Citation Nr: 21027544 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 17-09 684 DATE: May 6, 2021 ORDER Entitlement to service connection for a back disability is granted. Entitlement to service connection for left lower extremity peripheral neuropathy is granted. Entitlement to service connection for right lower extremity peripheral neuropathy is granted. Entitlement to service connection for diabetes mellitus is denied. Entitlement to service connection for obstructive sleep apnea (OSA) is denied. Entitlement to service connection for right upper extremity peripheral neuropathy is denied. Entitlement to service connection for left upper extremity peripheral neuropathy is denied. Entitlement to service connection for skeletal arthritis is denied. Entitlement to service connection for a bilateral kidney condition is denied. Entitlement to service connection for a bilateral eye disability is denied. FINDINGS OF FACT 1. Resolving all doubt in the Veteran's favor, the evidence shows that the Veteran's back disability is etiologically related to his service. 2. The evidence shows the Veteran's left lower extremity peripheral neuropathy is caused by his back disability. 3. The evidence shows the Veteran's right lower extremity peripheral neuropathy is caused by his back disability. 4. The preponderance of the evidence is against finding that the Veteran has diabetes mellitus due to an event, injury, or disease in service. 5. The preponderance of the evidence is against finding that the Veteran has OSA due to an event, injury, or disease in service. 6. The preponderance of the evidence is against finding that the Veteran has right upper extremity peripheral neuropathy due to an event, injury, or disease in service. 7. The preponderance of the evidence is against finding that the Veteran has left upper extremity peripheral neuropathy due to an event, injury, or disease in service. 8. The preponderance of the evidence is against finding that the Veteran has skeletal arthritis due to an event, injury, or disease in service. 9. The preponderance of the evidence is against finding that the Veteran has a bilateral kidney condition due to an event, injury, or disease in service. 10. The preponderance of the evidence is against finding that the Veteran has a bilateral eye disability due to an event, injury, or disease in service. CONCLUSIONS OF LAW 1. The criteria for establishing service connection for a back disability have been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for establishing service connection for left lower extremity peripheral neuropathy have been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for establishing service connection for right lower extremity peripheral neuropathy have been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for diabetes mellitus are not met. 38 U.S.C. § 1131; 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309, 3.310. 5. The criteria for service connection for OSA are not met. 38 U.S.C. § 1131; 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309, 3.310. 6. The criteria for entitlement to service connection for right upper extremity peripheral neuropathy have not been met. 38 U.S.C. § 1131; 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309, 3.310. 7. The criteria for entitlement to service connection for left upper extremity peripheral neuropathy have not been met. 38 U.S.C. § 1131; 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309, 3.310. 8. The criteria for entitlement to service connection for skeletal arthritis have not been met. 38 U.S.C. § 1131; 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309, 3.310. 9. The criteria for entitlement to service connection for a bilateral kidney condition have not been met. 38 U.S.C. § 1131; 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309, 3.310. 10. The criteria for entitlement to service connection for a bilateral eye disability have not been met. 38 U.S.C. § 1131; 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from June 1988 to April 1992. This matter is before the Board of Veterans' Appeals (Board) on appeal from April 2016 and October 2017 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In October 2019, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. Service Connection Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires (1) medical evidence of a presently existing disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claim in-service disease or injury and the present disability. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)); Hickson v. West, 12 Vet. App. 247, 253 (1999). The Board notes the Veteran had service in Southwest Asia. Under 38 C.F.R. § 3.317(a)(2)(i)(A)(B), compensation may be warranted on a presumptive basis for medically unexplained chronic multi-symptom illnesses as well as disabilities due to undiagnosed illness. Service connection may be established for objective indications of a chronic disability resulting from an undiagnosed illness or illnesses, provided that such disability (1) became manifest in service on active duty in the Armed Forces 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 (2) by history, physical examination, and laboratory tests cannot be attributed to a known clinical diagnosis. To fulfill the requirement of chronicity, the illness must have persisted for six months. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. Under 38 C.F.R. § 3.317(a)(2)(i)(B), if a Veteran has a chronic multi-symptom illness other than chronic fatigue syndrome, fibromyalgia or irritable bowel syndrome, it is solely a medical determination as to whether that illness qualifies under 38 C.F.R. § 3.317(a)(2)(i)(B) as a "medically unexplained chronic multi-symptom illness." 