Citation Nr: 21076503 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 17-51 640 DATE: December 27, 2021 ORDER 1. Entitlement to service connection for a left eye disability is denied. 2. Entitlement to service connection for a disability manifested by dizziness is denied. FINDINGS OF FACT 1. A left eye disability was not manifested during the Veteran's inactive duty for training (INACDUTRA), and any currently diagnosed left eye disability is not shown to be etiologically related to her service. 2. The Veteran is not shown to have (or during the pendency of this claim to have had) a disability manifested by dizziness. CONCLUSIONS OF LAW 1. Service connection for a left eye disability is not warranted. 38 U.S.C. §§ 101, 106, 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304. 2. Service connection for a disability manifested by dizziness is not warranted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from January 2001 to May 2001, from November 2001 to July 2002, from February 2003 to February 2004, from April 2005 to May 2006, and from July 2012 to December 2012 and had additional periods of Reserve service. These matters are before the Board of Veterans' Appeals (Board) on appeal of an October 2014 Department of Veterans Affairs (VA) rating decision. In February 2020, this case was remanded for additional development. The Board notes that following the RO's latest adjudication of the claims, the Veteran submitted additional evidence in August 2021, including copies of VA treatment records and a lay statement. The Board notes the Veteran filed her substantive appeal in September 2017. As the appeal was submitted after February 2, 2013, the new evidence is automatically subject to initial review by the Board, and the Veteran has not explicitly requested that the RO initially review such evidence. See 38 U.S.C. § 7105 (e). Thus, a remand for an additional SSOC is not necessary for the claims decided herein. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To establish service connection for a claimed disability, there must be evidence of: (i) a present claimed disability; (ii) incurrence or aggravation of a disease or injury in service; (iii) and a causal relationship between the present disability and the disease or injury incurred or aggravated in service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303 (a). The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104, F.3d 1328 (Fed. Cir. 1997). Secondary service connection is warranted for a disability which is caused or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310. To substantiate a claim of secondary service connection there must be evidence of: (1) a disability for which service connection is sought; (2) a disability that is already service connected; and (3) that the already service connected disability caused or aggravated the disability for which service connection is sought. Generally, in order to qualify for VA benefits, a claimant must be a veteran. See Dingess v. Nicholson, 19 Vet. App. 473, 484 (2006). A veteran is a person who served in the active military, naval, or air service, and who was discharged or released therefrom under conditions other than dishonorable. 38 U.S.C. § 101(2); 38 C.F.R. § 3.1(d). The term "active military, naval, or air service" includes active duty, any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty for training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty, or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident occurring during such training. 38 U.S.C. § 101(21), (24); see also 38 C.F.R. § 3.6. When a claim is based on a period of Reserve or National Guard service, it must be shown that the individual concerned became disabled as a result of an injury or disease during ACDUTRA or as a result of an injury during INACDUTRA. Smith v. Shinseki, 24 Vet. App. 40 (2010). A member of the National Guard serves in the federal military only when formally called into the military service of the United States. At all other times, a member of the National Guard serves solely as a member of the State militia under the command of a state governor. To have basic eligibility as a veteran based on a period of duty as a member of a state Army National Guard, a National Guardsman must have been ordered into Federal service (federalized). 38 U.S.C. §§ 315, 502, 503; 38 C.F.R. § 3.6(c), (d); Allen v. Nicholson, 21 Vet. App. 54, 57 (2007). Accordingly, for the Veteran's National Guard service, only federalized periods of service are qualifying service for the purpose of VA compensation benefits. 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 layperson. 38 C.F.R. § 3.159 (a)(2). Competent medical evidence is necessary where the determinative question requires medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). 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. Competent medical evidence may 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). 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 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 preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). 