Citation Nr: 21077585 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 19-36 575 DATE: December 30, 2021 ORDER Entitlement to service connection for chronic rhinitis is denied. Entitlement to service connection for sinus problems is denied. Entitlement to service connection for lung spots is denied. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for left lower extremity neuropathy, to include as a result of exposure to herbicide agents, is denied. Entitlement to service connection for left upper extremity neuropathy, to include as a result of exposure to herbicide agents, is denied. Entitlement to service connection for right upper extremity neuropathy, to include as a result of exposure to herbicide agents, is denied. Entitlement to service connection for a right ankle disorder is denied. Entitlement to service connection for sleep apnea is denied. Entitlement to service connection for vision problems is granted is denied. REMANDED Entitlement to service connection for traumatic brain injury (TBI) is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for right lower extremity neuropathy, to include as a result of exposure to herbicide agents, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has chronic rhinitis due to an in-service event, injury, or disease. 2. The preponderance of the evidence is against finding that the Veteran has sinus problems due to an in-service event, injury, or disease. 3. The preponderance of the evidence is against finding that the Veteran has a current disability of lung spots due to an in-service event, injury, or disease. 4. The preponderance of the evidence weighs against a finding that the Veteran has bilateral hearing loss for VA purposes. 5. The preponderance of the evidence is against finding that the Veteran has left lower extremity due to an in-service event, injury, or disease. 6. The preponderance of the evidence is against finding that the Veteran has left upper extremity due to an in-service event, injury, or disease. 7. The preponderance of the evidence is against finding that the Veteran has right upper extremity due to an in-service event, injury, or disease. 8. The preponderance of the evidence is against finding that the Veteran has a right ankle disorder due to an in-service event, injury, or disease. 9. The preponderance of the evidence is against finding that the Veteran has sleep apnea due to an in-service event, injury, or disease. 10. The preponderance of the evidence is against finding that the Veteran has a TBI due to an in-service event, injury, or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for chronic rhinitis have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for sinus problems have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for lung spots have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a), 3.385. 5. The criteria for entitlement to service connection for left lower extremity have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for entitlement to service connection for left upper extremity have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for entitlement to service connection for right lower extremity have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for entitlement to service connection for a right ankle disorder have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for entitlement to service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 10. The criteria for entitlement to service connection for TBI have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from August 1965 to October 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from September 2018 rating decisions of a Department of Veterans Affairs (VA) Regional Office. In September 2021, the appellant testified at a videoconference hearing before the undersigned Veterans Law Judge of the Board. A transcript of the hearing is of record. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). 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); 38 C.F.R. § 3.303. Certain chronic diseases will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence. Therefore, the Veteran prevails in a claim when: (1) the weight of the evidence supports the claim, or (2) when the evidence is in equipoise. It is only when the weight of the evidence is against the claim that the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to service connection for chronic rhinitis is denied. 