Citation Nr: 21013106 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 18-48 299 DATE: March 8, 2021 ORDER New and material evidence has been received to reopen the claim of entitlement to service connection for an acquired psychiatric disability, to include PTSD and depression; it is reopened. Entitlement to service connection for an acquired psychiatric disability, to include PTSD and depression is granted. Entitlement to service connection for chronic lymphocytic leukemia is granted. Entitlement to service connection for chronic fatigue syndrome is granted. Entitlement to service connection for sleep apnea is granted. Entitlement to service connection for a left shoulder rotator cuff tear is granted. Entitlement to service connection for a heart disability is granted. Entitlement to service connection for migraines, claimed as headaches, is granted. Entitlement to service connection for a right foot disability is granted. Entitlement to service connection for a left foot disability is granted. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for dyslipidemia is denied. Entitlement to a compensable evaluation for allergic rhinitis is denied. REMANDED Entitlement to service connection for a neck disability is remanded. Entitlement to service connection for immunoglobin M deficiency is remanded. FINDINGS OF FACT 1. Evidence added to the record since the final July 1995 rating decision presents a reasonable possibility of substantiating the Veteran’s acquired psychiatric disorder claim. 2. The Veteran’s acquired psychiatric disorder is related to the Veteran’s active service. 3. The Veteran’s chronic lymphocytic leukemia is proximately due to his service-connected acquired psychiatric disability. 4. The Veteran’s chronic fatigue syndrome is proximately due to his service-connected chronic lymphocytic leukemia. 5. The Veteran’s sleep apnea started while he was in service, and was caused and permanently aggravated by his multiple psychiatric conditions and use of SNRI and Gabapentin for said conditions. 6. The Veteran’s left shoulder rotator cuff tear is related to the Veteran’s active service, to include a fall. 7. The Veteran’s heart disease, to include coronary artery disease, was aggravated beyond its natural progression by service-connected acquired psychiatric disability. 8. The Veteran’s migraines started while he was in service and continued until his death. 9. The Veteran’s left foot disability, to include pes planus, began in service, and continued since then until the Veteran’s death. 10. The Veteran’s right foot disability, to include pes planus, began in service, and continued since then until the Veteran’s death. 11. The Veteran has a diagnosis of hyperlipidemia, which is a form of dyslipidemia; however, this is considered a laboratory reading and not a disability for VA compensation purposes. 12. The Veteran’s bilateral hearing loss did not manifest during service, or within one year of separation, and is not shown to be causally or etiologically related to an in-service event, injury or disease. 13. The Veteran’s allergic rhinitis has not created obstruction of at least 50 percent in either nasal passage or polyps during the course of the appellate period. CONCLUSIONS OF LAW 1. New and material evidence has been received to reopen the previously denied claims of entitlement to service connection for n acquired psychiatric disability. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (a) (2019). 2. The criteria for service connection for an acquired psychiatric disability are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 3. The criteria for service connection for chronic lymphocytic leukemia as secondary to an acquired psychiatric disability are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2019). 4. The criteria for service connection for chronic fatigue syndrome as secondary to chronic lymphocytic leukemia are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2019). 5. The criteria for entitlement to service connection for sleep apnea are met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 6. The criteria for service connection for a left shoulder rotator cuff tear are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 7. The criteria for service connection for heart disease, to include coronary artery disease as secondary to an acquired psychiatric disability, are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2019). 8. The criteria for entitlement to service connection for migraines are met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 9. The criteria for entitlement to service connection for a left foot disability are met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 10. The criteria for entitlement to service connection for a right foot disability are met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 11. Dyslipidemia/hyperlipidemia is not a disease, disability, or injury for which applicable law permits the award of service connection. U.S.C. §§ 101 (16), 105(a), 1110, 1131 (2012); 38 C.F.R. § 3.303 (c) (2019). 12. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309, 3.385. 13. The criteria for entitlement to a compensable evaluation for allergic rhinitis have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.97, DC 6522. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1974 to December 1975. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran passed away in March 2019; the Appellant is his surviving spouse and has been substituted as claimant. New and Material Evidence 1. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for an acquired psychiatric disability, to include PTSD and major depressive disorder In the July 1995 VA rating decision, service connection for a psychiatric condition was denied because the condition was considered constitutional or developmental abnormality, and the diagnosed major depression was noted to be related to post-service causes. The Veteran was notified of this action and of his appellate rights but did not file a timely NOD or submit new and material evidence within a year thereafter. Therefore, the July 1995 VA rating decision is final. See 38 U.S.C. § 7105 (b), (d); 38 C.F.R. §§ 20.204, 20.302, 20.1103. The Board has no jurisdiction to consider a claim based on the same factual basis as a previously disallowed claim. 38 U.S.C. § 7104 (b); King v. Shinseki, 23 Vet. App. 464 (2010); DiCarlo v. Nicholson, 20 Vet. App. 52, 55 (2006). However, the finality of a previously disallowed claim can be overcome by the submission of new and material evidence. See 38 U.S.C. § 5108. New evidence means existing evidence not previously submitted to agency decision makers. Evidence that is merely cumulative of other evidence in the record cannot be new and material even if that evidence had not been previously presented to the Board. Anglin v. West, 203 F.3d 1343 (Fed. Cir. 2000). Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). Evidence received since the July 1995 VA rating decision includes a February 2019 private disability benefits questionnaire and etiological opinion, which confirmed the Veteran’s diagnosis of major depressive disorder, and concludes that it more likely than not is related to military service. The Board finds that this evidence is new and material to the element of establishing an in-service incurrence and a nexus to service, which was not established at the time of the July 1995 VA rating decision. As a result, this claim is reopened. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. §§ 3.156 (a), 3.303. Service Connection 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, 1131 (2012); 38 C.F.R. § 3.303 (a) (2018). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called “nexus” requirement. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d) (2018). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b) (2012); 38 C.F.R. § 3.102 (2018). When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 2. Entitlement to service connection for an acquired psychiatric disability, to include major depressive disorder The Appellant contends that the Veteran’s acquired psychiatric disability is related to service. The Board concludes that the Veteran had a current disability during the pendency of the appeal that began during active service. 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). A February 2019 disability benefits questionnaire (DBQ) shows the Veteran had a diagnosis of major depressive disorder. Service treatment records show that between August 1974 and March 1975, the Veteran had many unauthorized absences; in February 1975 he was noted to have a constant disregard for discipline and authority; he was recommended for an administrative discharge due to unfitness; in April 1975, the Veteran was asked to have a psychiatric evaluation, which he refused; in November 1975, he was recommended for administrative separation due to character and behavior disorders; and in November 1975 the Veteran’s discharge was approved by reason of unsuitability due to defective attitudes. Thus, the question becomes whether the disability is related to service. On this question the only probative opinion of record is in favor of the claim. The evidence in favor of the claim includes a February 2019 private medical opinion, associated with the February 2019 DBQ by Dr. H.H.G. Pertinently, the private provider opined that the Veteran suffered from major depressive disorder, which more likely than not began in military service and continued uninterrupted since. In support of this opinion, it was noted that the Veteran was diagnosed with a personality disorder in service, and while such a disorder may have been part of the Veteran’s mental health at one time, his symptom presentation was reflective of a complex major depressive disorder embodying both depression and anxiety. The provider acknowledged that the Veteran had multiple mental health issues in his records, which endorsed the ongoing severity of his disease, which was namely major depressive disorder. The Veteran’s lay statements were also cited, including reports that his depression began in the military when he learned his marriage was irretrievably broken. Other lay statements of record from family members corroborating this account were also referenced. The Board notes that Dr. H.H.G. conducted a thorough review of the Veteran’s post-service treatment records, documenting continued mental health treatment, as well as pertinent medical journal articles. The opinion of record is probative. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There are no probative contrary opinions of record. In sum, the medical evidence establishes that the Veteran’s mental health diagnoses are related to service. Accordingly, the evidence weighs in favor of the claim and there is no doubt to be otherwise resolved. As such, service connection for an acquired psychiatric disorder is warranted and the appeal is granted. Because the Board is granting service connection on a direct basis, all other theories of service connection are rendered moot. 3. Entitlement to service connection for chronic lymphocytic leukemia The Appellant contends that the Veteran’s chronic lymphocytic leukemia is related to service. Leukemia is a chronic disease listed under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.303(b) applies. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a chronic disease in service or continuity of symptoms after service, the disease shall be presumed to have been incurred in service. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases, such as chronic myeloid leukemia, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. Where a disease is not manifest to a compensable within one year of service discharge, a veteran is not precluded from establishing service connection on a direct basis. See 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d) (the availability of service connection on a presumptive basis does not preclude consideration of service connection on a direct basis). A disability can also be service connected on a secondary basis if it is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310(a). Moreover, secondary service connection may be established, as well, by any increase in severity (i.e., aggravation) of a nonservice-connected condition that is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310(b), effective October 10, 2006. See 71 Fed. Reg. 52,744-52,747 (September 7, 2006). See also Allen v. Brown, 7 Vet. App. 439, 448 (1995); Tobin v. Derwinski, 2 Vet. App. 34, 39 (1991). Where a service-connected disability aggravates a nonservice-connected condition, a veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Allen, 7 Vet. App. at 448. In short, in order to establish entitlement to service connection on this secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) probative evidence establishing a nexus (i.e., link) between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). A February 2017 VA examination shows the Veteran had a current diagnosis of chronic lymphocytic leukemia (CLL), initially diagnosed in March 1999. It was noted that a 1987 examination of the Veteran revealed that he had an elevated white blood cell count. The Board notes that service connection is granted herein for an acquired psychiatric disability. The evidence in favor of the claim includes an August 2020 private medical opinion letter from Dr. M.B, who concludes, based on a review of the record, that the Veteran’s ongoing mental health symptoms at least as likely as not contributed to the development and continued aggravation of his CLL. It was reasoned that the young age of onset of CLL and medical research supports this conclusion. Specifically, Dr. M.B. referenced the Veteran’s mental health issues in service, medical research showing that chronic stress is associated with the pathogenesis of cancer, including via significant doses of stress hormones and prostaglandins. Further referenced were statistics from the American Cancer Society which show the average onset of CLL is approximately 70 years, while the Veteran was diagnosed when he was significantly younger – 44 years of age. Dr. M.B.’s opinion is probative, as it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There are no contrary opinions of record. Upon review of the record, the Board finds the preponderance of the evidence to be in favor of the claim. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for chronic lymphocytic leukemia is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 4. Entitlement to service connection for chronic fatigue syndrome The Appellant contends the Veteran’s chronic fatigue syndrome (CFS) is related to service, or in the alternative, to a service-connected disability. The January 2017 VA examination reflects that the Veteran had a current disability of chronic fatigue syndrome. The same VA examiner noted that the Veteran’s oncologist diagnosed him with CFS due to chronic lymphocytic leukemia – which has been service-connected herein. In this regard, the Board notes that review of the Veteran’s VA medical records dated in April 2017 shows that the Veteran presented his VA provider with a note from Dr. E.S. Dr. E.S. opined that the Veteran’s chronic fatigue is likely due to chronic lymphocytic leukemia, psychiatric diagnoses and associated medications. Service connection is now in place for leukemia and acquired psychiatric disability. There are no contrary etiological opinions of record. Upon review of the record, the Board finds the preponderance of the evidence to be in favor of the claim. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for sleep apnea is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. Entitlement to service connection for sleep apnea The Appellant contends that the Veteran’s diagnosed sleep apnea disability related to service. The Board concludes that the Veteran had a current disability during the pendency of the appeal that began during active service. 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). An August 2020 private DBQ noted that the Veteran was diagnosed with sleep apnea in January 2016. The Veteran’s reported symptoms included loud snoring, gasping and daytime sleepiness since service. Thus, the question becomes whether the disability is related to service. On this question the only probative opinion of record is in favor of the claim. The evidence in favor of the claim includes an August 2020 private medical opinion letter from Dr. M.B, who concludes, based on a review of the record, including the lay statements from the Appellant, that the Veteran’s sleep apnea began in service and continued thereafter. In this regard, Dr. M.B. noted the Veteran’s service-connected comorbidities, including his psychiatric disability– and based on cited medical research – psychiatric disabilities cause sleep apnea. Further, Dr. M.B. noted the Veteran’s boot camp colleague’s testimony, who reported the Veteran was snoring loudly and would stop breathing during his sleep while in service. Further, Dr. M.B. noted the Appellant’s testimony, reporting that throughout her time with the Veteran, he suffered from loud snoring and gasping symptoms. Additionally, medical research showing a higher prevalence of sleep apnea in subjects with depression as well as patients using SNRI medications and Gabapentin. Dr. M.B. opined that the Veteran’s sleep apnea started while he was in service, and was caused and permanently aggravated by his multiple psychiatric conditions and use of SNRI and Gabapentin for said conditions. The opinion of record is probative. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There are no probative contrary opinions of record. Upon review of the record, the Board finds the preponderance of the evidence to be in favor of the claim. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for sleep apnea is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 6. Entitlement to service connection for a left shoulder rotator cuff tear The Appellant contends that the Veteran’s left shoulder disability, to include rotator cuff tear, is related to service. The Board concludes that the Veteran had a current disability during the pendency of the appeal that began during active service. 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). A September 2016 VA examination shows the Veteran had a current diagnosis of left shoulder rotator cuff tear. Service treatment records dated in September and October 1975 document a fall on the Veteran’s left shoulder, for which he was evaluated to have a probable AC separation and possible tear, and was diagnosed with a contusion. The Veteran also reported continued pain in his left shoulder. Thus, the question becomes whether the disability is related to service. On this question the only probative opinions of record are in favor of the claim. The evidence in favor of the claim includes an August 2020 private medical opinion letter from Dr. M.B, who concludes, based on a review of the record, including the lay statements from the Appellant, that the Veteran’s left shoulder disability was related to service. Dr. M.B. cited statements from the Veteran’s sister, who reported that he complained of shoulder pain since his return from service. Also cited were subsequent treatment records, including a rotator cuff repair note in 2001 and complaints of persistent pain in medical records between 2002 and 2006. It was further reasoned that the Veteran’s left shoulder was in a weakened state since service, which would make further injury more probable. In addition to the private opinion of Dr. M.B., a VA medical opinion dated in April 2020 is associated with the record. Pertinently, the VA examiner opined that the Veteran’s left shoulder disability is related to service. It was reasoned that the Veteran’s medical records support that any currently diagnosed left shoulder condition is related to a left shoulder injury in service and subsequent physical therapy during service. The opinions of record are probative. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There are no probative contrary opinions of record. Upon review of the record, the Board finds the preponderance of the evidence to be in favor of the claim. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a left shoulder disability, to include a rotator cuff tear is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 7. Entitlement to service connection for migraines The Appellant contends that the Veteran’s diagnosed migraines are related to service. The Board concludes that the Veteran had a current disability during the pendency of the appeal that began during active service. 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). A January 2017 VA examination shows the Veteran had a current diagnosis of migraines. The examiner noted these migraines began in 1974. The Veteran had reported that his headaches started after his wife left while he was in service. Thus, the question becomes whether the disability is related to service. On this question the only probative opinion of record is in favor of the claim. The evidence in favor of the claim includes an August 2020 private medical opinion letter from Dr. M.B, who concludes, based on a review of the record, including the lay statements from the Appellant, that the Veteran’s migraines began in service and continued thereafter. Dr. M.B. noted that the Veteran’s service-connected comorbidities, including psychiatric disability, tinnitus and allergic rhinitis also began in service – and based on cited medical research – these disabilities cause headaches. Further, Dr. M.B. noted the Veteran’s testimony as well as the Appellant’s, reporting that since his separation from service, and throughout their time together, he suffered from headache symptoms. The Veteran is competent to testify to such lay observable symptomatology, and these statements are credible. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Headaches and pain are lay observable symptoms. The opinion of record is probative. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There are no probative contrary opinions of record. Upon review of the record, the Board finds the preponderance of the evidence to be in favor of the claim. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for migraines is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 8. Entitlement to service connection for heart disease The Appellant contends that the Veteran’s heart disease is related to service. Through the appeal period, the Veteran was diagnosed with coronary artery disease, acute myocardial infarction and coronary artery bypass graft. See January 2017 VA examination. A disability can be service connected on a secondary basis if it is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310(a). Moreover, secondary service connection may be established, as well, by any increase in severity (i.e., aggravation) of a nonservice-connected condition that is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310(b), effective October 10, 2006. See 71 Fed. Reg. 52,744-52,747 (September 7, 2006). See also Allen v. Brown, 7 Vet. App. 439, 448 (1995); Tobin v. Derwinski, 2 Vet. App. 34, 39 (1991). Where a service-connected disability aggravates a nonservice-connected condition, a veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Allen, 7 Vet. App. at 448. In short, in order to establish entitlement to service connection on this secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) probative evidence establishing a nexus (i.e., link) between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). The Board notes that service connection is granted herein for an acquired psychiatric disability. The evidence in favor of the claim includes an August 2020 private medical opinion letter from Dr. M.B, who concludes, based on a review of the record, that the Veteran’s ongoing mental health symptoms at least as likely as not contributed to the development and continued aggravation of his coronary artery disease. The provider noted the lay statements of record from friends and family, who testified that after service, the Veteran experienced depression, irritability, difficulty sleeping and substance abuse. The Veteran also testified he experienced stress, irritability and anger issues among other symptoms. In addition, Dr. M.B. referenced medical research which shows a link between psychological distress and the development of heart disease. Specifically, it was explained that the physical symptoms of anxiety such as rapid heartbeat, increased blood pressure and decreased heart rate variability can be especially damaging. Further referenced was research from the American Heart Association, which concludes that depressive symptoms raise the risk of mortality after acute myocardial infarction and constitute risk factors which contribute to the development of cardiac complications. Dr. M.B.’s opinion is probative, as it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There are no contrary opinions of record. Upon review of the record, the Board finds the preponderance of the evidence to be in favor of the claim. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for heart disease is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 9. Entitlement to service connection for a left foot disability 10. Entitlement to service connection for a right foot disability The Appellant contends that the Veteran’s bilateral foot disability, to include bilateral pes planus, is related to service. The Board concludes that the Veteran had a current disability during the pendency of the appeal that began during active service. 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). A December 2018 VA examination shows the Veteran had a current diagnosis of bilateral pes planus. Service treatment records dated in September 1974 reflect treatment for and diagnosis of painful pes planus; October 1974 service records show treatment for sore feet; November 1974 service records reflect an evaluation for symptomatica pes planus; was seen in July 1975 for left foot pain; and was seen in August 1975 for swollen feet, when he was also noted to be flat footed with fallen arches. Thus, the question becomes whether the current disability is related to service. On this question the only probative opinion of record is in favor of the claim. The evidence in favor of the claim includes an August 2020 private medical opinion letter from Dr. M.B, who concludes, based on a review of the record, including the lay statements from the Appellant, that the Veteran’s bilateral pes planus disability began in service and continued up to his death. It was reasoned that the Veteran did not have any foot problems noted on entry into service; he was seen and treated for bilateral pes planus in service; and his problems continued thereafter passed on a review of the records. Dr. M.B.’s opinion is probative, as it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There are no contrary opinions of record. Upon review of the record, the Board finds the preponderance of the evidence to be in favor of the claim. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a bilateral foot disability, to include pes planus is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 11. Entitlement to service connection for bilateral hearing loss The Board concedes that the first Shedden element of a current disability has been met, as the Veteran was diagnosed with bilateral hearing loss sufficient to meet VA disability standards. See September 2016 VA examination report, discussed below. The Board acknowledges the Veteran’s reports of being exposed to acoustic trauma in service to be credible given his consistent statements of noise exposure and his military occupation specialty as antitank artillery man. Service incurrence of acoustic trauma has been demonstrated. The second Shedden element has also been met. Therefore, the remaining pertinent element to be discussed is that of a nexus between the Veteran’s current hearing loss and service. According to his service treatment records, the Veteran’s Report of Medical Examination are absent of complaint, treatment, or diagnosis for hearing problems. A review of the record reveals that at the time of the Veteran’s September 1975 separation examination revealed no sensorineural hearing loss. In September 2016, the Veteran underwent a VA examination to assess the nature and etiology of his hearing loss. Pertinently, the