Citation Nr: 21007053 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 15-30 833 DATE: February 8, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder to include, but not limited to, Generalized Anxiety Disorder (GAD), posttraumatic stress disorder (PTSD) and an unspecified depressive disorder, is denied. Entitlement to service connection for hypertension, to include as secondary to an acquired psychiatric disorder, is denied. Entitlement to service connection for diabetes mellitus, type II, to include as secondary to an acquired psychiatric disorder and/or hypertension, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran’s diagnosed acquired psychiatric disorder, including but not limited to, GAD, PTSD, and an unspecified depressive disorder, began during active service, or is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence is against finding that the Veteran’s diagnosed hypertension began during active service or is otherwise related to an in-service injury or disease, nor is it secondary to any service-connected disability. 3. The preponderance of the evidence is against finding that the Veteran’s diagnosed diabetes mellitus, type II, began during active service or is otherwise related to an in-service injury or disease, nor is it secondary to any service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for an acquired psychiatric disorder, to include but not limited to, GAD, PTSD and an unspecified depressive disorder, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for hypertension due to service or secondary to any service-connected disease or injury are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 3. The criteria for service connection for diabetes mellitus, type II, due to service or secondary to any service-connected disease or injury are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from May 1988 to May 1990 and from January 1991 to March 1991. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of a Regional Office (RO) of the Department of Veterans Affairs (VA) dated February 2015 and November 2016. In November 2018, the Veteran and his wife testified before the undersigned Veterans Law Judge. The transcript from that hearing is in his file. In April 2019 the Board remanded the issues on appeal in order to: associate with the claims file all VA treatment records dated from November 2018 to present; schedule the Veteran for a VA psychiatric examination to obtain an opinion as to the nature and etiology of any currently-diagnosed acquired psychiatric disorders, with specific questions that the examiner was required to respond to; schedule the Veteran for a VA examination for hypertension to determine whether the Veteran’s hypertension was at least as likely as not incurred in or caused by his active service and whether the Veteran’s hypertension was caused or aggravated by a psychiatric disorders and; schedule the Veteran for a VA examination for diabetes mellitus and the examiner should opine as to whether the Veteran’s diabetes was aggravated by any acquired psychiatric disorder and whether the Veteran’s diabetes was aggravated by his currently diagnosed hypertension. The Board finds the RO substantially complied the remand instructions and an additional remand to comply with those remand directives is not required. See Stegall v. West, 11 Vet. App. 268 (1998); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (noting that Stegall requires substantial compliance with remand orders, rather than absolute compliance). The Board has thoroughly reviewed all evidence in the claims file. Consistent with the law, the analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim and the Board’s reasons for rejecting evidence favorable to the appellant. See Timberlake v. Gober, 14 Vet. App. 122 (2000). The Veteran must not assume the Board has overlooked evidence that is not explicitly discussed herein. In addition, pertinent regulations for consideration were provided in the September 2020 Supplemental Statement of the Case (SSOC) and are not repeated here in full. The Veteran has not raised any specific duty to notify or duty to assist issues regarding this appeal, nor any arguments concerning the conduct of his Board hearing. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board … to search the record and address procedural arguments when the Veteran fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Therefore, the Board will not discuss these duties any further. Service Connection 1. Entitlement to service connection for an acquired psychiatric disorder, to include, but not limited to, GAD, PTSD and an unspecified depressive disorder The Veteran contends that his diagnosed acquired psychiatric disorder is related to his active service, specifically fears connected to driving a Bradley Fighting Vehicle (Bradley) during Operation Desert Storm and trauma suffered at the hands of an abusive roommate at Fort Stewart, Georgia. Initially claimed as PTSD, the Veteran’s claim has been broadened to include any diagnosed acquired psychiatric diagnoses. The presumption of soundness applies only when a disease or injury not noted upon entry to service manifests in service, and a question arises as to whether it preexisted service. Gilbert v. Shinseki, 26 Vet. App. 48, 55 (2012), aff’d 749 F.3d 1370 (Fed. Cir. 2014). In this case, there is a question as to whether the Veteran’s acquired psychiatric disorder preexisted his military service based on his statements during treatment. However, the Veteran’s March 1988 and February 1991 entrance examinations are absent of any notations of psychiatric defects, infirmities, or disorders. Therefore, the presumption of soundness attaches. There was no mental health treatment during either period of active service. Therefore, this is not an aggravation case, and, instead, the Board will adjudicate the appeal as one for direct service connection. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection for posttraumatic stress disorder requires medical evidence diagnosing the condition in accordance with § 4.125(a) of this chapter; a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.303(f). Relevant to the Veteran’s claimed stressors, the regulation provides specific information regarding fear of hostile military activity and in-service personal assault. If a stressor claimed by a veteran is related to the veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of posttraumatic stress disorder and that the veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. For purposes of this paragraph, “fear of hostile military or terrorist activity” means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. 38 C.F.R. § 3.303(f)(3). If a posttraumatic stress disorder claim is based on in-service personal assault, evidence from sources other than the veteran's service records may corroborate the veteran's account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. 38 C.F.R. § 3.303(f)(5). The question before the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Veteran has current diagnoses of PTSD, GAD, and a depressive disorder. However, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of an acquired psychiatric disorder began during service or is otherwise related to an in-service injury, event, or disease. There was no mental health treatment during either period of active service. On the February 1991 Report of Medical History, the Veteran denied ever having depression or excessive worry or nervous trouble of any sort. He did report trouble sleeping, but there was no further explanation. The separation examination in March 1991 showed a normal psychiatric evaluation. On the March 1991 Report of Medical History, the Veteran denied ever having depression or excessive worry, nervous trouble of any sort, or trouble sleeping. Therefore, there is no showing a psychiatric condition actually manifested during service. Private treatment records show the Veteran was diagnosed with depression in May 1997, 6 years after the Veteran’s separation from active service. Dr. F.J.M. stated that the Veteran complained of fatigue and was under quite a bit of stress at work. The doctor’s impression was that the Veteran’s fatigue was probably related to depression. This medical provider also treated physical ailments, and there is no indication that this provider is a psychiatrist or psychologist. Therefore, that was not a valid diagnosis for VA disability purposes under the then-applicable DVM-IV. Between 1997 and 1998, the Veteran was treated by Dr. F.J.M. for depression. The record does not contain evidence related to the Veteran’s psychiatric disorder, treatment or diagnoses, between 1998 and 2008. In 2008, while being treated for hypertension, the private medical provider, Nurse J.M., made notes of the Veteran’s psychiatric state. In October 2008, no symptoms of depression or anxiety were noted. In November 2008, the Veteran reported insomnia, but denied depression. The Veteran was first diagnosed with anxiety in March 2010, 19 years after his separation from service. However, this initial diagnosis was made by a nurse practitioner, Nurse J.M. and therefore is not a valid diagnosis for VA disability purposes for the same reasons as above. At a follow up visit with the same provider in March 2010, the Veteran wanted to address hypertension, gastroesophageal reflux disease, low back pain, and depression and anxiety. Nurse J.M. stated that the Veteran had symptoms suggestive of depression with anxiety but did not yet have an official diagnosis of anxiety. He reported symptoms of apprehension and feeling tense, several times per week, but denied having panic attacks. Apparent triggers included occupational and family stressors. At the time, the Veteran had no prior or current treatment for anxiety. While the Veteran is competent to report having experienced symptoms of apprehension or feeling tense intermittently or having nightmares since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of depression or anxiety as there is no evidence of record that the Veteran is a licensed psychiatrist or psychologist. In a letter from the Veteran dated November 2014, he stated that he had nightmares and a lack of sleep due to PTSD, specifically related to his recall to active duty during Operation Desert Storm in 1991. A March 2016 letter from the Veteran is the earliest mention of the alleged physical abuse by his roommate. VA records show that the Veteran was diagnosed with generalized anxiety disorder and unspecified depressive disorder in December 2015 by a psychologist. At that appointment, the provider also noted that the Veteran did not meet the criteria for PTSD, although did not elaborate. The Veteran did not discuss his experience with his roommate at Fort Stewart, but rather focused