Citation Nr: 21007154 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 18-50 047A DATE: February 8, 2021 ORDER Service connection for tinnitus is granted. Service connection for bilateral hearing loss is granted. Service connection for low back disability is granted. Service connection for a right knee condition is denied. Service connection for a left knee condition is denied. Service connection for a neck condition is denied. Service connection for a right ankle condition is denied. Service connection for a left ankle condition is denied. Service connection for hypertension is denied. Service connection for a lung and respiratory condition is denied. Service connection for a prostate condition is denied. Service connection for diabetes mellitus is denied. Service connection for stroke is denied. Service connection for right lower neuropathy is denied. Service connection for left lower neuropathy is denied. Service connection for heart condition is denied. REMANDED Entitlement to service connection for erectile dysfunction is remanded. Entitlement to service connection for residuals, peptic ulcer surgery is remanded. Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for asthma is remanded. Entitlement to individual unemployability is remanded. Entitlement to service connection for posttraumatic stress disorder is remanded. Entitlement to special monthly compensation based on aid and attendance/housebound is remanded. FINDINGS OF FACT 1. Tinnitus had its onset in service. 2. The Veteran’s lower back condition began during active duty service. 3. The preponderance of the evidence is against finding that the Veteran’s right knee condition was incurred in or aggravated by active service. 4. The preponderance of the evidence is against finding that the Veteran’s left knee condition was incurred in or aggravated by active service. 5. The preponderance of the evidence is against finding that the Veteran’s neck condition was incurred in or aggravated by active service. 6. The preponderance of the evidence is against finding that the Veteran’s right ankle condition was incurred in or aggravated by active service. 7. The preponderance of the evidence is against finding that the Veteran’s left ankle condition was incurred in or aggravated by active service. 8. The preponderance of the evidence is against finding that hypertension was incurred in or aggravated by active service. 9. The preponderance of the evidence is against finding that a prostate condition was incurred in or aggravated by active service. 10. Bilateral hearing loss had its onset in service. 11. The preponderance of the evidence is against finding that a lung and respiratory condition was incurred in or aggravated by active service. 12. The preponderance of the evidence is against finding that diabetes mellitus was incurred in or aggravated by active service, including as a result of exposure to herbicides or chemical exposure. 13. The preponderance of the evidence is against finding that a stroke was incurred in or aggravated by active service, including as a result of exposure to herbicides chemical exposure. 14. The preponderance of the evidence is against finding that right lower neuropathy was incurred in or aggravated by active service. 15. The preponderance of the evidence is against finding that left lower neuropathy was incurred in or aggravated by active service. 16. The preponderance of the evidence is against finding that the Veteran’s heart condition was incurred in or aggravated by active service, including as a result of exposure to herbicides chemical exposure. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for tinnitus have been met. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303, 3.309. 2. The criteria for entitlement to service connection for lower back condition have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.  3. The criteria for entitlement to service connection for right knee condition have not been met. 38 U.S.C. §§ 1110, 1130, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for entitlement to service connection for left knee condition have not been met. 38 U.S.C. §§ 1110, 1130, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for entitlement to service connection for neck condition have not been met. 38 U.S.C. §§ 1110, 1130, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for entitlement to service connection for right ankle condition have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 7. The criteria for entitlement to service connection for left ankle condition have not been met. 38 U.S.C. §§ 1110, 1130, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for entitlement to service connection for hypertension (claimed as high blood pressure) have not been met. 9. The criteria for entitlement to service connection for bilateral hearing loss have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303, 3.307, 3.309. 10. The criteria for entitlement to service connection for a lung and respiratory condition have not been met. 38 U.S.C. §§ 1110, 1130, 5107; 38 C.F.R. §§ 3.102, 3.303. 11. The criteria for entitlement to service connection for prostate condition have not been met. 38 U.S.C. §§ 1110, 1130, 5107; 38 C.F.R. §§ 3.102, 3.303. 12. The criteria for entitlement to service connection for diabetes mellitus as a result of exposure to herbicides have not been met. 13. The criteria for entitlement to service connection for stroke have not been met. 38 U.S.C. §§ 1110, 1130, 5107; 38 C.F.R. §§ 3.102, 3.303. 14. The criteria for entitlement to service connection for bilateral lower neuropathy as secondary to heart condition have not been met. 38 U.S.C. §§ 1110, 1130, 5107; 38 C.F.R. §§ 3.102, 3.303. 