Citation Nr: 21021107 Decision Date: 04/09/21 Archive Date: 04/09/21 DOCKET NO. 16-10 435 DATE: April 9, 2021 ORDER Service connection for type II diabetes mellitus is denied. Service connection for obstructive sleep apnea to include as secondary to a service-connected disability is denied. Service connection for hypertension to include as secondary to a service-connected disability is denied. FINDINGS OF FACT 1. The preponderance of the evidence shows that the Veteran’s type II diabetes mellitus did not begin during active duty or active duty for training (ACDUTRA), is not presumed to be related to active duty service, and is not otherwise related to active duty or any injury or disease incurred during ACDUTRA. 2. The preponderance of the evidence shows that the Veteran’s obstructive sleep apnea did not begin during active duty or ACDUTRA, is not presumed to be related to active duty service, is not otherwise related to any injury or disease incurred during active duty or ACDUTRA, and is not caused by or aggravated by a service-connected disability. 3. The preponderance of the evidence shows that the Veteran’s hypertension did not begin during active duty or ACDUTRA, is not presumed to be related to active duty service, is not otherwise related to any disease or injury during active duty or ACDUTRA, and is not caused by or aggravated by a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for type II diabetes mellitus are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for obstructive sleep apnea are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 3. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Air Force National Guard from March 1977 to September 2011 with active duty from May 1977 to October 1977, from April 12, 1998 to April 25, 1998, from March 12, 2003 to March 21, 2003, on October 5, 2003, on November 13, 2003, and from October 2005 to February 2006 with various periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). This case is before the Board of Veterans’ Appeals (Board) on appeal from a May 2013 Regional Office (RO) rating decision.  In that rating decision, the RO denied entitlement to service connection for type II diabetes, sleep apnea, and high blood pressure. The Veteran’s notice of disagreement (NOD) was received in August 2013.  The RO issued a statement of the case (SOC) in January 2016.  The Veteran’s VA Form 9, substantive appeal to the Board, was received in February 2016. In September 2018 and August 2020, the Board remanded the case to the RO for further development and adjudicative action. Service Connection Generally, to establish service connection, there must be lay or medical evidence of (1) a current disability, (2) incurrence or aggravation of a disease or injury in service, and (3) a nexus between the in-service injury or disease and the current disability. See 38 U.S.C. § 1110; Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Certain chronic diseases, including diabetes mellitus, hypertension, and obstructive sleep apnea as an other organic disease of the nervous system, will be presumed to be related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303, 3.307, 3.309. Service connection for a claimed disability may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service-connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a). Active military, naval, or air service includes active duty, any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred in or aggravated in line of duty, and any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from injury incurred in or aggravated in line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident which occurred during such training. 38 U.S.C. § 101 (21-24); 38 C.F.R. § 3.6. Service connection may thus be granted for disability resulting from disease or injury incurred or aggravated while performing ACDUTRA in the Reserves, or from injury incurred or aggravated while performing inactive duty training in the Reserves. Members of the National Guard of the United States and Air National Guard of the United States are included as Reserves. Thus, while service connection may be granted for any injury or disease that had its onset during active duty or during ACDUTRA if such was incurred or aggravated in the line of duty, current disabilities must be shown to be related only to injuries, and not diseases, sustained in INACDUTRA for service connected to be granted. When a claim for service connection is based only on a period of ACDUTRA, there must be some evidence that the appellant became disabled as a result of a disease or injury incurred or aggravated in the line of duty during the period of ACDUTRA. Smith v. Shinseki, 24 Vet. App. 40, 47 (2010). In the absence of such evidence, the period of ACDUTRA would not qualify as “active military, naval, or air service,” and the appellant would not qualify as a “veteran” by virtue of ACDUTRA service alone. Id. For purposes of 38 U.S.C. § 101(24), the term “injury” refers to the results of an external trauma rather than a degenerative process. See VAOPGCPREC 4-2002 (May 14, 2002); VAOPGCPREC 86-90 (July 18, 1990); VAOPGCPREC 8-2001 (Feb. 26, 2001). Generally, no presumptions (including the presumptions of soundness, aggravation, or for presumptive diseases) attach to periods of ACDUTRA and INACDUTRA unless “veteran” status is attained during those periods. See Paulson v. Brown, 7 Vet. App. 466, 470 (1995). The term “active duty” includes full-time duty in the Armed Forces, other than active duty for training (ACDUTRA).  