Citation Nr: 21064856 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 15-07 318 DATE: October 21, 2021 ORDER Service connection for residuals of a shell fragment wound to the left hand and wrist (left hand disability) is granted. Service connection for right ear hearing loss is granted. Service connection for left ear hearing loss is granted. Service connection for tinnitus is granted. Service connection for hypertension, including as due to herbicide exposure, is denied. Service connection for chloracne, including as due to herbicide exposure, is denied. Service connection for a sleeping disorder, including as secondary to the service-connected posttraumatic stress disorder (PTSD), is denied. Service connection for a gastrointestinal disorder, including as secondary to the service-connected PTSD, is denied. Service connection for a sinus disorder is denied. FINDINGS OF FACT 1. The Veteran currently has a functionally impairing left hand disability; the Veteran sustained a fragment wound to the left wrist and hand during service; symptoms of the left hand disability have been continuous since service; the current left hand disability was incurred during active service. 2. The Veteran currently has right ear hearing loss disability; the Veteran was exposed to loud noise (acoustic trauma) while in service; the current right ear hearing loss is etiologically related to exposure to acoustic trauma during service. 3. The Veteran currently has left ear hearing loss disability; the Veteran was exposed to loud noise (acoustic trauma) while in service; the current left ear hearing loss is etiologically related to exposure to acoustic trauma during service. 4. The Veteran currently has tinnitus; the current tinnitus is etiologically related to exposure to acoustic trauma in service. 5. The Veteran is currently diagnosed with hypertension; symptoms of hypertension were not chronic in service, were not continuous since service separation, and did not manifest to a compensable degree within one year of service separation; the current hypertension did not have its onset during service and is not otherwise etiologically related to service, including to herbicide exposure during service. 6. The Veteran is not currently diagnosed with chloracne. 7. The Veteran is not currently diagnosed with a sleeping disorder. 8. The Veteran is not currently diagnosed with a gastrointestinal disorder. 9. The Veteran is not currently diagnosed with a sinus disorder. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in the Veteran's favor, the criteria for service connection for residuals of a fragment wound to the left hand and wrist have been met. 38 U.S.C. §§ 1110, 1112, 1154(b); 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. Resolving reasonable doubt in the Veteran's favor, the criteria for service connection for right ear hearing loss have been met. 38 U.S.C. §§ 1110, 1112, 1154(b), 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326, 3.385. 3. Resolving reasonable doubt in the Veteran's favor, the criteria for service connection for left ear hearing loss have been met. 38 U.S.C. §§ 1110, 1112, 1154(b), 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326, 3.385. 4. Resolving reasonable doubt in the Veteran's favor, the criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1112, 1154(b), 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 5. The criteria for service connection for hypertension, including as due to herbicide exposure, have not been met. 38 U.S.C. §§ 1110, 1112, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 6. The criteria for service connection for chloracne, including as due to herbicide exposure, have not been met. 38 U.S.C. §§ 1110, 1112, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 7. The criteria for service connection for a sleeping disorder, including as secondary to the service-connected PTSD, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.310, 4.14. 8. The criteria for service connection for a gastrointestinal disorder, including as secondary to the service-connected PTSD, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.310. 9. The criteria for service connection for a sinus disorder have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, served on active duty from September 1968 to April 1970. Duty to Assist Incarcerated Veterans Prior to addressing the merits of the claims on appeal, the Board will address whether the duty to assist incarcerated veterans has been met. The duty to assist incarcerated Veterans requires VA to tailor its assistance to meet the peculiar circumstances of confinement, because veterans in these circumstances are entitled to the same care and consideration given to non-incarcerated veterans. See Bolton v. Brown, 8 Vet. App. 185, 191 (1995). VA does not have the authority to require a correctional institution to release a veteran so that VA can provide him the necessary examination at the closest VA medical facility. Nevertheless, VA's duty to assist an incarcerated veteran includes: (1) attempting to arrange transportation of the claimant to a VA facility for