Citation Nr: 21004424 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 20-11 408 DATE: January 27, 2021 ORDER Entitlement to service connection for hyperlipidemia is denied. Entitlement to an effective date prior to June 26, 2018 for service connection for right lower extremity diabetic peripheral neuropathy, sciatic nerve (claimed as “neuropathy associated with DM2 (herbicide) with ED”) is denied. Entitlement to an effective date prior to June 26, 2018 for service connection for left lower extremity diabetic peripheral neuropathy, sciatic nerve (claimed as “neuropathy associated with DM2 (herbicide) with ED”) is denied. Entitlement to service connection for tick bite disease is denied. Entitlement to service connection for residual maladies of vaccines is denied. Entitlement to service connection for residuals of a broken nose is denied. Entitlement to service connection for inguinal hernia, to include residuals, is denied. Entitlement to service connection for malaria, to include residuals, is denied. Entitlement to service connection for umbilical hernia, to include residuals, is denied. REMANDED Entitlement to a compensable disability rating for erectile dysfunction (ED) is remanded. Entitlement to a disability rating in excess of 20 percent for right lower extremity diabetic peripheral neuropathy, sciatic nerve (claimed as “neuropathy associated with DM2 (herbicide) with ED”) is remanded. Entitlement to a disability rating in excess of 20 percent for right lower extremity diabetic peripheral neuropathy, sciatic nerve (claimed as “neuropathy associated with DM2 (herbicide) with ED”) is remanded. Entitlement to service connection for right upper extremity diabetic peripheral neuropathy, sciatic nerve (claimed as “neuropathy associated with DM2 (herbicide) with ED”) is remanded. Entitlement to service connection for left upper extremity diabetic peripheral neuropathy, sciatic nerve (claimed as “neuropathy associated with DM2 (herbicide) with ED”) is remanded. Entitlement to service connection for a kidney disorder is remanded. Entitlement to service connection for hypertension (HTN), to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for an acquired psychiatric disorder (as discrete from posttraumatic stress disorder (PTSD)), to include as secondary to service-connected disabilities is remanded. Entitlement to service connection for spine disorder(s) is remanded. Entitlement to service connection for sleep apnea, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for chronic obstructive pulmonary disease (COPD), to include as due to exposures to chemical resistant coating, Agent Orange, and asbestos, is remanded. Entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. Hyperlipidemia, also known has high cholesterol, is a laboratory finding, rather than a disability due to injury of disease for which VA compensation is available. 2. The Regional Office (RO) received that Veteran’s VA Form 21-526b (Supplemental Claim for Compensation) for service connection for right lower extremity diabetic peripheral neuropathy, sciatic nerve on June 26. 2018. 3. The RO received that Veteran’s VA Form 21-526b (Supplemental Claim for Compensation) for service connection for left lower extremity diabetic peripheral neuropathy, sciatic nerve on June 26, 2018. 4. The Veteran does not have a tick bite disease. 5. The Veteran does not have residual maladies of vaccinations. 6. The Veteran does not have residuals of a broken nose. 7. The Veteran does not have an either an inguinal hernia or residual symptoms which indicate the need for a supporting belt. 8. The Veteran does not have malaria or residuals of malaria. 9. The Veteran does not have an umbilical hernia or residuals of umbilical hernia. CONCLUSIONS OF LAW 1. A disability manifested by hyperlipidemia was not incurred in, or aggravated by, service. 38 U.S.C. § 1101, 1110, 1131, 1137, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 2. The criteria for an effective date prior to June 26, 2018 for service connection for right lower extremity diabetic peripheral neuropathy, sciatic nerve have not been met. 38 U.S.C. §§ 5107, 5110 (2012); 38 C.F.R. §§ 3.156(c); 3.400 (2019). 3. The criteria for an effective date prior to June 26, 2018 for service connection for left lower extremity diabetic peripheral neuropathy, sciatic nerve have not been met. 38 U.S.C. §§ 5107, 5110 (2012); 38 C.F.R. §§ 3.156(c); 3.400 (2019). 4. The criteria for entitlement to service connection for a tick bite disease have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2019) 5. The criteria for entitlement to service connection for residual maladies of vaccinations have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2019) 6. The criteria for entitlement to service connection for residuals of a broken nose have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2019) 7. The criteria for entitlement to service connection for inguinal hernia its residuals have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2019). 8. The criteria for entitlement to service connection for malaria and its residuals have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2019). 