38 U.S.C. § 101(21). The term Armed Forces means the United States Army, Navy, Marine Corps, Air Force, and Coast Guard, including the reserve components thereof.  38 U.S.C. § 101(10). ACDUTRA also includes full-time duty performed by members of the National Guard of any State, under 32 U.S.C. §§ 316, 502, 503, 504, or 505 or the prior corresponding provisions of law. 38 C.F.R. § 3.6(c)(3). This is considered federalized National Guard status. INACDUTRA also includes duty (other than full-time duty) performed by members of the National Guard of any State, under 32 U.S.C. §§ 316, 502, 503, 504, or 505 or the prior corresponding provisions of law. 38 C.F.R. § 3.6(d)(4). This too, is considered federalized National Guard status. Finally, ACDUTRA and INACDUTRA also includes any period of federalized National Guard service during which a member who is authorized or required by competent authority assumes an obligation to perform ACDUTRA or INACDUTRA and, who is disabled from an injury incurred while proceeding directly to, or returning directly from such ACDUTRA or INACDUTRA. 38 U.S.C. § 3.6(e). 1. Entitlement to service connection for type II diabetes mellitus. The Veteran contends that he has type II diabetes mellitus that had its onset during active duty. In this regard, the Veteran asserts that in 2002 and 2003 he was deployed to Prince Sultan Air Base in Saudi Arabia and while there he felt tingling and pain in his feet. He waited to see his private physician when he returned off duty and he was diagnosed with diabetes based on blood work. See February 2016 VA Form 9. The question for the Board is whether the Veteran has a current disability that is related to a disease that was incurred or aggravated during active duty or ACDUTRA while in the United States Air National Guard. While the Veteran has a current diagnosis of type II diabetes mellitus, the medical evidence shows that the Veteran was not first diagnosed with type II diabetes mellitus during active duty or ACDUTRA or within one year of active duty, and the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of type II diabetes mellitus is related to a disease or injury incurred or aggravated during active duty or ACDUTRA. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Turning to the evidence of record, a January 2011 National Guard treatment record shows that the Veteran had a diagnosis of type II diabetes mellitus. This diagnosis was recent to the filing of the Veteran’s claim in October 2011. See Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013). Furthermore, a VA examination dated in July 2019 provides a current diagnosis of type II diabetes mellitus. Thus, the Veteran has a current diagnosis of the claimed disability. Unfortunately, the Veteran’s active duty service treatment records from May 1977 to October 1977 and from October 2005 to February 2006 are unavailable. When a veteran’s service records are unavailable through no fault of his or her own, the Board has a heightened obligation to explain its findings and conclusions and to consider carefully the benefit-of-the-doubt rule. O’Hare v. Derwinski,1 Vet. App. 365 (1991). A review of the claims folder reveals that VA has fulfilled its heightened this obligation. The RO attempted to obtain these service treatment records from VA’s Record Management Center (RMC) in April 2012. The RO was informed that a special search was conducted, and no record was found. In June 2012, the RO received incomplete service treatment records from the Louisiana Air National Guard. The RO made a formal finding of the unavailability of the service treatment records based on the requests to the RMC and the Louisiana Air National Guard concluding that the records either do not exist, that the RMC and the Louisiana Air National Guard does not have them, or that future efforts to locate them would be futile. The RO sent a letter to the Veteran in June 2012 informing him that his some of his service treatment records could not be located and are unavailable for review. The RO notified the Veteran of the actions taken in an effort to obtain the records and asked him to send any service treatment record or other relevant evidence or information to support his claim. A June 2019 Report of General Information form reveals that the Veteran called the RO to inform them that his private medical records were lost in Katrina and his doctor is no longer in practice. He also stated that he has provided all his service treatment records which are in the electric claims file dated August 25, 2014 and November 22, 2013. The medical evidence of record does not show that the Veteran’s current type II diabetes mellitus had its onset during active duty or ACDUTRA or is otherwise related to such service. In this regard, the Veteran’s service treatment records that first mention a diagnosis of type II diabetes mellitus was dated March 26, 2009. The Veteran was not on active duty or ACDUTRA on that date. An August 2009 laboratory blood results show that the Veteran had high glucose level of 116 and high A1c of 6.8. There are no private or reserve treatment records prior to March 2009 that indicate the Veteran was diagnosed with type II diabetes or had symptoms attributed to the Veteran’s type II diabetes mellitus. Specifically, a February 2006 Post-Deployment Health Assessment the Veteran described his health in general as excellent and that he did not have any questions or concerns about his health. The physician documented that the Veteran reports that he felt well, and he