Citation Nr: 21014901 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 14-24 378 DATE: March 16, 2021 ORDER 1. Entitlement to service connection for a heart disability, to include as being due to exposure to herbicide agents, is denied. 2. Entitlement to service connection for a urinary disability, to include as being due to exposure to herbicide agents, is denied. 3. Entitlement to service connection for bilateral foot disability, to include tumors and numbness of the feet, and to include as being due to exposure to herbicide agents, is denied. 4. Entitlement to service connection for a right leg disability is denied. 5. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), major depressive disorder (MDD), Adjustment Disorder, and Insomnia, is denied. 6. Entitlement to an initial increased rating in excess of 10 percent for Type II diabetes mellitus is denied. FINDINGS OF FACT 1. The Veteran served in Vietnam and was exposed to Agent Orange during military service. 2. The Veteran’s heart and urinary disabilities did not have its onset in service and is not otherwise related to service, to include herbicide agent exposure. 3. The Veteran does not have diagnosis of a bilateral foot disability, manifested as numbness, that is separate from already service-connected peripheral neuropathy; the Veteran’s bilateral pes planus, hallux valgus, and excision of plantar fibromas did not have its onset in service and is not otherwise related to service, to include herbicide agent exposure. 4. The preponderance of the evidence of record is against finding that the Veteran’s right leg disability is related to service. 5. The preponderance of the evidence of record is against finding that the Veteran has had PTSD, or any other psychiatric disorder, at any time during or approximate to the pendency of the claim. 6. For the entire appeal period, the Veteran’s diabetes was managed by restricted diet only. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a heart disability, to include as being due to herbicide exposure, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 2. The criteria for entitlement to service connection for a urinary disability, to include as being due to herbicide exposure, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 3. The criteria for entitlement to service connection for a bilateral foot disability, to include as being due to herbicide exposure, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 4. The criteria for service connection for right leg disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 5. The criteria for entitlement to service connection for a psychiatric disorder, to include PTSD, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.125. 6. The criteria for an initial increased rating in excess of 10 percent for type II diabetes mellitus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.119, Diagnostic Code (DC) 7913. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1968 to October 1970. The Board of Veterans’ Appeals (Board) notes that prior to certification of the appeal to the Board, in an October 2020 rating decision, the RO granted service connection for bilateral lower extremity peripheral neuropathy as secondary to service-connected type II diabetes mellitus. This represents a full grant of the benefits sought and thus this issue is no longer before the Board. Regarding VA’s duty to assist, the record reflects that VA has made reasonable efforts to obtain service records. In a July 2007 administrative memorandum, VA found that the Veteran’s service treatment records (STRs) were not available and that further attempts to obtain them would be futile. Pursuant to the June 2018 Board remand, the AOJ attempted to obtain the Veteran’s STRs, however, a May 2019 Request for Information indicated that all available service records were sent in March 2019, as explained to the Veteran in the November 2020 supplemental statement of the case. When service treatment records are lost or missing, through no fault of the Veteran, VA has a heightened obligation to consider the applicability of the benefit of the doubt rule, to assist the claimant in developing the claim, and to explain its decision. No presumption, however, either in favor of the claimant or against VA, arises when there are lost or missing service records. The AOJ notified the Veteran of these missing STRs in a March 2019 notice and asked the Veteran to send any records still in his possession but received no further records from the Veteran. The Board concludes that all procedures to obtain any missing service treatment records were correctly followed. Since all efforts have been exhausted, further attempts would be futile. 