Citation Nr: 21066955 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 10-06 069 DATE: November 3, 2021 ORDER 1. Entitlement to service connection a left foot disorder other than the currently service-connected removal of exostosis of the left foot, to include pes planus, small vessel disease, arthritis, and metatarsalgia, and to include as secondary to service-connected disabilities is denied. 2. Entitlement to service connection a right foot disorder other than the currently service-connected removal of exostosis of the left foot, to include pes planus, small vessel disease, arthritis, and metatarsalgia, and to include as secondary to service-connected disabilities is denied. 3. Entitlement to service connection for a right shoulder disorder, to include a strain and acromioclavicular joint osteoarthritis, and to include as secondary to service-connected disabilities is denied. 4. Entitlement to service connection for a left hip disorder, to include functional impairment and mild vascular calcifications, and to include as secondary to service-connected disabilities is denied. 5. Entitlement to service connection for a right hip disorder, to include functional impairment and mild vascular calcifications, and to include as secondary to service-connected disabilities is denied. 6. Entitlement to service connection for a right ankle disorder, to include mild vascular calcifications, and to include as secondary to service-connected disabilities is denied. 7. Entitlement to service connection for fatigue, to include as secondary to service-connected disabilities is denied. 8. Entitlement to service connection for sleep apnea to include as secondary to service-connected disabilities is denied. 9. Entitlement to service connection for restless leg syndrome, to include as secondary to service-connected disabilities, is denied. 10. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), adjustment disorder, and major depressive disorder, and to include as secondary to service-connected disabilities is denied. FINDINGS OF FACT 1. The Veteran's current left foot conditions manifested greater than on year after service and were not caused by service or aggravated by service-connected disabilities. 2. The Veteran's current right foot conditions manifested greater than on year after service and were not caused by service or aggravated by service-connected disabilities. 3. The Veteran's current right shoulder condition manifested greater than on year after service and were not caused by service or aggravated by service-connected disabilities. 4. The weight of competent and credible evidence does not show functional impairment of the left hip to constitute a current left hip disability. 5. The weight of competent and credible evidence does not show functional impairment of the right hip to constitute a current right hip disability. 6. The weight of competent and credible evidence does not show functional impairment of the right ankle to constitute a current right ankle disability. 7. The weight of competent and credible evidence does not show a current disability manifested by fatigue during the appellate period. 8. The Veteran's restless leg syndrome manifested after service and was not caused by service or caused or aggravated by service-connected disabilities. 9. The Veteran's psychiatric disorder manifested after service and was not caused by service or caused or aggravated by service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for service connection for a left foot condition have not been met. 38 U.S.C. §§ 1110, 1112, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a) (2021). 2. The criteria for service connection for a right foot condition have not been met. 38 U.S.C. §§ 1110, 1112, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for a right shoulder condition have not been met. 38 U.S.C. §§ 1110, 1112, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for service connection for a left hip condition have not been met. 38 U.S.C. §§ 1110, 1112, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 5. The criteria for service connection for a right hip condition have not been met. 38 U.S.C. §§ 1110, 1112, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 6. The criteria for service connection for a right ankle condition have not been met. 38 U.S.C. §§ 1110, 1112, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 7. The criteria for service connection for a fatigue condition have not been met. 38 U.S.C. §§ 1110, 1112, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 8. The criteria for service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110, 1112, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 9. The criteria for service connection for restless leg syndrome have not been met. 38 U.S.C. §§ 1110, 1112, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 10. The criteria for service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 1112, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from February 1975 to February 1978 and from September 1978 to September 1995. These matters are before the Board of Veterans' Appeals (Board) on appeal from a September 2008 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. The case was subsequently transferred to the RO in St. Paul, Minnesota. In April 2015, August 2017, and January 2019, the Board remanded the appeal for further development. There has been substantial compliance with Board remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In general, service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disability which is aggravated by a service-connected disability. In order to prevail on the issue of secondary service connection, the record must show (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) competent evidence establishing that the service-connected disability caused or aggravated the nonservice-connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995). Lay evidence can be competent and sufficient to establish a diagnosis or etiology when (1) a lay person is competent to identify a medical condition; (2) the lay person 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, 1376-77 (Fed. Cir. 2007). Laypersons, such as the Veteran, are competent to report on matters observed or within his or her personal knowledge, to include the occurrence of injury, and as to the nature, onset, and continuity of symptoms experienced or observed. See 38 C.F.R. § 3.159 (a)(2) (2017); Charles v. Principi, 16 Vet. App. 370 (2002). Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Board, however, retains the discretion to determine the credibility and probative value of all evidence of record, including lay evidence. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In adjudicating a claim for VA benefits, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a claimant prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Entitlement to service connection a left foot disorder Entitlement to service connection a right foot disorder The Veteran contends that he has a bilateral foot disability, to include pes planus, small vessel disease, arthritis and metatarsalgia. As the Veteran has already been granted service connection for exostosis, it is not part of this claim. The Veteran has claimed that these feet disorders came about from running as a soldier and wearing Army issued combat boots. See July 2007 Third Party Correspondence. Service treatment records (STRs) show that upon entry into the Veteran's second period of active duty military service, pes planus was documented. However, at separation, no complaint, treatment, or diagnosis for any other foot condition was documented. See October 1995 STR-Medical, p. 12. Post-service, the Veteran's medical records indicate that he has been diagnosed with small vessel disease, arthritis and metatarsalgia. See February 2006 Medical Treatment Record Non Government Facility. While diagnosis has been shown, the Veteran's medical record does not contain any probative evidence offering theories as to the origin of the Veteran's medical conditions. The Board finds that the first and second elements of service connection have been met, as the evidence of record shows currently diagnosed bilateral feet conditions, and the Veteran has identified in-service events and injuries which might have been their cause. The Board turns to the third element of service connection, a medical nexus between a current condition and military service. The Board may not provide a nexus opinion, and neither the Veteran, nor his representative, has been shown to possess the requisite medical training or expertise to provide a competent opinion regarding the etiology of his back condition. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Jones v. West, 12 Vet. App. 383, 385 (1999) (where the determinative issue is one of medical causation or a diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue). As such, the Board turns to the medical evidence of record. VA examinations were provided in August 2008 and July 2012. In both cases the VA examiners found that the Veteran did not have a current diagnosis of a bilateral foot disability. The Board found both VA examinations to be inadequate, as the VA examiners did not consider private treatment records showing bilateral foot conditions. As such, in April 2015 the Board issued a remand order for a new examination. This was provided in November 2016. There, the VA examiner found that the Veteran had arthritis of the left foot and found that it was consistent with age. The Board, in August 2017, found this to be inadequate, as the VA examiner did not provide the requested opinion as to whether a bilateral foot disability manifested in service or is otherwise related to either active-duty military service or any of the Veteran's service-connected disabilities. As such, a new VA examination was ordered. See August 2017 Remand BVA. As per Board remand directives, a VA examination was provided in October 2017. The examiner noted that the Veteran was diagnosed with pes planus in service and still suffered from the condition. The Veteran reported that he had foot pain with prolonged walking and running in service with chronicity since that time. "Due to foot pain he had arterial doppler's that demonstrated bilateral small vessel disease." The Veteran's symptoms were described as aching in the feet caused by standing for over 10 minutes. He was diagnosed with bilateral pes planus, bilateral metatarsalgia, and left foot degenerative arthritis. See October 2017 C&P Exam. The examiner provided a negative nexus opinion, which was based upon the wrong legal standard. As such, an addendum opinion was ordered by the Board in January 2019. In August 2019, the Veteran underwent another foot examination. The examiner reviewed the file and noted the diagnoses of bilateral flat feet in the 1978 enlistment examination. The Veteran denied current foot pain, swelling, or tenderness. There was a loss of arch height bilaterally but no other deformity. On examination, the examiner noted no pain or loss of function for either foot. Imaging studies showed arthritis only on the left foot. The examiner found no evidence that the arthritis began while in the service nor for over a year after discharge or that there was continuity of the same symptomology. The examiner found that the current condition of the feet was more likely due to normal wear and tear. The examiner further found no evidence to support small vessel disease in the service and none to relate this to an in-service injury, event, or disease to include physical training. The examiner concluded that it was as likely as not that his foot conditions are a natural progression and not related to his service In accordance with the Board's remand directives, a VA examiner provided an addendum opinion in August 2019. Regarding left foot arthritis and bilateral small vessel disease, the VA examiner found that it was less likely than not due to service. This was due to the condition not being present at discharge, nor a year after discharge. The examiner opined that it was more likely than not due to "normal wear and tear." Regarding pes planus, the VA examiner found that the Veteran's STRs did not support a finding that the pes planus was caused by service, nor did the Veteran's STRs contain evidence of aggravation. As such, the VA examiner opined that the Veteran's current condition was due to normal progression. The examiner also noted that mild vascular calcifications are related to atherosclerosis and occur over time without precipitating causes that could be related to a specific event in service or found in the medical records. See August 2019 C&P Exam. In August 2021 the Veteran's representative sent in an appellate brief. The representative included a link to a website about osteoarthritis in general, and argued that ostearthritis is similar to posttraumatic arthritis, which the representative argued is the correct diagnosis of the Veteran's