Citation Nr: 21027130 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 16-28 098 DATE: May 4, 2021 ORDER Entitlement to service connection for sleep apnea, also claimed as sleep disturbance, to include as an undiagnosed illness or a medically unexplained chronic multi-symptom illness, is denied. Entitlement to service connection for muscle movement disorder in the eyes, claimed also as eye tremors, to include as due to an undiagnosed illness, is denied. Entitlement to service connection for dizziness or a balance disorder, to include as due to an undiagnosed illness or a medically unexplained chronic multi-symptom illness, is denied. FINDINGS OF FACT 1. The preponderance of the evidence weighs against finding that the Veteran has obstructive sleep apnea that began during active service or is otherwise related to an in-service injury or disease, due to an undiagnosed illness or a medically unexplained multi-symptom illness. 2. The Veteran does not have a diagnosis of muscle movement disorder in the eyes, claimed also as eye tremors. 3. The preponderance of the evidence weighs against finding that the Veteran has dizziness or a balance disorder that began during active service or is otherwise related to an in-service injury or disease, due to an undiagnosed illness or a medically unexplained multi-symptom illness. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for sleep apnea, also claimed as sleep disturbance, to include as an undiagnosed illness or a medically unexplained chronic multi-symptom illness have not been met. 38 U.S.C. §§ 1110, 1117, 1131; 38 C.F.R. §§ 3.303. 3.317. 2. The criteria for entitlement to service connection for muscle movement disorder in the eyes, claimed also as eye tremors, to include as due to an undiagnosed illness have not been met. 38 U.S.C. §§ 1110, 1117, 1131; 38 C.F.R. §§ 3.303. 3.317. 3. The criteria for entitlement to service connection for dizziness or a balance disorder, to include as due to an undiagnosed illness or a medically unexplained chronic multi-symptom illness have not been met. 38 U.S.C. §§ 1110, 1117, 1131; 38 C.F.R. §§ 3.303. 3.317. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1978 to July 1986; from January 1991 to March 1991 he served on active duty in support of Operation Desert Shield/Storm. He also had active duty training and inactive duty training in the Air Force Reserve from 1988 to 1992. "Active military, naval, or air service" includes any period of active duty for training during which the individual concerned was disabled or died from a disease or injury incurred in line of duty. Active military, naval, or air service also includes any period of inactive duty for training during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebral vascular accident occurring during such training. 38 U.S.C. § 101(24); 38 C.F.R. § 3.6(a). Active duty for training is full-time duty performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c). Inactive duty training means duty other than full-time duty prescribed for Reserves or the National Guard of any state. 38 U.S.C. § 101(23); 38 C.F.R. § 3.6(d). Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish service connection, the evidence generally must show: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). For Veterans who served in the Southwest Asia theater of operations during the Persian Gulf War, service connection may also be established for chronic disability that cannot be attributed to a known clinical diagnosis (undiagnosed illness) or for a medically unexplained multi-symptom illness (e.g., chronic fatigue syndrome, fibromyalgia, or irritable bowel syndrome). 38 C.F.R. § 3.317. Service connection may be established on a presumptive basis for a Persian Gulf Veteran who exhibits objective indications of chronic disability resulting from undiagnosed illness that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021, and which by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1). In claims based on undiagnosed illness, unlike those for direct service connection, there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004). Notably, laypersons are competent to report objective signs of illness. Id. A medically unexplained chronic multi-symptom illness is one defined by a cluster of signs or symptoms, and specifically includes chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome. 38 C.F.R. § 3.317(a)(2)(ii). It means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii). If signs or symptoms have been medically attributed to a diagnosed (rather than undiagnosed) illness, the Persian Gulf War presumption of service connection does not apply. VAOPGCPREC 8-98. The term Persian Gulf Veteran means a veteran who served on active duty during the Persian Gulf War in the Southwest Asia theater of operations, which refers to Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. 