38 C.F.R. § 3.159(c)(2), (3). With regard to the VA medical opinions obtained, although the Board requested that the VA examiner address whether the Veteran’s heart, urinary, and bilateral foot disabilities are related to the Veteran’s exposure to Agent Orange, given that the Veteran had not proffered evidence to support a connection between the disabilities and Agent Orange exposure and the examiners addressed whether the disability was related to service, the Board finds the VA examinations to be adequate and no additional action is required. The Veteran’s claim of entitlement to service connection for a heart disability was previously denied in an unappealed August 2007 rating decision. The agency of original jurisdiction (AOJ) adjudicated the claim on a de novo basis under the liberalizing regulation that creates a presumptive basis for the grant of service connection for issues such, to include ischemic heart disease, as secondary to herbicide exposure. See 75 Fed. Reg. 53, 202 (Aug. 31, 2010). The final rule noted that VA will apply this rule in re-adjudicating certain previously denied claims as required by court orders in Nehmer v. U.S. Department of Veterans Affairs, 284 F.3d 1158 (2002). Additionally, the RO previously denied the Veteran’s claim for service connection for hypertension. However, in the current appeal, the Veteran’s claim stems from a Nehmer review by the AOJ involving ischemic heart disabilities. The Board considers the heart disability claim under Nehmer to be a separate and distinct diagnosis from hypertension, and it is not part of the factual basis of the prior denial. Boggs v. Peake, 520 F. 3d 1330 (Fed. Cir. 2008); 38 C.F.R. § 3.156. See 38 C.F.R. § 4.104, Diagnostic Codes 7000, 7007, and 7020 (Cardiac valvular disorders are distinct from hypertensive heart disease and cardiomyopathies); 38 C.F.R. § 4.104, Diagnostic Code 7101 (hypertension classified as a disease of the arteries and veins). Significantly, the Veteran has not filed an application to reopen a claim for service connection for hypertension. Therefore, the current claim for service connection for a heart disability does not encompass an application to reopen a claim for service connection for hypertension. With regard to the claim for service connection for a urinary disability, claimed as urinary canal/growth bladder in September 2006, the Board notes that the claim was initially denied in a July 2007 rating decision. It appears that in June 2018, the Board did not characterize the claim as an application to reopen a claim for service connection for a urinary disability in light of the Veteran’s missing service treatment records and a March 2011 Request for Information confirming the Veteran’s service in Vietnam. Notably, pursuant to the Board remand, service personnel records were received in March 2019, which also confirmed the Veteran’s service in Vietnam from January 1970 to January 1971. Under 38 C.F.R. § 3.156(c), the July 2007 rating decision is not final due to relevant service personnel records being associated with the claims file afterwards, thus the issue is properly characterized as a service connection claim, rather than an application to reopen the claim for service connection for a urinary disability. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). 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. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In addition, service connection may also be established under 38 C.F.R. § 3.303(b) if a chronic disease is shown in service, and subsequent manifestations of the same chronic disease at any later date, however remote, are shown, unless clearly attributable to intercurrent causes. Service connection may also be established based upon a legal presumption by showing that a disorder manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from service. 38 U.S.C. § 1101; 38 C.F.R. §§ 3.307, 3.309(a). However, the disabilities at issue are not listed among the diseases enumerated under 38 C.F.R. § 3.309(a). Service connection may be granted on a presumptive basis for certain diseases associated with exposure to herbicide agents, which include ischemic heart disease. 38 C.F.R. § 3.307(a)(6). A veteran who, during active service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a)(6)(iii). The Veteran’s military personnel records show that he served in Vietnam from January 1970 to October 1970, and therefore he is presumed to have been exposed to herbicide agents. However, transurethral resection of bladder neck, endovenous radiofrequency ablation of right lower extremity, and congestive heart failure of non-ischemic cardiomyopathy are not diseases where a presumptive award of service connection may be granted on this basis. The Board has thoroughly reviewed all the evidence in the Veteran’s claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, each piece of evidence of record. The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, regarding the Veteran’s claim on appeal. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. 