left foot condition. The representative also reiterated the argument that the Veteran's bilateral pes planus was caused by service because it was first diagnosed in service. See August 2021 Appellate Brief. The Board finds that the representative's statements are not sufficient to constitute a nexus opinion, and that a tangentially related website link is not sufficient to trigger the need for a new examination or addendum opinion to be provided. A careful review of the record shows that there is a single probative nexus opinion of record, in the form of the August 2019 addendum opinion. The Board finds this nexus opinion to be adequate, as the examiner reviewed the claims file and described the disabilities in sufficient detail to enable the Board to make a fully informed decision on the claim. D'Aries v. Peake, 22 Vet. App. 97 (2008); Monzingo v Shinseki, 26 Vet. App. 97 (2012) (examination reports are adequate when, as a whole, they sufficiently inform the Board of a medical expert's judgment on a medical question and the essential rationale for the opinion, even when the rationale does not explicitly lay out the examiner's journey from the facts to a conclusion); Acevedo v. Shinseki, 25 Vet. App. 286 (2012) (the law imposes no reasons-or-bases requirement on examiners). The examiner specifically acknowledged and discussed what the medical evidence of record did and did not show in connection with the claim. The Veteran's contentions were addressed. There are no apparent inconsistencies or ambiguities in the examination or addendum opinion. The Board, in its own lay capacity, is not otherwise qualified to call into question the VA examiner's medical judgment, nor does the Board find any reason to do so. Monzingo v Shinseki, 26 Vet. App. 97 (2012). As the examination and opinions have sufficiently informed the Board of both the examiner's judgment on the medical questions at issue and the essential rationale for the opinions made, the Board finds that the August 2019 VA addendum is adequate. Given that the Board has found the nexus opinion to have probative value, and as there is no competing positive nexus opinion of record, the claims of service connection for left and right foot conditions must be denied. The Board has considered the applicability of the benefit of the doubt doctrine. Because the preponderance of the evidence is against the Veteran's claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). Entitlement to service connection for a right shoulder disorder, to include a strain and acromioclavicular joint osteoarthritis, and to include as secondary to service-connected disabilities The Veteran contends that he experiences a right shoulder disability due to his military service, to include as secondary to his service-connected disabilities. A review of the Veteran's STRs should that he injured his right shoulder when playing basketball in October 1978, causing muscle spasms. Pain was reported in May 1984 and June 1994. See October 1995 STR-Medical, pp. 3, 79, 82, 83. In May 1995, the Veteran's separation medical examination was normal, without report of a current shoulder disability. See October 1995 STR-Medical, p. 1. In July 2007 the Veteran submitted a claim of service connection for a right shoulder condition. A VA examination was provided in August 2008, in which the VA examiner opined that the Veteran did not have a current disability. The claim was denied by the RO in September 2008. A VA examination was then provided in July 2012. The Veteran was diagnosed with right shoulder strain, but a negative nexus opinion was given on direct service connection. The examiner acknowledged that the Veteran had an injury in service but stated that as of the separation examination in 1995, no disability was found. As such, the VA examiner wrote that "there does not seem to be sufficient evidence that a chronic shoulder problem resulted from blunt trauma in 1979." See July 2012 VA examination. The Board issued a remand order in April 2015 for a nexus opinion regarding secondary service connection and aggravation. In November 2016 a VA examination was provided, which included an in-person examination and a review of the Veteran's medical records. The Veteran was diagnosed with acromioclavicular joint osteoarthritis with a date of diagnosis being 2008. The Veteran reported injuring his shoulder in service, and that his "right shoulder has been bothering him past few years with pain." The VA examiner opined that the Veteran's right shoulder condition was less likely than not due to service, as his shoulder was normal upon examination and because his condition was due to age. See November 2016 C&P Exam. The Board found the VA examiner's rationale to be inadequate, as the examiner did not address the Veteran's lay statements regarding a connection between the Veteran's service-connected left shoulder and his current right shoulder disability. As such, a new VA opinion was ordered. See January 2019 BVA Decision. As per Board remand directives, an addendum opinion was provided in August 2019. The VA examiner conducted an in-person examination, reviewed the Veteran's medical records, and considered his lay statements. The VA examiner opined that the Veteran's right shoulder condition was most likely due to normal wear and tear, given the Veteran's age. The wrote that this finding was based on an inability to find any support in the Veteran's medical records for direct service connection, secondary service connection or aggravation. See August 2019 C&P Exam. The Veteran's representative responded with an appellate brief in August 2021. The representative included a link to a website about arthritis of the foot and ankle in support of the claim that the Veteran's in-service injury caused his current condition. See August 2021 Appellate Brief. The representative's conclusory statements and a website link about the mechanism of injury leading to arthritis in general is not sufficient to warrant a new VA examination or addendum opinion because a competent medical provider addressed the injury and found that in this Veteran's case, the injury did not cause the arthritis later in life. The Board finds that the first two elements of service connection have been met. The Veteran has been diagnosed with right shoulder conditions during the appellate period and has identified both an in-service injury and another service-connected conditions as being the possible causes of the current disability. As such, the second element is met. The Board thus turns to the third element of service connection, a medical nexus. The Board may not provide a nexus opinion, and neither the Veteran, nor his representative, has been shown to possess the requisite medical training or expertise to provide a competent opinion regarding the etiology of his back condition. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Jones v. West, 12 Vet. App. 383, 385 (1999). As such, the Board turns to the medical evidence of record. The Veteran's medical record does not contain any competent supportive nexus opinions regarding the etiology of the Veteran's right shoulder condition. The August 2019 VA examiner's opinion is adequate. In the instance of the July 2012 VA examiner's nexus opinion, he provided a negative nexus opinion on direct service connection. The August 2019 VA examiner provided a negative nexus opinion regarding secondary service connection and aggravation. In both instances, the opinions were made after in-person examinations, a review of the Veteran's medical records, and consideration of his lay statements, along with rationales supported by the record. As such, the Board finds these examinations to be of probative value. D'Aries v. Peake, 22 Vet. App. 97 (2008). As the examination and opinions have sufficiently informed the Board of both the examiner's judgment on the medical questions at issue and the essential rationale for the opinions made, the Board finds that the July 2012 and August 2019 VA addendum are adequate. Given that the Board has found the nexus opinion to have probative value, and as there is no competing positive nexus opinion of record, the claims of service connection for left and right foot conditions must be denied. The Board has considered the applicability of the benefit of the doubt doctrine. Because the preponderance of the evidence is against the Veteran's claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). Entitlement to a left hip disorder, to include functional impairment and mild vascular calcifications, and to include as secondary to service-connected disabilities Entitlement to service connection for a right hip disorder, to include functional impairment and mild vascular calcifications, and to include as secondary to service-connected disabilities The Veteran contends that he experiences a bilateral hip disability due to his military service. The Veteran's STRs do not show complaint, treatment, or diagnosis for a hip condition. In May 1995, the Veteran's separation medical examination was normal, without report of a current hip disability. See October 1995 STR-Medical, p. 1. In July 2007 the Veteran submitted a claim of service connection for his bilateral hip condition, claiming that his pain was due to physical training in the military. See July 2007 Correspondence. Post-service medical treatment records do not show any complaint, treatment, or diagnosis for a hip condition prior to the Veteran's claim of service connection. A VA examination was provided in July 2012. The VA examiner found that the Veteran did not have a current diagnosis for a hip condition, despite finding that there was mild vascular calcification of the hips. See July 2012 VA Examination, pp. 9, 16. The Board issued a remand order in April 2015, having found that the Veteran's medical treatment records indicated that there was a current disability. See April 2015 BVA Decision. A second VA examination was provided in November 2016. There, the Veteran reported his symptoms as being his "hips not [being] able to rest at night." Upon examination the VA examiner found that the Veteran did not have a left or right hip condition. See November 2016 C&P Exam. The Board issued a second remand order in August 2017. There, the Board noted that the Veteran's medical treatment records showed "potential non-orthopedic hip disabilities." The Board found the previous two examinations to be inadequate, as the VA examiners did not reference the Veteran's medical treatment records. See August 2017 BVA Decision. A third VA examination was provided in October 2017. There, the Veteran reported bilateral hip pain that "began in the service after lifting and squatting." Upon examination no pain was found upon range of motion, with or without weight bearing and after repetitive use testing. No functional impairment was found. The VA examiner did not provide a current diagnosis for a hip condition. See October 2017 C&P Exam. The Board issued a third remand order in January 2019, noting that the Veteran reported pain in the hips due to flare-ups and use of a cane for mobility. Finally, an addendum opinion was ordered, given that the August 2017 VA examiner only opined as towards a hip disability based upon range of motion. See October 2017 BVA Decision. As per Board remand directives, a VA examination was provided in August 2019. Upon examination, the VA examiner found that the Veteran did not have a chronic hip condition. In reaching this conclusion, the VA examiner explained that the Veteran had regular range of motion for the hips, with pain not being present with non-weight bearing, passive range of motion nor with weight bearing. The VA examiner wrote that "after examination of the veteran, listening to his complete history and current subjective complaints, combined with a review of the available records, I have no basis to offer additional losses of function or motion when it comes to repetitive use or during a flare-up." See August 2019 C&P Exam. In October 2020, an addendum opinion was provided. The VA examiner stated that for the Veteran's bilateral hip disorders, to include mild vascular calcifications were less likely than not caused by his military service or his service-connected disabilities. The VA examiner stated that the Veteran's condition was not directly due to his military service as his condition is a "generalized condition due to several different risk factors and not related to any in service injury or disease." The VA examiner also stated that the condition was not due to his service-connected hypertension. While hypertension was noted as being possibly related to vascular calcification, he opined that the Veteran's other risk factors made it impossible to determine whether hypertension caused the condition. See October 2020 C&P Exam. The Board finds that service connection for a bilateral hip condition must be denied on the grounds of there being no current disability. In reaching this conclusion the Board is cognizant that the Veteran has been diagnosed with mild vascular calcification. However, without any functional loss there cannot be a finding of a current disability. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir., 2018). In the present case, there have been three in-person VA examinations. In each examination it was found that there was no loss of range of motion and that there was no pain with or without weight-bearing. A review of the evidence shows that the Veteran initially only reported his symptoms as being a feeling of restlessness of his hips at night. After his claim was denied, the Veteran changed his claim to being that he had increasing hip pain that had chronicity since service. Given the inconsistency of the Veteran's lay statements, numerous examinations showing no hip pain upon examination when there was an opportunity to evaluate reported pain, and a lack of any claims of hip pain in the Veteran's medical records, the Board affords diminished probative value to the Veteran's lay statements regarding bilateral hip pain. In sum, even with sparse reporting of pain, the probative medical evidence of records does not show any functional loss due of the Veteran's hips. Therefore, notwithstanding the Veteran's complaints of bilateral hip pain late in the appellate period, the evidence shows that there is no functional loss and therefore no current disability for VA rating purposes. The threshold requirement for service connection to be granted is competent evidence of the current existence of a claimed disorder. See Degmetich v. Brown, 104 F.3d 1328 (1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992). Given that there is no probative evidence of functional loss, the Board finds that there is no current disability. Without a current left or right hip disability, at any time during the period on appeal, service connection for such cannot be granted. See id. Entitlement to service connection for a right ankle disorder, to include mild vascular calcifications, and to include as secondary to service-connected disabilities The Veteran contends that he suffers from a right ankle condition due to his military service. STRs show that the Veteran incurred a right ankle sprain in October 1991. However, the Veteran's May 1995 separation physical examination did not show any complaints or abnormalities of the right ankle. See October 1995 STR-Medical, p. 1. The first indication of a right ankle condition is in the Veteran's July 2007 claim of service connection. A VA examination was provided in August 2008. X-rays were normal, and the Veteran's right ankle had full range of motion, without evidence of pain, fatigue, weakness, or lack of endurance. As such, the VA examiner found that the Veteran did not have a right ankle condition, and the RO denied service connection in September 2008. The Veteran submitted an NOD in December 2008 and noted that his injury took place in active duty and expressed discontent on the condition not being found in either his medical records or his VA examination. See December 2008 Form 9 (misfiled). A second VA examination was then provided in July 2012. The examiner diagnosed right ankle strain, and the Veteran stated that his ankle pain began in the 1970s and had worsened since that time. See July 2012 VA Examination, p. 18. No nexus opinion was provided. In April 2013 the Board issued a remand order to obtain any outstanding medical records and to provide the Veteran with a new VA examination. In a November 2016 examination, the VA examiner found that the Veteran did not have a current right ankle condition. This was based on a finding of the Veteran's ankle range of motion being normal, as well as no pain found on examination, no crepitus, and no evidence of localized tenderness on palpitation. The VA examiner opined that "there is a less than 50% probability that he has incurred right ankle problems from his service or from back problems or cva, rationale is that his right ankle is normal." See November 2016 C&P Exam. The Board issued a remand order for an addendum opinion in August 2017, requesting that the VA examiner provide an opinion that took into consideration the Veteran's diagnosis of a right ankle strain during the appellate period. An addendum opinion was provided in September 2017. There, the VA examiner wrote that the Veteran was diagnosed with isolated right ankle strain but had "unremarkable rt ankle exams....simple strains resolve for the most part...thus, he had a strain of rt ankle in svc. It resolved and therefore he had an initial diagnosis of rt ankle strain but no subsequent residuals found...thus, it is less likely than not he has a rt ankle condition related to svc." See September 2017 VA Examination. The Board issued another remand in January 2019, having found that the Veteran had a diagnosis of mild vascular calcification of the right ankle. An addendum opinion was ordered to provide clarification and to reconcile this diagnosis with the prior VA examinations. As per Board remand directives, a VA examination and addendum opinion was provided. The VA examiner found no functional impact upon examination. Having considered the in-person examination, the Veteran's lay statements, and the medical record, the VA examiner opined that there was no evidence to support direct, indict or aggravation of the right ankle, to include mild vascular calcifications. See August 2019 C&P Exam. The existence of a current disability is the cornerstone of a claim for service connection and VA disability compensation. 38 U.S.C. § 1131 ; Degmetich v. Brown, 104 F.3d 1328, 1332 (Fed. Cir. 1997). Evidence must show that the Veteran currently has the disability for which benefits are being claimed. The Board finds that the Veteran's claim must be denied on the ground of there being no current disability. In reaching this conclusion, the Board is cognizant that the Veteran has been diagnosed with right ankle strain and mild vascular calcification of the right ankle during the appellate period. This is because there is no indication the Veteran has had symptoms of the condition that have caused him any functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018); see also Wait v. Wilkie, 33 Vet. App. 8 (2020) (to establish the presence of a disability pursuant to Saunders, there must be competent evidence specific to the claimant tending to show that his or her impairment rises to a level to affect earning capacity). Here, the Board notes that the Veteran has been provided 4 VA examinations during the appellate period, and in every examination the VA examiner found that the Veteran had no functional impairment caused by his right ankle. Furthermore, the Board has conducted a thorough review of the Veteran's medical treatment records and has not found any medical evidence that contradicts the findings of the numerous VA examinations. The Board does not question the Veteran's sincerity in his belief that service connection is warranted for his right ankle. However, without evidence of a current right ankle disability, a preponderance of the evidence is against the claim, and the benefit of the doubt doctrine is inapplicable. 