Citation Nr: 21007406 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 14-41 369 DATE: February 9, 2021 ORDER Service connection for an acquired psychiatric disability to include post-traumatic stress disorder (PTSD) is granted. Service connection for bilateral hearing loss is denied. Service connection for tinnitus is granted. Service connection for a thyroid disorder is denied. Service connection for a cardiac disability to include ischemic heart disease and coronary artery disease is denied. Service connection for arrhythmia, including atrial fibrillation post pacemaker implant is denied. Service connection for basal cell carcinoma is denied. Service connection for sleep apnea is denied. Service connection for a lumbar spine disability is denied. FINDINGS OF FACT 1. The Veteran’s currently shown PTSD has been medically linked to sexual assault during service. 2. The Veteran’s currently shown bilateral hearing loss was not manifested during service; and his hearing loss has been medically attributed to aging rather than to remote acoustic trauma; no connection to service is shown. 3. Tinnitus first manifested in service. 4. The Veteran is not shown to have been exposed to ionizing radiation during service; a thyroid disorder was not initially manifested during service or for many years after service; no other connection to service is shown including exposure to non-ionizing radiation. 5. The evidence does not include current diagnoses of ischemic heart disease or coronary artery disease. 6. Arrhythmia, including atrial fibrillation, was not initially manifested during service or for many years after service; no other connection to service is shown; such disability is not caused or aggravated by service-connected diabetes mellitus. 7. Basal cell carcinoma was not initially manifested during service or for many years after service; no other connection to service is shown. 8. Sleep apnea was not initially manifested during service or for many years after service, and was not proximately caused or aggravated by his service-connected diabetes mellitus; no other connection to service is shown. 9. A lumbar spine disability was not initially manifested during service or for many years after service; no other connection to service is shown. CONCLUSIONS OF LAW 1. The criteria for service connection for an acquired psychiatric disorder to include PTSD have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304. 2. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.385. 3. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 4. The criteria for service connection for a thyroid disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 5. The criteria for service connection for a cardiac disability to include ischemic heart disease and coronary artery disease have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 6. The criteria for service connection for arrhythmia, including atrial fibrillation post pacemaker implant have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303. 7. The criteria for service connection for basal cell carcinoma have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 8. The criteria for service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303. 9. The criteria for service connection for a lumbar spine disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1964 to January 1968, to include service in Vietnam. This matter comes before the Board of Veterans' Appeals (Board) from a January 2014 Agency of Original Jurisdiction (AOJ) decision. The Veteran presented sworn testimony in support of his appeal during a January 2018 videoconference hearing before the undersigned Veterans Law Judge. The record was held open for ninety days to allow the Veteran and his representative to submit further evidence, which they did. After the hearing, the Board provided the Veteran’s claims file to three different VA physicians for review and expert medical opinions on specialty topics. The Veteran and his representative were provided copies of the resulting opinions, pertaining to his thyroid disability, sleep apnea, and arrhythmia; along with the opportunity to present additional argument and evidence in December 2019. The Board remanded the appeal in February 2020 for further evidentiary development, to include a psychiatric examination, a spine examination, VA treatment records and private treatment records. The first three actions requested were accomplished by the AOJ. However, the AOJ was unable to obtain private treatment records because the Veteran did not sign the release forms to allow VA to request them on his behalf. He did not obtain and submit them himself, although this option had been discussed during the Board hearing. The unavailability of private treatment records hampers review of his claims pertaining to his cardiac disability, basal cell carcinoma, and sleep apnea in particular, as these disabilities are treated exclusively by private specialists. “The duty to assist is not always a one-way street. If a Veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence.” Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). If the Veteran wished to fully develop his claim, he had a corresponding duty to assist by providing the requested information. The Board therefore holds that, even though the Veteran’s claim has not been fully developed, the VA has fulfilled its duty to assist him to the extent possible, by providing him with the appropriate forms on two occasions subsequent to the Board’s remand and requesting that he complete them. Additionally, in the Board’s February 2020 remand, the importance of such medical evidence in proving his claims was explained to the Veteran. We will therefore proceed to evaluate the Veteran’s claim based on the evidence currently of record. Service Connection Generally, service connection may be granted for any disability resulting from injury suffered or disease contracted in line of duty, or for aggravation in service of a pre-existing injury or disease. 