examination; (2) contacting the correctional facility and requesting that their medical personnel conduct an examination according to VA examination work sheets (disability benefits questionnaires); or (3) sending a VA or fee-basis examiner to the correctional facility to conduct the examination. This appeal was previously before the Board in August 2018, at which time the Board remanded the matters for the Regional Office (RO) to fully comply with VA's duty to assist incarcerated veterans. At the time, the RO had previously scheduled the Veteran for several VA examinations, but the Veteran did not report for the examinations due to his incarceration. The record indicates that the RO then contracted a private examiner to conduct an examination. That examination was canceled once the contactor discovered that Veteran was incarcerated. The record holds a note that a local VHA (Veterans Health Administration) official mailed a letter to the prison in which the Veteran is held, but there was no reply. The local VHA official also attempted to call the prison; however, the local VHA official was unsuccessful in speaking to anyone at the prison with the authority to schedule the Veteran for an examination. The record indicates that no one from the prison called back to the local VHA official who was trying to arrange an examination. Since the Board's August 2018 remand, the RO has attempted to obtain authorization from the Veteran to request outstanding medical records, including from Elmore Correctional Facility, the correctional facility in which the Veteran is currently detained. In a July 2019 letter, the RO requested the Veteran to complete new VA Forms 21-4142 to authorize the release of outstanding medical evidence to VA. By law, a consent form is required in order to obtain medical records from a facility on the Veteran's behalf. The Board notes that neither the requested information nor additional pertinent information to support the Veteran's case has been received in regard to this appeal. Additionally, in August 2019, the RO requested VA examinations through a contractor, LHI. While LHI was able to complete the initial examination for posttraumatic stress disorder (PTSD), all other examinations were cancelled in October 2019 because LHI was informed that Elmore Correctional Facility does not have the equipment or space available on site to perform the examinations. In June 2021, the RO requested VA examinations through another contractor, QTC. That examination request was cancelled on August 2021 due to the point of contact for Elmore Correctional Facility being unresponsive to QTC's multiple attempts to arrange for the VA examinations to be conducted. Furthermore, the Veterans Benefits Administration (VBA) attempted to contact Elmore Correctional Facility on two separate occasions in August 2021 in order to facilitate the scheduling of VA examinations, but no return telephone calls were received. Finally, the VBA contacted the VHA C&P office at the Montgomery VA Medical Center in August 2021, but was informed that VHA does not have the capability to provide the Veteran with the requested examinations. The above attempts to schedule the Veteran for VA examinations are documented in an August 2021 Deferred Rating. The Veteran's representative generally argues that VA should exhaust all efforts in trying to obtain any medical records from the correctional facility and to schedule VA examinations for the Veteran because he is incarcerated. See October 2021 Third Party Correspondence. As discussed above, VA attempted to procure authorization from the Veteran to obtain medical records, including from Elmore Correctional Facility, but did not receive a response from the Veteran. VA has exhausted all efforts in trying to facilitate VA examinations for the Veteran; however, VA has not been successful largely due to the unresponsiveness of the relevant point of contacts for Elmore Correctional Facility. In reviewing the record, the Board finds that VA has met its duty to assist the Veteran. VA attempted to obtain authorization from the Veteran to obtain outstanding medical records, but the requested VA Forms 21-4142 were not returned. VA also attempted to schedule VA examinations through two contractors, each of whom were unable to do so either due to restrictions at Elmore Correctional Facility, or due to the facility's unresponsiveness. Similarly, VBA attempted to contact Elmore Correctional Facility to arrange for the Veteran to undergo VA examinations, but VA was unable to reach anyone at the facility and did not receive returned telephone calls. Based on the above efforts documented in the August 2021 Deferred Rating, the Board finds that VA has met its duty to assist the Veteran in obtaining outstanding medical records and arranging for VA examinations, and that any further attempts to do so would be futile. The Board will adjudicate the claims on the available evidence of record, lay and medical, with care to not hold an absence of evidence or findings or opinions that examinations might have produced against the Veteran's claims. Service Connection Legal Criteria Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). 