Citation Nr: 21072809 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 16-05 996 DATE: December 6, 2021 ORDER Entitlement to service connection for chronic pain syndrome, to include as due to exposure to herbicide agents or asbestos, is denied. Entitlement to service connection for cervicalgia (also claimed as an upper back condition), to include as due to exposure to herbicide agents or asbestos, is denied. Entitlement to service connection for a lower back disorder, to include as due to exposure to herbicide agents or asbestos, is denied. Entitlement to service connection for peripheral neuropathy of the left upper extremity, to include as due to exposure to herbicide agents or asbestos, is denied. Entitlement to service connection for peripheral neuropathy of the right upper extremity, to include as due to exposure to herbicide agents or asbestos, is denied. Entitlement to service connection for peripheral neuropathy of the left lower extremity, to include as due to exposure to herbicide agents or asbestos, is denied. Entitlement to service connection for peripheral neuropathy of the right lower extremity, to include as due to exposure to herbicide agents or asbestos, is denied. Entitlement to service connection for an acquired psychiatric disorder (claimed as depression, anxiety and insomnia), to include as due to exposure to herbicide agents or asbestos or as secondary to chronic pain syndrome, is denied. REMANDED Entitlement to service connection for coronary artery disease, to include as due to exposure to herbicide agents or asbestos, is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the Veteran has chronic pain syndrome associated with his service. 2. The preponderance of the evidence is against a finding that the Veteran has cervicalgia or an upper back condition associated with his service. 3. The preponderance of the evidence is against a finding that the Veteran has a lower back disorder associated with his service. 4. The preponderance of the evidence is against a finding that the Veteran has peripheral neuropathy of the left upper extremity associated with his service. 5. The preponderance of the evidence is against a finding that the Veteran has peripheral neuropathy of the right upper extremity associated with his service. 6. The preponderance of the evidence is against a finding that the Veteran has peripheral neuropathy of the left lower extremity associated with his service. 7. The preponderance of the evidence is against a finding that the Veteran has peripheral neuropathy of the right lower extremity associated with his service. 8. The preponderance of the evidence is against a finding that the Veteran has an acquired psychiatric disorder associated with his service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for chronic pain syndrome have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for cervicalgia (also claimed as an upper back condition) have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for a lower back disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for entitlement to service connection for peripheral neuropathy of the left upper extremity have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for entitlement to service connection for peripheral neuropathy of the right upper extremity have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for entitlement to service connection for peripheral neuropathy of the left lower extremity have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for entitlement to service connection for peripheral neuropathy of the right lower extremity have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for entitlement to service connection for an acquired psychiatric disorder (claimed as depression, anxiety and insomnia have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active military service in the U.S. Navy from August 1965 to August 1969. The Veteran's personnel records confirm that, during such service, the Veteran served on the USS Bon Homme Richard (CV-31) during the Vietnam Era. This matter comes before the Board of Veterans' Appeals (Board) on appeal from Department of Veterans Affairs (VA) Regional Office (RO) rating decisions issued in March 2015 and July 2015. This matter was previously before the Board in May 2019 when it was remanded for further development, to include so that outstanding evidence could be associated with the claims file and for inquiry into the Veteran's pay records and the location of his Navy ship during his Vietnam service. Since then, this matter has been returned to the Board for readjudication. 