Citation Nr: 21027702 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 18-48 767 DATE: May 6, 2021 ORDER 1. Entitlement to a compensable rating for a bilateral hearing loss disability is denied. 2. Entitlement to service connection for carpal tunnel syndrome (CTS) of the left upper extremity is denied. 3. Entitlement to service connection for CTS of the right upper extremity is denied. 4. Entitlement to service connection for restless leg syndrome of the left lower extremity, to include as secondary to PTSD, is denied. 5. Entitlement to service connection for restless leg syndrome of the right lower extremity, to include as secondary to PTSD, is denied. 6. Entitlement to service connection for hypertension is denied. 7. Entitlement to service connection for a psychiatric disorder, other than posttraumatic stress disorder (PTSD) and to include anxiety and depression, is denied. FINDINGS OF FACT 1. The evidence shows the bilateral hearing loss disability has been manifested by hearing acuity no worse than Level II in either the right and left ears. 2. The preponderance of the evidence is against finding that CTS of the left upper extremity had an onset in service, manifested within one year of service discharge, or is otherwise related to service, to include as due to exposure to Agent Orange (AO)/herbicides. 3. The preponderance of the evidence is against finding that CTS of the right upper extremity had an onset in service, manifested within one year of service discharge, or is otherwise related to service, to include as due to exposure to AO/herbicides. 4. The preponderance of the evidence is against finding that restless leg syndrome of the left lower extremity had an onset in service, manifested within one year of service discharge, is otherwise related to service, is secondary to service-connected PTSD, or is due to exposure to AO/herbicides. 5. The preponderance of the evidence is against finding that restless leg syndrome of the right lower extremity had an onset in service, manifested within one year of service discharge, is otherwise related to service, is secondary to service-connected PTSD, or is due to exposure to AO/herbicides. 6. The preponderance of the evidence is against finding that hypertension had an onset in service, manifested within one year of service discharge, or is otherwise related to service, to include as due to exposure to AO/herbicides. 7. The preponderance of the evidence is against finding that the Veteran has a diagnosis of a psychiatric disability other than PTSD, which diagnosis fully contemplates all the Veteran's psychiatric symptoms. CONCLUSIONS OF LAW 1. The criteria for entitlement to a compensable rating for a bilateral hearing loss disability have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100 (2020). 2. The criteria for entitlement to service connection for CTS of the left upper extremity have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 3. The criteria for entitlement to service connection for CTS of the right upper extremity have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). The criteria for entitlement to service connection for restless leg syndrome of the left lower extremity, to include as secondary to PTSD, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2020). 4. The criteria for entitlement to service connection for restless leg syndrome of the right lower extremity, to include as secondary to PTSD, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2020). 5. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 6. The criteria for entitlement to service connection for a psychiatric disorder, other than PTSD and to include anxiety and depression, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1963 to June 1966, including additional service in the Army Reserve. The Veteran and his spouse testified at a videoconference hearing before the undersigned Veterans Law Judge in May 2020. A transcript of the hearing was prepared and associated with the claims file. Increased Rating 1. Entitlement to a compensable rating for a bilateral hearing loss disability Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of the disability will be resolved in the veteran's favor. 38 C.F.R. § 4.3. Ratings of hearing loss range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of speech discrimination tests combined with the average hearing threshold levels as measured by pure tone audiometry tests in the frequencies 1000, 2000, 3000, and 4000 cycles per second. To rate the degree of disability for service-connected hearing loss, the Rating Schedule has established eleven auditory acuity levels, designated from level I, for essentially normal acuity, through level XI, for profound deafness. 38 C.F.R. § 4.85(h), Table VI. In order to establish entitlement to a compensable rating for a hearing loss disability, it must be shown that certain minimum levels of the combination of the percentage of speech discrimination loss and average pure tone decibel loss are met. The assignment of disability ratings for hearing impairment is derived by a mechanical application of the Rating Schedule to the numeric designations assigned after audiometric evaluations are rendered. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The criteria for rating hearing impairment use controlled speech discrimination tests (Maryland CNC) together with the results of pure tone audiometry tests. These results are then charted on Table VI, Table VIA, in exceptional cases as described in 38 C.F.R. § 4.86, and Table VII, as set out in the Rating Schedule. 