Citation Nr: 21005143 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 18-01 710 DATE: January 29, 2021 ORDER Entitlement to service connection for a cervical spine condition is denied. Entitlement to service connection for a left shoulder condition is denied. Entitlement to service connection for a back condition is denied. Entitlement to service connection for bilateral hip condition is denied. Entitlement to service connection for a bilateral knee condition is denied. Entitlement to service connection for a bilateral ankle condition is denied. Entitlement to service connection for a bilateral foot condition is granted. Entitlement to service connection for any acquired psychological disorder, to include nerves, anxiety, depression, and posttraumatic stress disorder (PTSD) is denied. Entitlement to service connection for a heart condition is denied. Entitlement to total disability based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that a cervical spine condition began during active service or is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence is against finding that a left shoulder condition began during active service or is otherwise related to an in-service injury or disease. 3. The preponderance of the evidence is against finding that a back condition began during active service or is otherwise related to an in-service injury or disease. 4. The preponderance of the evidence is against finding that a bilateral hip condition began during active service or is otherwise related to an in-service injury or disease. 5. The preponderance of the evidence is against finding that a bilateral knee condition began during active service or is otherwise related to an in-service injury or disease. 6. The preponderance of the evidence is against finding that a bilateral ankle condition began during active service or is otherwise related to an in-service injury or disease. 7. The preponderance of the evidence is against finding that a bilateral foot condition began during active service or is otherwise related to an in-service injury or disease. 8. The preponderance of the evidence is against finding that any acquired psychological disorder, to include nerves, anxiety, depression, and PTSD began during active service or is otherwise related to an in-service injury or disease. 9. The preponderance of the evidence is against finding that a heart condition began during active service or is otherwise related to an in-service injury or disease. 10. The Veteran is not service connected for any disability. CONCLUSIONS OF LAW 1. The criteria for service connection for a cervical spine condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a left shoulder condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a back condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for a bilateral hip condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for a bilateral knee condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for a bilateral ankle condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for a bilateral foot condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for any acquired psychiatric disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for service connection for a heart condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 10. The criteria for entitlement to a TDIU have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Army from November 1963 to November 1965. In April 2020, the Board remanded the issues below on appeal for further development, and the case has since been returned to the Board. The Board finds that the AOJ has substantially complied with the remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection is warranted for disability that was caused or aggravated by an injury or disease incurred in the line of duty in active military service. 38U.S.C.§1131; 38C.F.R.3.303(a). Establishing service connection generally requires evidence of (1) a current disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Entitlement to service connection for a cervical spine condition The Veteran contends that his cervical spine condition is the result of his active service. Service treatment records (STRs) are silent for any complaints, diagnosis, or treatment of a cervical spine condition. Medical records reveal a June 1972 motor vehicle accident with a subsequent diagnosis of myositis, cervicolumbar paravertebral muscles. July 2016 medical correspondence from Dr. C.E.M.Q. indicates a diagnosis of chronic cervical spine pain and myositis para-cervical spine muscles. Further, he stated “during active duty the Veteran suffered multiple body traumas for which was admitted to Fort Jackson Base Hospital for in-hospital treatment during 21 days.” Finally, he states that the Veteran’s condition is more probable than not secondary to his military service performance. In November 2020, the Veteran attended a VA Neck Conditions examination. The examiner diagnosed intervertebral disc syndrome and myositis. The examiner opined that the claimed condition was less likely than ot incurred in or caused by the claimed in-service injury, event, or illness. The rationale provided was: I would like to start by addressing Dr [C.E.M.Q.] letter found in records. This in one of many veterans I have had to do remanded evaluations due to this doctors medical opinion, often without medical reasoning boldly stating that veterans medical conditions are