38 U.S.C. §§ 1110, 1131. Service connection may be established by demonstrating that the disability was first manifested during service and has continued since service to the present time or by showing that a disability which pre-existed service was aggravated during service. Service connection may be granted for any disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303. To establish a right to compensation for a present disability on a direct basis, a Veteran must show: “(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). Disability which is proximately due to or the result of a service-connected disease or injury also shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310. As to the aggravation component, secondary service connection does not require a “permanent worsening” of disability but rather whether a service-connected disability results in any additional functional impairment associated with the nonservice-connected disability. See Ward v. Wilkie, 31 Vet. App. 233, 239 (2019); Saunders v. Wilkie, 886 F.3d. 1356, 1363 (Fed. Cir. 2018); Garner v. Tran, U.S. App. Vet. Claims LEXIS 81 (Jan. 26, 2021). The Veteran may benefit from a presumption of service connection based on a chronic disease, such as arthritis or an organic disease of the nervous system such as sensorineural hearing loss and tinnitus. 38 C.F.R. § 3.309(a). See Fountain v. McDonald, 27 Vet. App. 258 (2015) (holding that tinnitus is an “organic disease of the nervous system” subject to presumptive service connection where there is evidence of acoustic trauma and nerve damage). When a Veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, and arthritis becomes manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Even if a chronic disease is not shown within one year of discharge, service connection may be established by showing continuity of symptomatology. Continuity of symptomatology may be shown by demonstrating “(1) that a condition was ‘noted’ during service or any applicable presumption period; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology.” Barr v. Nicholson, 21 Vet. App. 303, 307 (2007); see also Davidson v. Shinseki, 581 F.3d 1316; Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board”). However, the Federal Circuit held that the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic in 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Regulations pertaining to herbicides used in Vietnam, provide that if a Veteran served on active duty in Vietnam during the Vietnam era, the Veteran is presumed to have been exposed to Agent Orange or similar herbicides. 38 C.F.R. § 3.307. These regulations also stipulate the diseases, including some types of heart disease, for which service connection may be presumed due to an association with exposure to herbicide agents. Cancers affecting the lung, bronchus, larynx, or trachea are covered by the presumption, and certain defined types of soft-tissue sarcoma. 38 C.F.R. §§ 3.307(a)(6), 3.309(e). Evidence which may be considered in rebuttal of service incurrence of a disease listed in Section 3.309 will be any evidence of a nature usually accepted as competent to indicate the time of existence or inception of disease, and medical judgment will be exercised in making determinations relative to the effect of intercurrent injury or disease. 38 C.F.R. § 3.307(d). PTSD In order to establish service connection for an acquired psychiatric disorder as PTSD due to military sexual trauma (MST), the evidence of record must include a medical diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a), 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. If a PTSD 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. § 3.304(f)(5). VA may submit any evidence to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. Id. The evidence shows that the Veteran has been receiving treatment for PTSD for many years. The current diagnosis is established. The Veteran testified during the January 2018 hearing regarding two different sexual assaults during service, and the resulting fear, distrust, and deleterious impact upon his mental health, in that he has difficulty trusting people and difficulty getting close to people to this day. He has also submitted written statements about his stressor events. The Veteran’s hearing testimony is deemed helpful to the Board and credible as it comports with the medical evidence of record. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991). Importantly, the VA examiner listed 3 separate “markers” which, in the opinion of the examiner, demonstrated corroborationg that the stressors occurred. Thus, there is professional medical opinion corroborating that claimed stressors occurred. 38 C.F.R. § 3.304(f)(5). The last element is the one of nexus. Pursuant to the Board’s remand, the Veteran underwent a VA examination for purposes of compensation in August 2020. Following a review of the Veteran’s records and a clinical examination, the examining psychologist confirmed the diagnosis of PTSD and opined that the Veteran’s PTSD was caused by his two military sexual traumas. Thus, the evidence supports a grant of service connection for PTSD, as all factual, legal and regulatory criteria for a grant have been met. Hearing loss and tinnitus The Veteran asserts that he was exposed to significant acoustic trauma during service, especially from jet noise, trenching machines, construction trucks and firing weapons; all without hearing protection. For the purposes of applying the laws administered by the VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 200, 3000, or 4000 hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Service connection for hearing loss may be granted where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service, as opposed to intercurrent causes. Hensley v. Brown, 5 Vet. App. 155, 159 (1993). When a chronic disease such as hearing loss, which is considered an organic disease of the nervous system, becomes manifest to a degree of 10 percent within one year of the Veteran’s discharge from service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the Veteran’s period of service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. As an alternative to the nexus requirement, service connection for these chronic disabilities may be established through a showing of “continuity of symptomatology” since service. 