38 C.F.R. § 4.85. An exceptional pattern of hearing loss occurs when the pure tone threshold at 1000, 2000, 3000, and 4000 Hertz is 55 decibels or more, or when the pure tone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz. 38 C.F.R. § 4.86 Audiological testing was completed in April 2018; the pure tone thresholds for the ears were as follows: HERTZ 1000 Hz 2000 Hz 3000 Hz 4000 Hz Average RIGHT 15 50 80 85 58 LEFT 15 50 65 85 54 Speech recognition scores were 94 percent in both ears. Based on these results, the Veteran does not have exceptional hearing loss in either his left or right ear per the guidelines of 38 C.F.R. § 4.86. Additional testing was completed in regard to the hearing loss disability at a November 2020 VA examination. The pure tone thresholds for the ears were as follows: HERTZ 1000 Hz 2000 Hz 3000 Hz 4000 Hz Average RIGHT 25 50 80 85 60 LEFT 25 50 70 85 58 Speech recognition scores were 94 percent in the right ear and 92 percent in the left ear. Based on these results, the Veteran, again, does not have exceptional hearing in either ear per the guidelines of 38 C.F.R. § 4.86. The Veteran believes that his bilateral hearing loss disability is worse than the noncompensable (0 percent) rating contemplates. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against a compensable rating for bilateral hearing loss disability. For example, the application of 38 C.F.R. § 4.85, Table VI to the April 2018 measurements results in assignment of Roman Numeral I to left ear and Roman Numeral II to the right ear for the purposes of determining a disability rating. This results in a noncompensable rating by intersecting row I with column II of Table VII. 38 C.F.R. § 4.85, Table VII. Additionally, the application of 38 C.F.R. § 4.85, Table VI to the November 2020 measurements results in assignment of Roman Numeral II to the both the left and right ears. This results in a noncompensable rating by intersecting row II with column II of Table VII. 38 C.F.R. § 4.85, Table VII. Thus, the hearing tests performed during the appeal period do not establish entitlement to a compensable rating for bilateral hearing loss disability. The Board acknowledges the Veteran's contentions as to the worsening of his hearing loss disability, and the testimony of the Veteran and his spouse that he has difficulty hearing high frequencies, such as doorbells and women's voices. However, disability ratings for hearing impairment are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric ratings are rendered. Lendenmann, 3 Vet. App. 345. Thus, based on the audiometric findings throughout the appeal period, a compensable rating for a bilateral hearing loss disability is denied. The Veteran had no other VA examinations and there are no other reports of audiological testing in the claims file. As a result, the requirements for a compensable rating for a bilateral hearing loss disability have not been met. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases, such as carpal tunnel syndrome and restless leg syndrome, which are organic diseases of the nervous system, become manifest within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a). If a veteran was exposed to an "herbicide agent," such as Agent Orange, used in support of the United States and allied military operations in the Republic of Vietnam from January 9, 1962, to May 7, 1975, then, absent affirmative evidence to the contrary, certain diseases will be service-connected even if there is no in-service record of the disease in service. 38 C.F.R. § 3.307(a)(6), (d), 3.309(e). Notwithstanding the foregoing presumptions, a veteran is not precluded from establishing service connection due to exposure to herbicides with proof of direct causation. Combee v. Brown, 38 F.3d 1039, 1042 (Fed. Cir. 1994). The claims file documents that the Veteran served in Vietnam and, is presumed to have been exposed to herbicide agents. As such, service connection is presumed for disabilities listed in 38 C.F.R. § 3.309(e). CTS, restless leg syndrome, and hypertension are not listed under 3.309(e). Thus, presumption of service connection for these disabilities does not apply. The Veteran has not provided competent or persuasive evidence to support a relationship between his bilateral CTS and restless leg syndrome and his exposure to AO/herbicides. The Veteran and his spouse testified at his May 2020 hearing to only vague assertions that these disabilities were caused by exposure to AO/herbicides. However, a vague assertion, without supporting documentation is not sufficient to warrant a grant of service connection or further development. While the Veteran's spouse was previously employed as a registered nurse, this does not establish that she is competent to provide a nexus between exposure to AO/herbicides and the onset of CTS and/or restless leg syndrome. Thus, to the extent that the Veteran has asserted service connection based on exposure to AO/herbicides for CTS and restless leg syndrome, the claims for entitlement to service connection based on presumptive exposure to herbicides are denied. The Board will further assess whether hypertension is caused by exposure to AO/herbicide below. 2. 3. Entitlement to service connection for CTS of the bilateral upper extremity The Veteran and his spouse testified that the Veteran developed bilateral CTS as a result of exposure to AO/herbicides during his service in Vietnam. The Veteran testified that his CTS prevents him from writing, feeding himself, and tying things as a result of the numbness and tingling in his hands and wrists. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for bilateral CTS. The reasons follow. As to evidence of a current disability, private treatment records document a diagnosis of bilateral CTS in March 2014. Therefore, the facts establish that the first element of a service-connection claim is met. As to evidence of a disease or injury in service, the service treatment records (STRs) do not show that the Veteran sustained a disease or injury suggestive of an onset of CTS during service. For example, on the June 1966 separation examination, clinical evaluations of the upper extremities and neurological system were normal, and the Veteran was assigned a PULHES's score of 1 for U. The "PULHES" profile reflects the overall physical and psychiatric condition of an individual on a scale of 1 (high level fitness) to 4 (medical condition or physical defect is below the level of medical fitness required for retention in military service). The "P" stands for "physical capacity or stamina," the "U" stands for "upper extremities," the "L" stand for "lower extremities," the "H" reflects the condition of the "hearing and ears," the "E" is indicative of the "eyes," and the "S" stand for "psychiatric condition." Odiorne v. Principi, 3 Vet. App. 456, 457 (1992). Additionally, on the associated separation Report of Medical History, the Veteran specifically denied having or having had lameness, neuritis, or paralysis in any extremity, despite reporting having or having had a history of mumps, eye trouble, wearing glasses, and foot trouble. The Board finds the Veteran's attention to detail in filling out this Report of Medical History and noting a history of many other abnormal symptoms make it likely that had the Veteran had symptoms related to an onset of CTS in service, he would have reported it on this document. As stated above, the Veteran is presumed to have been exposed to herbicide agents during service, and the in-service element of a service-connected connection claim is met to this extent. However, to the extent that the service treatment records do not document neurological symptoms involving the upper extremities during service, the separation examination showed that the Veteran's neurological system and upper extremities were normal and the Veteran denied neurological symptoms at service discharge, the Board finds that neurological symptoms involving the upper extremities were not experienced during service. As to evidence of a nexus between bilateral CTS and service, the Board finds the preponderance of the evidence is against a nexus. For example, following service discharge, the Veteran continued to deny symptoms suggestive of an onset of CTS throughout Reports of Medical History during his Guard service, including Reports of Medical History completed in August 1982, October 1986, July 1988, September 1993, and June 1996. The Veteran continued to report having or having had various other symptomatology on these reports, and, again, the Board finds this to be highly probative evidence that had the Veteran been experiencing symptoms of CTS throughout his Guard service, he would have reported it. The examinations associated with the Reports of Medical History all noted that clinical evaluations of the upper extremities and neurological system were normal, and, to the extent that PULHES's scores were reported on these examinations, the Veteran was consistently assigned a 1 for U. On the Report of Medical History conducted in February 2002, presumably just prior to the Veteran's discharge from his Guard service, the Veteran specifically denied a painful shoulder or wrist, numbness or tingling, and impaired use of the arms and hands, which the Board finds to be highly probative evidence that the Veteran was not experiencing the onset of CTS symptoms as late as February 2002. Additionally, this examination also documented that clinical evaluations of the upper extremities and neurological system were normal, and a PULHES score of 1 was assigned for U. Finally, private records from May 2002, May 2004, and June 2005 document that the upper extremities were clinically normal, which would include the hands and wrists. The Board finds that had the Veteran been experiencing significant symptoms of CTS at this time, he likely would have reported it. At this point, it had been approximately 39 years following service discharge, and the Veteran was denying neurological symptoms in the years following service discharge, and relevant clinical evaluations were normal. CTS shows up in the Veteran's "Problem List" in private medical records in 2014, which is more than 45 years following service discharge. This is evidence against a nexus between the post service diagnoses of bilateral CTS and service. Further, as CTS is shown decades after service, the preponderance of the evidence is against a finding that CTS manifested within one year following service discharge for consideration of presumptive service connection involving a chronic disease. The Board acknowledges the Veteran's statement at his December 2018 hearing before a decision review officer and the statement submitted by the Veteran's spouse in June 2017, in which they reported that the Veteran began complaining about pain and numbness in his hands and fingers during the night in the early-1990s and between 1995 and 1997, respectively. However, as noted above, the Veteran was specifically denying having or having had such symptomatology on Reports of Medical History through February 2002, and