed as posttraumatic stress disorder (PTSD) and depression, is denied. New and material evidence not having been received, the claim of entitlement to service connection for pancreatitis is not considered reopened and is denied. New and material evidence not having been received, the claim of entitlement to service for right ear hearing loss is not considered reopened and is denied. New and material evidence not having been received, the claim of entitlement to service for left ear hearing loss is not considered reopened and is denied. New and material evidence not having been received, entitlement to service connection for a right eye disability, claimed as cataracts, is not considered reopened and is denied. New and material evidence not having been received, entitlement to service connection for a left eye disability, claimed as cataracts, is not considered reopened and is denied. Entitlement to service connection for prostate cancer, to include as a result of radiation exposure, is denied. Entitlement to service connection for a bowel disability, to include as a result of radiation exposure, is denied. Entitlement to service connection for a gall bladder disability, to include as a result of radiation exposure, is denied. Entitlement to service connection for a bladder disability, to include as a result of radiation exposure, is denied. Entitlement to service connection for sleep apnea is denied. Entitlement to service connection for soft tissue sarcoma, claimed as skin lesions, is denied. Entitlement to service connection for a deviated septum caused by a broken nose is denied. Entitlement to service connection for a sinus disability is denied. Entitlement to a compensable disability rating for a scar from laceration on the right side of his chin is denied. REMANDED Entitlement to service connection for sterility is remanded. FINDINGS OF FACT 1. A March 2016 rating decision denied entitlement to service connection for an acquired psychiatric disability, a disability of the pancreas, bilateral hearing loss, and a bilateral eye disability; the Veteran did not file a timely notice of disagreement regarding that decision and no new and material evidence was submitted to VA within the applicable time period. 2. Evidence that relates to an unestablished fact necessary to substantiate the claim and that raises a reasonable possibility of substantiating the claims of service connection for an acquired psychiatric disability, a disability of the pancreas, bilateral hearing loss, and a bilateral eye disability has not been received since the March 2016 rating decision, and as such, the claims of entitlement to service connection for an acquired psychiatric disability, a disability of the pancreas, right ear hearing loss, left ear hearing loss, a right eye disability, and a left eye disability are not considered reopened. 3. The preponderance of the evidence is against finding that prostate cancer began during active service, manifested within five years of service or is otherwise related to an in-service event, injury, or disease, to include as a result of radiation exposure. 4. The preponderance of the evidence of record is against finding that the Veteran has had a bowel 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 a gall bladder disability 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 a bladder disability at any time during or approximate to the pendency of the claim. 7. The preponderance of the evidence is against finding that the Veteran has sleep apnea that began during active service or is otherwise related to an in-service event, injury, or disease. 8. The preponderance of the evidence of record is against finding that the Veteran has had a soft tissue sarcoma, claimed as a skin lesion, at any time during or approximate to the pendency of the claim. 9. The preponderance of the evidence of record is against finding that the Veteran has had a deviated septum at any time during or approximate to the pendency of the claim. 10. The preponderance of the evidence of record is against finding that the Veteran has had a sinus disability at any time during or approximate to the pendency of the claim. 11. The Veteran’s chin scar did not manifest with at least one characteristic of disfigurement. CONCLUSIONS OF LAW 1. The March 2016 rating decision is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.156, 20.302, 20.1103. 2. New and material evidence has not been received since the March 2016 denial of entitlement to service connection for an acquired psychiatric disability; therefore, the claim of entitlement to service connection for an acquired psychiatric disability is not considered reopened. 38 U.S.C. §§ 1131, 5103, 5108; 38 C.F.R. §§ 3.156, 3.303. 3. New and material evidence has not been received since the March 2016 denial of entitlement to service connection for pancreatitis; therefore, the claim of entitlement to service connection for pancreatitis is not considered reopened. 38 U.S.C. §§ 1131, 5103, 5108; 38 C.F.R. §§ 3.156, 3.303. 4. New and material evidence has not been received since the March 2016 denial of entitlement to service connection for hearing loss; therefore, the claim of entitlement to service connection for right ear hearing loss is not considered reopened. 38 U.S.C. §§ 1131, 5103, 5108; 38 C.F.R. §§ 3.156, 3.303. 5. New and material evidence has not been received since the March 2016 denial of entitlement to service connection for hearing loss; therefore, the claim of entitlement to service connection for left ear hearing loss is not considered reopened. 38 U.S.C. §§ 1131, 5103, 5108; 38 C.F.R. §§ 3.156, 3.303. 6. New and material evidence has not been received since the March 2016 denial of entitlement to service connection for an eye disability; therefore, the claim of entitlement to service connection for a right eye disability is not considered reopened. 