Citation Nr: 21003366 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 13-35 247 DATE: January 21, 2021 ORDER 1. Entitlement to service connection for coronary artery disease is denied. 2. Entitlement to service connection for diabetes mellitus is denied. 3. Entitlement to service connection for headaches is denied. 4. Entitlement to service connection for a psychiatric disorder, to include depressive disorder, is denied. 5. Entitlement to service connection for fatigue and feeling winded and/or out of breath (fatigue) is denied. 6. Entitlement to service connection for sinusitis is denied. 7. Entitlement to service connection for a left eye disability is denied. 8. Entitlement to service connection for a right eye disability is denied. REMANDED 9. Entitlement to service connection for hypertension is remanded. 10. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that coronary artery disease had an onset in service, manifested to a compensable degree within one year of service discharge, or is otherwise related to service. 2. The preponderance of the evidence is against finding that diabetes mellitus had an onset in service, manifested to a compensable degree within one year of service discharge, or is otherwise related to service. 3. The preponderance of the evidence is against finding that tension headaches began during active service or are otherwise related to an in-service injury or disease. 4. The preponderance of the evidence is against finding that a psychiatric disorder, to include depressive disorder, began during active service or is otherwise related to an in-service injury or disease. 5. The preponderance of the evidence is against finding that the Veteran has a diagnosis of chronic fatigue syndrome or any other disability related to his reported symptoms of fatigue. 6. The preponderance of the evidence is against finding that sinusitis began during active service or is otherwise related to an in-service injury or disease. 7. The preponderance of the evidence is against finding that a left eye disability began during active service or is otherwise related to an in-service injury or disease 8. The preponderance of the evidence is against finding that a right eye disability began during active service or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for coronary artery disease have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 2. The criteria for entitlement to service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 3. The criteria for entitlement to service connection for headaches have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 4. The criteria for entitlement to service connection for a psychiatric disorder, to include depressive disorder, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 5. The criteria for entitlement to service connection for fatigue have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 6. The criteria for entitlement to service connection for sinusitis have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 7. The criteria for entitlement to service connection for a left eye disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 8. The criteria for entitlement to service connection for a right eye disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1980 to March 1985. The Board remanded these matters in November 2017 for additional development. In consideration of the issues decided herein, the Board is satisfied there was substantial compliance with the remand directives and will proceed with review. Stegall v. West, 11 Vet. App. 268 (1998). Additionally, the Board notes that the Board remand directed that the Veteran be notified that records from Dr. S.R. required advanced payment for photocopies of medical records, that VA was unable to make such payments on his behalf, and that if the Veteran wanted to pay for and submit these records he could do so. In September 2018, the Veteran was mailed a letter containing the aforementioned notification, and the Veteran did not submit records from Dr. S.R. Thus, the Board finds that VA has fulfilled its duty to assist and will proceed with review. 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. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases, such as coronary artery disease and diabetes mellitus, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a). 1. Entitlement to service connection for coronary artery disease The Veteran believes that coronary artery disease had an onset in service. He reported in his October 2018 VA examination that his chest pain started in service. On his October 2013 VA Form 9, the Veteran reiterated that his chest pain began while he was on active duty, and he also reported that he experienced feeling tired even after sleeping in service, which he attributed to an onset of coronary artery disease in service. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for coronary artery disease. The reasons follow. As to evidence of a current disability, December 2002 private treatment records document a diagnosis of coronary artery disease. Therefore, the facts establish that the first element of a service-connection claim is met. As to evidence of a disease or injury in service, the service treatment records (STRs) do not show that the Veteran was diagnosed with heart disease, and he specifically denied a history of heart symptoms during service. For example, in a February 1985 separation examination, a clinical evaluations of the heart and vascular system were normal. Additionally, on the associated Report of Medical History, the Veteran specifically denied ever having or having had symptoms of shortness of breath, pain or pressure in his chest, palpitation or a pounding heart, or heart trouble. This is further