private records through June 2005 document that the upper extremities were normal. The Board finds these contemporaneous medical records are more probative than statements made by the Veteran's spouse, approximately two decades after the now-reported initial onset. The Board acknowledges that the Veteran's spouse is a registered nurse and has some training to recognize the onset of CTS. However, the Board finds this evidence makes it even more likely that the Veteran would have reported the onset of such symptomatology on Reports of Medical History and to private and military treatment providers, which, as is extensively documented above, the Veteran either did not report such symptoms or denied such symptoms. Facts documented contemporaneously with the time period in question are inherently more reliable. Accordingly, at the present time, there is no competent evidence of a nexus between the post-service diagnosis of bilateral CTS and service, to include exposure to an herbicide agent. Thus, the facts do not establish that the third element of a service-connection claim are met. VA has not provided the Veteran with a VA examination in connection with these claims. VA must provide a medical examination and/or medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Here, for the reasons described above, the Board finds that the evidence does not establish that bilateral CTS may be related to service. For a VA examination and/or medical opinion to be warranted, all the McLendon criteria have to be met, and at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for these service-connection claims. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for bilateral CTS is denied. 4. 5. Entitlement to service connection for bilateral restless leg syndrome The Veteran, and his spouse, testified that the Veteran developed bilateral restless leg syndrome as a result of exposure to AO/herbicides during his service in Vietnam. The Veteran testified that his whole body is restless and that he has to take a pill at night to help him sleep. In a January 2020 statement, the Veteran testified that his restless leg syndrome is secondary to his service-connected PTSD. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for bilateral restless leg syndrome. The reasons follow. As to evidence of a current disability, private treatment records document a current problem with restless leg syndrome in January 2016. While it is unclear whether this is a specific diagnosis or a symptom, the Board will proceed as though the Veteran has a current diagnosis and meets the first element of a service-connection claim. Initially, the Board notes that the Veteran has asserted that his bilateral restless leg syndrome is caused or aggravated by his service-connected PTSD. Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(b). However, the Veteran has not provided evidence, other than this vague assertion, to support this allegation. Absent medical evidence or literature supporting a possible connection between his restless leg syndrome and PTSD, a vague assertion of a connection is not sufficient to warrant service connection or further development. Thus, service connection for restless leg syndrome is denied on a secondary basis. Despite not meeting the requirements for service connection on a secondary basis, the Board will still assess whether the facts establish service connection on a direct basis. However, as to evidence of a disease or injury in service, the STRs do not show that the Veteran sustained a disease or injury to his legs during service that caused restless leg syndrome, nor did he report symptomatology consistent with an onset of restless leg syndrome in service. For example, on the June 1966 separation examination, clinical evaluations of the lower extremities and neurological system were normal, and the Veteran was assigned a PULHES's score of 1 for L, which stands for the lower extremities. Additionally, on the associated Report of Medical History, the Veteran specifically denied having or having had lameness, neuritis, or paralysis in any extremity, despite reporting having or having had a history of mumps, eye trouble, wearing glasses, and foot trouble, which was noted to be related to his asymptomatic pes planus, not an onset of restless leg syndrome. The Board finds the Veteran's attention to detail in filling out this Report of Medical History and noting a history of many other abnormal symptoms makes it likely that had the Veteran had symptoms related to an onset of restless leg syndrome in service, he likely would have reported it on this document. As stated above, the Veteran is presumed to have been exposed to herbicide agents during service, and the in-service element of a service-connected connection claim is met to this extent. However, to the extent that the service treatment records do not document neurological symptoms involving the lower extremities during service, the separation examination showed that the Veteran's neurological system and lower extremities were normal, and the Veteran denied neurological symptoms at service discharge, the Board finds that neurological symptoms involving the lower extremities were not experienced during service. As to evidence of a nexus between bilateral restless leg syndrome and service, the Board finds the preponderance of the evidence is against a nexus. For example, following service discharge, the Veteran continued to deny symptoms suggestive of an onset of restless leg syndrome throughout Reports of Medical History during his