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 generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in service disease or injury and the current disability. With any claim for service connection (under any theory of entitlement), it is necessary for a current disability to be present. See Brammer v. Derwinski, 3 Vet. App. 223 (1992); see also McClain v. Nicholson, 21 Vet. App. 319 (2007) (service connection may be warranted if there was a disability present at any point during the claim period, even if it is not currently present); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013) (when the record contains a recent diagnosis of disability immediately prior to a veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency). Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310(a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See id.; Harder v. Brown, 5 Vet. App. 183, 187 (1993). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In other words, service connection may be granted for a disability found to be proximately due to, or the result of, a service-connected disease or injury. To prevail on the issue of secondary service causation, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). The Veteran currently has right and left ear sensorineural hearing loss and tinnitus (organic diseases of the nervous system) and hypertension (as cardiovascular-renal disease), which are "chronic diseases" listed under 38 C.F.R. § 3.309(a). See Fountain v. McDonald, 27 Vet. App. 258, 271 (2015) (holding that where there is evidence of acoustic trauma, the presumptive provisions of 38 C.F.R. § 3.309(a) include tinnitus as an organic disease of the nervous system). Therefore, the presumptive provisions of 38 C.F.R. § 3.303(b) for "chronic" in-service symptoms and "continuous" post service symptoms apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a "chronic disease" in service or "continuity of symptoms" after service, the disease shall be presumed to have been incurred in service. For the showing of "chronic" disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of "continuity of symptoms" after service is required for service connection. 38 C.F.R. § 3.303(b). Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases, such as organic diseases of the nervous system or cardiovascular-renal disease, 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. While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 C.F.R. §§ 3.307, 3.309(a). Service connection may also be granted on a presumptive basis for certain diseases associated with exposure to certain herbicide agents, even though there is no record of such disease during service, if they manifest to a compensable degree any time after service, in a veteran who had active military, naval, or air service for at least 90 days, during the period beginning on January 9, 1962 and ending on May 7, 1975, in the Republic of Vietnam (Vietnam), including the waters offshore, and other locations if the conditions of service involved duty or visitation in Vietnam. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e), 3.313. This presumption may be rebutted by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. §§ 3.307, 3.309. Chloracne or other acneform disease is a disease deemed associated with herbicide exposure under VA legal authority. 38 C.F.R. § 3.309(e). As such, chloracne is a disease for which presumptive service connection based on exposure to herbicides may be granted. Notwithstanding the foregoing presumption provisions for herbicide exposure, a claimant is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994); see also Ramey v. Gober, 120 F.3d 1239, 1247-48 (Fed. Cir. 1997), aff'g Ramey v. Brown, 9 Vet. App. 40 (1996); Brock v. Brown, 10 Vet. App. 155, 160-61 (1997). 1. Service connection for residuals of a shell fragment wound to the left hand and wrist The Veteran asserts residuals of a shell fragment wound to the left hand and wrist (left hand disability) are the result of an injury sustained while engaged in combat in Vietnam. See January 2019 Statement in Support of Claim. After a review of all the evidence of record, lay and medical, the Board finds that the evidence is at least in equipoise on the question of whether the Veteran has a current left hand disability. Although the record does not include any current medical records that reflect current treatment for the left hand disability, a March 1970 service separation examination report reflects residuals of a fragment wound to the left hand and wrist include small scattered scars in the left hand and left wrist, and the Veteran asserts that the left hand disability has continuously manifested in functionally impairing symptoms of numbness, pain, and weakness since service separation. See January 2019 Statement in Support of Claim. Accordingly, resolving reasonable doubt in favor of the Veteran, the Board finds that the Veteran has a current left hand disability. See Saunders v. Wilkie, 886 F.3d 1356, 1367-68 (Fed. Cir. 