15. The criteria for entitlement to service connection for heart condition as a result of exposure to herbicides have not been met. 38 U.S.C. §§ 1110, 1130, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1962 to January 1965. The Veteran and his wife presented sworn testimony at a hearing before the undersigned in November 2020 before the undersigned Veterans Law Judge (VLJ). Service Connection The Veteran asserts that service connection for service connection is warranted because most of the disabilities due to Agent Orange. He also reports that service connection is warranted for low back disability, tinnitus and bilateral hearing loss because the disabilities had their onset in service. Service connection may be granted for a disability resulting from disease or injury incurred in, or aggravated by, service. See 38 U.S.C. § 1110, 1131; 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. See Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009), see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection will be presumed for certain diseases, if manifested to a compensable degree within one year after discharge from active duty. 38 U.S.C. §§ 1101 (3), 1112(a)(1); 38 C.F.R. §§ 3.307, 3.309(a). In this case, the Veteran did not manifest a chronic, tropical, prisoner of war related disease, or a disease associated with herbicide agents within the applicable time period, hence, the presumption does not apply. Service connection may also be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303 (d). A lay person is competent to report on the onset and reoccurrence of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge). When considering whether lay evidence is competent, the Board must determine, on a case by case basis, whether a veteran’s particular disability is the type of disability for which lay evidence may be competent. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. Gilbert v. Derwinski,1 Vet. App. 49, 57 (1990). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA’s policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. See 38 U.S.C. § 1154 (a); 38 C.F.R. § 3.303 (a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303 (a).  When there is an approximate balance of positive and negative evidence regarding a material issue, the Veteran is given the benefit of the doubt. 38 U.S.C. § 5107. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996).  1. Entitlement to service connection for tinnitus and bilateral hearing loss. The Board finds that service connection for tinnitus is warranted. The Veteran reported experiencing tinnitus during the appeal period. See November 2020 Hearing Transcript. The Veteran is competent to describe symptoms observable to his senses; as such, he is also competent to diagnose tinnitus. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Charles v. Principi, 16 Vet. App. 370, 374 (2003). The Board finds him credible, as his statements have been detailed and consistent. Therefore, the Board determines that the first element of service connection is satisfied. The Veteran’s military occupational specialty was a ground radio operator. The Veteran explained that he was exposed to noise from jets while in service. See November 2020 Hearing Transcript. The Veteran also denied recreational noise exposure without hearing protection. See December 2015 VA examination. The Veteran has reported that he began experiencing ringing in her ears while on active duty and has continued since that time, which the Board finds credible. Therefore, in-service injury is conceded. The Veteran competently and credibly reports that his tinnitus began during active duty service and has been recurrent since that time. See Layno v. Brown, 6 Vet. App. 465 (1994); see also November 2020 Hearing Transcript. The Board notes the December 2015 negative nexus VA medical opinion. However, even though his service treatment records are silent for reports of tinnitus in service, the Veteran is competent to give reports of tinnitus in service and continued symptoms since service. Thus, all three elements necessary to establish service connection have been met. See 38 C.F.R. § 3.303, 3.307, 3.309; Fountain v. McDonald, 27 Vet. App. 258 (2015). As to his bilateral hearing loss, he cites in-service acoustic trauma and reports that he has had impaired hearing since service. The Board finds the Veteran’s account credible and as he has bilateral hearing loss for VA compensation purposes. As such, service connection for bilateral hearing loss is warranted. 2. Entitlement to service connection for lower back condition. The Veteran claims entitlement to service connection for a lower back condition. Service treatment records note complaints and treatment for back injury resulting in persistent pain. See, e.g., STRs dated October 1964. Additionally, at the November 2020 Board Hearing, the Veteran testified that he has back pain that began while on active duty and has been continuous since service. Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. Saunders v. Wilke, 886 F. 3d 1356 (Fed. Cir. 2018). The Veteran is competent to report pain, but not competent to provide a diagnosis. Id. The Veteran reports of back pain that causes functional limitation. See Hearing Transcript, page 9, November 2020. This is highly probative evidence in favor of the claim, and there is no evidence in the record to the contrary. Based on the above, the evidence supports a grant of service connection for low back disability. 38 C.F.R. § 3.303. The appeal for service connection for a low back disability is granted. 3. Entitlement to service connection for right knee condition. 4. Entitlement to service connection for left knee condition. The Veteran seeks service connection for left and right knee conditions. The Board finds that service connection for left and right knee conditions are not warranted. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303(a). Based on a careful review of the medical treatment records, the Board finds that service treatment records are silent for complaints or diagnoses of left and right knee conditions during service. A review of the claims file does not show left and right knee conditions related to service. The Veteran testified during his November 2020 hearing that he did not remember how he sustained left and right knee conditions. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the Veteran is not competent to provide evidence as to more complex medical questions. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). The Veteran does not possess the medical knowledge to attribute left and right knee conditions to his military service or a service-connected disability. Therefore, the Veteran’s statement that he has left and right knee conditions related to service is not competent and therefore not probative. As there is no competent evidence, lay or otherwise, showing that the Veteran has left and right knee conditions aggravated by service or evidence showing an in-service event or injury that could cause such disability, the preponderance of the evidence is against the Veteran’s claims and there is no doubt to be resolved. Therefore, service connection for left and right knee conditions is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 5. Entitlement to service connection for a neck condition. The Veteran seeks service connection for a neck condition. The Board finds that service connection for a neck condition is not warranted. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303(a). Based on a careful review of the medical treatment records, the Board finds that service treatment records are silent for complaints or diagnoses of a neck condition during service. VA treatment records do not show a neck condition related to service. An April 2017 treatment record documents that no neck abnormalities were found. The Veteran testified during his November 2020 hearing that he did not remember how he sustained a neck injury. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the Veteran is not competent to provide evidence as to more complex medical questions. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). The Veteran does not possess the medical knowledge to attribute a neck conditions to his military service or a service-connected disability. Therefore, the Veteran’s statement that he has a neck condition related to service is not competent and therefore not probative. As there is no competent evidence, lay or otherwise, showing that the Veteran has a neck condition aggravated by service or evidence showing an in-service event or injury that could cause such disability, the preponderance of the evidence is against the Veteran’s claim and there is no doubt to be resolved. Therefore, service connection for a neck condition is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 6. Entitlement to service connection for right ankle condition. 7. Entitlement to service connection for left ankle condition. The Veteran seeks service connection for left and right ankle conditions. The Board finds that service connection for left and right ankle conditions are not warranted. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303(a). Based on a careful review of the medical treatment records, the Board finds that service treatment records are silent for complaints or diagnoses of a left ankle condition during service. Service treatment records indicate that a right ankle injury was sustained during a football game while in service. See October 1964 Treatment Record. The right ankle was treated with ice and included instructions for the Veteran to return to the clinic as needed. The Veteran’s service treatment records indicate the Veteran did not seek further treatment for a right ankle injury, nor does the record note complaint or diagnosis of a right ankle condition. VA treatment records do not show left and right ankle conditions related to service. The Veteran was afforded a VA examination of his right ankle in December 2015. The examiner evaluated the Veteran’s ankles and determined that the right ankle was normal. Specifically, the examiner explained that the Veteran’s history, physical, and X-Ray evidence does not support a claim for a right ankle condition. The examiner also noted that the Veteran did not have complaints regarding that ankle. Regarding the Veteran’s left ankle, the examiner diagnosed a left ankle condition, and explained that the condition was related to a stroke that the Veteran experienced. See December 2015 Ankle Conditions VA Examination. The Veteran is does not have a service-connected residuals of stroke disability. The Veteran testified during his November 2020 hearing that he did not remember how he sustained right and left ankle injuries. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the Veteran is not competent to provide evidence as to more complex medical questions. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). The Veteran does not possess the medical knowledge to attribute his left and right and left ankle conditions to his military service or a service-connected disability. Therefore, the Veteran’s statement that his left and right conditions are related to service is not competent and therefore not probative. As there is no competent evidence, lay or otherwise, showing that the Veteran has right or left ankle conditions aggravated by service or evidence showing an in-service event or injury that could cause such disability, the preponderance of the evidence is against the Veteran’s claims and there is no doubt to be resolved. Therefore, service connection for right or left ankle conditions is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 8. Entitlement to service connection for hypertension (claimed as high blood pressure) The Veteran is seeking service connection for hypertension. A review of the Veteran’s medical records shows that the Veteran has a current hypertension condition. See April 2017 VA Treatment Records. This diagnosis satisfies the first prong of the service connection claim, i.e. the existence of a current disability. Regarding the second prong of the service connection claim, the in-service injury, the Veteran’s service treatment records are silent for any complaints, findings, treatment or diagnoses related to hypertension. A review of the claims file fails to show that the Veteran’s hypertension disability occurred in service or within one year of service discharge. There is also no competent evidence establishing a diagnosis of hypertension until many years following service. The Veteran does not necessarily argue the contrary. As such, service connection for hypertension on the theory of direct onset is not established. 