Citation Nr: 21028412 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 06-00 363A DATE: May 11, 2021 ORDER Service connection for bilateral hearing loss is denied. Service connection for the residuals of heat stroke is denied. Service connection for hypertension, to include as secondary to posttraumatic stress disorder (PTSD), is denied. Service connection for epilepsy is denied. Service connection for cardiac arrhythmia, to include as secondary to PTSD, is denied. Service connection for chronic fatigue syndrome (CFS), to include as secondary to PTSD, is denied. Service connection for lower extremity edema, to include spider veins, is denied. Service connection for headaches is denied. Service connection for neurological effects, to include memory loss and vertigo, is denied. FINDINGS OF FACT 1. The Veteran has not been shown to have hearing loss for VA purposes in either ear. 2. The weight of the evidence is against finding that any residuals of heat stroke the Veteran currently experiences are due to his active duty service, to include his two reported in-service heat strokes. 3. The weight of the evidence is against finding that the Veteran's hypertension is due to his active duty service, or is otherwise secondary to his service-connected disabilities. 4. The weight of the evidence is against finding that the Veteran has had a diagnosis for a seizure disorder at any time during the period on appeal, and any reported seizures are not otherwise due to his active duty service or is secondary to any service-connected disabilities. 5. The weight of the evidence is against finding that the Veteran has had a diagnosis for cardiac arrhythmia at any time during the period on appeal, and any reported cardiac arrhythmias are not otherwise due to his active duty service or is secondary to any service-connected disabilities. 6. The weight of the evidence is against finding that the Veteran has had a diagnosis for CFS at any time during the period on appeal. 7. The weight of the evidence is against finding that the Veteran's edema or spider veins are due to his active duty service or his two reported in-service heat strokes. 8. The weight of the evidence is against finding that the Veteran's headaches are due to his active duty service or his two reported in-service heat strokes. 9. The weight of the evidence is against finding that the Veteran's neurological issues are due to his active duty service or his two reported in-service heat strokes. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for residuals of heat stroke have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for hypertension, to include as secondary to PTSD, have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for service connection for epilepsy, to include as secondary to a service-connected disability, have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 5. The criteria for service connection for cardiac arrhythmia, to include as secondary to a service-connected disability, have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 6. The criteria for service connection for cardiac arrhythmia, to include as secondary to a service-connected disability, have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 7. The criteria for service connection for lower extremity edema have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for headaches have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for service connection for neurologic effects, to include memory loss and vertigo, have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1990 to September 1998. The Veteran provided testimony regarding his service connection claims on appeal before two different Veterans Law Judges (VLJs) at July 2008 and October 2016 Board hearings. Complete transcripts of those hearings are of record. All VLJs who conduct hearings must participate in making the final determination of the claims on which testimony was received. 38 U.S.C. § 7107 (c); 38 C.F.R. § 20.707. By law, appeals can be assigned only to an individual VLJ or to a panel of not less than three members. See 38 U.S.C. § 7102 (a). Thus, when an appellant has had a personal hearing before two separate VLJs during the appeal and these hearings covered one or more common issues, a third VLJ is assigned to the panel after the second Board hearing has been held. The appeal is then ready for appellate review. In Arneson v. Shinseki, 24 Vet. App. 379 (2011), the United States Court of Appeals for Veterans Claims (Court) interpreted 38 C.F.R. § 20.707 as requiring that an appellant must be provided the opportunity for a hearing before all three VLJs involved in a panel decision. At the October 2016 hearing the Veteran was advised of his right to another hearing before the third member of the panel pursuant to Arneson; however, he elected to waive his right to a third hearing before that individual. Therefore, in accordance with Arneson, an additional hearing is not needed. This appeal was previously before the Board in March 2017. The Board noted that the Veteran received continuous care from VA and remanded the appeal to obtain his VA treatment records, since February 2014. The Board notes that the Veteran's outstanding VA treatment records from 2014, forward, have been associated with the Veteran's claims file. As such, the Board finds that the March 2017 Board remand directives have been substantially complied, with as they pertain to the outstanding treatment records. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The March 2017 Board decision also remanded for new VA examinations regarding the Veteran's numerous service connection claims. Those remand directives will be discussed in their respective sections. SERVICE CONNECTION Service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disability which is aggravated (made worse) by a service-connected disability. In order to prevail on the issue of secondary service connection, the record must show (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) competent evidence establishing that the service-connected disability caused or aggravated the nonservice-connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995). 1. Service connection for bilateral hearing loss is denied. The Veteran asserts that his bilateral hearing loss is due to his active duty service. Specifically, he asserts that he was a mortarman and was also a Ranger and dealt with all kinds of light weapons. This claim was remanded by the March 2017 Board decision for a new VA examination. The Board noted that the last time the Veteran had been afforded an audiological examination was in January 2011, which showed that the Veteran did not have hearing loss for VA purposes. At the October 2016 Board hearing, the Veteran testified that it was hard to gauge if his hearing had gotten worse; he reported that when there was ambient noise, he had to be near the person talking and be looking at them to really hear what they were saying. The Board found that based on the foregoing, the Veteran should be afforded a new VA examination. He was afforded VA examinations in March 2017 and in December 2020. As such, the Board finds that there has been substantial compliance with the March 2017 Board remand directives, as they pertain to the service connection claim for bilateral hearing loss. See Stegall v. West, 11 Vet. App. 268 (1998). For the purposes of applying the laws administered by VA, impaired hearing will be considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The provisions of 38 C.F.R. § 3.385 do not require that hearing loss be shown as defined in that regulation at the time of separation from service, if there is sufficient evidence to demonstrate a relationship between a veteran's service and his current disability. Hensley v. Brown, 5 Vet. App. 155 (1993). VA regulations do not require hearing loss for VA purposes to be present during service. Rather, hearing loss, if sensorineural in nature, is a "chronic disease" listed under 38 C.F.R. § 3.309 (a); therefore, 38 C.F.R. § 3.303 (b) applies. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a "chronic disease" in service or "continuity of symptoms" after service, the disease shall be presumed to have been incurred in service. For the showing of "chronic" disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease shown in service or within the presumptive period, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. A review of the Veteran's service treatment records (STRs) shows that he underwent audiological examinations and they revealed normal results. A review of the Veteran's post-service treatment records does not show that there are any audiological examinations, besides the March 2017 and in December 2020 VA examinations. The Veteran was afforded a VA examination in March 2017. The Veteran's puretone thresholds in decibels are as follows: Hertz 500 1000 2000 3000 4000 R. Ear 15 15 10 25 25 L. Ear 15 10 10 15 10 The Veteran's speech discrimination test (Maryland CNC), showed 100 percent in the right ear and 96 percent in the left ear. The examiner noted that the Veteran had a permanent positive threshold shift in the right ear, but not in the left ear. The examiner did not provide an etiology opinion because hearing loss for VA purposes was not present in either ear. The Veteran was afforded a VA examination in December 2020. The Veteran's puretone thresholds in decibels are as follows: Hertz 500 1000 2000 3000 4000 R. Ear 20 20 25 25 20 L. Ear 20 25 20 20 15 The Veteran's speech discrimination test (Maryland CNC), showed 100 percent in the right ear and 96 percent in the left ear. Here, the Board finds that service connection for bilateral hearing loss is not warranted. Based on the VA audiology tests of record, the Veteran does not have hearing loss for VA purposes because his puretone thresholds are all less than 40 decibels, he does not have at least three of the frequencies at 26 decibels or greater, and his speech recognition scores were 100 percent in the right ear and 96 percent in the left ear. The Board acknowledges the Veteran's complaints of hearing loss and his exposure to hazardous military noise in service. The Board also acknowledges the Veteran's testimony that he has a hard time hearing people when there is ambient noise around and that he has trouble with children and women's voices. He is considered competent to describe his perception of diminished hearing acuity because lay testimony is competent to establish the presence of observable symptomatology and may provide sufficient support for a claim of service connection. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, even to the extent the Veteran would be competent to report diminished hearing acuity, he is not be competent to diagnose hearing loss for VA purposes because a determination would require both objective audiometric and speech recognition testing, which the Veteran could not perform on himself. Thus, the Board must rely on the objective clinical testing and medical opinion of record, which shows that the Veteran does not have a hearing loss disability for VA purposes in either ear. Accordingly, service connection for bilateral hearing loss is denied. 2. Service connection for the residuals of a heat stroke is denied. The Veteran asserts that he has residuals of a heat stroke after suffering from two heat strokes during his active duty service. The Veteran's STRs do not reveal any diagnosis or treatment for heat stroke. However, the Veteran provided credible testimony that he suffered two in-service heat strokes and also provided a statement from a fellow servicemember dated in February 2012. The fellow servicemember recalled being summoned to the Squadron Aid Station by a Physician Assistant for an emergency medical condition update of the Veteran. The fellow servicemember recalled that the Veteran had symptoms of a heat stroke and was in recovery. The Veteran testified that he believed that after suffering the two in-service heat strokes, he had become predisposed to more heat strokes. He testified that when he feels a heat stroke coming on, he gets lightheaded, has cold sweats, and becomes dizzy. The Board also notes that the Veteran has submitted various articles, studies, and documents, including a VA information letter regarding the long-term effects of heat-related illnesses. The information letter reports that most heat stroke survivors make a full recovery, but perhaps 10 to 15 percent will have prolonged and/or permanent medical problems, including neurological, cognitive, and behavioral deficits from small strokes in the brain, liver abnormalities, and heat intolerance. A study was cited that found that soldiers who had experienced heat exhaustion found increased neurasthenia, poorer short-term memory, slower reaction time, and poorer postural stability two weeks after the acute episode, but no significant differences six and one half months after the episode. Another study was noted to reveal that military recruits experiencing a heat illness during recruit training were found to have slightly lower military retention rates, and higher subsequent military hospitalization rates, including for further exertional heat illnesses. An article submitted indicates that individuals are susceptible to thermal-induced arrhythmia and inflammatory myocardial damage during the acute phase of heatstroke. This claim was previously before the Board in March 2017. The Board decision noted that the Veteran had not been afforded a VA examination, with regard to residuals of heat stroke and remanded to afford the Veteran a VA examination. The Veteran was afforded a VA examination in March 2017 and after an in-person examination and a review of the Veteran's claims file, the examiner provided a medical opinion regarding residuals of heat stroke. As such, the Board finds that there has been substantial compliance with the March 2017 Board remand directives, as they pertain to the service connection claim for residuals of heat stroke. See Stegall v. West, 11 Vet. App. 268 (1998). The Veteran was afforded a VA examination in March 2017. After an in-person examination and a review of the Veteran's claims file, the examiner provided a negative nexus opinion. The examiner acknowledged that the Veteran reported having three different heat strokes, the first two being during his active duty service. The examiner noted that the STRs do not confirm or deny his reports of in-service heat strokes, but also noted the 2012 buddy statement that discussed the first in-service heat stroke. The examiner reviewed the medical literature that had been submitted by the Veteran and his representative, but found that the documents did not show a specific correlation between subsequent episodes, other than if the individual is exposed to environmental elements and does not have the proper hydration and gear to prevent issues. The examiner also reported that one study showed that after exertional heat stroke, the study participants were all heat acclimated by 61 days after the event, except one was acclimated after 11.5 months. The examiner also reported that the document noted that many factors predispose humans to exertional heat stroke, such as, sleep loss, sudden increase in physical training, and length exposure to heat stress. The examiner concluded that each of the Veteran's heat strokes were spaced apart and likely not at all related to service, other than the two that occurred in-service. The third episode occurred outside of service, under circumstances where he was in a hot environment and that he is not more susceptible when the occurrences are so far apart in time. To the extent that the Veteran believes that he has residuals of heat stroke, and