75 Fed Reg. 61,995,-01, 61,995-96 (Oct. 7, 2010). The term "medically unexplained chronic multi-symptom illness 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." 38 C.F.R.§ 3.317(a)(2)(ii). 1. Entitlement to service connection for a back disability The Veteran contends his back disability began during service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. STRs are void for evidence of a back disability. Treatment records from Dr. C. H., detail complaints of back pain dating back to 2008. The Veteran underwent an examination in September 2017. The Veteran reported back spasms, and had a history of back surgery. The examiner stated there is no nexus between his joint pain and Gulf War exposures. In an October 2016 statement, Dr. I. A., of Golden Triangle Neurocare, stated that the Veteran had a disc herniation which required surgical care. He explained that is more likely than not that his military service was a contributing factor to his back issues. Records from Southeast Texas Neurology, PA, detail the Veteran's treatment for low back pain, and radiating pain into his bilateral lower extremities. A January 2018 entry indicates he had back surgery in 2016, and had been doing well until about a month prior. He stated his back pain started without provocation, and occurred intermittently with radiating pain to his bilateral lower extremities. A September 2018 record indicates he reported low back pain. He denied a trauma or fall, and reported the low back pain started out of nowhere, that radiates into his bilateral lower extremities. At the Board hearing he testified to falling 8 feet during service and having back pain ever since. He had a back operation a few years ago, was wearing a back brace, and reported taking medication for pain and spasms as needed. In December 2020 the Veteran underwent a back examination and was diagnosed with intervertebral disc syndrome and bilateral lower extremity radiculopathy. He reported the onset following a fall from a wall in Kuwait in 1992. He reported seeking medical attention in 1992. He reported the condition had worsened since onset, and reported sciatica, low back pain, and occasional bilateral leg numbness. He underwent a L3 herniated disc repair with Dr. I A., a neurosurgeon approximately 6 years prior. The examiner opined it is less likely than not that a back disability was incurred in or caused by an in-service injury, event, or illness. There is an instance of complaints of back pain in 2004, approximately 12 years post-separation from service. There was no evidence found that support finding his back problems were incurred in or caused by service. The examiner commented on the statement of Dr. I. A., who opined it is more likely than not that his military service was a contributing factor to his back issues. The examiner stated that although the statement from Dr. A., suggests military service contributed to his back problems, there is no indication of a diagnosis of degenerative arthritis. There is no evidence to support the Veteran has arthritis related to an injury event or disease in service. In a March 2021 statement, the Veteran reported while stationed in Kuwait being subject to an incident wherein everyone had to flee the area, and run to the perimeter fence. He reported climbing the perimeter wall and landing on his back. He reported the fall, in conjunction with the heavy lifting that was required by his MOS, contributed to the low back injury he continues to suffer from today. An excerpt was submitted that details a fire in July 1991, at Camp Doha in Kuwait. The record details troops scrambled over a 15-foot high perimeter wall to escape the compound. The Veteran consistently asserted that he has had a back disability as a result of his time in service. A Veteran is also competent to testify regarding facts or circumstances that can be observed and described by a layperson. There is a negative opinion and positive opinion of record. The Veteran has relayed suffering an injury while fleeing a fire in Kuwait, and has submitted evidence of a fire that resulted in troops scaling a wall. The Veteran has consistently complained of a back disability since service. The positive and negative evidence is at least in relative equipoise. As such, all reasonable doubt is resolved in the Veteran's favor, and service connection for a back disability is granted. 2. Entitlement to service connection for left lower extremity radiculopathy 3. Entitlement to service connection for right lower extremity radiculopathy The Veteran's STRs are void of any reports of radiculopathy. A March 2018 record from Diagnostic Health reveals a diagnosis of lumbar spine disc protrusion, foraminal stenosis, and lumbar radiculopathy. A January 2018 record from Southeast Texas Neurology details an EMG report, that revealed chronic denervation changes asymmetrically on needle EMG consistent with radiculopathy bilaterally. February 2019 private treatment records from Promptu Immediate Care noted the Veteran to have low back pain, and reports of bilateral lower extremity numbness and tingling. At the Board hearing the Veteran testified to experiencing neuropathy that started while he was in service. In December 2020, the Veteran underwent an examination. The examiner opined it is less likely than not that the Veteran has right or left lower extremity peripheral neuropathy due to an in-service event, injury, or illness. The rationale was the c-file is silent for right or left lower extremity neuropathy in service. There is no indication it was incurred in or caused during service. The examiner then opined his right and left lower extremity neuropathy is a disease with a clear and specific etiology and diagnosis. It is less likely than not that his right and left lower extremity peripheral neuropathy is related to an exposure event experienced in Southwest Asia. The examiner then stated the Veteran has a history of a microdiskectomy that is more likely than not the cause of his bilateral lower extremity radiculopathy. Given that his right and left lower extremity radiculopathy has been deemed related to his back condition, and there is a positive medical opinion linking his radiculopathy to a likely herniated disc, and the positive MRI findings, the Board finds that the evidence is at least in equipoise to support the establishment of service connection for right and left lower extremity radiculopathy on a secondary basis. 