9. The criteria for entitlement to service connection for umbilical hernia and its residuals have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service in United States Army from May 1960 to April 1963 and from September 1964 to September 1967, including service in the Republic of Vietnam. The Veteran also had service in the Army National Guard starting in December 1982 to February 2000. These matters come before the Board of Veterans’ Appeals (Board) on appeal from multiple rating decisions from a Department of Veterans Affairs (VA) Regional Office (RO). The Board has recharacterized issues in light of the benefits sought by the Veteran and raised in the evidence of record. When a claimant makes a claim, he or she is seeking service connection for symptoms, regardless of how those symptoms are diagnosed or labeled. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). The Board has reviewed the evidence of record comprehensively. Although the Board has an obligation to provide reasons and bases to support a decision, there is no requirement to discuss, in detail, all the evidence submitted by or on behalf of a Veteran or an appellant. See Gonzales v. West, 218 F. 3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and the most relevant evidence about what this evidence shows, or fails to show, about the issues on appeal. The Veteran must not assume that the Board has overlooked pieces of evidence that are not discussed explicitly. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran or appellant). Active Duty and Active Duty for Training For VA purposes, the term “active military, naval, or air service” includes active duty, any period of active duty for training during which the Veteran was disabled or died from a disease or injury incurred in or aggravated in the line of duty, and any period of inactive duty training during which the individual was disabled or died from an injury incurred in or aggravated in the line of duty. 38 U.S.C.§ 101(24)(A)(B). Service Connection for Laboratory Findings Hyperlipidemia is not a service-connectable disability. The term “disability,” as used for VA purposes, refers to a condition resulting in an impairment of earning capacity. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). Consequently, although the Veteran has been noted to have high hyperlipidemia, this condition is not a disability for which VA compensation benefits are payable. 61 Fed. Reg. 20,440, 20,445 (May 7, 1996) (“Diagnoses of hyperlipidemia, elevated triglycerides, and elevated cholesterol are actually laboratory results and are not, in and of themselves, disabilities. They are, therefore, not appropriate entities for the rating schedule.”) While hyperlipidemia may be evidence of underlying disability or may later cause disability, service connection may not be granted for a laboratory finding alone. There is no evidence that the Veteran’s hyperlipidemia has caused any impairment of earning capacity or is a manifestation of other disease or injury for which service connection may be granted at this time. Competent Evidence 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). If the evidence is competent, the Board must then determine if the evidence is credible. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this regard, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. v. Brown, 7 Vet. App. 498, 511 (1995). In determining whether service connection or an increased disability rating 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 regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. Earlier Effective Dates The Veteran contends that he is entitled to an effective date prior to June 26, 2018 for service connection for both right and lower extremity diabetic peripheral neuropathy, sciatic nerve. Neither the Veteran nor his representative have indicated what effective date should be assigned. Moreover, these parties have not identified evidence that supports an earlier effective. “The duty to assist is not always a one-way street. If a veteran wants help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence.” Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim or a claim reopened after final disallowance, will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400. The effective date of an award of service connection shall be the day following the date of discharge or release if application is received within one year from such date of discharge or release. Otherwise, the effective date is the date of receipt of claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2)(i). Prior to March 24, 2015, VA recognized formal and informal claims. A claim is defined as a formal or informal communication in writing requesting a determination of entitlement, or evidencing a belief in entitlement, to a benefit. 38 C.F.R. § 3.1(p). An informal claim is any communication or action indicating intent to apply for one or more benefits and must identify the benefit sought. 