2018) (holding that pain can qualify as a disability where there is evidence of functional impairment of earning capacity). Next, the Board finds that the Veteran sustained a fragment injury to the left hand and wrist during in service. Service treatment records reflect the Veteran sustained a fragment wound to the left hand and wrist in March 1969 while participating in combat in Vietnam. See March 1969 service treatment record. The fragment wound was not immediately treated, which resulted in continued pain. See March 1969 service treatment records; April 1969 service treatment records. The Veteran was eventually evacuated to Japan for surgery to remove the fragments that were retained in the left hand and wrist. See April 1969 service treatment record. Although the retained fragments were removed from the left hand and wrist during service, the March 1970 service separation examination report shows that residuals of the left hand disability were still apparent at the time of service separation. The Board further finds that the evidence is at least in equipoise on the question of whether symptoms of the left hand disability have been continuous since service separation. Although the electronic file lacks medical records documenting any ongoing treatment for the current left hand disability, the Veteran has credibly reported that symptoms of pain, numbness, and weakness in the left hand and wrist have been continuous since service separation. The Veteran's statements are competent, credible, and probative. Resolving reasonable doubt in the Veteran's favor, the Board finds that, based on evidence of an in-service fragment wound injury to the left hand and wrist and continuous post-service symptoms of pain, numbness and weakness in the left hand and wrist, direct service connection for the left hand disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Service connection for right ear hearing loss 3. Service connection for left ear hearing loss The Veteran seeks service connection for right and left ear hearing loss due to exposure to hazardous noise from participating in combat during service. See November 2012 Notice of Disagreement. Additionally, the Veteran asserts that service audiometric examinations reflect decreased hearing acuity from the time of enlistment until the time of service separation. For VA purposes, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz (Hz) is 40 decibels (dB) or greater, the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, and 4000 Hz are 26 dB or greater, or speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Additionally, the Court has held that "the threshold for normal hearing is from 0 to 20 dBs [decibels], and higher threshold levels indicate some degree of hearing loss." See Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The evidence is at least in equipoise on the question of whether the Veteran has current right and left ear hearing loss disabilities as defined by VA regulatory criteria under 38 C.F.R. § 3.385. Although the electronic file does not include a current audiometric examination because VA has not been able to examine the Veteran due to the correctional facility's lack of cooperation in allowing the Veteran to be examined, the March 1970 service separation examination report is highly probative as this examination report already showed pure tone thresholds in the right ear measured at 15 decibels at 250 Hz, 5 decibels at 500 Hz, 5 decibels at 1000 Hz, 15 decibels at 2000 Hz, 15 decibels at 4000 Hz, and 20 decibels at 8000 Hz. Additionally, pure tone thresholds in the left ear were measured at 25 decibels at 250 Hz, 25 decibels at 500 Hz, 15 decibels at 1000 Hz, 25 decibels at 2000 Hz, 20 decibels at 4000 Hz, and 20 decibels at 8000 Hz. Since the March 1970 service separation examination, the Veteran asserts that hearing acuity in the right and left ears have progressively worsened. Given the unique facts of this case and the fact that the Veteran is incarcerated without the ability to be present at a VA audiometric examination, the Board is compelled to rely on the Veteran's lay descriptions of worsened hearing acuity in the right and left ears since service separation in finding that the Veteran currently has right and left ear hearing loss disabilities to meet the VA regulatory criteria under 38 C.F.R. § 3.385. The evidence shows that the Veteran was exposed to loud noise (acoustic trauma) while in service. The DD Form 214 reflects the Veteran was involved in combat, which indicates a probable exposure to excessive noise during service. Service treatment record also reflect significant shifts in pure tone thresholds occurred in the right and left ears during service. A May 1967 service preinduction examination report shows pure tone thresholds in the right ear were measured at 5 decibels, 0 decibels, 5 decibels, 5 decibels, and 15 decibels at 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, and 4000 Hz, respectively. Pure tone thresholds in the left ear were measured at 0 decibels, 0 decibels, 15 decibels, 15 decibels, and 10 decibels at 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, and 