examiner opined it was less likely than not any hearing loss was related to military noise exposure. The examiner reasoned that there were no significant positive threshold changes in both ears during military service. After reviewing all the pertinent evidence of record, the Board finds that the preponderance of the evidence is against the claim for service connection for bilateral hearing loss. Initially, the Board finds that presumptive service connection is not warranted as there is no evidence to show that the Veteran was diagnosed or had onset of bilateral hearing loss either during service or within the first year after separation from service. The Board finds it significant that the Veteran’s separation examination shows he had a normal audiological examination. The only medical opinion to address the medical relationship, if any, between the Veteran’s bilateral hearing loss and active service weighs against the claim. The September 2016 VA examiner’s opinion considered all the evidence of record, to include the Veteran’s assertion that his hearing loss was caused by noise exposure during active service, and opined that the Veteran’s bilateral hearing loss is not related to service. The Board finds that this opinion constitutes probative evidence on the medical nexus question, based on a review of the Veteran’s documented medical history, assertions, and physical examination. The opinion provides clear rationale based on an accurate discussion of the evidence of record, to include consideration of in-service and post-service noise exposure, as well as the Veteran’s opinions regarding the etiology of his hearing loss. Prejean v. West, 13 Vet. App. 444 (2000). The Board has considered the Veteran’s assertions that his hearing problems were due to his military service. In that regard, the Board acknowledges that the Veteran can attest to factual matters of which he has first-hand knowledge. His assertions in that regard are entitled to some probative weight. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Laypersons, however, are not generally competent to render an opinion as to the cause or etiology of a disability such as hearing loss because they do not have the requisite medical knowledge or training. See Rucker v. Brown, 10 Vet. App. 67, 74 (1997) (stating that competency must be distinguished from weight and credibility, which are factual determinations going to the probative value of the evidence). Moreover, they are not always competent to diagnose themselves with a disability. As there is no competent evidence of linking the Veteran’s bilateral hearing loss to his in-service noise exposure, the Board concludes that the preponderance of the evidence is against granting service connection. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply, and the claim for entitlement to service connection for bilateral hearing loss must be denied. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). 12. Entitlement to service connection for dyslipidemia is denied. The Appellant contends that the Veteran’s dyslipidemia, to include hyperlipidemia, is related to service. The record reflects that the Veteran has a diagnosis of hyperlipidemia during the pendency of the appeal. Concerning the dyslipidemia and hyperlipidemia, dyslipidemia is defined as “abnormality in, or abnormal amounts of, lipids and lipoproteins in the blood.” Dorland’s Illustrated Medical Dictionary 586 (31st ed. 2007). Hyperlipidemia refers to the “elevated concentration of any or all of the lipids in the plasma.” Dorland’s Illustrated Medical Dictionary 903 (31st ed. 2007). These are not considered disabilities in and of themselves. See 61 Fed. Reg. 20,440, 20,445 (May 7, 1996). In this regard, the Board notes its reliance on a medical dictionary to define a term is not in error. See O’Bryan v. McDonald, 771 F.3d 1376, 1380 (Fed. Cir. 2014). As noted above, VA’s position is that dyslipidemia, hyperlipidemia and elevated cholesterol are laboratory findings and are not disabilities in and of themselves for which VA compensation benefits are payable. See 61 Fed. Reg. 20,440, 20,445 (May 7, 1996). There is no case law to the contrary. See Neary v. Shinseki, No. 11-1407, 2012 WL 3641438 (Vet. App. Aug. 24, 2012). Service connection can only be granted for a disability due to disease or injury or caused or aggravated by service connected disease or injury. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310 (a),(b)}. In this case, although treatment records reflect hyperlipidemia and dyslipidemia, given the above definitions and position of VA with regard to the nature of dyslipidemia, hyperlipidemia and elevated cholesterol, the Board finds that the conditions for which the Veteran is claiming service connection are laboratory findings that manifest themselves only in laboratory test results and are not disabilities for which service connection can be granted. As such, service connection for dyslipidemia, to include hyperlipidemia, is denied. Increased Rating Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2 (2018). Consideration of factors wholly outside the rating criteria constitutes error as a matter of law. Massey v. Brown, 7 Vet. App. 204, 207-08 (1994). Evaluation of disabilities based upon manifestations not resulting from service-connected disease or injury and the pyramiding of ratings for the same disability under various diagnoses is prohibited. 38 C.F.R. § 4.14 (2018). It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case with all reasonable doubt to be resolved in favor of the claimant. However, the reasonable doubt rule is not a means for reconciling actual conflict or a contradiction in the evidence. 38 C.F.R. § 4.3 (2019). 