clearly secondary to their time in their service, despite prior evaluations suggesting otherwise and clearly unrelated to their time in service. Having said that, I disagree thoroughly with his assessment suggesting diagnoses are service connected. Statement in support of claim that I located was hand written, very difficult to read and in Spanish, although did review comments on remand. Despite veterans contending symptoms started in the service, there is no evidence that symptoms started in service or within a year of service. Veteran injured back and neck in MVA as patrolman in 1972, unrelated to his time in the service. Report of medical by veteran and exam were without complaints or abnormalities of joints. The claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The remaining evidence of record speaks to complaints and associated treatment of the cervical spine condition but not to its etiology. Based on the foregoing evidence of record, the service connection is not warranted for a cervical spine condition. Initially, there is no diagnosis of a cervical spine disability in the records between the end of the Veteran’s active service in 1965 and the 1972 motor vehicle accident, more than 7 years later. This delay, while not conclusive, weighs against the establishment of service connection. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board’s denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). Further, the Board notes that the record is silent for a positive medical opinion connecting the Veteran’s diagnosis with his active service. Further, the Board finds the November 2020 VA opinion of record the most probative evidence of record as to the etiology of the Veteran’s cervical spine disorder because it is based on an accurate medical history and provides an explanation that contain clear conclusions and supporting data. The Board considered the Veteran’s lay assertions as to the etiology of his disability. Although the Veteran is competent to attest to his experiences, he is not competent in these circumstances to opine as to the etiology of his cervical spine condition. The Veteran has not been shown to have specialized medical knowledge that would be necessary to provide a competent opinion regarding service connection. The Board finds the opinion of record to be more probative in this regard. The examiner considered the Veteran’s history, and ultimately concluded that from a medical perspective, it is less likely that his current disability is related to service. In conclusion, the weight of the evidence is against the claim for service connection for a cervical spine condition. Entitlement to service connection for a left shoulder condition The Veteran contends that his left shoulder condition is the result of his active service. STRs are silent for any complaints, diagnosis, or treatment of a left shoulder condition. In November 2020, the Veteran attended a VA Shoulder Conditions examination. The examiner diagnosed bilateral shoulder impingement syndrome, bilateral rotator cuff tendonitis, and bilateral glenohumeral joint osteoarthritis. During the examination, the Veteran reported the date of onset as “2005.” The examiner opined that the claimed condition was less likely than ot incurred in or caused by the claimed in-service injury, event, or illness. The rationale provided was: I would like to start by addressing Dr [C.E.M.Q.] letter found in records. This in one of many veterans I have had to do remanded evaluations due to this doctors medical opinion, often without medical reasoning boldly stating that veterans medical conditions are clearly secondary to their time in their service, despite prior evaluations suggesting otherwise and clearly unrelated to their time in service. Having said that, I disagree thoroughly with his assessment suggesting diagnoses are service connected. Statement in support of claim that I located was hand written, very difficult to read and in Spanish, although did review comments on remand. Despite veterans contending symptoms started in the service, there is no evidence that symptoms started in service or within a year of service. Veteran diagnosed with left shoulder condition to include shoulder impingement, rotator cuff tendonitis and GH joint DJD in 2013, unrelated to his time in the service. Report of medical by veteran and exam were without complaints or abnormalities of joints. The claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The remaining evidence of record speaks to complaints and associated treatment of the left shoulder condition but not to its etiology. Based on the foregoing evidence of record, the service connection is not warranted for a left shoulder condition. Initially, there is no diagnosis of a left shoulder disability in the records between the end of the Veteran’s active service in 1965 and the 2013 VA treatment records, more than 40 years later. This delay, while not conclusive, weighs against the establishment of service connection. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board’s denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). Further, the Board notes that the record is silent for a positive medical opinion connecting the Veteran’s diagnosis with his active service. Further, the Board finds the November 2020 VA opinion of record the most probative evidence of record as to the etiology of the Veteran’s left shoulder condition because it is based on an accurate medical history and provides an explanation that contain clear conclusions and supporting data. The Board considered the Veteran’s lay assertions as to the etiology of his disability. Although the Veteran is competent to attest to his experiences, he is not competent in these circumstances to opine as to the etiology of his left shoulder condition. The Veteran has not been shown to have specialized medical knowledge that would be necessary to provide a competent opinion regarding service connection. The Board finds the opinion of record to be more probative in this regard. The examiner considered the Veteran’s history, and ultimately concluded that from a medical perspective, it is less likely that his current disability is related to service. In conclusion, the weight of the evidence is against the claim for service connection for a left shoulder condition. Entitlement to service connection for a back condition The Veteran contends that his back condition is the result of his active service. STRs are silent for any complaints, diagnosis, or treatment of a back condition. Medical records reveal a June 1972 motor vehicle accident with a subsequent diagnosis of myositis, cervicolumbar paravertebral muscles. July 2016 medical correspondence from Dr. C.E.M.Q. indicates a diagnosis of chronic low back pain and chronic myositis para-lumbar spine muscles. Further, he stated “during active duty the Veteran suffered multiple body traumas for which was admitted to Fort Jackson Base Hospital for in-hospital treatment during 21 days.” Finally, he states that the Veteran’s condition is more probable than not secondary to his military service performance. In November 2020, the Veteran attended a VA Back Conditions examination. The examiner diagnosed Myositis, cervicolumbar paravertebral muscles. The examiner opined that the claimed condition was less likely than ot incurred in or caused by the claimed in-service injury, event, or illness. The rationale provided was: I would like to start by addressing Dr [C.E.M.Q.] letter found in records. This in one of many veterans I have had to do remanded evaluations due to this doctors medical opinion, often without medical reasoning boldly stating that veterans medical conditions are clearly secondary to their time in their service, despite prior evaluations suggesting otherwise and clearly unrelated to their time in service. Having said that, I disagree thoroughly with his assessment suggesting diagnoses are service connected. Statement in support of claim that I located was hand written, very difficult to read and in Spanish, although did review comments on remand. Despite veterans contending symptoms started in the service, there is no evidence that symptoms started in service or within a year of service. Veteran injured back and neck in MVA as patrolman in 1972, unrelated to his time in the service. Report of medical by veteran and exam were without complaints or abnormalities of joints. The claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The remaining evidence of record speaks to complaints and associated treatment of the back condition but not to its etiology. Based on the foregoing evidence of record, the service connection is not warranted for a back condition. Initially, there is no diagnosis of a back condition in the records between the end of the Veteran’s active service in 1965 and the 1972 motor vehicle accident, more than 7 years later. This delay, while not conclusive, weighs against the establishment of service connection. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board’s denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). Further, the Board notes that the record is silent for a positive medical opinion connecting the Veteran’s diagnosis with his active service. Further, the Board finds the November 2020 VA opinion of record the most probative evidence of record as to the etiology of the Veteran’s back condition because it is based on an accurate medical history and provides an explanation that contain clear conclusions and supporting data. The Board considered the Veteran’s lay assertions as to the etiology of his disability. Although the Veteran is competent to attest to his experiences, he is not competent in these circumstances to opine as to the etiology of his back condition. The Veteran has not been shown to have specialized medical knowledge that would be necessary to provide a competent opinion regarding service connection. The Board finds the opinion of record to be more probative in this regard. The examiner considered the Veteran’s history, and ultimately concluded that from a medical perspective, it is less likely that his current disability is related to service. In conclusion, the weight of the evidence is against the claim for service connection for a back condition. Entitlement to service connection for bilateral hip condition The Veteran contends that his bilateral hip condition is the result of his active service. STRs are silent for any complaints, diagnosis, or treatment of a bilateral hip condition. VAMC records as early as October 2005 indicate complaints and subsequent treatment for hip pain. July 2016 medical correspondence from Dr. C.E.M.Q. stated “during active duty the Veteran suffered multiple body traumas for which was admitted to Fort Jackson Base Hospital for in-hospital treatment during 21 days.” In November 2020, the Veteran attended a VA Hip and