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; 38 C.F.R. § 3.303(a). Disorders diagnosed after discharge may still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). To establish service connection for the claimed disorder, there must be evidence of (1) a current disability, (2) incurrence or aggravation of a disease or injury in service, and (3) a causal connection between the disease or injury in service and the current disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Notwithstanding the lack of evidence of disease or injury during service, service connection may still be granted if all of the evidence, including that pertinent to service, establishes that the disability was incurred in service. See 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 503 (1992). Under 38 C.F.R. § 3.310, service connection may be granted for disability that is proximately due to or the result of a service-connected disease or injury, or for the degree of disability resulting from aggravation of a nonservice-connected disability, by a service-connected disability. See also Allen v. Brown, 7 Vet. App. 439, 448 (1995). Service connection is limited to those cases where disease or injury has resulted in a disability. In the absence of proof of a present disability for which service connection is sought, there is no valid claim of service connection. Brammer v. Derwinski, 3 Vet. App. 223 (1992). The requirement of having a current disability is met 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). A disability under 38 U.S.C. § 1110 refers to functional impairment of earning capacity. Saunders v. Wilkie, 886 F.3d 1356 (2018). 38 U.S.C. § 1154 (a) requires that the VA give due consideration to all pertinent medical and lay evidence of record in evaluating a claim to disability benefits. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (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 (Fed. Cir. 2007). When analyzing lay evidence, the Board should assess the evidence and determine whether the disability claimed is of the type for which lay evidence is competent. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Kahana v. Shinseki, 24 Vet. App. 428 (2011). However, competent medical evidence is necessary where the determinative question is one requiring medical knowledge. Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises. It would also include statements contained in authoritative writings such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Board notes that it has reviewed all of the evidence record for this appeal, with an emphasis on the evidence pertinent to the issue on appeal. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Hence, the Board will summarize the relevant evidence, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claims. In addition, certain chronic diseases may be presumed to have been incurred during service if the disease becomes manifest to a compensable degree within one year of separation from qualifying military service. 38 U.S.C. §§ 1101, 1112; 1113; 38 C.F.R. §§ 3.307, 3.309. Additionally, service connection on the basis of continuity of symptomatology can be established for the chronic diseases specified at 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). For purposes of establishing service connection for a disability resulting from exposure to herbicide agents (colloquially known as Agent Orange), a veteran who had active military, naval, or air service in the Republic of Vietnam during the Vietnam Era, beginning on January 9, 1962, and ending on May 7, 1975, will be presumed to have been exposed to an herbicide agent during that service, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. See 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307. Service incurrence for certain diseases will be presumed on the basis of an association with certain herbicide agents. See 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e). Such a presumption, however, requires evidence of actual or presumed exposure to herbicide agents. Id. "Service in the Republic of Vietnam" includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam, that is, within the land borders, including the inland waters, of Vietnam. See 38 C.F.R. § 3.307(a)(6)(iii). First, in January 2019, the U.S. Court of Appeals for the Federal Circuit issued an en banc decision in Procopio v. Wilkie, 913 F.3d 1371 (Fed. Cir. 2019), which held that the phrase "service in the Republic of Vietnam" in 38 U.S.C. § 1116 includes the territorial sea of the Republic of Vietnam and is not limited to the landmass or inland waterways of that nation. In short, the Federal Court has concluded that a presumption of herbicide exposure may be granted to any Veteran who served within the territorial sea extending 12 nautical miles from the shores of the Republic of Vietnam. See Procopio v. Wilkie, 913 F.3d 1371 (2019). Second, in June 2019, the President signed into law the Blue Water Navy Vietnam Veterans Act of 2019 (BWN Act). The BWN Act adds section 1116A to title 38 of the United States Code which extends the existing Agent Orange Act of 1991 presumption codified at section 1116 to veterans who served offshore of the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975. The BWN Act defines "offshore" as a geographical area "not more than 12 nautical miles seaward of a line commencing on the southwestern demarcation line of the waters of Vietnam and Cambodia and intersecting eleven points of latitude and longitude listed in an included table." Id. Accordingly, to show service in