Citation Nr: 21062966 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 15-46 606 DATE: October 12, 2021 ORDER Entitlement to service connection for a respiratory disability (to include asthma and COPD) is denied. Entitlement to service connection for nasal problems is denied. Entitlement to service connection for sleep apnea is denied. Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. Entitlement to service connection for social anxiety is denied. Entitlement to service connection for right upper extremity ulnar neuropathy is denied. Entitlement to service connection for left upper extremity ulnar neuropathy is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that a respiratory disability (to include asthma and COPD) 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 nasal problems began during active service, or are otherwise related to an in-service injury or disease. 3. The preponderance of the evidence is against finding that sleep apnea began during active service, or is otherwise related to an in-service injury or disease. 4. The Veteran's PTSD clearly and unmistakably predated service. It was clearly and unmistakably not aggravated by service. 5. The preponderance of the evidence is against finding that social anxiety 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 right upper extremity ulnar neuropathy 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 left upper extremity ulnar neuropathy began during active service, or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a respiratory disability (to include asthma and COPD) are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for nasal problems are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for sleep apnea are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for PTSD are not met. 38 U.S.C. §§ 1131, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 5. The criteria for service connection for social anxiety are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for right upper extremity ulnar neuropathy are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for left upper extremity ulnar neuropathy are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1978 to October 1984. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, the Veteran testified before the Veterans Law Judge (VLJ). The matters on appeal were remanded by the Board in January 2020 and January 2021 for further development, which has been completed. The VLJ who previously held a hearing in this appeal has since retired. In a June 2021 letter, the Board offered the Veteran a new hearing before another VLJ, and provided her with 30 days within which to respond; no response was received. SERVICE CONNECTION Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection for a respiratory disability (to include asthma and COPD), nasal problems, and sleep apnea is denied. The Veteran contends that her respiratory disability, nasal problems, and sleep apnea are related to service. Specifically, she alleged that she was exposed to calcium chlorine in bottles and/or chlorine gas, and asbestos during service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. At her August 2019 Board hearing, the Veteran testified that during service, people reported her snoring, and that she was diagnosed with sleep apnea approximately 7-8 years ago (she had not heard of sleep apnea while she was in service). She also testified that she complained of shortness of breath during service, and that she has had it continuously since then. She stated that during service, she was exposed to asbestos and chlorine gas. She further testified that she was diagnosed with rhinitis 5-7 years ago, asthma a few months ago, and COPD a couple months ago. Service treatment records reflect that in March 1984, the Veteran reported a cough and nasal congestion of five days duration. She was noted to have slight maxillary sinus tenderness. She was assessed with an upper respiratory infection. There was no follow up or indications of a chronic disability. The Veteran underwent a separation examination in September 1984, and it yielded normal findings. The Veteran completed a Report of Medical History in which she stated that she had had ear, nose, and throat trouble; shortness of breath; and pain or pressure in chest. Her DD Form 214 reflects that she was a machinist aboard the U.S.S. Portland. The service treatment records include a January 1981 Asbestos Medical Surveillance Program Questionnaire reflecting that the Veteran was exposed to asbestos aboard the U.S.S. Dupont. A February 2008 treatment report reflects that the Veteran had a normal lung scan 20 years earlier. The Veteran reported that she has been having trouble taking deep breaths for several years. She reported that she had sinus surgery in the 1980s, and that she has had sinus infections each year. She was assessed with nasal/sinus polyps. A February 2008 CT scan showed a 7 mm. non-calcified nodule in the right lung near the apex. It also revealed mild sinusitis. A July 2008 sleep study was normal; and no lung abnormalities were noted on an August 2008 CT scan. Outpatient