had not health concerns. Regarding the issue of whether service connection is warranted on the basis of the presumption of service connection for chronic diseases, the weight of the above evidence is against manifestation of type II diabetes during active duty service or within the one-year presumptive period after discharge from active duty. See 38 U.S.C. §§ 1101(3), 1112(a)(1), 1113; 38 C.F.R. §§ 3.307 (a), 3.309(a). Concerning the Veteran’s lay statements that he experienced symptoms of type II diabetes mellitus while he was on active duty in 2003 in Saudi Arabia and he was diagnosed with type II diabetes mellitus when he returned home by his private physician, the Veteran is competent to report that he felt numbness and tingling in his feet while on active duty and that he received a diagnosis of type II diabetes mellitus from his private physician after he returned home. However, he is not competent to provide an opinion that the tingling and pain in his feet were symptoms of diabetes mellitus, as this requires medical knowledge and expertise. Nonetheless, even assuming arguendo, that those symptoms were related to diabetes, it is unclear based on these statements how soon after discharge from active duty in 2003 that the Veteran sought treatment for the tingling and pain in his feet or when he brought his paperwork the clinic on base to be included in the medical records. The Board finds that the Veteran’s National Guard treatment records indicate that this did not occur until several years after discharge from active duty in 2003. The evidence shows that the Veteran provided the National Guard with a copy of private treatment records dated in 2009 and 2010. The first evidence that indicates that the Air National Guard was aware of the Veteran’s diagnosis was in a January 2010 Health History Questions/Interval History, which is approximately 7 years after discharge from active duty in 2003 and approximately 4 years after discharge from active duty in 2006. Thus, the lay and medical evidence does not reflect that the Veteran was diagnosed of type II diabetes during active duty or within one year after discharge from active duty or during ACDUTRA. Furthermore, the claims file contains two negative VA medical opinions with respect to whether the Veteran’s type II diabetes mellitus was incurred in or caused by an in-service illness, event, or injury. Specifically, after considering history related by the Veteran, current examination, and review of medical records, a July 2019 VA examiner provided the medial opinion that the Veteran’s diabetes mellitus is less likely than not incurred in or caused by the claimed in-service illness, event, or injury. The examiner explained that the Veteran separated from active duty service in February 2006. He was not noted to have any complaints or prior history of diabetes noted on subsequent periodic examinations and physical in January 1987, December 1990, November 1995, and December 2000. He was noted be in good health during these examinations and he was not taking any medications at the time. Veteran stated on the Post Deployment Health Care Provider Review, Interview, and Assessment sheet in January 2006 that he was in excellent health. The Veteran stated that he felt well and had no health concerns at that time. A primary care physician note from November 2010 showed that the Veteran was now being treatment for type 2 diabetes. The examiner stated that he was unable to find any service treatment records during the Veteran’s active military service that show he sought medical attention for complaints pertaining to diabetes. Hemoglobin A1cs done in 2010 show increased rise from 6% up to 11.5%. In an August 2020 remand, the Board found that the July 2019 VA medical opinion was incomplete as the examiner did not mention the Veteran’s service in Southwest Asia in 2003. An October 2020 VA physician assistant also provided the medical opinion that the claimed condition is less likely than incurred in or caused by the claimed in-service injury, event, or illness. The physician assistant noted that all available medication records were reviewed. The Veteran’s service treatment records were negative for a diagnosis of diabetes during active duty service. The physician assistant explained that the etiology of diabetes is that it is an endocrine disorder related to the way the body produces or metabolizes insulin. The main cause of this condition is genetics. The physician assistant explained that there was no credible medical to support a causal link between diabetes and the Veteran’s active duty to include service in Southwest Asia in 2003. The medical opinions provided by the July 2019 examiner and the October 2020 physician assistant are persuasive and probative as to the issue of whether the Veteran’s type II diabetes mellitus had its onset in or is otherwise related to active duty or ACDUTRA, because the opinions were based on an accurate medical history and provided explanations that contain clear conclusions and supporting data. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Furthermore, the claims file does not contain a competent medical opinion to the contrary. While the Veteran is competent to report pain and tingling in his feet, the question of whether these symptoms are due to type II diabetes relates to an internal medical process that extends beyond an immediately observable cause-and-effect relationship that is of the type that the courts have found to be beyond the competence of witnesses. Compare Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007) (lay witness capable of diagnosing dislocated shoulder); Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007) (lay person competent to identify varicose veins); Falzone v. Brown, 8 Vet. App. 398, 403 (1995) (lay person competent to testify to pain and visible flatness of his feet); with Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009) (“It is generally the province of medical professionals to diagnose or label a mental condition, not the claimant”); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (unlike varicose veins or a dislocated shoulder, rheumatic fever is not a condition capable of lay diagnosis); Jandreau, 492 F.3d at 1377, n. 4 (“sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer”). Thus, the Veteran’s own assertions as to the etiology of his symptoms of are not competent. In conclusion, the preponderance of the evidence weighs against a finding that the Veteran was first diagnosed with type II diabetes mellitus during active duty or ACUTRA, was first diagnosed with type II diabetes mellitus within one year of discharge from active duty, or that the Veteran’s diagnosis of type II diabetes mellitus was incurred or aggravated during active duty or ACDUTRA in line of duty. Thus, entitlement to service connection for type II diabetes mellitus is not warranted. 2. Entitlement to service connection for obstructive sleep apnea. The Veteran contends that his obstructive sleep apnea is related to active duty service. In contrast, he asserts that it is due to his type II diabetes. Specifically, in the February 2016 VA form 9, the Veteran stated that after he provided the clinic on base with a copy of his private treatment records that showed a diagnosis of PTSD that he was told to get tested for sleep apnea. He stated that this was the result of his diabetes. Regarding the question of the whether the Veteran’s obstructive sleep apnea is secondary to the Veteran’s type II diabetes or a service-connected disability, the Board concludes that, while the Veteran has a current diagnosis of obstructive sleep apnea, the preponderance of the evidence is against finding that the Veteran’s obstructive sleep apnea is proximately due to or the result of, or aggravated beyond its natural progression by service-connected disability. 38 U.S.C. § 1110; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310 (a). The service connection claim for obstructive sleep apnea on a secondary basis is dependent upon a favorable outcome of the Veteran’s type II diabetes mellitus, discussed above. One of the requirements of a secondary service connection claim is evidence of a service-connected disability. 38 C.F.R. § 3.310. As the underlying claim of entitlement to service connection for type II diabetes mellitus is denied and at this time the Veteran is not in receipt of service connection for any disability, there is no legal basis upon which to grant his claim of service connection for obstructive sleep apnea on a secondary basis. Accordingly, the issue of entitlement to service connection for obstructive sleep apnea as secondary to a service-connected disability must be denied. Thus, the pertinent question for the Board is whether the Veteran has a current disability that is related to a disease that was incurred or aggravated during active duty or ACDUTRA while in the United States Air National Guard. While the Veteran has a current diagnosis of obstructive sleep apnea, the medical evidence shows that the Veteran was not first diagnosed with obstructive sleep apnea during active duty or ACDUTRA or within one year of active duty, and the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of obstructive sleep apnea is related to a disease or injury incurred or aggravated during active duty or ACDUTRA. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Turning to the evidence of record, a January 2011 National Guard treatment record shows that the Veteran had a diagnosis of sleep apnea. This diagnosis was recent to the filing of the Veteran’s claim in October 2011. See Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013). Furthermore, a July 2019 VA examination dated in provides a current diagnosis of obstructive sleep apnea. Thus, the Veteran has a current diagnosis of the claimed disability. Unfortunately, the Veteran’s active duty service treatment records from May 1977 to October 1977 and from October 2005 to February 2006 are unavailable. When a veteran’s service records are unavailable through no fault of his or her own, the Board has a heightened obligation to explain its findings and conclusions and to consider carefully the benefit-of-the-doubt rule. O’Hare v. Derwinski,1 Vet. App. 365 (1991). A review of the claims folder reveals that VA has fulfilled its heightened this obligation. The RO attempted to obtain these service treatment records from VA’s Record Management Center (RMC) in April 2012. The RO was informed that a special search was conducted, and no record was found. In June 2012, the RO received incomplete service treatment records from the Louisiana Air National Guard. The RO made a formal finding of the unavailability of the service treatment records based on the requests to the RMC and the Louisiana Air National Guard concluding that the records either do not exist, that the RMC and the Louisiana Air National Guard does not have them, or that future efforts to locate them would be futile. The RO sent a letter to the Veteran in June 2012 informing him that his some of his service treatment