Citation Nr: 21004197 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 07-33 729 DATE: January 26, 2021 ORDER Entitlement to service connection for diabetes mellitus is denied. Entitlement to service connection for diabetic retinopathy is denied. Entitlement to service connection for peripheral neuropathy of the lower extremities is denied. Entitlement to service connection for a diabetic ulcer of the toe, claimed as a hole in the right great toe is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for an upper respiratory disorder, to include sinusitis and nasal polyposis is denied. Entitlement to service connection for a pulmonary disorder, to include asthma is denied. Entitlement to service connection for a disability manifested by joint and bone pain is denied. Entitlement to service connection for hearing loss is denied. Entitlement to service connection for a clotting disorder/hemophilia, claimed as a free bleeder, is denied. Entitlement to service connection for a gangrenous gallbladder is denied. Entitlement to service connection for a sleep disorder, to include difficulty sleeping and sleep apnea is denied. Entitlement to service connection for a cardiovascular disability, other than hypertension ,is denied. Entitlement to service connection for a stomach or gastrointestinal disorder is denied. Entitlement to service connection for an acquired psychiatric disorder to include major depressive disorder is denied. Entitlement to service connection for kidney disease is denied. Entitlement to service connection for a bladder injury is denied. Entitlement to a total disability evaluation based on individual unemployability due to service-connected disabilities (TDIU)is denied. Entitlement to special monthly compensation (SMC) based on the need for aid and attendance is denied. Entitlement to special monthly pension (SMP) based on the need for aid and attendance from February 19, 2013, is granted. FINDINGS OF FACT 1. The Veteran’s diabetes mellitus did not have its onset during active duty, did not manifest to a compensable degree within one year of discharge from service, and is not otherwise related to service. 2. The Veteran’s diabetic retinopathy did not have its onset during active duty, did not manifest to a compensable degree within one year of discharge from service, and is not otherwise related to service. 3. The Veteran’s peripheral neuropathies of the lower extremities did not have its onset during active duty, did not manifest to a compensable degree within one year of discharge from service, and is not otherwise related to service. 4. The Veteran’s diabetic ulcer of toe, claimed as hole in right great toe, did not have its onset during active duty, did not manifest to a compensable degree within one year of discharge from service, and is not otherwise related to service. 5. The Veteran’s hypertension did not have its onset during active duty, did not manifest to a compensable degree within one year of discharge from service and is not otherwise related to service. 6. The Veteran’s claimed upper respiratory disorder, to include sinusitis and nasal polyposis did not manifest during active duty and it not otherwise shown to be related to military service. 7. The Veteran’s claimed pulmonary disorder, to include asthma, did not manifest during active duty and is not otherwise shown to be related to military service. 8. There is no competent evidence of record which shows the Veteran had a disability manifested by joint and bone pain that was related to his time in service. 9. There is no competent evidence of record which shows the Veteran had hearing loss that was causally related to active service or manifested within one year of his discharge from service. 10. The Veteran’s claimed clotting disorder/hemophilia, claimed as a free bleeder, did not manifest during active duty and is not otherwise shown to be related to military service. 11. There is no competent evidence of record which shows the Veteran’s gangrenous gallbladder manifested during active duty or was otherwise shown to be related to his military service. 12. There is no competent evidence of record which shows the Veteran had a sleep disorder that manifested during active duty or was otherwise shown to be related to his military service. 13. There is no competent evidence of record which shows the Veteran had cardiovascular disability, other than hypertension, that manifested during active duty or was otherwise shown to be related to his military service. 14. There is no competent evidence of record which shows the Veteran had a stomach or gastrointestinal disorder that manifested during active duty or was otherwise shown to be related to his military service. 15. There is no competent evidence of record which shows the Veteran had an acquired psychiatric disorder, to include major depressive disorder that manifested during active duty or was otherwise shown to be related to his military service. 16. There is no competent evidence of record which shows the Veteran had kidney disease that had its onset during active duty, manifested to a compensable degree within one year of discharge from service, or is otherwise related to service. 17. There is no competent evidence of record which shows the Veteran had a bladder injury that occurred during active duty or was otherwise shown to be related to his military service. 18. As the Veteran is not service connected for any disability, entitlement to TDIU and SMC based on the need for aid and attendance are denied as a matter of law. 19. Since February 19, 2013, the Veteran was shown to be in need of regular aid and attendance by another individual, for purposes of SMP. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for diabetes mellitus are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for diabetic retinopathy are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.307, 3.309, 3.310. 3. The criteria for entitlement to service connection for peripheral neuropathy of the lower extremities, to include as secondary to diabetes mellitus, are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.307, 3.309, 3.310. 