1. Entitlement to service connection for a left eye disability is denied. The Veteran asserts that she has a left eye disability related to service. Specifically, she asserts she incurred a left eye disability when a smoke grenade blew up in her face during service. See e.g. August 2021 Statement by Veteran. The Veteran's service treatment records (STRs) reflect a February 2006 Report of Medical History for purposes of separation of which the Veteran reported that her vision had become blurry since January. She further reported that her vision improved with corrective lens use. A January 2013 Statement of Medical Examination and Duty Status notes that on January 25, 2013 the Veteran sustained acute chemical conjunctivitis of the bilateral eye and sudden vision loss and that the injury was incurred in the line of duty during a period of federalized Reserve service (INACDUTRA). It was noted that the Veteran was in pre-mob training and a training grenade went off near her face. A January 25, 2013 emergency room (ER) report at South Austin Medical Center reflects that the Veteran was in military training and was crawling on her back in the field when a smoke grenade went off in proximity to her. She described smoke getting into her eyes, stated she was "stunned" but had no loss of consciousness. She described a chemical burning sensation to her eyes. Paramedics in the field irrigated and flushed the eyes copiously. She reported burning to her eyes without foreign body sensation. Visual acuity was 20/70 right, 20/50 left and 20/70 OU. The Veteran received a final diagnosis of acute chemical conjunctivitis bilaterally. A January 27, 2013 treatment record at Seton Healthcare reflects the Veteran's complaint of an eye injury and blurred vision for the past two days. She reported that a smoke bomb exploded in front of her eye. The clinical impression was eye vision loss and eye pain. A January 28, 2013 treatment record at Texas Retina Institute shows the Veteran was referred to the office from the ER for blurry vision. She was hit with a smoke bomb on Friday. She reported seeing flashes of light. Her vision was darker in the left eye than the right eye. The impression was sudden vision loss and contusion of eye bilaterally. A January 30, 2013 MRI was ordered to evaluate the Veteran for visual change status post smoke grenade injury on January 26, 2013. The impression was an unremarkable MRI of the brain and orbits. No posttraumatic changes were suggested. Results were discussed with R. G. A February 2013 treatment record (by Scott and White Temple) shows the Veteran returned to the clinic for follow-up of tear film insufficiency, unspecified both eyes. She was last seen a day before and described that her eyes felt dry. The impression was tear film insufficiency, unspecified and myopia. Dr. C. E. noted that the Veteran had "some mild dry eyes and mild refractive error, but [did] not see anything that would be a sequalae from her recent smoke-grenade accident. [Do not] see any ocular reason why she [could not] be deployed." An October 2014 VA eye condition examination report found no pathology to render a diagnosis, but the VA examiner also noted he was unsure if the Veteran's complaints were related to childhood amblyopia or optic nerve visual disturbance and that she needed a neurologic ophthalmology work up. A January 2015 report from "MyEyeDr." notes a history of ocular trauma in January 2012 when a smoke grenade blew up in the Veteran's face. A diagnosis of peripheral vision loss in the left eye was provided. An August 2017 private treatment report at Silk Vision & Surgical Center notes a diagnosis of injury to the optic nerve in the left eye. Pursuant to the February 2020 Board remand, the Veteran underwent VA examination in April 2020 to assess the etiology of her claimed left eye disability. The Veteran was diagnosed with left optic atrophy. Following interview and examination of the Veteran as well as review of the claims file, the examiner opined the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the examiner explained, An informed opinion cannot [be] provided at this time. The treatment records document the in-service event of the Veteran's left exposed to a smoke grenade. The Veteran was immediately evaluated after the incident. The Veteran's visual acuity was measured on [January 28, 2013]; right eyes 20/400 no improvement with pinhole Hand Motion no improvement with pinhole. Pupil measures were normal. Posterior assessment noted no pallor or disc edema. OCT measure of the macula were normal. The Veteran was given a presumptive diagnosis of a contusion and treated with topical non-steroidals. Veteran was again examined [February 8, 2013]. Best corrected visual acuity was 20/20 both eyes, normal pupils, anterior segment and fundus. These findings suggest a full recovery. Currently, the Veteran has significant measured vision loss in the left eye with an afferent pupillary defect. The etiology of these abnormal findings is unknown and it is unclear if these findings are related to the in-service injury or a new unrelated entity. MRI imaging of the orbits and brain would be useful in determining the etiology. The April 2020 VA examiner additionally remarked, "the Veteran has had a significant decrease in visual acuity, afferent pupillary defect, and optic nerve pallor. These ocular findings [were not] previously