that they are the result of his two in-service heat strokes, such a medical opinion requires medical expertise, and that determination cannot simply be made by lay observation alone; and the Veteran is not considered competent (meaning medically qualified by training or experience) to provide a medical opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Given that the Veteran's fellow servicemember submitted a buddy statement in 2012, reporting that the Veteran had the symptoms of a heat stroke in 1991, while in Kuwait, and his testimony that he suffered two in-service heat strokes; a VA examination was ordered to address the medical and lay evidence of record and to provide an etiology opinion. Unfortunately, the March 2017 VA examiner provided a negative nexus opinion. The Board notes that the Veteran has not offered any competent medical opinions that would otherwise undermine the findings and conclusions of the March 2017 VA examiner. Here, there is only one competent medical opinion of record, the March 2017 VA examiner's negative nexus opinion. The Board acknowledges the Veteran's submission of medical literature; however, the Board notes that the March 2017 examiner reviewed and addressed the materials. The examiner reported that the documents discussed subsequent heat stroke episodes if the individual is exposed to environmental elements and does not have the proper hydration and gear to prevent issues. However, the Veteran testified that he had a "heat card," which indicated that he was trained to hydrate and notice the symptoms of the onset of heat strokes. The examiner also reported that one study showed that after an exertional heat stroke, participants became heat acclimated by 61 days. The examiner concluded that the Veteran was not more susceptible because the occurrences were so far apart in time. The Board affords the March 2017 VA examiners' s opinion great probative weight because she had a chance to interview the Veteran and review his claims file before providing her medical opinion. The examiner also acknowledged the medical literature and lay statements of record in providing their opinion and rationale. The Board acknowledges the Veteran's sincere belief that he has residuals of a heat stroke and it is a result of his active duty service. The Board recognizes his testimony that he suffered two in-service heat strokes and believes that his third heat stroke, which occurred after his separation from the military, was a residual of the two in-service heat strokes. The Board is sympathetic to the Veteran's claim and does not wish to minimize his assertions or beliefs. However, the medical evidence is ultimately controlling in this case. Accordingly, service connection for residuals of heat stroke is denied. 3. Service connection for hypertension, to include as secondary to a service-connected disability, is denied. The Veteran asserts that his hypertension is secondary to his service-connected PTSD. The Board notes that the Veteran has also asserted that his hypertension could be secondary to the residuals of heat stroke. However, this Board decision has denied service connection for the residuals of heat stroke and the Veteran therefore cannot prevail on a theory of service connection as secondary to heat stroke. This claim was previously before the Board in March 2017. The Board decision noted that the Veteran was afforded a VA examination in December 2011, which noted that he was diagnosed with hypertension in 2003, but the examiner did not provide an etiology opinion. He was afforded another VA examination in January 2014, where the examiner provided a negative nexus opinion regarding both direct and secondary service connection. However, the March 2017 Board decision found that the nexus opinions were inadequate because the sole rationale provided by the examiner, regarding direct service connection, was that there was no notation of elevated blood pressure or treatment for hypertension in service. Regarding secondary service connection, the examiner did not comment on any significance of a heat stroke/injury in service. The examiner noted that the Veteran's hypertension was not aggravated by his PTSD based upon the rationale that one would have anticipated a rise in his medication doses. However, the examiner did not discuss whether it was at least as likely as not that the use of the use of medication until 2010 and high blood pressure readings in April 2012 and May 2012 represented aggravation due to PTSD. Lastly, the examiner stated that the Veteran's essential hypertension was not aggravated beyond its natural progression by PTSD. The Board noted that this was not the proper standard. Pursuant to 38 C.F.R. § 3.310, permanent aggravation is not required, any increase in disability is compensated. The Veteran was afforded VA examinations in March 2017 and in November 2020, and the medical opinions addressed both direct and secondary service connection. A medical opinion regarding whether the onset of his hypertension was within one year of his separation from the military; and whether his hypertension was caused or aggravated by his service connected PTSD or reported heat stroke was provided. As such, the Board finds that there has been substantial