Citation Nr: 21015014 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 17-26 094 DATE: March 16, 2021 ORDER No new and material evidence having been received, the application to reopen a service connection claim for a cognitive impairment disorder, is denied. No new and material evidence having been received, the application to reopen a service connection claim for posttraumatic stress disorder (PTSD) is denied. No new and material evidence having been received, the application to reopen a service connection claim for depression is denied. No new and material evidence having been received, the application to reopen a service connection claim for hypertension is denied. No new and material evidence having been received, the application to reopen a service connection claim for asbestosis is denied. No new and material evidence having been received, the application to reopen a service connection claim for insomnia is denied. The appeal for service connection for a communication disorder (claimed as speech impediment) is denied. The appeal for service connection for mild mental retardation is denied. The appeal for service connection for a urinary disorder is denied. The appeal for service connection for memory loss is denied. The appeal for service connection for a sleep disorder other than insomnia, to included sleep apnea, is denied. The appeal for service connection for chronic fatigue, also claimed as mood swing and difficulty thinking, is denied. The appeal for service connection for pes planus is denied. The appeal for a special monthly compensation based on loss of use is denied. A special monthly compensation (SMC) based on the need of the aid and attendance of another is granted. The appeal for a special monthly pension is denied. FINDINGS OF FACT 1. In a December 2008 rating decision, the agency of original jurisdiction (AOJ) denied the Veteran’s claim for service connection for cognitive impairment. He did not appeal the decision. 2. Additional evidence associated with the claims file since the December 2008 rating decision is cumulative or redundant of the evidence of record at the time of the prior final denial, and it does not relate to unestablished facts necessary to substantiate the claim, or raise a reasonable possibility of substantiating the claim. 3. In a March 2014 rating decision, the AOJ denied the Veteran’s claim for service connection for PTSD. He did not appeal the decision. 4. Additional evidence associated with the claims file since the March 2014 rating decision is cumulative or redundant of the evidence of record at the time of the prior final denial, and it does not relate to unestablished facts necessary to substantiate the claim, or raise a reasonable possibility of substantiating the claim. 5. In a March 2014 rating decision, the AOJ denied the Veteran’s claim for service connection for depression. He did not appeal the decision. 6. Additional evidence associated with the claims file since the March 2014 rating decision is cumulative or redundant of the evidence of record at the time of the prior final denial, and it does not relate to unestablished facts necessary to substantiate the claim, or raise a reasonable possibility of substantiating the claim. 7. In a March 2014 rating decision, the AOJ denied the Veteran’s claim for service connection for hypertension. He did not appeal the decision. 8. Additional evidence associated with the claims file since the March 2014 rating decision is cumulative or redundant of the evidence of record at the time of the prior final denial, and it does not relate to unestablished facts necessary to substantiate the claim, or raise a reasonable possibility of substantiating the claim. 9. In a March 2014 rating decision, the AOJ denied the Veteran’s claim for service connection for asbestosis. He did not appeal the decision. 10. Additional evidence associated with the claims file since the March 2014 rating decision is cumulative or redundant of the evidence of record at the time of the prior final denial, and it does not relate to unestablished facts necessary to substantiate the claim, or raise a reasonable possibility of substantiating the claim. 11. In a December 2008 rating decision, the AOJ denied the Veteran’s claim for service connection for insomnia. He did not appeal the decision. 12. Additional evidence associated with the claims file since the December 2008 rating decision is cumulative or redundant of the evidence of record at the time of the prior final denial, and it does not relate to unestablished facts necessary to substantiate the claim, or raise a reasonable possibility of substantiating the claim. 13. The preponderance of the evidence is against a finding that a current communication disorder (claimed as a speech impediment) disorder was caused or aggravated by service or service-connected disability, or otherwise related to service. 14. The preponderance of the evidence is against a finding that mild mental retardation disorder was caused or aggravated by service or service-connected disability, or otherwise related to service. 15. The preponderance of the evidence is against a finding that a current urinary disorder was caused or aggravated by service or service-connected disability, or otherwise related to service. 16. The preponderance of the evidence is against a finding that a current memory loss disorder was caused or aggravated by service or service-connected disability, or otherwise related to service. 