supported by the STRs, which document multiple reports of treatment for other injuries or illness, including injuries to the eyes, wrists, and feet as well as cold and flu symptoms, but do not document treatment for heart symptoms. Thus, the preponderance of the evidence is against a finding that the facts show the second element of a service-connection claim is met. As to the Veteran’s lay statements that his chest pain began in service, the Board finds the contemporaneous STRs to be more probative of the symptomatology in service than the lay statements made during the appeal, which were not made until decades after the Veteran’s discharge from service. The Board acknowledges that the Veteran is competent to report symptoms such as the onset of chest pain. However, as noted above, the Veteran specifically denied ever having or having had chest pain during active service on his February 1985 Report of Medical History. The Veteran again denied a history of chest pain in Reports of Medical History that he completed in June 1985 and January 1986, both of which he completed within one year of service discharge, which shows a consistency that he was not experiencing chest pain around that time. He also described himself as being in “excellent heath” in the June 1985 Report of Medical History. The Board finds this to be highly probative evidence that the Veteran did not experience chest pain during his period of active service as statements made contemporaneously to the time period in question tend to be highly reliable. Additionally, the Board notes that the STRs document that the Veteran received treatment for numerous symptoms in service, including cold and flu-like symptoms and treatment for his eyes, wrists, and feet. The Board finds that this repeated treatment in service for various symptoms and conditions weighs against the Veteran’s reports that he was experiencing symptoms of chest pain in service as the Veteran was clearly reporting other symptomatology and was given numerous opportunities to report symptoms of chest pain but did not do so. Thus, the Board finds the contemporaneous STRs to be more probative than the statements made by the Veteran decades later that are inconsistent with those STRs. The Board also acknowledges the Veteran’s lay statements that he felt tired in service even after sleeping, which he attributed to his later diagnosis of coronary artery disease. Initially, the Board notes that the STRs, which as noted above contained numerous incidents of treatment for various injuries and illness, did not include documentation of feeling tired even after sleeping. Furthermore, though the Veteran is competent to report such symptomatology, he is not competent to link this symptom to the later onset of coronary artery disease as medical expertise is required. In this regard, the question involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. Thus, the Veteran’s assertion that his feeling tired in service was indicative of the onset of a heart disability is not probative. Without evidence of a disease or injury in service, direct service connection is not warranted. Despite not meeting the requirements for service connection on a direct basis, the Board notes that coronary artery disease is a chronic disease under 38 C.F.R. § 3.309, which allows for service connection on a presumptive basis if the chronic disease is manifested to a compensable degree within one year of discharge from service. However, the preponderance of the evidence is against finding that coronary artery disease had an onset within one year of discharge from service. As noted above, the Veteran completed a Report of Medical History three months after service discharge in June 1985, and he denied a history of shortness of breath, pain or pressure in chest, palpitation or pounding heart, and heart trouble. A January 1986 Report of Medical Examination shows that clinical evaluations of the heart and vascular system were normal. In the corresponding Report of Medical History completed at that time (January 1986), the Veteran again denied a history of shortness of breath, pain or pressure in chest, palpitation or pounding heart, and heart trouble. The earliest documentation of coronary artery disease was in December 2002, approximately 17 years after the Veteran’s discharge from service at which time, it seemed to be around the time he was diagnosed with such. For example, a December 2002 private medical record noted that the Veteran had a history of hypertension and hyperlipidemia and “new onset” of angina. Soon after that, a diagnosis of coronary artery disease was entered. For these reasons, the Board finds that the preponderance of the evidence is against finding that the Veteran’s coronary artery disease had an onset within one year of discharge from active service. Additionally, the Board notes that, though the Veteran’s claim included an assertion related to a diagnosis of COPD, the claims file does not support a finding that the Veteran has a diagnosis of COPD, and it is unclear how this diagnosis relates to service. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for coronary artery disease is denied. 2. Entitlement to service connection for diabetes mellitus The Veteran asserted in his October 2013 VA Form 9, Appeal to the Board, that his diabetes mellitus symptoms arose prior to his discharge from active duty even though he did not receive a diagnosis until many years later. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for diabetes mellitus. The reasons follow. As to evidence of a current disability, December 2002 private treatment records document that the Veteran was diagnosed with diabetes mellitus. Therefore, the facts establish that the first element of a service-connection claim is met. As to evidence of a disease or injury in service, the STRs do not show that the Veteran had a diagnosis of diabetes mellitus during service, and a clinical evaluation of the Veteran at his February 1985 separation examination was normal. In the corresponding Report of Medical History, the Veteran denied a history of sugar in his urine. Additionally, the preponderance of the evidence is against finding that symptoms of diabetes mellitus had an onset in service. At the October 2018 VA examination, the examiner noted the symptoms of diabetes mellitus included neuropathy in the bilateral upper and lower extremities. Additionally, the Veteran reported to the examiner that the first symptoms he noticed related to his diabetes mellitus were numbness and tingling in his feet, though he was unsure of the year of onset of these symptoms. A thorough review of the STRs do not include a diagnosis of diabetes mellitus. Additionally, the STRs do not document symptoms of numbness or tingling in the feet or lower extremities during the Veteran’s active service. For example, at the separation examination, clinical evaluations of the upper and lower extremities, the feet, and neurological system were normal. On the associated Report of Medical History, the Veteran denied a history of lameness, neuritis, and paralysis. Although the Veteran reported a history of foot trouble, this is presumably related to August 1981 and August 1982 STRs, in which the Veteran was treated for pain in his right foot after being stepped on or May 1981, February 1984, and January 1985 treatment for calluses on his bilateral feet. The STRs, which document treatment related to the lower extremities, including feet, did not include reports of numbness or tingling in the feet. The Board finds these reports in contemporaneous STRs to be highly probative that the Veteran was not experiencing numbness or tingling in his feet, or the onset of any other diabetic symptomatology, during his active service, and given that the preponderance of the remainder of the STRs, which document significant reports of treatment for other injuries or illness, including multiple instances in which the Veteran was treated for pain or other symptoms in his feet do not document treatment for numbness or tingling in his feet that suggest an onset of neuropathy potentially related to the onset of diabetes mellitus, the Board finds the extensive contemporaneous records to be highly probative evidence against the onset of diabetes mellitus in service. Thus, the preponderance of the evidence is against a finding that the second element of a service-connection claim is met. As to the Veteran’s lay statements that his symptoms of diabetes mellitus began in service, the Board acknowledges that the Veteran is competent to report symptoms such as the onset of numbness and tingling in his extremities. However, the Board finds the contemporaneous STRs to be more probative of the Veteran’s actual symptomatology in service than the Veteran’s lay statements that his symptoms of diabetes mellitus had an onset in service as these statements of an earlier onset were not made until decades after the Veteran’s discharge from service and contradict the contemporaneous evidence in the STRs. The Veteran continued to deny a history of lameness, neuritis, and paralysis in Reports of Medical History in June 1985, January 1986, October 1988, and December 1989. Thus, four years after service, the Veteran was denying these symptoms. Additionally, the Veteran was also denying a history of sugar in his urine in these same Reports of Medical History. Further, clinical evaluations of the upper and lower extremities, the feet, and neurological system were all normal in January 1986, October 1988, and December 1989. Thus, to the extent that the Veteran has attempted to claim that these symptoms occurred in service or soon thereafter, the contemporaneous records do not support this. Additionally, at the October 2018 VA examination, the Veteran, when specifically asked the date of onset of his symptoms, could not recall the year but noted that the numbness and tingling in his feet was the first symptom he experienced. The Veteran’s statements to the October 2018 VA examiner also weigh against the credibility the Veteran’s statements that his diabetes mellitus symptoms had an onset in service, as the Veteran, when specifically provided an opportunity to state that his symptoms had an onset in service, declined to do so. Without evidence of a disease or injury in service, service connection on a direct basis is not warranted. Despite not meeting the requirements for service connection on a direct basis, the Board notes that diabetes mellitus is a chronic disease under 38 C.F.R. § 3.309, which allows for service connection on a presumptive basis if the chronic disease is manifested to a compensable degree within one year of discharge from service. However, in this case the preponderance of the evidence is against finding that the diabetes mellitus had an onset within one year of discharge from service. Rather, the October 2018 VA examination did not document a diagnosis of diabetes mellitus until 2000, and private treatment records do not document a diagnosis of diabetes mellitus until 2002, suggesting a diagnosis approximately 15 or more years after discharge from service. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for diabetes mellitus is denied. 3. Entitlement to service connection for headaches The Veteran asserted that headaches had an onset in service on his October 2013 VA Form 9, and he also reported this history to the October 2018 VA examiner. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for headaches. The reasons follow. As to evidence of a current disability, the October 2018 VA examiner diagnosed the Veteran with tension headaches. Therefore, the facts establish that the first element of a service-connection claim is met. As to evidence of a disease or injury in service, the STRs show that the Veteran reported headaches in December 1980 and February 1985 STRs, and he reported a positive history of ever having or having had severe headaches on his February 1985 Report of Medical History. Thus, the facts establish that the second element of a service-connection claim is met. As to evidence of a nexus between the current disability and service, the Board finds that this element of a service-connection claim is not met. In an October 2019 addendum opinion to the October 2018 VA examination, the examiner opined that the current tension headaches were not at least as likely related to the reports of headaches in service as the treatment records do not support the Veteran’s statements that he has had ongoing treatment for headaches since his discharge from service and the current headaches do not appear to be related to any headaches or incidents in service.. The Board finds the October 2019 medical opinion to be highly probative, as the examiner reviewed the file, listened to the Veteran’s report of history, physically examined the Veteran, and provided a rationale for the opinion that relied on the specific facts of the case. These reported facts are consistent with the treatment records. The STRs following his discharge from active service in March 1985 document that the Veteran was not continuing to experience headaches. Specifically, in June 1985, January 1986, and October 1988 Reports of Medical History, the Veteran specifically denied ever having or having had severe headaches. Clinical examinations conducted in association with these Reports of Medical History in January 1986, October 1988, and December 1989 show that clinical evaluations of the head and neurological system were normal. Additionally, VA records from September 2008, April 2010, December 2010, June 2011, and December 2015 document that the Veteran specifically denied having headaches. The Board is aware that the Veteran reported headaches to a VA treatment provider in September 2008; however, he related that his headaches were associated with taking his medication for diabetes mellitus, and there was no notation made that this report suggested the onset of a chronic headache disability, such as tension headaches. The VA treatment records from September 2010 in which the Veteran reported headaches document that the headaches seemed to be a symptom related to higher blood pressure. This is evidence consistent with the opinion of the VA examiner and against a nexus between the current disability and service, and the Board finds the opinion of the VA examiner and the Veteran’s medical treatment records to be the most probative evidence as it relates to a nexus between the currently diagnosed tension headaches and the headaches reported in service. Thus, the Board finds that the preponderance of the evidence is against finding a nexus between the current tension headaches and reports of severe headaches during active service. While the Veteran is competent to report symptoms that he experienced headaches in service and since service, he is not competent to directly link the current diagnosis of tension headaches to headaches he experienced in service, as medical expertise is required. In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran’s own opinion is nonprobative evidence. Furthermore, the Board finds the Veteran’s lay statements that he has experienced headaches since his discharge from service to be less probative than the contemporaneous medical records, including STRs after his period of active service and VA treatment records. While the Veteran is competent to report experiencing headaches since discharge, the Board finds these statements contradict the multiple instances, fully addressed above, in which the Veteran specifically denied experiencing headaches, and, therefore, the Board finds these statements to be less credible. Thus, the Board finds the Veteran’s reports of his symptomatology on official medical records and statements made to treatment providers at the time of treatment to be more probative than statements made decades later for the purposes of claiming service connection. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for headaches is denied. 4. Entitlement to service connection for a psychiatric disorder The Veteran asserted on his October 2013 VA Form 9 that his depression had an onset in service and that he did not report his symptoms, as he did not know how to ask for help. At the October 2018 VA examination, the Veteran reported that he went to “the dispensary” for anger spells when he was in service and noted that he got into conflicts with people on the ship on which he served. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for depression. The reasons follow. As to evidence of a current disability, an October 2018 VA examination report shows that the Veteran was diagnosed with mild persistent depressive disorder. Therefore, the facts establish that the first element of a service-connection claim is met. As to evidence of a disease or injury in service, the STRs are silent for treatment for a psychiatric disorder or psychiatric symptoms. A clinical evaluation conducted at the February 1985 separation examination was normal for psychiatric symptomatology, and on the associated Report of Medical History, the Veteran specifically denied ever having or having had depression or excessive worry and nervous trouble of any sort, despite noting a positive history of other symptoms. Given that the Veteran did report having or having had numerous symptoms on this Report of Medical History, the Board finds it is noteworthy, and probative, that the Veteran specifically denied ever having or having had depression or excessive worry or nervous trouble of any sort. The Board finds this to be probative evidence that the Veteran did not experience psychiatric symptoms during his period of active service given the completeness and attention to detail in reporting other symptomology. Additionally, the Board notes that the STRs document that the Veteran received treatment for numerous symptoms in service, including cold and flu-like symptoms and treatment for his eyes, wrists, and feet. The Board finds that this repeated treatment in service for various symptoms and conditions weighs against the credibility of the Veteran’s reports that he was experiencing symptoms of depression in service. Thus, the Board finds it highly probative that, despite significant treatment records, these treatment records do not document a psychiatric disorder in service. Additionally, the Board finds the Veteran’s lay statement that he experienced depression symptoms in service but did not know how to report them or get help to be not credible, as they contradict other statements made by the Veteran during the course of the appeal. Initially, the Board notes that this assertion was made on the October 2013 VA Form 9 for the purposes of obtaining service connection, which is notably after the Veteran’s claims had been denied and after the Veteran had been provided numerous opportunities to provide this information in support of his claim. Additionally, this statement is in direct contradiction to the Veteran’s reports to the October 2018 VA examiner. At the October 2018 VA examination, the Veteran reported that he went to “the dispensary” for anger spells when he was in service and that he got into fights with people on the ship on which he served. As the Veteran has provided contradictory statements in regard to whether he experienced and reported symptoms in service, the Board finds the Veteran’s lay statements to be not credible and, therefore, less probative than the contemporaneous treatment records, which do not document treatment for or complaints of depression or other psychiatric symptoms and that the Veteran specifically denied having such symptoms at separation. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for a psychiatric disorder, to include depressive disorder, is denied. 5. Entitlement to service connection for fatigue The Veteran believes that he has a chronic fatigue disability that is related to service. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for fatigue. The reasons follow. The first element of service connection requires a current disability. After thorough review of the evidence of record, the Board finds the preponderance of the evidence is against a finding of a current disability of chronic fatigue syndrome or any other chronic fatigue disability. At a VA examination, conducted in October 2018, the examiner found no diagnosis of chronic fatigue syndrome. The examiner acknowledged the Veteran’s reports of sluggishness and fatigue but noted that these symptoms were likely attributable to diabetes mellitus, which is not service connected. Absent evidence of a current disability and the fact that the symptoms the Veteran reports experiencing have been attributed to diabetes mellitus, service connection for fatigue is denied. The Board acknowledges the Veteran’s assertion that he has a chronic fatigue disability. However, the Veteran is not competent to diagnose such a disability as medical expertise is required. As such, the question of the existence of a diagnosed disability in this case may not be competently addressed by lay evidence, and the Veteran’s own opinion is nonprobative evidence. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for fatigue is denied. 6. Entitlement to service connection for sinusitis The Veteran presumably believes that his current sinusitis had an onset in service. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for sinusitis. The reasons follow. As to evidence of a current disability, an October 2018 VA examination report shows that the Veteran was diagnosed with chronic sinusitis, and VA treatment records from as early as April 2010 document that the Veteran was having difficulties with his sinuses. Therefore, the facts establish that the first element of a service-connection claim is met. As to evidence of a disease or injury in service, the STRs do not show that the Veteran was diagnosed with sinusitis or was noted to have chronic problems with his sinuses during service. The Board acknowledges that the STRs document several instances in which the Veteran was treated for cold and/or flu symptoms while in service, which often included reports of a runny nose, congestion, or running sinuses. However, these all seem to be singular instances of an illness that resolved without residuals. The Veteran reported sinus trouble on a February 1985 Dental Health Questionnaire; however, on the separation examination, which was also completed on the same day in February 1985, clinical evaluations of the ear, nose, and throat and sinuses were normal. Additionally, on the Report of Medical History associated with the separation examination, the Veteran specifically denied a history of ear, nose and throat trouble, sinusitis, or chronic or frequent colds. The Board finds this highly probative that the Veteran did not believe he had symptoms of chronic sinusitis in service because the Veteran did not check ever having or having had any of these symptoms in these three, separate boxes despite filling out a detailed Report of Medical History that included noting other