38 U.S.C. § 5107 ; 38 C.F.R. § 3.102 ; Gilbert v. Derwinski, 1 Vet. App., 49, 53-56 (1990). As such, service connection for a right ankle condition is denied. Entitlement to service connection for fatigue, to include as secondary to service-connected disabilities Entitlement to service connection for sleep apnea The Veteran contends that he experiences a fatigue disability and sleep apnea due to his military service. The Veteran's STRs does not show complaint, treatment, or diagnosis in service. See October 1995 STR-Medical, p. 1. Regarding fatigue, a review of the Veteran's post-service medical treatment records shows that the Veteran denied symptoms of fatigue in a December 2010, August 2015, September 2015, October 2015, November 2016, December 2016, and March 2017. See November 2016 CAPRI, pp., 95, 120, 123, 209, see also June 2017 CAPRI, pp. 1, 14, 17. In November 2017 the Veteran reported fatigue and pain in his hip area. See December 2017, p. 8. The Veteran reported that it was easy to be fatigued in September 2017. See August 2020 CAPRI, p. 89. However, in a May 2019 admission evaluation note, it was marked 'no' on the question of whether the Veteran has experienced fatigue. See October 2019 CAPRI, p. 159. The Board has not found any diagnosis for a unique fatigue disability in the Veteran's medical records. Concerning sleep apnea, the first indication of the disorder is an October 2009 pulmonary diagnostic study report. The author suspected that the Veteran might have sleep apnea, and as such an overnight polysomnography was performed. It was found that the Veteran did not have sleep apnea. The Veteran had a screening for sleep apnea in April 2015. There, the Veteran reported that he had been diagnosed with obstructive sleep apnea. Following this reporting, sleep apnea was added to the Veteran's list of active conditions in a May 2018 medical note. See October 2019 CAPRI, p337. Then, in May 2018, the Veteran reported that he had never been diagnosed with obstructive sleep apnea, that he snored at night, and that he was not often tired during the day. See August 2020 CAPRI, p. 263, 293, 14. A review of the record by the Board has not uncovered any diagnosis of sleep apnea based upon a sleep study or other medical testing. In July 2007 the Veteran submitted a claim of service connection for fatigue and sleep apnea. The Veteran claimed that he suffered from these symptoms due to his PTSD and depression. See July 2007 Correspondence. The Veteran's claim was denied, and he initiated a timely appeal. The claim was remanded by the Board for VA examinations. For fatigue, a VA examination was provided in October 2019. The VA examiner opined that the Veteran did not have, nor does the record show that he ever has had, chronic fatigue syndrome. See October 2019 C&P Exam. Another VA examination was provided in the same month for sleep apnea, with a VA examiner opining that "for the claimant's claimed condition of sleep apnea there is no diagnosis because there are no findings, signs and/or symptoms to support a diagnosis." See October 2019 C&P Exam. The Board acknowledges that the Veteran believes that he has chronic fatigue syndrome and sleep apnea. While the Veteran is competent to report what he has experienced, such as trouble sleeping, fatigue and snoring, the record does not show that he has the expertise, experience and education required to diagnosis a medical condition. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. §§ 1110, 1131; Degmetich v. Brown, 104 F.3d 1328 (1997). The current disability requirement is satisfied when a claimant "has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim," McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), or "when the record contains a recent diagnosis of disability prior to... filing a claim for benefits based on that disability." Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013). In the absence of proof of a current disability, there can be no valid claim. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In the present case, the only evidence of record supporting the claims of service connection for chronic fatigue syndrome and sleep apnea are the Veteran's lay statements. Given that the probative evidence of record shows that the Veteran has not been diagnosed with either condition, the Veteran's claims of service connection for chronic fatigue syndrome and sleep apnea must be denied. Entitlement to service connection restless leg syndrome, to include as secondary to service-connected disabilities Based on the findings of the September 2018 VA examination, the Board added restless leg syndrome to the Veteran's sleep apnea appeal. To date, the Veteran has not provided any lay statements regarding his restless leg syndrome, to include theories as to the cause of his condition. The Veteran's representative contended that the Veteran's restless leg syndrome was caused by his military service, to include as secondary to his service-connected disabilities, in his August 2021 Appellate Brief. However, aside from a brief and conclusory statement that service-connection is warranted, no lay statements have been offered in support of this claim. The Veteran's STRs do not show complaint, treatment, or diagnosis for restless leg syndrome. Post-service, the first record shows that restless leg syndrome was first diagnosed in December 2015. See October 2018 CAPRI, p. 372. As such, the first element of service connection has been met. Furthermore, restless leg syndrome has been raised in conjunction with the Veteran's sleep apnea claims, and as such the Board accepts that it has been contended that the Veteran's restless leg syndrome was caused by, or aggravated by, his service connected conditions, to include PTSD. This meets the criteria of the second element of service connection. As stated above, the third element of service connection is a medical nexus. The Board may not provide a nexus opinion, and neither the Veteran, nor his representative, has been shown to possess the requisite medical training or expertise to provide a competent opinion regarding the etiology of his back condition. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Jones v. West, 12 Vet. App. 383, 385 (1999). As such, the Board turns to the medical evidence of record. The Veteran's medical record does not contain any nexus opinions regarding the etiology of the Veteran's restless leg syndrome, except for nexus opinions within the September 2019 and August 2020 VA examinations. Within the scope of the September 2019 VA examination, the VA examiner opined that the Veteran's restless leg syndrome "was found incidentally during his sleep study. It is related to his sleep apnea, which was not caused by any service injury or event in the military." As such, the VA examiner opined that it was less likely than not caused by his military service. See September 2019 C&P Exam. A second opinion was provided in August 2020. There, the VA examiner wrote: "Unable to state Restless leg syndrome was related to in service event, injury or disease to include physical training during service as there was no objective evidence of condition during those times. Unless there is some proof of condition during active duty service it is not possible to state with 50% or greater probability that it is related to active duty service. There would be no relationship of restless leg syndrome with his other service-connected disabilities based on lack of pathophysiologic relationships. Unable to state that restless leg syndrome was aggravated beyond natural progression by his service-connected conditions reason being there is no pathophysiologic relationship between the conditions." See August 2020 C&P Exam. This opinion was reiterated by the VA examiner in October 2020. See October 2020 C&P Exam. The Board finds these VA examiner's nexus opinions to be of significant probative value, as the VA examiners conducted in-person examinations, reviewed the Veteran's medical records, and provided detailed lay statements based upon the record. Given that the Board has found these nexus opinions to have significant probative value, and as there is no competing positive nexus opinion, the claim must be denied for both direct and secondary service connection. The Board has considered the applicability of the benefit of the doubt doctrine. Because the preponderance of the evidence is against the Veteran's claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), adjustment disorder, and major depressive disorder, and to include as secondary to service-connected disabilities The Veteran contends that he has a psychiatric disorder due to his military service. The Veteran's service treatment records do not show any complaint, treatment, or diagnosis of a mental health condition, nor symptoms thereof. See October 1995 STR-Medical, p. 1. Service personnel records show that the Veteran served in supply and motor transport occupations with some service in Germany and Korea but not in combat areas. The first indication of a psychiatric condition is in July 2004 when the Veteran had an initial psychiatric assessment. The Veteran reported nightmares every night, flashbacks that occurred 1 to 2 times per week, suspiciousness, avoidance and "occasional death wishes" without suicidal ideation. The Veteran related these symptoms to the feeling that his subordinates in the Army were always out to "get him." See May 2005 Medical Treatment Record Government Facility, p. 17. Based on the Veteran's reporting, the psychiatrist found that the Veteran had a depressive disorder and PTSD. Id at 20. In July 2007 the Veteran submitted a claim for service connection for an acquired psychiatric disorder. Two letters were sent to the Veteran, requesting additional information to investigate the Veteran's claims. As the Veteran did not respond, the U.S. Army and Joint Services Records Research Center (JSRRC) found that there was insufficient evidence to research the Veteran's claims and as such submitted a formal finding of a lack of information required to corroborate stressors. See January 2008 Notification Letter. The Veteran's claim was denied by the RO in September 2008 and the Veteran appealed. In January 2009 the Veteran sent in a statement explaining his contended psychiatric condition. He wrote that he suffered nightmares because a friend in service was run over by a train, leading to anxiety and flashbacks whenever he would see a train. He also stated that another friend of his was murdered, and that hearing about it caused depression, anxiety, anger, and fear, with nightmares and flashbacks reported. See January 2009 VA 21-0781. A private physician wrote to the VA in December 2009. The private physician did not state whether he reviewed any of the Veteran's medical records or whether the Veteran was a patient of his, though the documentation indicates that there was an in-person examination. Rather, he reported a diagnosis of PTSD with an onset of 1976 with major depressive disorder based upon the Veteran's statements. The Veteran stated that he had daily depression, problems staying asleep, feelings of worthlessness, indecisiveness, and thoughts of suicide 2-3 times a week. The Veteran reported that his in-service stressors were the deaths of two fellow service members, as well as reporting "that part of his job was to clean up the rooms of soldiers who had been killed and supply the body bags, which he reported was traumatizing." See January 2010 Medical Treatment Record Non Government Facility. The Board has reviewed the Veteran's military personnel record and has not found any evidence supporting the claims of being involved in the disposal of human remains or the belongings of fallen soldiers. Based upon the Veteran's reporting, a line of duty report was requested for the two service members identified by the Veteran. In May 2013 it was found that no line of duty reports were of record. See VA 21-3101 Request for Information. In November 2011 the Veteran submitted a statement, in which he expressed that the stressor for his claimed disorder was a fellow service member being murdered by the fellow service member's wife. The Veteran wrote that the fellow service member was a good friend and that he "never really [got] over it." See November 2011 VA 21-0781a. In April 2015 the Board issued a remand order to