2. Entitlement to service connection for sinus problems is denied. The Veteran contends that he has chronic rhinitis and sinus problems that are related to an in-service, event, illness, or injury. A review of the Veteran's service medical records does not reflect any complaints, findings, or treatment for any conditions related to a respiratory disorder. A September 1969 separation medical examination reported the Veteran had no medical defects or diagnoses. The Veteran was provided a VA respiratory conditions examination in July 2018. The Veteran did not report any symptoms of a respiratory condition. According to the Veteran, he used inhalational bronchodilator therapy intermittently. The Veteran also reported that a CT scan of his lungs in 1990 showed spots. The examiner concluded that the Veteran did not have a diagnosable respiratory disorder. He noted that the Veteran's claims file is silent for any diagnosis or treatment of any lung conditions. The reported CT scan results and medication use are based on the Veteran's report. At the Veteran's September 2021 Board hearing, the Veteran stated that he was diagnosed with rhinitis and a sinus problem about 10 years ago and did not use any medications for his rhinitis. A lay person is competent to address etiology in some limited circumstances in which nexus is obvious merely through lay observation, such as a fall leading to a broken leg. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In this case, however, the Veteran contends that he has rhinitis and sinus problems that began many years after separation from active service and the question of causation extends beyond an immediately observable cause-and-effect relationship. As such, the Veteran is not competent to address the etiology of his claimed rhinitis and sinus problems. Consequently, the Board gives more probative weight to the July 2018 VA examination report in which the examiner found the Veteran did not have a diagnosis of a respiratory disorder. As described above, the first prong of a service connection claim is a current disability. The evidence does not demonstrate that the Veteran had chronic rhinitis or sinus problems during the pendency of the appeal. The U.S. Court of Appeals for Veterans Claims has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran's claims for service connection for chronic rhinitis and sinus problems. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not helpful to this claimant. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Service connection has not been established and the Veteran's claims for chronic rhinitis and sinus problems must be denied. 3. Entitlement to service connection for lung spots is denied. The Veteran contends that he has lung spots related to an in-service, event, illness, or injury. A review of the Veteran's service medical records does not reflect any complaints, findings, or treatment for any conditions related to any lung disorders. A September 1969 separation medical examination reported the Veteran's lungs were normal and that he had no medical defects or diagnoses. The Veteran was provided a VA respiratory conditions examination in July 2018. The Veteran did not report any symptoms of a respiratory condition. The Veteran reported that a CT scan of his lungs in 1990 showed spots. The examiner concluded that the Veteran did not have a diagnosable respiratory disorder. He noted that the Veteran's claims file is silent for any diagnosis or treatment of any lung conditions. The reported CT scan results and medication use are based on the Veteran's report. In December 2019, the Veteran submitted a January 2018 chest x-ray that revealed no evidence of consolidation or pleural effusion. There was minimal linear opacity in the left lung base suggesting discoid atelectasis. A May 2020 VA treatment record reported the Veteran used to smoke 3 packs daily but quit smoking more than 30 years ago. At the Veteran's September 2021 Board hearing, the Veteran testified that he was not diagnosed with a lung condition in service. According to the Veteran, about 40 years ago, spots were found on his lungs and "[t[hey didn't think it was anything serious." He stated that he did not receive any treatment for this condition. Although a chest x-ray showed minimal linear opacity in the left lung base, the finding of a lung spot is not a disability in and of itself for which VA compensation benefits are payable. The term "disability," as used for VA purposes, refers to impairment of earning capacity. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). There is no evidence of record suggesting the Veteran's lung spots causes any impairment of earning capacity. The Veteran testified in September 2021 that he did not receive any treatment for his lung spot. The Court has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran's claims for service connection for lung spots. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not helpful to this claimant. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Service connection has not been established and the Veteran's claim for lung spots must be denied. 4. Entitlement to service connection for bilateral hearing loss is denied. The Veteran contends that he has bilateral hearing loss related to in-service noise exposure. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). 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); 38 C.F.R. § 3.303. The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence. Therefore, the Veteran prevails in a claim when: (1) the weight of the evidence supports the claim, or (2) when the evidence is in equipoise. It is only when the weight of the evidence is against the claim that the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). For service connection to be granted for hearing loss, the requirements for service connection as defined in 38 C.F.R. § 3.385 need not be shown by the results of audiometric testing during a claimant's period of active service. 