4000 Hz, respectively. The March 1970 service separation examination report reflects pure tone thresholds in the right ear were measured at 15 decibels, 5 decibels, 5 decibels, 15 decibels, 15 decibels, and 20 decibels at 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz, and 8000 Hz, respectively. Pure tone thresholds in the left ear were measured at 25 decibels, 25 decibels, 15 decibels, 25 decibels, 20 decibels, and 20 decibels at 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz, and 8000 Hz, respectively. Sensorineural hearing loss is linked with nerve damage that most often occurs "when the tiny hair cells in the cochlea are injured." Fountain, 27 Vet. App. at 266. More specifically, in Fountain, the Court noted that chronic sensorineural hearing loss, as an organic disease of the nervous system, was due to a problem in the inner ear or in the auditory nerve between the inner ear and the brain, and was commonly caused by chronic exposure to excessive noise, in addition to age related hearing loss. The Court noted that chronic sensorineural hearing loss caused by acoustic trauma resulted in damage to the inner ear and qualified as an organic disease of the nervous system under 38 C.F.R. § 3.309. The Board finds that, based upon both medical and legal authority, the in service acoustic trauma caused permanent nerve damage to the auditory nerve or inner ear, which denotes the onset of the current right and left ear sensorineural hearing loss in service. Such sensorineural hearing loss is a permanent disability that was incapable of actual improvement of the nerve damage because chronic sensorineural hearing loss either progresses or remains the same (i.e., progression may be prevented), while restoration (i.e., improvement) of chronic sensorineural hearing loss that was caused by acoustic trauma is not medically possible. See Fountain, 27 Vet. App. 258. Based on the foregoing, and resolving reasonable doubt in the Veteran's favor, the Board finds that the criteria for service connection for right and left ear sensorineural hearing loss have been met. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. As service connection has been granted on a direct basis, there is no need to discuss entitlement to service connection on a presumptive or any other basis, as other theories of service connection have been rendered moot, leaving no question of law or fact to decide. See 38 U.S.C. § 7104. 4. Service connection for tinnitus The Veteran generally contends that tinnitus is the result of (secondary to) the same acoustic trauma during service that caused the now service-connected right and left ear hearing loss. Initially, the Board finds the Veteran is currently diagnosed with tinnitus. As discussed above, the electronic file does not include a current audiometric examination report, however, tinnitus can be reported by a lay individual. See Charles v. Principi, 16 Vet. App. 370, 374-75 (2002) (explaining that a veteran is competent to testify to in-service acoustic trauma, in-service symptoms of tinnitus, and post-service continuous symptoms of tinnitus" because ringing in the ears is capable of lay observation"). Accordingly, the present disability requirement is met. After a review of all the lay and medical evidence, the Board finds the evidence is at least in equipoise on the question of whether the tinnitus is etiologically related to acoustic trauma experienced during service. As discussed above, the Board finds that, based on both medical and legal authority, the Veteran was exposed to acoustic trauma during service that caused permanent nerve damage to the auditory nerve or inner ear, which resulted in the now service-connected right and left ear hearing loss disabilities. Because the Veteran sustained nerve damage that caused the service-connected sensorineural hearing loss, by necessary logical inference, the same nerve damage to the inner ear caused the current bilateral tinnitus. Such tinnitus is a permanent disability that was incapable of actual improvement of the nerve damage because tinnitus either progresses or remains the same (i.e., progression may be prevented), while restoration (i.e., improvement) of tinnitus that was caused by acoustic trauma is not medically possible. See Fountain. Based on the foregoing, the Board resolves reasonable doubt in the Veteran's favor to find that service connection for tinnitus is warranted as directly incurred in service. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.303(a), (d). As service connection has been granted on a direct basis, there is no need to discuss entitlement to service connection on a presumptive or any other basis, as other theories of service connection have been rendered moot, leaving no question of law or fact to decide. See 38 U.S.C. § 7104. 