his anxiety around driving a Bradley. In January 2016, the Veteran spoke with a VA mental health provider about his diagnosed GAD. The Veteran stated that he had always tended to worry, but when he was young, this may have helped motivate him to be more productive at work. In March 2016, the Veteran transferred VA treatment facilities, requesting continued treatment for PTSD. At a primary care appointment, the Veteran presented with a positive PTSD screening. At an initial evaluation for mental health treatment, however, the provider indicated that the Veteran did not have a then-current diagnosis of PTSD, rather he was diagnosed with GAD. The intake provider also noted that the Veteran did not meet criteria A for PTSD as to his fear related to driving a Bradley. At a treatment appointment, the psychiatrist diagnosed the Veteran with an unspecified anxiety disorder, with a note to rule out GAD versus PTSD. A treatment note from June 2016 indicates that the Veteran reported that his mental health was worse related to work stress, and that the increased stress was having an impact on management of his diabetes. A December 2016 letter from a VA social worker confirms that the Veteran had been consistently treated for GAD since March of that year. An additional letter from the same provider dated January 2019 verifies that the Veteran had continued treatment since March 2016 for GAD. His GAD caused significant impairment with social and occupational functioning without treatment. The Veteran appeared to be able to deal with his job but struggled with face-to-face interactions. In a June 2019 opinion and a July 2020 clarifying addendum opinion, the VA examiner concluded that the Veteran’s acquired psychiatric disorders are less likely than not related to an in-service injury, event, or disease, including the Veteran’s fear of driving a Bradley and interactions with his roommate at Fort Stewart, Georgia. The 2019 opinion was internally inconsistent, as the examiner used language providing a positive opinion, yet the rationale supported a negative opinion. Therefore, clarification was provided in 2020 by the same psychologist that her opinion was negative – that the conditions are less likely due to the reported service events. As to PTSD and an unspecified depressive disorder, the rationale was that there was no record of in-service mental illness and no marker indicating that the reported stressor affected the Veteran’s functioning. Additionally, the Veteran reported childhood trauma. While in-service treatment or markers of personal assault are not required for service connection of an acquired psychiatric disorder under 38 C.F.R. § 3.303(f)(5), even if the events are conceded, the examiner determined that it would have been mere guesswork to determine that the Veteran’s PTSD was incurred in or caused by the claimed in-service stressors, particularly when taken in consideration with his childhood trauma. In other words, the examiner considered the Veteran’s report of his stressor with his roommate and of his fear while driving a Bradley, yet still reached a negative opinion. The examiner also determined that the Veteran’s GAD existed prior to service, relying on the Veteran’s own report to his mental health provider that he’d been nervous as long as he could remember. As noted above, no psychiatric condition was noted at entry, so the Board will not consider his GAD as pre-existing service. However, there were no complaints of anxiety during service, and, as noted above, there is no persuasive evidence of anxiety dating back to service, as the Veteran never related such in the years he reported his symptoms prior to filing his claim with VA. Therefore, direct service connection is not warranted for GAD. The Veteran’s claimed stressor of fear of driving a Bradley does not fall under the fear of hostile military or terrorist activity subsection of 38 C.F.R. § 3.303(f)(3). For this subsection to apply, the Veteran must have experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others. While the Veteran was recalled to active service in support of Operation Desert Storm, he was not actually deployed to a place where hostile military or terrorist activities were occurring. Rather, he was stationed in Germany. While it is certainly reasonable that being activated while a war was happening in another country would be stressful, fear of hostile enemy activity would not be consistent with the circumstances of his service, and such a stressor cannot be conceded. The examiner’s opinions are probative, because they are based on an accurate medical history and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The examiner relied on the Veteran’s own contemporaneous reports to medical providers during treatment, which are given substantial weight when considering evidence. Consequently, the Board gives significant weight to the June 2019 examination and July 2020 clarifying addendum VA examiner’s opinions. The Veteran believes his acquired psychiatric disability is related to an in-service injury, event, or disease. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of psychology and/or psychiatry as well as the application of the DSM-V to the Veteran’s symptoms. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. As a result, the Board gives more probative weight to the VA examiner’s opinion. The Board also notes he submitted statements from his brother and wife, attesting to personality changes after service. While the Board appreciates their observations, they are also not medical professionals, and there remains a lack of any competent evidence linking his symptoms and psychiatric diagnoses to his service. In light of the above analysis, the Board finds the preponderance of the evidence is against entitlement to service connection for an acquired psychiatric disorder. In denying the claim, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. Entitlement to service connection for hypertension, to include as secondary to an acquired psychiatric disorder The Veteran asserts that his diagnosed hypertension is as a result of his active service. Alternatively, he contends that his hypertension is as a result of or was aggravated beyond its natural progression due to his acquired psychiatric disorder or disorders. As discussed above, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. As the Veteran has a diagnosis for a current disability, the determination to be made is whether his hypertension is related to his active service. Under Diagnostic Code 7101 (hypertensive vascular disease), hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure (bottom number) is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure (top number) is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm. At his entrance examination in March 1988, the Veteran’s blood pressure was 120/70. In June 1989, during service, the Veteran had his blood pressure taken while at an aid clinic and it measured as 120/78. In March 1990, at his exit report of medical examination prior to leaving active service, the Veteran’s blood pressure was 143/77 and noted as abnormal systolic. Although high for the Veteran at that time, 143 systolic blood pressure was not high enough to meet the threshold for hypertension under Diagnostic Code 7101, and it was an isolated reading. In April 1990, his blood pressure was 130/68. Therefore, hypertension was not factually shown during his first period of service. When the Veteran was activated for service in Operation Desert Storm in early 1991, he reported symptoms of shortness of breath, chest pain, frequent trouble sleeping and high or low blood pressure. During his entrance examination in February 1991, his blood pressure was measured at 120/90. The following month, March 1991, during his exit examination, the Veteran reported that he was in good health and his blood pressure was 126/64. In the March 1991 Report of Medical History, the Veteran denied ever having high or low blood pressure. Therefore, hypertension was not factually shown during his second period of service. At a private treatment facility in 2008, the Veteran stated that he had a history of hypertension that had been diagnosed more than five years prior. 2003-2004 private records from a family clinic showed diagnoses of hypertension. In March 2010, the Veteran had a follow-up appointment with a private treatment facility. His diagnosis was moderate hypertension for which he took daily medications. In June 2011, he was diagnosed with uncontrolled hypertension. Private and VA records thereafter show treatment for hypertension, with various prescribed medications. A VA examiner opined that the Veteran’s hypertension is less likely than not incurred in or caused by service. During his recall for Operation Desert Storm, the Veteran stated that he had chest pain, fatigue, high blood pressure, irregular heartbeat, and shortness of breath, which he noticed during physical training and out-processing. During the VA examination, the Veteran also stated that his hypertension had been treated with medication for the last 30 years. The Veteran’s service record dated March 1990 showed blood pressure of 142/77. The examiner’s rationale was that the Veteran was discharged in 1991, and consistently elevated blood pressure readings are not seen in the medical record until 2010. Therefore, it is less likely than not that Veteran’s hypertension was incurred in service. See May 2019 VA examination. The Veteran’s allegation that he has been on blood pressure medications for 30 years (i.e., since 1990) is refuted by his medical records. First, as to his service treatment records, in the March 1991 Report of Medical History, he expressly stated that he was not taking any medications. Second, the 1997 to 2004 private medical records from a family clinic show initial prescription of hypertension medication in 2003, when the Veteran complained of chest pains, with diagnosis of hypertension shown later in 2003. See 2003 records showing prescriptions for Toprol, https://www.rxlist.com/toprol-xl-drug.htm. None of the records from that practice prior to 2003 show such a prescription or diagnosis, although there was an elevated blood pressure reading of 152/100 in October 2002 and it was noted in 1998 his blood pressure would be watched. The 1998 note indicated no family history of hypertension, and it is reasonable to assume that if the Veteran himself had a history of such a diagnosis or were taking hypertension medications, this would have been reported at that time. It is also reasonable to assume that when his blood pressure was being monitored, if he were, in fact, taking medication, that would have been noted. Therefore, these private medical records which clearly show the Veteran’s medical history over a period of