17. The preponderance of the evidence is against a finding that a current sleep disorder was caused or aggravated by service or service-connected disability, or otherwise related to service. 18. The preponderance of the evidence is against a finding that a current chronic fatigue disorder (also claimed as mood swing and difficulty thinking disorder) was caused or aggravated by service or service-connected disability, or otherwise related to service. 19. The preponderance of the evidence is against a finding that the Veteran’s pes planus disability, which was noted upon entry to service, increased in severity during the Veteran’s period of active duty service. 20. The preponderance of the evidence is against a finding that any of the Veteran’s service-connected disorders resulted in loss of use. 21. The Veteran’s service-connected disabilities at least as likely as not rendered him in need of aid and attendance of another person for the entire period on appeal. 22. The appeal for a special monthly pension is moot as a special monthly compensation is granted herein and provides the greater benefit. CONCLUSIONS OF LAW 1. The December 2008 rating decision that denied the Veteran’s claim for service connection for cognitive impairment is final. 38 U.S.C. §§ 7103, 7104 (2012); 38 C.F.R. § 20.1100 (2020). 2. As evidence received since the December 2008 rating decision is not new and material, the criteria for reopening the claim for service connection for cognitive impairment are not met. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2020). 3. The March 2014 rating decision that denied the Veteran’s claim for service connection for PTSD is final. 38 U.S.C. §§ 7103, 7104 (2012); 38 C.F.R. § 20.1100 (2020). 4. As evidence received since the March 2014 rating decision is not new and material, the criteria for reopening the claim for service connection for PTSD are not met. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2020). 5. The March 2014 rating decision that denied the Veteran’s claim for service connection for depression is final. 38 U.S.C. §§ 7103, 7104 (2012); 38 C.F.R. § 20.1100 (2020). 6. As evidence received since the March 2014 rating decision is not new and material, the criteria for reopening the claim for service connection for depression are not met. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2020). 7. The March 2014 rating decision that denied the Veteran’s claim for service connection for hypertension is final. 38 U.S.C. §§ 7103, 7104 (2012); 38 C.F.R. § 20.1100 (2020). 8. As evidence received since the March 2014 rating decision is not new and material, the criteria for reopening the claim for service connection for hypertension are not met. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2020). 9. The March 2014 rating decision that denied the Veteran’s claim for service connection for asbestosis is final. 38 U.S.C. §§ 7103, 7104 (2012); 38 C.F.R. § 20.1100 (2020). 10. As evidence received since the March 2014 rating decision is not new and material, the criteria for reopening the claim for service connection for asbestosis are not met. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2020). 11. The December 2008 rating decision that denied the Veteran’s claim for service connection for insomnia is final. 38 U.S.C. §§ 7103, 7104 (2012); 38 C.F.R. § 20.1100 (2020). 12. As evidence received since the December 2008 rating decision is not new and material, the criteria for reopening the claim for service connection for insomnia are not met. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (2020). 13. The criteria for service connection for a communication disorder are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.310 (2020). 14. The criteria for service connection for a mild mental retardation disorder are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.310 (2020). 15. The criteria for service connection for a urinary disorder are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.310 (2020). 16. The criteria for service connection for a memory loss disorder are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.310 (2020). 17. The criteria for service connection for a sleep disorder other than insomnia, to included sleep apnea are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.310 (2020). 18. The criteria for service connection for pes planus are not met. 38 U.S.C. §§ 1110, 1131, 1111, 1153, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.306 (2020). 19. The criteria for service connection for chronic fatigue, also claimed as mood swing and difficulty thinking are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.310 (2020). 20. Special monthly compensation for loss of use of a creative organ is not available. 38 U.S.C. § 1114 (k) (2012); 38 C.F.R. § 3.350(a) (2020). 21. The criteria for entitlement to SMC based on the need for aid and attendance, as a result of service-connected disabilities are met, for the entirety of the appeal period. 38 U.S.C. § 1114 (2012); 38 C.F.R. § 3.352 (2020). 