38 C.F.R. § 3.155 (a). VA must look to all communications from a claimant that may be interpreted as applications or claims both formal and informal for benefits and is required to identify and act on informal claims for benefits. Servello v. Derwinski, 3 Vet. App. 196, 198 (1992). Effective on March 24, 2015, VA amended its rules as to what constitutes a claim for benefits; such now requires that claims be made on a specific claim form prescribed by the Secretary, which is available online or at the local Regional Office. These amendments are only applicable with respect to claims filed on or after March 24, 2015, and thus are applicable in the present matters. Although a claimant need not identify the benefit sought “with specificity,” see Servello v. Derwinski, 3 Vet. App. 196, 199-200 (1992), some intent on the part of the Veteran to seek benefits must be demonstrated. See Brannon v. West, 12 Vet. App. 32, 34-35 (1998). VA must perform a sympathetic reading to all pro se pleadings of record. Szemraj v. Principi, 357 F. 3d 1370, 1373 (Fed. Cir. 2004). A review of the evidence of record discloses that VA received the Veteran’s applicable VA Form 21-526b (Supplemental Claim for Compensation) on June 26, 2018. In associated correspondence, counsel specifically indicated that this was a “new claim for neuropathy secondary to diabetes mellitus.” See June 26, 2018 VA 21-526(b), p. 3. This VA 21-526(b) and associated correspondence includes an electronic facsimile imprint confirming successful transmission of the documents at 3:16 pm on June 26, 2018. Turning to the medical evidence of record, a VA clinician provided a diagnosis of bilateral lower extremity peripheral diabetic neuropathy as of the date of the July 31, 2018 VA diabetic sensory-motor peripheral neuropathy examination. Even if there had been a formal diagnosis of this disability prior to this clinician’s July 31, 2018 diagnosis, ir would be of no moment herein. The RO has already performed a sympathetic reading of the record by granting the effective date from the date of the June 26, 2018 VA 21-526(b), which was earlier than the date at which the entitlement arose with the diagnosis of bilateral lower extremity peripheral diabetic neuropathy on July 31, 2018. See Szemraj, supra. There is no earlier claim or document analogous to, or indicative of, a claim for the benefit articulated. The law is clear that the effective date shall be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400. Even extending the most sympathetic tactics of interpretation, the Board simply cannot discern an intent on the part of the Veteran to seek entitlement to service connection for right and lower extremity diabetic peripheral neuropathy, sciatic nerve which comports with the clear regulation. See Szemraj, Bannon, both supra. The preponderance of the evidence is against the Veteran’s claims and there is no doubt be resolved. See 38 U.S.C. § 5.107 (b); Gilbert, supra. Service Connection The Veteran contends that tick bite disease, residual maladies of vaccines, residuals of a broken nose, an inguinal hernia (and residuals), malaria (and residuals), and an umbilical hernia (and residuals) were incurred in, aggravated by, or otherwise attributable to, active duty service or Army National Guard active duty for training. In order to establish service connection on a direct basis, the record must contain competent evidence of: (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. 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, supra. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F. 3d 1039, 1043 (Fed. Cir. 1994). Evidence and Analyses Tick Bite Disease Residual Maladies of Vaccines A review of the Veteran’s STRs from active duty service do not contain a record of immunizations. This is unusual as even non-deploying soldiers are administered a number of immunizations and additional injections for overseas duty such as in Vietnam. Army National Guard active duty for training record do show infrequent administration of immunizations for tetanus, typhoid and polio. Therefore, the Board will acknowledge that the Veteran was administered the routine vaccinations provided to soldiers consistent with their duties. The Veteran has not identified a specific vaccine, the nature and timing of any acute reactions, or the residual disability associated with one. STRs fail to disclose that the Veteran complained of, was treated for, or diagnosed with either a tick bite disease. Moreover, upon review of the Veteran’s separation examinations, from each respect period of service, there is no indication of a chronic tick bite disease or residual maladies of vaccines. In the lay statement which VA received in March 2016, the Veteran wrote that there were many ticks present in the Republic of Vietnam; “everyone,” according to the Veteran “had a bite or two [,] including [the Veteran].” In March 2016, the Veteran submitted downloaded internet materials. In pertinent part, these downloaded materials provided illustrations of how various disease entities (Russian spring-summer encephalitis; tick-borne typhus; langat fever; and relapsing fever) spread from animal vectors to human beings. Also included were illustrations of species of ticks in Vietnam. Otherwise, there is print material addressing Agent Orange exposure; land mines; chemical agent resistant coating (CARC); and a host of complex chemical agents. While the Veteran included marginal notations vaccines that he received including plague and typhoid and general material about the use of anti-malaria medications in Vietnam. He generally cited the material for the principle that the potential for many diseases and exposure to hazardous