38 C.F.R. § 3.385; Ledford v. Derwinski, 3 Vet. App. 87 (1992). However, impaired hearing is only considered to be a disability for VA purposes if the auditory threshold for any of the frequencies of 500, 1000, 2000, 3000, and 4000 hertz is 40 decibels or greater; the auditory thresholds for at least three of these frequencies are 26 decibels or greater; or speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Therefore, the threshold question that must be addressed is whether the Veteran's claimed hearing loss qualifies as a disability, as defined by VA. In the absence of proof of a present disability, there is no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223 (1992). Turning to the evidence, an August 1965 entrance medical examination included an audiological evaluation that revealed pure tone thresholds, in decibels, for the right ear at -5 (500 Hz), -10 (1000 Hz), -5 (2000 Hz), -10 (3000 Hz), and -5 (4000 Hz), and for the left ear at -5 (500 Hz), -5 (1000 Hz), -5 (2000 Hz), -5 (3000 Hz), and -5 (4000 Hz). The Board has acknowledged that audiometric threshold values in service department records dated prior to November 1, 1967 are presumed to use the American Standards Association (ASA) standard. Around 1967, the service departments changed to International Standards Organization-American National Standards Institute (ISO-ANSI) units. Therefore, the Board has converted the units recorded in the August 1965 examination report to ISO-ANSI units by adding between 5 and 15 decibels to the recorded data as follows: At 500, 1000, 2000, 3000, and 4000 Hz. add 15, 10, 10, 10, and 5 dB, respectively. The ISO-ANSI values for the August 1965 examination report at the respective frequencies are, for the right ear: 10 (500 Hz), 0 (1000 Hz), 5 (2000 Hz), 0 (3000 Hz), and 0 (4000 Hz), and for the left ear: 10 (500 Hz), 5 (1000 Hz), 5 (2000 Hz), 5 (3000 Hz), and 0 (4000 Hz). The Veteran's service treatment records do not indicate any complaints, treatment, or diagnoses related to hearing loss in service. A September 1969 separation medical examination indicates that the Veteran scored 15 out of 15 on a whispered voice test. The Board notes that whispered voice tests cannot be considered as reliable evidence that hearing loss was or was not present. The Veteran submitted a private audiological examination that was conducted in May 2018. The audiological evaluation revealed pure tone thresholds, in decibels, for the right ear at 25 (500 Hz), 25 (1000 Hz), 25 (2000 Hz), 15 (3000 Hz), 15 (4000 Hz), and for the left ear at 30 (500 Hz), 25 (1000 Hz), 30 (2000 Hz), 25 (3000 Hz), 25 (4000 Hz). Speech audiometry using the Maryland CNC test revealed speech recognition ability of 94 percent in the right ear and 94 percent in the left ear. The Veteran was afforded a VA hearing loss examination in June 2018. A VA authorized audiological evaluation revealed pure tone thresholds, in decibels, for the right ear at 20 (500 Hz), 25 (1000 Hz), 20 (2000 Hz), 15 (3000 Hz), 20 (4000 Hz), and for the left ear at 25 (500 Hz), 20 (1000 Hz), 25 (2000 Hz), 20 (3000 Hz), 30 (4000 Hz). Speech audiometry revealed speech recognition ability of 100 percent in the right ear and 100 percent in the left ear. The audiologist diagnosed the Veteran with right ear mixed hearing loss and left ear sensorineural hearing loss in the frequency range of 500-4000 Hz. The audiologist reported that there was no permanent positive threshold shift (worse than reference threshold) greater than normal measurement variability at any frequency between 500 and 6000 Hz for the right and left ear. The audiologist opined that the Veteran's bilateral hearing loss was less likely as not caused by or a result of noise exposure while in service. As rationale, the examiner explained that the Veteran's service treatment records are silent for hearing loss. The Veteran reported an onset of hearing decrease as something that occurred gradually over a number of years post-separation after exposure to recreational and/or occupational noise exposure. The Board finds that the objective results from the May 2018 and June 2018 VA audiological examinations do not show the requisite levels of pure-tone thresholds or speech discriminations to constitute a current disability. Hearing loss is considered a disability only when any of those above noted categories reach 40 decibels or higher, or at least three of those categories reach 26 decibels or greater. 38 C.F.R. § 3.385. The Veteran's hearing acuity in his right and left ear have not been shown to reach a level considered to be a disability under VA regulations. The Veteran's speech discrimination remains above the threshold to be considered a disability. While the Veteran has complained of hearing loss, there is no objective evidence of loss of hearing in either ear that constitutes a disability. 