38 C.F.R. § 3.303 (a). The Board notes that a VA examination to determine the etiology of this disability was not necessary. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Under McLendon, a VA examination is warranted where the record does not contain sufficient information to make a decision on the claim. Id. That is not the case here. Rather, the information of record reflects there is no in-service element to the Veteran’s service-connection claim and the Veteran’s hypertension manifested many years after separation from service. As noted above, an examination would not alter the Board’s conclusions on this point. Therefore, even under the low threshold of McLendon, examinations for these claims are not warranted. Thus, based on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran’s claim of service connection for hypertension. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 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 his claims, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). 9. Entitlement to service connection for prostate condition. The Veteran is seeking service connection for a prostate condition. A review of the Veteran’s medical records shows that the Veteran has a current a prostate condition. See April 2017 VA Treatment Records. This diagnosis satisfies the first prong of the service connection claim, i.e. the existence of a current disability. Regarding the second prong of the service connection claim, the in-service injury, the Veteran’s service treatment records are silent for any complaints, findings, treatment or diagnoses related to a prostate condition. A review of the claims file fails to show that the Veteran’s prostate disability occurred in service or within one year of service discharge. There is also no competent evidence establishing a diagnosis of a prostate condition until many years following service. The Veteran does not necessarily argue the contrary. As such, service connection for a prostate condition on the theory of direct onset is not established. 38 C.F.R. § 3.303 (a). The Board notes that a VA examination to determine the etiology of this disability was not necessary. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Under McLendon, a VA examination is warranted where the record does not contain sufficient information to make a decision on the claim. Id. That is not the case here. Rather, the information of record reflects there is no in-service element to the Veteran’s service-connection claim and the Veteran’s a prostate condition manifested many years after separation from service. As noted above, an examination would not alter the Board’s conclusions on this point. Therefore, even under the low threshold of McLendon, examinations for the claim is not warranted. Thus, based on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran’s claim of service connection for a prostate condition and service connection must be denied. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 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 his claims, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). 10. Entitlement to service connection for stroke. The Veteran is seeking service connection for a stroke disability. A review of the Veteran’s medical records shows that the Veteran has a current stroke condition. See January 2017 VA Treatment Records. This diagnosis satisfies the first prong of the service connection claim, i.e. the existence of a current disability. Regarding the second prong of the service connection claim, the in-service injury, the Veteran’s service treatment records are silent for any complaints, findings, treatment or diagnoses related to a stroke condition. A review of the claims file fails to show that the Veteran had a stroke condition disability that occurred in service or within one year of service discharge. There is also no competent evidence establishing a diagnosis of a stroke until many years following service. The Veteran does not necessarily argue the contrary. As such, service connection for a stroke condition on the theory of direct onset is not established. 38 C.F.R. § 3.303 (a). The Board notes that a VA examination to determine the etiology of this disability was not necessary. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Under McLendon, a VA examination is warranted where the record does not contain sufficient information to make a decision on the claim. Id. That is not the case here. Rather, the information of record reflects there is no in-service element to the Veteran’s service-connection claim and the Veteran’s stroke manifested many years after separation from service. As noted above, an examination would not alter the Board’s conclusions on this point. Therefore, even under the low threshold of McLendon, examinations for these claims are not warranted. Thus, based on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran’s claim of service connection for a stroke condition, and service connection must be denied. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 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 his claims, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). 11. Entitlement to service connection for lung and respiratory due to Agent Orange and exposure to chemicals is denied. 