38 C.F.R. § 3.303(b). The option of establishing service connection through a demonstration of continuity of symptomatology rather than through a finding of nexus is specifically limited to the chronic disabilities listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Additionally, for an enumerated “chronic disease” shown in service (or within a presumptive period under § 3.307), subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. See Groves v. Peake, 524 F.3d 1306, 1309 (2008). Tinnitus is a medical term referring to symptoms of noise in the ears, such as ringing, buzzing, roaring or clicking. See Dorland’s Illustrated Medical Dictionary, 1322 (32nd ed. 2012). In adopting the current rating criteria for tinnitus under Diagnostic Code (DC) 6260, VA described tinnitus as follows: Tinnitus is classified either as subjective tinnitus (over 95% of cases) or objective tinnitus. In subjective or “true” tinnitus, the sound is audible only to the patient. In the much rarer objective tinnitus (sometimes called extrinsic tinnitus or “pseudo-tinnitus”), the sound is audible to other people, either simply by listening or with a stethoscope. 67 Fed. Reg. 59033-01 (Sept. 19, 2002). Thus, tinnitus is a rare type of disability that, in the vast majority of cases, may be established on the basis of lay evidence alone. See Charles v. Principi, 16 Vet. App. 370 (2002). According to the Veteran’s service treatment records, his hearing acuity was within normal limits upon several occasions when it was tested by audiometer. The Veteran specifically denied experiencing hearing loss or other ear trouble on the Report of Medical History which he completed in conjunction with the general medical examination conducted prior to his separation from service in November 1967. Unfortunately, the earliest post-service medical records available for review are dated in 1996, more than twenty-five years after the Veteran’s discharge from service. A December 2003 private audiological consultation report shows that the Veteran was assessed for hearing status and chronic tinnitus symptoms. Audiometric studies were interpreted as showing mild bilateral high frequency sensorineural hearing loss, slightly more pronounced in the left ear. The interpreting physician noted the Veteran’s history of having been a locomotive engineer for thirty-four years, and deemed it was probable that the majority of the Veteran’s mild hearing loss related to cumulative noise exposure form the locomotive cab and radio transmissions, etc. The Veteran reported having worn ear protection for roughly the prior ten years. The Veteran also reported that tinnitus had been an issue for the past seven months. The physician noted that the etiology of the tinnitus was unclear, but that it was medically benign. In connection with his claim for service connection, the Veteran underwent a VA examination for purposes of compensation in October 2013. These testing results showed that the Veteran’s hearing acuity was sufficiently impaired to meet the criteria set forth in 38 C.F.R. § 3.385 as of 2013. The Veteran himself reported during the examination that his hearing loss had become apparent approximately seven years previously. The examiner reviewed the Veteran’s service treatment records and noted that his hearing acuity was within normal limits with no threshold shift between entrance and separation. The examiner then concluded that because 1) the Veteran was discharged with normal hearing acuity bilaterally, 2) there was no threshold shift during service, 3) the Veteran himself reported his hearing loss began seven years ago, well after the service, and 4) his current audiogram was in the configuration of presbycusis (age-related hearing loss), it is less likely that his hearing loss was caused by or a result of military noise exposure. With regard to tinnitus, the Veteran told the examiner that constant ringing in the ears started about five years previously. The Veteran specifically denied that his tinnitus had started in service. Based upon this history, the examiner opined that tinnitus was less likely related to service. During the January 2018 hearing on appeal, the Veteran described his current difficulties with hearing, even with his hearing aids. He reported that he initially noticed a hearing problem when he was working for the railroad, and that he had not complained of hearing loss or tinnitus during service. However, the Veteran described hearing ringing in his ears for hours following jet noise exposure during service. Upon review, the Board determines that the Veteran’s current bilateral hearing loss and tinnitus is established in the record. The Board also finds that the Veteran mostly likely had significant noise exposure in service, as would be consistent with his military occupational specialty of wire/antenna/systems installation and maintenance, as well as consistent with his hearing testimony and written statements of loud noise exposure