Citation Nr: 21063629 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 16-32 487 DATE: October 15, 2021 ORDER 1. Entitlement to service connection for a traumatic brain injury (TBI) is denied. 2. Entitlement to service connection for a disability manifested by dizziness and/or vertigo, to include as secondary to a TBI, tinnitus, a hearing loss disability and/or a lumbar spine disability, is denied. 3. Entitlement to service connection for diabetes mellitus, to include as secondary to a TBI, is denied. 4. Entitlement to service connection for prostate hypertrophy, to include as secondary to a TBI, is denied. 5. Entitlement to service connection for a left shoulder disability is denied. 6. Entitlement to service connection for a right hand disability, claimed as a swollen right hand, is denied. 7. Entitlement to service connection for a left heel spur is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has a diagnosis of a TBI that had an onset in service or is otherwise related to service. 2. The preponderance of the evidence is against finding that a disability manifested by dizziness and/or vertigo is secondary to service-connected hearing loss and/or tinnitus or is otherwise related to an in-service injury or disease. 3. The preponderance of the evidence is against finding that diabetes mellitus had an onset in service, manifested within one year of service discharge, or is otherwise related to service. 4. The preponderance of the evidence is against finding that the diagnosed prostate hypertrophy had an onset in service or is otherwise related to service. 5. The preponderance of the evidence of record is against finding that the Veteran has had a left shoulder disability, to include pain that causes functional impairment of earning capacity, at any time during or approximate to the pendency of the claim or that any left shoulder disability had an onset in service or is otherwise related to service. 6. The preponderance of the evidence is against finding that a right hand disability, to include carpal tunnel syndrome, had an onset in service, manifested to within one year of service discharge, or is otherwise related to service. 7. The preponderance of the evidence is against finding that the Veteran has a diagnosis of a left heel spur or a left foot disability, to include pain causing functional impairment of earning capacity. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a TBI have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 2. The criteria for entitlement to service connection for a disability manifested by dizziness and/or vertigo, to include as secondary to a TBI, tinnitus, a hearing loss disability and/or a lumbar spine disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2020). 3. The criteria for entitlement to service connection for diabetes mellitus, to include as secondary to a TBI, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 4. The criteria for entitlement to service connection for prostate hypertrophy, to include as secondary to a TBI, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 5. The criteria for entitlement to service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 6. The criteria for entitlement to service connection for a right hand disability, claimed as a swollen right hand, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 7. The criteria for entitlement to service connection for a left heel spur have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1944 to June 1946 and from June 1948 to June 1952. Following his active service, the Veteran served in the Army National guard from October 1960 to July 1987. The Board remanded these matters in September 2017, August 2018, and April 2020 for additional development. In consideration of the appeal, the Board is satisfied there was substantial compliance with the remand directives and will proceed with review of the claims on appeal. Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection is also warranted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(b). Additionally, where a veteran served 90 days or more of active service and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a). Active military, naval, or air service includes any period of ACDUTRA during which the individual concerned was disabled or died from disease or injury incurred in or aggravated in the line of duty, or any period of INACDUTRA during which the individual concerned was disabled or died from injury (but not disease) incurred in or aggravated in the line of duty. 38 U.S.C. §§ 101(21), (22), (23), (24), 106; 38 C.F.R. § 3.6(a), (c), (d). A "veteran" is a person who served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable. 38 C.F.R. § 3.1(d). The term "active military, naval, or air service" includes active duty, any period of active duty for training during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty training during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty. 38 U.S.C. § 101(24); 38 C.F.R. § 3.5(a), (d). When a claim is based on a period of ACDUTRA, there must be evidence that the individual concerned died or became disabled during a period of ACDUTRA as a result of a disease or injury incurred or aggravated in the line of duty. In the absence of such evidence, the period of ACDUTRA would not qualify as "active military, naval, or air service" and the claimant would not achieve veteran status for purposes of that claim. See 38 U.S.C. § 101(2)-(24); Mercado-Martinez v. West, 11 Vet. App. 415, 419 (1998). 1. Entitlement to service connection for a TBI Over the course of the appeal, the Veteran has asserted multiple onsets of a TBI. Initially, the Veteran reported that the concussive blast from cannon fire that damaged his eyes caused a TBI. He later reported that a kamikaze attack on his ship in May 1945 caused a TBI. The Veteran also reported that he hit his head on a grease plug while peeling potatoes in 1945, causing a TBI. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for a TBI. The reasons follow. The first element of service connection requires a current disability. After thorough review of the evidence of record, the Board finds the preponderance of the evidence is against a finding of a current disability of a TBI or residuals of a TBI. VA examinations conducted in May 2015, December 2017, April 2019, and July 2021 all specifically document that the Veteran does not have a TBI or residuals of a TBI. The examiners have acknowledged that the Veteran has some cognitive defects, but each examiner associates this symptomatology with the regular aging process and not due to a head injury after performing a thorough review of the Veteran's assertions and his service treatment records (STRs). The December 2017 VA examiner acknowledged the December 2006 CT, which revealed hypodensities in the white matter of the brain but opined that this abnormality was not unusual for an individual of the Veteran's age and does not constitute a diagnosis of a TBI or head trauma and is not consistent with a history of a concussive blast. The December 2017 VA examiner also addressed the Veteran's reports that his gait instability and balance issues are related to a TBI but noted that VA treatment records do not document reports of