Citation Nr: 21010243 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 16-38 954 DATE: February 24, 2021 ORDER Service connection for diabetes mellitus, type II, to include as secondary to herbicide exposure, is denied. Service connection for peripheral neuropathy, to include as secondary to diabetes mellitus, type II, and as result of herbicide exposure is denied. Service connection for an acquired psychiatric disorder, to include a sleep disturbance, to include as due to service-connected ischemic heart disease and/or herbicide exposure is denied. Service connection for an adrenal gland disorder, to include as secondary to herbicide exposure, is denied. Service connection for benign paroxysmal vertigo/Meniere's disease, to include as secondary to herbicide exposure, is denied. REMANDED Service connection for a skin disability, to include as due to herbicide exposure is remanded. FINDINGS OF FACT 1. The Veteran served in the Republic of Vietnam during the Vietnam War and is presumed to have been exposed to certain herbicide agents. 2. The preponderance of the evidence of record is against finding that the Veteran has had diabetes mellitus, type II, at any time during or approximate to the pendency of the appeal, or that he has a blood sugar disability that is otherwise related to service. 3. Peripheral neuropathy did not manifest during service or within one year of separation or within a year after the date of his last exposure to herbicide agents. The competent and credible evidence of record fails to establish an etiological relationship between the Veteran’s peripheral neuropathy and his active service. 4. The Veteran is not diagnosed with an acquired psychiatric disability. 5. An adrenal cortical adenoma and benign paroxysmal vertigo/Meniere’s disease are not recognized by VA as causally related to exposure to herbicide agents used in Vietnam. 6. The preponderance of the competent and credible evidence of record fails to establish that an adrenal gland disorder or benign paroxysmal vertigo/Meniere’s disease manifested in service or within one year of service discharge or that they are otherwise etiologically related to the Veteran’s active service (including his in-service exposure to herbicides). CONCLUSIONS OF LAW 1. The criteria for service connection for diabetes mellitus, type II, to include as secondary to herbicides are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for a peripheral neuropathy disability, to include as secondary to diabetes mellitus, type II, and as result of herbicide exposure are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 3. The criteria for service connection for an acquired psychiatric disability are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for an adrenal gland disorder, to include as secondary to herbicide exposure are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for benign paroxysmal vertigo/Meniere’s disease, to include as secondary to herbicide exposure, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1968 to December 1969. The Veteran testified before the undersigned Veterans Law Judge in August 2019. A copy of the transcript is of record. This case was previously before the Board in January 2020, when the claims listed above were remanded for additional development. A September 2020 supplemental statement of the case was most recently issued and the claims are once again before the Board. The Board notes that documents in the Spanish language have been translated to English. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence 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, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden / Caluza element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a). Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d). In addition to the regulations cited above, service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id. Finally, 38 U.S.C. § 1154(a) requires that VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Specifically, “[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). 1. Service connection for diabetes mellitus, type II, to include as secondary to herbicides The Board will first address the Veteran’s contentions that his disability is due to his exposure to herbicides. Records in his claim file reflect that the Veteran served in Vietnam. As such, exposure to herbicides is presumed. Applicable regulations provide that a Veteran who served on active duty in Vietnam during the Vietnam era is presumed to have been exposed to Agent Orange or similar herbicide. 38 C.F.R. § 3.307(a)(1)(6)(iii). The specific statute pertaining to claimed Agent Orange exposure is 38 U.S.C. § 1116. Regulations issued pursuant thereto stipulate the diseases for which service connection may be presumed due to an association with exposure to herbicide agents. The diseases that are entitled to presumptive service connection based on herbicide exposure are listed in 38 C.F.R. § 3.309(e). 38 C.F.R. § 3.309(e) provides that presumptive service connection based on Agent Orange exposure is available for the following diseases: AL amyloidosis; chloracne or other acneform disease consistent with chloracne; type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes); Hodgkin’s disease; ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal’s angina); all chronic B-cell leukemias (including, but not limited to, hairy-cell leukemia and chronic lymphocytic leukemia); multiple myeloma; non-Hodgkin’s lymphoma; Parkinson’s disease; early onset peripheral neuropathy; porphyria cutanea tarda; prostate cancer; respiratory cancers (cancer of the lung, bronchus, larynx, or trachea); soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma). Despite the Veteran’s presumed exposure to an herbicide agent, presumptive service connection under 38 C.F.R. § 3.307(a)(6) is still not for application. Service connection