environmental factors existed in Vietnam, but neither his notations nor the text provided competent findings as to how all of this relates to the specific facts of the Veteran’s medical history. Therefore, the Board finds these materials of topical interest, it assigns limited probative weight to them. In June 2016, the Veteran was afforded a VA infectious diseases examination. The Veteran conveyed that he had been bitten by ticks in the past—without either symptoms or any modes of treatment. The clinician opined that the Veteran did not currently have or had not been diagnosed with an infectious disease or associated residual of such—to include a tick bite disease. There was no current evidence of any infectious disease entity, of which tick bite disease entities and residual maladies of vaccines would necessarily fall. The Board has considered the Veteran’s lay contentions concerning tick bite disease and residual maladies of vaccines. While the Veteran is competent to report discernable symptoms, he has not identified any instances of acute exposure, onset of disease, or existence of specific residual disability. He is not competent to either diagnose infectious disease entities or render opinions as to causation or etiology. See Jandreau, supra. The Board assigns substantial weight to the June 2016 VA clinician’s report. This medical professional reviewed the claims file; considered the Veteran’s lay accounts of his medical history; and conducted an appropriate evaluation in light of the claimed infectious disease entities. As noted above, this clinician posited that there was no current evidence of any infectious disease entity whatsoever, of which tick bite disease entities and residual maladies of vaccines would necessarily fall. In the absence of proof of a present disability there can be no valid claim. Brammer, supra. As the weight of evidence is against finding current disease entities associated with tick bite and/or residual maladies of vaccines, service connection cannot be established on any basis. See Brammer supra. Residuals of a Broken Nose As a threshold issue, the RO reopened the Veteran’s claim for residuals of a broken nose in a rating decision of August 2016. The Board finds that the RO erred in applying the standards of new and material evidence for this issue. A review of the record discloses that sections of the Veteran’s military personnel and treatment records, particularly records from National Guard service, were not associated with the Veteran’s claims file until April and July 2018. The issue here is one of reconsideration. Specifically, 38 C.F.R. § 3.156(c) requires VA to reconsider a claim “at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim.” Id. A review of the Veteran’s STRs from active duty service and Army National Guard active duty for training fails to disclose that the Veteran broke his nose during active duty service or Army National Guard active duty for training. The Veteran wrote that he fractured his nose in 1970 and there were no current problems (viz, residuals). See November 1995 report of medical history, no. 11 physician’s summary. Upon review of the Veteran’s extensive Army National Guard personnel records, there is no indication in either training rosters or retirement point registries that the Veteran had any active duty for training in 1970. A review of VA treatment records disclosed that the Veteran endorsed a history of a nose fracture. In June 2016, the Veteran was afforded a nose, throat, larynx and pharynx examination. The clinician indicated that the Veteran had been diagnosed with a deviated nasal septum. While the clinician indicated a diagnosis as of 1965, the Board finds that such is not reflected in the Veteran’s STRs. As noted above, the first report of deviated nasal septum dates from 1970. Even with this point in mind, this clinician did not indicate that there was any objective evidence of current residuals. Furthermore, there were no current residual scars. The Board has considered the Veteran’s lay contentions concerning residuals of a broken nose. While the Veteran is competent to report the nose injury as this is observable to a lay person, he is not competent to described residuals such as occluded passages and internal deformation requiring medical examination. discernable symptoms, he is not competent to either render opinions as to causation or etiology. See Jandreau, supra. The Board assigns substantial probative weight to the above-noted VA examination report. Even though the clinician erred in terms of the incurrence date, this medical professional indicated that there was no current disability constitutive of “residuals of a broken nose”—neither objective evidence that the Veteran’s nasal passages were at least 50 percent obstructed by dint of the deviated nasal septum or current residual scars. Here, there is no evidence of an injury on active duty or active duty for training nor a current disability. Thus, service connection cannot be established for residuals of a broken nose on any basis. See 38 U.S.C.