Guard service, including Reports of Medical History completed in August 1982, October 1986, July 1988. September 1993, and June 1996. The Veteran continued to report having or having had various other symptomatology on these reports, and again, the Board finds this to be highly probative evidence that had the Veteran been experiencing symptoms of restless leg syndrome throughout his Guard service, he would have reported it. The examinations associated with the Reports of Medical History all noted that clinical evaluations of the lower extremities and neurological system were normal, and, to the extent that PULHES's scores were reported on these examinations, the Veteran was consistently assigned a 1 for L. On the Report of Medical History conducted in February 2002, presumably just prior to the Veteran's discharge from his Guard service, the Veteran specifically denied numbness or tingling and impaired use of the legs or feet, which the Board finds to be highly probative evidence that the Veteran was not experiencing the onset of restless leg syndrome symptoms as late as February 2002. Additionally, this examination also documented that clinical evaluations of the lower extremities and neurological system were normal, and a PULHES score of 1 was assigned for L. Further supporting a finding that restless leg syndrome did not have an onset in service, including any periods of ACDUTRA or INACDUTRA during the Veteran's Guard service, private treatment records from May 2002, May 2004, and June 2005 document that the extremities were clinically normal, which would include the lower extremities. The Board finds that had the Veteran been experiencing significant symptoms of restless leg syndrome at this time, he likely would have reported it. At this point, it had been approximately 39 years following service discharge, and the Veteran was denying neurological symptoms in the years following service discharge, and relevant clinical evaluations were normal. Restless leg syndrome shows up in 2016 private medical records, which is almost 50 years following service discharge. This is evidence against a nexus between the post service diagnoses of bilateral restless leg syndrome and service. Further, as restless leg syndrome is shown decades after service, the preponderance of the evidence is against a finding that such manifested within one year following service discharge for consideration of presumptive service connection involving a chronic disease. Finally, the Veteran's spouse reported in a statement submitted in June 2017 that the symptoms of restless leg syndrome had an onset between 2007 and 2009, five to seven years after his discharge from his Guard service and over 40 years after his discharge from active duty. Such fact does not establish a nexus between the restless leg syndrome and the Veteran's service. This further supports the Board's finding that the Veteran's restless leg syndrome did not have an onset in service. Accordingly, at the present time, there is no competent evidence of a nexus between the post-service diagnosis of bilateral restless leg syndrome and service, to include exposure to an herbicide agent. Thus, the facts do not establish that the third element of a service-connection claim are met. VA has not provided the Veteran with a VA examination in connection with these claims. VA must provide a medical examination and/or medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Here, for the reasons described above, the Board finds that the evidence does not establish that bilateral restless leg syndrome may be related to service. For a VA examination and/or medical opinion to be warranted, all the McLendon criteria have to be met, and at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for these service-connection claims. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for a bilateral restless leg syndrome is denied. 6. Entitlement to service connection for hypertension The Veteran, and his spouse, testified that the Veteran hypertension was a result of exposure to AO/herbicides during his service in Vietnam. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for hypertension. The reasons follow. As to evidence of a current disability, VA treatment records from May 2011 document borderline hypertension and VA treatment records from February 2013 document a diagnosis of hypertension. Therefore, the facts establish that the first element of a service-connection claim is met. Initially, the Board notes that hypertension is not listed in 38 C.F.R. § 3.309(e) as a disability for which service connection is presumed based on exposure to AO/herbicides. Furthermore, despite not being presumed service-connected due to AO/herbicides, the Board notes that the February 2021 VA examiner also opined that the hypertension was not due to presumed exposure to AO/herbicides as the 2018 NAS study, though it did suggest a relationship or association between the AO/herbicide exposure and the development of hypertension, it did not establish a cause. In this case, the examiner opined that the Veteran's hypertension was not incurred in service, including as due to AO/herbicide exposure, as the Veteran did not develop borderline hypertension until 2011, which the Board notes is approximately 45 years after separation from active service and service in Vietnam. The examiner went on to note that hypertension has many other risk factors, including age, family history salt intake, exercise routine, and/or diet that were the more likely cause of the Veteran's hypertension. The