is only warranted on this basis for a specific list of diseases set forth under 38 C.F.R. § 3.309(e). As the Veteran’s impaired fasting glucose is not among those listed under 38 C.F.R. § 3.309(e), an award of presumptive service connection based on herbicide exposure is not warranted. As will be explained in more detail below, the Veteran does not have a confirmed diagnosis of diabetes mellitus, type II. The Board notes that records in the claims file initially noted a possible diagnosis of diabetes mellitus. For example, an October 2018 prescription note reflects the Veteran has been prescribed Glipizide. Someone handwrote next to it “diabetes.” Additionally, a February 2019 private referral form for orthopedic surgery noted a diagnosis of “type 2 diabetes mellitus with diabetic neuropathy.” Moreover, some of the Veteran’s Social Security Administration (SSA) disability records note diabetes. The Veteran was initially afforded an April 2010 VA examination to determine his exact diagnosis. An April 2010 VA examiner, after a thorough evaluation of the Veteran and review of his records, determined that the Veteran did not have diabetes. The Veteran submitted a September 2019 Diabetes Mellitus Disability Benefits Questionnaire (DBQ). The examiner noted that the Veteran does not meet the diagnosis of diabetes. Finally, the Veteran was again afforded an additional Diabetes Mellitus examination in September 2020. Although the Veteran was diagnosed with impaired fasting glucose, the Veteran did not meet the criteria for a diagnosis of diabetes mellitus, type II. Finally, with respect to presumptive service connection under § 3.309(a), in light of the lack of medical evidence reflecting a diagnosis of diabetes mellitus, type II, within one year of the Veteran’s separation from service, service connection on a presumptive basis for this disability is also not available. 38 C.F.R. § 3.309. Next, where the evidence does not warrant presumptive service connection, the United States Court of Appeals for the Federal Circuit has determined that an appellant is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). However, the evidence does not show a causal relationship between the Veteran’s diagnosed impaired fasting glucose and in-service herbicide exposure or any other incident of active service. Review of the record reflects that the Veteran’s service treatment records do not show treatment for a blood sugar disability. A November 1969 examination, at service separation, noted a negative sugar urinalysis. Diabetes or a blood sugar disability were not demonstrated. Next, and more importantly, post-service evidence does not reflect complaints or treatment associated with glucose disability for many years after service discharge. Such tends to negate a finding for service connection based on direct service incurrence. The Veteran’s reported history of continued symptomatology since active service has also been considered but is not found to be accurate. In making this determination, the Board may consider internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board is not required to accept an appellant’s uncorroborated account of his active service experiences. Wood v. Derwinski, 1 Vet. App. 190 (1991). Notably, records do not reflect problems related to the Veteran’s glucose problems for many years following separation from service. Treatment records first reflect treatment for a glucose issue, specifically impaired fasting glucose, in October 2007. The mere absence of medical records does not contradict a Veteran’s statements about his symptom history. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). However, if it is determined based upon reliable evidence that there was an extended period of time after service without any manifestations of the claimed condition, then that tends to weigh against a finding of a connection between the disability and service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). This long period without problems weighs against the claim. The value of the Veteran’s assertions is additionally diminished, given that there is clinical evidence indicating that his blood sugar was normal at the end of his period of active service. Accordingly, the Board finds the Veteran’s statements asserting continuity of symptomatology of a glucose disability since service lack credibility and are without probative value. See, e.g. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (the Board is entitled to discount the credibility of evidence in light of its own inherent characteristics and its relationship to other items of evidence); Pond v. West, 12 Vet. App. 341 (1999) (although Board must take into consideration a veteran’s statements, it may consider whether self-interest may be a factor in making such statements). Continuity of symptomatology has not here been established, either through the competent evidence or through the Veteran’s statements. Having determined that the Veteran’s alleged clinical history regarding onset and continuity of a glucose disability is not consistent with the evidence, the Board next considers that service connection may be granted when the evidence establishes a medical nexus between active service and current complaints. Here, however, the service and post-service evidence provides particularly negative evidence against this claim. The Board has closely reviewed the medical and lay evidence in the Veteran’s claims file and finds no evidence that may serve as a medical nexus between the Veteran’s service, including herbicide exposure, and his glucose disability. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case, the etiology of a glucose disability, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). In light of the above discussion, the Board concludes that the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. 