Citation Nr: 21000840 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 20-03 414 DATE: January 6, 2021 ORDER Service connection for an ear disorder, claimed as ear blisters leaking fluid secondary to a skin and/or neurological disorder, is denied. Service connection for a balance disorder, claimed as impaired equilibrium secondary to a skin and/or neurological disorder, is denied. Service connection for an eye disorder, claimed as impaired vision and swollen eyelids secondary to a skin and/or neurological disorder, is denied. Service connection for facial numbness secondary to a skin and/or neurological disorder is denied. Service connection for an occipital nerve disorder is denied. FINDINGS OF FACT 1. The Veteran has not been diagnosed with a skin and/or neurological disorder, other than his service-connected skin disorders, that manifests with ear blisters that leak fluid. 2. There is no probative medical evidence indicating the Veteran has been diagnosed with a balance disorder, or that his disequilibrium is related to an undiagnosed neurological and/or skin disorder. 3. There is no probative medical evidence indicating the Veteran has been diagnosed with an eye disorder, or that his claimed eye-related symptoms are manifestations of an undiagnosed neurological and/or skin disorder. 4. There is no probative medical evidence indicating the Veteran has been diagnosed with any medical condition manifesting with facial numbness. 5. The Veteran’s occipital headache symptoms are presently compensated by his disability rating for a headache disorder secondary to tinnitus. CONCLUSIONS OF LAW 1. The criteria to establish service connection for an ear disorder, claimed as ear blisters leaking fluid secondary to a skin and/or neurological disorder, have not been met. 38 U.S.C. §§ 1110, 5107 (b); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310. 2. The criteria to establish service connection for a balance disorder, claimed as impaired equilibrium, have not been met. 38 U.S.C. §§ 1110, 5107 (b); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310. 3. The criteria to establish service connection for an eye disorder, claimed as impaired vision and swollen eyelids secondary to a skin and/or neurological disorder, have not been met. 38 U.S.C. §§ 1110, 5107 (b); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310. 4. The criteria to establish service connection for facial numbness secondary to a skin and/or neurological disorder have not been met. 38 U.S.C. §§ 1110, 5107 (b); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310. 5. The criteria to establish service connection for an occipital nerve disorder have not been met. 38 U.S.C. §§ 1110, 5107 (b); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from April 1968 to November 1969. He served in the Republic of Vietnam and his military decorations include the Combat Infantryman Badge and the Bronze Star Medal. In August 2020, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. The undersigned noted the issues on appeal and engaged in a colloquy with the Veteran toward substantiation of the claims. See Bryant v. Shinseki, 23 Vet. App. 488, 496-97 (2010). A copy of the hearing transcript is associated with the claims file. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). “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. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d); see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Additional disability resulting from the aggravation of a nonservice-connected condition by a service-connected condition is also compensable under 38 C.F.R. § 3.310 (b). See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307 (a)(6)(iii). The Veteran’s service personnel records indicate he has combat service in the Republic of Vietnam during the presumptive period and there is no evidence suggesting he was not exposed to herbicides. Accordingly, his exposure to herbicide agents is presumed. In order to benefit from the presumption of service connection for diseases associated with herbicide exposure, the Veteran must have one of the diseases enumerated in 38 C.F.R. § 3.309 (e). None of the claimed skin, eye, ear, neurological or other conditions are so listed. Id. Therefore, presumptive service connection due to herbicide agent exposure is not warranted. However, the Veteran is not prevented from establishing service connection on a direct basis. Combee v. Brown, 34 F.3d 1039, 1042 (Fed Cir. 1994). In deciding an appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination about the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran’s disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104 (a). When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 1. Service connection for an ear disorder, claimed as leaking blisters secondary to a skin and/or neurological disorder. The Veteran reports