Citation Nr: 21002359 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 13-13 584 DATE: January 13, 2021 ORDER Entitlement to service connection for hypertension is denied. Entitlement to service connection for lupus is denied. Entitlement to service connection for a disorder manifested by syncope and seizures is denied. Entitlement to service connection for venous thrombosis is denied. Entitlement to service connection for chronic rheumatoid arthritis is denied. Entitlement to service connection for disorder manifested by bilateral leg muscle weakness is denied. Entitlement to service connection for a heart disorder is denied. REMANDED Entitlement to service connection for a vision disorder is remanded. Entitlement to service connection for an acquired psychiatric disability with short term memory loss is remanded. Entitlement to service connection for a respiratory disorder, to include bronchitis and chronic obstructive pulmonary disease (COPD), is remanded. FINDINGS OF FACT 1. Hypertension is not shown to be causally or etiologically related to any disease, injury, or incident during active duty for training (ACDUTRA). 2. Lupus is not shown to be causally or etiologically related to any disease, injury, or incident during ACDUTRA. 3. The appellant’s syncope disorder preexisted entrance into her period of ACDUTRA and was not aggravated during ACDUTRA; the appellant has not had a seizure disorder at any time during or approximate to the pendency of the claim. 4. Venous thrombosis is not shown to be causally or etiologically related to any disease, injury, or incident during ACDUTRA. 5. Chronic rheumatoid arthritis is not shown to be causally or etiologically related to any disease, injury, or incident during ACDUTRA. 6. A disorder manifested by bilateral leg weakness is not shown to be causally or etiologically related to any disease, injury, or incident during ACDUTRA; the disability has been attributed to nonservice-connected rheumatoid arthritis and low back disability. 7. The preponderance of the evidence of record is against finding that the appellant has had a heart disorder at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 101(24), 1110, 5107); 38 C.F.R. §§ 3.1(d), 3.6(a), 3.102, 3.303. 2. The criteria for service connection for lupus have not been met. 38 U.S.C. §§ 101(24), 1110, 5107); 38 C.F.R. §§ 3.1(d), 3.6(a), 3.102, 3.303. 3. The criteria for service connection for disorder manifested by syncope and seizures have not been met. 38 U.S.C. §§ 101(24), 1110, 5107); 38 C.F.R. §§ 3.1(d), 3.6(a), 3.102, 3.303. 4. The criteria for service connection for venous thrombosis have not been met. 38 U.S.C. §§ 101(24), 1110, 5107); 38 C.F.R. §§ 3.1(d), 3.6(a), 3.102, 3.303. 5. The criteria for service connection for chronic rheumatoid arthritis have not been met. 38 U.S.C. §§ 101(24), 1110, 5107); 38 C.F.R. §§ 3.1(d), 3.6(a), 3.102, 3.303. 6. The criteria for service connection for a disorder manifested by bilateral leg weakness have not been met. 38 U.S.C. §§ 101(24), 1110, 5107); 38 C.F.R. §§ 3.1(d), 3.6(a), 3.102, 3.303. 7. The criteria for service connection for a heart disorder have not been met. 38 U.S.C. §§ 101(24), 1110, 5107); 38 C.F.R. §§ 3.1(d), 3.6(a), 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant had reserve service in the United States Naval Reserve, including periods of inactive duty for training (IDT) and a period of active duty for training (ACDUTRA) from July 5, to July 17, 2005. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2010 rating decision. The appellant testified at a hearing before a Decision Review Officer at the Regional Office in January 2011. A transcript of the hearing has been associated with the electronic claims file. The Board remanded these matters for additional development in January 2017 and August 2018. With respect to the issues decided herein, the Board finds that there has been substantial compliance with the prior Board remand directives. The Board recognizes that with respect to the issue of service connection for rheumatoid arthritis, the Board previously requested that a VA examiner opine whether any diagnosed condition clearly and unmistakably pre-existed the Veteran’s entrance into military service and, if so whether there is clear and unmistakable evidence that the disorder was not aggravated by her short period of active service in July 2005. Unfortunately, as discussed further below, the presumption of soundness does not apply in this case and thus, any such opinion would be based on an incorrect legal standard. Moreover, the Board has found that the appellant did not have a preexisting disability. Accordingly, the appropriate opinion addressing whether the Veteran’s rheumatoid arthritis was related to her period of ACDUTRA was obtained and, thus, there has been substantial compliance with the prior Board remand directive seeking an adequate VA examination with opinion. See Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand confers on the claimant, as a matter of law, the right to compliance with the remand order); see also D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (holding that substantial, rather than strict, compliance with remand directives is required). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996). The term “active military, naval, or air service” includes: (1) active duty; (2) any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty; and (3) any period of inactive duty for training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in the line of duty. 38 U.S.C. § 101 (24); 38 C.F.R. § 3.6 (a). ACDUTRA includes full-time duty performed by members of the National Guard of any State or the Reserve. INACDUTRA includes duty other than full-time duty performed by a member of the Reserve or the National of any State. 38 C.F.R. § 3.6 (c), (d). As in the instant case, the advantage of certain evidentiary presumptions, provided by law, that assist veterans in establishing service connection for a disability do not extend to those who claim service connection based on a period of ACDUTRA or INACDUTRA. Paulson v. Brown, 7 Vet. App. 466, 470-71 (1995) (noting that the Board did not err in not applying presumptions of sound condition and aggravation to veteran’s claim where he served only on ACDUTRA and had not established any service-connected disabilities from that period); McManaway v. West, 13 Vet. App. 60, 67 (1999), vacated on other grounds sub nom; McManaway v. Principi, 14 Vet. App. 275 (2001) (citing Paulson, 7 Vet. App. at 469-70, for the proposition that if a claim “relates to period of [ACDUTRA], disability must have manifested itself during that period; otherwise, period does not qualify as active military service and claimant does not achieve veteran status for purposes of that claim.” (emphasis added in McManaway)); see also Biggins v. Derwinski, 1 Vet. App. 474, 479 (1991). In the instant case, the appellant has not achieved ‘veteran’ status for the purposes of her current claim. Therefore, the presumption of soundness does not attach. Consequently, the essential inquiry in this case is whether any of her disabilities were incurred or aggravated in the line of duty during her period of ACDUTRA from July 5, 2005, to July 17, 2005. By way of background, in written statements of record and during her January 2011 hearing, the Appellant has asserted that her claimed disorders manifested during or were causally related to her short period of ACDUTRA in July 2005. In addition, she also contended that her chronic rheumatoid arthritis pre-existed her entry into reserve service in 2000 and was aggravated during her short period of ACDUTRA in July 2005. She also indicated that multiple claimed disorders such as leg weakness, vision loss, venous thrombosis, and memory loss were secondary to lupus. By way of background, an April 2000 reserve service enlistment examination report revealed normal clinical evaluations of all systems. In an April 2000 Report of Medical History, the appellant marked yes to having or ever had arthritis, rheumatism, etc. Service treatment records during her the July 2005 period of ACDUTRA revealed that the appellant was treated for symptoms of pre-syncope and atypical chest pain in July 2005 before mobilization. The provider listed a finding of rule out seizure disorder and ordered neurology and cardiology consultations. Service personnel records showed that the Appellant was part of reserve component personnel mobilized to active duty but was found unfit for mobilization. In August 2005, she was found to be Temporarily Not Physically Qualified (TNPQ) for deployment. She was discharged under honorable conditions from active duty in December 2005 for unsatisfactory participation in ready reserve. Entitlement to service connection for hypertension As discussed above, the appellant contends that her hypertension was incurred during the July 2005 period of ACDUTRA. The question for the Board is whether the appellant has a current disability that is at least as likely as not incurred in or aggravated during the July 2005 period of ACDUTRA. The Board concludes that, while the appellant has a current diagnosis of hypertension, the preponderance of the evidence weighs against finding that the appellant’s diagnosis of hypertension is related to an in-service disease or injury during ACDUTRA. Importantly, service treatment records during this short period do not show a diagnosis of hypertension. Although the appellant reported onset of hypertension during this period, the Board finds her statements not credible. The appellant’s reports are internally inconsistent with the service treatment records that show no findings of hypertension and that her blood pressure was 113/87. Moreover, in her subsequent August 2005 Annual Certificate of Physical Condition, the appellant expressly denied any physical defects. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Further, the October 2019 VA examiner indicated that the appellant’s hypertension was diagnosed in 2006 and opined that the appellant’s hypertension was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was there is no evidence of chronicity of care and a nexus has not been established. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The appellant believes her hypertension is related to an in-service injury, event, or disease during ACDUTRA. The appellant in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires specialized medical knowledge. Therefore, it is outside the competence of the appellant in this case because the record does not show that she 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 VA examination with opinion. In conclusion, based on the analysis above, the Board finds that the preponderance of evidence is against the appellant’s claim for service connection for hypertension. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. Entitlement to service connection for lupus As discussed above, the appellant contends that her lupus was incurred during the July 2005 period of ACDUTRA. The question for the Board is whether the appellant has a current disability that is at least as likely as not incurred in or aggravated during the July 2005 period of ACDUTRA. The Board concludes that, while the appellant has a current diagnosis of lupus, the preponderance of the evidence weighs against finding that the appellant’s diagnosis of lupus is related to an in-service disease or injury during ACDUTRA. Importantly, service treatment records during this short period do not show a diagnosis of lupus. Although the appellant reported onset of lupus during this period, the Board finds her statements not credible. The appellant’s reports are internally inconsistent with the service treatment records that show no findings of lupus. Moreover, in her subsequent August 2005 Annual Certificate of Physical Condition, the appellant expressly denied any physical defects. Further, post-service private treatment records showed that she was diagnosed with lupus in 2006. She also reported symptoms dating back 20 years, which would have been prior to her period of ACDUTRA. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Further, the December 2019 VA examiner indicated that the appellant’s lupus was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was during service, condition was acute only. There is no evidence of chronicity of care. A nexus has not been established. There is no evidence that the diagnosis of lupus began during or was causally related to her short period of active military service in July 2005. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The appellant believes her lupus is related to an in-service injury, event, or disease during ACDUTRA. The appellant in this case is not competent to provide a nexus opinion regarding this issue. Again, the issue is medically complex, as it requires specialized medical knowledge. Therefore, it is outside the competence of the appellant in this case because the record does not show that she 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 VA examination with opinion. In conclusion, based on the analysis above, the Board finds that the preponderance of evidence is against the appellant’s claim for service connection for lupus. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. Entitlement to service connection for a disorder manifested by syncope and seizures is denied. As discussed above, the appellant contends that her disorder manifested by syncope and seizures was incurred during the July 2005 period of ACDUTRA. Initially, the Board concludes that the appellant does not have a current diagnosis of a seizure disorder 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). After examining the appellant and reviewing the claims file, the March 2020 VA examiner clearly found that there was no evidence of diagnosis of a seizure disorder and there was no diagnosis on the day of the examination. Further, VA and private treatment records also do not show a diagnosis of a seizure disorder. With respect to the appellant’s episodes of syncope, private treatment records show that the Veteran experienced a syncope episode in April 2005 and was instructed to follow up with cardiology. As noted above, the presumption of soundness does not apply to the appellant. Based on this probative evidence, it is clear that the appellant began experiencing syncope episodes prior to entry into ACDUTRA and, thus, any such disorder preexisted her ACDUTRA. Accordingly, it must be shown that the appellant’s pre-existing disorder was aggravated during service. With respect to a claim for aggravation of a preexisting condition during ACDUTRA, because the “active military, naval, or air service” that, under 38 U.S.C. § 1153, is a prerequisite for benefits based on a theory of aggravation requires the aggravation to occur “in [the] line of duty” (38 U.S.C. § 101 (24)(B)), the application of 38 U.S.C. § 101 (24)(B) requires direct evidence both that a worsening of the condition occurred during the period of ACDUTRA and that the worsening was caused by the period of ACDUTRA. As both elements are required under the definition of “in [the] line of duty,” just establishing that the condition worsened during service is not enough; thus, the presumption of aggravation does not apply where a claim is based on a period of ACDUTRA. Accordingly, because the presumption of aggravation does not apply here, direct evidence must show that both a worsening of the appellant’s condition occurred during the period of ACDUTRA and that the worsening was caused by the period of ACDUTRA. Here, there is no evidence of a worsening syncope disorder during the period of ACDUTRA in July 2005. In this regard, a July 2005 service treatment record does show