2. Entitlement to service connection for peripheral neuropathy, to include as secondary to diabetes mellitus, type II, and as result of herbicide exposure As noted above, certain diseases are deemed to be associated with herbicide exposure. These diseases include early onset peripheral neuropathy. 38 C.F.R. § 3.309(e). To qualify for presumptive service connection, early onset peripheral neuropathy must have become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service. 38 C.F.R. § 3.307(a)(6)(ii). The Veteran initially claims service connection for peripheral neuropathy secondary to diabetes mellitus. As noted above, the Board is denying service connection for diabetes mellitus. As the Veteran is not service-connected for diabetes mellitus, his secondary service connection claim for peripheral neuropathy must be denied as a matter of law. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310; see also Sabonis v. Brown, 6 Vet. App. 426 (1994). The Board notes that the RO initially obtained a secondary opinion with respect to any relationship between the Veteran’s claimed peripheral neuropathy and his service-connected ischemic heart disease. Although the medical opinion obtained in November 2015 was not adequate, the Veteran in his July 2016 substantive appeal specifically stated that he was not claiming his peripheral neuropathy as related to heart disease but rather asserting that it is related to exposure to herbicides in Vietnam. As such, a remand to obtain an additional opinion is not necessary and discussion as to whether his peripheral neuropathy is secondary to his service-connected ischemic heart disease is not warranted. The Board also considers the theory of entitlement to service connection for a peripheral neuropathy, on a direct basis. Combee v. Brown, 34 F.3d 1039, 1041-42 (Fed. Cir. 1994). The Veteran contends that he developed neuropathy due to exposure to Agent Orange during his service in Vietnam. Service treatment records do not reflect treatment for peripheral neuropathy. A November 1969 separation examination reflected a normal neurological clinical evaluation. Post-service treatment records first reflect notations of diminished patellar jerk and absent achilles tendon jerk in February 2007. An October 2015 VA treatment record noted peripheral neuropathy. The Veteran underwent a November 2015 VA Examination of Peripheral Nerves Conditions. The VA examiner diagnosed the Veteran with mixed type, sensorimotor neuropathy affecting the lower extremities by nerve conduction study. A diagnosis date of October 2014 was noted. The examiner noted the Veteran’s reports of bilateral lower extremity numbness of his lower extremities since approximately 1980. The Veteran submitted a September 2019 Diabetic Sensory-Motor Peripheral Neuropathy DBQ. No diagnosis was rendered. The Veteran was provided an additional VA examination in September 2020. After examining the Veteran, the VA examiner opined that the Veteran’s medical records do not support that any currently diagnosed condition is at least as likely as not incurred in or caused by service. The examiner noted that peripheral neuropathy had not been diagnosed in service and the medical records indicate bilateral sciatic discogenic disease status-post lumbosacral laminectomy 1977, which is years after discharge from service. The examiner stated that they did not find documentation in the claims file of complaints, evaluation, diagnosis or treatment related to peripheral neuropathy occurring within 1 year of discharge. The examiner stated that they were unable to establish a nexus and therefore, the diagnosed peripheral neuropathy and radiculopathy conditions are less likely as not caused by service. Upon review of the record, the Board finds that Veteran’s peripheral neuropathy is not related to his herbicide exposure during service. The neuropathy did not manifest to a compensable degree within a year after the date of his last exposure to herbicide agents. Additionally, there is no evidence of neuropathy, an organic disease of the nervous system, shown in service. To determine that a chronic disease was shown in service, the disease identity must be established. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Characteristic manifestations sufficient to identify the disease (neuropathy, an organic disease of the nervous system) entity were not noted. Additionally, there is no evidence of neuropathy within one year of separation from service. 38 U.S.C. § 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. § 3.303(b), 3.307, 3.309. The only other evidence of record supporting this claim is the Veteran’s general lay assertions, attributing his neuropathy to in-service herbicide exposure. Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno v. Brown, 6 Vet. App. 465 (1994) (distinguishing between competency (“a legal concept determining whether testimony may be heard and considered”) and credibility (“a factual determination going to the probative value of the evidence to be made after the evidence has been admitted”)); see also Barr v. Nicholson, 21 Vet. App. 303 (2007). The Board retains the discretion to make credibility determinations and otherwise weigh the evidence submitted, including lay evidence. Buchanan v. Nicolson, 451 F.3d 1331 (Fed. Cir. 2006). The Veteran is competent to report symptoms associated with his neuropathy and as noted herbicide exposure has been conceded. The Veteran’s statements are competent and credible in this regard. However, the Veteran is not competent to relate his neuropathy to any in-service exposure. Given the medically complex issue presented in this case, medical expertise is needed to create this nexus. The Veteran has not been medically trained. Moreover, in this case, the Board finds the opinion of the VA examiner in September 2020 to be more probative than the Veteran’s lay statements concerning the etiology of his peripheral neuropathy. The VA examiner reviewed the claims file and considered the Veteran’s reported history. She additionally used her expertise in reviewing the facts of this case and determined that the Veteran’s peripheral neuropathy is unrelated to his period of service, including presumed exposure to herbicides therein. It is clear that the VA examiner fully understood the basis for the claim yet still determined, after reviewing the facts of the case, that the Veteran’s peripheral neuropathy was not at least as likely related to service. For the foregoing reasons, the Board finds that the claim of entitlement to service connection for peripheral neuropathy, to include as a result of in-service exposure to herbicide agents, must be denied. 