4. The criteria for entitlement to service connection for a diabetic ulcer of the toe, claimed as a hole, right great toe are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.307, 3.309, 3.310. 5. The criteria for entitlement to service connection for hypertension, to include as secondary to diabetes mellitus, are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 6. The criteria for service connection for an upper respiratory disorder, to include sinusitis and nasal polyposis, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for a pulmonary disorder, to include asthma, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for a disability manifested by joint and bone pain are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for service connection for hearing loss are not met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 10. The criteria for service connection for clotting disorder/hemophilia, claimed as a free bleeder, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 11. The criteria for service connection for a gangrenous gallbladder are not met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 12. The criteria for service connection for a sleep disorder are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 13. The criteria for service connection for a cardiovascular disability, other than hypertension, are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 14. The criteria for service connection for a stomach or gastrointestinal disorder are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 15. The criteria for service connection for an acquired psychiatric disorder, to include major depressive disorder, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 16. The criteria for service connection for kidney disease are not met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 17. The criteria for service connection for a bladder injury are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 18. The criteria for TDIU are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.340, 3.341, 4.15, 4.16. 19. The criteria for SMC based on the need for aid and attendance are not met. 38 U.S.C. §§ 1114(l), 5107; 38 C.F.R. §§ 3.102, 3.350, 3.352(a). 20. The criteria for SMP based on the need for aid and attendance are met from February 19, 2013. 38 U.S.C. §§ 1521, 5121, 5107; 38 C.F.R. §§ 3.351, 3.352. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 1974 to June 1977. The Veteran died in September 2014. The Appellant is his surviving spouse. She requested, and was granted status as a substituted appellant for purposes of pursuing the Veteran’s claims to a conclusion. 38 U.S.C. § 5121A; 38 C.F.R. § 3.1010. These matters come before the Board of Veterans’ Appeals (Board) on appeal from February 2007 and May 2012 rating decisions by the Jackson, Mississippi Regional Office (RO) of the United States Department of Veterans Affairs. These issues have been before the Board previously, most recently in July 2018. In its July 2018 decision, the Board denied all of the Appellant’s claims. The Appellant appealed the Board’s decision to the Court of Appeals for Veteran’s Claims (Court). In July 2019, the parties agreed to a Joint Motion for Remand (JMR). The Court remanded the matter to the Board for action consistent with the JMR. Specifically, the matter was remanded because the Board erred in failing to provide the Appellant with a requested hearing. The Appellant’s requested hearing was scheduled, and she testified at an October 23, 2020, hearing held before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is associated with the claims file. Duty to Notify and Assist VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326(a). These duties have been satisfied in this case. Appropriate notice was provided in January 2015. The RO associated the Veteran’s service and VA private outpatient treatment records with the claims file. All released or submitted private treatment records have been associated with the claims file. No other relevant records have been identified and are outstanding. Appropriate and necessary examinations were afforded the Veteran, and are adequate for evaluation, as they include needed findings to permit application of the rating schedule and identification of current disability. As such, VA has satisfied its duty to assist with the procurement of relevant records. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). The Appellant has not raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. Service connection may also 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). In order to establish service connection on a direct basis, the record requires competent evidence showing: (1) the existence of a present disability; (2) in service incurrence or aggravation of an injury or disease; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Some chronic diseases may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). Diabetes mellitus, calculi of the kidney, bladder or gallbladder, hypertension, and hearing loss as an organic disease of the nervous system, each with a presumptive period of one year following separation from service, are listed conditions. Finally, a disability which is proximately due to, or the result of, or aggravated by a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. §§ 3.306, 3.310. Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). A layperson is generally not capable of opining on matters requiring medical knowledge. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence, the benefit of the doubt is afforded the claimant. Diabetes Mellitus The Appellant asserts the Veteran’s diabetes mellitus is related to his time in service. The Veteran’s service treatment records (STRs) are negative for a diagnosis and/or treatment of diabetes mellitus. Private medical records dated February 27, 1979, show the first record of a diagnosis of diabetes with a fasting blood sugar (FBS) of 250. A thorough review of the medical records shows no evidence of treatment for diabetes mellitus or a records of elevated glucose levels prior to this date. A letter from the Veteran’s private physician Dr. HFC dated May 1995 states the Veteran was diagnosed with diabetes mellitus in the spring of 1976. A September 1995 letter from Dr. HFC states the Veteran has been treated by Dr. HFC for most of his adult life. Dr. HFC stated that the Veteran was first diagnosed with diabetes in 1968 with an FBS of 270 and was place on a strict diet. This was not successful, and the Veteran was later put on oral medication and finally insulin. Dr. HFS noted that the Veteran had recently begun to have symptoms from diabetes in the form of leg problems and visual problems. The Veteran testified at a hearing before a Decision Review Officer at the RO in August 2007. He testified that he was not diagnosed or treated for type II diabetes while he was inservice. He testified that he thought he was treated for this condition six or seven months after his discharge from service. At an August 2009 Board hearing, the Veteran testified that he was diagnosed with type II diabetes in 1978 at the Wiggins Family Clinic. He testified that he believed he had symptoms of diabetes mellitus while in service – frequent urination, drinking a lot of water and losing weight. The Appellant testified that the Veteran lost weight after he was separated from service. The Veteran underwent a VA diabetes mellitus examination in April 2014. The Veteran reported that during his separation physical examination, he was told he might have diabetes. He stated he was seen by his family doctor who did not diagnose him with diabetes. He stated that, after seeing a kidney doctor, he was sent back to his family doctor who diagnosed him with diabetes. He reported that he was initially treated with oral medication but due to poor response he was started on insulin. At the time of the VA examination, he was taking insulin once as day and oral medications twice a day but was not following a diabetic diet. The VA examiner determined that it was less likely than not that the Veteran’s diabetes mellitus first manifested in service or within one year of his discharge from service. The VA examiner noted a letter from Dr. HFC included in the Veteran’s private medical records which indicated the Veteran’s first diagnosis of diabetes was in 1968 with an FBS of 270 and that he was later put on oral medications for several years. The VA examiner noted that if this date was correct, the Veteran would have been diagnosed with diabetes mellitus 6 years prior to entering service. However, his enlistment physical did not indicate a diagnosis of or treatment for diabetes. The VA examiner determined that it was more probable the Dr. HFC recorded the incorrect date. Further review of the Veteran’s private medical records reveals the first treatment note to document diabetes mellitus was dated February 27, 1979 which included a notation of elevated glucose. A subsequent treatment note dated March 1, 1979 indicated the Veteran’s blood sugar was elevated and he was to start on oral medication. The VA examiner noted that the Veteran was diagnosed with diabetes mellitus in 1979, which was 2 years after his discharge from service. The VA examiner also noted that other records suggested the Veteran was diagnosed with diabetes mellitus in 1976 while in active service, but that his STRs do not indicate a diagnosis of diabetes mellitus or at that time, or at the time of his separation from service. Based on a thorough review of the Veteran’s medical records and a VA examination, the VA examiner concluded that the Veteran’s current diabetes mellitus was not diagnosed during his active duty or within one year after his separation from service. The Appellant testified that when the Veteran got back from the Army, he started losing weight. He went to the doctor and found out he was diabetic. She also testified that at that time, the Veteran had a sore on his leg related to diabetes. She further testified that the Veteran told her that he felt like he had diabetes when he was getting out of the service. She testified that the Veteran told her that one of his “sergeants or something said, ‘That’s alright. He’s going home.’” The Board has considered both the Veteran’s and Appellant’s assertions that the Veteran developed diabetes mellitus while he was in service. However, the Veteran and the Appellant, as lay people, are not competent to offer a diagnosis of diabetes mellitus as they do not possess the requisite special knowledge. No probative value is given to their statements beyond their worth as physical observations. In this regard, such a diagnosis requires the administration and interpretation of glucose test results. Therefore, as this is a complex medical question, neither the Veteran nor the Appellant are competent to offer a diagnosis of diabetes mellitus. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). They can, of course, report what a medical professional told them. Such evidence, however, is not persuasive. Dr. HFC contradicts himself as to date of onset, and STRs contradict the Veteran’s first-hand and the Appellant’s second-hand reports. The Board assigns more weight to the competent medical evidence which establishes a diagnosis of diabetes mellitus on February 27, 1979, more than one year after the Veteran’s June 1977 separation from service. As diabetes mellitus did not manifest to a compensable degree within one year of the Veteran’s discharge from service, presumptive service connection for this disability is not warranted. Direct service connection must also be denied. There is no evidence of diabetes mellitus in service, nor is there competent and credible evidence of a nexus to service. Accordingly, the preponderance of the evidence is against the Veteran’s claim for service connection for diabetes mellitus. The benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, at 1 Vet. App. 49 (1990). Diabetic Retinopathy, Peripheral Neuropathy of the Lower Extremities, Diabetic Ulcer of Toe, and Hypertension The Appellant asserts that the Veteran’s diabetic retinopathy, peripheral neuropathy of the lower extremities, and hypertension are secondary to his