Citation Nr: 21009490 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 16-15 137A DATE: February 22, 2021 ORDER Entitlement to service connection for a heart condition is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for right ear sensorineural hearing loss (SNHL) is denied. Entitlement to service connection for residuals of chicken pox is denied. Entitlement to service connection for a low back condition is denied. Entitlement to service connection for erectile dysfunction is denied. Entitlement to service connection for diabetes mellitus, type II is denied. Entitlement to service connection for varicose veins is denied. Entitlement to service connection for peripheral vascular disease is denied. Entitlement to service connection for peripheral neuropathy of the right upper extremity is denied. Entitlement to service connection for peripheral neuropathy of the left upper extremity is denied. Entitlement to service connection for peripheral neuropathy of the right lower extremity is denied. Entitlement to service connection for peripheral neuropathy of the left lower extremity is denied. Entitlement to a total disability rating based on individual unemployability as due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. The competent evidence does not demonstrate that the Veteran currently has a diagnosable heart condition, nor has he experienced such a condition during the pendency of the appeal or recent to the filing of the claim. 2. The preponderance of the competent medical evidence does not demonstrate that hypertension was incurred in service, manifested within a year of service, or is otherwise attributable to the Veteran’s service, to include as due to purported exposure to toxic herbicide agents in service. 3. The evidence clearly and unmistakably shows that the Veteran’s preexisting right ear SNHL was not aggravated by in-service injury or as a result of any incident in service. 4. The preponderance of the competent medical evidence does not demonstrate that the Veteran has a residual condition that is attributable to in-service chicken pox. 5. The preponderance of the competent medical evidence does not demonstrate that a low back condition was incurred in service, manifested within a year of service, or is otherwise attributable to the Veteran’s service, to include as due to purported exposure to toxic herbicide agents in service. 6. The competent medical evidence does not demonstrate that the Veteran’s erectile dysfunction was incurred in service or is otherwise attributable to his service. 7. The preponderance of the competent medical evidence does not demonstrate that diabetes mellitus, type II was incurred in service, manifested within a year of service, or is otherwise attributable to the Veteran’s service, to include as due to purported exposure to toxic herbicide agents in service. 8. The competent medical evidence does not demonstrate that the Veteran’s varicose veins condition was incurred in service or is otherwise attributable to his service. 9. The competent medical evidence does not demonstrate that the Veteran’s peripheral vascular disease was incurred in service or is otherwise attributable to his service, to include as due to purported exposure to toxic herbicide agents in service. 10. The competent evidence does not demonstrate that the Veteran currently has peripheral neuropathy of the right upper extremity, nor has he experienced such a condition during the pendency of the appeal or recent to the filing of the claim. 11. The competent evidence does not demonstrate that the Veteran currently has peripheral neuropathy of the left upper extremity, nor has he experienced such a condition during the pendency of the appeal or recent to the filing of the claim. 12. The competent evidence does not demonstrate that the Veteran currently has peripheral neuropathy of the right lower extremity, nor has he experienced such a condition during the pendency of the appeal or recent to the filing of the claim. 13. The competent evidence does not demonstrate that the Veteran currently has peripheral neuropathy of the left lower extremity, nor has he experienced such a condition during the pendency of the appeal or recent to the filing of the claim. 14. The weight of the evidence fails to establish that the Veteran was unable to secure or follow substantially gainful employment due solely to his service-connected disabilities for the entire appeal period. CONCLUSIONS OF LAW 1. Service connection for a heart condition is not warranted. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. § 3.303. 2. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 1112, 1116, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. The criteria for entitlement to service connection for right ear SNHL have not been met. 38 U.S.C. §§ 1110, 1111; 38 C.F.R. §§ 3.303, 3.304, 3.306, 3.307, 3.309, 3.385. 4. Service connection for residuals of chicken pox is not warranted. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. § 3.303. 5. The criteria for service connection for a low back condition have not been met. 38 U.S.C. §§ 1110, 1131, 1112, 1116, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. 6. Service connection for erectile dysfunction is not warranted. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. § 3.303. 7. The criteria for service connection for diabetes mellitus, type II have not been met. 38 U.S.C. §§ 1110, 1131, 1112, 1116, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. 8. Service connection for varicose veins is not warranted. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. § 3.303. 9. The criteria for service connection for peripheral vascular disease have not been met. 38 U.S.C. §§ 1110, 1131, 1112, 1116, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. 10. Service connection for peripheral neuropathy of the right upper extremity is not warranted. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. § 3.303. 11. Service connection for peripheral neuropathy of the left upper extremity is not warranted. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. § 3.303. 12. Service connection for peripheral neuropathy of the right lower extremity is not warranted. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. § 3.303. 13. Service connection for peripheral neuropathy of the left lower extremity is not warranted. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. § 3.303. 14. The criteria for entitlement to TDIU have not been met. 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.3, 4.15, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1971 to December 1973. He filed his claim with the Regional Office located in San Juan, Puerto Rico. These matters were last before the Board in April 2020, whereupon they were remanded to the Agency of Original Jurisdiction (AOJ) for further development of the record, to include translation of certain documents in Spanish. Following that development and the issuance of a September 2020 supplemental statement of the case continuing the denial of all the issues above, the case was returned to the Board for its adjudication. Herbicide Exposure As an initial matter, the Board acknowledges that the Veteran has contended generally that many of the claimed disabilities for which he is seeking service connection are attributable to his exposure to toxic herbicide agents while in service. Certain diseases associated with in-service Agent Orange exposure are presumed to be service connected if the disease is manifested to a compensable degree within a specified time period. 