years conclusively establish that, although there were some isolated elevated readings previously, hypertension was not officially diagnosed until 2003, and the Veteran did not begin hypertensive medications until that same year. The Veteran had one blood pressure measurement in service where his diastolic blood pressure was exactly 90, while the rating criteria requires the blood pressure to be taken two or more times over three different days and the diastolic blood pressure to measure at 90 or higher each time. The Veteran was diagnosed with hypertension in 2003, which was 12 years after the Veteran left active service. The Board concludes that, while the Veteran has a diagnosis of hypertension, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. First, although hypertension is a chronic condition, the disability was not shown as chronic in service. Again, there was a single, isolated elevated reading, with no diagnosis during service. The condition also did not manifest to a compensable degree within a presumptive period, as it was diagnosed in 2003, 12 years after his separation from service. Although there were isolated, elevated blood pressure readings prior to that time, they do not meet VA’s definition of hypertension, nor did a doctor conclude they did, as hypertension was not diagnosed at the time of those elevated readings prior to 2003. While the Veteran is competent to report having experienced symptoms of fatigue, chest pain, irregular heartbeat, and shortness of breath since service and consistently since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of hypertension as the Veteran has not demonstrated the necessary medical expertise. The issue is medically complex, as it requires medical testing and tracking. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. In the alternative, the Veteran contends that his diagnosed hypertension is secondarily related to his acquired psychiatric disorder. Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. As his acquired psychiatric disorder is not service connected, secondary service connection is not warranted. In light of the above analysis, the Board finds the preponderance of the evidence is against entitlement to service connection, directly or secondarily, for hypertension. In denying the claim, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to service connection for diabetes mellitus, type II, to include as aggravated by an acquired psychiatric disorder and/or hypertension The Veteran asserts that his diagnosed diabetes mellitus, type II (diabetes), is as a result of his active service. Alternatively, he contends that his diabetes is as a result of or was aggravated beyond its natural progression due to his acquired psychiatric disorder or disorders and/or his diagnosed hypertension. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Veteran was first diagnosed with diabetes mellitus, type II, in December 2011 by Dr. T.F. at a private treatment facility, 10 years after service. Prescription records from VA treatment centers indicate that the Veteran was first prescribed a glucometer by the VA in December 2015. Diabetes mellitus was added to the VA’s problem list, which is a list of diagnoses, at that time. In June 2016, the Veteran indicated during mental health treatment that the stress he was under caused his diabetes to become more difficult to manage, requiring him to use more insulin. The Veteran was not diagnosed with diabetes until 10 years after his service. Additionally, the Veteran’s service treatment records do not show any indication of diabetes. There is no persuasive medical evidence linking his diabetes to any in-service disease or injury. The Board concludes that, while the Veteran has a diagnosis of diabetes mellitus, type II, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. Although diabetes mellitus is a chronic condition, it was not shown as chronic in service, nor did it manifest to a compensable degree within a presumptive period. VA and private treatment records show the Veteran was not diagnosed with diabetes until December 2011, several years after service. While the Veteran is competent to report having experienced blurry vision, shortness of breath, dizziness, fatigue, occasional headaches, increased thirst, frequent urination, and inability to concentrate during service or consistently since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of diabetes, as the Veteran has not demonstrated the necessary medical expertise. The issue is medically complex, as it requires long-term medical testing and tracking. Consequently, the Board gives more probative weight to the competent medical evidence. In the alternative, the Veteran contends that his diagnosed diabetes is secondarily related to his acquired psychiatric disorders and/or his hypertension, to include that his hypertension and diabetes are aggravated as a result of acquired psychiatric disorders. However, as his acquired psychiatric disorder and/or hypertension are not service connected, secondary service connection is not warranted. In light of the above analysis, the Board finds the preponderance of the evidence is against entitlement to service connection, directly or secondarily, for diabetes mellitus, type II. In denying the claim, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Parker N. Reynolds, 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.