compliance with the March 2017 Board remand directives, as they pertain to the service connection claim for hypertension. See Stegall v. West, 11 Vet. App. 268 (1998). The Veteran was afforded a VA examination in March 2017. After an in-person examination and a review of the Veteran's claims file, the examiner provided a negative nexus opinion regarding direct service connection and for service connection as secondary to the Veteran's non-service-connected heat stroke. The examiner explained that the Veteran reported seeking treatment for hypertension in 2001 and 2002, but did not have elevated blood pressure until 2008 and that hypertension was less likely as not due to his active duty service because it started too many years after he was discharged from service. The examiner also opined that hypertension did not manifest within one year of his separation from service. The explained that hypertension was not secondary to the Veteran's reported heat stroke because the time between the two conditions was distant and not correlated. The examiner declined to provide an opinion regarding service connection as secondary to PTSD because they were not a mental health examiner. The Veteran was afforded a VA examination in November 2020. After a telehealth examination and a review of the Veteran's claims file, the examiner provided a negative nexus opinion regarding secondary service connection. The examiner reported that the Veteran was treated for hypertension while in service and then was not treated for hypertension for several years and was not treated with antihypertensives, while having flares of PTSD. The examiner also noted that there were other times he had elevated blood pressure, without flares of PTSD. The examiner concluded that the Veteran's medical history supports finding that his hypertension is not secondary to, or aggravated by his PTSD. To the extent that the Veteran believes that his hypertension is the result of active duty service or is secondary to his service-connected PTSD, such a medical opinion requires medical expertise, and that determination cannot simply be made by lay observation alone; and the Veteran is not considered competent (meaning medically qualified by training or experience) to provide a medical opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Given that the March 2017 Board decision found that a previous medical opinion was inadequate; a VA examination was ordered to address the medical and lay evidence of record and to provide an etiology opinion, regarding the theories of both direct and secondary service connection. Unfortunately, the March 2017 and November 2020 VA examiners provided negative nexus opinions. The Board notes that the Veteran has not offered any competent medical opinions that would otherwise undermine the findings and conclusions of these examiners. Here, there are only two competent medical opinions of record, the March 2017 and November 2020 VA opinions regarding both direct and secondary service connection. The Board acknowledges the Veteran's assertions. However, the Board affords the Veteran's lay assertions no probative weight because he is not medically qualified to provide nexus opinions. However, on the other hand, the Board affords great probative weight to the March 2017 and November 2020 VA examiners because they both had a chance to interview the Veteran, review his claims file, and provided a rationale for their respective opinions. The Board acknowledges the Veteran's sincere belief that his hypertension is the result of his active duty service, or is secondary to his service-connected PTSD. The Board is sympathetic to the Veteran's claim and does not wish to minimize his assertions or beliefs. However, the weight of the evidence of record is against his claim for service connection for hypertension, and it is therefore denied. 4. Service connection for epilepsy, to include as secondary to a service-connected disability, is denied. The Veteran asserts that his seizures are due to an undiagnosed illness, or are secondary to the heat strokes he experienced during his active duty service. However, this Board decision has denied service connection for the residuals of heat stroke and the Veteran therefore cannot prevail on a theory service connection, as secondary to heat stroke. This claim was previously before the Board in March 2017. The Board decision noted that the Veteran was afforded a VA examination in February 2011, and the examiner noted that he had petit mal seizures, but no opinion was rendered regarding the etiology. He was afforded another VA examination in December 2011 and the examiner provided a negative nexus opinion regarding direct service connection. However, the Board found that an additional medical opinion was needed regarding the Veteran's assertion that his seizures were due to his reported in-service heat strokes. The Veteran was afforded a VA examination in March 2017 and in June 2020, and the medical opinion addressed whether his seizures were secondary to his reported in-service heat strokes. As such, the Board finds that there has been substantial compliance with the March 2017 Board remand directives, as they pertain to the service connection claim for epilepsy. See Stegall