that, since separating from service, he has had ear blisters that occasionally leak fluid, mostly at night. Although his dermatitis (eczema) is service connected, including that of the ears, hands, face and scalp, he contends his symptoms are a manifestation of a separate skin and/or neurological disorder. Alternatively, he asserts his ear-related symptoms are directly related to his exposure to herbicides in Vietnam. Service treatment records (STRs) are silent for reports of fluid leaking from the ears or any other ear condition. In the Veteran’s August 1968 induction report of medical history, he denied ever having had ear trouble or skin diseases. In a report of medical examination of the same date, his clinical head, face, neck, scalp and ear evaluations were normal. The Veteran’s November 1969 separation medical examination also indicated normal clinical findings. However, in a November 1969 report of medical history, he reported having had “skin diseases” but denied ear trouble or “running ears.” The examining clinician noted all the Veteran’s claimed conditions existed prior to service but did not provide additional details regarding specific diagnoses. There are otherwise no references to an ear or skin condition or related symptoms during service. The Veteran asserts he has had intermittent leaking from his ears since separation from active service which has continued for over 50 years. He has reported having both drainage from external ear blisters and drainage from inside his ears. Post-service VA treatment records indicate the Veteran first reported ear trouble in 2009. In June 2009 primary care record, the Veteran reported breakouts of itchy blisters on his ears since service. He reported that these blisters drained pus when he applied pressure on them. The attending physician noted it was unclear what caused the breakouts and indicated they may be caused by stress or a viral syndrome. In a July 2009 dermatology consultation record, the Veteran reported that his ears were occasionally itchy and “scaly.” Upon physical examination, a VA dermatologist diagnosed the Veteran with seborrheic dermatitis of the ears – a disorder for which service connection is in effect and has been since June 2009 . An August 2009 VA record indicates the Veteran reported to the emergency room with an itchy rash and swelling of the left eye, lips, face and earlobes. He reported he had been gardening and had similar symptoms while gardening four years prior. He also stated he believed he had a mold or dust allergy. The attending clinician gave an impression of a fine papular rash due to an allergic reaction. The Veteran was afforded a VA skin examination in December 2009. The VA examiner noted the Veteran had recurrent dermatitis (eczema) of the hands and ears since 1969 and that the ears were a continuous problem. The Veteran reported using an unknown cream on his ears every day since 1989. He reported occasionally waking at night because of itching, but he did not report having fluid leak from his ears. The examiner indicated the Veteran’s ears were normal on the date of the examination. He opined the Veteran’s dermatitis was more likely than not related to the skin condition noted in the Veteran’s November 1969 separation report of medical history. The Veteran was granted service connection for dermatitis of the ears, neck and scalp in a March 2010 rating decision. In a September 2012 Report of General Information (VA Form 21-0820), the Veteran stated his inner ears were leaking and that he believed fluid from his ears impaired his eyesight every morning for one to three hours. At the March 2018 Board hearing, the Veteran reported experiencing breakouts of swelling and blisters on his head, ears, scalp and neck. He indicated that he had four of these breakouts since leaving Vietnam. He stated his breakouts were treated with penicillin and Benadryl and resolved within one to three weeks. In May 2018, the Veteran reported itching and a watery discharge on his scalp and ears. However, on physical examination, a VA dermatologist noted the Veteran’s scalp and ears were clear of red itchy bumps or any other abnormalities. The Veteran was afforded an additional VA skin conditions examination in September 2018. He continued to report having painful blisters from head to toe and that the condition had worsened. The examiner indicated there were no visible characteristics of dermatitis and corrected the Veteran’s diagnosis to psoriasis. In an October 2018 VA otolaryngology consult note, the Veteran continued to report having bilateral ear drainage since separation. He was unable to describe the drainage and stated only that his ears “felt wet.” The Veteran denied having otalgia (earache), hearing loss, tinnitus or vertigo. He also reported having left-sided facial numbness for approximately five years. Upon physical examination, the