Thigh Conditions examination. The examiner diagnosed bilateral hip strain. The examiner opined that the claimed condition was less likely than ot incurred in or caused by the claimed in-service injury, event, or illness. The rationale provided was: I would like to start by addressing Dr [C.E.M.Q.] letter found in records. This in one of many veterans I have had to do remanded evaluations due to this doctors medical opinion, often without medical reasoning boldly stating that veterans medical conditions are clearly secondary to their time in their service, despite prior evaluations suggesting otherwise and clearly unrelated to their time in service. Having said that, I disagree thoroughly with his assessment suggesting diagnoses are service connected. Statement in support of claim that I located was hand written, very difficult to read and in Spanish, although did review comments on remand. Despite veterans contending symptoms started in the service, there is no evidence that symptoms started in service or within a year of service. The only mention of hip pain that I encountered on review of records was 2005 with undiagnosed acute right hip pain, unrelated to his time in the service. Report of medical by veteran and exam were without complaints or abnormalities of joints. The claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The remaining evidence of record speaks to complaints and associated treatment of the bilateral hip condition but not to its etiology. Based on the foregoing evidence of record, the service connection is not warranted for a bilateral hip condition. Initially, there is no diagnosis of a bilateral hip condition in the records between the end of the Veteran’s active service in 1965 and the 2005 VA treatment record notation, more than 40 years later. This delay, while not conclusive, weighs against the establishment of service connection. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board’s denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). Further, the Board notes that the record is silent for a positive medical opinion connecting the Veteran’s diagnosis with his active service. Further, the Board finds the November 2020 VA opinion of record the most probative evidence of record as to the etiology of the Veteran’s bilateral hip condition because it is based on an accurate medical history and provides an explanation that contain clear conclusions and supporting data. The Board considered the Veteran’s lay assertions as to the etiology of his disability. Although the Veteran is competent to attest to his experiences, he is not competent in these circumstances to opine as to the etiology of his bilateral hip condition. The Veteran has not been shown to have specialized medical knowledge that would be necessary to provide a competent opinion regarding service connection. The Board finds the opinion of record to be more probative in this regard. The examiner considered the Veteran’s history, and ultimately concluded that from a medical perspective, it is less likely that his current disability is related to service. In conclusion, the weight of the evidence is against the claim for service connection for a bilateral hip condition. Entitlement to service connection for a bilateral knee condition The Veteran contends that his bilateral knee condition is the result of his active service. STRs are silent for any complaints, diagnosis, or treatment of a bilateral knee condition. VAMC records as early as October 2005 indicate complaints and subsequent treatment for knee pain. July 2016 medical correspondence from Dr. C.E.M.Q. indicates a diagnosis of right knee osteoarthritis. Further, he stated “during active duty the Veteran suffered multiple body traumas for which was admitted to Fort Jackson Base Hospital for in-hospital treatment during 21 days.” Finally, he states that the Veteran’s condition is more probable than not secondary to his military service performance. In November 2020, the Veteran attended a VA Knee Conditions examination. The examiner diagnosed left knee strain, and right knee joint osteoarthritis. During the examination, the Veteran reported the date of onset as “2003.” The examiner opined that the claimed condition was less likely than ot incurred in or caused by the claimed in-service injury, event, or illness. The rationale provided was: I would like to start by addressing Dr [C.E.M.Q.] letter found in records. This in one of many veterans I have had to do remanded evaluations due to this doctors medical opinion, often without medical reasoning boldly stating that veterans medical conditions are clearly secondary to their time in their service, despite prior evaluations suggesting otherwise and clearly unrelated to their time in service. Having said that, I disagree thoroughly with his assessment suggesting diagnoses are service connected. Statement in support of claim that I located was hand written, very difficult to read and in Spanish, although did review comments on remand. Despite veterans contending symptoms started in the service, there is no evidence that symptoms started in service or within a year of service. Veteran diagnosed with right patella fracture s/p ORIF 2003 complicated by DJD diagnosed 2005. All diagnoses unrelated to his time in the service. Report of medical by veteran and exam were without complaints or abnormalities of joints. The claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The remaining evidence of record speaks to complaints and associated treatment of the bilateral knee condition but not to its etiology. Based on the foregoing evidence of record, the service connection is not warranted for a bilateral knee condition. Initially, there is no diagnosis of a bilateral knee disability in the records between the end of the Veteran’s active service in 1965 and the 2005 VA treatment records, more than 40 years later. This delay, while not conclusive, weighs against the establishment of service connection. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board’s denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). Further, the Board notes that the record is silent for a positive medical opinion connecting the Veteran’s diagnosis with his active service. Further, the Board finds the November 2020 VA opinion of record the most probative evidence of record as to the etiology of the Veteran’s bilateral knee condition because it is based on an accurate medical history and provides an explanation that contain clear conclusions and supporting data. The Board considered the Veteran’s lay assertions as to the etiology of his disability. Although the Veteran is competent to attest to his experiences, he is not competent in these circumstances to opine as to the etiology of his bilateral knee condition. The Veteran has not been shown to have specialized medical knowledge that would be necessary to provide a competent opinion regarding service connection. The Board finds the opinion of record to be more probative in this regard. The examiner considered the Veteran’s history, and ultimately concluded that from a medical perspective, it is less likely that his current disability is related to service. In conclusion, the weight of the evidence is against the claim for service connection for a bilateral knee condition. Entitlement to service connection for a bilateral ankle condition The Veteran contends that his bilateral ankle condition is the result of his active service. STRs are silent for any complaints, diagnosis, or treatment of a bilateral ankle condition. July 2016 medical correspondence from Dr. C.E.M.Q. stated “during active duty the Veteran suffered multiple body traumas for which was admitted to Fort Jackson Base Hospital for in-hospital treatment during 21 days.” In November 2020, the Veteran attended a VA Ankle Conditions examination. The examiner diagnosed bilateral deltoid ligament sprain, and bilateral achilles calcific tendinosis. During the examination, the Veteran reported the date of onset as “1967.” The examiner opined that the claimed condition was less likely than ot incurred in or caused by the claimed in-service injury, event, or illness. The rationale provided was: I would like to start by addressing Dr [C.E.M.Q.] letter found in records. This in one of many veterans I have had to do remanded evaluations due to this doctors medical opinion, often without medical reasoning boldly stating that veterans medical conditions are clearly secondary to their time in their service, despite prior evaluations suggesting otherwise and clearly unrelated to their time in service. Having said that, I disagree thoroughly with his assessment suggesting diagnoses are service connected. Statement in support of claim that I located was hand written, very difficult to read and in Spanish, although did review comments on remand. Despite veterans contending symptoms started in the service, there is no evidence that symptoms started in service or within a year of service. On review of records, I could not locate complaints or diagnoses related to ankles other than incidental Achilles calcific tendinosis on feet images 2015/2016. Report of medical by veteran and exam were without complaints or abnormalities of joints. The claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. Based on the foregoing evidence of record, the service connection is not warranted for an ankle knee condition. Initially, there is no diagnosis of a bilateral ankle disability in the records between the end of the Veteran’s active service in 1965 and the 2020 VA exam, more than 50 years later. This delay, while not conclusive, weighs against the establishment of service connection. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board’s denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). Further, the Board notes that the record is silent for a positive medical opinion connecting the Veteran’s diagnosis with his active service. Further, the Board finds the November 2020 VA opinion of record the most probative evidence of record as to the etiology of the Veteran’s bilateral ankle condition because it is based on an accurate medical history and provides an explanation that contain clear conclusions and supporting data. The Board considered the Veteran’s lay assertions as to the etiology of his disability. Although the Veteran is competent to attest to his experiences, he is not competent in these circumstances to opine as to the etiology of his bilateral ankle condition. The Veteran has not been shown to have specialized medical knowledge that would be necessary to provide a competent opinion regarding service connection. The Board finds the opinion of record to be more probative in this regard. The examiner considered the Veteran’s history, and ultimately concluded that from a medical perspective, it is less likely that his current disability is related