4. Entitlement to service connection for diabetes mellitus The Veteran contends his diabetes mellitus is related to service. STRs are void for evidence of diabetes or elevated sugar. At the Board hearing he reported being diagnosed with diabetes sometime in 2015, and taking oral medication to control his symptoms. The Veteran underwent an examination in December 2020. The Veteran was diagnosed with diabetes in 2015, that is managed by a restricted diet and oral hypoglycemics. As for diabetic peripheral neuropathy, he reported seeking medical attention approximately 12 years ago. He reported experiencing bilateral leg tingling, shocking pain, and numbness. He was not undergoing treatment. The examiner opined diabetes was less likely than not incurred in or caused by an in-service injury, event, or illness. There is no evidence of diabetes while in service. He was not diagnosed with diabetes until 2015, approximately 23 years after separation from service. There is no evidence to support that diabetes was incurred in or caused by an event during service. Although the Veteran believes his diabetes is due to his time in service, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body/interpretation of complicated diagnostic medical testing. Consequently, the Board gives more probative weight to the VA examiner's opinion. The December 2020 examination concluded the diabetes is not due to service. The examiner referenced the Veteran's STRs that are devoid of any reports of the claimed disability. Further, there is a gap of over 20 years between discharge and the first indication of diabetes. In sum, the examiner's opinion is highly probative, because it is based on an accurate medical history, considered the Veteran's lay reports, and provided an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The most probative evidence of record does not show that the Veteran's claimed diabetes is directly due to service. The Board appreciates the Veteran's sincere belief that the claimed disability is directly related to service. The Veteran is competent to describe the symptoms of his diabetes, but he is not competent to provide an opinion linking his disability to service. He has not been shown to have the requisite medical expertise to provide nexus opinions as to this matter. Service connection for diabetes mellitus is denied. 5. Entitlement to service connection for obstructive sleep apnea (OSA) The Veteran contends his OSA began during service. STRs are void for evidence of OSA or excessive sleepiness. Private treatment records reveal the first report of sleep apnea was in 2005 at Dr. C. H.'s office. VA treatment records document a history of OSA. A May 2017 sleep study from The Medical Center of Southeast Texas Sleep Disorders Center, resulted in a diagnosis of OSA. At the Board hearing he reported experiencing sleep problems that started during service that have continued. In December 2020, the Veteran underwent an examination and was diagnosed with OSA. The examiner opined OSA was less likely than not incurred in or caused by an in-service event, injury, or illness. The claims file is silent for claims of sleep apnea during service. There is no evidence of complaints of fatigue or persistent daytime sleepiness while in service that would suggest a plausible connection. He was diagnosed in 2017 with sleep apnea, 25 years post separation from service. There is no evidence of record that his OSA is related to service. Although the Veteran believes his OSA is due to his time in service he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body/interpretation of complicated diagnostic medical testing. Consequently, the Board gives more probative weight to the VA examiner's opinion. The December 2020 examination concluded the Veteran's OSA is not due to service. The examiner referenced the Veteran's STRs that are devoid of any reports of the claimed disability. Additionally, the Veteran's claim that he experienced apnea ever since service, is not supported by the contemporaneous evidence of record, and is further discounted by the fact there is a gap of over 25 years between discharge and the first indication of OSA. In sum, the examiner's opinion is highly probative, because it is based on an accurate medical history, considered the Veteran's lay reports, and provided an explanation that contains clear conclusions and supporting data. The most probative evidence of record does not show that the Veteran's claimed OSA is directly due to service. The Board appreciates the Veteran's sincere belief that the claimed disability is directly related to service. The Veteran is competent to describe the symptoms of his OSA, but he is not competent to provide an opinion linking his disability to service. He has not been shown to have the requisite medical expertise to provide nexus opinions as to this matter. Service connection for OSA is denied. 