1. Entitlement to service connection for a heart disability, to include as due to exposure to herbicide agents. The Veteran believes that his heart disability is due to his exposure to Agent Orange while in Vietnam as claimed in a November 2011 statement. After carefully reviewing the evidence of record, the Board finds that the preponderance of the evidence is against the claim of entitlement to service connection for a heart disability. The reasons follow. Regarding evidence of a current disability, the evidence shows that the Veteran was diagnosed with congestive heart failure, non-ischemic cardiomyopathy, as confirmed in an October 2020 C&P examination. Thus, the facts establish that the first element of a service-connection claim is met. As to the question of whether the Veteran has a diagnosis of ischemic heart disease (IHD) and is thus entitled to the award of presumptive service connection due to exposure to Agent Orange, the Board finds that the preponderance of evidence against the finding that the Veteran has a valid diagnosis of IHD or any ischemic heart disease. Here, an April 2011 VA treatment record noted a stress myocardial scan revealed an abnormal myocardial perfusion scan showing no evidence of ischemia with fixed inferior defect out of proportion to increased LV size and reduced ejection fraction. Although a June 2011 VA treatment record noted cardiomyopathy thought to be ischemic in origin considering myocardial scan findings, a coronary angiograph was requested for full evaluation. Later that month, the Veteran underwent an angiograph, which revealed normal coronaries in right dominant system and nonischemic cardiomyopathy. An August 2015 private treatment records note there was no ischemic changes on electrocardiogram (ECG) cardiomyopathy thought to be ischemic in origin in light of myocardial scan findings and the Veteran had nonischemic cardiomyopathy managed with medication. In addition, a January 2019 VA treatment record also confirmed nonischemic congestive cardiomyopathy and chronic heart failure, which has been associated with his non-service-connected hypertension, as noted in a June 2011 VA treatment record. The October 2020 VA examiner noted a March 2020 ECG was conducted and provided diagnosis of nonischemic cardiomyopathy and associated congestive heart failure, both diagnosed in 2014. Thus, the evidence shows the Veteran does not have a diagnosis of ischemic heart disease. As to evidence of an in-service disease or injury, as indicated above, service treatment records are not available. Notably, an August 1969 physical performance reported reflects the Veteran passed his physical test. Here, the Veteran has not alleged that his heart disability manifested during service. Therefore, the preponderance of the evidence is against a complaint, treatment, or diagnosis of heart disability while in service. However, as the Veteran served in Vietnam, he is presumed to have been exposed to herbicide agents. Thus, to this extent, the Veteran was exposed to herbicide agents during service. As to evidence of a nexus between the diagnosis of heart disability and service, the Board finds the preponderance of the evidence is against a nexus. Here, the evidence in the record shows in March 2001, the Veteran denied having heart disease. The Veteran underwent a heart echocardiogram in March 2006, which noted mild left ventricular enlargement, mild left hypertrophy, mild pulmonary insufficiency, trace mitral regurgitation with left atria, enlargement. A January 2007 VA treatment record noted no active heart disease. A November 2007 VA treatment record noted the heart is not enlarged and on the lateral radiograph there is a nodular density in the anterior mediastinum and a calcified nodule in the right mid lung field is seen, noted as a new abnormality. A December 2007 computerized tomography (CT) chest scan noted a noncalcified left lower lobe lung nodule, right lower pneumatoceles, most likely post traumatic in nature, benign right lung nodule, diverticulosis without diverticulitis. In addition, in a January 2010 VA treatment record, the Veteran denied having problems associated with the presumptive diagnosis of Agent Orange exposure. An April 2011 ECG noted an abnormal cardio-reduced LV function and the May 2011 VA treatment record notes that he probably has early congestive heart failure (CHF) and he was diagnosed with CHF in June 2011. This shows that his claimed disability manifested within many years after service discharge. The first instance of an abnormal heart issue was in March 2006, and a formal diagnosis was in June 2011, which is 34- and 40-years following service discharge, respectively. The October 2020 VA examiner noted there was no evidence of a heart disability during active duty service found in medical record review. The examiner noted medical records from 2016 indicate non-ischemic cardiomyopathy and congestive heart failure, diagnosed many years after service. He explained there is no evidence of any specific event, illness, or exposure during service that could have caused the heart disabilities and there is not enough evidence to support that the current nonischemic cardiomyopathy and CHF are directly due to service. As the Veteran has not alleged that this disability manifested during service and given the length of time from service to his initial heart complaint and diagnosis, and the examiner provided rationale consistent with the record, the Board finds that the opinion is adequate. Thus, the Board finds that the preponderance of the evidence is against the claim for service connection for heart disability on a direct basis. The Board has also considered the Veteran’s assertions that his disabilities are directly related to his in-service exposure to herbicide agents, specifically Agent Orange. However, he has not provided competent evidence of a nexus between the diagnosis of his heart disability and herbicide agent exposure. This does not establish a nexus between the diagnosis of his heart disability and Agent Orange/herbicide agent exposure. Although the Veteran submitted a Department of Veterans Affairs article in November 2011 that discusses the relationship between IHD and Agent Orange, as the Veteran has not been diagnosed with IHD, as discussed above, the article is not applicable to the Veteran. To the extent that the Veteran asserts that his heart disability is related to his exposure to Agent Orange during service, such assertion is not probative, as medical expertise is required. In this regard, the question of causation of heart disabilities involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. The Veteran has not established that he is competent to provide a medical nexus opinion. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran’s own opinion is nonprobative evidence. For all the reasons laid out above, the Board finds that the preponderance of the evidence is against the claim for service connection for heart disability on both direct and presumptive bases, to include as being due to exposure to Agent Orange during service. Thus, as the preponderance of the evidence is against the claim, there is no reasonable doubt to be resolved, and the claim for service connection is denied. 38 U.S.C. § 5107(b). 2. Entitlement to service connection for a urinary disability, to include as being due to exposure to herbicide agents. The Veteran believes that his urinary disability is due to his exposure to Agent Orange while in Vietnam as claimed in a November 2011 statement. After carefully reviewing the evidence of record, the Board finds that the preponderance of the evidence is against entitlement to service connection for a urinary disability. The reasons follow. Regarding evidence of a current disability, the evidence shows that the Veteran had surgery for transurethral resection of the bladder neck and bladder neck incision in August 2006. Thus, the facts establish that the first element of a service-connection claim is met. As to evidence of an in-service disease or injury, as indicated above, service treatment records are not available. Notably, an August 1969 physical performance reported reflects the Veteran passed his physical test. Here, the Veteran has not alleged that his urinary disability manifested during service. Therefore, the preponderance of the evidence is against a complaint, treatment, or diagnosis of urinary disability while in service. However, as the Veteran served in Vietnam, he is presumed to have been exposed to herbicides. Thus, to this extent, the Veteran was exposed to herbicides during service. As to evidence of a nexus between the diagnosis of the urinary disability and service, the Board finds the preponderance of the evidence is against a nexus. Here, the evidence in the record shows that the Veteran first reported problems urinating in November 2001 and he had surgery in August 2006, which is approximately 31- and 35-years following service discharge, respectively. In addition, in a January 2010 VA treatment record, the Veteran denied having problems associated with the presumptive diagnosis of Agent Orange exposure. This shows that his claimed disability manifested many years after service. The October 2020 VA examiner noted the Veteran had transurethral resection of bladder neck due to bladder neck contracture. He explained there is no evidence of bladder disability or urinary disability during service found in medical records and that the disability occurred many years after service. He noted there is no evidence of any event, illness, or exposure during service that could have caused the disability and there is not enough evidence to support that the transurethral resection of bladder neck is due to service. As the Veteran has not alleged that this disability manifested during service and the examiner provided rationale consistent with the record, the Board finds that this opinion is adequate. Thus, service connection on a direct basis is not warranted. The Board has also considered the Veteran’s assertions that his urinary disability is directly related to his in-service exposure to herbicide agents, specifically Agent Orange. However, he has not provided competent evidence of a nexus between the diagnosis of urinary disability and herbicide agent exposure. This does not establish a nexus between the diagnosis of urinary disability and Agent Orange/herbicide exposure. The Veteran has not been diagnosed with bladder cancer. To the extent that the Veteran asserts that his urinary disability is related to his exposure to Agent Orange during service, such assertion is not probative, as medical expertise is required. In this regard, the question of causation of urinary disability involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. The Veteran has not established that he is competent to provide a medical nexus opinion. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran’s own opinion is nonprobative evidence. For all the reasons laid out above, the Board finds that the preponderance of the evidence is against the claim for service connection for a urinary disability on both a direct and presumptive basis, as due to exposure to Agent Orange during service. Thus, as the preponderance of the evidence is against the claim, there is no reasonable doubt to be resolved, and the claim for service connection is denied. 