v. West, 11 Vet. App. 268 (1998). A review of the Veteran's STRs does not show any complaints of treatment for epilepsy, or any seizures. As previously mentioned, the December 2011 VA examiner provided a negative nexus opinion regarding direct service connection. The examiner explained that there was no documentation of treatment for seizures in the Veteran's STRs and that epilepsy has not identifiable cause in about half of those who have the condition. In the other half, it has been attributed to genetic influence, head trauma, strokes, heart attacks, dementia, prenatal injuries, and developmental disorders. The Veteran was afforded a VA examination in March 2017. After an in-person examination and a review of the Veteran's claims file, the examiner found that there was no diagnosis for a seizure disorder, but did note that the Veteran had experienced minor, petit mal, seizures, in 2002 and most recently in 2015. An etiology opinion does not appear to have been rendered immediately after this examination VA provided an etiology opinion regarding the Veteran's service connection claim for epilepsy in June 2020. After a review of the Veteran's claims file, the examiner provided a negative nexus opinion. The examiner also explained that it was less likely than not that he had experienced petit mal seizures. The examiner noted that the Veteran reported in 2017, that when discussing this condition with his representative, he was told that he likely had seizures, so he requested that it be included as a claim. However, the examiner reported that the Veteran has not been tested for a seizure disorder since 2002 and further noted that the Veteran underwent a sleep study in 2016, which revealed no signs of seizure activity. The examiner stated that the representative who "diagnosed" the Veteran with seizures is not a sufficient diagnosis and recommended he considered seeing a neurologist for an evaluation. Regarding whether his seizures have been caused by his reported in-service heat stroke, the examiner noted that after a lengthy review of the claims file, to include of the Veteran's STRs and post-service treatment records, there was no diagnosis for a seizure disorder and based on that, was less likely than not that his reported in-service heat strokes caused him to have claimed seizures. To the extent that the Veteran believes that he is diagnosed with a seizure disorder, or that it is due to his active duty service, or is a residual of in-service heat strokes, such a diagnosis and medical opinions require medical expertise, and those determinations cannot simply be made by lay observation alone; and the Veteran is not considered competent (meaning medically qualified by training or experience) to provide a diagnosis or a medical opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). A medical opinion was sought to address whether the Veteran had a seizure disorder as a result of his service, but the opinions have consistently answered that question in the negative. Here, there are only two competent medical opinions of record, the December 2011 VA examiner who provided a nexus opinion regarding direct service connection and the June 2020 VA examiner's nexus opinion regarding secondary service connection. The Board acknowledges the Veteran's assertions. However, the Board affords the Veteran's lay assertions no probative weight because he is not medically qualified to provide a diagnosis for a seizure disorder or to provide medical opinions. However, on the other hand, the Board affords great probative weight to the December 2011 and June 2020 VA examiners because they both had a chance to interview the Veteran, review his claims file, and provided rationales for their opinions. In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement that a current disability be present is satisfied "when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim...even though the disability resolves prior to the Secretary's adjudication of the claim." McClain v. Nicholson, 21 Vet. App. 319 (2007). Accordingly, service connection for epilepsy is denied. 5. Service connection for cardiac arrhythmia, to include as secondary to a service-connected disability, is denied. The Veteran asserts that his cardiac arrhythmia is secondary to his service-connected PTSD and in the alternative is secondary to his non-service-connected hypertension or heat strokes. However, this Board decision has denied service connection for the residuals of heat stroke and for hypertension and the Veteran therefore cannot prevail on a theory of service connection secondary to heat stroke or hypertension. This claim was previously before the Board in March 2017. The Board decision noted that the Veteran was afforded a VA examination in December 2011, which noted that he was diagnosed with cardiac arrhythmia, with a date of diagnosis in 2009. The examiner provided a nexus opinion regarding direct service connection. However, the Board found that a new VA examination was warranted so that the Veteran could get an etiology opinion regarding whether his claimed cardiac arrhythmia was secondary to PTSD and/or heat stroke. The Veteran was afforded a VA examination in March 2017 and in November 2020, and the medical opinions