12. Entitlement to service connection for diabetes mellitus as a result of exposure to herbicides. The Veteran is seeking service connection for a lung and respiratory condition, and diabetes mellitus as a result of exposure to herbicides and chemicals while on active duty. A review of the Veteran’s medical records shows that the Veteran has a current lung and respiratory condition, erectile dysfunction, and diabetes mellitus conditions. See April 2017 VA Treatment Records. This diagnosis satisfies the first prong of the service connection claim, i.e. the existence of current disabilities. As to the second prong of the service connection claim, the in-service injury, the service treatment records are silent for any complaints, findings, treatment or diagnoses related to lung and respiratory condition, or diabetes mellitus. A review of the claims file fails to show that the Veteran had lung and respiratory, and diabetes mellitus conditions that occurred in service or within one year of service discharge. There is also no competent evidence establishing a diagnosis of the conditions until many years following service. The Veteran does not necessarily argue the contrary. As such, service connection for lung and respiratory condition, erectile dysfunction, and diabetes mellitus conditions on the theory of direct onset is not established. 38 C.F.R. § 3.303 (a). The Board notes that VA examinations to determine the etiology of the claimed disabilities was not necessary. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Under McLendon, a VA examination is warranted where the record does not contain sufficient information to make a decision on the claim. Id. That is not the case here. Rather, the information of record reflects there is no in-service element to the Veteran’s service-connection claim and the Veteran’s lung and respiratory condition, and diabetes mellitus conditions manifested many years after separation from service. As noted above, an examination would not alter the Board’s conclusions on this point. Therefore, even under the low threshold of McLendon, examinations for these claims are not warranted. Thus, based on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran’s claim of service connection for lung and respiratory condition, erectile dysfunction, and diabetes mellitus conditions, including as due to exposure to herbicides, and service connection must be denied. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 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 his claims, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). 13. Entitlement to service connection for left and right lower neuropathy as secondary to heart condition. The Veteran states that he has left and right lower neuropathy directly attributable to his heart condition, and that thus he is entitled to service connection for left and right lower neuropathy as secondary to heart condition. To begin, the Board notes that the Veteran has not asserted that he developed left and right lower neuropathy while in service or within a year of service. A review of service treatment records does not show any complaints, findings or treatment related bilateral lower neuropathy. Available records show that the Veteran was prescribed gabapentin for neuropathy in May 2019. Under these circumstances, therefore, the Board finds that service connection for left and right lower neuropathy directly on a direct basis pursuant to 38 C.F.R. § 3.303(a) is not warranted. Furthermore, the Veteran’s claimed left and right lower neuropathy do not meet the requirements to be subject to presumptive service connection as a chronic condition. 38 U.S.C. § 1112, 38 C.F.R. §§ 3.307, 3.309. Finally, as there is no evidence of continuity of symptomatology to support the claim of service connection for left and right lower neuropathy directly, the preponderance of the evidence is against the claim of service connection for left and right lower neuropathy directly based on continuity of symptomatology under 38 C.F.R. § 3.303(b). Moving on to the Veteran’s claim of secondary service connection, the Board notes that pursuant to 38 C.F.R. § 3.310, a disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. Secondary service connection is permitted based on aggravation. Compensation is payable for the degree of aggravation of a nonservice-connected disability caused by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Here, however, the underlying condition, that is, a heart condition, has been shown to not warrant service connection. There is no evidence to suggest, and the Veteran has not contended so, that his claimed left and right lower neuropathy directly is secondary to his only service-connected disabilities, bilateral hearing loss, tinnitus, or a back disability. Therefore, the Veteran’s claims of secondary service connection for left and right lower neuropathy directly must also be denied. The Veteran may still be entitled to service connection if all of the evidence establishes that the bilateral lower neuropathy directly was incurred in service. 38 C.F.R. § 3.303(d). Here, however, there is no evidence of incurrence in service, and there is a more than 50-year gap between discharge and the first indication that left and right lower neuropathy was diagnosed. Without any evidence to support an etiological connection between the bilateral lower neuropathy directly and service, VA has not afforded the Veteran a VA examination, and the Veteran has not submitted an examination and/or an opinion from a private physician in support of his claim. Thus, the Board concludes that the preponderance of the evidence weighs against a finding that the Veteran’s claimed left and right lower neuropathy lower neuropathy directly is otherwise attributable to service. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection for left and right lower neuropathy lower neuropathy directly under 38 C.F.R. § 3.303(d) is denied, and as such the Veteran’s claims for left and right lower neuropathy lower neuropathy directly in total must be denied. As the preponderance of the evidence is against the Veteran's claim of service connection for bilateral lower neuropathy directly, the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C. § 5107(b). 