38 U.S.C. § 5107(b). 3. Entitlement to service connection for bilateral foot disability, to include tumors and numbness of the feet, and to include as being due to in service exposure to herbicide agents. The Veteran believes that his bilateral foot disability, manifested as numbness of the feet, is due to his exposure to Agent Orange while in Vietnam as claimed in a November 2011 statement. After carefully reviewing the evidence of record, the Board finds that the preponderance of the evidence is against entitlement to service connection for a bilateral foot disability. The reasons follow. The Board concludes that the Veteran does not have a current and separate diagnosis from residuals of excision of foot tumors, claimed as symptoms manifested as numbness in the feet and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b), 38 C.F.R. § 3.303(a), (d). In the October 2020 VA examination report, the examiner noted the Veteran has diabetic peripheral neuropathy of bilateral lower extremities secondary to service-connected diabetes mellitus. Consistent with this finding, the September 2020 VA peripheral neuropathy examination report reflects symptom of numbness, burning and stinging pain in the lower extremities attributable to the diabetes mellitus. A September 2020 VA treatment record notes the Veteran presented with diabetic pedal evaluation and treatment and that his current symptoms include enlarged nail and numbness/tingling feet. Accordingly, the evidence supports that the Veteran’s symptoms of numbness, tingling, and or pain are attributed to his service-connected peripheral neuropathy of the bilateral lower extremities, secondary to his service-connected type II diabetes mellitus and that the Veteran does not have a separate diagnosis of a feet disorder manifested by symptoms of numbness. The Board notes that the Veteran has been diagnosed with pes planus, hallux valgus, and plantar fibromas. However, the October 2020 examiner concluded there is no evidence of pes planus, hallux valgus, excision of plantar fibromas during service found in medical records and that the disability occurred many years after service. He noted there is no evidence of any event, illness, or exposure during service that could have caused the disabilities and there is not enough evidence to support that the disabilities are due to service. The examiner has not attributed the Veteran’s symptoms of bilateral foot numbness to pes planus, hallux valgus, or excision of plantar fibromas, as detailed above. As the Veteran has not alleged that pes planus, hallux valgus, plantar fibromas is related to service, and the examiner provided rationale consistent with the record, the Board finds that this opinion is adequate. Thus, service connection on a direct basis for a feet disability is not warranted. While the Veteran is competent to report having symptoms of numbness in his feet, which the Board finds is supported by the record and which the separate 10 percent ratings currently assigned for peripheral neuropathy of the right and left lower extremity, specifically contemplates, he is not competent to state that he has a separate and distinct disorder manifested by bilateral foot numbness. The issue is medically complex, as it requires specialized medical education. Consequently, the Board gives more probative weight to the conclusions made by competent professionals. For the reasons explained above, the Board concludes that the preponderance of the evidence is against a finding that the Veteran has a current diagnosis of a bilateral foot disorder that is separate from his peripheral neuropathy symptoms that are contemplated as part of his service-connected peripheral neuropathy of the right and left lower extremities. In addition, the preponderance of the evidence is against a finding that that Veteran’s pes planus, hallux valgus, and plantar fibromas are related to service. 38 U.S.C. §§ 1110, 1131, 5107(b), 38 C.F.R. § 3.303(a), (d). In sum, without competent evidence of a current disability that is separate from the service-connected peripheral neuropathy associated with diabetes mellitus, or that the Veteran’s pes planus, hallux valgus, or plantar fibromas is related to service, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for a bilateral foot disability manifested, and the claim is denied. 