addressed whether his claimed cardiac arrhythmia was secondary to his service-connected PTSD. As such, the Board finds that there has been substantial compliance with the March 2017 Board remand directives, as they pertain to the service connection claim for cardiac arrhythmia. See Stegall v. West, 11 Vet. App. 268 (1998). As previously mentioned, the Veteran was afforded a VA examination in December 2011. The examiner indicated that the Veteran was diagnosed with cardiac arrhythmia in 2009. However, the examiner also noted that the Veteran reported that he had experienced left sided chest pain while jogging, but ruled out a cardiac origin. The examiner noted that the Veteran underwent a stress test in 2008, which showed negative results. The examiner also noted a normal EKG and cardiac studies. In the "Arrhythmia" section, the examiner reported that the Veteran did not have a cardiac arrhythmia. After an in-person examination and a review of the Veteran's claims file, the examiner provided a negative nexus. The examiner explained that his diagnostic tests were all normal and was not on any medication for arrhythmia. The Veteran was afforded a second VA examination in March 2017. The Veteran reported being unsure about having heart arrhythmia. The examiner noted that the Veteran had experienced chest pain in 2008 and presented for medical attention. However, a nuclear stress test was performed at that time and showed that the exercise test was negative for exercise-induced ischemia of the coronary arteries. The examiner reported that the Veteran did not have any heart conditions that qualify within the generally accepted medical definition of ischemic heart disease (IHD). The examiner reported that the Veteran has not had a cardiac arrhythmia. No etiology opinion was provided at this examination. VA provided an etiology opinion regarding the Veteran's service connection claim for cardiac arrhythmia in November 2020. After a telehealth examination and a review of the Veteran's claims file, the examiner provided a negative secondary nexus opinion. The examiner acknowledged that the Veteran had a history of chest pain, but also noted that previous testing for cardiac arrhythmia had been negative. The examiner opined that it was less likely than not that the Veteran had cardiac arrhythmia because the available records showed no evidence of the condition. Further, the examiner explained that because the evidence has not shown the presence of cardiac arrhythmia, it was less likely than not that it was secondary to, or aggravated by his service-connected PTSD. To the extent that the Veteran believes that he is diagnosed with a cardiac arrhythmia, or that it is due to his active duty service, or is secondary to service-connected PTSD, such a diagnosis and medical opinions require medical expertise, and those determinations cannot simply be made by lay observation alone; and the Veteran is not considered competent (meaning medically qualified by training or experience) to provide a diagnosis or a medical opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Given that the March 2017 Board decision found that an etiology opinion was necessary, in regard to the secondary service-connection; a VA examination was ordered to address the medical and lay evidence of record. Unfortunately, the November 2020 VA examiner explained that there was no diagnosis for a cardiac condition and provided a negative nexus opinion. The Board notes that the Veteran has not offered any competent medical opinions that would otherwise undermine the findings and conclusions of the November 2020 VA examiner. Here, there are only two competent medical opinions of record, the December 2011 VA examiner who provided a nexus opinion regarding direct service connection and the November 2020 VA examiner's nexus opinion regarding secondary service connection. Neither examination found cardiac arrhythmia. In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement that a current disability be present is satisfied "when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim...even though the disability resolves prior to the Secretary's adjudication of the claim." McClain v. Nicholson, 21 Vet. App. 319 (2007). Accordingly, service connection for cardiac arrhythmia is denied. 6. Service connection for CFS, to include as secondary to PTSD, is denied. 7. The Veteran asserts that his fatigue is a residual of his reported in-service heat stroke. In the alternative, he also asserts that his chronic fatigue is due to his service-connected PTSD. However, neither VA treatment records, nor VA examinations, have shown that he has actually been clinically diagnosed with chronic fatigue syndrome. There has been acknowledgement that he has fatigue, but the fatigue has been related to his non service connected back disability. 