balance or gait issues until approximately April 2014, at which time the Veteran was 87 years oldan age at which such gait instability is expected and common. Furthermore, the December 2017 examiner noted that if such symptoms of cognitive decline or balance or gait issues were associated with a history of a concussive blast or were residuals of a TBI, they would have begun within a short time of the injury. The examiner noted that medical literature supports that neurological symptoms and cognitive disability attributable to a TBI typically begin within three months of the initial injury. As the symptoms in this Veteran's case did not have an onset until decades after his now-reported concussive injury, the symptoms are less likely than not related to a history of a TBI, nor are they residuals of a TBI, even if such an incident did occur. The July 2021 VA examiner addressed the documentation of a history of headaches in the 1949 and 1950 STRs, and the examiner opined that these headaches are frequently associated with other medical conditions and appear to have resolved without residual based on the remainder of the records in the claims file and were not suggestive of a history of a TBI or ongoing residuals of a TBI in service. Given the multiple opinions by the many VA examiners, which, when combined, fully address the current symptomatology as well as the historical symptomatology, the Board finds the preponderance of the most evidence of record is against finding that the Veteran has a diagnosis of a TBI or residuals of a TBI. Absent evidence of current residuals of a TBI, service connection is denied. Additionally, the Board also finds the preponderance of the evidence is against a disease or injury in service involving a TBI. The STRs do not show that the Veteran sustained a disease or injury suggestive of a TBI during service. For example, in STRs completed in June and November 1945, just after the two of three of the Veteran's reported injuries to his head in service, the Veteran was examined and noted to be physically qualified to transfer. In June 1946, an examination documented that the nervous system was clinically normal; there was no documentation of a history of a head injury, a TBI, or ongoing residuals from a TBI, and the Veteran was documented to be physically qualified for duty. On the Application for Enlistment for the second period of active service, completed in March 1947, the Veteran reported a history of a head injury, but did not document any specifics as to the onset of a head injury, and in subsequent examinations conducted during that period of active service, including examinations completed in May 1948 and June 1948 and the June 1952 separation examination, the Veteran denied a history of a head injury and, in June 1948, the Veteran specifically documented that he was not concealing any disease or disability. Concurrent clinical evaluations did not document abnormalities and did not document a history of a TBI or residuals of a TBI. The Veteran reported headaches in August 1948 and May 1951. However, in August 1949, the Veteran denied having long periods of unconsciousness. In October 1960, at the entrance to his National Guard service, the Veteran, on a Report of Medical History, specifically denied having or having had a history of frequent or severe headaches, frequent trouble sleeping, depression or excessive worry, loss of memory or amnesia, or nervous trouble of any sort, despite reporting having had issues with his ear, nose, and throat; frequent indigestion; and appendicitis. When asked if he had consulted or been treated by clinics, physicians, healers, or other practitioners within the past five years, the Veteran checked, "Yes" and documented a stomach infection. He denied an illness or injury other than those reported. The associated medical examination documented that a neurologic and psychiatric examination were clinically normal. Additionally, examinations during the Veteran's National Guard service continue to document that the Veteran did not have a history of a TBI or residuals of a TBI, nor did he experience a TBI during his National Guard service. In April 1979 and October 1982, the Veteran completed Reports of Medical History. On both reports, the Veteran specifically denied having or having had a history of frequent or severe headaches, frequent trouble sleeping, depression or excessive worry, loss of memory or amnesia, nervous trouble of any sort, or periods of unconsciousness, despite reporting other symptoms, including having or having had swollen or painful joints. piles or rectal disease, arthritis, and recurrent back pain. Though the Veteran reported having or having had a head injury on the April 1979 report, he provided no explanation as to the circumstances surrounding such an injury. On the October 1982 Report of Medical History, the Veteran also reported a history of a head injury, but on this report, the Veteran reported that the injury occurred while he was playing 35 years prior, which would have been in approximately 1947, which would be between periods of active service and unrelated to the later-reported incidents of head trauma in service. Examinations conducted in association with these reports of medical history document that neurologic and psychiatric examinations were clinically normal, and despite the reports that the Veteran had a history of a head injury, the examiner did not document that the Veteran had any residuals of a TBI. The Board finds the aforementioned evidence is against a finding that the Veteran had a head injury suggestive of a TBI during his active service. Additionally, in an August 2006 VA treatment record, the examiner documented that the Veteran denied a history of a head injury with loss of consciousness. Furthermore, in a March 2015 statement, the Veteran denied that he had received any treatment during his National Guard service and notes that he makes no claims as to anything that occurred during his National Guard service. Thus, the preponderance of the evidence is also against the facts establishing the second element of a service-connection claim requiring an onset of a disability in service. The Board must analyze the credibility and probative value of the evidence, account for the evidence it finds persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the Veteran. Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011). This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record. See King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012); Kahana, 24 Vet. App. at 43334. A lay person is competent to report to the onset and continuity of his symptomatology. Id. at 438. Moreover, lay evidence may be competent and sufficient evidence of a diagnosis or nexus if (1) the particular condition at issue is the type of condition that is within the competence or common knowledge of a lay person, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 137677 (Fed. Cir. 2007). The Board must determine on a case-by-case basis whether a particular condition is the type of condition that is within the competence of a lay person. See Kahana, 24 Vet. App. at 433, n. 4. A veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009); see also Walker v. Shinseki, 708 F.3d 1331, 1334 (Fed. Cir. 2013). In making its ultimate determination, the Board must give a veteran the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. Fagan, 573 F.3d at 1287 (quoting 38 U.S.C. § 5107(b)). The Board finds that the VA medical opinions, particularly those provided by the December 2017 and June 2021 examiners, are highly probative, as the examiners reviewed the file, including the Veteran's service treatment records, listened to the Veteran's report of history, physically examined the Veteran, and provided a rationale that relied on the specific facts of the case, which facts are accurate. This is evidence against a current disability resulting from a TBI. There is no competent evidence to weigh against these medical opinions. Additionally, while the Veteran is competent to report symptoms that he has experienced in service and since service, the Board finds the Veteran's reports related to the onset of his TBI are not credible. The reasons follow. Initially, the Veteran's reports as to what he asserts caused a TBI have been inconsistent, which the Board finds weighs against his credibility. Over the course of the appeal, the Veteran has reported no less than three, separate incidents, which he, at various times, asserts are the onset of a TBI, often without mentioning any of the other incidents. The first documentation in the record that the Veteran believes that he suffered TBI symptoms related to his active service was noted when the Veteran filed his claim for a TBI in November 2009. This first documentation is decades after the Veteran's discharge from active service and over a decade after his discharge from his National Guard service. On the claim, the Veteran reported that in May 1945, there was a kamikaze attack on his ship. The Veteran reiterated the report of a kamikaze attack at the May 2015 VA examination, adding that he felt the blast but was not knocked down or knocked out. At a May 2015 VA examination, the Veteran reported a new incident in service that damaged his eyes after a cannon fired across his line of sight, just 10 feet in front of him. He did not report that he was knocked down or knocked out by this incident. The Veteran had previously reported this incident to a private provider, Dr. Lee, which Dr. Lee notes in a January 2002 record that has been associated with the file. The January 2002 letter from Dr. Lee does not document that the Veteran reported TBI or concussion-related symptoms to Dr. Lee. Rather, Dr. Lee documented that the blast caused an injury to the Veteran's eyes. VA treatment records from April 2006 also document the Veteran reporting symptoms related to his eyes related to this incident without mentioning symptoms of a TBI occurring at the same time. The Board finds this to be highly probative evidence that the Veteran did not experience symptoms of a TBI related to this incident, as he would have reported it to Dr. Lee or to the VA treatment provider in April 2006 when he initially reported the incident. As noted above, in an August 2006 VA treatment record, the Veteran specifically denied a history of a head injury. The Veteran's later reports that he experienced TBI-related symptoms associated with this incident are not credible, as they are inconsistent with his previous reports and because the TBI symptoms were not mentioned until decades after the reported incident. At the December 2017 VA examination, the Veteran again reported the incident in 1945, in which a kamikaze pilot crashed into his ship. Here, the Veteran added additional details, noting that the bomb did not explode. However, he now reported that he had a concussion, contradicting his previous reports, but denied that he was knocked out. He also added that the gun blast threw him out of balance and that he had a gap in his memory for about a month. He denied having lasting symptoms related to the incident, though he reported that he now has difficulty remembering things. At this examination, the Veteran did not mention the incident related to the cannon fire passing just in front of him, which he had previously reported caused his TBI symptoms, though the examiner addressed the contention in the opinion provided, as the examiner had seen the Veteran's written contention. At the April 2019 VA examination, the Veteran did not report either the kamikaze pilot incident or the cannon fire incident. Rather, the Veteran reported an incident in which he was peeling potatoes in service, was surprised by something causing him to stand up, and then hit his head on a grease plug. The Veteran had not previously reported this incident and did not provide any information as to when the incident reportedly occurred, but he denied that he lost consciousness. At the July 2021 VA examination, the Veteran again failed to mention either the incident related to the kamikaze pilot or the incident related to the cannon fire, but he reiterated the incident in which he reportedly hit his head while peeling potatoes, now adding that the incident took place in 1945. Over the course of the appeal, the Veteran has changed his story related to what he now asserts was the onset of a TBI during his active service. The Veteran frequently reported one incident or the other but did not continuously report any incident throughout the entire period on appeal. The Board finds this inconsistent reporting makes the Veteran an unreliable and not credible reporter of his history related to this incident. Further weighing against the Veteran's credibility is the fact that the Veteran began reporting the incident related to the nearby cannon fire for approximately 13 years without mentioning that the incident caused symptoms related to a TBI before adding such symptoms when reporting his medical history. The Board finds it unlikely that the Veteran would not have reported being knocked down or having significant TBI symptoms when he was reporting having other symptoms related to the incident, such as an injury to his eyes. Finally, the Veteran did not report any of these incidents until decades after his service discharge, despite reporting many other symptoms during his National Guard service and to VA examiners and treatment providers, specifically those related to his claimed eye disability. Second, the Veteran's reports as to these various incidents, all of which he asserts caused his TBI at different times throughout the record as noted above, are not consistent with the STRs from his periods of active duty. Initially, a thorough review of the evidence of record, does not document any of these incidents occurred. The Board finds that these incidents, particularly the incidents of close cannon fire and a kamikaze attack are significant incidents that would have likely been documented in subsequent STRs had the Veteran been injured in any such major incident. Furthermore, during his active service, in multiple examinations, Reports of Medical History, and other STRs, the Veteran did not report ongoing symptoms related to any of these incidents. As noted above, during the first period of active service, examinations conducted in June 1945, November 1945, and June 1946, the Veteran was examined and noted to be physically qualified to transfer with