4. Entitlement to service connection for a right leg disability is denied. The Veteran believes that his right leg disability, manifested as pain occurred during service, as claimed in a November 2011 statement. After carefully reviewing the evidence of record, the Board finds that the preponderance of the evidence is against entitlement to service connection for a right leg disability. The reasons follow. Regarding evidence of a current disability, the evidence shows a diagnosis of endovenous radiofrequency ablation of right lower extremity as confirmed in an October 2020 C&P examination. Thus, the facts establish that the first element of a service-connection claim is met. As to evidence of an in-service disease or injury, as indicated above, service treatment records are not available. Here, in a November 2011 statement, the Veteran alleged that he experienced pain in his lower legs sometime in January 1969 during basic training. He reported that it caused him discomfort throughout the years and that it became unbearable recently. Notably, an August 1969 physical performance reported reflects the Veteran passed his physical test. The Board finds he is competent to report such observations and symptomology during service and that he is credible absent evidence to the contrary. Lay assertions of symptomatology or injury may suffice where the determinative issue is not medical in nature. Falzone v. Brown, 8 Vet. App. 398, 406 (1995). As to evidence of a nexus between the diagnosis of right leg venous disability and service, the Board finds the preponderance of the evidence is against a nexus. Here, the evidence in the record shows that the Veteran first reported problems of stiffness in the muscle in his right leg in February 2011, which is approximately 40 years following service discharge. In addition, an April 2011 VA treatment record noted that an electromyography (EMG) revealed possible mild right leg radiculopathy, as well as in June 2011. A June 2018 VA treatment record noted the Veteran was diagnosed with Peripheral Vascular Disease (PVD) and history of venous ablation. The October 2020 VA examiner noted the Veteran had endovenous radiofrequency ablation of right lower extremity in 2018 for treatment of PVD which was many years after service. He explained there is no evidence of PVD, or any other artery or vein disability found in review of service medical records. He also noted there is no evidence of any specific event, illness, or exposure during service that could have caused the PVD requiring the endovenous radiofrequency ablation and there is not enough evidence to support that the endovenous radiofrequency ablation of right lower extremity is directly due to service. Thus, to the extent that the Veteran alleges having experienced right leg symptoms continuously since service, the Board finds that such allegations are not credible given the passage of many years between discharge from active service and the medical documentation of a claimed disability. In addition, the VA examiner’s opinion is considered probative, as it was definitive, based upon a complete review of the Veteran’s entire claims file, and supported by a rationale. Consequently, the Board gives more probative weight to this opinion. Additionally, the right left ablation is related to the Veteran’s PVD, which is not service connected. Further, the Veteran’s right leg symptoms have also been attributed to his service-connected peripheral neuropathy, and possibly radiculopathy associated with a non-service-connected back disability. See 38 C.F.R. § 3.310 (there is no legal basis upon which to award service connection for a disability that is secondary to a disability that is not service connected). For all the reasons laid out above, the Board finds that the preponderance of the evidence is against the claim for service connection for a right leg disability. Thus, as the preponderance of the evidence is against the claim, there is no reasonable doubt to be resolved, and the claim for service connection is denied. 38 U.S.C. § 5107(b). 5. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, MDD, Adjustment Disorder, and Insomnia, is denied. Service connection for PTSD specifically requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. See 38 C.F.R. §§ 3.304(f), 4.125(a). The Veteran asserts that service connection for an acquired psychiatric disorder is warranted because it is caused by or otherwise related to his military service. The Veteran contends that while in service, he was arrested in an off-limit area and that commanding officer had to get him, resulting in punishment. He reported that someone within his company pointed a firearm at him and grabbed and pushed him. He reported that after telling his supervisor, he faced racial harassment, including being told that the problem is that the Veteran thinks he is white. He reported he had nightmares and lost weight rapidly from 200lbs to 130lbs before leaving service. See November 2011 VA examination and August 2015 PTSD Disability Benefits Questionnaire (DBQ). The preponderance of the evidence is against a finding that the Veteran has a diagnosis of PTSD, which conforms to Diagnostic and Statistical Manual of Mental Disorders, DMS IV (Fourth Edition) or DSM-5 (Fifth Edition), as specifically required for service-connection for PTSD. See 38 C.F.R. §§ 3.304(f), 4.125(a). The evidence also does not show a diagnosis of another acquired psychiatric disorder, which conforms to DSM IV or DSM-5. The Veteran was provided an initial PTSD VA examination in November 2011. The VA examiner indicated that the Veteran did not have a diagnosis of PTSD, which conformed with DSM-IV criteria. The examiner also indicated that the Veteran did not have another mental disorder that conformed with DSM-IV criteria. The examiner explained that the Veteran had a few symptoms of PTSD, but his symptoms did not appear to meet the full diagnostic criteria. Similarly, the August 2015 VA