38 C.F.R. § 3.385. Therefore, the Board finds that without a current disability of bilateral hearing loss for VA purposes, the claim for service connection cannot prevail. Brammer v. Derwinski, 3 Vet. App. 223 (1992). While the Board acknowledges that the Veteran may be competent to state that his hearing acuity is less than it was before, or as it was prior to service, he is not competent to speak to the specific level or severity of any hearing loss as it relates to achieving audiometric guidelines. For the purposes of applying the laws and regulations administrated by VA, the level of impairment is determined by a mechanical application of the objective criteria of VA regulations. Here, the objective criteria are not met by the Veteran's hearing acuity, and therefore, the Veteran's bilateral hearing loss cannot be considered a disability for which service connection may be granted. Accordingly, as the preponderance of evidence is against the finding of a current disability of bilateral hearing loss for VA purposes, the Veteran's claim of service connection for bilateral hearing loss must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. Entitlement to service connection for left lower extremity neuropathy, to include as a result of exposure to herbicide agents, is denied. 6. Entitlement to service connection for left upper extremity neuropathy, to include as a result of exposure to herbicide agents, is denied. 7. Entitlement to service connection for right upper extremity neuropathy, to include as a result of exposure to herbicide agents, is denied. The Veteran contends that he has neuropathy of his left lower extremity, right upper extremity, and left upper extremity that are related to an in-service, event, illness, or injury. A review of the Veteran's service medical records does not reflect any complaints, findings, or treatment for any conditions related to neuropathy of the extremities. A September 1969 separation medical examination reported the Veteran's had no medical defects or diagnoses. A January 2016 VA Agent Orange examination reported the Veteran complained of "numbness of leg/feet." In May 2018, the Veteran submitted a VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, in which he claimed service connection for "neuropathy." The Veteran was provided a VA examination of his peripheral nerves in July 2018. The Veteran reported he started feeling numbness in his right leg in 1980. He reported experiencing intermittent numbness and "pins and needles" in his right leg. An assessment of symptoms for peripheral nerve condition of the Veteran's left lower extremity, right upper extremity, and left upper extremity reported no constant or intermittent pain and no numbness, paresthesias, or dysesthesias. Testing of muscle strength, reflexes, and sensation were all normal for the Veteran's left lower extremity, right upper extremity, and left upper extremity. The examiner reported that the nerves of the Veteran's left lower extremity, right upper extremity, and left upper extremity were all normal. At the Veteran's September 2021 Board hearing, the Veteran testified that he has always had neuropathy, though he first went to see an acupuncturist about 20 years ago because his "thigh was falling asleep all the time." According to the Veteran, the acupuncturist told him he had neuropathy. While the Veteran contends that he has neuropathy of his left lower extremity, right upper extremity, and left upper extremity related to his military service, he is not competent to provide a nexus opinion in this case. The issue of the etiology of the Veteran's neuropathy is medically complex, requiring specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Thus, the Board finds the Veteran's statements are not competent medical evidence. Consequently, the Board gives more probative weight to the July 2018 VA examination report in which it was assessed that the nerves of the left lower extremity, right upper extremity, and left upper extremity were all normal. As described above, the first prong of a service connection claim is a current disability. The evidence does not demonstrate that the Veteran had neuropathy of his left lower extremity, right upper extremity, and left upper extremity during the pendency of the appeal. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for neuropathy of his left lower extremity, right upper extremity, and left upper extremity. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not helpful to this claimant. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Service connection has not been established and the Veteran's claim for neuropathy of his left lower extremity, right upper extremity, and left upper extremity must be denied. 