the Republic of Vietnam and establish entitlement to presumptive service connection due to alleged herbicide exposure, the evidence must show that the Veteran served within the land borders (including the inland waters) or served on a ship within the territorial sea extending 12 nautical miles from the shores of the Republic of Vietnam or 12 nautical miles seaward of the line defined by the BWN Act. If the Veteran did not serve in the Republic of Vietnam during the Vietnam era, actual exposure to herbicides must be verified through appropriate service department or other sources for the presumption of service connection for an herbicide-related diseased under 38 C.F.R. § 3.309(e) to be applicable. Exposure to herbicides is not presumed in such instances. However, once exposure to herbicides is established, the presumption of service connection found in 38 C.F.R. § 3.309(e) for herbicide-related diseases is applicable. Asbestos and Herbicide Agent Exposure Here, the Veteran contends that his disabilities are associated with his service, including exposure to asbestos and herbicide agents. See, e.g., November 2018 Board Hearing Transcript. First, regarding asbestos, the Veteran testified that he was exposed to asbestos while serving on the USS Bon Homme Richard (CV-31) during the Vietnam Era. Accordingly, the Board finds that the evidence is at least in equipoise and exposure to asbestos is acknowledged. Next, regarding herbicide agent exposure, the Veteran contends that he was exposed during his service aboard the Bon Homme Richard, which is an aircraft carrier. His military records confirm his service aboard the USS Bon Homme Richard (CVN-31) from January 8, 1968 to August 1, 1969. The records further show he was assigned to Fighting Squadron 53 (VF-53 or FITRON 53) from January 1968 until July 1969. The Veteran contends that he served on the USS Bon Homme Richard during its fourth and fifth Vietnam cruises in the Gulf of Tonkin at Yankee Station in 1968 and 1969. See July 2014 VA Form 21-4138 and July 2016 DRO hearing transcript. The Veteran's primary contention of herbicide agent exposure is that he had boots on ground in Vietnam. He asserts that, when his service time was expiring, he was flown off ship on either July 31, 1969 or August 1, 1969 and taken by prop plane to Da Nang, Vietnam where he stayed from one to three days (initially he stated it was three days, but at the November 2018 hearing and thereafter, he has stated it was only one day overnight) until he could get a flight out to Subic Bay, Philippines. In addition, at the July 2016 DRO hearing, the Veteran presented testimony alleging exposure to herbicide agents while aboard the USS Bon Homme Richard through the water supply by taking salt water showers and from cooking with and drinking water from the bay (i.e., Gulf of Tonkin). Through his representative, he alleged that the herbicide agents sprayed on land ran off into the Gulf of Tonkin in the land water, and that the herbicides in the Gulf were in concentrated doses so Navy Veterans were probably more exposed than the servicemembers who were on the ground unless they were being directly sprayed on. The Veteran testified that his ship took water from the Gulf of Tonkin when they ran out of water, and that they had to take salt water showers. However, he did not remember if they took the salt out of the water used for other purposes or how they processed it, although his representative said they did remove the salt and that they would have had a desalination station onboard to make the water potable. However, for the reasons set forth below, the Board finds that the preponderance of the evidence demonstrates that the Veteran was not present in the Republic of Vietnam, including its 12-mile territorial waters. The preponderance of the evidence does not support the Veteran's report of in-service herbicide exposure due to his stated presence in Da Nang, Vietnam. In March 2015, the U.S. Army and Joint Services Records Research Center (JSRRC) attempted to verify the Veteran's claimed visit to Vietnam in 1969 by reviewing the unit history of the VF-53, the command history of the USS Bon Homme Richard for 1969, and the deck logs for the USS Bon Homme Richard for the period of July 1st to September 1st of 1969. The JSRRC was not able to find any notation that anyone was recorded as going ashore to Vietnam. Furthermore, the ships movements do not show it reaching Yankee Station in the Gulf of Tonkin until July 31, 1969, which is either the day the Veteran left the ship or the day before he left. There was also no record of aircraft departing the ship for Da Nang and no aircraft are recorded as landing in Vietnam. Therefore, the JSRRC was unable to verify the Veteran's report that he was in Vietnam in 1969. Furthermore, the JSRRC's search verified that the Veteran was not in the Gulf of Tonkin in 1969 for enough time to be exposed to herbicide agents through the water supply because his ship arrived in the Gulf on July 31, 1969, either the day, or the day before, he left the ship. In accordance with