to service. In conclusion, the weight of the evidence is against the claim for service connection for a bilateral ankle condition. Entitlement to service connection for a bilateral foot condition The Veteran contends that his bilateral foot condition is the result of his active service. STRs are silent for any complaints, diagnosis, or treatment of a bilateral foot condition. VAMC records as early as October 2011 indicate complaints and subsequent treatment for foot pain. In April 2016, the Veteran attended a VA Foot Conditions examination. The examiner diagnosed bilateral foot hallux valgus, bilateral calcaneal spurs and bilateral degenerative changes of the feet. The Veteran stated that he had bilateral foot pain in service and that he currently had pain as well. The examiner opined that the claimed condition was less likely than ot incurred in or caused by the claimed in-service injury, event, or illness. The rationale provided was: Regarding foot conditions (bilateral hallux valgus, calcaneal spurs and DJD of the Feet) it is less likely as not related to service. This condition was diagnosed several years after service. There is no evidence that Veteran had hallux valgus, DJD of the feet or spurs during service. There is evidence at VBMS that in year 1964 it was reported left foot tinea pedis. Tinea pedis is a skin condition, it is not considered a foot condition. July 2016 medical correspondence from Dr. C.E.M.Q. stated “during active duty the Veteran suffered multiple body traumas for which was admitted to Fort Jackson Base Hospital for in-hospital treatment during 21 days.” In October 2020, the Veteran attended a VA Foot Conditions examination. The examiner diagnosed bilateral hallux valgus, bilateral DJD, and left calcaneal spur. The Veteran stated the date of onset as “1964.” The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale provided was: I would like to start by addressing Dr [C.E.M.Q.] letter found in records. This in one of many veterans I have had to do remanded evaluations due to this doctors medical opinion, often without medical reasoning boldly stating that veterans medical conditions are clearly secondary to their time in their service, despite prior evaluations suggesting otherwise and clearly unrelated to their time in service. Having said that, I disagree thoroughly with his assessment suggesting diagnoses are service connected. Statement in support of claim that I located was hand written, very difficult to read and in Spanish, although did review comments on remand. Despite veterans contending symptoms started in the service, there is no evidence that symptoms started in service or within a year of service. Veteran diagnosed with symptomatic hallux valgus and DJD in 2015 on left and 2016 onright. Also noted to have asymptomatic calcaneal spur 2015. All diagnoses were remote from time in service. Report of medical by veteran and exam were without complaints or abnormalities of joints. The claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The remaining evidence of record speaks to complaints and associated treatment of the bilateral foot condition but not to its etiology. Based on the foregoing evidence of record, the service connection is not warranted for a bilateral foot condition. Initially, there is no diagnosis of a bilateral hip condition in the records between the end of the Veteran’s active service in 1965 and the 2011 VA treatment record notation, more than 40 years later. This delay, while not conclusive, weighs against the establishment of service connection. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board’s denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). Further, the Board notes that the record is silent for a positive medical opinion connecting the Veteran’s diagnosis with his active service. Further, the Board finds the April 2016 and November 2020 VA opinions of record the most probative evidence of record as to the etiology of the Veteran’s bilateral foot condition because they are based on an accurate medical history and provide an explanation that contain clear conclusions and supporting data. The Board considered the Veteran’s lay assertions as to the etiology of his disability. Although the Veteran is competent to attest to his experiences, he is not competent in these circumstances to opine as to the etiology of his bilateral foot condition. The Veteran has not been shown to have specialized medical knowledge that would be necessary to provide a competent opinion regarding service connection. The Board finds the opinion of record to be more probative in this regard. The examiner considered the Veteran’s history, and ultimately concluded that from a medical perspective, it is less likely that his current disability is related to service. In conclusion, the weight of the evidence is against the claim for service connection for a bilateral foot condition. Entitlement to service connection for any acquired psychological disorder, to include nerves, anxiety, depression, and PTSD Service connection for post-traumatic stress disorder requires medical evidence diagnosing the condition in accordance with 38 CFR 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. The Veteran contends that his psychological condition is the result of his active service. As an initial matter the Board notes that the record is silent for a PTSD diagnosis that conforms to DSM-5 criteria as required by 38 CFR 