38 U.S.C. §§ 1131, 5103, 5108; 38 C.F.R. §§ 3.156, 3.303. 7. New and material evidence has not been received since the March 2016 denial of entitlement to service connection for an eye disability; therefore, the claim of entitlement to service connection for a left eye disability is not considered reopened. 38 U.S.C. §§ 1131, 5103, 5108; 38 C.F.R. §§ 3.156, 3.303. 8. The criteria for service connection for prostate cancer have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.311. 9. The criteria for service connection for a bowel disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.311. 10. The criteria for service connection for a gall bladder disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.311. 11. The criteria for service connection for a bladder disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.311. 12. The criteria for service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 13. The criteria for service connection for soft tissue sarcoma claimed as skin lesions have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 14. The criteria for service connection for a deviated septum have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 15. The criteria for service connection for a sinus disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 16. The criteria for a compensable disability rating for a scar from laceration on the right side of his chin have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7800. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from October 1960 to October 1962 in the United States Army. The Board notes that additional VA treatment records were associated with the claims file in June 2020 without waiver of adjudication by the Agency of Original Jurisdiction. However, the Board additionally notes that the records up to April 2020 were considered in the April 2020 statement of the case and there are no records dated post-April which are new and relevant and require waiver. Thus, the Board will proceed with adjudication. New and Material Evidence Generally, if a claim of entitlement to service connection has been previously denied and that decision became final, the claim can be reopened and reconsidered only if new and material evidence is presented with respect to that claim. 38 U.S.C. § 5108 (West 2014). “New” evidence is defined as existing evidence not previously submitted to agency decisionmakers. “Material” evidence means evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative, nor redundant of the evidence previously of record, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). The threshold to reopen a claim is low. Shade v. Shinseki, 24 Vet. App. 110 (2010). For the purpose of establishing whether new and material evidence has been received, the credibility of the evidence, but not its weight, is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). In a March 2016 rating decision, the RO denied service connection for an eye disability, hearing loss, a psychiatric disability, prostate cancer, and a pancreas disability. The Veteran did not file a notice of disagreement regarding the March 2016 rating decision. Therefore, that decision became final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.156, 20.302, 20.1103. The Veteran also did not submit any information or evidence within one year of the March 2016 rating decision to render the decision non-final for VA purposes. See 38 C.F.R. § 3.156(b) (2016); see also Buie v. Shinseki, 24 Vet. App. 242, 251-52 (2011) (holding that when statements are received within one year of the rating decision, the Board’s inquiry is not limited to whether the statements constitute notices of disagreement, but whether they include the submission of new and material evidence under 38 C.F.R. § 3.156(b). 1. New and material evidence having not been received, the claim of entitlement to service connection for an acquired psychiatric disability, claimed as PTSD and depression. The March 2016 rating decision denied entitlement to service connection for an acquired psychiatric disability as the evidence did not show an in-service event, disease, or injury, service treatment records did not show complaint, treatment or diagnosis of a psychiatric disability, and no current disability was clinically diagnosed. Evidence received since the rating decision in March 2016 includes VA treatment records. The evidence was not of record at the time of the prior denials and is therefore new evidence, but the Board finds that the evidence is not considered material. The evidence shows no current symptoms, complaints, diagnosis, or treatment of a psychiatric disability. The Veteran had a negative screening for PTSD again in May 2016 and a negative screening for depression in November 2016. Therefore, such evidence is new, but not material, and the claim for service connection for an acquired psychiatric disability is not considered reopened. 2. New and material evidence not having been received, the claim of entitlement to service connection for pancreatitis is not considered reopened. The March 2016 rating decision denied entitlement to service connection for a pancreatic disability due to the lack of event, disease, or injury during service, the lack of complaints, treatment or diagnosis during service, and a lack of a link between the asserted medical condition and his active service. Evidence received since the rating decision in March 2016 includes VA treatment records. The evidence was not of record at the time of the prior denials and is therefore new evidence, but the Board finds that the evidence is not considered material. The evidence shows no current symptoms, complaints, diagnosis, or treatment of a disability of the pancreas and no new evidence relating a pancreatic disability to the Veteran’s active service. Therefore, such evidence is new, but not material, and the claim for service connection for a pancreatic disability is not considered reopened. 