38 C.F.R. §§ 3.307, 3.309. If a Veteran was exposed to an herbicide agent, including Agent Orange, during active military, naval, or air service, certain diseases shall be service-connected if the requirements of 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113 and 38 C.F.R. § 3.307(d) are also satisfied. A Veteran who served in the Republic of Vietnam between January 9, 1962 and May 7, 1975 is presumed to have been exposed to Agent Orange. However, the Veteran’s service records do not show that he served in the Republic of Vietnam, and he does not contend that he served in Vietnam; rather, he states that he was exposed to herbicides while serving in Germany. As the Veteran did not have active service in the Republic of Vietnam, exposure to Agent Orange cannot be presumed. That being said, the Board still has an obligation to consider the claim on a direct service connection basis. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). To that end, the Board notes that the Veteran in a July 2015 correspondence asserted that while he was stationed in Germany, he was assigned to surveillance of a warehouse in which he was told was herbicides. He contends that these herbicide agents were toxic in nature and led to his development of various health problems later in life. In response to the Veteran’s contentions, first raised in his initial claim dated in October 2014, the AOJ sent him a letter in May 2015 requesting additional information in support of his claim that he was exposed to toxic herbicide agents in service; to date, the Board does not find that a response to this letter was ever received by VA. The file was then provided to a coordinator from the Joint Services Records Research Center (JSRRC), who reviewed the file, to include the Veteran’s available personnel records. That individual issued an October 2015 memorandum of record indicating that an independent review of the Veteran’s personnel records did not show any evidence that the Veteran stepped foot in the Republic of Vietnam during service or that he was exposed to herbicides in service. The Veteran himself has provided no further evidence to substantiate his contention that he was exposed to toxic herbicide agents at any point during his service other than his lay testimony to that effect. Accordingly, under these circumstances, the Board concludes that the preponderance of the available evidence is against a determination that the Veteran was exposed to toxic herbicide agents as he contends, and so presumptive service connection on this limited basis is not warranted. The Board will not further consider the Veteran’s contentions as to herbicide exposure with regards to any of the claimed disabilities addressed below. Service Connection Entitlement to service connection requires evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The Board is cognizant that the Veteran’s service treatment records (STRs) from his period of active duty have not been associated with the claims file, other than copies of his entrance examination and Report of Medical History, both dated in August 1971. VA is required to obtain relevant documents held by any Federal department or agency that the Veteran adequately identifies and authorizes the Secretary to obtain. 38 U.S.C. § 5103A(c)(3); 38 C.F.R. § 3.159(e). The Board acknowledges that VA has a heightened duty to assist the Veteran in developing his claims since the records may have been lost, as well as an obligation to explain its findings and conclusions and carefully consider the benefit-of-the-doubt rule. Washington v. Nicholson, 19 Vet. App. 362, 369-70 (2005); O’ Hare v. Derwinski, 1 Vet. App. 365 (1991). Case law does not, however, lower the legal standard for proving a claim for service connection but simply increases the Board’s obligation to consider that evidence which may be favorable to the Veteran. Russo v. Brown, 9. Vet. 46, 51 (1996). 1. Entitlement to service connection for a heart condition. The Veteran seeks service connection generally for a heart condition. Without delving into the question of the potential etiology of this condition, the Board finds that the Veteran has never been diagnosed with any disability that could competently be considered a “heart condition” and there is no evidence to suggest that such a diagnosis is appropriate; as such, entitlement to service connection must be denied. A review of available VA and private medical records does not reflect that the Veteran has ever been diagnosed with or treated for any disability of the heart. To be clear, the Board acknowledges that the Veteran has been diagnosed with and received treatment for hyperlipidemia, dyslipidemia, and hypertension throughout the appeal period. However, he has never been diagnosed with or treated for a disability of the heart. He underwent a cardiology diagnostic study through VA in May 2017, the results of which were negative for any active heart disease; moreover, he denied any history of diagnosis of or treatment for heart disease. Further review of available VA medical records does not show that a heart disability or condition has ever been listed as one of his active medical problems. The Veteran has submitted an May 2009 arterial study performed by his private treatment provider, which revealed a diagnosis of bilateral atherosclerosis vascular disease. This is a condition that specifically impacts the lower extremities and while potentially suggestive of a diagnosable heart condition, does not equate to such a diagnosis. No subsequent private medical records reveal any diagnosis of or treatment for a heart condition. Ultimately, there is no competent evidence that the Veteran has a heart condition or symptomatology that suggests that a diagnosis of the condition would be appropriate. Accordingly, without supporting records, the Board concludes that the Veteran does not have a diagnosable heart condition and has not had such a condition during the appeal period. The Veteran himself does not have the medical training or credentials to offer an opinion as to a diagnosis or its etiology. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In the absence of competent supporting evidence, a VA examination also is not required. Service connection is denied. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). As the preponderance of the evidence is against the Veteran’s claim, the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C. § 5107(b). 2. Entitlement to service connection for hypertension. The Veteran contends generally that his currently diagnosed hypertension is attributable to service. As stated, although the Veteran alternatively claims that his hypertension is attributable to purported exposure to toxic herbicide agents in service, there is no evidence of such exposure, and so the Board will not further consider this alternative theory of the entitlement. The question for the Board is whether the Veteran has hypertension that began during service or is at least as likely as not related to an in-service injury, event, or disease. In the alternative, the question for the Board is whether the Veteran has a chronic disease that manifested to a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service. The Board concludes that, while the Veteran has hypertension, which is a chronic disease under the appropriate regulations, it did not manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. 38 U.S.C. §§ 1101(3), 1112, 1113, 1137; 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). As stated, the Board does not have copies of any service treatment records for review other than the August 1971 entrance examination and corresponding August 1971 Report of Medical History. Moreover, the Veteran has not specifically asserted that he developed hypertension in service. Accordingly, service connection for hypertension on a direct basis pursuant to 38 C.F.R. § 3.303(a) is denied. Post-service medical records show that the Veteran was diagnosed with and receiving treatment for hypertension as early as March 2009. He has been followed for hypertension through VA for the entirety of the appeal period. On this basis, therefore, the Board concludes that the Veteran’s hypertension did not manifest within the applicable one-year presumptive period, and, accordingly, service connection for hypertension on a presumptive basis as a chronic disease is denied. 