no mention of any major incidents resulting in injury like a kamikaze attack or close cannon fire, nor is there a mention of a head injury. The Veteran was consistently documented to be clinically normal involving the various bodily systems. During his second period of active duty, the Veteran's reporting surrounding his history of a head injury is inconsistent. On his Application for Enlistment, completed in March 1947, he reported having a history of a head injury, but on a May 1948 Application for Enlistment, he denied having head injuries. In August 1948 and May 1951, he reported occasional headaches, but in June 1952, he was examined and found physically qualified for duty with no documentation of a head injury or any other defects. The Board finds it weighs against the Veteran's credibility that even when he reported a history of having a head injury or headaches, the Veteran did not report the three incidents he now reports were an onset of a TBI in service. Given the severity of the incidents, the Board finds the Veteran would likely have provided such details to treatment providers at the time, especially given that he took the time to document a history of a head injury. Regardless, the inconsistency of his facts has damaged his overall credibility. Finally, the National Guard records, to the extent they are available, also do not document that the Veteran experienced symptoms of a TBI following a kamikaze attack, a close incident of cannon fire, or after injuring his head while peeling potatoes. Rather, the Veteran consistently denied symptoms of residuals of a TBI on Reports of Medical History, as noted above, and to the extent that he reported a history of a head injury, the Veteran attributed the injury to other incidents that took place prior to or in-between periods of service. Specifically, on his April 1979 Report of Medical History, the Veteran reported a head injury occurred in "h.s.," which the Board presumes means a head injury occurring in high school and not during a period of active service, and even if "h.s." refers to something else, it does not clearly refer to any of the incidents the Veteran now reports caused residuals of a TBI. Again, the Board finds it unlikely that the Veteran would not have reported any of these incidents at that time had they occurred. Additionally, as noted above, in the October 1982 Report of Medical History, the Veteran attributed his history of a head injury to an injury that occurred while playing 35 years ago, which the Board notes would be between periods of service, and not to any of the later-reported incidents he now asserts caused residuals of a TBI in service. Given the significance of the incidents and the fact that the Veteran reported having experienced other incidents in service, the Board finds it unlikely that the Veteran would not have reported symptoms of a TBI during this time, weighing heavily against the Veteran's credibility. As the Veteran is not a credible reporter of his history related to incidents which may have caused a TBI in-service, the Veteran's own reported history as to these incidents does not have probative value. Thus, the Board finds the preponderance of the evidence is against finding that the Veteran experienced a TBI during a period of active service and did not have residuals of a TBI during the period on appeal. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for a TBI is denied. 2. Entitlement to service connection for a disability manifested by dizziness and/or vertigo, to include as secondary to a TBI, tinnitus, a hearing loss disability and/or a lumbar spine disability The Veteran believes that he has dizziness and vertigo caused by the cannon fire blast he now asserts occurred in service or is caused by the service-connected tinnitus and/or bilateral hearing loss disability. The Veteran also asserts that his dizziness and vertigo is caused or aggravated by a TBI. Finally, in private treatment records from Mission Physical Rehabilitation, the Veteran consistently reports that he has decreased balance related to a lumbar spine disability. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for a disability manifested by dizziness and/or vertigo. The reasons follow. As to evidence of a current disability, a May 2014 VA examiner diagnosed the Veteran with benign paroxysmal positional vertigo, and, while December 2017 and April 2019 VA examiners documented the Veteran had no diagnosis of any such disability, the July 2021 VA examiner also documented a diagnosis of a benign paroxysmal positional vertigo. While it does not appear that the Veteran had a diagnosis of benign paroxysmal vertigo throughout the entire period on appeal, the record supports a finding that, for at least some portion of the appeal period, the Veteran had a diagnosis of benign paroxysmal vertigo. Therefore, the facts establish that the first element of a service connection claim is met. As to evidence of a disease or injury in service, the STRs do not show that the Veteran sustained a disease or injury causing, dizziness, vertigo and/or the onset of benign paroxysmal vertigo during service. For example, during the first period of active service, STRs from June and November 1945 document that the Veteran was examined and noted to be physically qualified to transfer. An examination from June 1946, just prior to the Veteran's discharge from active duty, did not document reported symptoms of dizziness or vertigo, nor did it document clinical abnormalities suggestive of the onset of a benign paroxysmal vertigo. Prior to entering his second period of active service, the Veteran specifically denied in March 1947 and May 1948 Applications for Enlistment that he had experienced ear trouble or dizziness or fainting spells. The June 1948 enlistment examination did not document clinical abnormalities suggestive of the onset of any peripheral vestibular disorder, nor did it suggest the Veteran had reported symptoms of dizziness or vertigo. In October 1960, just prior to entering National Guard service, the Veteran completed a Report of Medical History. On this report, the Veteran specifically denied having or having had symptoms of dizziness or fainting spells. On this report, the Veteran reported having or having had ear, nose, and throat trouble; frequent indigestion; and appendicitis. The Board finds this probative evidence that the Veteran filled out this form with some attention to detail, and had he experienced symptoms of dizziness or vertigo at the time, he likely would have reported it given that he reported having had other symptomatology. Thus, his denial of a history of such symptoms is evidence against his experiencing these symptoms. Clinical evaluations conducted at the same time also documented normal findings involving the ears, ear drums, or neurological system. Furthermore, in March 2015, the Veteran specifically denied that he received any treatment during his National Guard service and that his claims are not based upon an injury or disease that occurred during his National Guard service. This statement is consistent with the STRs available from this period of service. For example, Reports of Medical History completed by the Veteran in April 1979 and October 1982, during