3. New and material evidence not having been received, the claim of entitlement to service for right ear hearing loss is not considered reopened. The March 2016 rating decision denied entitlement to service connection for hearing loss due to the lack of complaints, treatment or diagnosis during service, and a lack of a link between the asserted medical condition and his active service. Evidence received since the rating decision in March 2016 includes VA treatment records. The evidence was not of record at the time of the prior denials and is therefore new evidence, but the Board finds that the evidence is not considered material. The evidence shows no new evidence relating any current hearing loss to the Veteran’s active service. Therefore, such evidence is new, but not material, and the claim for service connection for right ear hearing loss is not considered reopened. 4. New and material evidence not having been received, the claim of entitlement to service for left ear hearing loss is not considered reopened. The March 2016 rating decision denied entitlement to service connection for hearing loss due to the lack of complaints, treatment or diagnosis during service, and a lack of a link between the asserted medical condition and his active service. Evidence received since the rating decision in March 2016 includes VA treatment records. The evidence was not of record at the time of the prior denials and is therefore new evidence, but the Board finds that the evidence is not considered material. The evidence shows no new evidence relating any current hearing loss to the Veteran’s active service. Therefore, such evidence is new, but not material, and the claim for service connection for left ear hearing loss is not considered reopened. 5. New and material evidence not having been received, entitlement to service connection for a right eye disability, claimed as cataracts, is not considered reopened. The March 2016 rating decision denied entitlement to service connection for a bilateral eye disability due to the lack of complaints, treatment or diagnosis during service, and a lack of a link between the asserted medical condition and his active service. Evidence received since the rating decision in March 2016 includes VA treatment records. The evidence was not of record at the time of the prior denials and is therefore new evidence, but the Board finds that the evidence is not considered material. The evidence shows no new evidence relating any current eye disability to the Veteran’s active service. Therefore, such evidence is new, but not material, and the claim for service connection for a right eye disability is not considered reopened. 6. New and material evidence not having been received, entitlement to service connection for a left eye disability, claimed as cataracts, is not considered reopened The March 2016 rating decision denied entitlement to service connection for a bilateral eye disability due to the lack of complaints, treatment or diagnosis during service, and a lack of a link between the asserted medical condition and his active service. Evidence received since the rating decision in March 2016 includes VA treatment records. The evidence was not of record at the time of the prior denials and is therefore new evidence, but the Board finds that the evidence is not considered material. The evidence shows no new evidence relating any current eye disability to the Veteran’s active service. Therefore, such evidence is new, but not material, and the claim for service connection for a left eye disability is not considered reopened. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a chronic condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed.Cir.2013) (holding that only conditions listed as chronic diseases in 38 C.F.R. § 3.309(a) may be considered for service connection under 38 C.F.R. § 3.303(b)). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Additionally, disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. The Board also notes that secondary service connection on the basis of aggravation is permitted under 38 C.F.R. § 3.310, and compensation is payable for that degree of aggravation of a nonservice-connected disability caused by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995); 38 C.F.R. § 3.310(b). In order to establish entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) competent evidence establishing a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Certain specified disabilities becoming manifest in a “radiation-exposed veteran” shall be service connected. See 38 U.S.C. § 1112 (c)(1), (2); 38 C.F.R. § 3.309 (d)(1), (2). The term “radiation-exposed veteran” means a veteran who participated in a “radiation-risk activity.” See 38 U.S.C. § 1112 (c)(3)(A); 38 C.F.R. § 3.309 (d)(3)(i). The Veteran is a “radiation-exposed veteran. “ The provisions of 38 C.F.R. § 3.311 (b)(2)(vii) define “radiogenic disease” as a disease that may be induced by ionizing radiation. In all claims in which it is established that a radiogenic disease first became manifest after service and was not manifest to a compensable degree within any applicable presumptive period as specified in 38 C.F.R. §§ 3.307, 3.309, and it is contended that the disease is a result of exposure to ionizing radiation in service, an assessment will be made as to the size and nature of the radiation dose or doses. 