development undertaken to obtain the Veteran's pay records following the May 2019 Board remand, all available documentation pertaining to his pay records was determined to be in the claims file and there was no record of any onshore leave or service or temporary duty in Vietnam. The Board is in receipt of lay statements submitted by the Veteran, to include one attributed to S.T., stating that the Veteran flew from the USS Bon Homme Richard to Da Nang, Vietnam as a first stop after leaving the ship upon discharge. The Board acknowledges the contentions therein and notes that pursuant to the Veteran's own testimony at the November 2018 Board hearing, S.T. was not serving with the Veteran at the time of his claimed stopover in Da Nang. Rather, S.T.'s statement indicated that he departed the Bon Homme Richard months earlier, in May 1969. Credibility determinations of a witness or claimant are multifaceted and require consideration of factors such as: inconsistent statements, internal inconsistency of statements, consistency with other evidence of record, and other factors. See Southall-Norman v. McDonald, 28 Vet. App. 346, 356 (2016). Here, the Board finds that the Veteran's own inconsistent statements about the date of his flight (he has contended that it was July 31 or August 1, 1969), the duration of his stay in Da Nang (initially he stated it was three days, but at the November 2018 hearing and thereafter, he has stated it was only one day overnight), and uniform inconsistency with the contemporaneous military personnel records of the time render those statements not credible and therefore not for affording probative weight. These personnel records provide an evidentiary foundation for drawing inferences against the Veteran from a lack of documentation. Fountain v. McDonald, 27 Vet. App. 258, 272 (2015). Also pursuant to the May 2019 Board remand, VA performed further development in February 2021 matching the movements of the Veteran's vessel when he was aboard in relation to Vietnam as defined by the BWN Act. A February 2021 Formal Finding by VA determined the Veteran's exposure to herbicides could not be conceded as the evidence of record did not show the Veteran had duty or visitation in the Republic of Vietnam, or on its inland waterways, or nautical service in the offshore eligible waters as defined in the BWN Act. The findings from a professional researcher from the Veterans Benefits Administration, Compensation Service, Military Records Research Center, were associated with the record in December 2020. They reflect the professional researcher completed comprehensive research on the Veteran's claimed exposure to herbicides while serving aboard the USS Bon Homme Richard, to include an all-inclusive search spanning November 1965 to August 1969. This review utilized the pertinent Command Histories in an attempt to substantiate the Veteran's claimed exposure. However, no evidence was located to support documentation of the claimed exposure. Moreover, data from the Blue Water Navy Ship Locator Dashboard and a map plotting the latitude and longitude of the USS Bon Homme Richard was associated with the record in February 2021, and demonstrates the ship was not within 12 nautical miles of the Republic of Vietnam. Specifically, the only date listed in brown or blue water was on August 16, 1969, after the Veteran was transferred off the ship on August 1, 1969. Therefore, the Veteran was not on board on the only documented date during the deployments of the USS Bon Homme Richard in 1968 and 1969 when it entered Blue Water. Moreover, associated deck log observation sheets provided data on the Bon Homme Richard's position during the period at issue and support the Blue Water Navy Ship Locator Dashboard finding showing no service within 12 nautical miles of the Republic of Vietnam. The Board finds that the deck logs and information from the Blue Water Navy Ship Locator Dashboard which plotted the Bon Homme Richard's position based on information from the deck logs is probative and does not support the Veteran's contention that his service aboard the Bon Homme Richard constituted service in the Republic of Vietnam during the Vietnam Era. Based on the above, the Board finds that the Veteran is neither presumed, nor upon facts found, to have been exposed to herbicide agents. Entitlement to service connection for chronic pain syndrome; entitlement to service connection for cervicalgia (also claimed as an upper back condition); entitlement to service connection for a lower back disorder; entitlement to service connection for peripheral neuropathy of the left upper extremity; entitlement to service connection for peripheral neuropathy of the right upper extremity; entitlement to service connection for peripheral neuropathy of the left lower extremity; and entitlement to service connection for peripheral neuropathy of the right lower extremity, to include as due to exposure to herbicide agents or asbestos Here, the Veteran contends that he has chronic pain syndrome, cervicalgia (also claimed as an upper back condition), a lower back