§ 101(24)(A)(B); Brammer, supra. Inguinal Hernia and Residuals Here too, the RO reopened the Veteran’s claim for inguinal hernia and residuals in a rating decision of August 2016. The Board finds that the RO erred in applying the standards of new and material evidence for this issue. A review of the record discloses that sections of the Veteran’s military personnel and National Guard treatment records were not associated with the Veteran’s claims file until April and July 2018. The issue here is one of reconsideration. Specifically, 38 C.F.R. § 3.156(c) requires VA to reconsider a claim “at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim.” Id. A review of the Veteran’s STRs from active duty service and Army National Guard active duty for training fails to reveal complaints of, treatment for, or a diagnosis of, an inguinal hernia or residuals. A review of VA treatment records and private treatment records discloses that the Veteran complained of inguinal hernia symptoms between 1982 and 1987. In a June 1989 report of operation from CCH, a private healthcare facility, a physician reported that the Veteran underwent a right inguinal hernia procedure. This physician described the surgical repair and suturing. Blood loss was minimal; moreover, this physician indicated that the Veteran tolerated the procedure well. In a May 1991 Army National Guard “over 40” report of medical examination, a physician noted that the Veteran underwent a hernia surgical procedure, adding that there were no associated sequelae. In the lay statement which VA received in March 2016, the Veteran wrote that he lifted vehicle components that each weighed approximately 200 pounds as well as other heavy equipment during service. The Veteran posited that these acts of lifting heavy objects caused his inguinal hernia. In June 2016, the Veteran was afforded a VA inguinal hernia examination. A clinician performed VA examination protocols. The clinician indicated that the Veteran was first diagnosed with an inguinal hernia in 1986. The Veteran reported that he sustained the inguinal hernia during active duty for training. The Veteran indicated that he had surgery and no further treatment; however, as of the examination date the Veteran endorsed pain upon general lifting and bending. Upon examination, the clinician found that there was neither current inguinal hernia nor an indication for a supporting belt. The Board has considered the Veteran’s lay contentions concerning an inguinal hernia. While the Veteran is competent to report discernable symptoms, he is not competent to either diagnose an inguinal hernia and its specific residuals or render opinions as to causation or etiology. See Jandreau, supra. The Board assigns substantial probative weight to the opinion of the VA clinician, as noted above. Upon examination, this clinician found that there was neither current inguinal hernia nor an indication for a supporting belt. Here, the Board takes especial notice of the fact that the Veteran is service-connected for a gunshot wound to the right thigh and bilateral lower extremity diabetic peripheral neuropathy. Indeed, the Veteran lacks the specialized training and expertise in multiple disciplines in the field of medicine to associate symptoms of “pain lifting and bending” to one contended disability when he has other current diagnosed disabilities. Id. Whereas, VA adjudicators are not free to ignore or disregard the medical conclusions of a medical clinician and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991), Hence, the weight of evidence discloses that the Veteran does not have a current inguinal hernia or residuals—to include indication for a supporting belt. In the absence of proof of a present disability there can be no valid claim. Brammer, supra. As such, service connection cannot be established on any basis. Malaria and Residuals Umbilical Hernia and Residuals The RO denied reopening the Veteran’s claims for malaria and its residuals and umbilical hernia and its residuals in a rating decision of August 2016. For reasons cited above, the Board finds that the issue here is one of reconsideration. A review of the Veteran’s STRs from active duty service and Army National Guard active duty for training fails to reveal complaints of, treatment for, or diagnoses of, either malaria and associated residuals or umbilical hernia and associated residuals. In a September 1995 “periodic over 39 screening” report of medical examination, the Veteran reported a “small tender umbilical hernia.” In a November 1995 medical history questionnaire, the Veteran reported that he had undergone a hernia operation in 1992 by a private physician. A November 1995 NCO evaluation report indicates that the Veteran successfully met the requirements of physical fitness and military bearing. In the lay statement which VA received in March 2016, the Veteran conveyed that his umbilical hernia was incurred in the same way as his inguinal hernia. This refers to the operation in 1992. As to malaria, the Veteran wrote: [T]here are some forms of malaria which can cause relapses. They can lay dormant [in the liver] and re-enter the blood. […] This can cause chills [which] I get from [time-to-time] for no apparent reason. (plasmodium vivax & plasmodium ovale). The March 2016 downloaded internet materials, as noted above, also references the disease entity of malaria. Again, while the Board finds these materials of topical interest, it assigns quite limited probative weight to them. There