treatment records reflect chronic dyspnea beginning in March 2013. An October 2013 report reflected that pulmonary function tests (PFTs) were normal but it did not exclude a diagnosis of asthma. The Veteran underwent a VA examination in March 2020. The examiner opined that the Veteran's sinusitis, rhinitis, and other ear, nose, and throat problems were less likely than not incurred in service or caused by an in-service event. The examiner noted that Veteran was seen by ENT and diagnosed with chronic nasal obstruction and hypertrophic turbinates in 2008. She was found to have very minimal sinusitis of the left ethmoid sinus at this time. Her allergy testing in 2008 was negative. She has a history of deviated septum repair. The examiner noted that there is no evidence in the medical record that her deviated septum was traumatic; and the record is silent for sinusitis prior to 2008. Consequently, the examiner concluded that a nexus has not been established. In a separate opinion, the examiner opined that the Veteran's alleged respiratory disability was less likely than not incurred in service or caused by an in-service event. The examiner noted that the Veteran's symptoms were subjective only. She stated that there was no evidence of a current respiratory disability. The Veteran reported a diagnosis of emphysema; but this is not reflected in the available medical record. She was not taking any respiratory medications. The examiner noted that pulmonary function testing (PFTs) and imaging are normal. Additionally, the objective exam is normal; and there was no objective evidence of a chronic condition. She found that a nexus has not been established. Finally, the examiner issued another opinion in which she found that sleep apnea was less likely than not incurred in service or caused by an in-service event. The examiner noted that the Veteran reported that her snoring began during service; but the examiner noted that there is no evidence of this in the medical record. The Veteran had a sleep study performed in 2008 which was negative for sleep apnea. A repeat study in 2011 was positive. The examiner concluded that the Veteran's sleep apnea is definitely not related to service and is more likely due to obesity. In January 2021, the Board found these opinions to be incomplete insofar as they did not address the Veteran's contentions regarding exposure to asbestos and chlorine gas. Moreover, the examiner did not address a September 1984 Report of Medical History in which the Veteran reported shortness of breath and pain/pressure in her chest. Pursuant to the Board's January 2021 Remand, the RO obtained addendum opinions regarding the etiology of the Veteran's disabilities. In a February 2021 opinion, a VA examiner acknowledged that she had reviewed the claims file, including the Veteran's statements regarding asbestos exposure and chlorine gas. She further noted that the Veteran reported chest pressure and shortness of breath in a Report of Medical History. However, the examiner noted that the reports of the Veteran are not diagnostic. She noted that the Veteran's separation exam was unremarkable for a sinus condition and instead found normal sinuses. Consequently, the examiner was unable to link sinus problems to service, to include noxious stimuli of chlorine gas exposure. The examiner also noted that the Veteran denied frequent trouble sleeping on her September 1984 Report of Medical History, and that she has a history of morbid obesity with BMI 39. The examiner noted that the Veteran does have a diagnosis of sleep apnea, it is not related to service. The separation exam was unremarkable for obstructive sleep apnea. She noted that the Veteran's reports of snoring during service are not diagnostic. She noted that the confirmatory test for sleep apnea is the PSG, which was not conducted until many years after service. Treatment records show the Veteran was not diagnosed with a respiratory disability, nasal problems, or sleep apnea until decades after her separation from service. While the Veteran is competent to report having experienced symptoms of since service, she is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of her current disabilities. The issue is medically complex, as it requires knowledge of pathology. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Further, the VA examiner opined that the Veteran's disabilities are not at least as likely as not related to an in-service injury, event, or disease, including exposure to chlorine and asbestos. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). As the preponderance of the evidence is against these claims, the benefit-of-the-doubt doctrine does not apply, and the claim for service connection for respiratory disability (to include asthma and COPD), nasal problems, and sleep apnea must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection for PTSD and social anxiety is denied. At her August 2019 Board hearing, the Veteran testified that she was harassed, bullied, teased, and called names as a result of being transgender. She stated that she feared for her safety after hearing stories about people getting thrown overboard. She also testified that that she feared for her safety when she was deployed to Beirut. She was fearful of enemy fire, bombing of the barracks, dogfights, etc. The Veteran's DD Form 214 does not reflect evidence of combat. In order to grant service connection for PTSD to a non-combat Veteran, there must be credible evidence to support the Veteran's assertion that the stressful event occurred. Cohen v. Brown, 10 Vet. App. 128, 142 (1997); Moreau v. Brown, 9 Vet. App. 389, 395396 (1996). If the evidence establishes that the Veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran's service, the Veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f). Subsection 3.304(f)(3) states that, " 'fear of hostile military or terrorist activity' means that a Veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; [and] small arms fire." 38 C.F.R. § 3.304(f). The Veteran's military personnel records reflect that she was on board the U.S.S. Dupont for "extended naval gunfire support ship assignments for Sixth Fleet Amphibious Task Force during both the PLO Evacuation from Beirut and in support of Multi-National Force operations in Lebanon." The Veteran underwent a VA examination in October 2010. She reported that was intersexed and had to undergo surgery to her genital area. She leaked urine and an odor was present. She was punished by her parents for being lazy. She felt that she was sexually assaulted during medical examinations by physicians who treated her as a curiosity. She was taunted and teased by peers. She stated that the surgeries and the related events (teasing, taunting, sexual assault) is the majority of her PTSD. Her PTSD stressors were all noted to have occurred prior to service. The examiner opined that the Veteran's PTSD was likely caused by childhood traumas, as (by her own report) these traumas were far more severe than anything she experienced during service. Notwithstanding the findings of the October 2010 VA examiner, the Veteran's enlistment examination yielded normal findings. When no preexisting condition is noted upon entry into service, the Veteran is presumed to have been sound upon entry. The burden then falls on the government to rebut the presumption of soundness by clear and unmistakable evidence that the Veteran's disability was both preexisting and not aggravated by service. The government may show a lack of aggravation by establishing that there was no increase in disability during service or that any "increase in disability [was] due to the natural progress of the" preexisting condition. 38 U.S.C. § 1153. If this burden is met, then the Veteran is not entitled to service-connected benefits; however, if the government fails to rebut the presumption of soundness under section 1111, the Veteran's claim is one for service connection. This means that no deduction for the degree of disability existing at the time of entrance will be made if a rating is awarded. See 38 C.F.R. § 3.322. The Veteran contends that even if psychiatric disabilities were caused by childhood traumas, they were aggravated by service. An April 2011 Affidavit from Dr. D.G. reflects that the Veteran was diagnosed with Gender Identity Disorder, and that Dr. D.G. performed sex reassignment surgery in March 2011. The Veteran submitted a November 2015 statement from A.R. in which she opined that the Veteran's mental health issues of depression, PTSD, and social anxiety were all exacerbated by military service. A.R. stated that the Veteran was subjected to trauma in the form of homophobic and other extreme harassment by her military peers. A.R. stated that the Veteran left the military due to her fears over her safety and well-being. Treatment records from Banner Health include an assessment of PTSD, but they do not identify the stressor(s) responsible for it. The Veteran underwent a VA examination in February 2020. The examiner noted that the Veteran expressed a strong desire to be of another gender that is incongruent from assigned gender during childhood. She had a strong conviction to be treated as an alternative gender. For example, the Veteran was involved in legal proceedings to have intersex as gender marker on her passport. Finally, she demonstrated strong desire for sex characteristics as evidenced by reported "vaginal opening" surgery in 2012. The Veteran reported numerous pre-service stressors. She reported that she was raped/sodomized at the age of 14 by an adult male known by her brother. She also reported that she woke during childhood gender assignment surgery. She reported that at the age of 11, she had severe complications with surgeries and the urethra resulting in incontinence. Regarding childhood/pre-military family and peer relationships/social functioning, the Veteran stated that she was born with ambiguous genitalia, and that she underwent several childhood surgeries between 3 6 years old to assign male gender. She noted sexual identity confusion for most of childhood and adult life. She reported childhood teasing and bullying related to incontinence secondary to surgical complications. Regarding