8. Entitlement to service connection for a right ankle disorder is denied. The Veteran contends that he has a right ankle disorder related to an in-service, event, illness, or injury. The Board notes that the Veteran was not afforded a VA examination for his service connection claim for a right ankle disorder. In determining whether the duty to assist requires that a VA medical examination be provided, or medical opinion obtained with respect to a Veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumptive period; (3) whether there is an indication that the disability or symptoms may be associated with service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d) and 38 C.F.R. § 3.159 (c)(4). The third factor, in particular, is a low threshold. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this regard, the Board finds that the Veteran has not submitted sufficient evidence to indicate that he has a right ankle disorder related to an event, injury, or disease that occurred in service. Accordingly, the Board finds that no further development of the claims for service connection for a right ankle disorder is required. A review of the Veteran's service medical records does not reflect any complaints, findings, or treatment for any conditions related to a right ankle disorder. A September 1969 separation medical examination reported the Veteran's lower extremities were normal and that he had no medical defects or diagnoses. In January 2016, the Veteran presented for a VA Agent Orange registry examination. The Veteran reported several ailments as his past medical history: anxiety/depression, hypertension, atrial fibrillation, enlarged prostate hypertrophy, vertigo, and a stroke. Notably, the Veteran did not report right ankle pain. A physical examination of the extremities did not report any ankle defects. An August 2018 VA primary care note reported right ankle pain due to a March 2018 injury as a major illness. An examination of the right ankle showed no swelling or tenderness. At the Veteran's September 2021 Board hearing, the Veteran testified that he tore ligaments when he slipped in a hole running down a hill in service. He stated he was not receiving any treatment for his ankle other than being told by a foot doctor "you need rest." As previously described, the Veteran's service treatment records show no evidence of treatment or diagnosis for a right ankle disorder. Furthermore, a separation medical examination reported his lower extremities were normal and that he had no defects. The earliest documented evidence of a right ankle disorder was the Veteran's report of ankle pain in August 2018. This pain was attributed to a March 2018 injury. Notably, the Veteran did not report right ankle pain at a January 2016 examination and a physical examination of his extremities at that time did not report any ankle defects. Thus, the earliest documented evidence of right ankle disorder was the right ankle pain from an injury in March 2018, more than 38 years after the Veteran's discharge. Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for a right ankle disorder. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not helpful to this claimant. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Service connection has not been established and the Veteran's claim for a right ankle disorder must be denied. 9. Entitlement to service connection for sleep apnea is denied. The Veteran contends that he has sleep apnea related to an in-service, event, illness, or injury. A review of the Veteran's service medical records does not reflect any complaints, findings, or treatment for any conditions related to a sleeping disorder. A September 1969 separation medical examination reported the Veteran had no medical defects or diagnoses. An April 2007 sleep study diagnosed the Veteran with obstructive sleep apnea. The Veteran was provided a VA sleep apnea examination in July 2018. The Veteran reported the onset of his sleep apnea was in 1970, when his spouse noticed he snored heavily and would stop breathing in the middle of the night. The examiner noted the Veteran had a diagnosis of obstructive sleep apnea based on the April 2007 sleep study. At the Veteran's September 2021 Board hearing, the Veteran testified that he did not have a sleep disorder in service. He stated the onset of his sleep apnea was 20 years after service. When asked why he believed his sleep disorder was related to service, the Veteran stated, "I think it has to do a lot with my PTSD." He said he did not have trouble sleeping before he had PTSD. In view of the above, the Board finds the Veteran's lay statement at his July 2018 examination that his sleep apnea began in 1970 is unreliable. It is unreliable because it is inconsistent with his sworn testimony at his September 2021 Board hearing that the onset of his sleep apnea was 20 years after service and that he did not have a sleep disorder in service. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d. 604 (Fed. Cir. 1996). Although the Veteran testified that he believes his sleep apnea is related to his service-connected PTSD, a medical opinion is not warranted based on the Veteran's surmise that his sleep apnea may be related to a service-connected disorder. See Waters v. Shinseki, 601 F. 3d 1274, 1278 (Fed. Cir. 2010) (noting that a veteran's conclusory generalized statement that a service illness caused his present medical problems was not enough to entitle him to a VA medical examination since all veterans could make such a statement, and such a theory would eliminate the carefully drafted statutory standards governing the provision of medical examinations and require VA to provide such examinations as a matter of course in virtually every disability case). The Veteran has submitted no evidence indicating that his PTSD caused his sleep apnea. As such, a VA examination is not necessary to address whether PTSD caused his sleep apnea. As previously described, the Veteran's service treatment records do not reflect any diagnoses or treatment for a sleep disorder. A September 1969 separation medical examination reported the Veteran had no medical defects or diagnoses. The earliest documented evidence of sleep apnea was the sleep study confirming a diagnosis of obstructive sleep apnea in April 2007, more than 37 years after the Veteran's discharge. Moreover, the Veteran testified in September 2021 that he did not have a sleep disorder in service and that his sleep apnea began 20 years after service. Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for sleep apnea. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not helpful to this claimant. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Service connection has not been established and the Veteran's claim for sleep apnea must be denied. 10. Entitlement to service connection for vision problems is denied. The Veteran contends that he has vision problems related to an in-service, event, illness, or injury. A July 1965 enlistment examination reported the Veteran's vison was normal. A March 1967 service treatment record reported the Veteran was prescribed eyewear as he had lost his glasses. It was reported that he was essentially negative for any active pathology. A September 1969 separation medical examination reported the Veteran's eyes were normal and he had no medical defects or diagnoses. The Veteran was provided a VA eye conditions examination in July 2018. The Veteran was diagnosed with age-related cataracts and dry eye syndrome with an unknown date of onset for both diagnoses. The Veteran reported he had been using Restasis without improvement. He had vision fluctuations due to dryness. The examiner opined that the Veteran had a diagnosis of cataracts in both eyes, which is age-related and not connected to any service-connected condition. The examiner explained that the cataracts would more likely than not be present at the Veteran's age regardless of military service. The examiner also reported that the Veteran had a condition of dry eye syndrome that was more likely than not caused by his sleep apnea and lack of sleep. The examiner concluded that the Veteran's dry eye syndrome is what is making him feel like he can't see clearly and why things blur in and out. The examiner also noted that the Veteran stated he does not sleep well and conclude that this was contributing to his dry eye syndrome. At the Veteran's September 2021 Board hearing, he testified that he had glaucoma and had "black things floating around my eyes." The Veteran stated that he believed his current vision problem was due to his active service because he frequently had sunlight in his face while aboard naval vessels. The issue of the etiology of the Veteran's vision problems is medically complex, requiring specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Thus, the Board finds the Veteran's statements are not competent medical evidence. Consequently, the Board gives more probative weight to the July 2018 VA examination, which found that the Veteran had cataracts that are age-related and not connected to any service-connected condition. The examiner found that the cataracts would more likely than not be present at the Veteran's age regardless of military service. The examiner also reported that the Veteran had a condition of dry eye syndrome that was more likely than not caused by his sleep apnea and lack of sleep. A theory of service connection on a secondary basis to sleep apnea is not viable as the Veteran's claim of entitlement to service connection for sleep apnea is being denied herein. 38 C.F.R. § 3.310. Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for vision problems. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, that doctrine is not helpful to this claimant. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Service connection has not been established and the Veteran's claim for vision problems must be denied. REASONS FOR REMAND 1. Entitlement to service connection for a TBI is remanded. The Veteran contends that he has a TBI related to an in-service, event, illness, or injury. A review of the Veteran's service medical records does not reflect any complaints, findings, or treatment for any conditions related to a head injury. A September 1969 separation medical examination reported the Veteran's neurologic system was normal and that he had no medical defects or diagnoses. The Veteran was provided a VA headache conditions examination in July 2018. The Veteran described an in-service incident in which he was thrown about 50 feet that caused a loss of consciousness for an unknown period. Since then, he has been experiencing headaches. He stated that he experienced "usual headaches" once a week, but he bad headaches every six months. The examiner diagnosed the Veteran with migraine, including migraine variants, and post-traumatic headaches. The examiner did not provide a medical nexus opinion. In July 2018, the same VA examiner who conducted the headache conditions examination also conducted a TBI examination. The examiner reported the Veteran's symptoms were mild memory loss, headaches, and anxiety. The examiner remarked that the Veteran as thrown 50 feet on a ship and had loss of consciousness for an unknown period of time and since then he started getting headaches and having memory issues. The examiner concluded that she was unable to differentiate TBI from mental health symptoms without resorting to speculation as it is very common for TBI and mental health symptoms to overlap. The Veteran was provided a VA PTSD examination in April 2021. The symptoms associated with his diagnosed PTSD did not include headaches. As the July 2018 examiner who conducted the TBI and headache conditions examinations found that the Veteran had diagnoses of post-traumatic headaches and migraines but did not provide a nexus opinion, the Board finds that remand is warranted to obtain an addendum opinion to address the etiology of the Veteran's headache and migraine disorder. Although the examiner stated that she was unable to differentiate TBI from mental health symptoms without resorting to speculation, there is no evidence that the Veteran's headaches are related to his PTSD. By this remand, the Board makes no determination, express or implied, concerning the credibility of any lay statements on file. 2. Entitlement to service connection for hypertension is remanded. The Veteran contends that he has hypertension related to an in-service, event, illness, or injury. At the Veteran's September 2021 Board hearing, the Veteran suggested that his hypertension may be related to Agent Orange exposure. The Veteran's exposure to herbicide agents has been conceded. A review of the Veteran's service medical records does not reflect any complaints, findings, or treatment for any conditions related to hypertension. A September 1969 separation medical examination reported the Veteran had no medical defects or diagnoses. A blood pressure of 100/60 was reported. In January 2016, the Veteran underwent a VA Agent Orange registry examination. He reported that his past medical history included hypertension. The Veteran's blood pressure at the examination was 116/82. The Veteran was provided a VA examination of his hypertension in July 2018. The Veteran reported that he was initially diagnosed with hypertension in 1980 and was taking Lopressor and Losartan to treat his hypertension. The examiner reported blood pressure readings taken on three different days were 152/95, 156/98, and 167/90. The examiner concluded that the Veteran did not have a diagnosis of hypertension as the claims file is silent for any diagnosis or treatment of hypertension and the medication use for hypertension was based on the Veteran's report. In December 2019, the Veteran submitted copies of private medical records that he believed he had sent with his notice of disagreement in December 2018. One of the records was a private medical record that reported a problem list that included a diagnosis of essential hypertension with an onset date of January 2014. Another record was a private health record that reflects that high blood pressure was diagnosed in October 2017. The Veteran was prescribed Losartan to take daily. An October 2020 VA pharmacotherapy note reported the Veteran was referred for hypertension management by the cardiology department. It was reported that the Veteran's hypertension was reasonably controlled per limited home readings provided by the Veteran. The Veteran had been prescribed Losartan to administer daily. The Veteran was advised to monitor his blood pressure more frequently to review with his providers at follow-up visits. As previously described, the Veteran's exposure to herbicide agents has been conceded. Although VA has not conceded a presumptive relationship between hypertension and herbicide agent exposure, the National Academies of Sciences, Engineering, and Medicine (NAS) has placed hypertension in a "sufficient evidence" category in the NAS Veterans and Agent Orange: Update 11 (2018). Although hypertension has not been added to the list of diseases presumptively associated with exposure to herbicide agents, the NAS has recognized "sufficient evidence" of an association between the two such that a correlation cannot be ruled out with reasonable confidence. As the record shows the Veteran has a diagnosis of hypertension that has been treated with medication since 2017, remand is warranted for an addendum opinion to address the etiology of the Veteran's hypertension that considers his conceded exposure