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); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990) 3. Service connection for an acquired psychiatric disorder, to include sleep disturbance, to include as due to service-connected ischemic heart disease and/or herbicide exposure The Veteran seeks service connection for an acquired psychiatric disability. However, the Board finds that service connection is not warranted. Service treatment records do not reflect treatment for an acquired psychiatric disability. The Veteran’s November 1969 clinical psychiatric evaluation at service separation was normal. Significantly, the evidence does not show a current disability of an acquired psychiatric disability. VA regulations require that mental disorder diagnosis be based upon the criteria provided in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association. 38 C.F.R. § 4.125 (a). Without a current disability, service connection cannot be granted. At a November 2015 VA examination, the examiner noted that the Veteran did not have, and had not been, diagnosed with a mental disorder. The examiner reviewed the claims file and interviewed the Veteran. The examiner noted that the Veteran’s service treatment record is silent for behavioral health referrals, and findings, diagnoses, or treatment for a mental disorder. It was noted that the Veteran does not have symptoms that would meet the DSM-5 criteria for a diagnosis of a mental disorder. The Veteran submitted a September 2019 Mental Disorders DBQ. The examiner noted that the Veteran does not have and has never been diagnosed with a mental disorder. The Veteran underwent an additional VA examination in March 2020. It was once again noted that the Veteran did not meet the criteria for a mental health disorder. The examiner noted the Veteran’s reports of having trouble falling asleep and staying asleep his entire life. The examiner reiterated that the Veteran does not meet the criteria for a mental health disorder. Without a diagnosis of an acquired psychiatric disability that conforms with DSM-5 criteria, there is no current disability to support the service connection claim for an acquired psychiatric disorder. See Martinez-Bodon v. Wilkie, 32 Vet. App. 393 (2020). The Board acknowledges the Veteran’s contentions and sympathizes with his symptoms. However, while he is competent to testify as to his observations, establishing a psychiatric diagnosis that meets the DSM criteria is a complex medical question which falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Therefore, the Veteran’s lay opinion as to whether he has a psychiatric diagnosis is not afforded probative value. In this case, the evidence does not show that the Veteran’s mental health symptoms result in a psychiatric diagnosis that meets the DSM criteria. Weighing against the claims are the VA examination reports and Veteran submitted DBQ, which show no diagnosis of this claimed disability. Moreover, in the March 2020 VA examination and September 2019 DBQ reports, under occupational and social impairment, the VA examiner specifically marked no mental disorder diagnosis. The Veteran’s symptoms do not constitute a disability for which service connection can be granted. For the foregoing reasons, the preponderance of the evidence reflects that the Veteran has not met the current disability requirements with regard to his claim for entitlement to service connection for an acquired psychiatric disability. The benefit of the doubt doctrine is therefore not for application in this regard and the claim for an acquired psychiatric disability on a direct or secondary basis is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 4. Service connection for an adrenal gland disorder, to include as secondary to herbicide exposure 5. Service connection for benign paroxysmal vertigo/Meniere’s disease, to include as secondary to herbicide exposure The Board first considers whether the Veteran is entitled to service connection for an adrenal gland disorder and benign paroxysmal vertigo/Meniere’s disease on a presumptive basis. Here, however, despite the Veteran’s presumed exposure to an herbicide agent during his service in Vietnam, presumptive service connection under 38 C.F.R. § 3.307(a)(6) is still not for application. Service connection is only warranted on this basis for a specific list of diseases set forth under 38 C.F.R. § 3.309(e). As the Veteran’s adrenal gland disorder and benign paroxysmal vertigo/Meniere’s disease are not among those listed under 38 C.F.R. § 3.309(e), an award of presumptive service connection based on herbicide exposure is not warranted. Additionally, with respect to presumptive service connection under § 3.309(a), in light of the lack of medical evidence reflecting a diagnosis of an adrenal gland disorder or a benign paroxysmal vertigo/Meniere’s disease disability, within one year of the Veteran’s separation from active service, service connection on a presumptive basis for this disability is also not available. 