38 C.F.R. § 3.311 (a)(1). Dose data will be requested from the Department of Defense in claims based on participation in atmospheric nuclear testing. 38 C.F.R. § 3.311 (a)(2)(i)(ii). Section 3.311(b) provides for referral of claims for service connection for a disability due to exposure to ionizing radiation to the Under Secretary for Benefits when a veteran was exposed to ionizing radiation as a result of participation in atmospheric testing of nuclear weapons, the occupation of Hiroshima or Nagasaki, or other activities as claimed, and he subsequently develops a radiogenic disease within a specified time. Id. Prostate cancer, skin cancer, and any other cancer are all considered “radiogenic diseases” under 38 C.F.R. § 3.311(b)(2)(i). Service connection for conditions claimed to be due to exposure to ionizing radiation in service can be established in any of three different ways. See Davis v. Brown, 10 Vet. App. 209, 211 (1997); Rucker v. Brown, 10 Vet. App. 67, 71 (1997). First, prostate cancer is an enumerated radiogenic disease. 38 C.F.R. § 3.311 (b)(2)(xxiii). Prostate cancer, as one of the “other diseases” specified in paragraph (b)(2), must become manifest 5 years or more after exposure. 38 C.F.R. § 3.311 (b)(5)(iv). Second, service connection may be established under 38 C.F.R. § 3.303 (d) with the assistance of the procedural advantages found in 38 C.F.R. § 3.311 if the condition at issue is a “radiogenic disease,” and other conditions specified by regulation are met, such as an evidentiary showing of exposure to ionizing radiation. See 38 C.F.R. § 3.311 (b)(2), (4). Third, direct service connection may be established under 38 C.F.R. § 3.303 (d) by showing that the disease began during or was aggravated by service without regard to the statutory presumptions. Combee v Brown, 34 F.3d 1039 (Fed Cir 1994). The Board has reviewed all the evidence in the record. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate each claim and what the evidence in the claims file shows, or fails to show, with respect to each claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for prostate cancer, to include as a result of radiation exposure. The Veteran contends that he has prostate cancer that is causally related to his exposure to ionizing radiation during service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board 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. The Board concludes that, while the Veteran has a current diagnosis of prostate cancer, and evidence shows that he was participated in Operation Dominic I conducted at the Nevada Test Site in 1962, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of prostate cancer began during service or is otherwise related to an in-service injury, event, or disease. In January 2017, an administrative decision noted no reasonable possibility that the Veteran’s prostate cancer resulted from radiation exposure during service. Medical records confirmed diagnosis of adenocarcinoma of the prostate. The record showed no evidence of diagnosis of prostate cancer during military service and the medical evidence confirms the diagnosis was more than one year following discharge from active duty. The Defense Threat Reduction Agency confirmed in January 2017 that the Veteran participated in Operation Dominic I conducted at the Nevada Test Site in 1962. As a participant, the Veteran could have received no more than external gamma dose 16 rem; external neutron dose 0.5 rem; internal committed dose to the prostate (alpha) 0 rem; internal committed dose to the prostate (beta plus gamma) 1 rem. A memorandum dated December 21, 2006, from the Chief Public Health and Environmental Hazards Officer provided instructions for expedited methodology processing using worst-case dose assessment. The adjusted total prostate dose for Nevada Test Site participants is 19 rems. The adjusted total prostate dose is less than the applicable screening doses; therefore, it was unlikely that the prostate cancer resulted from exposure to ionizing radiation in service. The administrative decision is probative, because it is based on an accurate history and provided an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board acknowledges that the record contains a private nexus opinion dated in July 2017. The examiner noted that the Veteran was exposed to ionizing radiation while in military service. He was exposed to an atmospheric test carried out by the United States Army and was exposed adequately to attempt. This occurred in 1952. The private examiner noted the time between the exposure and the diagnosis of his prostate cancer, which was 54 years. It is likely, however, that the exposure to ionizing radiation may not have played a role in the genesis of his adenocarcinoma of the prostate; however there has to be a high index of suspicion that the radiation exposure, especially the ingestion or transcutaneous absorption of radioactive isomers and fat soluble radioactive organic molecules may have been deposited in the prostate thus contaminating the organ. In the private examiner’s opinion, he specifically found that it was likely that it may not have played a role in the genesis of his adenocarcinoma of the prostate. The Board notes that this is a negative nexus opinion. The Board also finds that the use of the phrase “may have been” regarding the absorption of radioactive isomers and fat soluble radioactive organic molecules in the prostate is so tentative, by its own terms, so as to be of very little probative value. The Court has previously held that an opinion that the use of terms such as “may have been” does not provide the degree of certainty required for medical nexus evidence. See Bloom v. West, 12 Vet. App. 185, 187 (1999); See also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006) (finding doctor’s