38 C.F.R. § 3.317 (e)(1)(2). The Persian Gulf War is defined as the period beginning on August 2, 1990 and ending on the date thereafter prescribed by law. 38 U.S.C. § 101(33). Here, the Veteran's service personnel records verify he had service in the Persian Gulf from January 1991 to March 1991 and therefore, the presumption contained in 38 C.F.R. § 3.317 is applicable. 1. Entitlement to service connection for sleep apnea, also claimed as sleep disturbance, to include as due to an undiagnosed illness or a medically unexplained chronic multi-symptom illness The Veteran has a current diagnosis of sleep apnea. See October 2018 VA medical center respiratory therapy note. He asserts that he has sleep apnea that is related to an undiagnosed illness or a medically unexplained chronic multi-symptom illness from his Gulf War service. See January 2016 notice of disagreement and April 2016 correspondence. The Veteran's service treatment and medical records are negative for any complaints, treatment, or diagnosis of a sleep disorder of any kind. On his May 1986 service separation medical report, he indicated he did not have frequent trouble sleeping and on clinical evaluation there was no mention of a sleep disorder. The Veteran entered Reserve service in 1988. In a January 1988 Reserve enlistment medical examination report he again indicated he had not had frequent trouble sleeping; nor did clinical evaluation reveal any sort of sleep disorder. Subsequent medical examinations conducted during the Veteran's Reserve service show he consistently noted he had not had frequent trouble sleeping. Such was shown in medical examination reports dated in June 1988, May 1989, April 1990, and May 1992. Moreover, in June 1989 the Veteran completed a supplemental history occupational health examination and essentially indicated he had no sleeping difficulties. Consequently, service connection for sleep apnea, also claimed as sleep disturbance, on a direct basis, that is, it became manifest in service and was incurred therein, is not warranted. The Veteran has asserted that he had sleep disturbances since his service in the Gulf War. In May 1996 correspondence the Veteran stated that in June 1991, when he received his annual flight physical, he had symptoms of high blood pressure along with problems sleeping, and that his sleeping problems worsened. He stated that this took place prior to June of 1992. He provided additional statements in August 1996 that his symptoms including sleep disturbances, began between the summer of 1991 and spring of 1992 and that his sleep disturbances continued to the present time. Of record is a 1995 VA clinical record report on the Persian Gulf Registry, which indicates the Veteran had no sleep disturbance. A September 1997 VA mental disorders examination report notes the Veteran was seen by a private physician and was started on Prozac four years ago mainly for "mood swings and sleep." During the September 1997 examination, the Veteran reported he sleeps seven hours at night and does not have insomnia. To the extent the Veteran is asserting continuity of symptomatology since service, the Board finds that a chronic sleep disorder was not shown in service. Even considering the Veteran's lay statements of in-service incurrence, the Board finds those statements are inconsistent with the overall record. While the Veteran claims the onset of sleep problems in 1991, he has not credibly shown that his current sleep apnea/sleep disturbance was incurred in or related to service and continued since service. His assertions are inconsistent with service treatment and medical records and post-service medical evidence. Additional evidence in the Veteran's record shows in November 1997 he underwent a VA general medical examination. He reported that before he went to the "Gulf" he slept eight hours per night and since being back he sleeps only six hours with interruptions within three hours mostly due to heartburn. The examiner diagnosed insomnia, undiagnosed illness and noted that since coming back from the Persian Gulf the Veteran has complained of insomnia [among other conditions]. The examiner further noted that as a Persian Gulf Veteran multiple laboratory work pertaining to his signs and symptoms were done which revealed unremarkable findings. On November 2002 VA mental disorders examination, the Veteran described having problems with fatigue and "copes" by sleeping. He stated he rarely takes naps and that he sleeps nine hours per day. A January 2014 VA Persian Gulf examination report lists obstructive sleep apnea as a medical concern/complaint of the Veteran. It was noted the Veteran has a prior medical history of obstructive sleep apnea and wears CPAP [continuous positive airway pressure]. Following physical examination there was no diagnosis rendered regarding a sleep