records could not be located and are unavailable for review. The RO notified the Veteran of the actions taken in an effort to obtain the records and asked him to send any service treatment record or other relevant evidence or information to support his claim. A June 2019 Report of General Information form reveals that the Veteran called the RO to inform them that his private medical records were lost in Katrina and his doctor is no longer in practice. He also stated that he has provided all his service treatment records which are in the electric claims file dated August 25, 2014 and November 22, 2013. The medical and lay evidence of record does not show that the Veteran’s current obstructive sleep apnea had its onset during active duty or ACDUTRA or is otherwise related to such service. In this regard, a February 2006 Post-Deployment Health Assessment the Veteran described his health in general as excellent and that he did not have any questions or concerns about his health. The physician documented that the Veteran reports that he felt well, and he had not health concerns. The Veteran’s service treatment records that first mention a diagnosis of obstructive sleep apnea was dated January 23, 2010. In addition, the July 2019 VA examiner documented that the onset of his symptoms of loud snoring and daytime fatigue began in 2010. He underwent a sleep study in 2010 and he was put on CPAP. Regarding the issue of whether service connection is warranted on the basis of the presumption of service connection for chronic diseases, the weight of the above evidence is against manifestation of obstructive sleep apnea during active duty service or within the one-year presumptive period after discharge from active duty. See 38 U.S.C. §§ 1101(3), 1112(a)(1), 1113; 38 C.F.R. §§ 3.307 (a), 3.309(a). Furthermore, the claims file contains two negative VA medical opinions with respect to whether the Veteran’s obstructive sleep apnea was incurred in or caused by an in-service illness, event, or injury. Specifically, after considering history related by the Veteran, current examination, and review of medical records, a July 2019 VA examiner provided the medial opinion that the Veteran’s obstructive sleep apnea is less likely than not incurred in or caused by the claimed in-service illness, event, or injury. The examiner explained that the Veteran separated from active duty service in February 2006. He was not noted to have any complaints or prior history of sleep apnea noted on subsequent periodic examinations and physical in January 1987, December 1990, November 1995, and December 2000. He was noted be in good health during these examinations and he was not taking any medications at the time. Veteran stated on the Post Deployment Health Care Provider Review, Interview, and Assessment sheet in January 2006 that he was in excellent health. The Veteran stated that he felt well and had no health concerns at that time. A primary care physician note from November 2010 showed that the Veteran was now being treatment for sleep apnea with CPAP. The examiner stated that he was unable to find any service treatment records during the Veteran’s active military service that show he sought medical attention for complaints pertaining to obstructive sleep apnea. In an August 2020 remand, the Board found that the July 2019 VA medical opinion was incomplete as the examiner did not mention the Veteran’s service in Southwest Asia in 2003. An October 2020 VA physician assistant also provided the medical opinion that the claimed condition is less likely than incurred in or caused by the claimed in-service injury, event, or illness. The physician assistant noted that all available medication records were reviewed. The Veteran’s service treatment records were negative for a diagnosis of obstructive sleep apnea during active duty service. The physician assistant explained that the etiology of obstructive sleep apnea is that it is an anatomical condition in which the structures of the upper airway relax/prolapse during sleep. This results in the temporary occlusion of the airway. It is not related to any exposure or activity during active duty service to include in Southwest Asia. The physician assistant explained that there was no credible medical evidence to support a causal link between obstructive sleep apnea and the Veteran’s active duty to include service in Southwest Asia in 2003. The medical opinions provided by the July 2019 examiner and the October 2020 physician assistant are persuasive and probative as to the issue of whether the Veteran’s obstructive sleep apnea had its onset in or is otherwise related to active duty or ACDUTRA, because the opinions were based on an accurate medical history and provided explanations that contain clear conclusions and supporting data. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Furthermore, the claims file does not contain a competent medical opinion to the contrary. While the Veteran is competent to report symptoms of snoring and daytime fatigue the etiology of obstructive sleep apnea relates to an internal medical process that extends beyond an immediately observable cause-and-effect relationship that is of the type that the courts have found to be beyond the competence of witnesses. Compare Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007) (lay witness capable of diagnosing dislocated shoulder); Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007) (lay person competent to identify varicose veins); Falzone v. Brown, 8 Vet. App. 398, 403 (1995) (lay person competent to testify to pain and visible flatness of his feet); with Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009) (“It is generally the province of medical professionals to diagnose or label a mental condition, not the claimant”); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (unlike varicose veins or a dislocated shoulder, rheumatic fever is not a condition capable of lay diagnosis); Jandreau, 492 F.3d at 1377, n. 4 (“sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer”). Thus, the Veteran’s own assertions as to the etiology of his symptoms of are not competent. In conclusion, the preponderance of the evidence weighs against a finding that the Veteran was first diagnosed with obstructive sleep apnea during active duty or ACUTRA, was first diagnosed with obstructive sleep apnea within one year of discharge from active duty, or that the Veteran’s diagnosis of obstructive sleep apnea was incurred or aggravated during active duty or ACDUTRA in line of duty. Thus, entitlement to service connection for obstructive sleep apnea is not warranted. 3. Entitlement to service connection for hypertension. The Veteran contends that his hypertension is related to active duty service. In contrast, he asserts that it is due to his type II diabetes and/or obstructive sleep apnea. Specifically, in the February 2016 VA form 9, the Veteran stated his other problems were the result of his diabetes. Regarding the question of the whether the Veteran’s hypertension is secondary to the Veteran’s type II diabetes, obstructive sleep apnea, or a service-connected disability, the Board concludes that, while the Veteran has a current diagnosis of hypertension, the preponderance of the evidence is against finding that the Veteran’s hypertension is proximately due to or the result of, or aggravated beyond its natural progression by service-connected disability. 38 U.S.C. § 1110; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310 (a). The service connection claim hypertension on a secondary basis is dependent upon a favorable outcome of the Veteran’s type II diabetes mellitus and obstructive sleep apnea, discussed above. One of the requirements of a secondary service connection claim is evidence of a service-connected disability. 38 C.F.R. § 3.310. As the underlying claims of entitlement to service connection for type II diabetes mellitus and obstructive sleep apnea are denied and at this time the Veteran is not in receipt of service connection for any disability, there is no legal basis upon which to grant his claim of service connection for hypertension on a secondary basis. Accordingly, the issue of entitlement to service connection for hypertension as secondary to a service-connected disability must be denied. Thus, the pertinent question for the Board is whether the Veteran has a current disability that is related to a disease that was incurred or aggravated during active duty or ACDUTRA while in the United States Air National Guard. While the Veteran has a current diagnosis of hypertension, the medical evidence shows that the Veteran was not first diagnosed with hypertension during active duty or ACDUTRA or within one year of active duty, and the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of hypertension is related to a disease or injury incurred or aggravated during active duty or ACDUTRA. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Turning to the evidence of record, a January 2011 National Guard treatment record shows that the Veteran had a diagnosis of hypertension. This diagnosis was recent to the filing of the Veteran’s claim in October 2011. See Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013). Furthermore, a July 2019 VA examination dated in provides a current diagnosis of hypertension. Thus, the Veteran has a current diagnosis of the claimed disability. Unfortunately, the Veteran’s active duty service treatment records from May 1977 to October 1977 and from October 2005 to February 2006 are unavailable. When a veteran’s service records are unavailable through no fault of his or her own, the Board has a heightened obligation to explain its findings and conclusions and to consider carefully the benefit-of-the-doubt rule. O’Hare v. Derwinski,1 Vet. App. 365 (1991). A review of the claims folder reveals that VA has fulfilled its heightened this obligation. The RO attempted to obtain these service treatment records from VA’s Record Management Center (RMC) in April 2012. The RO was informed that a special search was conducted, and no record was found. In June 2012, the RO received incomplete service treatment records from the Louisiana Air National Guard. The RO made a formal finding of the unavailability of the service treatment records based on the requests to the RMC and the Louisiana Air National Guard concluding that the records either do not exist, that the RMC and the Louisiana Air National Guard does not have them, or that future efforts to locate them would be futile. The RO sent a letter to the Veteran in June 2012 informing him that his some of his service treatment records could not be located and are unavailable for review. The RO notified the Veteran of the actions taken in an effort to obtain the records and asked him to send any service treatment record or other relevant evidence or information to support his claim. A June 2019 Report of General Information form reveals that the Veteran called the RO to inform them that his private medical records were lost in Katrina and his doctor is no longer in practice. He