attending dermatologist indicated the Veteran’s ears were internally and externally normal, he had no head or neck rashes, and an August 2015 brain MRI was negative for any abnormalities. The dermatologist opined that the Veteran’s bilateral ear drainage was likely cerumen (earwax). In an August 2019 dermatology note, the Veteran reported that the fluocinolone solution he took for his skin conditions caused his face to “blow up” and erupt with blisters. He stated that he believed he has an “internal condition” which causes outbreaks of rashes, itching, blisters on his entire head and neck. He also reported symptoms of facial numbness and disequilibrium (imbalance) during these episodes. On physical examination, the attending dermatologist found no active lesions, erosions or blisters on the Veteran’s face or scalp. The examiner opined the Veteran’s lesions are not likely to be related to any neurological condition and encouraged the Veteran to take pictures of his blisters during an outbreak and schedule a same-day appointment for a biopsy. In an October 2019 VA dermatology record, the Veteran reported having a “volcano of blisters” erupting from his scalp. The attending dermatologist reviewed photos of the Veteran’s scalp on the Veteran’s phone, noting the photos were blurry but revealed non-specific dermatitis, and no blisters or vesicles were visible. On physical examination, the VA dermatologist noted there were no blisters on the Veteran’s head, despite the Veteran’s insisting that they were present. In a November 2019 VA medical opinion, the examiner noted the Veteran’s reports of “water blisters” on his head, hands, ears and scalp, facial numbness, and fluid covering half of his head. The examiner noted the Veteran had previously been diagnosed with psoriasis but there was no evidence of any current lesions upon physical examination. The examiner further noted that an April 2018 VA neurology evaluation was negative for nerve problems and did not conclude that the Veteran’s skin condition caused numbness. In a January 2020 substantive appeal, the Veteran reported his ears “leak,” and explained the outer layer of the skin on his ears peels off and a sticky fluid is apparent beneath. In a May 2020 addendum to the November 2019 VA opinion, the examiner opined there was no objective evidence indicating that the Veteran has neurological damage caused by his skin conditions. The examiner noted the Veteran’s April 2018 neurology assessment revealed no objective evidence of neurological damage and the Veteran’s subjective reports of facial numbness did not correspond to the distribution of the trigeminal or other cranial nerves. At the August 2020 Board hearing, the Veteran continued to report experiencing fluid draining from his ears since service. He reported that no medical provider has diagnosed the condition and that he was told the fluid was earwax. He testified that the fluid in his ears causes his balance problems. The Veteran, through counsel, indicated he intended to see a non-VA doctor to clarify his ear condition and obtain an opinion as to its cause. He was afforded 60 days from the date of the hearing to produce additional evidence in support of his claim but did not do so. In November 2020, the Veteran was afforded an additional VA examination assessing his skin conditions and related symptoms. The examiner noted diagnoses of seborrheic dermatitis, scalp folliculitis, and resolving skin cancer. She further indicated that, at the time of the examination, the Veteran did not have any other skin condition without any visible characteristic lesions. The Veteran reported having dry and itchy skin, with breakouts of brown spots on his head, face, and arms. He did not report blisters or fluid drainage associated with his skin disorders. The VA examiner concluded that the Veteran had no other pertinent physical findings, complications, conditions, signs and/or symptoms related to any skin condition. The preponderance of the evidence is against finding service connection for an ear and/or skin disorder manifesting with fluid leaking from the inner and outer ear. Several VA examiners have evaluated the Veteran and found no evidence of lesions, blisters, fluid, or drainage, and inner and outer ear examinations have not indicated any abnormalities. Ultimately, no medical provider has diagnosed the Veteran with an ear/skin disorder separate from his already service-connected dermatitis of the ears. Without a current disability, there can be no claim for service connection. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (“Congress specifically limits entitlement to service-connected disease or injury to cases where such incidents have resulted in a disability. In absence of proof of a present disability there can be no valid claim.”). For these reasons, the claim is denied. The Board has considered the Veteran’s lay assertions that he has a skin and/or neurological disorder that manifests with facial numbness, disequilibrium, and breakouts of water blisters on his ears, scalp and head. While the Veteran is competent to report observable symptoms, he is not competent to diagnose himself with a medically complex skin condition or attempt to link his symptoms with his in-service herbicide exposure. See Jandreau, supra. As indicated above, the Veteran was afforded an opportunity to submit medical evidence substantiating his claim but did not do so. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 2. Service connection for a balance disorder, claimed as impaired equilibrium secondary to a skin and/or neurological disorder. The Veteran asserts that he has imbalance and disequilibrium due to a neurological disorder. He has not been diagnosed with a balance disorder and no medical provider has linked his imbalance symptoms with his service-connected skin disorders. Nevertheless, the Veteran contends his balance symptoms are related to his herbicide exposure during active service. The Veteran’s STRs do not contain contemporaneous reports of imbalance, dizziness, or related neurological symptoms. In a report of medical history recorded at separation, the Veteran reported having had “dizziness or fainting spells,” although there is no further description of these symptoms. In an August 2015 VA primary care note, the Veteran reported experiencing dizziness and poor equilibrium that had worsened in the previous three years. A September 2015 VA record reports that the Veteran declined vestibular therapy for his balance problems and instead preferred to follow up with the neurology clinic. In a February 2017 neurology note, the Veteran continued to report intermittent disequilibrium and was advised that heel-to-toe exercises could improve his balance. The VA neurologist indicated that MRI revealed changes consistent with microvascular disease, which could possibly cause imbalance. She further indicated that the Veteran was found to have low vitamin B12 in 2013, which could also cause imbalance. In April 2018, the Veteran reported having daily occipital headaches and intermittent episodes of disequilibrium. Upon neurological examination, the Veteran’s higher functions, cranial nerves, motor system, sensory system, coordination, gait and station were all normal. The attending neurologist indicated the Veteran had a positive left Babinski sign which may suggest long tract (spinal cord) involvement. She indicated an impression of cervical stenosis, occipital neuralgia, and left facial numbness of unknown cause. The examiner noted that MRI indicated age-related neurological changes and Electroencephalogram (EEG) testing was normal. In an October 2018 VA dermatology record, the Veteran reported experiencing disequilibrium when standing up too fast, but not true vertigo. The attending clinician noted that 2015 MRI of the brain did not reveal evidence of lesions, a stroke, or other abnormalities. The Veteran declined additional MRI and indicated he believed his balance issues were due to a skin problem. A November 2018 VA neurology note reports diagnoses of cervical (neck) spinal stenosis, DJD, and right occipital nerve neuralgia. The Veteran reported left sided facial numbness and disequilibrium, although he had not fallen. The attending clinician indicated the Veteran’s neck disorder was causing imbalance but otherwise asymptomatic. The clinician noted the Veteran’s occipital neuralgia was possibly related to DJD in the Veteran’s upper neck/spine. In a December 2019 VA neurology note, the Veteran reported having occipital neuralgia, cervical (neck) spinal degenerative joint disease (DJD), and a right eye visual episode of lower altitudinal defect. The attending neurologist indicated the Veteran’s neck DJD may be the cause of his imbalance problems. In a May 2020 VA medical opinion, a VA-contracted physician opined there was no evidence of any neurological damage associated with the Veteran’s service-connected dermatitis, including facial numbness, difficulty opening his eyes, or other problems. The physician noted the Veteran was treated by VA neurologists in April 2018 who found no objective signs of neurological abnormalities and stated the Veteran’s subjective reports of facial numbness did not correspond to the distribution of the trigeminal nerve or any other cranial nerve. The examiner noted there were no neurological abnormalities found during the Veteran’s cataract surgeries or his November 2019 skin examination. The preponderance of the evidence is against finding service connection for a balance disorder. Several VA neurologists have evaluated the Veteran and indicated that MRI and other objective testing did not reveal neurological abnormalities other than age-related changes. These neurologists suggested that the Veteran’s