22. The criteria for payment of special monthly pension benefits are not met. 38 U.S.C. §§ 1114, 1521, 5107 (2012); 38 C.F.R. § 3.351 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from November 1996 to November 2006. Claims to reopen For claims to reopen filed on or after August 29, 2001, such as the Veteran’s, evidence is considered “new” if it was not previously submitted to agency decision makers. “Material” evidence is 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” can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether evidence is new and material, the “credibility of the evidence is to be presumed.” Justus v. Principi, 3 Vet. App. 510, 513 (1992). The United States Court of Appeals for Veterans Claims (Court) has held that the determination of whether newly submitted evidence raises a “reasonable possibility of substantiating the claim” should be considered a component what constitutes new and material evidence, rather than a separate determination to be made after the Board has found that evidence is new and material. See Shade v. Shinseki, 24 Vet. App. 110 (2010). The Court has also held that new evidence would raise a reasonable possibility of substantiating the claim if, when considered with the old evidence, it would at least trigger the Secretary’s duty to assist by providing a medical opinion. Id. 1. Whether new and material evidence was received to reopen the claim for service connection for a cognitive impairment disorder. The claim for service connection for a cognitive impairment disorder was originally denied in a December 2008 rating decision. The Veteran did not appeal the decision nor was new and material evidence received within one year of the rating decision. At the time of the December 2008 rating decision, the Veteran’s service treatment records were reviewed. The AOJ found that evidence indicated that the Veteran had a history of poor comprehension prior to service and required a waiver for enlistment. The AOJ also found that although the Veteran needed special assistance to teach him jobs during service, records noted that once he was shown how to do something, he performed it excellently. The AOJ based the decision on the finding that despite the comprehension difficulty during service, the Veteran’s separation examination did not indicate any medical problems. The claim was ultimately denied as the AOJ found that a cognitive impairment disability was not incurred in or caused by service. The evidence added to the record since the December 2008 rating decision includes VA and private treatment records as well as VA examination reports. The new evidence does not indicate that the Veteran has a cognitive impairment disability apart from his schizophrenia, which is service connected. Indeed, the Veteran’s symptoms of difficulty understanding and gross impairment in thought processes and communication are already contemplated in the 100 percent schedular rating for service-connected schizophrenia. As such, the Board finds that although the VA and private treatment records as well as VA examination reports are new, they are not material to the claim as the evidence does not support a finding that the Veteran has a cognitive impairment disorder separate from his service-connected schizophrenia that is otherwise related to service. As no new and material evidence is shown, the claim is not reopened. 2. Whether new and material evidence was received to reopen the claim for service connection for PTSD. The claim for service connection for PTSD was originally denied in a March 2014 rating decision. The Veteran did not appeal the decision nor was new and material evidence received within one year of the rating decision. At the time of the March 2014 rating decision, the Veteran’s service treatment records as well as VA treatment records were reviewed. The evidence added to the record since the December 2008 rating decision includes VA and private treatment records as well as VA examination reports. The new evidence does not support a diagnosis of PTSD, or otherwise contain information material to the question of whether PTSD may be related to service. As no new and material evidence is shown, the claim is not reopened. 3. Whether new and material was received to reopen the claim for service connection for depression is denied. The claim for service connection for depression was originally denied in a March 2014 rating decision. The Veteran did not appeal the decision nor was new and material evidence received within one year of the rating decision. At the time of the March 2014 rating decision, the Veteran’s service treatment records as well as VA treatment records were reviewed. The evidence added to the record since the March 2014 rating decision includes VA and private treatment records as well as VA examination reports. The new evidence does not support a finding of a depression, separate from schizophrenia, that is related to service. In this regard, the March 2017 VA examination report included the Veteran’s depression symptoms as symptoms of service-connected schizophrenia. As no new and material evidence is shown, the claim is not reopened. 4. Whether new and material evidence having been received, the appeal for service connection for hypertension is denied. The claim for service connection for hypertension was originally denied in a March 2014 rating decision. The Veteran did not appeal the decision nor was additional, pertinent evidence received within one year of the rating decision. At the time of the March 2014 rating decision, the Veteran’s service treatment records as well as VA treatment records were reviewed. The evidence added to the record since the March 2014 rating decision includes VA and private treatment records as well as VA examination reports. The new evidence does not contain additional information material to the question of whether hypertension is related to service. As no new and material evidence is shown, the claim is not reopened. 