diabetes mellitus. As the Veteran is not service connected for diabetes mellitus, service connection for diabetic retinopathy, peripheral neuropathy of the lower extremities, diabetic ulcer of toe claimed as hole right great toe, and hypertension cannot be granted on a secondary basis. The Veteran’s STRs are negative for diagnoses and/or treatment of diabetic retinopathy, peripheral neuropathy of the lower extremities, diabetic ulcer of the toe, and hypertension. The Board notes that hypertension is subject to a presumption of service connection if manifested to a compensable degree within one year of separation from service. The medical evidence of record shows the Veteran sought treatment from a private provider in March 2003 for complaints of elevated blood pressure. He was diagnosed with hypertension at that time. As this diagnosis was made 26 years after the Veteran’s discharge from service, the presumption of service connection is not warranted for hypertension. 38 C.F.R. § 3.307, 3.309. Similarly, neuropathy is reported to have had its onset around 2001, well after service and beyond any applicable presumptive period. The Appellant has not made any other contentions in regard to these claims and has not pointed to an in-service event or injury to support her claims for service connection. Thus, the criteria for the claims of entitlement to service connection for diabetic retinopathy, peripheral neuropathy of the lower extremities, diabetic ulcer of toe, and hypertension have not been met. 38 C.F.R. § 3.303, 3.310. Upper Respiratory Disorder, Pulmonary Disorder The Appellant asserts that the Veteran had an upper respiratory disorder, to include sinusitis and nasal polyposis and a pulmonary disorder, to include asthma that were related to his time in service. The Veteran’s STRs reflect treatment for possible lobe pneumonia in July 1974. He was treated for bronchitis in December 1976. His separation physical is negative for a record of any upper respiratory or pulmonary disorder. Post-service medical records dated January 1996 note nasal polyposis. A November 1996 hospital report notes the Veteran’s history of bronchial asthma. A December 1996 radiology report from a chest X-ray reflected an increased in bronchovascular congestion in the superior segment of the right lower lobe with development of subsequent atelectatic changes in the left lower lobe. On February 12, 1996, the Veteran sought treatment at a VA emergency room for a nosebleed. He reported that he had polyps removed on the last Wednesday and did not have any problems until he started bleeding the night before. The clinician noted that there was not apparent bleeding at the time of the visit. A VA treatment note dated March 1996 notes the Veteran had asthma. An October 1996 treatment note indicates the Veteran had recurrent polyps on his left side with chronic sinusitis. Findings from a February 1997 CT scan of the Veteran’s sinuses were consistent with his diagnosis of polyposis. February 1997 treatment notes indicated that Veteran’s polyposis was greater on the left than the right. A September 1997 chest x-ray revealed an essentially stable chest since January 1996. There were no signs of acute lung disease. The Veteran underwent a VA sinusitis examination and a VA respiratory examination in January 2012. The VA examiner noted the Veteran’s diagnoses of allergic rhinitis, nasal polyps and asthma. The VA examiner determined that it was less likely than not that the Veteran’s claimed conditions were related to his time in service. The VA examiner noted that the Veteran was treated once in service for an upper respiratory infection and for pneumonia. There was no record of treatment for allergic rhinitis or sinusitis and no continuity of care for those disabilities. The Veteran reported he was diagnosed with asthma in 1985. The VA examiner concluded that it was less likely than not that the Veteran’s asthma was related to service. At her October 2020 hearing the Appellant testified that the Veteran had surgery on his nose. Based on a thorough review of the evidence of record, the Board finds that service connection for an upper respiratory disorder, to include sinusitis and nasal polyposis and service connection for a pulmonary disorder, to include asthma are not warranted. The competent evidence of record does not establish that the Veteran had an upper respiratory disability, to include sinusitis and nasal polyposis or a pulmonary disorder, to include asthma that were either caused or aggravated by service; nor does it show the Veteran experienced symptoms of either or condition that continued from service until his death. The first record of nasal polyposis, chronic sinusitis was documented in 1996, 19 years after his discharge from service. The Veteran reported that he was diagnosed with asthma in 1985, 8 years after his discharge from service. Although the Appellant believes that the Veteran’s claimed upper respiratory disorders and pulmonary disorders were related to his time in service, she is not competent to render an opinion as to such as she is a layperson lacking the necessary training and knowledge to do so. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Additionally, no medical professional has supported her position. Accordingly, the preponderance of the evidence is against the Veteran’s claims for service connection for an upper respiratory disorder, to include sinusitis and nasal polyposis and for a pulmonary disorder, to include asthma. The benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, at 1 Vet. App. 49 (1990). Fibromyalgia/Joint and Bone Pain The Appellant asserts the Veteran had a disability manifested by joint and bone pain that was related to his time in service. STRs show treatment for complaints of muscle strain in November 1975 from performing leg lifts. The Veteran’s separation physical examination was negative for bone or joint deformity and there is no record of a disability manifested by joint and bone pain. The Veteran underwent a VA spine examination in January 2011. The Veteran’s degenerative joint disease of the spine was determined to not be related to his time in-service. The Board noted that this issue is not on appeal. Private medical records dated August 2014 reflect complaints of joint pain and left pain with walking. After a thorough review of the record, the Board finds that there is no medical evidence that establishes the Veteran had a disability manifested by joint and bone pain. There is no evidence which shows a disability manifested by joint pain and bone pain manifested to a compensable degree within one year of service, nor is there any evidence of continuity of symptoms. 