13. Entitlement to a compensable evaluation for allergic rhinitis The Veteran’s rhinitis is evaluated under 38 C.F.R. § 4.97, DC 6522. To warrant a 10 percent evaluation, the Veteran must have greater than 50 percent obstruction of the nasal passage on both sides, or a complete obstruction on one side. To warrant an evaluation in excess of 30 percent for allergic or vasomotor rhinitis, there must be polyps. The Veteran has had several VA examinations regarding this condition that are relevant to the period on appeal: one in September 2016 and, and one in February 2017. All examinations have noted that the Veteran did not have a 50 percent or greater obstruction of the nasal passage on both sides or complete obstruction on one side, and have also noted that the Veteran’s condition did not present with polyps, hypertrophy or granulomatous conditions. The Veteran was noted to take over-the-counter medications as needed, and was also noted to have had a deviated septum. The Veteran did not meet the schedular criteria for a compensable evaluation for any portion of the appellate period, which requires at least a 50-percent obstruction of the nasal passage or nasal polyps. Medication is not a relevant factor in determining the percentage of disability for this condition, and the record does not suggest that he was functionally impaired as a result of taking medication. The Veteran’s allergic rhinitis does not warrant a higher evaluation based on the schedular criteria. The evidence preponderates against the claim for an increased rating, and there is no doubt to resolve. 38 C.F.R. § 4.3. The claim for an increase remains denied. REASONS FOR REMAND 1. Entitlement to service connection for a neck disability is remanded. When VA undertakes to obtain an examination/opinion, it must ensure that the examination/opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion/examination is considered adequate “where it is based on consideration of the veteran’s prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board’s evaluation of the claimed disability will be a fully informed one.” Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The Veteran was afforded VA examinations in February 2017 to assess the nature and etiology of his neck disability. While the examiners assessed the Veteran had a current clinical diagnosis, there is no etiological opinion of record. Therefore, the examination is inadequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As such, the Board finds remand is necessary for an addendum opinion addressing the etiology of the claimed neck disability. In this regard, the Board notes that in September 1975 medical records, a backwards fall is documented, and in the February 2017 VA examination, the Veteran reported injuring his neck and shoulder while playing football in service. 2. Entitlement to service connection for an immune disorder, to include immunoglobulin M deficiency A medical examination or medical opinion is necessary in a claim for service connection when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. § 5103A (d)(2) (2012); 38 C.F.R. § 3.159 (c)(4)(i) (2019). The McLendon elements are met with regard to the Immunoglobulin M deficiency claim. During the appellate period, the Veteran is shown to have had a diagnosis of selective immunoglobulin M deficiency. See July and October 2016 VA medical records. In addition, the same VA treatment records are suggestive that the deficiency may be triggered by allergies, including service-connected allergic rhinitis. However, the Veteran was not afforded a VA examination, nor was a medical opinion sought to assess the nature and etiology of the Immunoglobulin M deficiency. The matters are REMANDED for the following action: 1. Forward the claims file to an appropriate VA clinician to obtain addendum opinions regarding the Veteran’s neck disability. Following review of the claims file, the clinician should opine: Whether it is at least as likely as not (50 percent probability or greater) that any neck disability had its onset during service or is otherwise related to service. In so doing, the clinician must review the entire claims file, including but not limited to the February 2017 VA examination, as well as service treatment records showing a back fall in service. A complete rationale should be provided for all opinions and conclusions expressed. If the clinician cannot provide an opinion without resort to speculation, it is essential that he or she explain why an opinion cannot be provided (i.e. lack of records, limits of medical knowledge, etc.). 2. Thereafter, forward the claims file to an appropriate VA clinician to obtain an addendum opinion regarding the Veteran’s Immunoglobulin M deficiency claim. Following review of the claims file, the clinician should opine: Whether it is at least as likely as not (50 percent probability or greater) that any Immunoglobulin M deficiency, had its onset during service or is otherwise related to service or to a service-connected disability. In so doing, the clinician must review the entire claims file, including but not limited to July and October 2016 VA medical records, which diagnosed the disability. Further, the examiner should specifically comment on the suggestion that the Immunoglobulin M deficiency may be related to the Veteran’s allergies, including allergic rhinitis. A complete rationale should be provided for all opinions and conclusions expressed. If the clinician cannot provide an opinion without resort to speculation, it is essential that he or she explain why an opinion cannot be provided (i.e. lack of records, limits of medical knowledge, etc.). Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.