opinion that “it is possible” and “it is within the realm of medical possibility” too speculative to establish medical nexus); Goss v. Brown, 9 Vet. App. 109, 114 (1996) (using the word “could not rule out” was too speculative to establish medical nexus); Warren v. Brown, 6 Vet. App. 4, 6 (1993) (medical opinion expressed only in terms such as “could have been” is not sufficient to reopen a claim of service connection); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992) (medical opinion framed in terms of “may or may not” is speculative and insufficient to support an award of service connection for the cause of death); Obert v. Brown, 5 Vet. App. 30, 33 (1993) (physician’s statement that the Veteran “may have been having some symptoms of his multiple sclerosis for many years prior to the date of diagnosis” was insufficient to award service connection); Beausoleil v. Brown, 8 Vet. App. 459, 463 (1996) (a generic statement about the possibility of a link between chest trauma and restrictive lung disease was “too general and inconclusive” to support an award of service connection). The Veteran believes his prostate cancer is related to his exposure to ionizing radiation during service. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of pathology and the interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the evidence noted above. Based on the evidence cited above, the Board finds that the preponderance of the evidence is against the claim of service connection for prostate cancer. As the preponderance of the evidence is against the claim for service connection for prostate cancer, the benefit of the doubt rule does not apply. 38 C.F.R. § 5107; 38 C.F.R. § 3.102. 2. Entitlement to service connection for a bowel disability, to include as a result of radiation exposure. The Veteran contends that he has a bowel disability that is causally related to his active service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board 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. The Board concludes that the Veteran does not have a current diagnosis of a bowel disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The record contains no evidence of complaints, treatment, or diagnosis of a bowel disability. The Veteran has not specified any complaints or symptoms regarding his asserted disorder. While the Veteran believes he has a current diagnosis of a bowel disability, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Based on the evidence cited above, the Board finds that the preponderance of the evidence is against the claim of service connection for a bowel disability. As the preponderance of the evidence is against the claim for service connection for a bowel disability, the benefit of the doubt rule does not apply. 38 C.F.R. § 5107; 38 C.F.R. § 3.102. 3. Entitlement to service connection for a gall bladder disability, to include as a result of radiation exposure. The Veteran contends that he has a gall bladder disability that is causally related to his active service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board 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. The Board concludes that the Veteran does not have a current diagnosis of a gall bladder disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The record contains no evidence of complaints, treatment, or diagnosis of a gall bladder disability. The Veteran has not specified any complaints or symptoms regarding his asserted disorder. While the Veteran believes he has a current diagnosis of a gall bladder disability, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Based on the evidence cited above, the Board finds that the preponderance of the evidence is against the claim of service connection for a gall bladder disability. As the preponderance of the evidence is against the claim for service connection for a gall bladder disability, the benefit of the doubt rule does not apply. 38 C.F.R. § 5107; 38 C.F.R. § 3.102. 4. Entitlement to service connection for a bladder disability, to include as a result of radiation exposure. The Veteran contends that he has a bladder disability that is causally related to his active service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board 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. The Board concludes that the Veteran does not have a current diagnosis of a bladder disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The record contains no evidence of complaints, treatment, or diagnosis of a bladder disability. The Veteran has not specified any complaints or symptoms regarding his asserted disorder. The record shows one complaint of dysuria that was related to his prostate cancer treatment and was expected to resolve within two weeks. The record showed no further complaints or treatment. Therefore, the Board notes that the single complaint of dysuria did not constitute a chronic bladder disability. While the Veteran believes he has a current diagnosis of a bladder disability, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Based on the evidence cited above, the Board finds that the preponderance of the evidence is against the claim of service connection for a bladder disability. As the preponderance of the evidence is against the claim for service connection for a bladder disability, the benefit of the doubt rule does not apply. 38 C.F.R. § 5107; 38 C.F.R. § 3.102. 5. Entitlement to service connection for sleep apnea. The Veteran contends that he has sleep apnea that is causally related to his claimed acquired psychiatric disability. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). In order to establish entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) competent evidence establishing a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Although the Veteran has asserted that his sleep apnea is secondary to his PTSD, as the Veteran has not been service-connected for a psychiatric disability, service connection on a secondary basis may not be granted. The question for the Board, therefore, 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. The Board concludes that, while the Veteran may have a current diagnosis of sleep apnea, the preponderance of the evidence weighs against finding that any sleep apnea began during service or is otherwise related to an in-service injury, event, or disease. The August 1962 separation report of medical history showed no current complaints or history of frequent trouble sleeping or nose trouble. The corresponding report of medical examination showed clinically normal nose, throat, and sinuses. Post-service treatment records do not indicate a diagnosis of sleep apnea that was causally related to the Veteran’s active service and there is no indication of an in-service event or incident. Based on the evidence cited above, the Board finds that the preponderance of the evidence is against the claim of service connection for sleep apnea. As the preponderance of the evidence is against the claim for service connection for sleep apnea, the benefit of the doubt rule does not apply. 38 C.F.R. § 5107; 38 C.F.R. § 3.102. 6. Entitlement to service connection for soft tissue sarcoma, claimed as skin lesions. The Veteran contends that he has soft tissue sarcoma, claimed as skin lesions, that is causally related to his active service, specifically to his exposure to radiation during service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board 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. The Board concludes that the Veteran does not have a current diagnosis of a skin cancer, to include any soft tissue sarcomas, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The record contains no evidence of complaints, treatment, or diagnosis of skin lesions or soft tissue sarcomas. The Veteran was afforded a VA examination in February 2016. The examiner reviewed the claims file and performed an in-person examination. The examiner noted that the Veteran does not now have, nor has he ever had, a skin condition. The skin examination did not show any cancerous appearing lesions. The Veteran had no diagnosis of skin cancer found in his available records. Therefore, a nexus could not be established. While the Veteran believes he has a current diagnosis of soft tissue sarcoma or skin lesions, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Therefore, the Board finds that the medical evidence of record is more probative than the Veteran’s lay assertions. Based on the evidence cited above, the Board finds that the preponderance of the evidence is against the claim of service connection for soft tissue sarcomas. As the preponderance of the evidence is against the claim for service connection for soft tissue sarcomas, the benefit of the doubt rule does not apply. 38 C.F.R. § 5107; 38 C.F.R. § 3.102. 7. Entitlement to service connection for a deviated septum caused by a broken nose. The Veteran contends that he has a deviated septum that is causally related to a broken nose incurred during active service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board 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. The Board concludes that the Veteran does not have a currently diagnosed deviated septum and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). On the August 1962 report of medical history, the Veteran noted no current or past nose trouble. On the corresponding report of medical examination, the examiner noted a clinically normal nose. The Veteran was afforded a VA examination in August 2015. The examiner found no objective evidence of a broken nose or deviated septum on examination. The examiner noted that no diagnosis of a condition was warranted. While the Veteran believes he has a current diagnosis of a deviated septum disability, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Therefore, the Board finds the medical evidence noting no diagnosed deviated septum to be more probative than his lay statements. Based on the evidence cited above, the Board finds that the preponderance of the evidence is against the claim of service connection for a deviated septum. As the preponderance of the evidence is against the claim for service connection for a deviated septum, the benefit of the doubt rule does not apply. 38 C.F.R. § 5107; 38 C.F.R. § 3.102. 8. Entitlement to service connection for a sinus disability. The Veteran contends that he has a sinus disability that is causally related to nuclear fallout. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board 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. The Board concludes that the Veteran does not have a currently diagnosed sinus disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). On the August 1962 report of medical history, the Veteran noted no current or past nose trouble. On the corresponding report of medical examination, the examiner noted a clinically normal nose. The Veteran was afforded a VA examination in August 2015. The examiner noted no diagnosis of sinusitis. While the Veteran believes he has a currently diagnosed sinus disability, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Therefore, the Board finds the medical evidence noting no diagnosed sinus disability to be more probative than his lay statements. Based on the evidence cited above, the Board finds that the preponderance of the evidence is against the claim of service connection for a sinus disability. As the preponderance of the evidence is against the claim for service connection for a sinus disability, the benefit of the doubt rule does not apply. 