disorder, and bilateral peripheral neuropathy of the upper and lower extremities associated with his Navy service. However, the Board determines that to the extent the Veteran has these current disabilities, the preponderance of the evidence is against finding that the second element of service connection has been met (incurrence or aggravation of a pertinent disease or injury in service). As to each of the claims, the Board finds that the evidence of record does not indicate that the Veteran's disabilities had onset during military service or are otherwise etiologically linked to the Veteran's service. During the November 2018 Board hearing before the undersigned, the Veteran contended that they are due to Agent Orange exposure (not shown, as described above) or else asbestos exposure. To the extent reference has been made elsewhere in the record to unsubstantiated symptomatology during service, it has not been contended that the disabilities began in service and have continued during the intervening 50 years since the Veteran separated from the Navy in 1969. The Veteran's service treatment records contain no suggestion of chronic pain syndrome, cervicalgia, a lower back disorder, nor bilateral peripheral neuropathy of the upper and lower extremities, including on the August 1969 service separation examination report. During the separation examination, competent medical professionals determined that that the Veteran had no clinical abnormalities apart from a scar on his left index finger and defective visual acuity that was corrected to 20/20 with lenses. The service treatment records (STRs) weigh against finding that the Veteran's disabilities pathology had onset during service. STRs show that the Veteran visited sick call on multiple occasions over the years spanning his Navy service, including while aboard the USS Bon Homme Richard; however, STRs are silent as to the claims for service connection herein. The Veteran's statements during service are more reliable evidence than is any more recent contrary testimony in support of the claims for benefits. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The service record evidence documents the Veteran's presentation of information to medical treatment providers, including in the context of seeking medical evaluation and care. It is reasonable to expect that the Veteran's report of pertinent health history in such a context would be complete and accurate to the best of his knowledge. See Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (statements made for the purposes of medical treatment may be afforded greater probative value because there is a strong motive to tell the truth to receive proper care). Post-service evidence includes private medical records (PMRs) from July 2012 showing low back pain and others dated December 2013 showing chronic pain syndrome and cervicalgia. A letter from the Veteran's physician in April 2018 states that he has peripheral neuropathy. The Board observes that this evidence is more than 40 years after his separation from service. The significant distance between the diagnoses and the conclusion of the Veteran's military service is another factor that weighs against finding that his disabilities resulted from an in-service injury, event, or disease. None of the competent evidence of record, including from the Veteran's own PMRs, indicates that the Veteran's disabilities had onset during service or are related to asbestos exposure; nor does any evidence identify any other manner of etiological link between their pathology and the Veteran's service that might identify another manner of pertinent in-service injury or event as potentially leading to the Veteran's disabilities. To the extent that the April 2018 letter from the Veteran's private physician suggested a possible link between some the Veteran's disabilities and Agent Orange exposure, the Board reiterates that said exposure has not been found. The most probative evidence weighs against demonstration of any in-service diagnoses or complaints related to chronic pain syndrome, cervicalgia, a lower back disorder, and bilateral peripheral neuropathy of the upper and lower extremities, or demonstration of a relevant in-service injury, event, or disease. Accordingly, the second Shedden element of a claim for service connection on a direct incurrence basis is not met. Thus, a VA examination or a medical opinion addressing this claim on a direct incurrence basis is not warranted. 