to jet engine noise. The evidence does not show, however, that his bilateral hearing loss is related to service in any way. Rather, his hearing was normal upon separation from service and the available medical records show that he initially complained of hearing difficulties many years after service. The medical evidence, as interpreted by experts in audiology and otolaryngology shows that the Veteran’s hearing loss is age-related in nature. No connection to service or to noise exposure in service is established. Service connection is not warranted for hearing loss on a presumptive basis as there is no competent evidence of record documenting the presence of hearing loss for VA purposes within one year of discharge. To the extent the lay evidence may allege a perception to decreased hearing acuity since service, these perceptions do not adequately support a finding of actual sensorineural hearing loss disability being first manifested in service or within one year of service discharge as the existence of a “disability” is specifically defined at 38 C.F.R. § 3.385 in terms of specific levels of tone threshold perceptions and speech recognition which is beyond lay competence to measure. See McKinney v. McDonald, 28 Vet. App. 15, 24-5 (2016). In short, any lay recollections of decreased hearing acuity since service are not capable of showing it rose to the level of a “disability” for VA purposes in service, or to a ratable level of disability within one year of service discharge. As such, the Board must deny the Veteran’s claim for entitlement to service connection for hearing loss. As for the tinnitus, the Veteran has credibly reported experiencing ear ringing following episodes of loud noise exposure during service. However, he previously denied tinnitus during service. The Board resolves reasonable doubt in favor of the Veteran by finding that he manifested temporary ear ringing following episodes of loud noise exposure during service. The Board observes that there is a presumption of service connection for a chronic disease such as tinnitus, rebuttable only by clearly attributable intercurrent causes, which manifests during service and then again “at any later date, however remote.” Groves, 524 F.3d at 1309. Here, the Veteran currently manifests tinnitus. Thus, pursuant to Groves, the Board finds that the criteria for entitlement to service connection for tinnitus have been met as there is no clear intercurrent cause of tinnitus experienced during service and the tinnitus experienced currently. Thyroid In 2010, the Veteran developed a thyroid nodule and a multinodular goiter. These were surgically removed and determined to be benign. Since that time, the Veteran has required thyroid supplementation. During the hearing on appeal, the Veteran postulated that his thyroid growths may have been related to working with radio towers and radar antenna systems during active duty. In March 2018, he submitted a statement from his treating endocrinologist to the effect that the Veteran’s post-operative thyroid nodular disease may have been instigated by “radiation in the form of microwave activity during his service in the Air Force from 1964-1968. As radiation is well known to instigate thyroid nodule and possible thyroid cancer, it is my belief that [the Veteran] should be service-connected for his post-operative hypothyroidism secondary to his nodular disease.” The Board generally notes microwaves are a form of non-ionizing radiation. See Rucker v. Brown, 10 Vet. App. 67, (1997) (citing The Microwave Problem, Scientific American, September 1986; Effects upon Health of Occupational Exposure to Microwave Radiation (RADAR), American Journal of Epidemiology, Vol. 112, 1980; and Biological Effects of Radiofrequency Radiation, United States Environmental Protection Agency, September 1984). This was confirmed by an opinion from a VA physician with particular expertise in occupational and environmental medicine, and public health (addressed below). The Veteran has not submitted or claimed that any component within his proximity to service duties emitted ionizing radiation. In the absence of any evidence suggesting ionizing radiation exposure, the Board finds that the provisions relating to ionizing radiation exposure are not applicable. In the attempt to substantiate the Veteran’s assertion, the Board obtained an informed medical opinion from a VA physician with particular expertise in occupational and environmental medicine, and public health. In a June 2018 opinion, the physician provided a thorough summary of the Veteran’s medical history vis a vis his thyroid status and military responsibilities and exposures. Of particular importance to this claim, the physician clarified that communication microwaves such as from radio towers and radar systems is non-ionizing in nature. The physician also summarized medical research regarding the effects of non-ionizing communication microwaves, to which the Veteran was exposed between 1964 and 1968. The reviewing physician also did not find any support for a link between non-ionizing radiation or electromagnetic fields and thyroid nodules or thyroid cancer. Based upon these studies, the review of the Veteran’s medical records and service records, in conjunction with the physician’s expertise and experience, the reviewer concluded that it is less likely the Veteran’s military exposures contributed to the thyroid nodules which he later developed. Upon careful review, the Board holds that service connection is not warranted for residuals of the Veteran’s thyroid nodules. The Veteran’s treating physician opinion is unclear whether as to whether ionizing and/or non-ionizing radiation was being considered, and refers to no specific information supporting this conclusion. On the other