38 C.F.R. § 3.307(a)(3). In an October 2014 correspondence, the Veteran’s treating physician, a Dr. M.J.C.M, noted that the Veteran had a history of treatment for hypertension, and associated it with the Veteran’s exposure to toxic herbicide agents. As detailed above, the preponderance of the evidence is against a determination that the Veteran was exposed to toxic herbicides while in service; accordingly, the Board need not contend with Dr. M.J.C.M.’s determination regarding the association between the Veteran’s hypertension and any purported in-service exposure to toxic herbicide agents. Dr. M.J.C.M. did not comment further on the likely etiology of the hypertension. As such, Dr. M.J.C.M.’s correspondence lacks any probative value. Sklar v. Brown, 5 Vet. App. 140 (1993). The Veteran has not been afforded an examination in connection with his hypertension service connection claim, but VA does not have a duty to provide one here, as there is no indication that the condition may be associated with the Veteran’s service. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). He has not presented any competent evidence or testimony in support of the claim, and there are no records of the Veteran receiving a diagnosis of or treatment for the condition prior to 2009. There is simply no competent evidence to support that the condition first diagnosed over 35 years after the Veteran’s discharge is related to service, other than Dr. M.J.C.M.’s determination which is based on the refuted finding that the Veteran was exposed to toxic herbicides agents in service. The Veteran’s own lay assertions as to the onset and etiology of the hypertension does not constitute competent evidence, as he lacks medical training or credentials. Jandreau, supra. Accordingly, there is no duty to provide the Veteran with an examination to evaluate the etiology of his hypertension. Upon review of the available evidence, the Board concludes that the preponderance of the evidence is against a finding that the Veteran’s hypertension is related to service or that he developed it within a year of service, as would be necessary for entitlement to service connection on a presumptive basis. While the Veteran is competent to report having experienced symptoms of hypertension and when they began, he is not competent to provide a diagnosis in this case or determine that any such symptoms were manifestations of hypertension. The issue is medically complex, as it requires the interpretation of complicated diagnostic medical testing. Jandreau, supra. The fact remains that the claims file does not contain a diagnosis of hypertension until March 2009, over 35 years after the Veteran was discharged from service. This is persuasive evidence tending to demonstrate that there is no continuity of symptomatology after service. The Veteran has provided no objective medical evidence in support of his general contention that his hypertension is attributable to service other than Dr. M.J.C.M.’s correspondence, which has been shown to lack significant probative value. Therefore, the preponderance of the evidence is against the Veteran’s service connection claim for hypertension based on continuity of symptomatology under 38 C.F.R. § 3.303(b) and also as a post-service manifestation under 38 C.F.R. § 3.303(d). Consequently, the benefit of the doubt rule does not apply, and the claim is denied. 3 8 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 3. Entitlement to service connection for right ear hearing loss. The Veteran contends that his diagnosed right ear hearing loss, which preexisted his entrance into service, was nevertheless aggravated permanently by his service, and therefore that he is entitled to service connection for the condition. Every veteran is presumed to have been in sound condition at entry into service except as to defects, infirmities, or disorders noted at the time of such entry, or where clear and unmistakable evidence demonstrates that the injury or disease existed before entry and was not aggravated by such service. 38 U.S.C. § 1111. Clear and unmistakable evidence” is a more formidable evidentiary burden than the preponderance of the evidence standard. See Vanerson v. West, 12 Vet. App. 254, 258 (1999). It is an “onerous” evidentiary standard, requiring that the preexistence of a condition and the no-aggravation result be “undebatable.” See Cotant v. West, 17 Vet. App. 116, 131 (2003), citing Laposky v. Brown, 4 Vet. App. 331, 334 (1993). VA’s General Counsel has held that to rebut the presumption of sound condition under 38 U.S.C. § 1111, VA must show by clear and unmistakable evidence both that the disease or injury existed prior to service and that the disease or injury was not aggravated by service. The Veteran is not required to show that the disease or injury increased in severity during service before VA’s duty under the second prong of this rebuttal standard attaches. See VAOPGCPREC 3-2003; see also Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004). For the purposes of applying the laws administered by VA, impaired hearing will be considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory threshold for at least three of the frequencies 500, 1000, 2000, 3000, 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. Puretone thresholds in decibels on an entrance examination dated in August 1971 were: HERTZ 500 1000 2000 3000 4000 RIGHT 40 35 35 Not Tested 65 LEFT 5 10 15 Not Tested 25 These audiometric findings clearly qualify as right ear SNHL for VA compensation purposes. Moreover, the Veteran’s defective hearing in his right ear was acknowledged by his examiner on the August 1971 entrance examination. Accordingly, the Board finds that the first element of the presumption of soundness has been rebutted, as the evidence clearly and unmistakably shows that right ear hearing loss preexisted service; the next query is whether the preexisting right ear hearing loss clearly and unmistakably was not aggravated by the Veteran’s service. To that end, the Board notes that a preexisting disease or injury will be presumed to have been aggravated by service only if the evidence shows that the underlying disability underwent an increase in severity; the occurrence of symptoms, in the absence of an increase in the underlying severity, does not constitute aggravation of the disability. See Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002); 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a). Mere “temporary or intermittent flare-ups” of a preexisting condition are generally insufficient to show that in-service worsening has occurred. See Jensen v. Brown, 4 Vet. App. 304, 306-07 (1993). However, the degree of in-service worsening need not be so great as to warrant compensation in order for the presumption of aggravation to attach. Browder v. Derwinski, 1 Vet. App. 204, 207 (1991). Notably, once the presumption of aggravation does attach, the government bears the burden of showing, by clear and unmistakable evidence, “that the increase in disability is due to the natural progress of the disease.” 