6. Entitlement to service connection for right upper extremity peripheral neuropathy 7. Entitlement to service connection for left upper extremity peripheral neuropathy The Veteran asserts he has bilateral upper extremity peripheral neuropathy related to service. STRs are void for evidence of peripheral neuropathy of the upper extremities. A November 1998 private treatment record from Dr. C. H. documents reports of left arm pain and neck pain that radiates and causes arm numbness. No diagnosis was made. The next mention of arm numbness or tingling was when the Veteran filed in 2017. A March 2018 record from Diagnostic Health reveals a diagnosis of lumbar spine disc protrusion, foraminal stenosis, and lumbar radiculopathy. February 2019 private treatment records from Promptu Immediate Care noted the Veteran to have low back pain, and reports of bilateral lower extremity numbness and tingling. At the Board hearing the Veteran testified to experiencing neuropathy that started while he was in service. In December 2020, the Veteran underwent an examination. The examiner opined it is less likely than not that a left or right upper extremity radiculopathy was incurred in or caused by an in-service injury, event, or illness. Rationale was the claims file is silent for claims of left or right upper extremity radiculopathy while in service. There is no evidence to support the condition as incurred in or caused by active duty in service. As for the potential relation to his back, the examiner stated upper extremity radiculopathies tend to occur with injury to the cervical spine. There is no evidence that a low back injury will cause symptoms of radiculopathy in the upper extremities. The claimed left and right upper extremity radiculopathies are less likely than not proximately due to or the result of the Veteran's back. The examiner stated the Veteran's left upper and right extremity peripheral neuropathy is a disease with a clear and specific etiology and diagnosis. It is less likely than not that peripheral neuropathy is related to an exposure event experienced in Southwest Asia. Left upper and right upper extremity radiculopathy occurs due to inflammation to the nerves or injury the cervical spine. The examiner stated the Veteran does not have bilateral upper extremity radiculopathy, he has peripheral neuropathy of the bilateral upper extremities, with no evidence of an event, injury, or disease in active duty to cause such condition. There is no competent opinion to the contrary Although the Veteran believes he suffers from bilateral upper extremity peripheral neuropathy due to his time in service he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body/interpretation of complicated diagnostic medical testing. Consequently, the Board gives more probative weight to the VA examiner's opinion. The 2020 examiner concluded the Veteran does not suffer from bilateral upper extremity peripheral neuropathy, due to service or specifically to Gulf War exposures. The examiner referenced the Veteran's STRs that are devoid of any reports of the claimed disability. In sum, the examiners opinion is highly probative, because it is based on an accurate medical history, considered the Veteran's lay reports, and provided an explanation that contains clear conclusions and supporting data. The most probative evidence of record does not show that the Veteran to suffer from upper extremity peripheral neuropathy due to service. The Board appreciates the Veteran's sincere belief that the claimed disability is directly related to service. The Veteran is competent to describe the symptoms of numbness and tingling, however, the Veteran is not competent to provide an opinion linking his disability to service. He has not been shown to have the requisite medical expertise to provide nexus opinions as to this matter. As for the fact the Veteran is Persian Gulf War veteran having served in the Southwest Asia Theater of operations, his peripheral neuropathies have been associated to inflammation to the nerves or injury the cervical spine, so the statute and regulations pertaining to such service are not applicable. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. 8. Entitlement to service connection for skeletal arthritis entire joints The Veteran contends he has skeletal arthritis related to service. STRs are void for evidence of skeletal arthritis. At the Board hearing he reported arthritis/joint pain in his feet, toes, heels, wrists, elbows, and shoulders. He reported his symptoms started in service. VA treatment records document treatment for pain in his shoulder, elbows, and back. Records from Dr. C. H.'s office, detail complaints of right-hand pain in 2006, shoulder pain in 2008, elbow pain in 2013, and shoulder pain in 2016, all with no diagnosis or conclusive findings made. The Veteran underwent an examination in September 2017. The Veteran reported pain in his elbows and knees and ankle for years. The examiner stated the Veteran does not have any diagnoses. The Veteran did not have a rheumatological disorder. He also has tendonitis in his elbows. The examiner stated there is no nexus between his joint pain and Gulf War exposures. In December 2020, he underwent another examination. The examiner stated that on examination the Veteran did not have a non-degenerative arthritis condition. The x-rays of his lumbar, bilateral ankle, left shoulder, and bilateral foot were all normal. X-ray of his right shoulder revealed mild degenerative changes. There is no evidence to support that the Veteran has a diagnosis of skeletal arthritis that is at least as likely as not incurred in or caused by an event, injury, or illness during active during service. The examiner opined his skeletal arthritis is a disease with a clear and specific etiology and diagnosis. It is less likely than not that skeletal arthritis is related to an exposure event