disorder. A September 2015 VA initial posttraumatic stress disorder (PTSD) examination report diagnosed obstructive sleep apnea syndrome. The Veteran reported he fights in his sleep. He stated he does not sleep well. The report showed the Veteran had sleep disturbance and chronic sleep impairment as symptoms associated with the Veteran's mental disorder diagnosis. A September 2015 VA sleep apnea examination diagnosed the Veteran with having obstructive sleep apnea. However, there were no current findings, signs, or symptoms attributable to sleep apnea. The examiner noted the Veteran had a sleep study performed, but the results were not available for review. The examiner opined that the Veteran's obstructive sleep apnea, claimed as sleep disturbance, is not caused by or a result of a specific exposure event experienced by the Veteran during service in Southwest Asia. The rationale for the opinion was that sleep apnea is a disease with a clear and specific etiology and diagnosis. It is caused by a combined reduced upper airway size and diminished neural output to the upper airway muscles during sleep and at apnea onset can result in partial or complete upper airway collapse. The results are obstructive and mixed apneas. Review of the available medical literature reveals no evidence of an association between environmental exposures and the development of obstructive sleep apnea. On September 2015 VA chronic fatigue syndrome examination, the Veteran reported that very often he will be aggressive while he is sleeping. He stated that it has been reported to him that for the past 20 years, he snores. In a January 2020 VA medical opinion, by the same examiner who conducted the September 2015 VA sleep apnea examination, the examiner opined that obstructive sleep apnea was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The rationale for the opinion was that there is no evidence of subjective complaints indicative of sleep apnea in the service treatment records or records following service for several years. Furthermore, the Veteran's service treatment records and review of the Veteran's claims file reveal no evidence the Veteran developed sleep apnea during his second period of service or within a year of service. There is no evidence that his sleep apnea is related to his second period of service. There is no evidence in the current medical literature that military service causes or increase the risk of developing sleep apnea. In an October 2020 VA addendum medical opinion, the same examiner who conducted the September 2015 VA sleep apnea examination and provided the January 2020 VA medical opinion opined that the Veteran's obstructive sleep apnea was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale for the opinion was that the Veteran's subjective report of sleep disturbances did not equate to a diagnosis of obstructive sleep apnea. Further, the symptoms reported by the Veteran in 1996 and 1997 that he contends began in 1991 are not consistent with obstructive sleep apnea. Sleep apnea does not cause a person to violent swinging while asleep or leaping or jumping out of bed. The sleep disturbance symptoms reported by the Veteran in 1996 and 1997, with 1991 onset, are not consistent with symptoms attributable to obstructive sleep apnea. Here, as noted above, the Veteran has been diagnosed with sleep apnea. As such, there is no undiagnosed condition that warrants presumptive service connection analysis under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317, which provides compensation for qualifying chronic disability of undiagnosed illness or medically unexplained chronic multi-symptom illnesses. The Board further finds that the evidence does not support that the Veteran's diagnosed sleep apnea is related to his service. As reported, service treatment records are negative for complaints, treatment or diagnosis of a sleep disorder. Notwithstanding the Veteran's unsupported and less than credible history of sleep problems in 1991, it was not until November 1997, more than 10 years after the Veteran's first period of service, nearly 6 years after his second service period and 5 years since his discharge from a Reserve component that the Veteran reported interruptions in his sleep and was diagnosed with having insomnia, which he related was mostly due to heartburn. The multi-year gap after service provides highly probative evidence against the claim. Furthermore, the Board finds that as a lay person the Veteran is not competent to opine as to the etiology of a sleep disorder. Moreover, the competent evidence of record is against the Veteran's claim for service connection for sleep apnea. The VA examiner who conducted the September 2015 VA sleep apnea examination and provided the January and October 2020 addendum opinions opined that the Veteran's obstructive sleep apnea was less likely than not incurred in or caused by the claimed in-service injury, event or illness, nor caused by or a result of a specific exposure event experienced by the Veteran during service in Southwest Asia. The Board finds the opinions of the VA examiner highly probative in this instance, as the examiner considered the Veteran's lay statements, cited to accurate factual data, and provided a detailed rationale. The Board has considered the Veteran's assertions that he has a sleep disorder related to service. While lay persons are competent to provide opinions on some medical issues, the etiology of the Veteran's sleep disorder, also claimed as sleep disturbance, is outside the realm of common knowledge. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Accordingly, the Board concludes that the preponderance of the evidence is against the claim for service connection for sleep apnea, also claimed as sleep disturbance. 38 U.S.C. § 5107(b). 2. Entitlement to service connection for muscle movement disorder in the eyes, claimed also as eye tremors, to include as due to an undiagnosed illness The Veteran contends service connection is warranted because he has tremors in his eyes related to service to include as due to an undiagnosed illness. Specifically he has decreased vision in his left eye, "stacked, vertical, blurred vision[,]" which he claims as neurological symptoms. The Veteran's service treatment and medical records are negative for any complaints, treatment, or diagnosis of a muscle movement disorder in the eyes. In June 1984, he completed a supplemental history occupational health examination and indicated he had no eye trouble. On his May 1986 service separation medical report, he indicated he did not have eye trouble, and on clinical evaluation there were no abnormalities of the eyes. The Veteran entered Reserve service in 1988. In a January 1988 Reserve enlistment medical examination report, he again indicated he had not had eye trouble, nor did clinical evaluation reveal any abnormalities of the eyes. Subsequent medical examinations conducted during the Veteran's Reserve service show he consistently noted he had not had eye trouble. Such was shown in medical examination reports dated in June 1988, May 1989, April 1990, and May 1992. Consequently, service connection for muscle movement disorder in the eyes, on a direct basis, that is, it became manifest in service and was incurred therein, is not warranted. The Veteran underwent VA examinations regarding the claimed muscle movement of his eyes, but none provides a link of the claimed disorder to his military service. For example, on October 1997 VA miscellaneous neurological disorders examination there were no complaints or any mention of muscle movement of the Veteran's eyes. On November 1997 VA general medical examination, the Veteran's eyes were unremarkable. On December 2002 VA Gulf War guidelines examination, there was no mention of the Veteran's eyes. In October 2015 the Veteran underwent a VA eye conditions examination. The diagnosis section of the examination report indicates that the Veteran does not have or has ever been diagnosed with an eye disorder other than congenital or developmental errors of refraction. On physical examination, the Veteran reported decreased vision in the left eye "stacked, vertical, blurred vision" claiming neurological symptoms. It was noted that the Veteran is aware that he has astigmatism and there are no other known left eye problems. The examiner noted that the Veteran does not have nor has he ever had any ocular disease of the eyes. The examiner found it more likely than not that the Veteran experiences monocular diplopia of the left eye; and it is more likely than not that the Veteran's monocular diplopia of the left eye is secondary to his under-corrected refractive error (his astigmatism of the left eye) in the left eye. The examiner noted further that based on the fact that refractive error is not a condition which can be service connected in this instance, no medical opinion was warranted. In November 2018 the Board remanded the Veteran's claim for service connection for muscle movement disorder in the eyes for an addendum opinion from the October 2015 VA eye examiner as to whether tremors of the Veteran's eyes are at least as likely as not (50 percent or greater probability) related to his exposure to hazards, taking the "PB pills," anthrax vaccine, and depleted uranium missions. The Board remand also noted that the VA examiner did not address a December 2013 VA treatment record that noted a positive perioral tremor of the eyes. Pursuant to the November 2018 Board remand the October 2015 VA eye examiner provided the requested addendum opinion. In a December 2019 addendum opinion, the examiner noted review of pertinent records and related that based on review of the medical evidence there is no subjective