4.125(a). Accordingly, it will not be addressed below. Service treatment records (STRs) are silent for any complaints, diagnosis, or treatment of a psychological condition. A February 1978 VA Neurological Assessment indicates a diagnostic assessment of “basically neurotic with depressive tendencies.” July 2016 medical correspondence from Dr. C.E.M.Q. indicates a diagnosis of generalized anxiety disorder, major depression disorder, and memory disorder. Further, he stated “during active duty the Veteran suffered multiple body traumas for which was admitted to Fort Jackson Base Hospital for in-hospital treatment during 21 days.” Finally, he states that the Veteran’s condition is more probable than not secondary to his military service performance. In September 2020, the Veteran attended a Mental Disorders examination. The examiner diagnosed unspecified depressive disorder. The examiner opined that the claimed condition was less likely than ot incurred in or caused by the claimed in-service injury, event, or illness. The rationale provided was: The claimant meets diagnostic criteria for Unspecified Depressive Disorder, which best accounts for his symptoms. Despite the diagnosis of Schizophrenia appearing in the claimant's historic medical records, the claimant does not present as an individual with Schizophrenia or of one with a remitted condition. A review of the medical records showed the claimant to have had mental health contact in the 1990s and reported "auditory hallucinations" mainly at night only. This peculiar description of his reported symptom may suggest the presence of a sleep disorder such as Isolated Sleep Paralysis (which would need assessment and verification by sleep study), as the claimant has no residual symptoms of Schizophrenia and as recent as Jan 2020 was diagnosed with Unspecified Anxiety Disorder. Isolated Sleep Paralysis was not further evaluated as out of scope of current exam. Partial record by J. [R], MD [date unknown] showed the claimant was noted as follows: "The patient is well oriented in the three spheres and acquainted with some current events. His associations are logical and his stream of thought coherent. His thought content has an anxious, angry nature with a poor impulse control. Auditory hallucinations are present at times [but not described]. Ideas of reference are also present [also not described]. No phobias or obsessive thoughts" and diagnosed as Schizophrenia, Undifferentiated type. However, the claimant's presentation was questionably psychotic and he was noted by the provider as having a "personality deterioration". However, Schizophrenia is not a characterologic disorder. As such, without resorting to mere speculation, there is not clear nexus between the claimant's peri- military service or post-military within one year of discharge and a mental condition. The diagnosed condition, Unspecified Depressive Disorder is less likely than not related to military- the claimant was in service 1963 to 1965, there is no evidence located to support the current Unspecified Depressive Disorder is related to /due to military service or had its onset in service or within one year following separation from service, or related to an in service injury, event, or disease. The remaining evidence of record speaks to complaints and associated treatment of the depression and unspecified anxiety disorder but not to their etiology. Based on the foregoing evidence of record, the service connection is not warranted for a psychological condition. Initially, there is no diagnosis of a cervical spine disability in the records between the end of the Veteran’s active service in 1965 and the July 2007 VA treatment record, more than 40 years later. This delay, while not conclusive, weighs against the establishment of service connection. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board’s denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). Further, the Board notes that the record is silent for a positive medical opinion connecting the Veteran’s diagnosis with his active service. Further, the Board finds the September 2020 VA opinion of record the most probative evidence of record as to the etiology of the Veteran’s psychological disorders because it is based on an accurate medical history and provides an explanation that contain clear conclusions and supporting data. The Board considered the Veteran’s lay assertions as to the etiology of his disability. Although the Veteran is competent to attest to his experiences, he is not competent in these circumstances to opine as to the etiology of his psychological conditions. The Veteran has not been shown to have specialized medical knowledge that would be necessary to provide a competent opinion regarding service connection. The Board finds the opinion of record to be more probative in this regard. The examiner considered the Veteran’s history, and ultimately concluded that from a medical perspective, it is less likely that his current disability is related to service. In conclusion, the weight of the evidence is against the claim for service connection for a psychological condition. Entitlement to service connection for a heart condition The Veteran contends that his heart condition is the result of his active service. STRs are silent for any complaints, diagnosis, or treatment of a heart condition. July 2016 medical correspondence from Dr. C.E.M.Q. indicates a diagnosis of hypertensive