is a lack of application of facts to the specificities of the Veteran’s medical history. The Veteran—in marginal commentary or even in extended narratives—lacks the specialized training in epidemiology, infectious disease medicines, or public heath to render an opinion as to etiology, causation, or aggravation. See Jandreau, supra. As noted above, the clinician who conducted the VA infectious diseases examination reported that there was no evidence to support a diagnosis of any infectious disease entity whatsoever. Stated differently, there was no current evidence of any infectious disease entity, of which malaria and its residuals would necessarily fall. The Veteran’s lay contentions, to include his clutch of downloaded internet materials, warrant diminished probative weight. Here, the Board assigns substantial weight to the June 2016 VA clinician’s report. This medical professional reviewed the claims file; considered the Veteran’s lay accounts of his medical history; and conducted an appropriate evaluation in light of the claimed malaria disease entity and associated residuals. As noted above, this clinician posited that there was no current evidence of any infectious disease entity whatsoever, of which malaria and its residuals would necessarily fall. The Veteran has not been provided with a VA examination and request for a medical opinion on the issue of direct causation for an umbilical hernia and residuals. As noted above, the Veteran reported that he lifted vehicle components that each weighed approximately 200 pounds as well as other heavy equipment during service which he believes caused a self-endorsed “small tender umbilical hernia.” However, the evidence of record does not contain reports of such in active duty service or active duty for training. Moreover, the evidence of record provides no clinical guidance as to the existence of this abnormality. As the evidence does not establish that the Veteran suffered “an event, injury or disease in service,” it is not necessary to obtain a VA medical opinion with regard to etiology of a “small tender umbilical hernia.” 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The Court has held that VA is not required to provide a medical examination when there is not credible evidence of an event, injury, or disease in service. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010). Additionally, conclusory generalized lay statements that a service event or illness caused the claimant’s current condition (or lack thereof) are insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, 601 F. 3d 1274, 1278 (2010). The weight of evidence is against these two service connection claims. In the absence of proof of a present disability there can be no valid claim. Brammer, supra. The medical evidence of record fails to disclose the existence of either malaria and residuals or umbilical hernia and residuals. As such, service connection cannot be established on any basis for these two alleged disabilities. Id. Therefore, the preponderance of evidence is the Veteran’s 8 service connection claims. As such, there are no doubts to be resolved. See 38 U.S.C. § 5107(b); Gilbert, supra. REASONS FOR REMAND The RO indicated in an August 2020 rating decision that the issues of DM2, chronic bronchitis, and maxillary sinusitis will be decided in a future rating decision. As such, these issues are not before the Board at this time. Although the Board regrets an additional delay, a remand is necessary to ensure that due process is followed and that there is a full record upon which to decide the Veteran’s claims so that he is afforded every possible consideration. 38 U.S.C. § 5102; 38 C.F.R. § 3.159. A compensable disability rating for ED An increased disability rating for right lower extremity diabetic peripheral neuropathy, sciatic nerve (claimed as “neuropathy associated with DM2 (herbicide) with ED”) An increased disability rating for left lower extremity diabetic peripheral neuropathy, sciatic nerve (claimed as “neuropathy associated with DM2 (herbicide) with ED” Service connection for right upper extremity diabetic peripheral neuropathy, sciatic nerve (claimed as “neuropathy associated with DM2 (herbicide) with ED”) Service connection for left upper extremity diabetic peripheral neuropathy, sciatic nerve (claimed as “neuropathy associated with DM2 (herbicide) with ED”) Service connection for a kidney disorder Entitlement to service connection for an acquired psychiatric disorder (as discrete from posttraumatic stress disorder (PTSD)), to include as secondary to service-connected disabilities Following the issuance of the February 2020 and May 2020 statements of the case (SOCs), the RO continued to develop evidence pertinent to these eight claims. A series VA examinations were conducted in July 2020 and VA treatment records obtained subsequent to the respective SOCs. To date, the RO has not sent a supplemental statement of the case (SSOC) to either the Veteran or his counsel, in order to provide the opportunity to respond to the new medical evidence. Moreover, the Veteran has not waived consideration of this pertinent evidence by the RO. Therefore, the appropriate Board action is to remand this issue to the RO for issuance of an SSOC. See 38 C.F.R. § 19.37(b). Service