or objective evidence that the Veteran has an eye tremor. In August 2020 the Board remanded the Veteran's claim for service connection for muscle movement disorder in the eyes for another addendum opinion to address the December 2013 VA treatment record that noted a positive perioral tremor of the eyes, and to clarify whether the Veteran has a diagnosis of an eye tremor and whether such diagnosis is at least as likely as not related to an undiagnosed illness or related to a medically unexplained chronic multi-symptom illness as defined in 38 C.F.R. § 3.317(a)(2). Pursuant to the August 2020 Board remand directives, a response was provided in October 2020 by the October 2015 VA eye examiner who opined that the Veteran did not have any pertinent eye/ocular disabilities identified during the pendency of the claim for "eye tremors", therefore a nexus opinion, including related to an undiagnosed illness or a medically unexplained chronic multi-symptom illness was not applicable because there were no conditions present relating to "eye tremors." Regarding the December 2013 VA treatment record that noted a positive perioral tremor of the eyes, after researching the matter, the examiner found that "perioral tremor" is not an "eye tremor" nor would it cause ocular symptoms but pertains to the mouth. The examiner noted that he was unable to find a single record in which the Veteran was diagnosed with an eye tremor or nystagmus (rhythmic involuntary eye movements). Further, the examiner noted that the Veteran's unilateral vertical double vision or stacked vertical, blurred vision of the left eye would not occur from an eye tremor. The examiner reiterated his belief that the Veteran's subjective complaints regarding his left eye were secondary to under-corrected refractive error. The Board finds the VA eye examiner's opinions highly probative as the examiner conducted an in-depth review of the pertinent evidence of record, including the Veteran's statements, cited to accurate factual data, and provided a detailed rationale. Here, the preponderance of the evidence shows that there is no diagnosis found in the record of muscle movement of the eyes, claimed also as eye tremors by any VA or private medical provider. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992). Accordingly, the Board finds that the preponderance of the evidence is against the claim, and the claim for service connection for muscle movement disorder in the eyes, claimed as eye tremors is denied. 38 U.S.C. § 5107(b). 3. Entitlement to service connection for dizziness or a balance disorder, to include as due to an undiagnosed illness or as a medically unexplained chronic multi- symptom illness The Veteran asserts that he has dizziness or balance issues to include as due to an undiagnosed illness or as a medically unexplained chronic multi-symptom illness. He stated that the dizziness he experiences is not like "spinning dizzy". He does not have a sensation that the room or surroundings are spinning, but the problem is he feels like he cannot keep his balance. See September 2015 VA ear conditions examination report. The Veteran's service treatment and medical records are negative for any complaints, treatment or diagnosis of dizziness or balance issues. On his May 1986 service separation medical report, he indicated he did not have dizziness and on clinical evaluation there was no mention of dizziness or balance issues. The Veteran entered Reserve service in 1988. In a January 1988 Reserve enlistment medical examination report he again indicated he had not had dizziness; nor did clinical evaluation reveal he had dizziness or balance issues. Subsequent medical examinations conducted during the Veteran's Reserve service show he consistently noted he had not had dizziness. Such was shown in medical examination reports dated in June 1988, May 1989, April 1990, and May 1992. Moreover, in June 1989 the Veteran completed a supplemental history occupational health examination and essentially indicated he had not been troubled with dizziness or lightheadedness nor with keeping his balance. Consequently, service connection for dizziness or a balance disorder, on a direct basis, that is, it became manifest in service and was incurred therein, is not warranted. On September 2015 VA ear conditions examination, the Veteran reported that he filed a claim for service connection for "constant dizziness." He related that the dizzy sensation he was experiencing was not a sensation that the room or surroundings were spinning, but that he feels he cannot keep his balance. He stated it becomes noticeable when he is on his motorcycle, when he goes downstairs, and when he walks on flat surfaces. After examining the Veteran, the examiner found the Veteran did not have or had ever been diagnosed with an ear or peripheral vestibular condition. The examiner