balance problems may be caused by vitamin B12 deficiency or neck DJD. Ultimately, no medical provider has diagnosed the Veteran with a balance disorder or linked the Veteran’s symptoms with service or any service-connected disorder. Without a current disability, there can be no claim for service connection. See Brammer, supra. For these reasons, the claim must be denied as a matter of law. The Board has considered the Veteran’s lay assertions that he has a skin and/or neurological disorder that causes his balance problems. While the Veteran is competent to report these symptoms, he is not competent to diagnose himself with a medically complex condition or attempt to link his symptoms with his in-service herbicide exposure. See Jandreau, supra. Accordingly, the Veteran’s lay assertions are substantially outweighed by the May 2020 VA opinion indicating that he does not have neurological or balance issues as a result of his service-connected skin disorder. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 3. Service connection for an eye disorder, claimed as impaired vision and swollen eyelids secondary to a skin and/or neurological disorder. The Veteran contends he has an eye disorder that manifests with symptoms including swollen eyelids and impaired vision. He contends these symptoms are related to undiagnosed neurological and skin disorders. STRs do not contain reports of treatment, symptoms, or diagnosis for an eye condition. In his enlistment medical examination, the Veteran’s clinical eye evaluation was normal and he denied ever having had “eye trouble.” In his separation physical, the Veteran had a normal clinical evaluation and continued to deny eye trouble. In an August 2009 E.R. record, the Veteran reported experiencing severe swelling of his face, including his left eye. He reported his symptoms began while gardening and that he had similar symptoms in the past. The E.R. report notes a clinical impression of a rash due to an allergic reaction. The Veteran’s facial swelling resolved with steroid and Benadryl. In an August 2015 VA neurology record, the Veteran reported experiencing blurry vision and dizziness and was referred to a VA eye clinic for further examination. In an August 2015 VA ophthalmology consultation, the Veteran reported his visual difficulty and dizziness had been present for the past ten years. He denied any other previous eye-related issues or surgeries but reported a family history of cataracts. Upon examination, the attending ophthalmologist noted the external parts of the Veteran’s eyes were normal for his age. Further testing indicated evidence of age-related nuclear cataracts and suspected glaucoma. VA medical records indicate continued treatment for glaucoma in both eyes and cataract surgeries in 2016 and 2019. At the March 2018 Board hearing, the Veteran reported experiencing left-sided facial numbness, loss of vision, and swelling in his eye after a cataract operation. In a November 2018 VA neurology note, the Veteran reported having right eye optic nerve damage and lower altitudinal defect which occurred ten years prior. The examiner indicated the cause of the Veteran’s eye impairment was unclear. In an October 2019 VA dermatology record, the Veteran reported his eye had “swollen half shut” after he began using doxycycline to treat his scalp folliculitis. He later reported that the swelling resolved. In a May 2020 VA medical opinion, a VA-contracted physician opined there was no evidence of any neurological damage associated with the Veteran’s service-connected dermatitis, including facial numbness, difficulty opening his eyes, or other problems. At the August 2020 Board hearing, the Veteran asserted that he has optic nerve damage in his right eye due to internal fluid. He reported that no medical provider had told him his vision problem was related to Agent Orange or any other herbicide. The Veteran was afforded 60 days from the date of the hearing to produce additional evidence in support of his claim but did not do so. The preponderance of the evidence is against finding service connection for an eye disorder. The probative medical evidence indicates the Veteran has been diagnosed with and treated for age-related glaucoma and cataracts but has not been diagnosed with any other eye condition. Without a current disability, there can be no claim for service connection. See Brammer, supra. The claim is denied. The Board has considered the Veteran’s lay assertions that his eye-related symptoms are due to an undiagnosed skin or neurological disorder that manifests with fluid inside his head that occasionally leaks into his eyes. While the Veteran is competent to report these symptoms, he is not competent to diagnose himself with a medically complex eye condition or attempt to link his symptoms with his in-service herbicide exposure. See Jandreau, supra. Additionally, the Veteran’s reports of leaking fluid have not been substantiated by any medical provider or objective testing. The Veteran’s lay assertions are not probative as to the ultimate question of whether his symptoms are indicative of a distinct eye disorder that is related to service. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 4. Service connection for facial numbness secondary to a skin and/or neurological disorder. The Veteran reports experiencing numbness in his face, head and scalp. He contends these are symptoms of an undiagnosed skin or neurological disorder related to herbicide exposure during active service. However, as noted, the Veteran’s dermatitis of the hands, ears, hair and scalp are service connected. The Veteran’s STRs do not contain reports of facial numbness or similar neurological symptoms. His clinical neurological evaluations were normal both at enlistment and at separation. An August 2015 VA neurology record reports that the Veteran endorsed symptoms of dizziness, occipital headaches and blurred vision, but denied numbness or a head/neck injury. In a November 2017 VA neurology note, the Veteran reported experiencing numbness on the left side of his face, but not the right. The attending neurologist noted that MRI indicated spinal compression in the neck area had no apparent correlation with the Veteran’s reports of facial numbness and “fluid between his eyes.” In a January 2018 VA pain consult note, the Veteran reported his right-sided facial numbness began three years prior during his eye surgeries. In a May 2020 VA medical opinion, a VA-contracted physician opined there was no evidence of any neurological damage associated with the Veteran’s service-connected dermatitis, including facial numbness. At the August 2020 Board hearing, the Veteran reported that “95 percent” of his face was numb and that he believes the numbness is caused by liquid inside his head. As indicated above, the Veteran was afforded 60 days to obtain a medical opinion diagnosing his claimed condition but did not do. The preponderance of the evidence is against finding service connection for facial numbness. No medical provider has diagnosed the Veteran with any medical condition based on his reported symptoms or linked his symptoms with any service-connected disability. MRI and other objective testing have not indicated any neurological abnormalities. Further, the May 2020 VA examiner indicated that the Veteran has no current neurological or balance issues as a result of his service-connected skin disorder. Without a current disability, there can be no claim for service connection. See Brammer, supra. The claim is denied. The Board has considered the Veteran’s lay assertions that his facial numbness is caused by liquid inside his head, and/or some undiagnosed skin or neurological disorder. While the Veteran is competent to report numbness, he is not competent to diagnose himself with a medically complex neurological condition or attempt to link his symptoms with his in-service herbicide exposure. See Jandreau, supra. The Veteran’s lay assertions are substantially outweighed by the fact that multiple clinical tests, including MRI, have not confirmed the Veteran’s reports of internal fluid. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 5. Service connection for an occipital nerve disorder. The Veteran contends he has an occipital nerve disorder related to his herbicide exposure during active service. VA neurology records document reports of occipital headaches as early as 2015 and a diagnosis of occipital neuralgia (headaches). The Veteran was afforded a VA headaches examination in October 2020. He reported having occipital headaches during service that have continued to the present. The VA examiner opined the Veteran’s occipital headaches are likely caused by the Veteran’s tinnitus or idiopathic intracranial hypertension (IIH). Based on the examiner’s report, the RO granted service connection for headaches secondary to the Veteran’s service-connected tinnitus. The Veteran’s occipital headaches have been incorporated into the Veteran’s rating for his headache disorder and cannot be used to support service connection for an additional distinct disability. VA regulations and case law provide that evaluating duplicative or overlapping symptomatology under several diagnostic codes, known as pyramiding, must be avoided. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994).  The preponderance of the evidence is against awarding service connection for an occipital nerve disorder. The Veteran is already being compensated for his occipital headaches and to award service connection for a separate occipital nerve disorder based on the exact same symptoms would constitute pyramiding. Accordingly, the claim is denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Hiaasen 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.