further investigate the alleged deaths of the two service members identified by the Veteran and for a VA examination to be provided. A VA examination was provided in October 2016. However, the Board found that the examination was inadequate, as the examiner did not consider the private physician's diagnosis. As such, an addendum opinion was ordered in August 2017. In September 2018 a VA examination was provided, which the Board found to be inadequate. Specifically, the Board found that the VA examiner did not provide any direct or secondary service connection opinions, and merely provided a generalized and conclusory statement regarding aggravation. As such, a new examination was ordered. As per Board remand directives a VA examination was provided in April 2021. There, the Veteran's symptoms were said to include trouble sleeping at night with nightmares and cold sweats reported, followed by feeling tired during the day, and an inability to stop thinking about his time in the military. The Veteran reported that the only stressor in the military was two fellow service members dying, one in a car accident and the other being killed by the service member's wife. The Veteran stated that the men served in his unit. The VA examiner opined that it was unlikely that either service member was a close friend of the Veteran as the Veteran did not attend either of their funerals. The VA examiner found that the Veteran had an adjustment disorder but opined that it was less likely than not due to his military service. Rather, the VA examiner found that it was more likely due to post-service marital conflicts. Specifically, he stated: "After review of the Veteran's record to include prior private and VA examinations and treatment records, it is the opinion of this examiner that based on the totality of the record, the Veteran never met DSM diagnostic criteria for PTSD or Major Depressive Disorder. While he was diagnosed wish such on various occasions, a review of the record does not provide adequate evidence to meet required diagnostic criteria. Primary issues documented throughout the record revolve around marital conflict and divorce proceedings. Further evidence of this tumultuous relationship includes one year of probation in 2004 for domestic violence and another domestic assault charge against the Veteran in 2008. Clinical documentation throughout the questioned time span consistently notes marital conflict and contentious divorce as the primary issues addressed. Given the totality of the record the most appropriate diagnosis is reflected in an Adjustment Disorder related to marital conflict which is less likely than not related to military service and less likely than not aggravated by military service." See April 2021 C&P Exam. The first element of service connection has been met. The Veteran has been diagnosed, at various points in the appellate period, with depressive disorder, PTSD, and an adjustment disorder. However, the claim must be denied on the grounds that the second and third elements of service connection have not been met. Regarding the second element of service connection, an in-service event or injury, the Board begins with the Veteran's lay statements. The Veteran is competent to describe what he has experienced. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the Board affords diminished probative value to the Veteran's lay statements due to inconsistencies in the record. The Veteran initially reported that the only stressor from the military was the feeling that his subordinates were "out to get him." See May 2005 Medical Treatment Record Government Facility, p. 17. The Veteran then reported the deaths of two friends in the military, though at times only spoke of one. Despite repeated attempts by VA, neither death has been confirmed, to include a contended death of a military personnel due to an accident in service. Finally, the Veteran has reported once, and only once, that he provided body bags for fallen soldiers and clearing out the belongings of the fallen. The Board notes that the Veteran's military occupational specialty was that of a supply and transportation sergeant. See July 2012 Military Personnel Record, p. 16, see also July 2006 Certificate of Release or Discharge from Active Duty, p. 1. A collection of the Veteran's previous assignments shows that he worked as a clerk and a unit supply sergeant throughout his military career. See July 2012 Military Personnel Record, p. 18. In the course of these duties the Board has not found any evidence to support the Veteran's contentions as the response to a death on duty or off base is the responsibility of medical or mortuary personnel. At most, an administrative supervisor may be tasked with collecting personal items to be sent to next of kin. In sum, the Veteran's lay statements lack consistency and are without any supporting evidence. As such, the Board finds the Board finds that there is insufficient probative evidence of record to find that there has been an in-service event or injury. Finally, the Board turns to the question of a nexus between the Veteran's military service and his condition. Neither the Board, nor the Veteran, may provide such a nexus opinion. A review of the record shows that there are two probative opinions of record. The first is the December 2009 private physician's letter and the second is the April 2021 VA examiner's nexus opinion. The Board finds that the April 2021 VA examiner's opinion is of greater probative value. The December 2009 private examiner's opinion was conducted without any indication that the examiner reviewed the Veteran's record. Rather, the diagnosis was based upon the statements of the Veteran reporting symptoms of in-service events and was without consideration of any post-service stressors. The April 2021 VA examiner, on the other hand, conducted an in-person examination, reviewed the entirety of the Veteran's medical records, considered the Veteran's lay statements, and provided a rationale based upon the record. Given that the April 2021 VA examiner expressly considered both the Veteran's statements and did a thorough review of the record, the Board finds that it is of greater probative value. As such, the third element of service connection is not met. For the aforementioned reasons, the Veteran's claim of service connection for an acquired psychiatric disorder is denied. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Abels, Associate 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.