his National Guard service, continue to document that he specifically denied having or having had dizziness or fainting spells, despite reporting having or having had a head injury, pain or pressure in his chest, and piles or rectal disease. Given that the Veteran reported having or having had other symptoms on this report, the Board finds it likely that if he was continuing to experience spontaneous dizziness, vertigo, or other symptoms involving the onset of benign paroxysmal vertigo during this time, he would have reported it. Clinical evaluations conducted at the same time as these Reports of Medical History both documented that clinical evaluations of the ear, ear drums, and neurological system were normal, and the examiner did not document symptoms suggestive of the later-diagnosed peripheral vestibular disorder. Based on the aforementioned, the Board finds the preponderance of the evidence is against a finding that the second element of a service-connection claim is met, including that these symptoms are related to the in-service incident in which he was exposed to close cannon fire, in part because, as noted above, the Veteran is not a credible reporter of his medical history related to this incident. Additionally, the Board finds the preponderance of the probative evidence is against a finding of a nexus between the current disability and service. The December 2017 VA examiner opined that had the Veteran developed vertigo or dizziness due to an incident or event in service, the symptoms would have begun at the time the injury occurred. The Veteran reported to the December 2017 VA examiner that his symptoms of dizziness did not start until 1955 and began spontaneously. An onset in 1955 would suggest an onset three years after discharge from active service and prior to the National Guard service. Furthermore, the examiner noted that the feelings of light-headedness upon rising are more likely related to his orthostatic hypotension, which is noted to be caused by some of the medications he takes. The examiner also noted that these symptoms are a common condition for those in the Veteran's age group. Despite not meeting the requirements for service connection on a direct basis, the Board will still address whether the facts establish entitlement to service connection on a secondary basis. The Veteran is currently service connected for bilateral hearing loss disability and tinnitus, and the Veteran asserts that these disabilities have caused or aggravated the diagnosis of peripheral vestibular disorder. The April 2019 VA examiner, despite not diagnosing the Veteran with a peripheral vestibular disorder, addressed the symptomatology, including the Veteran's reports of dizziness and vertigo. The examiner noted the record does not support that this symptomatology is caused by tinnitus or bilateral hearing loss. Rather, the examiner opined that the Veteran's feelings of lightheadedness upon arising is more likely than not related to his orthostatic hypotension given that he is taking Amlodipine, Metoprolol, and Tamsolusin. The examiner noted that these medications are known to cause orthostatic hypotension. Furthermore, the examiner noted that hypotension is common in the Veteran's age group. The VA treatment records show that Amlodipine and Metoprolol are medications prescribed for hypertension. taken for hypertension and Tamsolusin is medication prescribed for benign prostatic hypertrophy, and none of these disabilities are service connected, and the Board finds, as discussed below, that service connection for benign prostatic hypertrophy is not warranted. Thus, the taking of these medications is not related to a service-connected disability or disabilities. The Board finds that the April 2019 opinion is competent and probative regarding secondary service connection, opining that the service-connected bilateral hearing loss and tinnitus are not at least as likely as not related to the Veteran's symptoms. The examiner reviewed the evidence of record and provided a rationale for the conclusion that the Veteran's symptoms were more likely the result of orthostatic hypotension or the Veteran's age. While the examiner did not specifically address "aggravation," the Board finds that the opinion is distinguishable from the holding in El-Amin v. Shinseki, 26 Vet. App. 136 (2013). In that case, the U.S. Court of Appeals for Veterans Claims (Court) found that the examiner's opinion that it was "more likely than not that the veteran's alcohol abuse was related to factors other than the veteran's post-traumatic stress disorder" did not rule out the possibility that the veteran's service-connected PTSD aggravated his alcohol abuse to some degree. Id. In contrast, here, the April 2019 examiner explained that that the symptomatology was more likely due to other facts, specifically the Veteran's age group and side-effects of the medications the Veteran takes, which the Board notes is supported by the medical records in the claims file. Furthermore, the examiner noted that the nature of the symptoms were not a separate and distinct disability. Because the examiner opined that the most likely medical relationship was between the symptoms and the Veteran's age or medication than any other cause, such as tinnitus or bilateral hearing loss, the examiner's statement, unlike that of the examiner in El-Amin, rules out the possibility that the service-connected disability may aggravate to some degree the non-service-connected disability. Thus, the Board finds that the examiner's opinion addressed both causation and aggravation and is, therefore, probative regarding whether the service-connected tinnitus or bilateral hearing loss disability caused or aggravated the symptoms of vertigo and dizziness. Furthermore, the Board finds that the April 2019 VA medical opinion is highly probative, as the examiner reviewed the file, listened to the Veteran's report of history, physically examined the Veteran, and provided a rationale for the opinion that relied on the specific facts of the case, which facts are accurate. There is no competent evidence to weigh against this medical opinion. Thus, service connection for the peripheral vestibular disorder on a secondary basis is also not warranted. The Veteran also claimed that his peripheral vestibular disorder, manifested by dizziness and vertigo, was caused or aggravated by a lumbar spine disability and/or residuals of a TBI. However, the Veteran is not service connected for a lumbar spine disability, and, as addressed above, service connection for a TBI has been denied. Thus, service connection on a secondary basis to these disabilities is also denied. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for a disability manifested by dizziness and/or vertigo is denied. 3. Entitlement to service connection for diabetes mellitus, to include as secondary to a TBI The Veteran believes that diabetes mellitus was caused or aggravating by a TBI, speculating that a TBI aggravated his endocrine system. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for diabetes mellitus. The reasons follow. As to evidence of a current disability, VA treatment records from 2003 document that the Veteran has a diagnosis of diabetes mellitus. Therefore, the facts establish that the first element of a service-connection claim is met. As to evidence of a disease or injury in service, STRs do not show that the Veteran had an onset of diabetes mellitus during service. For example, during the first period of active service, STRs from June and November 1945 document that the Veteran was examined and documented to be physically qualified to transfer. The separation examination, conducted in June 1946, did not document any clinical abnormality suggestive of an onset of diabetes mellitus. During the second period of active service, the June 1952 separation examination also did not document anything suggestive of an onset of diabetes mellitus, and he was documented to be physically qualified for duty. Furthermore, the National Guard STRs, to the extent they are available, do not document a diagnosis of diabetes mellitus. On examinations conducted in October 1960, April 1979, and October 1982, the endocrine system was documented to be clinically normal. The only documentation in the STRs suggestive of an onset of diabetes mellitus prior to discharge from the National Guard was August 1985 records, which documented that the glucose was abnormally high. This documentation was over 30 years after discharge from active service and did not take place during a period of ACDUTRA. Even if this documentation took place during a period of INACDUTRA, service connection is not warranted for diseases, versus an injury. Thus, an elevated glucose reading, even if it was suggestive of an onset of diabetes mellitus in 1985, cannot be service connected, and the preponderance of the evidence is against a finding that the second element of a service-connection claim is met. Despite not meeting the requirements for service connection on a direct basis, the Board notes that diabetes mellitus is a chronic disease under 38 C.F.R. § 3.309, which allows for service connection on a presumptive basis if the chronic disease is manifested to a compensable degree within one year of discharge from service. However, in this case the preponderance of the evidence is against finding that the diabetes mellitus had an onset within one year of discharge from service. Rather, the record documents that the Veteran was not diagnosed with diabetes mellitus until approximately 2003, which is decades after his discharge from active service and his National Guard service. Furthermore, even if the high glucose in August 1985 was suggestive of an onset of diabetes mellitus, this still shows an onset over 20 years after discharge from active service. Additionally, the Veteran asserts that a TBI aggravated his endocrine system, causing his diabetes mellitus. However, as the Board has denied service connection for residuals of a TBI, service-connection as secondary to a TBI is also not warranted. VA did not provide the Veteran with an examination or medical opinion in connection with the claim for service connection for diabetes mellitus. The Board finds that entitlement to a VA examination or medical opinion is not warranted. VA must provide a medical examination and/or medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The preponderance of evidence is against evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifested during an applicable presumptive period or an indication that the disability may be associated with service or with another service-connected disability. For a VA examination and/or medical opinion to be warranted, all the McLendon criteria have to be met, and at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for this claim. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for diabetes mellitus is denied. 4. Entitlement to service connection for prostate hypertrophy, to include as secondary to a TBI The Veteran believes that his benign prostate hypertrophy was aggravated by a TBI. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for benign prostate hypertrophy. The reasons follow. As to evidence of a current disability, VA treatment records from 2003 document a history of benign hypertrophy of the prostate. Therefore, the facts establish that the first element of a service connection claim is met. The Veteran is not service connected for a TBI. Thus, service connection as secondary to a TBI is not warranted. As to evidence of a disease or injury in service, the STRs do not show that the Veteran sustained a disease or injury suggestive of an onset of benign hypertrophy of the prostate during service. For example, STRs from June and November 1945 document that the Veteran was examined and noted to be physically qualified to transfer, and the separation examination, conducted in June 1946 documents that a clinical evaluation of the genitourinary system was normal. The entrance examination from the second period of active service, conducted in June 1948 also documents that a clinical evaluation of the genitourinary system was normal. Furthermore, during his National Guard service, examinations completed in October 1960, April 1979, and October 1982 also continue to document that clinical evaluations of the genitourinary system was normal. Additionally, the Veteran himself, in a March 2012 statement, documented that he was not diagnosed with prostate hypertrophy until 1992, approximately seven years after his discharge from the National Guard and 40 years after his discharge from his most recent period of active duty. Thus, the preponderance of the evidence is against a finding that the second and third elements of a service-connection claim are met. Without the second and third elements, service connection is not warranted. VA did not provide the Veteran with an examination or medical opinion in connection with the claim for service connection for benign hypertrophy of the prostate. The Board finds that entitlement to a VA examination or medical opinion is not warranted. VA must provide a medical examination and/or medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The preponderance of evidence is against evidence establishing that an event, injury, or disease occurred in service or an indication that the disability may be associated with service or with another service-connected disability. For a VA examination and/or medical opinion to be warranted, all the McLendon criteria have to be met, and at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for this claim. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for a benign hypertrophy of the prostate is denied. 5. Entitlement to service connection for a left shoulder disability The Veteran believes that he has a left shoulder disability that had an onset in service, though the record does not clearly document a specific contention as to why he believes service connection is warranted or when the Veteran suffered a disease or injury to his left shoulder during service. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for a left shoulder disability. The reasons follow. The Board concludes that the preponderance of the evidence is against the Veteran having a current disability related to his left shoulder, and he has not had a disability at any time during the pendency of the claim or recent to the filing of the claim. While the Veteran is competent to report pain in his left shoulder, he is not competent to provide a diagnosis in this case. His allegations of left shoulder pain are general. In Saunders v. Wilkie, the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) held that "'disability' in § 1110 refers to the functional impairment of earning capacity" and "pain in the absence of a presently-diagnosed condition can cause functional impairment," en route to its conclusion that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability." Saunders, 886 F.3d 1356, 1363, 1368, 1369 (Fed. Cir. 2018). However, the Federal Circuit also made clear that a veteran cannot "demonstrate service connection simply by asserting subjective painto establish a disability, pain must amount to a functional impairment. To establish the presence of a disability, a Veteran will need to show that [his or] her pain reaches the level of a functional impairment of earning capacity." Id. at 1367-68. Here, the Veteran has not provided this evidence. For example, the Veteran reported to VA treatment providers in August 2018 that he had general pain in his shoulders. The Veteran reported that the pain in his shoulders impairs his ability to ambulate and perform activities of daily living, and March 2019 VA treatment records document that he received an injection in his left shoulder. However, the record does not document that the Veteran has consistently reported symptoms rising to the level of pain that causes functional impairment of earning capacity. Rather, other than these two reports, the claims file is generally silent for reports of pain or injury in the left shoulder despite repeated documentation of pain in the right shoulder and a history of a dislocated right shoulder. Thus, the facts cannot satisfy the basic compensation statutes. A claim for pain alone is an insufficient factual showing that the pain derives from an in-service disease or injury. Consequently, the Board does not have evidence to establish that the Veteran has a current disability manifested by pain in the left shoulder that causes functional impairment of earning capacity and is related to service. Absent a current disability, service connection is not warranted. Regardless of whether pain in the left shoulder causes a functional impairment sufficient to constitute a disability for VA purposes, and conceding that May 1951 STRs document that the Veteran had reported no shoulder pain for six months, presumably conceding that the Veteran experienced pain in at least one of his shoulders during servicethough the record does not document whether it was the right or left shoulderthe preponderance of the evidence is against finding that any current shoulder pain is related to service because the record suggests that any left shoulder pain that may have occurred in service was acute in nature and resolved prior to his discharge from active service. Specifically, following the May 1951 record that documented that his shoulder pain had resolved, a June 1952 separation examination documented that the Veteran was examined and physically qualified for duty with no treatment or defect related to the left shoulder noted. Furthermore, records from his National Guard service document that in October 1960, April 1979, and October 1982 Reports of Medical History the Veteran specifically denied having or having had painful or "trick" shoulder or arthritis. Examinations conducted at the same time as these Reports of Medical History document that clinical evaluations of the upper extremities were normal. The Board finds this is highly probative evidence that any pain in the left shoulder resolved prior to discharge from active service in June 1952 and was not chronic in nature, nor does the evidence support the Veteran continued to experience flare-ups of a prior injury, as he repeatedly denied ongoing pain in his left shoulder on Reports of Medical History throughout his nearly 30 years of service in the National Guard, nor did examinations during that time document clinical abnormalities in the upper extremities. Furthermore, in a March 2015 statement, the Veteran specifically denied receiving any treatment during his National Guard service and stated that his claims did not arise during his National Guard service. In a March 2012 statement, when providing evidence to support his claims, the Veteran did not report any treatment for his left shoulder prior to October 1992, which was five years after his discharge from the National Guard and 40 years after his discharge from active service. Thus, the element of a service connection claim requiring a nexus between the current disability and service is also not met. VA did not provide the Veteran with an examination or medical opinion in connection with the claim for service connection for a left shoulder disability. The Board finds that entitlement to a VA examination or medical opinion is not warranted. VA must provide a medical examination and/or medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The preponderance of evidence is against a current left shoulder disability or persistent or recurrent symptoms of a disability, or if a disability exists that the evidence establishes that the disability or persistent or recurrent symptoms of a disability may be associated with service. For a VA examination and/or medical opinion to be warranted, all the McLendon criteria have to be met, and at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for this claim. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for a left shoulder disability is denied. 6. Entitlement to service connection for a right hand disability, claimed as a swollen right hand The Veteran believes that he has a right hand disability that had an onset in service, though the record does not clearly document a specific contention as to why he believes service connection is warranted or when the Veteran suffered an injury to his left shoulder during service. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for a right hand disability. The reasons follow. As to evidence of a current disability, VA treatment records from December 2006 document that the Veteran reported having carpal tunnel syndrome in his right hand. Therefore, the facts establish that the first element of a service connection claim is met. As to evidence of a disease or injury in service, the STRs do not show that the Veteran sustained a disease or injury involving his right hand during his two periods of active service. For example, June 1945 and November 1945 STRs from the first period of active service document that the Veteran was examined and noted to be physically qualified to transfer. A separation examination, conducted in June 1946 documented that a clinical evaluation of the nervous system was normal, which the Board finds is evidence against an onset of carpal tunnel syndrome in the right hand during the first period of service. There was no other documentation suggesting swelling or any other symptomatology in the right hand on the examination. During the second period of active service, the June 1948 enlistment examination documented that clinical evaluations of the upper extremities and the nervous system were documented to be normal, and the examiner stamped "none" documenting