examination report reflects the examiner indicated that the Veteran did not have a diagnosis of PTSD, which conformed with DSM-5 criteria. The July 2020 VA examiner also indicated the Veteran did not have a diagnosis of PTSD or another mental disorder that conformed with DSM-5 criteria. The Board also notes that VA treatment records from January 2002 to July 2015 reflect depression, PTSD, and psychiatric screens were negative. The Veteran described feeling depressed for several days in August 2015. The Board finds statements made for the purpose of treatment to be highly reliable, as it is in the patient’s best interest to provide information as accurate as possible to receive the most appropriate treatment. See Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). Lay assertions do not constitute a competent clinical diagnosis of PTSD or another acquired psychiatric disorder. See 38 C.F.R. § 3.159(a)(1). The VA examiners made specific findings that the Veteran does not have a diagnosis of PTSD nor another acquired psychiatric disorder, which conformed to DSM-IV or DSM-5. As noted above, the Veteran had not complained of PTSD or other psychiatric symptoms or prior to filing the claim for service connection and the treatment records do not reflect a diagnosis of a psychiatric disorder. In the absence of a qualifying current diagnosis for any acquired psychiatric disorder, to include PTSD, which conforms to DSM-IV or DSM-5, service connection for an acquired psychiatric disorder, including PTSD, cannot be established. See 38 C.F.R. §§ 3.304(f), 4.125(a); Brammer v. Derwinski, 3 Vet. App. 223 (1992). The preponderance of the evidence is against the claim of service connection for an acquired psychiatric disorder, to include PTSD, the benefit-of-the-doubt doctrine is not for application, and the claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 6. Entitlement to an initial increased rating in excess of 10 percent for Type II diabetes mellitus is denied Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects the Veteran’s ability to function under the ordinary conditions of daily life, including employment, by comparing the Veteran’s symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual disabilities in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. In the April 2015 rating decision currently on appeal, service connection for type II diabetes mellitus was granted, and a 10 percent evaluation was assigned, effective June 27, 2014. Under DC 7913, diabetes mellitus which is manageable by restricted diet only is rated at 10 percent. Diabetes mellitus requiring insulin and restricted diet, or oral hypoglycemic agent and restricted diet, is rated at 20 percent. Diabetes mellitus requiring insulin, restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational activities) is rated at 40 percent. Diabetes mellitus requiring insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year, or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately rated, is rated at 60 percent. Diabetes mellitus requiring more than one daily injection of insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately rated, is rated at 100 percent. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of an initial increased rating in excess of 10 percent for diabetes mellitus. The reasons follow. The evidence shows that the Veteran’s diabetes mellitus is not manifested by requiring one or more daily injection of insulin and restricted diet, or; oral hypoglycemic agent and restricted diet for the entire appeal period. At worst, the Veteran’s diabetes was repeatedly found to be manageable by restricted diet only. Here, the August 2015 and September 2020 respective examiners specifically stated that the Veteran’s diabetes was manageable by restricted diet only. Additionally, in a January 2019 VA treatment record, the Veteran stated he is a non-insulin dependent diabetic. The Board notes that an April 2019 VA treatment record noted the Veteran’s diabetes was in good control with insulin. However, the Board finds this was inaccurate, as the VA treatment records, to include a subsequent December 2019 VA treatment record did not reflect the Veteran was prescribed insulin or medication for his diabetes mellitus. In addition, an August 2020 VA treatment record noted the Veteran’s history of diet-controlled diabetes. As noted above, the August 2015 and September 2020 VA opinions showed that the Veteran’s diabetes was controlled with diet alone and without insulin or medication. Additional VA and private treatment records in this part of the appeal period do not support that the Veteran’s diabetes required one or more daily injections of insulin and restricted diet, or; oral hypoglycemic agent and restricted diet, to warrant a 20 percent rating. In sum, the evidence does not show that an initial disability rating in excess of 10 percent for type II diabetes mellitus prior is warranted. As the preponderance of the evidence is against the claim for a higher rating, the benefit of the doubt doctrine is not for application, and the Veteran’s claim for an increased rating is denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Sarah Campbell, 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.