38 U.S.C. § 1153; 38 C.F.R. § 3.306; Wagner, 370 F. 3d at 1096 (Fed. Cir. 2004). As stated, the Board does not have available to it any copies of service treatment records subsequent to the August 1971 entrance examination and corresponding August 1971 Report of Medical History. Post-service, the first instance of the Veteran seeking treatment for hearing loss is a May 2007 audiometric evaluation, during which the Veteran reported difficulty hearing conversation. Puretone thresholds on an audiometric examination were: HERTZ 500 1000 2000 3000 4000 RIGHT 35 55 45 75 70 LEFT 30 40 40 40 45 Speech discrimination scores were 80 percent in the right ear and 96 percent in the left ear; however, the examiner did not note that they used the Maryland CNC word list in testing the Veteran. The examiner confirmed the diagnosis of SNHL bilaterally and prescribed the use of hearing aids bilaterally. Subsequent VA medical records show that bilateral hearing loss continued to be listed as an active problem for the remainder of the appeal period. The Veteran was afforded a VA audiology examination in January 2010, during which he reported experiencing impaired hearing ever since service and denied any history of hearing loss prior to service. Puretone thresholds on an audiometric examination were: HERTZ 500 1000 2000 3000 4000 RIGHT 35 60 50 75 80 LEFT 30 30 40 40 40 Speech discrimination scores using the Maryland CNC word list were 92 percent bilaterally. The examiner confirmed the diagnosis of SNHL bilaterally. The examiner then declined to offer an opinion as to the likely etiology of the right ear hearing loss, finding that to do so would require him to resort to speculation as there was no separation examination to compare the entrance testing results to. The Veteran was next afforded a VA audiology examination in January 2013. Puretone thresholds on an audiometric examination were: HERTZ 500 1000 2000 3000 4000 RIGHT 95 105+ 105+ 105+ 105+ LEFT 90 95+ 105+ 105+ 105+ The examiner did not endorse the validity of these testing results, however, as they noted that the Veteran exaggerated his responses to the testing in an inconsistent manner. The examiner did report that speech discrimination scores using the Maryland CNC word list were 80 percent in the right ear and 88 percent in the left ear. The examiner confirmed the diagnosis of SNHL bilaterally. The examiner then opined that the right ear SNHL was less likely than not incurred in or otherwise attributable to service on the grounds that the Veteran had preexisting hearing loss in his right ear upon entrance to service. Thereafter, the Veteran was afforded another VA audiology examination in September 2015. Puretone thresholds on an audiometric examination were: HERTZ 500 1000 2000 3000 4000 RIGHT 35 40 40 65 70 LEFT 30 30 25 35 40 Speech discrimination scores using the Maryland CNC word list were 94 percent in the right ear and 98 percent in the left ear. The examiner confirmed the diagnosis of SNHL bilaterally. The examiner then neglected to opine as to the likely etiology of the right ear SNHL after erroneously noting that the Veteran was already service connected for right ear SNHL. The Veteran was afforded yet another VA audiology examination in August 2016. Puretone thresholds on an audiometric examination were: HERTZ 500 1000 2000 3000 4000 RIGHT 30 40 45 65 70 LEFT 30 30 25 35 40 Speech discrimination scores using the Maryland CNC word list were 96 percent in the right ear and 98 percent in the left ear. The examiner confirmed the diagnosis of SNHL bilaterally. The examiner then opined that it was less likely than not that the right ear SNHL was incurred in or otherwise attributable to service. In support thereof, the examiner confusingly discussed the lack of significant change in the Veteran’s hearing since he began seeking treatment through VA in 2007 and found this to support a determination that the Veteran’s hearing was not aggravated by service. The examiner did not discuss the Veteran’s service other than to note that he did have preexisting right ear SNHL upon entrance to service. Most recently, the Veteran was scheduled for a VA audiology examination in March 2018. Puretone thresholds on an audiometric examination were: HERTZ 500 1000 2000 3000 4000 RIGHT 25 40 45 55 60 LEFT 0 25 25 35 40 Speech discrimination scores using the Maryland CNC word list were 96 percent in the right ear and 100 percent in the left ear. The examiner confirmed the diagnosis of SNHL bilaterally, and also found that the right ear SNHL clearly and unmistakably existed prior to service based on the August 1971 entrance examination. The examiner then opined that the preexisting right ear SNHL clearly and unmistakably was not aggravated by service on the grounds that the Veteran’s audiometric testing results were largely unchanged from the time of his entrance into service until the May 2007 audiology examination, which is the next available medical record concerning the Veteran’s right ear SNHL. The Board also acknowledges that the Veteran submitted a November 2011 correspondence from a Dr. N. A. O.V., who did not indicate the extent to which she had treated the Veteran or review his medical history. She found that it was at least as likely as not that his bilateral SNHL was incurred in or otherwise attributable to service. In support thereof, she noted that the Veteran was exposed to high frequency noises while in service and further highlighted that the Veteran was placed on a profile due to hearing problems while he was in service. The Board does not find this correspondence to be probative whatsoever as Dr. N.A.O.V. did not refer to any specific evidence in the claims file and furthermore did not address the operative question of whether the preexisting right ear SNHL was aggravated beyond its normal progression by service; indeed, she did not even acknowledge that the Veteran’s right ear SNHL existed upon his entrance into service. Sklar, supra. After a review of the claims file, the Board finds that the evidence does not substantiate that there was an increase in disability of the Veteran’s preexisting right ear SNHL during service. As noted previously, there is no documentation of the Veteran having sought treatment for right ear SNHL following the August 1971 entrance examination until the May 2007 audiometric testing performed at the Veterans local VA Medical Center. In reviewing the VA examinations of record, the Board acknowledges that the numerous VA examinations afforded to the Veteran prior to the March 2018 audiology examination largely lack any probative value, at least as they concern the operative query of whether the preexisting right ear hearing loss was clearly and unmistakably aggravated beyond natural progression by service. This is due to the fact that the VA examiners who administered those examinations neglected to even address this query or utilized the incorrect standard of evaluation. That being said, the Board does find that the March 2018 VA examiner opinion is highly probative as to the operative query, as the examiner reviewed the entirety of the claims file and utilized the proper standard in setting forth her conclusion as to whether the Veteran’s right ear SNHL was aggravated by service. Sklar, supra. The Board does recognize that the Veteran has contended that he developed right ear hearing loss during service that continued after his discharge and that his hearing loss was attributable to his exposure to hazardous degrees of military noise and the lack of proper hearing protection in service. While he is competent to report as to incidence of his right ear hearing loss symptomatology, his lay opinion as to the etiology of his right ear SNHL does not constitute competent evidence, as he lacks medical training or credentials. Jandreau, supra. Ultimately, objective medical evidence is needed to support a finding that the preexisting disorder increased in severity in service, and the Veteran has not submitted any medical evidence which would serve to suggest that his preexisting right ear SNHL may have increased in severity during active service. See Paulson v. Brown, 7 Vet. App. 466, 470-471 (1995); Crowe v. Brown, 7 Vet. App. 238, 246 (1994). The Veteran’s contentions, unsubstantiated as they are, must be considered in light of the highly probative opinion of the March 2018 VA examiner who supported her conclusions by reference to the claims file and the Veteran’s documented medical history. In the Board’s estimation, the Veteran’s contentions are far outweighed by the objective medical evidence of record, which overwhelmingly suggests to the “clear and unmistakable” standard that the Veteran’s preexisting right ear SNHL was not worsened beyond normal progression during service. Accordingly, the Board concludes that service connection for right ear SNHL by way of aggravation or direct service connection, is not warranted. The Board further notes that as the presumption of soundness has been clearly and unmistakably rebutted, there is no further need to evaluate whether the Veteran is entitled to service connection on any alternative basis. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 4. Entitlement to service connection for residuals of chicken pox. The Veteran contends generally that he has a residual condition stemming from his contraction of chicken pox in service. Without delving into the question of the potential etiology of this condition, the Board finds that the Veteran has never been diagnosed with any disability that is a residual of his contraction of chicken pox and there is no evidence to suggest that such a diagnosis is appropriate; as such, entitlement to service connection must be denied. A review of available VA and private medical records does not reflect that the Veteran has ever been diagnosed with or treated for any residual condition attributable to his purported contraction of chicken pox in service. He was afforded a VA examination in September 2020 to evaluate whether he had any residual skin or neurological condition attributable to his contraction of chicken pox in service, and the VA examiner found no evidence any such condition. On this basis, the examiner opined that it was less likely than not that the Veteran had a chicken pox residual condition that was incurred in or otherwise attributable to service. As the VA examiner reviewed the claims file and referred to her own in-person examination of the Veteran, the Board finds this examination and opinion to be highly probative. Sklar, supra. Ultimately, there is no competent evidence that the Veteran has a residual condition attributable to his contraction of chicken pox in service or symptomatology that suggests that a diagnosis of such a condition would be appropriate. The Board does acknowledge that Dr. M.J.C.M. in the October 2014 correspondence detailed that the Veteran reported contracting chicken pox in service. However, Dr. M.J.C.M. offered no opinion as to any currently diagnosable residual condition attributable to this in-service chicken pox; as such, the Board finds that the letter provides little probative evidence in support of the Veteran’s claim. In summation, without supporting records, the Board concludes that the Veteran does not have a diagnosable residual condition attributable to his contraction of chicken pox in service and has not had such a condition during the appeal period. The Veteran himself does not have the medical training or credentials to offer an opinion as to a diagnosis or its etiology. Jandreau, supra. In the absence of competent supporting evidence, a VA examination also is not required. Service connection is denied. Brammer, supra. As the preponderance of the evidence is against the Veteran’s claim, the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C. § 5107(b). 5. Entitlement to service connection for a low back condition. The Veteran contends generally that his currently diagnosed low back condition is attributable to service. As stated, although the Veteran alternatively claims that his low back condition is attributable to purported exposure to toxic herbicide agents in service, there is no evidence of such exposure, and so the Board will not further consider this alternative theory of the entitlement. The question for the Board is whether the Veteran has a low back condition that began during service or is at least as likely as not related to an in-service injury, event, or disease. In the alternative, the question for the Board is whether the Veteran has a chronic disease that manifested to a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service. The Board concludes that, while the Veteran has degenerative arthritis of the lumbosacral spine, which is a chronic disease under the appropriate regulations, it did not manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. 38 U.S.C. §§ 1101(3), 1112, 1113, 1137; 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). As stated, the Board does not have copies of any service treatment records for review other than the August 1971 entrance examination and corresponding August 1971 Report of Medical History. Moreover, the Veteran has not specifically asserted that he developed degenerative arthritis of the lumbosacral spine in service. Accordingly, service connection for a low back condition on a direct basis pursuant to 38 C.F.R. § 3.303(a) is denied. Post-service VA medical records show that the Veteran complained of low back pain in November 2013 that began a few weeks earlier. Subsequent records show continued assessments of low back pain without a formal diagnosis. The Veteran submitted an October 2005 private spine examination which showed a normal lumbar radiograph. Thereafter, a February 2009 private spine examination shows lower cervical and lumbar apophysial joints facet osteoarthritis as well narrowing of L5-S1 intervertebral disk space. Subsequent private records show continued treatment for low back pain; however, none of these records show that the degenerative arthritis of the lumbar spine was ever attributed to service. As the first indication of the degenerative arthritis is in February 2009, the Board concludes that the Veteran’s low back condition did not manifest within the applicable one-year presumptive period, and, accordingly, service connection for a low back condition on a presumptive basis as a chronic disease is denied. 38 C.F.R. § 3.307(a)(3). In an October 2014 correspondence, the Veteran’s treating physician, a Dr. M.J.C.M, noted that the Veteran had a history of treatment for lumbar disc degeneration as well as lumbar osteoarthritis and associated both conditions with the Veteran’s exposure to toxic herbicide agents. As detailed above, the preponderance of the evidence is against a determination that the Veteran was exposed to toxic herbicides while in service; accordingly, the Board need not contend with Dr. M.J.C.M.’s determination regarding the association between the Veteran’s low back conditions and any purported in-service exposure to toxic herbicide agents. Dr. M.J.C.M. did not comment further on the likely etiology of the claimed low back condition. As such, Dr. M.J.C.M.’s correspondence lacks any probative value. Sklar, supra. The nature and etiology of the low back condition was evaluated in a September 2020 VA examination, during which the Veteran reported that he developed low back pain in service and was admitted to the hospital for one week for treatment. After confirming a diagnosis of degenerative arthritis of the spine as well as intervertebral disc syndrome and degenerative disc disease of the lumbar spine, the examiner found it less likely than not that any claimed low back condition was incurred in or caused by service. In support thereof, the examiner referred to the lack of any objective medical evidence to suggest that the Veteran experienced symptoms of a low back condition in service. While the examiner did correctly note that there are no objective medical records to suggest that the Veteran experienced low back pain in service, they did not contend with the Veteran’s lay testimony regarding his experiencing low back pain in service. As such, the Board finds that the September 