that the Veteran had "no physical defects, however slight." The June 1952 separation examination did not document any treatment or defects and it was documented that the Veteran was examined and found physically qualified for duty. During his National Guard Service, the Veteran reported that he was also a civilian employee for the Air Force. The Veteran submitted a May 1978 Superior Officer Statement related to this civilian employment that documented that the Veteran was having problems with his hands, noting he was unable to hold wrenches and work as efficiently as expected in his role as an electrical equipment repairman. The Board notes that this took place during the time in which the Veteran was still in the National Guard. In April 1979 and October 1982 Reports of Medical History, conducted as part of his National Guard service, the Veteran reported having or having had swollen or painful joints, though he did not document that this notation specifically related to his hands. While the evidence shows that the Veteran's pain and impairment in his right hand began as early as May 1978, the Board finds that the Veteran did not have a specific injury or disease of right hand during a period of ACDUTRA or a specific injury involving the right hand during a period of INACDUTRA. Despite the Veteran reporting that he had a history of having swollen or painful joints, clinical evaluations conducted in April 1979 and October 1982 of the upper extremities were documented to be normal. Neurological examinations conducted on both of these examinations were also normal. The Board finds this to be highly probative evidence that the Veteran did not have a chronic injury or diagnosed disease of the right hand, to include carpal tunnel syndrome. Additionally, on a July 1979 Statement of Medical Examination and Duty Status, the Veteran reported that he had fallen and injured his hip. Records from just a few days prior to these records document that the Veteran was reporting pain in his hips and lumbar spine, as well as issues with his shoulder and knee. The Board finds that had the Veteran been experiencing ongoing issues with his right hand since the May 1978 report, he likely would have reported it here given that he reported experiencing pain in many other joints. Furthermore, in a March 2015 statement, the Veteran reported that he did not receive any treatment during or related to his National Guard service, and he specifically reported that none of his claims, including the claim related to his right hand, were related to his National Guard service. Given all of the aforementioned information, the Board finds the preponderance of the evidence is against the second element of a service-connection claim being met, including during any period of INACDUTRA or ACDUTRA. Despite not meeting the requirements for service connection on a direct basis, the Board notes that carpal tunnel syndrome is a chronic disease under 38 C.F.R. § 3.309, which allows for service connection on a presumptive basis if the chronic disease is manifested to a compensable degree within one year of discharge from service. However, in this case, the preponderance of the evidence is against finding that the right hand carpal tunnel syndrome had an onset within one year of discharge from service. Rather, the evidence does not document that the Veteran reported a diagnosis of right carpal tunnel syndrome to VA treatment providers until 2006, which is decades after his most recent discharge from active service. VA did not provide the Veteran with an examination or medical opinion in connection with the claim for service connection for a right hand disability, including carpal tunnel syndrome. The Board finds that entitlement to a VA examination or medical opinion is not warranted. VA must provide a medical examination and/or medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The preponderance of evidence is against evidence establishing that an event, injury, or disease occurred in service or establishing that carpal tunnel syndrome manifested during an applicable presumptive period for which the claimant qualifies. For a VA examination and/or medical opinion to be warranted, all the McLendon criteria have to be met, and at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for this claim. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for a right hand disability, to include carpal tunnel syndrome, is denied. 7. Entitlement to service connection for a left heel spur The Veteran believes that he has a left heel spur disability that had an onset in service, though the record does not clearly document a specific contention as to why he believes service connection is warranted. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for a left heel spur. The reasons follow. The first element of service connection requires a current disability. After a thorough review of the evidence of record, the Board finds the preponderance of the evidence is against a finding of a current disability of a left heel spur, to include pain that causes functional impairment of earning capacity. The Veteran has not reported a current diagnosis of a left heel disability, and the preponderance of the evidence is against a diagnosis of a left heel spur during the period on appeal, nor does the claims file document reports of pain or functional impairment in the left heel or foot during the period on appeal. Absent evidence of a current disability that causes functional impairment of earning capacity, service connection is not warranted. The Veteran reports that he was diagnosed with a left heel spur at Kelly Air Force Base in July 1994. While VA was unable to obtain these records, the remainder of the claims file, which includes hundreds of pages of VA treatment records that also document a substantial list of the disabilities for which the Veteran has a history, as well as treatment for many other physical ailments, including reports of pain in his shoulders, hands, eyes, and back and urinary leakage, among other ailments. Thus, the Board finds that to the extent that the Veteran may have had a left heel spur diagnosed in 1994, he has not had any ongoing residuals of such a diagnosis at any point during the period on appeal as any such disability would likely have been documented in the many VA treatment records associated with the claims file dating back to 2006. VA did not provide the Veteran with an examination or medical opinion in connection with the claim for service connection for a left heel spur. The Board finds that entitlement to a VA examination or medical opinion is not warranted. VA must provide a medical examination and/or medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The preponderance of evidence is against a current left heel spur disability or persistent or recurrent symptoms of a disability. For a VA examination and/or medical opinion to be warranted, all the McLendon criteria have to be met, and at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for this claim. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for a left heel spur disability is denied. A. P. SIMPSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Keninger, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.