that the Veteran reported episodes while driving or near syncope episodes. The assessment was rule out seizure disorder. Although the Veteran reported such episodes, there was no indication that any such episodes were worse than the episode prior to ACDUTRA, or that ACDUTRA had caused any such worsening. The subsequent diagnosis was symptoms of pre-syncope and atypical chest pain. However, again, in her subsequent August 2005 Annual Certificate of Physical Condition, the appellant expressly denied any physical defects. Importantly, the February 2020 VA examiner found that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner rationalized that while there is evidence of a chronic condition of syncope, including treatment during active service dates, there is no evidence of onset during service. The examiner again indicated that the episodes of syncope was prior to the appellant’s active duty. Importantly, there was no evidence of a chronic diagnosis of syncope. Although the examiner did not give an opinion on aggravation, by finding that such disorder did not have its onset in service, it appears to indicate that there was no worsening from the prior episodes. Moreover, the finding of the lack of onset in service would also be indicative that any worsening was not caused by ACDUTRA. Likewise, the finding that there is no current disability would further be indicative of no aggravation. As such, the Board finds that based on the medical evidence of record, the appellant’s syncope episodes did not worsen during her period of ACDUTRA. The Board recognizes that the appellant believes that she has a disorder manifested by syncope and seizures that was incurred in service. However, while she is competent to describe her symptoms, she has not been shown to have the requisite medical knowledge necessary to diagnose any such disorder and determine whether her condition permanently worsened due to ACDUTRA service. In conclusion, based on the analysis above, the Board finds that the preponderance of evidence is against the appellant’s claim for service connection for disorder manifested by syncope and seizures. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. Entitlement to service connection for venous thrombosis is denied. As discussed above, the appellant contends that her venous thrombosis was incurred during the July 2005 period of ACDUTRA. The question for the Board is whether the appellant has a current disability that is at least as likely as not incurred in or aggravated during the July 2005 period of ACDUTRA. The Board concludes that, while the appellant has a current diagnosis of venous thrombosis, the preponderance of the evidence weighs against finding that the appellant’s diagnosis of venous thrombosis is related to an in-service disease or injury during ACDUTRA. Importantly, service treatment records during this short period do not show a diagnosis of venous thrombosis. Although the appellant reported onset of venous thrombosis during this period, the Board finds her statements not credible. The appellant’s reports are internally inconsistent with the service treatment records that show no findings of venous thrombosis. Moreover, in her subsequent August 2005 Annual Certificate of Physical Condition, the appellant expressly denied any physical defects. Further, post-service private treatment records showed that she was diagnosed with venous thrombosis in September 2006. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Further, the February 2020 VA examiner indicated that the appellant’s venous thrombosis was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that the venous thrombosis condition was treated in September 2006 after appellant was separated from the military. There is no objective evidence for a chronic and a current venous thrombosis condition while in service. A nexus has not been established. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The appellant believes her venous thrombosis is related to an in-service injury, event, or disease during ACDUTRA. The appellant in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires specialized medical knowledge. Therefore, it is outside the competence of the appellant in this case because the record does not show that she 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 VA examination with opinion. In conclusion, based on the analysis above, the Board finds that the preponderance of evidence is against the appellant’s claim for service connection for venous thrombosis. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. Entitlement to service connection for chronic rheumatoid arthritis is denied. Again, the appellant contends that her rheumatoid arthritis was incurred during the July 2005 period of rheumatoid arthritis. In addition, she also contended that her chronic rheumatoid arthritis pre-existed her entry into reserve service in 2000 and was aggravated during her short period of active service in July 2005. The question for the Board is whether the appellant has a current disability that is at least as likely as not incurred in or aggravated during the July 2005 period of ACDUTRA. As discussed above, the Board notes that in her April 2000 Report of Medical History upon entrance to the Reserves, the appellant reported a history of arthritis, rheumatism or bursitis. However, her entrance examination documented no such abnormalities and there were no further notations as to the time concerning arthritis. Follow up dental records continue to show a report of arthritis, but with no further information. In sum, there are no medical records showing a diagnosis of rheumatoid arthritis prior to the appellant’s July 2005 period of ACDUTRA. Post service treatment records show a report of rheumatoid arthritis in September 2006. Importantly, at the October 2019 VA examination, the Veteran reported the onset of rheumatoid arthritis was in 2005 during ACDUTRA. Given the lack of objective evidence of a diagnosis prior to July 2005 as well as the appellant’s contradictory statements concerning onset of rheumatoid arthritis. The Board find that the preponderance of the evidence is against finding that she had a preexisting rheumatoid arthritis condition. Thus, the question turns on whether the appellant’s rheumatoid arthritis is related to an in-service disease or injury during ACDUTRA. The Board concludes that, while the appellant has a current diagnosis of rheumatoid arthritis, the preponderance of the evidence weighs against finding that the appellant’s diagnosis of rheumatoid arthritis is related to an in-service disease or injury during ACDUTRA. Importantly, service treatment records during this short period do not show a diagnosis of rheumatoid arthritis. Although the appellant reported onset of rheumatoid arthritis during this period, the Board finds her statements not credible. The appellant’s reports are internally inconsistent with the service treatment records that show no findings of rheumatoid arthritis. Moreover, in her subsequent August 2005 Annual Certificate of Physical Condition, the appellant expressly denied any physical defects. Further, post-service private treatment records showed that she was diagnosed with rheumatoid arthritis in 2006. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Further, the October 2019 VA examiner indicated that the appellant’s rheumatoid arthritis was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that there is no connection between physical activity during the military and chronic rheumatoid arthritis. Active Military Service and exercises are not etiologies for Rheumatoid arthritis that is an immunologic disease. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The appellant believes her rheumatoid arthritis is related to an in-service injury, event, or disease during ACDUTRA. The appellant in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires specialized medical knowledge. Therefore, it is outside the competence of the appellant in this case because the record does not show that she 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 VA examination with opinion. In conclusion, based on the analysis above, the Board finds that the preponderance of evidence is against the appellant’s claim for service connection for rheumatoid arthritis. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. Entitlement to service connection for disorder manifested by bilateral leg muscle weakness is denied. The appellant also contends that she has a disorder manifested by bilateral leg muscle weakness that was incurred during the July 2005 period of ACDUTRA. The question for the Board is whether the appellant has a current disability that is at least as likely as not incurred in or aggravated during the July 2005 period of ACDUTRA. The Board concludes that, while the appellant has current symptoms manifested by bilateral leg weakness, the preponderance of the evidence weighs against finding that the appellant’s diagnosis of bilateral leg weakness is related to an in-service disease or injury during ACDUTRA. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Importantly, service treatment records during this short period do not show any reports of bilateral leg weakness. Although the appellant reported onset of bilateral leg weakness during this period, the Board finds her statements not credible. The appellant’s reports are internally inconsistent with the service treatment records that show no findings of bilateral leg weakness. Moreover, in her subsequent August 2005 Annual Certificate of Physical Condition, the appellant expressly denied any physical defects. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Further, the October 2019 VA examiner indicated that the appellant’s claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was the appellant’s bilateral leg muscle weakness was due to her lumbar sprain and chronic rheumatoid arthritis. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The appellant believes her bilateral leg weakness is related to an in-service injury, event, or disease during ACDUTRA. The appellant in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires specialized medical knowledge. Therefore, it is outside the competence of the appellant in this case because the record does not show that she 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 VA examination with opinion. In conclusion, based on the analysis above, the Board finds that the preponderance of evidence is against the appellant’s claim for service connection for bilateral leg weakness. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. Entitlement to service connection for a heart disorder is denied. The Veteran again contends that she has a heart disorder incurred during ACDUTRA. 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 appellant does not have a current diagnosis of a heart disorder 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 February 2020 VA examiner evaluated the appellant, reviewed the claims file and determined that she did not have a diagnosis of heart condition. In turn, the examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that on October 2006 examination, there is evidence of intermittent palpitations for a year with no history of known valvular heart disease, coronary artery disease, or endocarditis. However, available claim files lack evidence for a current, chronic diagnosis for a heart condition. A nexus has not been established. Further, despite consistent treatment over the course of the appeal, VA and private treatment records do not contain a diagnosis of heart disorder. Further, as the examination was normal, there exists no basis for finding that a threshold of functional impairment of earning capacity has been met. Absent such evidence, there can be no finding of a disability. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). While the appellant believes she has a current diagnosis of a heart disorder, she is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. In conclusion, based on the analysis above, the Board finds that the preponderance of evidence is against the appellant’s claim for service connection for a heart disorder. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. REASONS FOR REMAND Entitlement to service connection for a vision disorder, an acquired psychiatric disability with short term memory loss, and a respiratory disorder, to include bronchitis and COPD, are remanded. The Board previously remanded these issues for VA examinations with opinions. With respect to the Veteran’s claimed vision disorder, the October 2019 VA examiner diagnosed dry eye syndrome and opined that it was at least as likely as not incurred in or caused by the claimed in-service injury, event or illness. However, in the rationale, the examiner indicated that the Veteran’s dry eye disease was likely caused by her lupus. As discussed above, service connection has not been awarded for lupus. As such, given the apparent contradictions in the opinion, the Board finds that the opinion is inadequate and this issue must be remanded for an addendum opinion to clarify the examiner’s findings. With respect to the issue of service connection for an acquired psychiatric disorder, the October 2019 VA examiner for mental disorders found that the Veteran did not meet the diagnostic criteria for mental disorder. In turn, the examiner opined that the Veteran’s condition was not related to service. The rationale was that the Veteran did not have a current diagnosis. Likewise, the February 2020 VA examiner also found that a respiratory disorder was not related to service. The examiner again based this opinion on lack of current diagnosis of a respiratory condition. However, earlier private treatment records show depression and anxiety. Further, VA clinical records show diagnoses of COPD and bronchitis. The Court has held that the requirement of a current disability is satisfied when the claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim, and that a claimant may be granted service connection even though the disability resolves prior to adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Accordingly, an addendum opinion with rationale is necessary with respect to these issues. The matters are REMANDED for the following action: 1. Obtain a clarifying addendum opinion with respect to the appellant’s vision disorder from the October 2019 examiner or another appropriate clinician. The examiner must opine whether the appellant’s vision disorder, diagnosed as dry eye syndrome, is at least as likely as not related to her short period of ACDUTRA in July 2005. A rationale for the opinion must be provided. The examiner is advised that the appellant has not been awarded service connection for lupus. 2. Obtain an addendum opinion with respect to the appellant’s mental disorder from the October 2019 VA examiner or another appropriate clinician. The examiner must opine whether the appellant’s depression and anxiety is at least as likely as not related to her short period of ACDUTRA in July 2005. A rationale for the opinion must be provided. The examiner is advised that the Veteran has a current disability for VA purposes. 3. Obtain an addendum opinion with respect to the appellant’s respiratory disorder from the February 2020 VA examiner or another appropriate clinician. The examiner must opine whether the appellant’s respiratory disorder, including COPD and bronchitis, is at least as likely as not related to her short period of ACDUTRA in July 2005. A rationale for the opinion must be provided. The examiner is advised that the Veteran has a current disability for VA purposes. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.N. Moats 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.