opined that the Veteran's dizziness is not caused by or a result of a specific exposure event he experienced during service in Southwest Asia. The rationale for the opinion was there was no subjective or objective evidence of dizziness, vertigo, etc., but that the Veteran subjectively reported problems with balance; and his problem with balance is most likely due to radiculopathy noted on EMG [electromyograph] and is not a separate condition. In November 2018, the Board remanded the claim for an addendum opinion from the September 2015 examiner regarding the Veteran's dizziness. The examiner was asked to provide an addendum opinion as to whether the current dizziness is at least as likely as not (50 percent or greater probability) related to the Veteran's second period of service. The September 2015 VA examiner provided an addendum opinion in January 2020. The examiner opined that the Veteran's dizziness was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that there is no subjective or objective evidence of the claimed dizziness. In addressing the January 2014 VA Persian Gulf examination report and the October 2014 VA treatment record, which shows there were subjective accounts of dizziness, the examiner explained that the Veteran's statements in the January 2014 VA Persian Gulf examination report regarding dizziness were inherently contradictory. In addition, regarding the October 2014 VA treatment record, the examiner reiterated what the Veteran actually reported at the time, which was at times he feels dizzy and lightheaded and might not take Benicar. The examiner notes that Benicar is a medication for hypertension and not used to treat dizziness. However, the Veteran reported that the hypertension medication occasionally caused him to feel dizzy or lightheaded. A medication change was made in October 2014, and there was resolution of the dizziness by December 2014. During the January 2020 VA examination for fibromyalgia the Veteran reported having additional symptoms including dizziness, which he described as "horrible." He related that he does okay on flat surfaces but must hold onto something on stairs and ladders "because it happens so often." Here, upon adjudicating the claim, the Board found that the Veteran's claim is a claim for balance issues rather than dizziness. The Board again remanded the claim (in August 2020) for another addendum opinion from the VA provider who issued the September 2015 and January 2020 medical opinions to address the Veteran's balance issue, claimed as dizziness. In October 2020 the same VA examiner provided the requested addendum opinion. The examiner noted that the Veteran's claimed balance disorder is caused by lumbar radiculopathy and therefore was not considered an undiagnosed illness or a medically unexplained chronic multi-symptom illness because lumbar radiculopathy is a condition with a clear and specific etiology and diagnosis. The examiner opined that the claimed balance disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale for the opinion was that the Veteran's claimed balance disorder is caused by lumbar radiculopathy, and there is no evidence of a back disorder, a back injury, or back pain in the service treatment records. There was also no evidence of radiculopathy or a lumbar spine disorder in service or within a year of service. There is no evidence of lumbar radiculopathy being related to any in-service event, injury, or illness. The Board finds that the competent evidence of record is against the Veteran's claim for service connection for dizziness or a balance disorder. The VA examiner who conducted the September 2015 VA ear and fibromyalgia examinations and provided the January and October 2020 addendum opinions opined (in separate opinions) that the Veteran's dizziness and a balance disorder are less likely than not incurred in or caused by the claimed in-service injury, event or illness; nor caused by or a result of a specific exposure event experienced by the Veteran during service in Southwest Asia. The Board finds the opinions of the VA examiner highly probative in this instance, as the examiner considered the Veteran's lay statements, cited to accurate factual data, and provided detailed rationales. The Board has considered the Veteran's assertions that he has dizziness, or a balance disorder related to service. While lay persons are competent to provide opinions on some medical issues, the Veteran is not shown to have the medical training necessary to link the claimed dizziness or a balance disorder to his military service. See Jandreau, 492 F.3d at 1376-77. Accordingly, the preponderance of the evidence is against the claim for service connection for dizziness or a balance disorder. 38 U.S.C. § 5107(b). A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Young, 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.