2020 VA examiner is only moderately probative. Sklar, supra. The Board further notes the lack of objective medical evidence tending to suggest that the Veteran’s low back condition is attributable to service precludes the need to remand this matter again for a more comprehensive medical opinion to evaluate the likely etiology of the low back condition. See McLendon, supra. Upon review of the record, the Board concludes that the preponderance of the evidence is against a finding that the Veteran’s low back condition is related to service or that he developed it within a year of service, as would be necessary for entitlement to service connection on a presumptive basis. While the Veteran is competent to report having experienced symptoms of a low back condition and when they began, he is not competent to provide a diagnosis in this case or determine that any such symptoms were manifestations of hypertension. The issue is medically complex, as it requires the interpretation of complicated diagnostic medical testing. Jandreau, supra. The fact remains that the claims file does not contain a diagnosis of a low back condition until February 2009, over 35 years after the Veteran was discharged from service. This is persuasive evidence tending to demonstrate that there is no continuity of symptomatology after service. The Veteran has provided no objective medical evidence in support of his general contention that he has a low back condition that is attributable to service, other than Dr. M.J.C.M.’s determination which is based on the refuted finding that the Veteran was exposed to toxic herbicides agents in service. Moreover, while the September 2020 VA examiner’s opinion is not ideally dispositive, it does lend further support for a finding against service connection in this case. Therefore, the preponderance of the evidence is against the Veteran’s service connection claim for a low back condition based on continuity of symptomatology under 38 C.F.R. § 3.303(b) and also as a post-service manifestation under 38 C.F.R. § 3.303(d). Consequently, the benefit of the doubt rule does not apply, and the claim is denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 6. Entitlement to service connection for erectile dysfunction. The Veteran contends generally that his currently diagnosed erectile dysfunction is attributable to service. The question for the Board is whether the Veteran has erectile dysfunction that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has erectile dysfunction, the preponderance of the evidence is against a finding that the erectile dysfunction began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). As stated, the Board does not have copies of any service treatment records for review other than the August 1971 entrance examination and corresponding August 1971 Report of Medical History. Moreover, the Veteran has not specifically asserted that he developed erectile dysfunction in service. Accordingly, service connection for erectile dysfunction on a direct basis pursuant to 38 C.F.R. § 3.303(a) is denied. Post-service medical records show that the Veteran was diagnosed with and receiving treatment for erectile dysfunction as early as November 2008. Subsequent medical records show that the Veteran continued to have erectile dysfunction listed as an active problem, and the Veteran continued to receive treatment for the condition. The Veteran has not been afforded an examination in connection with his erectile dysfunction service connection claim, but VA does not have a duty to provide one here, as there is no indication that the condition may be associated with the Veteran’s service. See McLendon, supra. He has not presented any competent evidence or testimony in support of the claim, and there are no records of the Veteran receiving a diagnosis of or treatment for the condition prior to 2008. There is simply no competent evidence to support that the condition first diagnosed 35 years after the Veteran’s discharge is related to service. The Veteran’s own lay opinion as to the onset and etiology of the erectile dysfunction does not constitute competent evidence, as he lacks medical training or credentials. Jandreau, supra. Accordingly, there is no duty to provide the Veteran with an examination to evaluate the etiology of his erectile dysfunction. Without any evidence in support of the Veteran’s claim, the Board finds that no medical nexus exists between the Veteran’s erectile dysfunction and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(a), (d). As the preponderance of the evidence is against the Veteran’s claim, the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C. § 5107 (b). 7. Entitlement to service connection for diabetes mellitus, type II. The Veteran contends generally that his currently diagnosed diabetes mellitus, type II is attributable to service. As stated, although the Veteran alternatively claims that his diabetes mellitus, type II is attributable to purported exposure to toxic herbicide agents in service, there is no evidence of such exposure, and so the Board will not further consider this alternative theory of the entitlement. The question for the Board is whether the Veteran has diabetes mellitus, type II that began during service or is at least as likely as not related to an in-service injury, event, or disease. In the alternative, the question for the Board is whether the Veteran has a chronic disease that manifested to a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service. The Board concludes that, while the Veteran has diabetes mellitus, type II, which is a chronic disease under the appropriate regulations, it did not manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. 38 U.S.C. §§ 1101(3), 1112, 1113, 1137; 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). As stated, the Board does not have copies of any service treatment records for review other than the August 1971 entrance examination and corresponding August 1971 Report of Medical History. Moreover, the Veteran has not specifically asserted that he developed diabetes mellitus, type II in service. Accordingly, service connection for diabetes mellitus, type II on a direct basis pursuant to 38 C.F.R. § 3.303(a) is denied. Post-service medical records show that the Veteran was diagnosed with and receiving treatment for diabetes mellitus, type II as early as March 2009. However, a March 2011 endocrinology note shows that a VA medical treatment provider dismissed that diagnosis on the basis of diagnostic testing. That being said, subsequent medical records show that the Veteran continued to have diabetes mellitus, type II listed as an active problem, and the Veteran continued to receive treatment for the condition. In any event, as the first indication of the condition is in March 2009, the Board concludes that the Veteran’s diabetes mellitus, type II did not manifest within the applicable one-year presumptive period, and, accordingly, service connection for diabetes mellitus, type II on a presumptive basis as a chronic disease is denied. 