hand, the VA physician with particular expertise in occupational and environmental medicine, and public health specifically discussed that communication microwaves such as from radio towers and radar systems are non-ionizing in nature, and reviewed medical literature for this specific form of exposure. The Veteran was provided a copy of this opinion with the opportunity to provide a rebuttal, but has not. On this record, the Board places greater evidentiary weight upon the better-informed opinion provided by the VA expert in environmental medicine which is clearer on the specific form of “radiation” exposure applicable to the circumstances of this case. The Veteran does not allege the onset of a thyroid disorder in service or for many years after service. He has also presented no particular knowledge of actual exposure to ionizing radiation. As for his belief that his thyroid disorder is due to service, the Veteran’s own opinion holds no probative value as he is not shown to possess the requisite expertise to diagnose the onset and/or cause of a thyroid disorder. The preponderance of the evidence is against the claim for service connection for a thyroid disorder. The appeal is denied. Ischemic heart disease and coronary artery disease As noted above, both ischemic heart disease and coronary artery disease may be presumed to have been caused by exposure to herbicides in Vietnam. The Veteran had such exposure and service connection is already in effect for another herbicide-presumptive disease, diabetes mellitus. However, the evidence shows that the Veteran does not carry a diagnosis of either ischemic heart disease or coronary artery disease. He receives careful monitoring of his cardiac status due to his established diagnoses of arrhythmia, hyperlipidemia, and hypertension; however, as of the most recent medical evidence contained in the file, which is dated in August 2020, he has not developed ischemic heart disease or coronary artery disease. In addition to disease or injury in service, service connection requires competent medical evidence of a current related disability. Degmetich v. Brown, 104 F.23d 1328 (1997). A threshold requirement for the grant of service connection for any disability is that the disability claimed must be shown present. 38 U.S.C. §§ 1110, 1131. The Court has interpreted the requirement of current disability thus: Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C. § 1110. In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Absent a current disability involving either ischemic heart disease or coronary artery disease, the Veteran does not have a valid claim for service connection. The Veteran himself is not shown to be competent to self-diagnose coronary artery disease/ischemic heart disease. There is no competent evidence of any functional impairment of the heart other than caused by his atrial fibrillation. He is advised, however, that if he does develop such in the future, that he may want to submit an application for service connection at that time. Cardiac arrhythmia According to private medical records, the Veteran has had recurrent palpitations since the 1990s, and was initially diagnosed with atrial fibrillation in 2007. He underwent cardioversion and ablation, and subsequently had a pacemaker implanted. During the hearing on appeal, the Veteran testified that he did not have the symptoms of heart palpitations during service. The Board sought an advisory medical opinion from a VA staff cardiologist. This cardiologist first noted that arrhythmia (atrial fibrillation) was diagnosed 6 years to the diagnosis of diabetes mellitus, and that is was not possible that diabetes mellitus caused atrial fibrillation. The examiner further opined that diabetes mellitus would not be expected to cause or exacerbate arrhythmia. The examiner further opined that medical literal did not support a causal connection between arrhythmia and herbicide exposure. The Board finds the VA staff cardiologist opinion holds significant probative value as it based on an accurate review of the claims folder, and is rendered by a specialist with review of medical literature and the specific facts of this case. In particular, the examiner answered the causation factor that diabetes mellitus was not medically capable of causing arrhythmia and the aggravation factor that diabetes mellitus would not medically be expected to make arrhythmia worse. Overall, the Board can discern no relationship between the Veteran’s current cardiac arrhythmia and service. The Veteran has not suggested such and the evidence shows that his early symptoms developed many years after service. The Veteran is not shown to be competent to diagnose the onset and etiology of a cardiac disorder. As cardiac arrhythmia was not initially manifested during service, and is not shown to be related to service in any other way, or shown to be proximately due to service-connected disability, the preponderance of the evidence is against the claim. The appeal is denied. Basal cell carcinoma Medical records show that the Veteran had a basal cell carcinoma removed from his left arm in 2010. He had several other noncancerous skin lesions to include actinic keratoses removed from his head and arms between 2000 and the present. During the hearing on appeal, the Veteran testified that the cancer was surgically removed and fortunately has not recurred. A similar analysis applies to the question of entitlement to service connection for basal cell carcinoma. The carcinoma was not present during service or for many years after. The Veteran does not claim that basal cell carcinoma was present in service or within one year of service discharge. Basal cell carcinoma is not one of the soft tissue cancers which may be presumed to have been caused by herbicide