also stated that he has provided all his service treatment records which are in the electric claims file dated August 25, 2014 and November 22, 2013. The medical and lay evidence of record does not show that the Veteran’s current hypertension had its onset during active duty or ACDUTRA or is otherwise related to such service. In this regard, a November 1995 Periodic National Guard examination shows that the Veteran’s blood pressure was slightly elevated at 122/90. A December 2000 periodic examination shows that the Veteran’s blood pressure was within normal limits at 112/68. A February 2006 Post-Deployment Health Assessment the Veteran described his health in general as excellent and that he did not have any questions or concerns about his health. The physician documented that the Veteran reports that he felt well, and he had not health concerns. The Veteran’s service treatment records that first mention a diagnosis of hypertension was dated October 22, 2009. Moreover, the Veteran does not assert that his hypertension began during ACDUTRA or INACDUTRA. Regarding the issue of whether service connection is warranted on the basis of the presumption of service connection for chronic diseases, the weight of the above evidence is against manifestation of hypertension during active duty service or within the one-year presumptive period after discharge from active duty. See 38 U.S.C. §§ 1101(3), 1112(a)(1), 1113; 38 C.F.R. §§ 3.307 (a), 3.309(a). Furthermore, the claims file contains two negative VA medical opinions with respect to whether the Veteran’s hypertension was incurred in or caused by an in-service illness, event, or injury. Specifically, after considering history related by the Veteran, current examination, and review of medical records, a July 2019 VA examiner provided the medial opinion that the Veteran’s hypertension is less likely than not incurred in or caused by the claimed in-service illness, event, or injury. The examiner explained that the Veteran separated from active duty service in February 2006. He was not noted to have any complaints or prior history of hypertension noted on subsequent periodic examinations and physical in January 1987, December 1990, November 1995, and December 2000. He was noted be in good health during these examinations and he was not taking any medications at the time. Veteran stated on the Post Deployment Health Care Provider Review, Interview, and Assessment sheet in January 2006 that he was in excellent health. The Veteran stated that he felt well and had no health concerns at that time. A primary care physician note from November 2010 showed that the Veteran was now being treatment for hypertension with medication. The examiner stated that he was unable to find any service treatment records during the Veteran’s active military service that show he sought medical attention for complaints pertaining to hypertension. In an August 2020 remand, the Board found that the July 2019 VA medical opinion was incomplete as the examiner did not mention the Veteran’s service in Southwest Asia in 2003. An October 2020 VA physician assistant also provided the medical opinion that the claimed condition is less likely than incurred in or caused by the claimed in-service injury, event, or illness. The physician assistant noted that all available medication records were reviewed. The Veteran’s service treatment records were negative for a diagnosis of hypertension during active duty service. The physician assistant explained that the etiology of hypertension is that it is vascular disorder and the etiology is multifactorial; however, it is not related to any exposure or activity during active duty service to include in Southwest Asia. The physician assistant explained that there was no credible medical to support a causal link between hypertension and the Veteran’s active duty to include service in Southwest Asia in 2003. The medical opinions provided by the July 2019 examiner and the October 2020 physician assistant are persuasive and probative as to the issue of whether the Veteran’s hypertension had its onset in or is otherwise related to active duty or ACDUTRA, because the opinions were based on an accurate medical history and provided explanations that contain clear conclusions and supporting data. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Furthermore, the claims file does not contain a competent medical opinion to the contrary. Although the Veteran believes his hypertension is related to active duty or ACDUTRA, he is not competent to provide a diagnosis of hypertension or a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge and interpretation of medical testing. Therefore, it is outside the competence of the Veteran, because the record does not show that he has the medical training or credentials to make such a determination. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the July 2019 and October 2020 negative medical opinions. (Continued on the next page)   In conclusion, the preponderance of the evidence weighs against a finding that the Veteran was first diagnosed with hypertension during active duty or ACUTRA, was first diagnosed with hypertension within one year of discharge from active duty, or that the Veteran’s diagnosis of hypertension was incurred or aggravated during active duty or ACDUTRA in line of duty. Thus, entitlement to service connection for hypertension is not warranted. L. B. CRYAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Berry, 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.