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006). Additionally, as the second element for the claim for service connection on a direct-incurrence basis is not met, additional discussion of the Shedden elements for service connection need not be further discussed. As the evidence is not at least in equipoise regarding the second element of service connection (incurrence or aggravation of a pertinent disease or injury in service), the Veteran's claims of entitlement to service connection must be denied. See 38 U.S.C. § 5107 (a); 38 C.F.R. § 3.303; Shedden, 381 F.3d at 1167. The Board finds that the preponderance of the evidence is against the claims of entitlement to service connection for the above claims. As the preponderance of the evidence is against the claims, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). Accordingly, the claims must be denied. Entitlement to service connection for an acquired psychiatric disorder (claimed as depression, anxiety and insomnia), to include as due to exposure to herbicide agents or asbestos or as secondary to chronic pain syndrome Under 38 C.F.R. § 3.310, service connection may be granted for disability that is proximately due to or the result of a service-connected disease or injury, or for the degree of disability resulting from aggravation of a nonservice-connected disability, by a service-connected disability. See also Allen v. Brown, 7 Vet. App. 439, 448 (1995). Here, the Veteran has contended that he has a psychiatric disorder secondary to chronic pain syndrome. Although VA treatment records dated January 2020 show a diagnosis of depression, pursuant to the analysis above, service connection for chronic pain syndrome has been denied. Accordingly, the Veteran's claim cannot be granted on this secondary basis. The Veteran's contentions and the evidence of record do not indicate that his psychiatric disorder is etiologically linked to any of his established service-connected disabilities. Furthermore, the Veteran has not contended, and the evidence does not suggest, that the psychiatric disorder is secondary to any of the disabilities subject to pending claims on appeal being remanded for evidentiary development at this time, nor is there any evidence it is associated with asbestos exposure or another direct basis in keeping with the analysis already articulated above for the claims of chronic pain syndrome, cervicalgia, a lower back disorder, and bilateral peripheral neuropathy of the upper and lower extremities. The Board finds that there is no basis in this case for an award of service connection for the psychiatric disorder on either a direct or secondary basis. The Board finds that the preponderance of the evidence is against the claim of entitlement to service connection for an acquired psychiatric disorder. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). Accordingly, the claim must be denied. REASONS FOR REMAND Entitlement to service connection for coronary artery disease (CAD), to include as due to exposure to herbicide agents or asbestos, is remanded. Where there is competent evidence of a current disability or persistent or recurrent symptoms of a disability, evidence establishing that an event, injury, or disease occurred in service, and an indication that the disability or persistent symptoms of a disability may be associated with service or another service-connected disability, but there is insufficient competent medical evidence to make a decision on the claim, the Veteran must be afforded a VA examination. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Here, the Veteran has a current diagnosis of CAD pursuant to VA treatment records dated June 2020. As previously noted, the Board has determined that in-service exposure to asbestos is conceded. In February 2021, the Veteran submitted an item of medical literature indicating that asbestos exposure significantly increased the risk of cardiovascular diseases. As a result, the Board finds that further development and a VA medical opinion is warranted. The matters are REMANDED for the following action: 1. Please associate with the claims-file any outstanding pertinent treatment records, including additional VA treatment records (such as those that may have been created since the last such update of the claims file). Additionally, ask the Veteran to complete a VA Form 21-4142 for any new outstanding records from private providers of pertinent medical treatment of his disabilities on appeal that the Veteran may wish VA to assist him in obtaining for the record. 2. After the record is determined to be complete, please obtain a VA medical opinion to determine the etiology of his coronary artery disease. The Veteran's claims-file should be made available for review by the opinion provider. The clinician is asked to respond to the following: (a) Is it at least as likely as not (i.e., a 50 percent or greater probability) that a cardiovascular disability, including coronary artery disease, began during or is otherwise related to his active duty Navy service. The examiner must specifically address (1) the Veteran's conceded asbestos exposure in-service aboard the USS Bon Homme Richard (CV-31) between 1965 1969 and (2) the item of medical literature added to the claims file in February 2021 regarding asbestos exposure increasing the risk of cardiovascular diseases. The opinion expressed by the VA examiner should be accompanied by a complete rationale. If the VA examiner is unable to offer an opinion without resorting to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided. M. C. GRAHAM Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Fales, 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.