38 C.F.R. § 3.307(a)(3). In an October 2014 correspondence, the Veteran’s treating physician, a Dr. M.J.C.M, noted that the Veteran had a history of treatment for diabetes mellitus, type II, and associated it with the Veteran’s exposure to toxic herbicide agents. As detailed above, the preponderance of the evidence is against a determination that the Veteran was exposed to toxic herbicides while in service; accordingly, the Board need not contend with Dr. M.J.C.M.’s determination regarding the association between the Veteran’s diabetes mellitus, type II and any purported in-service exposure to toxic herbicide agents. Dr. M.J.C.M. did not comment further on the likely etiology of the diabetes mellitus, type II. As such, Dr. M.J.C.M.’s correspondence lacks any probative value. Sklar, supra. The Veteran has not been afforded an examination in connection with his diabetes mellitus, type II service connection claim, but VA does not have a duty to provide one here, as there is no indication that the condition may be associated with the Veteran’s service. See McLendon, supra. He has not presented any competent evidence or testimony in support of the claim, and there are no records of the Veteran receiving a diagnosis of or treatment for the condition prior to 2009. There is simply no competent evidence to support that the condition first diagnosed over 35 years after the Veteran’s discharge is related to service, other than Dr. M.J.C.M.’s determination which is based on the refuted finding that the Veteran was exposed to toxic herbicides agents in service. The Veteran’s own lay assertions as to the onset and etiology of the diabetes mellitus, type II does not constitute competent evidence, as he lacks medical training or credentials. Jandreau, supra. Accordingly, there is no duty to provide the Veteran with an examination to evaluate the etiology of his diabetes mellitus, type II. Upon review of the available evidence, the Board concludes that the preponderance of the evidence is against a finding that the Veteran’s diabetes mellitus, type II is related to service or that he developed it within a year of service, as would be necessary for entitlement to service connection on a presumptive basis. While the Veteran is competent to report having experienced symptoms of diabetes mellitus, type II and when they began, he is not competent to provide a diagnosis in this case or determine that any such symptoms were manifestations of diabetes mellitus, type II. The issue is medically complex, as it requires the interpretation of complicated diagnostic medical testing. Jandreau, supra. The fact remains that the claims file does not contain a diagnosis of diabetes mellitus, type II until March 2009, over 35 years after the Veteran was discharged from service. This is persuasive evidence tending to demonstrate that there is no continuity of symptomatology after service. The Veteran has provided no objective medical evidence in support of his general contention that his diabetes mellitus, type II is attributable to service other than Dr. M.J.C.M.’s correspondence, which has been shown to lack significant probative value. Therefore, the preponderance of the evidence is against the Veteran’s service connection claim for diabetes mellitus, type II based on continuity of symptomatology under 38 C.F.R. § 3.303(b) and also as a post-service manifestation under 38 C.F.R. § 3.303(d). Consequently, the benefit of the doubt rule does not apply, and the claim is denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 8. Entitlement to service connection for varicose veins. The Veteran contends generally that his currently diagnosed varicose veins condition is attributable to service. The question for the Board is whether the Veteran has a varicose veins condition that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a varicose veins condition, the preponderance of the evidence is against a finding that the varicose veins condition began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). As stated, the Board does not have copies of any service treatment records for review other than the August 1971 entrance examination and corresponding August 1971 Report of Medical History. Moreover, the Veteran has not specifically asserted that he developed varicose veins in service. Accordingly, service connection for a varicose veins condition on a direct basis pursuant to 38 C.F.R. § 3.303(a) is denied. Post-service medical records show that the Veteran was diagnosed with and receiving treatment for varicose veins as early as October 2003, which is the earliest available date for VA medical records in the file. Subsequent medical records show that the Veteran continued to have varicose veins listed as an active problem, and the Veteran continued to receive treatment for the condition. The Veteran has submitted an May 2009 arterial study performed by his private treatment provider, which revealed a diagnosis of bilateral atherosclerosis vascular disease, bilateral intimal wall calcification, and bilateral venous valve insufficiency; however, none of the conditions were attributed to service. The Veteran has not been afforded an examination in connection with his varicose veins service connection claim, but VA does not have a duty to provide one here, as there is no indication that the condition may be associated with the Veteran’s service. See McLendon, supra. He has not presented any competent evidence or testimony in support of the claim, and there are no records of the Veteran receiving a diagnosis of or treatment for the condition prior to 2008. There is simply no competent evidence to support that the condition first diagnosed 35 years after the Veteran’s discharge is related to service. The Veteran’s own lay opinion as to the onset and etiology of the varicose veins condition does not constitute competent evidence, as he lacks medical training or credentials. Jandreau, supra. Accordingly, there is no duty to provide the Veteran with an examination to evaluate the etiology of his varicose veins condition. Without any evidence in support of the Veteran’s claim, the Board finds that no medical nexus exists between the Veteran’s varicose veins condition and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(a), (d). As the preponderance of the evidence is against the Veteran’s claim, the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C. § 5107(b). 9. Entitlement to service connection for peripheral vascular disease. The Veteran contends generally that his currently diagnosed peripheral vascular disease is attributable to service. As stated, although the Veteran alternatively claims that his diabetes mellitus, type II is attributable to purported exposure to toxic herbicide agents in service, there is no evidence of such exposure, and so the Board will not further consider this alternative theory of the entitlement. The question for the Board is whether the Veteran has peripheral vascular disease that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has peripheral vascular disease, the preponderance of the evidence is against a finding that the peripheral vascular disease began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). As stated, the Board does not have copies of any service treatment records for review other than the August 1971 entrance examination and corresponding August 1971 Report of Medical History. Moreover, the Veteran has not specifically asserted that he developed peripheral vascular disease in service. Accordingly, service connection for peripheral vascular disease on a direct basis pursuant to 38 C.F.R. § 3.303(a) is denied. A review of post-service VA medical records does not show a diagnosis of or treatment for peripheral vascular disease. The Veteran has submitted an May 2009 arterial study performed by his private treatment provider, which revealed a diagnosis of bilateral atherosclerosis vascular disease, bilateral intimal wall calcification, and bilateral venous valve insufficiency; however, none of the conditions were attributed to service. In an October 2014 correspondence, the Veteran’s treating physician, a Dr. M.J.C.M, noted that the Veteran had a history of treatment for peripheral vascular disease, and associated it with the Veteran’s exposure to toxic herbicide agents. As detailed above, the preponderance of the evidence is against a determination that the Veteran was exposed to toxic herbicides while in service; accordingly, the Board need not contend with Dr. M.J.C.M.’s determination regarding the association between the Veteran’s peripheral vascular disease and any purported in-service exposure to toxic