38 C.F.R. § 5107; 38 C.F.R. § 3.102. 9. Entitlement to a compensable disability rating for a scar from laceration on the right side of his chin. Disability ratings are determined by applying the criteria set forth in the VA Schedule of Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a questions as to which of two evaluations apply, assigning a higher of the two where the disability pictures more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person’s ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). A claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Thus, separate ratings can be assigned for separate periods of time based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran contends that he is entitled to a higher rating for the scar on his chin. The Veteran’s scar is rated under Diagnostic Code 7800, for scar of the head, face, or neck. VA amended the criteria for rating skin disabilities effective from August 13, 2018. However, Diagnostic Code 7800 was not changed by the August 13, 2018, amendments. Under Diagnostic Code 7800, one characteristic of disfigurement warrants a 10 percent rating. A scar with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with two or three characteristics of disfigurement warrants a 30 percent rating. A scar with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with four or five characteristics of disfigurement warrants a 50 percent rating. A scar with visible or palpable tissue loss and either gross distortion of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with six or more characteristics of disfigurement warrants an 80 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7800 list the eight characteristics of disfigurement: a scar 5 or more inches in length; a scar at least one-quarter inch wide at widest part; surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo- or hyper-pigmented in an area exceeding six square inches; skin texture abnormal in an area exceeding six square inches; underlying soft tissue missing in an area exceeding six square inches; and, skin indurated and inflexible in an area exceeding six square inches. Id. The Board finds that the preponderance of the evidence is against the assignment of a compensable rating under Diagnostic Code 7800 because he does not have at least one characteristic of disfigurement. The scar was less than 5 inches in length and less than one quarter inch wide. The surface contour was not elevated or depressed on palpation and it did not adhere to underlying tissue. The area did not exceed six square inches. The August 2015 VA examination noted that the Veteran had a laceration on the right side of his chin. He had three stitches to close a 2 cm laceration. It was not painful or unstable and did not have frequent loss of covering of skin over the scar. The scar was 2 cm by 0.125 cm. The examiner noted no elevation, depression, adherence to underlying tissue, or missing underlying soft tissue. The scar resulted in no functional impact on his ability to work. The examiner summarized that the Veteran sustained a 2 cm uncomplicated well-healed virtually non-visible scar on the right underside of the chin. The remaining treatment records do not show any additional symptoms or complaints related to the scar on his chin. The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran’s scar is not deep and non-linear and is not associated with underlying soft tissue damage. Although it is superficial and not associated with underlying soft tissue damage, it does do not cover an area or areas of 144 square inches or greater. Moreover, the Veteran’s scar is not unstable or painful. Therefore, Diagnostic Codes 7801, 7802, and 7804, both prior to and from August 13, 2018, are inapplicable. Finally, the evidence of record shows there are no other disabling effects not considered in a rating provided under Diagnostic Codes 7800-04 as contemplated under both pre- and post-August 13, 2018, Diagnostic Code 7805. The Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability rating reflects. Moreover, the Veteran is competent to report observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, he does not assert, and medical records do not show, that the Veteran’s scar manifested with a characteristic of disfigurement. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a compensable rating for the scar on his chin. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND Entitlement to service connection for sterility is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for sterility because no VA examiner has opined whether the Veteran has a disability that is related to service, to include his exposure to ionizing radiation. The matters are REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any sterility or weak sperm. The examiner should also determine whether the Veteran has erectile dysfunction related to service or any incident of service. Following a complete review of the evidence of record and with consideration of the Veteran’s lay statements, assuming the statements are credible for the limited purpose of the request herein, the medical professional is requested to provide the following opinion: whether the remanded disability is at least as likely as not related to an in-service injury, event, or disease, including the Veteran’s exposure to ionizing radiation. (Continued on the next page)   A complete rationale must be provided for all opinions offered. If any opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what, if any, additional evidence would potentially allow for a more definitive opinion. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Patricia Veresink, 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.