connection for spine disorder(s) The Board notes that conflicting opinions concerning the etiology of this claimed disability require a VA spine conditions examination. In a June 2016 examination report, a VA clinician indicated a current diagnosis of degenerative arthritis of the spine; the clinician did not opine that such was incurred in, aggravated by, or otherwise attributable to, the Veteran’s active duty service or active duty for training. Whereas, in November 2020, VA received a private physician-consultant’s report. In pertinent part, this consultant opined that the Veteran’s spine disorder(s) is/are the direct result of the Veteran’s exposure to “whole body vibration” (WBV) during service (or active duty for training) The Board finds that these discrepancies render these conflicted reports insufficient for adjudication purposes. As noted above, VA adjudicators are not free to ignore or disregard the medical conclusions of a medical clinician and are not permitted to substitute their own judgment on a medical matter. See Colvin, supra. Hence, development is required so the Board has a fully informed examination of the Veteran’s contended spine disorder(s)” Ardison v. Brown, 6 Vet. App. 405, 407 (1994). Service connection for sleep apnea, to include as secondary to service-connected disabilities, is remanded. The Veteran contends that sleep apnea was proximately caused by, or aggravated by, service-connected disabilities. In August 2019, a private physician-consultant submitted an opinion of which a copy has been associated with the claims file. However, there is no indication that this consultant performed any form of in-person evaluation. This consultant wrote that he had reviewed the claims file, VA examinations, and private medical records. Amongst other claimed disabilities, this consultant wrote that he was asked to provide an opinion as to the etiology of the Veteran’s sleep apnea. According to this consultant, the Veteran’s obstructive sleep apnea is the result of the Veteran’s diabetes mellitus type 2. As a rationale, the consultant wrote that medical literature indicates causation between diabetes mellitus type 2 and sleep apnea. According to a cited author: “The overall prevalence of obstructive sleep apnea full polysomnography in type 2 diabetic patients in approximately 71 percent on (sic) the average of data from five studies including a total number of nearly 1200 type 2 diabetic patients.” The consultant also noted additional studies to support his positive nexus opinion and pointed to his degree of expertise. Upon a September 2019 examination, a VA clinician, upon review of the claims file, consideration of the Veteran’s accounts, and evaluation, opined that the Veteran’s sleep apnea is less likely than not proximately due to or the result of the Veteran’s service-connected disabilities. As a rationale for this negative nexus opinion, the clinician wrote that the claimed disorder of sleep apnea (adding that the Veteran’s most recent sleep study showed no evidence of obstructive sleep apnea) is a separate disease entity from the Veteran’s other service-connected disabilities. More specifically, diabetes mellitus type 2 and ED are unrelated to sleep apnea. And, moreover, the medical literature does not support such a medical relationship. As such, a nexus to establish service connection of a secondary basis has not been established. A VA addendum opinion is necessary to address the Veteran’s sleep apnea claim. The divergences in these two reports and etiological opinions require reconciliation for the Board to evaluate the Veteran’s claim in a fully informed way. See Ardison v. Brown, 6 Vet. App. 405, 407 (1994). Service connection for COPD, to include as due to exposures to chemical resistant coating, Agent Orange, and asbestos, is remanded The Veteran contends that COPD was caused by exposures to chemical coating, Agent Orange, and asbestos in service. In July 2019, a private physician-consultant submitted a letter. This consultant indicated that he had reviewed the Veteran’s claims file. After a discussion of the Veteran’s service history (include consideration of the Veteran’s military occupational specialty of helicopter repairman) and medical history, this consultant wrote that, [T]he Veteran does have a history of smoking. He quit in 1982 after 15 years. I am not discounting the effect of [the Veteran’s] smoking history on the development of his COPD. The issue is not whether one exposure or the other contributed more to the outcome, that question is not answerable. Both smoking and asbestos represent significant risk for developing lung disease. One cannot say that because of his smoking history, [the Veteran] would have developed COPD anyway without asbestos exposure. […] [The Veteran] quit smoking decades prior to his diagnosis [of COPD]. According to multiple scientific studies, the risk of lung disease diminishes greatly with cessation. […] [A study] noted that quitting smoking by the age of 40 reduces the risk of dying from smoke-related disease by about 90 percent. Due to [this], it is my professional medical opinion that is also at least as likely as not that the Veteran’s COPD is a direct result of his exposure to asbestos during active duty service. Upon an April 2020 