Board finds that the February 2021 VA medical opinion is highly probative, as the examiner reviewed the file, listened to the Veteran's report of history, physically examined the Veteran, and provided a rationale for the opinion that relied on the specific facts of the case, which facts are accurate, and considered the findings of the NAS study. This is evidence against a nexus between the current hypertension and presumed exposure to AO/herbicides in service. There is no competent evidence to weigh against this medical opinion. Despite not meeting the requirements for service connection as due to exposure to AO/herbicides, the Board notes that hypertension is a chronic disease under 38 C.F.R. § 3.309. However, in this case the preponderance of the evidence is also against finding that the hypertension had an onset within one year of discharge from service. Rather, the Veteran developed borderline hypertension in approximately 2011 and was diagnosed with hypertension until 2013, which is over 40 years after his discharge from active service. Thus, consideration of presumptive service connection involving a chronic disease is not warranted. Despite not meeting the requirements for service connection as due to exposure to AO/herbicides or as a chronic disability, the Board will still assess whether the Veteran meets the requirements for direct service connection. However, again, hypertension was not diagnosed until 2013, and, even though borderline hypertension was diagnosed in 2011, this is still many years after the Veteran's discharge from service. At separation from his initial period of active service in June 1966, a separation examination documented the Veteran's blood pressure was 130/78, and on the associated Report of Medical History, the Veteran denied having or having had high or low blood pressure. During the Veteran's Guard service, examinations conducted in August 1982, October 1986, July 1988, September 1993, June 1996, and February 2002 documented blood pressure readings of 130/70, 120/68, 106/84, 106/84, 142/98, and 116/66, respectively. The Board notes that these are not elevated blood pressure readings. On associated Reports of Medical History, the Veteran specifically denied having or having had high or low blood pressure, despite noting various other symptoms, which the Board finds tends to suggest that had the Veteran experienced symptoms of high or low blood pressure during his Guard service, he would have reported such symptoms on these reports. Finally, private treatment records from June 2002 document that the private treatment provider was not aware of the Veteran having documented problems with hypertension. Thus, the Veteran does not meet the second element of a service-connection claim. As noted above, the February 2021 VA examiner noted that the hypertension was less likely than not related to active service, as the Veteran did not develop borderline hypertension until November 2011 and was not diagnosed with hypertension until February 2013. Rather, the examiner noted that the hypertension was more likely caused by one of the other main risk factors of hypertension, including age, family history, salt intake, exercise routine, and/or diet. As noted above, the Board finds the February 2021 VA examiner's medical opinion is highly probative, as the examiner provided a rationale for the opinion, which was based upon the facts and medical principles. This is evidence against a nexus between hypertension and service. There is no competent evidence to weigh against this medical opinion. Thus, the Board finds that the preponderance of the evidence is against finding a nexus between the Veteran's current hypertension and his active service. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for hypertension is denied. 7. Entitlement to service connection for a psychiatric disorder, other than PTSD and to include anxiety and depression The Veteran and his spouse testified at his May 2020 hearing that the Veteran continues to experience psychiatric symptoms. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the claim for service connection for a psychiatric disability other than PTSD. The reasons follow. The Veteran was provided a VA examination in November 2018 to assess the nature of his psychiatric symptoms. The Veteran was diagnosed with PTSD. When asked if the Veteran has more than one mental disorder, the examiner specifically checked "no." The Veteran was granted service connection for PTSD. As the VA examiner specifically checked that the psychiatric symptoms were fully addressed by his diagnosis of PTSD and that the Veteran did not have any other diagnosis of a mental disorder, the Board finds that service connection for a psychiatric disorder other than PTSD is not warranted as the Veteran does not have a current diagnosis of a psychiatric disorder other than PTSD, and the psychiatric symptoms are fully compensated under the service-connected PTSD diagnosis. The Board acknowledges that the Veteran has, at various times in private and VA treatment records, though infrequently, reported that he has anxiety or depression. However, these symptoms are contemplated by the rating criteria. See 38 C.F.R. § 4.30 (listing "depressed mood" and "anxiety" as examples of symptoms contemplated by the rating criteria). In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for a psychiatric disorder other than PTSD is denied. A. P. SIMPSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Keninger, 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.