38 C.F.R. § 3.309. Next, where the evidence does not warrant presumptive service connection, the United States Court of Appeals for the Federal Circuit has determined that an appellant is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). However, the evidence does not show a causal relationship between the Veteran’s adrenal gland disorder and benign paroxysmal vertigo/Meniere’s disease disability and in-service herbicide exposure or any other incident of active service. Here, the Veteran claims that his adrenal gland disorder and benign paroxysmal vertigo/Meniere’s disease disability are the result of his service, to include exposure to herbicides. Essentially, the Veteran asserts that service connection is warranted under the theories of direct service connection and presumptive service connection. As noted above, presumptive service connection is not warranted. The Board will next address the Veteran’s contentions that his adrenal gland disorder and benign paroxysmal vertigo/Meniere’s disease are the result of service. However, the evidence does not show a causal relationship between the Veteran’s adrenal gland disorder and benign paroxysmal vertigo/Meniere’s disease and in-service herbicide exposure or any other incident of active service. The Veteran’s service treatment records are devoid of any instance of treatment for an adrenal gland disorder or benign paroxysmal vertigo/Meniere’s disease. In fact, a November 1969 separation examination reflected a normal clinical evaluation of his endocrine system and neurologic system. VA treatment records first show an adrenal gland issue in December 2013. The Veteran was given a provisional diagnosis of adrenal cortical adenoma. VA treatment records first reflect complaints of vertigo around June 2007. The Veteran’s reported history of continued symptomatology since active service has been considered but is not found to be accurate. In making this determination, the Board may consider internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board is not required to accept an appellant’s uncorroborated account of his active service experiences. Wood v. Derwinski, 1 Vet. App. 190 (1991). Notably, as noted above, treatment records first reflect a diagnosis of adrenal issues around 2013 and vertigo issues around 2007. The mere absence of medical records does not contradict a Veteran’s statements about his symptom history. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). However, if it is determined based upon reliable evidence that there was an extended period of time after service without any manifestations of the claimed condition, then that tends to weigh against a finding of a connection between the disability and service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). This long period without problems is a factor that weighs against the claims. The value of the Veteran’s assertions is additionally diminished, given that there is clinical evidence indicating that his endocrine and neurologic systems were normal at separation from service. Accordingly, the Board finds the Veteran’s statements asserting continuity of symptomatology of an adrenal gland disorder and benign paroxysmal vertigo/Meniere’s disease since service lack credibility and are without probative value. See, e.g. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (the Board is entitled to discount the credibility of evidence in light of its own inherent characteristics and its relationship to other items of evidence); Pond v. West, 12 Vet. App. 341 (1999) (although Board must take into consideration a veteran’s statements, it may consider whether self-interest may be a factor in making such statements). Continuity of symptomatology has not here been established, either through the competent evidence or through the Veteran’s statements. Having determined that the Veteran’s alleged clinical history regarding onset and continuity of an adrenal gland disorder and benign paroxysmal vertigo/Meniere’s disease is not consistent with the evidence, the Board next considers that service connection may be granted when the evidence establishes a medical nexus between active service and current complaints. Here, however, the service and post-service evidence provides particularly negative evidence against these claims. The objective medical evidence of record does not establish a link between the Veteran’s adrenal gland disorder and benign paroxysmal vertigo/Meniere’s disease, and his period of military service, to include his presumed herbicide exposure. With respect to his adrenal gland disorder claim, the Board has closely reviewed the medical and lay evidence in the Veteran’s claims file and finds no evidence that may serve as a medical nexus between the Veteran’s service, including herbicide exposure, and his claimed disability. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case, the etiology of an adrenal gland disorder, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). The Board notes that no examination was conducted nor is one warranted in conjunction with the service connection claim for an adrenal gland disorder. In this regard, under 38 U.S.C. § 5103A(d), VA’s duty to assist includes providing a claimant a medical examination or obtaining a medical opinion when an examination or opinion is necessary to make a decision on a claim and the claims file contains competent evidence that the claimant has a current disability and indicates that the disability may be associated with the claimant’s service. The types of evidence that indicate that a current disability may be associated with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Specifically, there is no indication that the Veteran’s adrenal gland disorder is related to his service. Further, the Board notes that a mere conclusory generalized lay statement that a service event or illness caused the claimant’s current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). The Court has held that VA is not required to provide a medical examination when there is not credible evidence of an event, injury, or disease in service. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010). With respect to his claim for benign paroxysmal vertigo/Meniere’s disease, the Veteran submitted a September 2019 Ear Conditions (including Vestibular and Infectious Conditions) DBQ. It was noted that the Veteran had vertigo. No nexus opinion was provided. The Veteran was afforded a September 2020 Ear Conditions VA examination. The examiner noted that the current exam results do not warrant a vertigo diagnosis and the Veteran did not have paroxysmal vertigo, Meniere’s disease or a vestibular disorder. The VA examiner opined that the medical records do not support that any currently diagnosed condition related to the Veteran’s claimed paroxysmal vertigo/Meniere’s disease are at least as like as not incurred in or caused by service. The examiner noted that there was no documentation of an ear disability in service and vertigo is not diagnosed currently. She concluded that she was unable to establish a nexus. The examiner additionally noted no documentation of this condition within 1 year of discharge from military service and stated that it was less likely as not caused by service. The examiner considered the Veteran’s herbicide exposure while in Vietnam. She noted some medical literature. She stated that the Veteran’s vertigo occurred in 2007, many years after discharge from military service and the Veteran’s service treatment records do not detail inner ear damage or a severe blow to the head. She concluded that the Veteran’s vertigo/Meniere’s disease and vestibular disability are less likely than not related to any incident/even of the Veteran’s active duty service. There are no contradictory opinions of record. The Board has closely reviewed the medical and lay evidence in the Veteran’s claims file and finds no evidence that may serve as a medical nexus between the Veteran’s service and his claim for benign paroxysmal vertigo/Meniere’s disease. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case, the etiology of his benign paroxysmal vertigo/Meniere’s disease, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). In any event, the probative value of the contentions of the Veteran is outweighed by the medical opinion of record. Thus, the Board finds that the weight of the competent and credible evidence of record is against the Veteran’s claim under the theory of direct service connection. In conclusion, the Board finds that the preponderance of the evidence is against the entitlement to service connection for an adrenal gland disorder and benign paroxysmal vertigo/Meniere’s disease, to include as due to his in-service herbicide exposure. As such, the appeal is denied. REASONS FOR REMAND Unfortunately, another remand is required in this case. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran’s claim so that he is afforded every possible consideration. 1. Service connection for a skin disorder to include as due to herbicide exposure The Board remanded the Veteran’s claim in January 2020, in order to provide the Veteran with a VA examination and opinion. The Board notes that the Veteran has claimed that his currently diagnosed skin disabilities are due to service, to include herbicide exposure. Additionally, the Veteran asserted in an April 2015 VA treatment record that he worked in construction during service and was exposed to a lot of sun in service. The Veteran was most recently afforded a September 2020 VA examination. He was diagnosed with actinic keratosis of the left arm and left hand and status post removal of squamous cell carcinoma of the left arm. In an accompanying opinion, the VA examiner provided a negative nexus opinion. However, the examiner noted that she was unable to tell from the evidence if the Veteran’s squamous cell carcinoma was invasive and was therefore unable to establish a nexus without a pathology report. Additionally, the examiner noted that literature supports that UV rays from the sun cause almost all actinic keratoses. She did not consider the Veteran’s alleged sun exposure in service when then formulating her negative opinion. Given the deficiencies in the September 2020 VA opinion, the Board finds that an addendum opinion is necessary to determine the etiology of the Veteran’s currently diagnosed skin disability. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The matters are REMANDED for the following actions: 1. Obtain outstanding skin treatment records. The September 2020 VA examiner noted in their medical opinion that they needed information regarding whether or not the Veteran’s squamous cell carcinoma is invasive. It was noted that pathology reports could not be found related to a May 2018 diagnosis. Attempts to obtain these records should be made. 2. Following the development in remand paragraph one, obtain an addendum opinion from an appropriate clinician regarding: • Whether the Veteran’s skin disability is at least as likely as not related to his in-service sun exposure. In this regard, the examiner should specifically address the Veteran’s contentions that he was exposed to excessive sun every day while working in construction during service. • Whether it is at least as likely as not (i.e., probability of approximately 50 percent) that any diagnosed skin disability is related to service, to include exposure to herbicide agents. A complete rationale for the requested opinions should be provided. If the examiner feels that the requested opinions cannot be rendered without resorting to speculation, he or she must explain why this is so. 3.After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran’s claim should be readjudicated based on the entirety of the evidence. If any of the claims remain denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. M. Clark, 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.