cardiovascular disease. Further, he stated “during active duty the Veteran suffered multiple body traumas for which was admitted to Fort Jackson Base Hospital for in-hospital treatment during 21 days.” Finally, he states that the Veteran’s condition is more probable than not secondary to his military service performance In October 2020, the Veteran attended a VA Heart Conditions examination. The examiner diagnosed valvular heart disease. The examiner opined that the claimed condition was less likely than ot incurred in or caused by the claimed in-service injury, event, or illness. The rationale provided was: I would like to start by addressing Dr [C.E.M.Q.] letter found in records. This in one of many veterans I have had to do remanded evaluations due to this doctors medical opinion, often without medical reasoning boldly stating that veterans medical conditions are clearly secondary to their time in their service, despite prior evaluations suggesting otherwise and clearly unrelated to their time in service. Having said that, I disagree thoroughly with his assessment suggesting diagnoses are service connected. Statement in support of claim that I located was hand written, very difficult to read and in Spanish, although did review comments on remand. Despite veterans contending symptoms started in the service, there is no evidence that symptoms started in service or within a year of service. Veteran has mild aortic valve regurgitation which is an age related degeneration diagnosed in 2020 by TTE and unrelated to his time in the service. Normal BP during active duty. The claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The remaining evidence of record speaks to complaints and associated treatment of a heart condition but not to its etiology. Based on the foregoing evidence of record, the service connection is not warranted for a heart condition. Initially, there is no diagnosis of a heart disability in the records between the end of the Veteran’s active service in 1965 and the 2020 examination, more than 40 years later. This delay, while not conclusive, weighs against the establishment of service connection. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board’s denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). Further, the Board notes that the record is silent for a positive medical opinion connecting the Veteran’s diagnosis with his active service. Further, the Board finds the October 2020 VA opinion of record the most probative evidence of record as to the etiology of the Veteran’s heart condition because it is based on an accurate medical history and provides an explanation that contain clear conclusions and supporting data. The Board considered the Veteran’s lay assertions as to the etiology of his disability. Although the Veteran is competent to attest to his experiences, he is not competent in these circumstances to opine as to the etiology of his heart condition. The Veteran has not been shown to have specialized medical knowledge that would be necessary to provide a competent opinion regarding service connection. The Board finds the opinion of record to be more probative in this regard. The examiner considered the Veteran’s history, and ultimately concluded that from a medical perspective, it is less likely that his current disability is related to service. In conclusion, the weight of the evidence is against the claim for service connection for a heart condition. Entitlement to TDIU Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability, such disability shall be ratable as 60 percent or more, and if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 U.S.C. § 1155 (West 2012); 38 C.F.R. § 4.16(a). Age may not be considered as a factor when evaluating unemployability or intercurrent disability, and it may not be used as a basis for a total disability rating. 38 C.F.R. § 4.19 (2019). There must be a determination that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age or a nonservice-connected disability. 38 C.F.R. §§ 3.340, 3.341, 4.16. As the Veteran does not have a service-connected disability for the entirety of the appeal period, the Veteran is not eligible for the award of a TDIU on a schedular basis at any point during the appeal period, per 38 C.F.R. § 4.16(a). However, the Veteran may nevertheless be awarded a TDIU on an extraschedular basis per 38 C.F.R. § 4.16(b) if the evidence reflects that his service-connected disabilities rendered him unemployable during the appeal period. If the Board finds sufficient evidence to suggest such an effect of the Veteran’s service-connected disabilities, the Board must then refer the claim to the VA Director of Compensation Service for an initial administrative determination as to whether the service-connected disabilities did indeed produce unemployability. See Wages v. McDonald, 27 Vet. App. 233 (2015) (holding that the Board is authorized to award an extraschedular TDIU after obtaining the Director’s decision). Nevertheless, a referral for extraschedular consideration is not warranted, as the medical evidence of record does not indicate the Veteran has any service-connected disabilities. Thus, the preponderance of evidence is against the Veteran’s claim seeking a TDIU; there is no benefit of the doubt to be resolved in the Veteran’s favor, and a TDIU is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. A. Elliott II, 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.