documented and base[d] on the Veteran's case history they are new onset. The etiology of the abnormal ocular findings is unknown. Without a diagnosis one must resort to speculation to opine whether the Veteran's current condition was caused by the in-service injury." The examiner also determined, "the Veteran's progressive vision loss and persistent headaches require further evaluation by a neurologist." The Veteran was afforded another a VA examination in December 2020 to assess the etiology of her claimed left eye disability. Following interview and examination of the Veteran as well as review of the claims file, the examiner opined the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the examiner explained, Based on a review of the treatment record the Veteran's vision loss and presumed optic atrophy is [less] likely tha[n] not due to or related to the in-service injury. The ER report dated [January 25, 2013] documents the following, "She describes smoking getting into her eyes, states she was "stunned" but had no loss of consciousness. She described a chemical burning sensation to her eyes". The visual acuity was measured as 20/70 right eyes 20/50 [left] eyes; uncorrected. Pupils normal. The immediate anterior segment exam was normal no corneal injuries noted. The Veteran was provided with prophylactic treatment to control inflammation. The Veteran was again evaluated on [January 27, 2013] at the ER (Bastrop) for "eye injury" and complaints of blurred vision. The initial visual acuity measure was 20/200 both eyes. Within one day the Veteran was again evaluated by Ophthalmology ([January 27, 2013 Seton Healthcare Dr. [R.]). The Veteran exhibited a normal pupillary response (indicating no asymmetric neurological damage between the two eyes.) and the anterior and posterior exam was unremarkable. As a result of the unexplained vision loss an MRI was ordered. Dr. [M. M.] in consult with [R. G.] at Seton Medical Center found the MRI of brain and orbit to be unremarkable, "no post traumatic changes are suggested". Onset [January 31, 2013], the Veteran's visual acuity was 20/20 right eyes 20/20- left eye (normal) and ocular pathology was noted [February 8, 2013] at Scott and Temple [by] Dr. [C. E.] The Veteran's best-corrected visual acuity was measured at 20/20 in both eyes at both distance and near. Normal IOP measure and anterior segment normal. The corneal topography was measure[d] as well [as] the density [and] both measures were normal. Dr. [C. E.] concluded no findings that would be considered sequalae of the "smoke grenade accident" and the then solider was OK for deployment. The Veteran's changes in the visual field and visual acuity did not present until [January 17, 2015] at MyEyeDr. The Veteran was best-corrected 20/20 in both eyes but the clinician noted a constricted visual field left eye. A visual field test was performed on [February 27, 2015], the provider noted left eye constriction but did not consider it glaucomatous. The provider also noted a mild color vision deficiency in the left eye and nerve pallor indicated atrophy. The treatment record documents that the Veteran had a full recovery after the January 2013 event. The exam by Dr. [C. E.] was normal and she was fit for deployment. The delay in onset of symptoms [of] 1.5 years makes it more unlikely [than] not that the Veteran's current decrease in vision is related to the [January] 2013 event. The physical exam performed for this opinion was limited by the Veteran's report light sensitivity. Objective visual function testing is recommended. The Veteran was scheduled to undergo a Central Nervous System and Neuromuscular Disease VA examination in January 2021. The examiner interviewed the Veteran and completed review of the claims file. However, when providing an etiological opinion, the examiner stated she was unable to render a medical opinion regarding VA's request of "completing MRI imaging of the orbits and the brain" due to an inability to order the diagnostic test. The examiner explained, "diagnostic imaging is needed to further evaluate the Veteran's condition and in determining etiology as an x-ray would only show the structural component of the eye; therefore, an MRI is better suited. Moreover, this examination will be better addressed by an ophthalmologist/eye specialist as this is above my scope of practice." In April 2021, the RO sought to obtain a VA addendum opinion as the January 2021 VA Central Nervous System and Neuromuscular Disease provider was unable to provide an opinion for the reasons explained above. Accordingly, a VA addendum opinion was provided in April 2021. The Veteran's claims file was reviewed. The examiner stated, Based on a review of the treatment record including the MRI, it['s] the examiner's opinion that the Veteran's decrease in vision is not due to the service related injury. There is no physiological explanation for the decrease in vision of the left eye. The in-service injury occurred, [January] 2013. The Veteran reported that a smoke grenade detonated in close proximity to her face. In the immediate days after the incident the [Veteran] reported a decrease in vision. The visual acuity was measured at R: 20/200 L:20/200 (it is unclear if this measure was corrected or