herbicide agents. Dr. M.J.C.M. did not comment further on the likely etiology of the peripheral vascular disease. As such, Dr. M.J.C.M.’s correspondence lacks any probative value. Sklar, supra. The Veteran has not been afforded an examination in connection with his peripheral vascular disease service connection claim, but VA does not have a duty to provide one here, as there is no indication that the condition may be associated with the Veteran’s service. See McLendon, supra. He has not presented any competent evidence or testimony in support of the claim, and there are no records of the Veteran receiving a diagnosis of or treatment for the condition prior to 2009. There is simply no competent evidence to support that the condition first diagnosed over 35 years after the Veteran’s discharge is related to service. The Veteran’s own lay opinion as to the onset and etiology of the peripheral vascular disease does not constitute competent evidence, as he lacks medical training or credentials. Jandreau, supra. Accordingly, there is no duty to provide the Veteran with an examination to evaluate the etiology of his peripheral vascular disease. Without any evidence in support of the Veteran’s claim, the Board finds that no medical nexus exists between the Veteran’s peripheral vascular disease and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(a), (d). As the preponderance of the evidence is against the Veteran’s claim, the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C. § 5107(b). 10. Entitlement to service connection for peripheral neuropathy of the bilateral upper and lower extremities. The Veteran seeks service connection generally for neurological symptomatology of the bilateral upper and lower extremities, which the Board has characterized together as peripheral neuropathy. Without delving into the question of the potential etiology of these separately claimed conditions, the Board finds that the Veteran has never been diagnosed with peripheral neuropathy or any other neurological conditions effecting the bilateral upper and/or lower extremities and there is no evidence to suggest that such diagnoses are appropriate; as such, entitlement to service connection must be denied for all four claimed conditions. A review of available VA and private medical records does not reflect that the Veteran has ever been diagnosed with or treated for peripheral neuropathy or any other neurological conditions impacting the bilateral upper or lower extremities. The Board does acknowledge that the Veteran has been diagnosed with and received treatment for vascular disease impacting the lower extremities as detailed above. However, he has never been diagnosed with or treated for a neurological condition effecting the extremities. VA medical records show continued and repeated denials of such symptomatology on consecutive evaluations during the entirety of the appeal period. Ultimately, there is no competent evidence that the Veteran has peripheral neuropathy or any other neurological conditions impacting the bilateral upper or lower extremities, or symptomatology that suggests that a diagnosis such a condition would be appropriate. Accordingly, without supporting records, the Board concludes that the Veteran does not have peripheral neuropathy, or any other neurological conditions impacting the bilateral upper or lower extremities and has not had such a condition during the appeal period. The Veteran himself does not have the medical training or credentials to offer an opinion as to a diagnosis or its etiology. Jandreau, supra. In the absence of competent supporting evidence, a VA examination also is not required. Service connection is denied. Brammer, supra. As the preponderance of the evidence is against the Veteran’s claim, the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C. § 5107(b). Entitlement to TDIU TDIU may be assigned when the combined schedular rating for the claimant’s service-connected disabilities is less than 100 percent, and when it is found that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age, provided that, if there is only one such disability, this disability is ratable at 60 percent or more, or, if there are two or more disabilities, there is at least one disability ratable at 40 percent or more and additional disabilities sufficient to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16. The Veteran’s service-connected disabilities, alone, must be sufficiently severe to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). The relevant issue is not whether the veteran is unemployed or has difficulty obtaining employment, but whether the veteran is capable of performing the physical and mental acts required by employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). In determining whether unemployability exists, consideration may be given to the Veteran’s level of education, special training, and previous work experience, but not to age or to any impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. Where the percentage requirements for TDIU are not met, a total disability rating may nevertheless be assigned on an extraschedular basis when the veteran is unable to secure or follow a substantially gainful occupation as a result of his or her service-connected disability or disabilities. 38 C.F.R. § 4.16(b). The Board is precluded from assigning a TDIU rating on an extraschedular basis in the first instance. Instead, the Board must refer any claim that meets the criteria for referral for consideration of entitlement to TDIU on an extraschedular basis to the Director of Compensation and Pension Service. See Bowling v. Principi, 15 Vet. App. 1, 10 (2001). Effective November 21, 2011, the Veteran was in receipt of a 10 percent rating for tinnitus and a noncompensable rating for left ear SNHL, for a combined total of 10 percent. While the Veteran does not meet the criteria for schedular consideration for TDIU, he may still be entitled to referral for consideration of an extraschedular grant of TDIU if the evidence shows that he was unable to secure or follow a substantially gainful occupation as a result of his or her service-connected disability or disabilities. 38 C.F.R. § 4.16(b). Upon review of the record, the Board finds that the preponderance of the evidence is against a determination that the Veteran was unable to secure or follow a substantially gainful occupation as a result of his service-connected tinnitus and left ear SNHL. To date, the Veteran has not provided VA with any information regarding his employment history or the circumstances of his purported inability to secure and follow substantially gainful employment, despite numerous requests for such information. A review of available VA medical records does not reflect that the Veteran has ever noted any inability to secure employment or that he has even discussed his employment history or lack thereof with VA treatment providers. Moreover, while the many VA examiners who have evaluated the Veteran on the several audiology examinations he has been afforded during the appeal period have noted that his left ear SNHL and tinnitus impair his ability to hear conversation, none of those examiners have ever concluded that the two conditions together wholly preclude his ability to secure and follow a substantially gainful occupation. In summation, the Board concludes that the preponderance of the evidence is against a determination that the Veteran has been precluded from securing and following substantially gainful employment by virtue of his service-connected disabilities. Accordingly, referral to the Director of Compensation and Pension service for extraschedular consideration of entitlement to TDIU is not warranted. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Christopher M. Collins, 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.