social/marital issues during military service, the Veteran reported a "witch hunt" before Don't Ask Don't Tell for identifying and discharging homosexuals. While on her first ship, she stated that she anonymously received homosexual pornography on her bunk. She stated that she was "block checked" on several occasions, and that she was interrogated by NIS regarding her sexuality. She denied continued problems on her second ship or threats of discharge. The Veteran reported several in-service stressors. She reported that she served in combat in the Falkland Islands War and 3 tours in Beirut. Her duties consisted of protecting the Secretary of State, classified operations in Beirut, and providing close cover and logistics to Marines on shore. The examiner noted that her DD 214 noted Navy service 10/1978 - 10/1984 as Machinist. The Veteran denied mental health evaluation, mental health diagnoses, and treatment for mental health issues during military service. The Veteran reported a stressor that occurred in 1983, involving a truck bombing of Marine Barracks in Beirut in which 241 military personnel were killed. She later stated that it was 271 killed and unknown wounded. She stated that she felt the blast 500 yards away while inside the engine room on the ship. The examiner noted that this stressor does not meet Criterion A for a diagnosis of PTSD, and it is not related to fear of hostile military or terrorist activity. The Veteran reported a second stressor that occurred in 1980-1981. She stated that while in the Strait of Hormuz, her duties included station at the machine gun on ship. She stated that military personnel would fire at oil tankers and machine gun boats. She reported firing once. She laughed about the inaccuracy of artillery due to lilting seas. She reported being highly bothered by the idea of potentially killing a human being. The examiner noted that the stressor met Criterion A as adequate to support the diagnosis of PTSD, and that it was related to the Veteran's fear of hostile military or terrorist activity. Another of the Veteran's stressors occurred in 1982. She stated that she was "knocked out" for a minute by repercussion from a gun fired from the ship. She stated that she was located in a fan room and did not hear warnings that guns would be fired. She stated that a corpsman wiped blood from her ears, administered aspirin, and sent her back to work. She reported subsequent difficulty standing, and a need to relearn how to work machines due to hearing difficulties. She expressed anger, frustration, and irritation due to hearing difficulties. She stated that this event "changed my personality" with declining work performance (e.g. poor communication and not getting along with subordinates). She denied disciplinary action. The examiner noted that military records do not support a diagnosis of TBI, and that service connection for TBI was denied. Additionally, the examiner stated that the stressor did not meet criterion A and was inadequate to support a diagnosis of PTSD. The stressor is not related to fear of hostile military or terrorist activity. Finally, the Veteran also reported that in 1982, terrorists in Greece blew up a bar one hour after the Veteran had left it. She also reported that in 2010, she was involved in a motor vehicle accident while riding a motorized scooter struck and being struck by a vehicle making a left turn. She stated that she injured/broke three ribs, disks in back, and had a left shoulder injury misdiagnosed by the emergency room. She reported the onset of anxiety due to witnessing tracers during military service with thought of "people are dying." The examiner noted that in regard to PTSD related to military sexual trauma (i.e. sexual harassment) and social anxiety, the clinical interview and military/post-military records do not support the claim. The examiner noted that October 2010 VA examination which diagnosed PTSD and unspecified depressive disorder related to childhood trauma associated with intersex issues, surgery, teasing and taunting by peers, physical abuse by parents, [and] physical discomfort caused by medical providers. The examiner noted that references to social anxiety in post-military VAMC treatment records resulted in diagnoses of gender identity and major depressive disorder. She stated that the Veteran has never been diagnosed with social anxiety Disorder. Instead, a current diagnosis of gender dysphoria accounts for her claimed depression, suspiciousness/mistrust of others, and social anxiety that impacts social functioning. Gender dysphoria was first diagnosed in 2015 at the VA and she is currently under treatment with a VA psychiatrist. Pursuant to the Board's January 2021 Remand, the RO obtained an addendum opinion regarding the etiology of the Veteran's psychiatric disabilities. The February 2021 examiner noted that the evidence in the claims file provides clear and unmistakable evidence that the Veteran's major depressive disorder had its onset prior to enlisting in the military, even if the Veteran's depression symptoms would have been an unspecified depressive disorder at that