38 C.F.R. § 3.307, 3.309; Walker, 703 F.3d 1331. While the Appellant is credible to describe the symptoms of joint pain and bone pain the Veteran experienced, determining the exact nature and diagnosis of any joint or bone disorder requires specialized testing and medical knowledge or training which the Appellant is not shown to have. She lacks the knowledge and training to conclude whether such observable symptoms are part of a chronic disease or disorder, or to opine regarding the cause of such. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Additionally, no medical professional has supported her position. The preponderance of the evidence is therefore against a finding of service connection for a disability manifested by joint and bone pain and the claim must be denied. There is no reasonable doubt to be resolved in this case. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, at 1 Vet. App. 49 (1990). Hearing Loss The Appellant asserts the Veteran had hearing loss which was due to his time in service. The Veteran’s STRs reflected normal hearing on both his entrance and separation examinations, with a mild loss at 4kHz in the right ear. The Veteran’s service personnel records reflect his military occupational specialty (MOS) was 36K20, a tactical wire operations specialist. The Appellant testified that the Veteran had trouble hearing while he was in service, stating that one had to repeat things for the Veteran to hear. Private and VA treatment records are negative for treatment for complaints of hearing loss. The Veteran underwent a VA hearing loss examination in January 2012. The VA examiner noted the Veteran had conductive hearing loss and sensorineural hearing loss. The VA examiner noted that no threshold shifts in hearing were noted during the Veteran’s military service and determined that it is less likely than not that the Veteran’s hearing loss was caused by or a result of the Veteran’s military service. After a thorough review of the record, the Board finds that service connection for hearing loss is not warranted. The Board notes that the Veteran filed an initial claim for service connection in 1995, which was limited to service connection for diabetes. The Veteran did not file a claim for hearing loss until March 2010, 33 years after his separation from service. Although the Appellant testified that the Veteran had trouble hearing since his time in service, the Veteran has not made such a statement. Further, the actual diagnosis of hearing loss requires specialized testing and medical knowledge or training which the Appellant is not shown to have. She lacks the knowledge and training to conclude whether such observable symptoms were part of a chronic disease or disorder, or to opine regarding the cause of such. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). This is particularly true in light of January 2012 examination findings indicating the role of sinus problems causing conductive, not noise-induced sensorineural loss. Clotting/Hemophilia/Free Bleeder The Appellant asserts the Veteran had hemophilia, also claimed as a free bleeder that was related to his time in service. The Veteran’s STRs are negative for a diagnosis of hemophilia, a free bleeder or any type of blood disorder. A review of the Veteran’s post service medical records shows that on December 7, 1996 the Veteran underwent an exploratory laparotomy for intra-abdominal bleeding which occurred after his gall bladder removal surgery on December 5, 1996. The postoperative diagnosis was bleeding diathesis. The Appellant testified that after service, the Veteran had an outpatient surgery on his nose. When he returned home, his nose started bleeding and wouldn’t stop. He went back to the hospital and they gave him plasma. She testified that every time the Veteran had surgery, he had to get plasma. She told his doctors that he was a hemophiliac. After a careful review of the record, the Board finds that the preponderance of the evidence is against the claim. Although the Appellant has expressed her belief in a connection, she lacks the knowledge and training required to render a nexus opinion on a cause and effect relationship unobservable to a lay person. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The Veteran has simply asserted her opinion, without a clear rationale or support; no probative value is given her statements beyond their worth as physical observations. There is no medical evidence associated with the file that establishes a link between the Veteran’s service and his post service diagnosis of bleeding diathesis, nor has the Appellant asserted that a medical professional told either her or the Veteran that this condition was related to any injury or disease sustained in service. The Board finds there is no competent evidence of record which links this disability to the Veteran’s active duty service. Accordingly, the Board concludes that the preponderance of the evidence is against the claim for service connection for a clotting disorder/hemophilia, a free bleeder or any type of blood disorder, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Gangrenous Gallbladder The Appellant asserts that the Veteran’s gangrenous gallbladder was related to service. The Veteran’s STRs are negative for a diagnosis of a gallbladder disability and/or symptoms of a gallbladder disability. There is no record of such on the report of his separation physical examination. The Appellant testified at her hearing that the Veteran developed gangrene which affected his gallbladder approximately two years after his discharge from service. The Veteran’s post service medical records reflect he underwent surgery on December 5, 1996. The preoperative diagnosis was acute cholecystitis; postoperative diagnosis was gangrenous gallbladder. After a careful review of the record, the Board finds that the preponderance of the evidence is against the claim. Although the Appellant has expressed her belief in a connection, she lacks the knowledge and training required to render a nexus opinion on a cause and effect relationship unobservable to a lay person. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The Veteran has simply asserted her opinion, without a clear rationale or support; no probative value is given her statements beyond their worth as physical observations. There is no medical evidence associated with the file that establishes a link between the Veteran’s service and his post service diagnosis of gangrenous gallbladder, nor has the Appellant asserted that a medical professional told either her or the Veteran that this condition was related to any injury or disease sustained in service. Additionally, as the Veteran’s gangrenous gallbladder did not manifest to a compensable degree within one year of the Veteran’s discharge from service, presumptive service connection for this disability is not warranted. The Board finds there is no competent evidence of record which links this disability to the Veteran’s active duty service. Accordingly, the Board concludes that the preponderance of the evidence is against the claim for service connection for a gangrenous gallbladder, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Sleep disorder, to include Sleep Apnea The Appellant asserts that the Veteran had a sleep disorder, to include sleep apnea, that was related to service. The Veteran’s STRs are negative for treatment for complaints of trouble sleeping and/or sleep apnea while he was in service. The Appellant testified that the Veteran had trouble sleeping at night and would sleep in his chair during the daytime. She testified that he snored and that he stopped breathing, and that he passed away prior to a sleep apnea test. She testified that she remembered him snoring when he was both in and out of the service. The Veteran’s post service medical records are negative for a diagnosis of a sleep disorder and/or sleep apnea. While the Appellant is competent to report the Veteran’s snoring and difficulty sleeping, as these are observable symptoms, she lacks the knowledge and training to conclude whether such are part of a chronic disease or disorder. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The Board concludes that the Veteran did not have a current diagnosis of a sleep disorder, to include sleep apnea, and did not have such at any time since the filing of his claim. In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 255 (1992). Accordingly, service connection for a sleep disorder, to include sleep apnea is not warranted. The Board has considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the claim for service connection for a sleep disorder, to include sleep apnea, the doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Cardiovascular Disability The Appellant asserts that the Veteran had a cardiovascular disability, other than hypertension, that was related to service. The Veteran’s STRs are negative for treatment for complaints and/or a diagnosis of a cardiovascular disability while he was in service. The Veteran’s post service medical records reflect a new diagnosis of mild cardiomyopathy in September 2014. A private treatment record dated August 2014 reflected regular rate and rhythm of heard, no murmurs. After a careful review of the record, the Board finds that the preponderance of the evidence is against the claim. Although the Appellant has expressed her belief in a connection, she lacks the knowledge and training required to render a nexus opinion on a cause and effect relationship unobservable to a lay person. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The Veteran has simply asserted her opinion, without a clear rationale or support; no probative value is given her statements beyond their worth as physical observations. There is no medical evidence associated with the file that establishes a link between the Veteran’s service and his post service diagnosis of mild cardiomyopathy 37 years after his discharge from service, nor has the Appellant asserted that a medical professional told either her or the Veteran that this condition was related to any injury or disease sustained in service. The Board finds there is no competent evidence of record which links this disability to the Veteran’s active duty service. Accordingly, the Board concludes that the preponderance of the evidence is against the claim for service connection for a cardiovascular disability, other than hypertension, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Stomach/Gastrointestinal Disorder The Appellant asserts that the Veteran had a stomach and/or gastrointestinal disorder that was related to his time in service. The Veteran’s STRs are negative for treatment and/or a diagnosis of a stomach or gastrointestinal disorder during service. The Appellant testified that the Veteran had trouble controlling his bowels and had accidents. The Veteran’s post service medical records are negative for a diagnosis of a stomach and/or gastrointestinal disorder. While the Appellant is competent to report the Veteran’s had difficulty controlling his bowels, as these are observable symptoms, she lacks the knowledge and training to conclude whether such are part of a chronic disease or disorder. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The Board concludes that the Veteran did not have a current diagnosis of a stomach and/or gastrointestinal disorder and did not have such at any time since the filing of his claim. In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 255 (1992). Accordingly, service connection for a stomach and/or gastrointestinal disorder is not warranted. The Board has considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the claim for service connection for a stomach and/or gastrointestinal disorder, the doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Acquired Psychiatric Disorder, to include Major Depressive Disorder The Appellant asserts that the Veteran had depression that was related to his time in service. The Veteran’s STRs are negative for treatment for symptoms of and/or a diagnosis of depression. The Veteran’s post service medical treatment records are negative for treatment for symptoms of and/or a diagnosis of depression. The Appellant testified that the Veteran was depressed and that his depression started right after service. While the Appellant is competent to report the Veteran’s was depressed, as these are observable symptoms, she lacks the knowledge and training to conclude whether such are part of a chronic disease or disorder. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The Board concludes that the Veteran did not have a current diagnosis of an acquired psychiatric disorder, to include major depressive disorder and did not have such diagnosis at any time since the filing of his claim. In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 255 (1992). Accordingly, service connection for an acquired psychiatric disorder, to include major depressive disorder is not warranted. The Board has considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the claim for service connection for an acquired psychiatric disorder, to include major depressive disorder, the doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Kidney Disease The Appellant asserts that Veteran’s kidney disease was related to service. The Veteran’s STRs are negative for a diagnosis of kidney disease and/or treatment for symptoms of a kidney disability. There is no record of such on the report of his separation physical examination. The Veteran’s post service medical records reflect treatment for a urinary tract infection in May 1990 and for trouble with his prostate and kidneys in April 1993. A September 2003 treatment note indicates possible kidney stones. After a careful review of the record, the Board finds that the preponderance of the evidence is against the claim. Although the Appellant has expressed her belief in a connection, she lacks the knowledge and training required to render a nexus opinion on a cause and effect relationship unobservable to a lay person. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The Veteran has simply asserted her opinion, without a clear rationale or support; no probative value is given her statements beyond their worth as physical observations. There is no medical evidence associated with the file that establishes a link between the Veteran’s service and his claimed kidney disease, nor has the Appellant asserted that a medical professional told either her or the Veteran that this condition was related to any injury or disease sustained in service. The Board notes that the Veteran may have had kidney stones in 2003; however, as this did not manifest to a compensable degree within one year of the Veteran’s discharge from service, presumptive service connection for this disability is not warranted. The Board finds there is no competent evidence of record which links the Veteran’s claimed kidney disease to his active duty service. Accordingly, the Board concludes that the preponderance of the evidence is against the claim for service connection for a gangrenous gallbladder, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Bladder Injury The Appellant asserts that the Veteran had a bladder injury that was related to service. The Veteran’s STRs are negative for treatment for complaints of a bladder injury or a diagnosis of a bladder disability while he was in service. As noted above, the Veteran’s post service medical records reflect treatment for a urinary tract infection in May 1990 and for trouble with his prostate and kidneys in April 1993. The Veteran’s post service medical records are negative for a diagnosis of a bladder injury or disability. The Board concludes that the Veteran did not have a current diagnosis of a bladder injury and did not have such at any time since the filing of his claim. In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 255 (1992). Accordingly, service connection for a bladder injury is not warranted. The Board has considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the claim for service connection for a bladder injury, the doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). TDIU TDIU is awarded where service-connected disabilities render a Veteran unable to secure and follow substantially gainful employment. Basic eligibility is established where a Veteran has a single service-connected disability rated at least 60 percent disabling, or multiple service-connected disabilities rated a combined 70 percent disabling, with at least one of the conditions rated at least 40 percent disabling. 38 C.F.R. § 4.16(a). In this case, the Veteran was not service connected for any disability prior to his death, and the Board has not found him entitled to such now. Therefore, the Veteran is ineligible for consideration for TDIU. Entitlement to TDIU is denied as a matter of law. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16. SMC Based on the Need for Aid and Attendance, or on Being Housebound Special monthly compensation (SMC) at the aid and attendance (A&A) rate under subsection (l) is payable when a Veteran, due to service-connected disability, has the anatomical loss or loss of use of both feet, or of one hand and one foot, or is blind in both eyes, with 5/200 visual acuity or less, or is permanently bedridden or has such significant disabilities as to be in need of regular A&A. 38 C.F.R. § 1114 (i); 38 C.F.R. § 3.350(b), 3.352(a). SMC at the housebound rate under subsection (s) is awarded where the Veteran has a service-connected disability rated as total and (1) has additional service-connected disability or disabilities independently ratable at 60 percent or more, or (2) is permanently housebound due to such service-connected disability or disabilities. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350 (i). The following criteria will be considered in determining the need for regular A&A: inability of a claimant to dress or undress himself, or to keep himself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid; inability to feed himself through the loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect him from hazards or dangers incident to his daily environment. See 38 C.F.R. §§ 3.350(b)(3), (4), 3.352(a). It is only necessary that the evidence establish that the Veteran is so helpless as to need regular A&A, not that there be a constant need. See 38 C.F.R. § 3.352(a). Importantly, in order for the Veteran to prevail in this claim, the evidence must show that it is a service-connected disability that has resulted in his being in need of regular A&A or being housebound. See Prejean v. West, 13 Vet. App. 444 (2000). In this case, the Veteran was not service connected for any disability prior to his death, and the Board has not found him entitled to such now. Therefore, the Veteran is ineligible for consideration for SMC based on the need for Aid and Attendance or on Being Housebound. Entitlement to SMC based on the need for Aid and Attendance or on Being Housebound is denied as a matter of law. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16. SMP Based on Need for Aid and Attendance Each veteran who meets certain service requirements and who is permanently and totally disabled from non-service-connected disability not the result of the veteran's willful misconduct shall receive pension reduced by the amount of the veteran's annual income. 38 U.S.C. § 1521. An increased rate of pension in the form of SMP is provided when an otherwise eligible veteran needs regular aid and attendance. 38 U.S.C. § 1521; 38 C.F.R. § 3.351. Entitlement to SMP by reason of need for aid and attendance will be established if the evidence shows one of the following: (1) the veteran is blind or so nearly blind as to have corrected visual acuity of 5/200 or less in both eyes, or concentric contraction of the visual field to 5 degrees or less; (2) the veteran is a patient in a nursing home because of mental or physical incapacity; or (3) the veteran has a factual need for aid and attendance under the criteria set forth in 38 C.F.R. §§ 3.351(c), 3.352(a); 38 U.S.C. § 1502(b). The criteria considered in determining a factual need for need for aid and attendance include, in pertinent part, the inability to perform such tasks as to dress and undress oneself, to maintain ordinary cleanliness, to feed oneself, to attend to the wants of nature, or to have physical or mental incapacity which requires care or assistance on a regular basis to protect the claimant from the hazards or dangers incident to his or her daily environment. 38 C.F.R. § 3.352 (a). Not all the above disabling conditions need be found to exist in order to grant aid and attendance benefits. Id. It is only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there be a constant need. Id. The Veteran was in receipt of nonservice connected pension benefits from April 18, 1997. Private medical records dated June 2011 reflect the Veteran was legally blind in both eyes. The best corrected vision in his right eye was 20/400 and in his left eye was 20/200. The Veteran underwent a VA Aid and Attendance or Housebound Examination in May 2012. The Veteran reported that he remained independent in his activities of daily living. He would leave his home as he chose to and had the capacity to protect himself from hazards of daily environment. He reported that he had stopped driving four years earlier due to decreased vision. He stated that he would run errands with his wife and leave his home as he desired. He would tidy up his yard, picking up papers and trash. He watched television and used his cell phone. He self-administered medications. He attended church, visited his mother, and his adult children. He reported his wife did all his household chores. The VA examiner can walk without the assistance of another up to a few hundred yards. The Veteran submitted a VA Aid and Attendance, or Housebound Examination form dated February 19, 2013. The private examiner noted that the Veteran was able to feed himself. He was not able to prepare his own meals. He needed assistance in bathing and tending to his needs, and he required medication management. The Veteran was noted to lack the ability to manage his financial affairs. He was blind in his left eye. The Veteran underwent a VA eye condition examination in August 2014. His uncorrected distance vision was 20/100 and uncorrected near vision 20/50 in his right eye. In January 2015, the Appellant submitted a VA form 21-2680 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance which she completed regarding the Veteran. The Appellant stated that the Veteran was able to feed himself but dropped most of his food. He was not able to prepare his own meals. He needed assistance with bathing and attending to his hygiene needs. He did not require nursing home care, but the Appellant and her daughter took care of the Veteran. The Veteran required medication management and did not have the ability to manage his financial affairs. At the hearing, the Appellant testified that she bathed and dressed the Veteran. He did not go anywhere by himself; she went with him at all times. She cooked for him and did everything for him. She testified that he was not able to perform tasks such as boiling water or dusting. She testified that the Veteran was never left alone, because he was afraid to be by himself. Either the Appellant or one of her children was with the Veteran at all times. The Board finds that the evidence establishes that the Veteran’s disabilities necessitated regular aid and attendance as of February 19, 2013. He needed regular attendance from February 19, 2013 until his death in September 2014. As such, the claim for SMP based on aid and attendance is granted. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. M. Lunger, 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.