experienced in Southwest Asia. He does not have a diagnosis of non-degenerative skeletal arthritis. On examination, he had no diagnosis of skeletal arthritis, with the exception of some mild degenerative changes in the right shoulder diagnosed on the day of examination. His claims file is silent for claims of arthritis or symptoms that would give a plausible connection while in service. The Board acknowledges that the Veteran is competent to describe symptoms that he is able to perceive through the use of his senses. In addition, arthritis is a condition explicitly recognized as chronic under 38 C.F.R. § 3.309(a), and therefore, the Veteran's statements regarding continuity of symptomatology may be sufficient for purposes of establishing service connection. The record does not indicate he suffers from arthritis, with the exception of right shoulder arthritis that was only recently discovered at the 2020 examination. The Veteran has reported on occasion, experiencing skeletal pain ever since his time in service; however, he did not file a claim for service connection until 2017, over twenty-five years post discharge. The first indication in the treatment records of pain in his hand was in 2006, elbow in 2008, shoulder in 2016, still these reports of pain were over twenty years post-discharge. As such, the Board finds the Veteran's statements of having experienced joint pain ever since service to lack credibility. The contemporaneous medical records show right shoulder degenerative arthritis several decades after service. Although the Veteran believes he suffers from skeletal arthritis proximately due to service, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body/interpretation of complicated diagnostic medical testing. Further, he was not shown to have arthritis in the first post-service year, with the evidence indicating he was not diagnosed with arthritis of his shoulder until only recently. His contentions that he experienced skeletal pain since service are not corroborated by the contemporaneous medical evidence of record and are controverted by the probative VA opinion, noting no in-service complaints, and no indication of arthritis until the date of exam when his right shoulder was found to have mild degenerative changes. Consequently, the Board does not afford the Veteran's lay statements probative value. The VA examiner's opinion has significant probative value as it reflects consideration of all relevant factsto include the Veteran's lay statements regarding in-service injuries and the in-service and post-service treatment records. It also provided a detailed rationale for the conclusions reached. Ultimately, the most probative evidence of record does not show that he suffers from skeletal arthritis, to include the right shoulder mild degenerative changes, directly due to service or presumptively related to service. Absent probative evidence linking his claimed disability to service, service connection must be denied. As for the fact the Veteran is Persian Gulf War veteran having served in the Southwest Asia Theater of operations, he has not been found to have skeletal arthritis, and his right shoulder arthritis has been attributed to a known clinical diagnosis so the statute and regulations pertaining to such service are not applicable. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. 9. Entitlement to service connection for a bilateral kidney condition The Veteran contends he suffers from a kidney condition related to his time in service. STRs are void for evidence of kidney related complaints. At the Board hearing the Veteran testified to urinating frequently during service, and continuing to do so. He reported recent lab work that documents normal kidney function. In an April 2005 record from Dr. C. H., the Veteran reported frequent urination. In December 2020, the Veteran underwent an examination. The Veteran reported his kidney levels are normal. He reported occasional urinary tract infections, frequent urination, and thirst. He was not diagnosed with a kidney condition. The objective examination was normal. He reported recurrent UTIs, with the etiology being bacteria, and STI. The examiner opined it is less likely than not that the Veteran has a kidney condition that was incurred in or caused by an in-service injury, event, or illness. Further, as there is no indication he suffers from a kidney condition, it is less likely than not that a kidney condition would be related to an exposure event experienced in Southwest Asia. Although the Veteran believes he suffers from a kidney condition due to his time in service he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body/interpretation of complicated diagnostic medical testing. Consequently, the Board gives more probative weight to the VA examiner's opinion. The 2020 examination concluded the Veteran does not suffer from a kidney condition, nor did he have kidney related complaints (as a urinary tract infection is not a kidney condition), and therefore there is nothing to link to either service, or specifically to Gulf War exposures. The examiner referenced the Veteran's STRs that are devoid of any reports of the claimed disability. In sum, the examiners opinion is highly probative, because it is based on an accurate medical history, considered the Veteran's lay reports, and provided an explanation that contains clear conclusions and supporting data. The most probative evidence of record does not show that the Veteran to suffer from a kidney condition that is due to service. The Board appreciates the Veteran's sincere belief that the claimed disability is directly related to service. The Veteran is competent to describe the symptoms of urinary frequency, however this has been tied to urinary tract infections, and nothing has been identified in the record of a kidney-related condition or complaints, and further, the Veteran is not competent to provide an opinion linking his disability to service. He has not been shown to have the requisite medical expertise to provide nexus opinions as to this matter. As for the fact the Veteran is Persian Gulf War veteran having served in the Southwest Asia Theater of operations, he has not been found to have a kidney condition, but a urinary tract condition, so the statute and regulations pertaining to such service are not applicable. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. 10. Entitlement to service connection for a bilateral eye disability The Veteran contends he suffers from an eye disability that began during service. STRs are void for evidence of eye complaints. In a May 1999 private treatment record from the office of Dr. C. H., the Veteran was seen with complaints of an eye strain. Records from the Singla Eye Institute from 2015 to 2018 were reviewed. These records document a history of cataracts, keratitis of both eyes, but no diabetic retinopathy. At the Board hearing he reported being on prescription eye drops because his eyes are so dry. He reported being advised to avoid sunlight, and needing to wear transition lenses. In December 2020, the Veteran underwent an examination and was diagnosed with pterygium in the nasal sector and cortical cataracts. The record indicates he was diagnosed with a cortical cataract in April 2016. The first mention of pterygium in both eyes is from an examination conducted in April 2018. The examiner noted the Veteran was diagnosed with diabetes in 2015, and found the Veteran did not suffer from diabetic retinopathy. The examiner opined the Veteran's eye condition was less likely than not incurred in or caused by an in-service injury, event, or illness. The examiner found the Veteran's age-related cataracts and pterygium in both eyes are not related to an event, injury, or disease in service. The rationale was based upon the fact that his cataracts are age-related as he is 50 years old and of sufficient age to ascribe this cause, and the pterygium found in both eyes is a common condition caused by normal sunlight exposure and cannot be said to be caused by or related to an event, injury or disease in service without speculation. Therefore, the age-related cataracts and sunlight induced pterygiums have a clear etiology and diagnosis, however they are regarded more as an ocular condition rather than ocular disease, neither of which can be linked to a specific exposure event experienced by the Veteran during his service in Southwest Asia. According to past examinations, the Veteran has had episodes of blepharitis (inflammation of the eyelid margins), along with keratitis (inflammation of the corneal surface) and this diagnosis was attributed to "dry eye" for which artificial tears were prescribed. There are no signs of these diagnoses on examination. However, those diagnoses are often considered chronic in nature with a tendency to return after efforts to mitigate are suspended. Thus, making it a disease with clear and specific etiology and diagnosis. The examiner went on to state it is impossible that its presence is related to a specific event experienced by the Veteran during service in Southwest Asia. Rationale being based on the fact that dry eyes resulting in blepharitis and keratitis are fairly common diagnoses found among the general population. To say otherwise would be shear speculation. The examiner stated blepharitis and keratitis in both eyes, are caused by dryness of the eyes, which can be viewed as a chronic eye condition. It is possible he had an episode of dry eyes that resulted in blepharitis and keratitis during the appeal period, however there is no relation to service. Although the Veteran believes he suffers from an eye disability due to his time in service he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body/interpretation of complicated diagnostic medical testing. Consequently, the Board gives more probative weight to the VA examiner's opinion. The 2020 examiner concluded the Veteran does not suffer from an eye disability due to service. The examiner referenced the Veteran's STRs that are devoid of any reports of the claimed disability. Further, there is a gap of over 25 years between discharge and the first indication of eye complaints in 2015. In sum, the examiners opinion is highly probative, because it is based on an accurate medical history, considered the Veteran's lay reports, and provided an explanation that contains clear conclusions and supporting data. The most probative evidence of record does not show that the Veteran to suffer from an eye disability directly due to service. The Board appreciates the Veteran's sincere belief that an eye disability is directly related to service. The Veteran is competent to describe the symptoms of eye complaints, but he is not competent to provide an opinion linking his disability to service. He has not been shown to have the requisite medical expertise to provide nexus opinions as to this matter. As for the fact the Veteran is Persian Gulf War veteran having served in the Southwest Asia Theater of operations, he has age-related cataracts and sunlight induced pterygiums which have a clear etiology and diagnosis, and the Veteran has had episodes of blepharitis and keratitis, with the diagnoses being attributed to dry eye. As such these conditions have been attributed to known clinical diagnoses so the statute and regulations pertaining to such service are not applicable. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Skiouris, 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.