to herbicide agents. By this remand, the Board makes no determination, express or implied, concerning the credibility of any lay statements on file. 3. Entitlement to service connection for right lower extremity neuropathy, to include as a result of exposure to herbicide agents, is denied. The Veteran contends that he has right lower extremity neuropathy related to an in-service, event, illness, or injury. A January 2016 VA Agent Orange examination reported the Veteran complained of "numbness of leg/feet." The Veteran was provided a VA examination of his peripheral nerves in July 2018. The Veteran reported he started feeling numbness in his right leg in 1980. He reported experiencing intermittent numbness and "pins and needles" in his right leg. An assessment of symptoms for peripheral nerve condition of the Veteran's right lower extremity reported mild numbness and paresthesias/dysesthesias. Sensory testing showed decreased sensation in the right lower extremity. The examiner reported mild incomplete paralysis of the right external popliteal nerve and right anterior crural nerve. The examiner did not provide a nexus opinion. At the Veteran's September 2021 Board hearing, the Veteran testified that he has always had neuropathy, though he first went to see an acupuncturist about 20 years ago because his "thigh was falling asleep all the time." According to the Veteran, the acupuncturist told him he had neuropathy. As the July 2018 examiner found that the Veteran had right lower extremity neuropathy but did not provide a nexus opinion, the Board finds that remand is warranted to obtain an addendum opinion to address the etiology of the Veteran's right lower extremity neuropathy. By this remand, the Board makes no determination, express or implied, concerning the credibility of any lay statements on file. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain all outstanding relevant private treatment records. 3. After the above development is completed, obtain an addendum opinion from a qualified medical professional to determine the nature and etiology of the Veteran's headache disorder. The need for an in-person examination is left to the discretion of the clinician providing the opinion. The clinician is asked to provide opinions addressing whether it is at least as likely as not (probability of 50 percent or greater) that the Veteran's headache disorder is related to his military service. 4. After the above development is completed, obtain a VA medical opinion from an appropriate medical professional to determine the etiology of his claimed hypertension. The need for an in-person examination is left to the discretion of the clinician providing the opinion. The clinician is asked to provide opinions addressing the following: (a.) Has the Veteran had a diagnosis of hypertension during the pendency of the appeal (from May 2018 to the present)? (b.) If the Veteran has had a diagnosis of hypertension, whether it is at least as likely as not (probability of 50 percent or greater) that the Veteran's hypertension is related to active service, to include conceded herbicide agent exposure in Vietnam. (c.) In rendering the opinion, the clinician is reminded that the fact that hypertension is not on the presumptive list of conditions due to herbicide agent exposure cannot by itself be the sole basis for a negative nexus opinion. Rather, the clinician should consider the Veteran's specific military history, medical history, risk factors, and any other circumstances deemed relevant by the clinician in rendering an opinion. Furthermore, the clinician is also asked to consider "Update 11 (2018)" from the National Academy of Sciences that indicates "sufficient evidence" of an association between hypertension and herbicide agent exposure in rendering an opinion. 5. After the above development is completed, obtain a VA medical opinion from an appropriate medical professional to determine the etiology of his right lower extremity neuropathy. The need for an in-person examination is left to the discretion of the clinician providing the opinion. The clinician is asked to provide opinions addressing whether it is at least as likely as not (probability of 50 percent or greater) that the Veteran's right lower extremity neuropathy is related to his military service, to include conceded herbicide agent exposure in Vietnam. 6. A complete and fully explanatory rationale should be provided for all opinions. If any opinion cannot be rendered without resorting to speculation, the examiner should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, by a deficiency in the record, or because the examiner does not have the needed knowledge or training. 7. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If any determination remains unfavorable to the appellant, send the appellant and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. The appellant has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). These claims must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Moore, 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.