VA medical examination, a VA clinician who reviewed the claims file and considered the Veteran’s lay accounts wrote that it is less likely than not that the Veteran’s COPD was incurred in or caused by the Veteran’s claimed exposures to chemical coating, Agent Orange, and asbestos. As a rationale for this negative nexus opinion, the clinician underscored that a computed tomography (CT) scan of the Veteran’s chest provides no evidence of interstitial lung disease. A VA addendum opinion is necessary to address the Veteran’s sleep apnea claim. The divergences in these two reports and etiological opinions also require reconciliation for the Board to evaluate the Veteran’s claim in a fully informed way. See Ardison v. Brown, 6 Vet. App. 405, 407 (1994). TDIU The Veteran’s claim for a TDIU is intrinsically intertwined with the other issues on appeal. See Smith (Daniel) v. Gober, 236 F. 3d 1370, 1373 (Fed, Cir, 2001) (where the facts underlying separate claims are “intimately connected,” the interests of judicial economy and avoidance of piecemeal litigation require that the claims be adjudicated together); see also Harris v. Derwinski, 1 Vet. App. 180 (1991). Therefore, a thorough consideration of this issue must be deferred pending the development indicated above. The matters are REMANDED for the following actions: 1. Provide the Veteran and his representative an SSOC on the eight claims identified above. The SSOC must contain notice of all relevant actions taken, to include a summary of the evidence and applicable laws and regulations considered pertinent to the issues currently on appeal. The Board herein intimates no opinion as to the outcome of this case. The Veteran need take no action until so informed. The purpose of this remand is to ensure compliance with due process requirements. 2. Contact the Veteran and counsel and request that they provide or identify and authorize the recovery of any additional private records of treatment for the alleged disabilities. If obtained, associate these treatment records with the claims file. The RO must make two attempts to obtain these relevant records, id so identified, unless the first attempt demonstrates the further attempts would be futile. Should the RO determine that more than one attempt to obtain these relevant records would be futile, the RO must make a formal finding delineating the steps that have been taken and explaining, with specificity, why any further attempts to obtain these relevant records would be futile. Should these records not be obtained, the AOJ must (1) inform the Veteran of the records that were not obtained (2) tell the Veteran what steps were taken to obtain them, and (3) tell the Veteran that the claim will be adjudicated without the records. See 38 U.S.C. § 5103A(b)(2)(B). 3. Ascertain whether there are any outstanding VA treatment records. If so, associate these records with the Veteran’s claims file. 4. Arrange for VA spine conditions, sleep apnea, and COPD examinations and opinions with appropriate clinicians. Telehealth examinations may be used if the examiner determines that method to be adequate to provide the necessary observations and opinions. The clinicians must review the entirety of the claims file and indicate such review in the body of the respective opinions or examination reports. The clinician should perform all necessary evaluation protocols. Upon completion of the above, the clinician is asked to respond to the following inquiries: a. What, if any, current diagnosis (or diagnoses) is apposite to, or best approximates, the Veteran’s claimed spine disorder(s), claimed sleep apnea, and claimed COPD? Upon determination of apposite diagnoses, if any, clinicians should opine: i. Whether it is at least as likely as not (50 percent probability or more) that the current diagnosed spine disorder, sleep apnea and/or COPD had onset in service or active duty for training or is/are otherwise etiologically related to the Veteran’s active service or active duty for training, including any incidence of service? ii. Additionally, the clinician rendering an opinion as to sleep apnea should render an opinion as to whether it is at least as likely as not the Veteran’s sleep apnea was proximately caused by, or aggravated beyond its natural course by, the Veteran’s service-connected disabilities (notably diabetes mellitus type 2 and ED, and PTSD)? iii. The clinician who renders an opinion as to alleged COPD must address with specificity the Veteran’s claims as to exposures to chemical resistant coating, Agent Orange, and asbestos. For all opinions, complete rationales should be provided. Clinicians should reconcile any opinion with all other clinical evidence of record and the Veteran’s and other lay evidence. The Board notes that the Veteran is competent to report his symptoms and history. Such reports, including those of continuity of symptomatology, must be acknowledged and considered in formulating any opinion. Should a clinician reject the Veteran’s reports, she/he must provide an explanation for such rejection. 5. Upon completion of the above-directed tasks, adjudicate the Veteran’s claim for entitlement to a TDIU. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. J. Komins, 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.