14. Entitlement to service connection for a heart condition as a result of exposure to herbicides. The Veteran is seeking service connection for a heart condition, to include as secondary to exposure to herbicides. A review of the Veteran’s medical records shows that the Veteran has a current heart condition. See January 2020 Private Treatment Records. This diagnosis satisfies the first prong of the service connection claim, i.e. the existence of a current disability. Regarding the second prong of the service connection claim, the in-service injury, the Veteran’s service treatment records are silent for any complaints, findings, treatment or diagnoses related to a heart condition. A review of the claims file fails to show that the Veteran had a heart condition disability that occurred in service or within one year of service discharge. There is also no competent evidence establishing a diagnosis of a heart condition until many years following service. The Veteran does not necessarily argue the contrary. As such, service connection for a heart condition on the theory of direct onset is not established. 38 C.F.R. § 3.303 (a). The Board notes that a VA examination to determine the etiology of this disability was not necessary. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Under McLendon, a VA examination is warranted where the record does not contain sufficient information to make a decision on the claim. Id. That is not the case here. Rather, the information of record reflects there is no in-service element to the Veteran’s service-connection claim and the Veteran’s heart condition manifested many years after separation from service. As noted above, an examination would not alter the Board’s conclusions on this point. Therefore, even under the low threshold of McLendon, examinations for these claims are not warranted. Thus, based on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran’s claim of service connection for a heart condition, including as due to exposure to herbicides, and service connection must be denied. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 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 his claims, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). REASONS FOR REMAND 16. Entitlement to service connection for residuals, peptic ulcer surgery is remanded. 17. Entitlement to service connection for sleep apnea is remanded. 18. Entitlement to service connection for asthma due to Agent Orange is remanded. 19. Entitlement to individual unemployability is remanded. 20. Entitlement to service connection for posttraumatic stress disorder is remanded. 21. Entitlement to service connection for erectile dysfunction is remanded. 22. Entitlement to special monthly compensation based on aid and attendance/housebound is remanded. The Veteran explains that he is entitled to service connection for residuals of peptic ulcer surgery, sleep apnea, asthma, and posttraumatic stress disorder, as well as entitlement to individual unemployability, and special monthly compensation based on aid and attendance/housebound. Under McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006), a VA medical examination must be provided when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. See 38 U.S.C. § 5103A (d)(2); 38 C.F.R. § 3.159 (c)(4)(i). The third prong, which requires that the evidence of record “indicate” that the claimed disability or symptoms “may be” associated with the established event, is a low threshold. McLendon, 20 Vet. App. at 83. The Veteran reports symptoms of posttraumatic stress disorder due to injury in service that manifests as outbursts that are at times violent, self-isolation, startle reflex, and shaking. See November 2020 Board Hearing. The Veteran’s spouse also presented sworn testimony that she observed her husband having breathing problems, difficulty breathing at night, stomach and digestive issues shortly after his discharge from service. Id. A private examiner diagnosed sleep apnea in November 2019. Thus, the minimal criteria set out in McLendon have been met. The Board finds that remand is necessary so that the Veteran can be afforded VA examinations regarding the nature and etiology of residuals of peptic ulcer surgery, sleep apnea, asthma, posttraumatic stress disorder. The Board finds the claims for a TDIU and SMC are inextricably intertwined with the claims above. The matters are REMANDED for the following action: Schedule the Veteran for VA examinations (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) as to the etiology of any diagnosed residuals of peptic ulcer surgery, sleep apnea, asthma, and psychiatric disability, to specifically include posttraumatic stress disorder disabilities. The determination of whether an in-person examination should be left to the discretion of the examiner. All necessary tests should be conducted. The claims file must be sent to the examiner for review. The examiner(s) should specifically take into consideration lay witness statements regarding each claimed condition. The VA examiner(s) is requested to address the following: Is it at least as likely as not that the Veteran has of residuals of peptic ulcer surgery, sleep apnea, asthma, posttraumatic stress disorder that had its onset during, or is otherwise related to, his active military service? The examiner must also opine as to whether it is at least as likely as not that his psychiatric disability and erectile dysfunction was caused by his low back disability, tinnitus and bilateral hearing loss, to include in the aggregate. The examiner must also opine as to whether it is at least as likely as not that his psychiatric disability and erectile dysfunction was aggravated by his low back disability, tinnitus and bilateral hearing loss, to include in the aggregate. A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner’s own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Booker 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.