not). At that time, no external ocular abnormalities were observed. The [Veteran's] decrease in vision was unexplained. The Veteran was sent for MRI; [the] results were unremarkable; again no explanation for the decrease in vision. The [Veteran] was then again evaluated [January 31, 2013] at the Texas Retina Institute. The Veteran's visual acuity was measured at R:20/20 - L: 20/20- which is a significant improvement from the previous measure. Texas Retina Institute documented no abnormal posterior findings; the optic nerve and retina were intact and normal. The Veteran was examined [February 8, 2013] at Scott and White Temple. The exam was [essentially] normal, the best corrected visual acuity 20/20 in both eyes at both distance and near. The examiner diagnosed dry eyes and specifically stated, "Pt has some mild dry eyes and a mild refractive error, but, [do not] see anything that would be a sequalae from her recent smoke-grenade accident. [Do not] see any reason why she [could not] be deployed. Return to clinic prn." Based on the exam at the time of the injury, it appears that the [Veteran] recovered with no complications. It is unclear what the cause of the Veteran's left eye decrease in vision. Based on the treatment record evidence I am unable to connect the Veteran's reported decrease in vision to the [January 2013] event. A May 2021 VA treatment record reflects that a recently conducted "MRI was unremarkable, and other than some subtle pallor OS, nerves look healthy." A June 2021 VA treatment record shows the Veteran presented to the ophthalmology clinic for evaluation. She reported that in 201[3] a smoke grenade detonated in her face and she lost vision in her left eye. She reported that she stayed in the hospital for 2 weeks, regained vision OD, however never regained vision in OS. She stated an optometrist told her that her "retina was stunned and possible optic nerve damage." Subsequently, she reported seeing an ophthalmologist in Washington, D.C., who told her she had optic nerve damage. She averred experiencing headaches daily with severe migraines two to three times per week. The examiner indicated that "OS still LP today [and] APD OS." The Veteran's "labs from prior appt [were] largely unremarkable." Upon careful review, the preponderance of the competent (medical) evidence is against a finding that the Veteran's current left optic atrophy is etiologically related to her service. The Board finds the opinions by the December 2020 and April 2021 VA consulting providers cumulatively probative and persuasive. Addressing the specific rationale against the claim, the December 2020 examiner explained that the treatment records document that the Veteran had a full recovery after the January 2013 event. The February 2013 examination by Dr. [C. E.] was normal and she was fit for deployment. The examiner further explained that the delay in onset of symptoms of 1.5 years made it more unlikely that the Veteran's current decrease in vision is related to the January 2013 smoke grenade injury. Similarly, the April 2021 examiner explained that based on the examination at the time of injury, the Veteran recovered with no complications. The examiner further explained that there is no physiological explanation for the decrease in vision of the left eye and that in the immediate days after the incident, no external ocular abnormalities were observed. In fact, when evaluated days after the incident, the Veteran's visual acuity measurements were a significant improvement from the previous measure. An MRI of the brain and orbit, also conducted during that time, was unremarkable. Additional testing in February 2013 further revealed no findings that would be considered sequalae of the smoke grenade injury and the Veteran was deemed fit for deployment. In conclusion, the April 2021 examiner explained that the evidence does not show the January 2013 smoke grenade accident as the cause of the Veteran's reported decrease in vision. The April 2021 VA opinion-provider is a medical professional, and is competent to offer her opinion, and the opinion reflects a familiarity with the Veteran's entire record and includes rationale that cites to supporting factual data and medical principles. The opinion is probative evidence in the matter. The Veteran has not submitted any competent (medical opinion or treatise) evidence to the contrary, and the Board finds it persuasive. The Board has considered the Veteran's general assertions that her current left eye disability is related to when a smoke grenade blew up in her face during service. She is a layperson, and is not shown (and does not profess) to have medical training/expertise. Her own opinion is not competent evidence in the matter. She has not presented any competent (medical opinion/textual) evidence supporting this proposed theory of entitlement. See Jandreau, 492 F.3d 1372, 1377. Considering the foregoing, the Board finds that the preponderance of the evidence is against this claim, and that the appeal in the matter must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for a disability manifested by dizziness is denied. The Veteran asserts that she has a disability manifested by dizziness related to service. Specifically, the Veteran asserts that she