5. Whether new and material evidence having been received, the appeal for service connection for asbestosis is denied. The claim for service connection for asbestosis was originally denied in a March 2014 rating decision. The Veteran did not appeal the decision nor was new and material evidence received within one year of the rating decision. At the time of the March 2014 rating decision, the Veteran’s service treatment records as well as VA treatment records were reviewed. The evidence added to the record since the March 2014 rating decision includes VA and private treatment records as well as VA examination reports. The new evidence does not support a diagnosis of asbestosis, or otherwise contain information relating an asbestos-related disability with exposure during service. As no new and material evidence is shown, the claim is not reopened. 6. Whether new and material evidence was received to reopen the claim for service connection for insomnia. The claim for service connection for insomnia was originally denied in a December 2008 rating decision. The Veteran did not appeal the decision nor was new and material evidence received within one year of the rating decision. At the time of the December 2008 rating decision, the Veteran’s service treatment records and VA treatment records were reviewed. VA treatment records included the Veteran’s reports that he had difficulty sleeping, that he had gone 17 days without sleeping, and included a possible diagnosis of sleep apnea. See e.g. June 2008 VA treatment record and March 2008 private treatment record. The evidence added to the record since the December 2008 rating decision includes VA and private treatment records as well as VA examination reports. The new evidence does not indicate that the Veteran has an insomnia disorder apart from his schizophrenia, which is service connected. In this regard, the March 2017 VA examination was new but not material as it linked the Veteran’s symptom of chronic sleep impairment to service-connected schizophrenia and did not establish a separate disorder for insomnia. Remaining VA and private treatment records, although new, are not material as they do not establish an insomnia disorder. Further, the new records are duplicative of the Veteran’s complaints of record at the time of the December 2008 decision – namely, that he had difficulty sleeping so much so that he had nights where he was unable to sleep and had gone days without sleep. As no new and material evidence is shown, the claim is not reopened. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease 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). Direct service connection may not be granted without evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disease or injury. 38 U.S.C. § 1112; 38 C.F.R. § 3.304. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Additionally, for Veterans who served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including arthritis, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). The use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection is also warranted on a secondary basis, 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. Under any theory of entitlement, service connection may only be granted for a current disability; when a claimed condition is not shown, there may be no grant of service connection. See 38 U.S.C. § 1110 (2012); Rabideau v. Derwinski, 2 Vet. App. 141 (1992) (Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. The current disability requirement for a service connection claim is satisfied if the claimant has a disability at the time the claim is filed or during the pendency of that claim. See McClain v. Nicholson, 21 Vet. App. 319 (2007). Additionally, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a Veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. Additionally, if a current disability is not specifically diagnosed, service connection may also be warranted for pain that amounts to functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356, 1363-64 (Fed. Cir. 2018). The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104 (a) (2012); Baldwin v. West, 13 Vet. App. 1 (1999); see 38 C.F.R. § 3.303 (a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for a memory loss disorder. For the reasons explained below, the Board finds that the claim fails because there is no indication that the Veteran has a memory loss disorder, separate from his service-connected schizophrenia. In this regard, the March 2017 VA examiner reviewed all of the pertinent treatment records as well as the Veteran’s statements regarding his memory loss and determined that the Veteran only had one acquired psychiatric disorder – schizophrenia. The examiner also attributed the Veteran’s memory loss symptoms to the schizophrenia. Service connection is already in effect for the Veteran’s schizophrenia. The Board places a high probative value on the March 2017 VA opinion as the examiner reviewed all of the pertinent records in reaching the conclusion. VA and private treatment records do not indicate that the Veteran has a memory loss disorder separate from schizophrenia. The Board acknowledges the Veteran’s belief that he has separate memory loss disorder related to service. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, diagnosis and etiology of an acquired psychiatric 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). Based on the foregoing, the appeal for service connection for a memory loss disorder must be denied. 2. Entitlement to service connection for mild mental retardation. For the reasons explained below, the Board finds that the claim fails because there is no indication that the Veteran has mild mental retardation, separate from his service-connected schizophrenia. In this regard, the March 2017 VA examiner reviewed all of the pertinent treatment records as well as the Veteran’s statements regarding his mild mental retardation and determined that the Veteran only had one acquired psychiatric disorder – schizophrenia. The examiner also attributed all of the Veteran’s psychiatric symptoms to the schizophrenia. Service connection is already in effect for the Veteran’s schizophrenia. The Board places a high probative value on the March 2017 VA opinion as the examiner reviewed all of the pertinent records in reaching the conclusion. VA and private treatment records do not indicate that the Veteran has mild mental retardation separate from schizophrenia. The Board acknowledges the Veteran’s belief that he has mild mental retardation related to service. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, diagnosis and etiology of mild mental retardation, 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). Based on the foregoing, the appeal for service connection for mild mental retardation must be denied. 3. Entitlement to service connection for a urinary disability. For the reasons explained below, the Board finds that the claim fails because there is no indication that the Veteran has a current urinary disability. VA and private treatment records do not indicate that the Veteran has a urinary disorder. The Board acknowledges that in August 2011, the Veteran reported episodes of urinary urgency to a VA clinician, but the VA clinician did not diagnose a urinary disorder. Further, other VA treatment records indicate that the Veteran consistently denied urinary problems. See e.g. VA treatment records dated in June 2008, July 2008, and March 2013. The Board acknowledges the Veteran’s belief that he has a urinary disorder related to service. The Board acknowledges that the Veteran is competent to offer statements as to symptoms observed through his senses, see Layno v. Brown, 6 Vet. App. 465, 469 (1994); however, diagnosis of a urinary disorder requires observation and testing by a medical professional. The Veteran has not been shown to be competent to diagnose a urinary disorder or provide a medical opinion regarding the etiology of the same. See Jandreau, supra. Based on the foregoing, the appeal for service connection for a urinary disorder must be denied. 4. Entitlement to service connection for sleeplessness. For the reasons explained below, the Board finds that the claim fails because the evidence is against a finding that the Veteran has a current diagnosis of a sleep disorder, to include “sleeplessness.” VA and private treatment records do not indicate that the Veteran has a sleep disorder. The Board acknowledges that during VA treatment in June 2008, the Veteran reported that he had been told at one time that he had sleep apnea. He reported a history of snoring and poor sleep. Thereafter, a July 2008 VA treatment record indicated that the Veteran had “possible sleep apnea.” However, remaining treatment records did not indicate any diagnosis of sleep apnea or a “sleeplessness” disorder. Notably, despite the Veteran’s report to VA clinicians that he had a possible history of sleep apnea, VA clinicians did not diagnose the Veteran with the same. As discussed above, all of the Veteran’s sleep impairment symptomatology has been attributed to his service-connected schizophrenia. The Board acknowledges the Veteran’s belief that he has a stand-alone sleep disorder related to service. The Board also acknowledges the Veteran’s statements that he should have a sleep apnea study and CPAP machine. See May 2017 Substantive Appeal Form 9. However, as the competent evidence of record does not indicate that the Veteran has sleep apnea, or a similar sleep disorder, or that such disability may be related to an event or injury in service, the AOJ did not err by not providing the Veteran with a VA examination for the same. Although the Veteran is competent to offer statements as to symptoms observed through his senses, see Layno v. Brown, 6 Vet. App. 465, 469 (1994); diagnosis of a specific sleep disorder requires observation and testing by a medical professional. The Veteran has not been shown to be competent to diagnose a sleeplessness disorder or provide a medical opinion regarding the etiology of the same. See Jandreau, supra. Based on the foregoing, the appeal for service connection for a sleep disorder, to include sleeplessness, must be denied. 