exposure. There is no theory of entitlement to support service connection for this disability. The Board further finds that VA’s duty to obtain an opinion has not been triggered as there is no competent evidence suggesting that this disorder is related to service. See Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010) (holding that a conclusory generalized statement that a service illness caused his present medical problems was insufficient to trigger duty to provide medical examination as this theory would eliminate the carefully drafted statutory standards governing the provision of medical examinations and require the Secretary to provide such examinations as a matter of course in virtually every veteran’s disability case). The preponderance of the evidence is against the Veteran’s claim for service connection for basal cell carcinoma. The appeal is denied. Sleep apnea The available medical records document that obstructive sleep apnea was diagnosed in 1996. The Veteran was successfully treated with a BiPAP machine. The Veteran testified during the January 2018 hearing that he did not have sleep apnea during service. He did not suggest a theory of entitlement for service connection for sleep apnea. The Board obtained an informed medical opinion based upon review of the information in the Veteran’s claims file in July 2018. A VA physician, who is a specialist in pulmonology and sleep medicine reviewed the Veterans’ records and determined that it is less likely that the Veteran’s sleep apnea was proximately caused or aggravated by his service-connected diabetes. In particular, the expert opined that diabetes mellitus is a disorder which does not contribute towards causing obstructive sleep apnea nor leading to aggravation of obstructive sleep apnea – thus finding no medical basis to cause or aggravate obstructive sleep apnea. The Board affords this opinion great probative weight. Upon review, the Board holds that service connection for obstructive sleep apnea is not warranted. The evidence shows that apnea developed many years after service, with no relationship to service. The Veteran’s own belief holds no probative value as he is not shown to possess the requisite knowledge to diagnose the onset and causes of obstructive sleep apnea. The preponderance of the evidence is against the Veteran’s claim for service connection for obstructive sleep apnea. The appeal is denied. Lumbar spine The Veteran contends service connection for a lumbar spine disorder is warranted based upon the heavy lifting and pulling cables that he did as part of his military duties. He testified in January 2018 that his back would sometimes be sore after a day’s work during active service. The Veteran’s service treatment records contain no record of complaints or treatment pertaining to the Veteran’s back during service. Upon clinical examination in November 1967 prior to his separation from service, he spine and musculoskeletal system were deemed to have been normal. On his medical history portion of the separation examination report, the Veteran indicated that he did not have and had never had recurrent back pain, arthritis or rheumatism, or other bone or joint deformity. The earliest available medical records do not reflect complaints involving the Veteran’s back. The report of a June 2002 Routine Adult Physical Examination shows the Veteran’s back was deemed to have been normal at that time. Currently the Veteran has diagnoses of lumbosacral strain and degenerative arthritis of the lumbar spine with occasional sciatica. Following a September 2020 VA examination, during which the Veteran provided a thorough and helpful description of his strenuous responsibilities in service, along with photographs of the wire work he was responsible for, the examiner concluded that the Veteran’s current lumbar spine problems are unrelated to his duties in service. In particular, the examiner reasoned that, while the Veteran may have had some back soreness during service duties, the absence of treatment until 2012 implied that the condition resolved. Additionally, the examiner noted the Veteran’s x-rays only demonstrated very mild arthritis. The Board concludes that the Veteran’s current lumbosacral strain and degenerative arthritis were not initially manifest during service or for many years after service. The Veteran does not contend, and the evidence does not show, that he has had recurrent and/or persistent back symptoms since service or within one year of service. The Veteran denied recurrent back pain at separation for which the Board finds no basis to determine this contemporaneous report was not credible. The Veteran has not claimed chronicity, but rather that the rigors of his military duties caused his current low back disability. As such, the provisions of 38 C.F.R. § 3.303(b) and 38 C.F.R. § 3.309(a) are not applicable. The VA examiner considered the Veteran’s theory of causation and provided a reasoned explanation considering the very mild arthritic changes which the Board finds is based on an accurate factual history as there is no claimed history of chronic back symptoms or treatment until many years after service. The Veteran’s own belief holds no probative value as he is not shown to possess the expertise to diagnose the onset and etiology of an orthopedic disorder. Because there is no indication of arthritis within one year of discharge, arthritis cannot be presumed to have been incurred during service. No other relationship to service is established. The preponderance of the evidence is against the Veteran’s claim for service connection for a disability of the lumbar spine. The appeal is denied. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Heather J. Harter, 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.