has constant dizziness associated with her service-connected headache disability and non service-connected left eye disability. STRs reflect a February 2006 Report of Medical History for purposes of separation of which the Veteran denied ever having or presently having dizziness or fainting spells or frequent or severe headache. An October 2013 neurological review of systems revealed no dizziness and no vertigo. A December 2013 medical record reflects the Veteran's complaint for chest pain. She denied dizziness. A June 2014 treatment record reflects the Veteran's complaint of cervical spine pain. A general health screen noted "dizziness associated with headache: room can spin." Pursuant to the February 2020 Board remand, the Veteran underwent an initial VA examination in April 2020 to assess the etiology of her claimed disability manifested by dizziness. The examiner noted that per the Veteran's self-report, she had a training accident in 2012 with training grenade. She reported lost vision both eyes. Her vision came back blurry. She had double vision in right eye [and] stated was completely blind in the left eye. She said she was getting a prescription for the right eye. A year later, in 2013, she developed dizziness or vertigo where the whole room would spin. She reported having headaches daily 24/7. She had nausea and vomiting with the vertigo. She was seen in the ER with vertigo in 2013 and given medicine. She reported her current symptoms were dizziness or vertigo nausea with vomiting 2 or 3 times a month lasting up to 45 minutes. Following interview and examination of the Veteran as well as review of the claims file, the examiner opined the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the examiner explained, The Veteran's disability manifested by dizziness or vertigo (dizziness) is at least as likely as not (50 percent or greater probability) incurred in or caused by in service injury or event or disease because there is documentation of dizziness, vertigo and acute headache with diagnosis page 1038 noted by Dr. [D.C.] M.D. dated Tuesday, September 24, 2013 or within a year of active duty. Dizziness was noted on separation exam in 2006. A nexus has been established. The April 2020 VA examiner additionally opined the claimed condition was less likely than not proximately due to or the result of Veteran's service connected condition. As rationale, the examiner explained, The Veteran's disability manifested by dizziness or diagnosis of vertigo (dizziness) is less than likely not (50 percent or lesser probability) incurred in or caused by (the) headache and left eye disorder during service because this examiner is unable to comment on the left eye disorder as I am not an ophthalmologist and did not examine or diagnose the left eye condition and therefore would not be able to comment on the causal relationship between the dizziness, vertigo and the left eye disorder. Also[,] the weight of the current medical literature does not support. Vertigo is usually caused by inner ear problems, dehydration or medication side effects, and or low blood pressure. reference: Dizziness or Vertigo, US National Library of Medicine. https://medlineplus.gov/dizzinessandvertigo.html. [April 1, 2020]. A nexus has not been established. In June 2021, the RO scheduled the Veteran for another VA examination after finding the previous April 2020 VA examination did not show any objective indicators, etc. to support the diagnosis provided. The RO stated, "it is not clear whether the [V]eteran meets the criteria for a distinct and separate disability OR whether the dizziness/vertigo is a symptom of another diagnosed condition." Accordingly, the Veteran underwent a June 2021 VA Ear Conditions VA examination. Physical examination was normal. The Veteran did not have any vestibular conditions. The examiner remarked that subjective symptomatology and its severity was not supported by objective medical evidence in treatment records. The examiner was asked to address whether the Veteran's any disability manifested by dizziness was at least as likely as not aggravated beyond its natural progression by her service connected tension headaches and/or tinnitus. Following interview and examination of the Veteran as well as review of the claims file, the examiner opined the condition claimed was less likely than not incurred in or caused by the claimed in-service injury. The examiner reasoned that "there is no clear evidence of a chronic disability related her claimed condition. The [V]eteran's ability to hold a steady employment in the warehouse that involve record management and physical labor [for] 20 years is inconsistent with the subjective symptoms and the severity." The examiner concluded, "[there is] no objective medical evidence to substantiate an ear/peripheral vestibular disorder, claimed as "dizziness". The examiner further explained, Based on all available evidence during and following [active duty] service, the [V]eteran does NOT have an ear/peripheral vestibular disorder, claimed/manifested by "dizziness". Moreover, [service treatment records] showed one isolated incident of dizziness in 2006 that resolved with vision correction. Extensive review of records, failed to show objective evidence of an