symptomatology he experienced during service. The evidence supports a finding that the in-service reports of some nasal symptomatology being resolved prior to discharge, as the Veteran continued to specifically deny ever having or having had ear, nose, and throat trouble, sinusitis, and chronic or frequent colds on Reports of Medical History completed in June 1985, January 1986, October 1988, and December 1989. Additionally, VA examinations conducted in January 1986, October 1988, and December 1989 all included documentation that clinical evaluations of the ear, nose, and throat and sinuses were normal. Thus, the preponderance of the evidence is against a finding that the second element of a service-connection claim is met. The Board also finds it probative that the Veteran did not provide an assertion as to an onset in service or symptomatology since his discharge from service for his sinusitis. On the October 2013 VA Form 9, the Veteran only states “I take issue with you denying my claim for service-connected compensation for sinusitis.” The Veteran did not provide a rationale to support that assertion, a notable absence considering the Veteran reported on the same VA Form 9 that he believed he had an onset of symptoms in service and/or continuous symptoms since service for many of his other claimed disabilities. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for sinusitis is denied. 7. – 8. Entitlement to service connection for a bilateral eye disability The Veteran reported on his October 2013 VA Form 9 that he believes that his current eye disabilities are related to service, as he had blurred vision in service and has continued to experience this symptom, along with pain in his eyes, since that time. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for a bilateral eye disability. The reasons follow. As to evidence of a current disability, an October 2018 VA examination report shows that the Veteran was diagnosed with bilateral nuclear sclerotic cataracts and bilateral mild, nonproliferative diabetic retinopathy. Therefore, the facts establish that the first element of a service-connection claim is met. As to evidence of a disease or injury in service, the STRs show that the Veteran had multiple incidents in which he reported injuries or symptomatology associated with his eyes in service. In April 1981, the Veteran was diagnosed with conjunctivitis, though it was noted that his field of vision was “okay.” In November 1982, the Veteran reported pain after he was poked in the left eye, and he was diagnosed with a corneal abrasion at that time. In October 1983, the Veteran reported eye problems and it was documented to be possible conjunctivitis. In May 1984, the Veteran reported blurred vision, tearing, and redness. He was diagnosed with iritis at that time. January 1985 records document another diagnosis of a mild corneal abrasion. Despite these multiple instances of treatment, the Board notes that the Veteran denied ever having or having had eye trouble in service, and he reported having vision in both of his eyes on the Report of Medical History associated with his February 1985 separation examination, and clinical evaluations of the eyes, ophthalmoscopic, pupils, and ocular motility were normal at that time, suggesting that any symptoms associated with the multiple injuries and diagnoses related to the eyes in service had resolved. This finding is supported by the January 1986, October 1988, and December 1989 Reports of Medical Examination, which show clinical evaluations of the eyes, ophthalmoscopic, pupils, and ocular motility were normal at those times, which covers the first four years following service discharge. Additionally, the Veteran consistently denied a history of eye trouble in the Reports of Medical History he completed in June 1985, January 1986, October 1988, and December 1989. These facts tend to show that the Veteran was not having ongoing eye problems in the years following service discharge, which does not support a nexus to service. Regardless of whether or not the symptoms related to eye injuries or illness in service had resolved prior to the Veteran’s discharge from active service, the Board finds the most probative evidence of record is against finding a nexus between the in-service incidents and the current diagnoses of diabetic retinopathy and nuclear sclerotic cataracts. At the October 2018 VA examination, the examiner opined that the current diagnoses were not at least as likely as not related to the Veteran’s service as these particular diagnoses were not made during service. Additionally, the examiner opined that the cataracts are likely related to the Veteran’s age, and the diabetic retinopathy was likely related to his diagnosis of diabetes mellitus, which the examiner noted to be likely hereditary in the Veteran’s case. The Board finds that the October 2018 VA medical opinion is highly probative, as the examiner reviewed the file, listened to the Veteran’s report of history, physically examined the Veteran, and provided a rationale for the opinion that relied on the specific facts of the case, which facts are accurate. This is evidence against a nexus between the current disability and service. Thus, the Board finds that the preponderance of the evidence is against finding a nexus between the current eye disabilities and treatment for conjunctivitis, iritis, and other symptomatology related to the eyes in service. While the Veteran is competent to report symptoms that he has experienced in service and since service, the Board finds the Veteran’s lay statements that he has continued to experience blurred vision and pain in his eyes to be less probative than the contemporaneous medical records and the negative nexus opinion. The