5. Entitlement to service connection for chronic fatigue. For the reasons explained below, the Board finds that the claim fails because there is no indication that the Veteran has a current chronic fatigue disability. VA and private treatment records do not indicate that the Veteran has chronic fatigue syndrome. The Board acknowledges the August 2011 VA treatment record which noted the Veteran’s complaint of fatigue but also notes that no VA clinician suggested a diagnosis of chronic fatigue syndrome at any time. Moreover, there is no competent evidence indicating that any chronic fatigue disability may be related to the Veteran’s period of active duty service. The Board acknowledges the Veteran’s belief that he has a chronic fatigue disability related to service. The Board acknowledges that the Veteran is competent to offer statements as to symptoms observed through his senses, see Layno v. Brown, 6 Vet. App. 465, 469 (1994); however, diagnosis of chronic fatigue syndrome requires observation and testing by a medical professional. The Veteran has not been shown to be competent to diagnose chronic fatigue syndrome or provide a medical opinion regarding the etiology of the same. See Jandreau, supra. Based on the foregoing, the appeal for service connection for chronic fatigue syndrome must be denied. 6. Entitlement to service connection for a communication disorder, not otherwise specified. For the reasons explained below, the Board finds that the claim fails because there is no indication that the Veteran has a communication disorder, separate from his service-connected schizophrenia. In this regard, the March 2017 VA examiner reviewed all of the pertinent treatment records as well as the Veteran’s statements regarding his communication disorder and determined that the Veteran only had one acquired psychiatric disorder – schizophrenia. The examiner also attributed all of the Veteran’s psychiatric symptoms to the schizophrenia. Service connection is already in effect for the Veteran’s schizophrenia. The Board places a high probative value on the March 2017 VA opinion as the examiner reviewed all of the pertinent records in reaching the conclusion. VA treatment records do not indicate a diagnosis of a communication disorder that is separate from the Veteran’s schizophrenia. The Board acknowledges the July 2008 VA treatment record which indicated that the Veteran’s communication was very limited. However, the VA clinician did not indicate a separate diagnosis for a communication disorder not otherwise specified. Remaining evidence does not indicate a separate diagnosis of a communication disorder separate from the Veteran’s service-connected schizophrenia. The Board acknowledges the Veteran’s belief that he has a communication disorder related to service. The Board acknowledges that the Veteran is competent to offer statements as to symptoms observed through his senses, see Layno v. Brown, 6 Vet. App. 465, 469 (1994); however, diagnosis of a specific psychiatric disorder requires evaluation by a medical professional. The Veteran has not been shown to be competent to diagnose a communication disorder or provide a medical opinion regarding the etiology of the same. See Jandreau, supra. Based on the foregoing, the appeal for service connection for a communication disorder NOS must be denied. 7. Entitlement to service connection for pes planus. The Veteran asserts that he has pes planus aggravated by service. For the reasons explained below, the Board finds that the claim fails. In addition to the regulations cited above, a veteran will be considered to have been in sound condition when examined and accepted for service, except as to disorders noted on entrance into service, or when clear and unmistakable evidence demonstrates that the disability existed prior to service and was not aggravated by service. Only such conditions as are recorded in examination reports are to be considered as noted. 38 U.S.C. § 1111; 1132 (2012; 38 C.F.R. § 3.304 (b) (2017). When determining whether a defect, infirmity, or disorder is “noted” at entrance into service, supporting medical evidence is needed. Crowe v. Brown, 7 Vet. App. 238 (1994). If a preexisting disorder is noted upon entry into service, service connection may be granted based on aggravation during service of that disorder. 38 U.S.C. § 1153 (2012); 38 C.F.R. § 3.306 (2020). A preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153 (2012); 38 C.F.R. § 3.306 (a) (2020). Clear and unmistakable evidence (obvious or manifest) is required to rebut the presumption of aggravation where the pre-service disability underwent an increase in severity during service. For a disorder to be considered aggravated in service, there must be worsening of the underlying condition, not just temporary or intermittent flare-ups of the symptoms of the condition. Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). Evidence of a veteran being asymptomatic on entry into service, with an exacerbation of symptoms during service, does not constitute evidence of aggravation. Green v. Derwinski, 1 Vet. App. 320, 323 (1991). In order to support a finding of aggravation, the evidence must establish that the underlying disability underwent an increase in severity; the mere occurrence of symptoms, in the absence of an increase in the underlying severity, does not constitute aggravation of the disability. Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002); 38 C.F.R. § 3.306 (a) (2017). In this case, the Veteran’s January 1996 service entrance report of medical examination noted pes planus at entry and indicated that the Veteran’s pes planus was severe but asymptomatic. Service treatment records include a notation of pes planus on the February 2001 report of medical examination. However, on the Veteran’s August 2006 service separation report of medical history, the Veteran denied any impaired use of his feet. The August 2005 separation examination noted normal feet and when given the opportunity to specifically indicate whether the Veteran had a normal arch, pes cavus, or pes planus, the examiner indicated that the Veteran had a normal arch. The probative evidence is against a finding that his pes planus disability worsened during service. The Board acknowledges the Veteran’s belief that his pes planus disability worsened during service; however, the Board finds the Veteran’s denial of foot trouble at the time of service separation to be more probative than his current statements made in connection with the claim for benefits. Thus, the preponderance of the evidence is against a finding that the Veteran’s pre-existing pes planus disability worsened during service. As the preponderance of the evidence is against this finding, the “benefit of the doubt” rule is not applicable, and the Board must deny the claim. See 38. U.S.C. §5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Special Monthly Compensation and/or Pension 1. Entitlement to special monthly compensation (SMC) for loss of use of a creative organ. The Veteran claimed SMC for loss of use of a creative organ due to medication. At the time of the February 2016 rating decision at issue, service connection had not yet been granted for the Veteran’s schizophrenia. Review of the record indicates that the Veteran is treated with prescription medication for his schizophrenia. SMC under 38 U.S.C. § 1114(k) is payable if a Veteran, as a result of service-connected disability, has anatomical loss or loss of use of one hand, one foot, both buttocks, one or more creative organs, blindness of one eye having only light perception, deafness of both ears, having absence of air and bone conduction, complete organic aphonia with constant inability to communicate by speech or, in the case of a woman veteran, the anatomical loss of 25 percent or more of tissue from a single breast or both breasts in combination (including loss by mastectomy or partial mastectomy) or has received radiation treatment of breast tissue. Entitlement to SMC based on loss of use of a creative organ can also be granted based on erectile dysfunction in male Veterans. 38 C.F.R. § 3.350 (a)(1)(ii). In this case, service connection is in effect for schizophrenia as well as tinnitus and bilateral hearing loss. There is no evidence to indicate that the Veteran has complete deafness of both ears, having absence of air and bone conduction, or complete organic aphonia with constant inability to communicate by speech. Therefore, SMC is not warranted based on service-connected hearing loss or tinnitus. Further, there is no indication that the Veteran has loss of use of a creative organ is due to his schizophrenia medication. In this regard, although the March 2017 VA examiner noted that the Veteran has been prescribed three medications to treat schizophrenia, the examiner did not indicate that any of the medications resulted in loss of use of a creative organ. The Veteran has not provided any evidence that his schizophrenia medications are known to result in loss of use of a creative organ. VA and private treatment records likewise do not indicate any loss of use of a creative organ due to the Veteran’s medications. The remaining categories regarding loss of use are not applicable in this case as service connection is not in effect for any disabilities other than the psychiatric and audiological disabilities. For these reasons, the appeal for SMC for loss of use must be denied. 2. Entitlement to special monthly compensation for aid and attendance. The Veteran claimed entitlement to a SMC based on a need for the aid and attendance of another, or a special monthly pension for the same. For the reasons explained below, the Board finds that a SMC based on a need for the aid and attendance of another is warranted. SMC at the aid and attendance rate is payable when a veteran, due to service-connected disability, has suffered the anatomical loss or loss of use of both feet or one hand and one foot, or is blind in both eyes, or is permanently bedridden or so helpless as to be in need of regular aid and attendance. See 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b). The following will be accorded consideration in determining the need for regular aid and attendance: inability of a claimant to dress or undress himself, or to keep himself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid; inability to feed himself through the loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect him from hazards or dangers incident to his daily environment. It is not required that all of the above disabling conditions be found to exist before a favorable rating may be made. The particular personal functions that a veteran is unable to perform should be considered in connection with his condition as a whole. It is only necessary that the evidence establish that a veteran is so helpless as to need regular aid and attendance, not that there is a constant need. Determinations that a veteran is so helpless as to need regular aid and attendance will not be based solely upon an opinion that his condition is such as would require him to be in bed. They