ear/peripheral vestibular disorder, claimed as "dizziness", as a direct result of the incident in 2012. Thus, a diagnosis of an ear/peripheral vestibular condition, claimed as "dizziness", [cannot be confirmed. The Veteran's last audiogram showed [non]-organic [left]-sided hearing loss. MRI of the brain showed no central or vestibular lesions/abnormality. [Examination] today showed completely normal [tympanous membranes] bilaterally, with no evidence of prior [left] [tympanous membrane] injury. Thus, "the opinion indicated the [V]eteran's dizziness is vertigo that is at least as likely as not related to dizziness reported at discharge in 2006" was baseless, as [there is] no clear objective indicators/findings to support the diagnosis. Given the inconsistencies and discrepancies history [and] lack of objective findings/evidence throughout medical treatment records, during [active duty] [and] after separation from service, further work-up is not indicated at this time. The examiner also cited to UpTODate, noting the "central causes of vertigo generally comprise 20 percent of cases; of these, vestibular migraine and vascular etiologies are the most common. Central vertigo can result from lesions affecting the brainstem and cerebellum. It is rare for vertigo to result from lesions affecting the vestibular cortex [47]." The examiner also noted that "vertigo is a symptom of illusory movement. Almost everyone has experienced vertigo as the transient spinning dizziness immediately after turning around rapidly several times. Vertigo can also be a sense of swaying or tilting. Some perceive self-motion whereas others perceive motion of the environment. Vertigo is a symptom, not a diagnosis. There are many causes of vertigo. It is customary to organize causes of vertigo into peripheral and central disorders, using features of nystagmus, and the presence or absence of postural instability, hearing loss or tinnitus." The threshold requirement here (as in any claim seeking service connection) is that there must be competent evidence that the Veteran has (or during the pendency of the claim has had) the disability for which service connection is sought, i.e., a bilateral upper and/or lower extremity neuropathy disability. See 38 U.S.C. § 1110. In the absence of proof of current disability there is no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board acknowledges the Veteran's belief that she has a disability manifested by dizziness. However, such theory of entitlement presents a medical question that is beyond the scope of common knowledge or resolution by lay observation; it requires medical expertise. See Jandreau, 492 F.3d at 1377. The Board notes that while the April 2020 VA examiner determined the Veteran had a disability manifested by dizziness (that was related to the Veteran's smoke grenade injury), the June 2021 VA examiner, following the clinical evaluation, concluded the Veteran does not have a current diagnosis of dizziness or vertigo and explained why the notations of such a diagnosis in the Veteran's medical records were not a valid diagnosis. As the June 2021 VA examiner explained, the Veteran's last audiogram (in February 2021) showed [non]-organic [left]-sided hearing loss. MRI of the brain showed no central or vestibular lesions/abnormality. The June 2021 VA examination showed completely normal [tympanous membranes] bilaterally, with no evidence of prior [left] [tympanous membrane] injury. The Board finds that the June 2021 VA examiner's conclusions provide the most probative evidence regarding the Veteran's current diagnosis, because it is based on a review of relevant medical records, objective testing, and medical principles, and provides a thoroughly reasoned analysis for its conclusions. By contrast, while the April 2020 VA examination report refers to a diagnosis of dizziness or vertigo, that diagnosis is not supported by the available diagnostic testing or any other clinical findings. Accordingly, the Board concludes that the June 2021 VA examiner's findings are more persuasive. While the Veteran is certainly competent to report her history of dizziness, he has not demonstrated that he has the requisite specialized knowledge or training to diagnosis a disability manifested by dizziness, to include vertigo. Layno v. Brown, 6 Vet. App. 465, 470 (1994); See Jandreau, 492 F.3d 1372, 1377. The Veteran has not presented any competent and credible evidence of a current diagnosis for a disability manifested by dizziness, to include vertigo. Accordingly, the Veteran's assertions that she has a disability manifested by dizziness, to include vertigo, have little probative value. No underlying disability has been clinically diagnosed during the appeal period or proximate thereto. McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). In summary, the preponderance of the evidence weighs against finding in favor of the Veteran's service connection claim for a disability manifested by dizziness, to include vertigo. Therefore, the benefit-of-the-doubt rule does not apply, and the service connection claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55. R. Erdheim Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Griffith 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.