time. She stated that although the Veteran did not have a mental health evaluation or diagnosis prior to enlisting in the military or during their military service, treatment records from Mountain Crest inpatient admissions from March 2003 and June 2004 clearly and unmistakably document a history of depression symptoms that had their onset in childhood, including a report of a suicide attempt in junior high, and statements by the Veteran including comments that she has always had mood swings, cannot remember a time when she was not depressed, onset of "early" depression, and comments of "lifelong" depression. Documentation of the Veteran's report of depression symptoms with onset in childhood, including suicide attempt in junior high, is clear and unmistakable evidence that although not diagnosed prior to enlisting in the military, the depressive disorder had its onset in childhood, prior to enlisting in the military. The February 2021 VA examiner opined that the Veteran had clear and unmistakable evidence of a depressive disorder, currently diagnosed as major depressive disorder, recurrent episode, prior to military service. However, she found no evidence in service treatment records, and Veteran did not present any evidence during the interview to suggest that her symptoms were exacerbated by military service. For example, the Veteran has reported attempting suicide in junior high, which indicates at least one episode of severe depression symptoms prior to enlisting in the military. Then, throughout military service, the Veteran consistently denied experiencing depression symptoms and there was no depressive disorder diagnosed nor symptoms of depression reported at separation. This indicates the depression was not exacerbated by military service. Review of the claims file indicates the Veteran's depressive symptoms have fluctuated throughout their life with the level of symptoms waxing and waning over time, which is consistent with the natural course of the disorder. In April 2020, her depressive symptoms were noted as stable and she evidenced a euthymic mood, suggesting minimal current depression symptoms. Therefore, the examiner opined that it is apparent that the Major Depressive Disorder, recurrent episode was not permanently aggravated by military service. Regarding social anxiety, the examiner noted that the Veteran is not diagnosed with social anxiety disorder. The social anxiety the Veteran describes is related to her gender dysphoria diagnosis, which is explained by the February 2020 VA examiner. The February 2021 VA examiner agreed with the February 2020 medical opinion regarding social anxiety being subsumed under Gender Dysphoria diagnosis as this conclusion is consistent with the evidence in the claims file. Evidence weighing in favor of the claims includes a November 2015 statement by A.R., who opined the Veteran's mental health issues of depression, PTSD, and social anxiety were all exacerbated by military service. Evidence weighing against the claim includes opinions by the October 2010 and February 2021 VA examiners. The Court has held that the Board must determine how much weight is to be attached to each medical opinion of record. See Guerrieri v. Brown, 4 Vet. App. 467 (1993). Greater weight may be placed on one medical professional's opinion over another, depending on factors such as reasoning employed by the medical professionals and whether or not, and the extent to which, they reviewed prior clinical records and other evidence. Gabrielson v. Brown, 7 Vet. App. 36 (1994). Adequate reasons and bases, in short, must be presented if the Board adopts one medical opinion over another. In assessing evidence such as medical opinions, the failure of the physician to provide a basis for his opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Other factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion. See Prejean v. West, 13 Vet. 444, 448-9 (2000). In some cases, the physician's special qualifications or expertise in the relevant medical specialty or lack thereof may be a factor. In every case, the Board must support its conclusion with an adequate statement of its reasoning of why it found one medical opinion more persuasive than the other. There are substantial and significant factors which favor the valuation of the VA medical opinions over the opinion of A.R. in this case. In determining the probative value to be assigned to a medical opinion, the Board must consider three factors. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case. A review of the claims file is not required, since a medical professional can also become aware of the relevant medical history by having treated a Veteran for a long period of time or through a factually accurate medical history reported by a Veteran. Nieves-Rodriguez, 22 Vet. App. at 303-04. The second inquiry involves consideration of whether the medical expert provided a fully articulated opinion. See Id. A medical opinion that is equivocal in nature or expressed in speculative language does not provide the degree of certainty required for medical nexus evidence. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third and final factor in determining the probative value of an opinion involves consideration of whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Therefore, a medical opinion containing only data and conclusions is not entitled to any weight. In fact, a review of the claims file does not substitute for a lack of a reasoned analysis. See Nieves-Rodriguez, 22 Vet. App. at 304; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). All examiners expressed a fully articulated opinion that was unequivocal. However, the opinions of the VA examiners are far more probative in that they demonstrated a more thorough understanding of the Veteran's medical history, and they provided far thorough rationales to support their conclusions. A.R. concluded that the Veteran's psychiatric disabilities were exacerbated by service. However, she did not provide any rationale to support her opinion. The VA examiners, on the other hand, frequently cited to the treatment records which showed severe symptoms (including a suicide attempt) prior to service, and service treatment records in which the Veteran denied psychiatric symptoms. Consequently, the Board gives more probative weight to the VA opinions, most notably the opinion of the February 2021 examiner. As the preponderance of the evidence is against these claims, the benefit-of-the-doubt doctrine does not apply, and the claims for service connection for PTSD and social anxiety must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Entitlement to service connection for right and left upper extremity ulnar neuropathy is denied. Service treatment records fail to reflect any findings attributed to ulnar neuropathy. Upon separation from service, the Veteran completed a September 1984 Report of Medical History in which she answered "yes" to whether she had swollen or painful joints, and answered "Don't know" when asked about neuritis. At her January 2019 Board hearing, the Veteran testified that she had a diagnosis of carpal tunnel syndrome from the Medical Center of the Rockies. By way of a June 2020 rating decision, the RO granted service connection for right and left upper extremity carpal tunnel syndrome status post carpal tunnel release. The Veteran underwent a VA examination in March 2020. The examiner opined that it was less likely than not that the Veteran's ulnar neuropathy began during service or was due to an in-service event. She explained that there was no evidence of ulnar neuropathy while the Veteran was in service. The medical record is silent regarding this condition until 2009. The March 2020 VA examiner failed to acknowledge the Veteran's reports of swollen or painful joints and possible neuritis. Consequently, the Board remanded the claims in January 2021 so that the RO could obtain an addendum opinion. The RO obtained an addendum opinion in February 2021. The examiner came to the same conclusion as the March 2020 VA examiner. She noted that she reviewed all available medical records. She acknowledged that the Veteran marked "Don't know" when asked if she had ever had neuritis, and that she marked "yes" when asked if she ever had swollen or painful joints. The examiner noted that the Veteran's reports notwithstanding, the separation examination yielded normal findings regarding the neurological system and upper extremities. She noted that the Veteran's claims folder is silent until 2009 with NCV noting bilateral ulnar compression due to c/o arm numbness. She stated that there is no evidence that the disability began during service or within one year of separation from service. She opined that it was less likely than not that the Veteran's current disability (ulnar neuropathy) is related to the Veteran's reports of swollen or painful joints or possible neuritis in 1984. She stated that a nexus is not established. Treatment records show the Veteran was not diagnosed with ulnar neuropathy until 2009, more than two decades after discharge from service. Further, the February 2021VA examiner opined that the Veteran's ulnar neuropathy is not at least as likely as not related to an in-service injury, event, or disease, including her reports of swollen/painful joints and possible neuritis. The rationale was that there was no objective medical evidence of neuropathy during service or for many years after service. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). (Continued on the next page) The Veteran believes her ulnar neuropathy is related to an in-service injury, event, or disease. She is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of pathology. Therefore, it is outside the competence of the Veteran in this case because the record does not show that she has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the February 2021 VA examiner. As the preponderance of the evidence is against these claims, the benefit-of-the-doubt doctrine does not apply, and the claims for service connection for ulnar neuropathy of the right and left upper extremities must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Prem, 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.