5. Service connection for hypertension The Veteran generally contends that hypertension is the result of active service, including as due to herbicide exposure during service. The evidence shows a current diagnosis of hypertension. See March 2007 private treatment record. Additionally, the Veteran was presumptively exposed to herbicides during service in Vietnam. See DD Form 214. After a review of all the evidence or record, lay and medical, on the question of direct service connection, the Board finds that hypertension did not have its onset during service and is not otherwise caused by service, including herbicide exposure during service. Specifically, service treatment records do not show any complaints, symptoms, diagnosis, or treatment for hypertension, including no chronic symptoms of hypertension during service. A March 1970 service separation examination report reveals that the vascular system was clinically normal, and the Veteran denied a history of high or low blood pressure on a March 1970 Report of Medical History. With regard to "chronic" disease presumptive service connection, the lay and medical evidence weighs against a finding of continuous symptoms of hypertension since service separation; therefore, presumptive service connection under the provisions of 38 C.F.R. § 3.303(b) is not warranted based on either "chronic" in-service or "continuous" post service symptoms. As discussed above, neither the service treatment records nor the March 1970 service separation examination indicated any history or findings or diagnosis of hypertension, or any other issues with high blood pressure. The earliest evidence of hypertension was not shown until 2007 in a March 2007 private treatment record, 37 years after service separation and 36 years outside of the applicable one year presumptive period. On the question of direct nexus between hypertension and service, the evidence weighs against a finding that the currently-diagnosed hypertension is causally related to service, including to herbicide exposure during service. Specifically, hypertension was not shown until after active service as the Veteran was not treated for high blood pressure until 2007. Additionally, as the evidence of record does not contain a competent medical opinion establishing a medical nexus between the current hypertension and active service, including to herbicide exposure, the medical evidence weighs against the claim. The Board has considered the Veteran's lay statements that hypertension was caused by service. He is competent to report some hypertension symptoms because this requires only personal knowledge as it comes to him through his senses, though other symptoms are not discernable by sense observation, but require clinical measures. Under the facts of this case, where there were no symptoms or findings until decades after service, the Veteran is not competent to offer an opinion as to the etiology of his current disorder that began decades after service, due to the medical complexity of the matter involved. In light of the above, the Board finds that the preponderance of the evidence is against finding that the current hypertension is etiologically related to active service, including to herbicide exposure during service; therefore, the claim for service connection for hypertension, under all theories of service connection, must be denied. 6. Service connection for chloracne 7. Service connection for a sleeping disorder 8. Service connection for a gastrointestinal disorder 9. Service connection for a sinus disorder The Veteran contends that service connection for chloracne as due to herbicide exposure, a sleeping disorder (including as secondary to the service-connected PTSD), a gastrointestinal disorder (including as secondary to the service-connected PTSD), and a sinus disorder are warranted. See November 2010 VA Form 21-526; February 2012 Statement in Support of Claim. (Continued on the next page) After a review of all the lay and medical evidence of record, the Board finds that the weight of the evidence demonstrates that the Veteran is not currently diagnosed with, or have current disabilities of, chloracne, a sleeping disorder, a gastrointestinal disorder, or a sinus disorder. The electronic file does not include any treatment records during the relevant claims period on appeal. The only post-service treatment records that are included in the electronic file are private treatment records from March 2007 reflecting diagnosis and treatment of a duodenal ulcer, hiatal hernia, and peptic ulcer disease; the electronic file includes no further treatment records reflecting that the duodenal ulcer, hiatal hernia, and peptic ulcer disease had not been resolved by the treatment rendered in March 2007. In the absence of a current disability at any time during or immediately prior to the relevant claim period on appeal, the claims for service connection for chloracne, a sleeping disorder, a gastrointestinal disorder, and a sinus disorder, must be denied. See Brammer, 3 Vet. App. 223; McClain, 21 Vet. App. 319 (disability needs to be present at any point during the claim period); Romanowsky, 26 Vet. App. 289 (current disability includes a recent diagnosis of disability immediately prior to a veteran filing a claim for benefits). J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Choi, 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.