must be based on the actual requirement of personal assistance from others. See 38 C.F.R. § 3.352(a). In this case, service connection is in effect for schizophrenia, bilateral hearing loss, and tinnitus. A June 2010 letter from the Veteran’s private psychiatrist noted that he was unable to work due to his mental condition. In a February 2013 form for aid and attendance, which appears to have been completed by the Veteran’s mother, it was noted that the Veteran was unable to prepare his own meals. The March 2017 VA examiner determined that the Veteran’s schizophrenia rendered him totally occupationally and socially impaired. A July 2017 private examination regarding need for aid and attendance noted that the Veteran was not able to prepare meals, required medication management, and was not able to manage his own financial affairs. The examiner noted that the Veteran’s diagnoses pertaining to the report included schizophrenia. The examiner also noted that the Veteran was not able travel alone due to his mental health status. Also, in July 2017, the AOJ determined that the Veteran was not competent to handle disbursement of funds. VA treatment records confirm that the Veteran lives with his mother and that she gives him his medications each morning and evening. See e.g. VA treatment records dated in July 2008, January 2010, April 2017, September 2017, November 2017, and January 2018. A July 2011 VA treatment record noted the Veteran’s father’s report that the Veteran had to be watched closely or else he would wander off and not realize it. A January 2018 VA treatment record noted that the Veteran had cognitive deficits that were potential barriers to his ability to function. Based on the foregoing, the Board finds that the Veteran’s service-connected schizophrenia at least as likely as not rendered him in need of the regular assistance of another person to attend to the activities of his daily living for the entire period pertinent to the appeal. In this regard, the evidence is in favor of finding that the Veteran is unable to manage his daily medications or safely prepare his own meals, both of which are requirements of daily living. As such, the Board resolves doubt and finds that the Veteran regularly needs help to ensure that he takes his medication as prescribed and has safe access to meals. The Board also finds that such assistance amounts to regular aid and attendance. Moreover, the Board finds that aid and attendance is warranted for the entire period on appeal, beginning October 29, 2015. As such, entitlement to SMC based on the Veteran’s need for aid and attendance is granted. The Board notes in passing that the above finding renders the question of whether the SMC is available at the housebound rate moot, as SMC based on the need for aid and attendance is the greater monetary benefit. Compare 38 U.S.C. § 1114(l) with 1114(s). Special Monthly Pension Entitlement to special monthly pension. Disability pension will be paid to a Veteran of a period of war who meets statutorily defined service, net worth, and annual income requirements; and who is permanently and totally disabled from nonservice-connected disability not the result of willful misconduct. 38 U.S.C. §§ 1502, 1503, 1521 (2012). Section 1521 further provides for an increased rate of pension, in the form of a special monthly pension (SMP), when an otherwise eligible Veteran is in need of regular aid and attendance or has a disability rated as permanent and total and (1) has an additional disability or disabilities ratable at 60 percent, or (2) is permanently housebound. 38 U.S.C. §§ 1521 (d), (e); see also 38 C.F.R. § 3.351. The purpose of VA pension benefits is to provide a subsistence income for Veterans of a period of war who are totally disabled and who are otherwise unable to maintain a basic, minimal income level. 38 U.S.C. §§ 1521, 1522. The statutory scheme generally provides that a Veteran who has been awarded compensation for service-connected disability cannot receive pension at the same time, unless the amount of pension available is greater than the amount of compensation available. In this case, the Veteran has been awarded a total compensable evaluation for schizophrenia, 10 percent disability rating for tinnitus, and noncompensable rating for bilateral hearing loss, all from October 29, 2015. A total disability rating due to individual unemployability (TDIU) has also been granted from October 29, 2015. Under 38 U.S.C. §§ 1521, if the Veteran met the requirements for pension due to the need for regular aid and attendance, the highest amount payable would be $19,736 annually. This amount, when divided into 12 monthly payments, amounts to approximately $1,645 per month which is less than the amount of compensation the Veteran receives each month for his service-connected disabilities and special monthly compensation granted above. As the special monthly compensation benefit is greater than the potential pension benefit, the claim for special monthly pension is rendered moot from the time that the Veteran’s total rating has been in effect. In this case, the Veteran’s total rating due to service-connected disabilities has been in effect for the entire period on appeal. Thus, the appeal for special monthly pension must be denied. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Donna D. Ebaugh, 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.