STRs in the years immediately following his active service do not document that the Veteran was experiencing pain in his eyes or blurred visions. Rather, clinical evaluations of the eyes were normal in January 1986, October 1988, and December 1989. His vision was also documented to be 20/20 on all three of these examinations with no documentation of blurred vision. Additionally, on Reports of Medical History in June 1985, January 1986, October 1988, and December 1989, the Veteran specifically denied ever having or having had eye trouble, and he reported having vision in both eyes. These reports directly contradict the Veteran’s reports, made decades after discharge from service and for the purpose of obtaining service connection for an eye disability after initially being denied, of ongoing symptoms since discharge from service. The Board finds these repeated and specific contemporaneous denials of symptomatology of blurred vision or eye pain to be more probative and credible than the Veteran’s lay statements made decades later. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for a bilateral eye disability is denied. REASONS FOR REMAND 9. Entitlement to service connection for hypertension Regrettably, the Board finds an additional remand is necessary as to the claim for entitlement to service connection for hypertension. The November 2017 remand directed the AOJ to provide another VA examination that considered the Veteran’s lay statements that he experienced elevated blood pressure in service that was manifestation of his later-diagnosed hypertension. In October 2019, an opinion was provided that noted that there was no documentation of elevated blood pressure in service and that, though the Veteran reported that he started medication for hypertension six months after discharge, the documentation in the file does not support that contention. The Board finds that this is not an accurate representation of the facts documented in the STRs. Rather, the STRs document that the Veteran was noted to have elevated blood pressure of 142/100 in May 1984. And in January 1986, less than one year after the Veteran’s discharge from service, on a Report of Medical History, it was documented that the Veteran was taking medication for hypertension. In Reports of Medical History in October 1988 and December 1989 the Veteran reported having or having had high or low blood pressure, and examinations conducted in October 1988 and December 1989 documented his blood pressure as 128/78 and 130/80 respectively. As the VA examiner inaccurately represented the facts of the case and presumably based the negative nexus opinion on the inaccurate facts, a remand is necessary for an addendum opinion based on an accurate representation of the claims file. 10. Entitlement to a TDIU rating The issue of entitlement to a TDIU is inextricably intertwined with the issue of entitlement to service connection for hypertension, and thus, must also be remanded. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding the onset and etiology of the diagnosed hypertension. If the clinician finds that an examination is warranted, an examination should be scheduled. The examiner is asked to carefully review the claims file, especially the service treatment records, post-service medical records, and the Veteran’s statements. The examiner’s attention is specifically drawn to the following evidence: • The Veteran served on active duty from March 1980 to March 1985. • The Veteran’s contentions that he had elevated blood pressure and chest pain during service and that these symptoms were manifestations of hypertension and heart disease. See VBMS entry with document type, “Form 9,” receipt date 10/24/2013. • The May 1984 STR documenting elevated blood pressure of 142/100. See VBMS entry with document type, “STR-Medical,” receipt date 12/14/2015, pp. 63. • The January 1986 Report of Medical Examination, documenting blood pressure of 128/78, and the associated Report of Medical History, in which the Veteran reported having well-controlled hypertension and that he was taking medication for hypertension. See VBMS entry with document type, “STR-Medical,” receipt date 12/14/2015, pp. 17–18, 21–22. • The October 1988 Report of Medical Examination, documenting blood pressure of 130/80, and the associated Report of Medical History in which the Veteran reported a history of ever having or having had high or low blood pressure. See VBMS entry with document type, “STR-Medical,” receipt date 12/14/2015, pp. 24–26. • The December 1989 Report of Medical Examination, documenting blood pressure of 122/80, and the associated Report of Medical History in which the Veteran documented a history of ever having or having had pain or pressure in his chest that he associated with high blood pressure and high or low blood pressure. See VBMS entry with document type, “STR-Medical,” receipt date 12/14/2015, pp. 13–16. • The examiner's review of the record is NOT restricted to the evidence listed above. This list is provided in an effort to assist the examiner in locating potentially relevant evidence. After considering the entirety of the claims file, including the Veteran’s lay statements regarding reported symptoms, the examiner should opine as to whether it is at least as likely as not (50 percent probability or greater) that hypertension manifested during service from March 1980 to March 1985, within one year of service. The examiner is asked to provide a rationale for each opinion given, including providing the medical principles and evidence relied upon for each opinion. If the examiner is unable to provide an opinion without resorting to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Keninger, 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.