8. This claim was previously before the Board in March 2017. The Board decision noted that the Veteran was afforded a VA examination in February 2011, however, he was not diagnosed with CFS and an etiology opinion was not rendered. The Veteran then submitted articles suggesting that his fatigue was a symptom of heat stroke and he was afforded another VA examination in January 2014. The examiner once again found that he was not diagnosed with CFS and therefore was less likely as not due to or a residual of his military service. He was then afforded a VA examination for PTSD in May 2014, where he reported that his energy levels were usually pretty low. The Board found that it was unclear as to whether the Veteran had a fatigue disability, or whether it was a symptom of his service-connected PTSD and remanded for a new VA examination. Of note, the Veteran is service connected for PTSD and rated at 100 percent. The Board sought etiology opinions regarding both direct and secondary service connection. 9. The Veteran was afforded VA examinations in March 2017 and in November 2020. At the March 2017 VA examination, the examiner acknowledged that the Veteran had shown signs and symptoms to CFS; however, after an in-person examination and a review of the Veteran's claims file, the Veteran was not diagnosed with chronic fatigue syndrome. The examiner also reported that during the interview, the Veteran denied any current issues with chronic fatigue. The examiner concluded that based on their being no current problems with chronic fatigue and there being no evidence that he had problems with fatigue during his active duty service, it was less likely than not incurred in or caused by his active duty service. 10. At the November 2020 telehealth examination, the examiner provided a negative nexus opinion regarding secondary service connection. The examiner acknowledged that the Veteran underwent an examination for chronic fatigue in 2017, but reported that there was no evidence to suggest that it was secondary to or aggravated by his service-connected PTSD. After interviewing the Veteran, the examiner indicated that he attributed his fatigue and inability to function to his sciatica issues. The examiner concluded that because the Veteran did not indicate a relationship between the two conditions and there were no records indicating that the conditions were related (there was no evidence of concurrent exacerbation or close proximity between the symptoms of the two conditions), it was less likely than not caused or aggravated by PTSD. 11. To the extent that the Veteran believes that he has chronic fatigue syndrome, such a diagnosis and medical opinions require medical expertise. The Veteran is certainly competent to assert that he feels tired or fatigued, but the determination of whether the symptoms constitute chronic fatigue syndrome is considered to be a medical determination, and the Veteran is not considered competent (meaning medically qualified by training or experience) to provide a diagnosis or a medical opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). 12. VA examinations were ordered to address the medical and lay evidence of record. Unfortunately, the March 2017 and November 2020 VA examiners provided negative nexus opinions, in regard to both direct and secondary service connection. The Board notes that the Veteran has not offered any competent medical opinions that would otherwise undermine the findings and conclusions of the November 2020 VA examiner. 13. Additionally, it is noted in the VA treatment records that the Veteran has not been given a diagnosis of chronic fatigue syndrome by any medical professional at VA. As noted, the Veteran has a number of clinical problems which may trigger fatigue. For example, the Veteran has indicated that his back problems cause his legs to become fatigued. 14. In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement that a current disability be present is satisfied "when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim...even though the disability resolves prior to the Secretary's adjudication of the claim." McClain v. Nicholson, 21 Vet. App. 319 (2007). 15. The Board acknowledges the Veteran's sincere belief that he has a diagnosis for a chronic fatigue condition and is due to his active duty service or secondary to his service-connected PTSD. However, the fact remains that chronic fatigue syndrome has not actually been diagnosed, and no fatigue based disorder has been linked to either service or a service connected disability, despite multiple examinations being provided. As such, the weight of the evidence is against the claim, and the claim is denied. 16. Service connection for lower extremity edema, to include spider veins is denied. The Veteran asserts that his lower extremity edema is due to his active duty service, to include his two reported in-service heat strokes. At a VA examination in February 2011, the Veteran reported prolonged walking caused his lower extremity edema. In a March 2017 Board decision, it was noted that the Veteran had testified in July 2008 that he first noticed edema after he fell off of a roof, after his separation from the military. His representative also submitted a document stating that heat edema of the legs was noted to have resolved spontaneously and was of no clinical significance. The Board found that it was unclear as to whether the Veteran's reported edema represented a disability, or a symptom of the Veteran's reported in-service heat strokes and remanded for an etiology opinion regarding direct service connection and whether his edema was caused by or aggravated by his reported in-service heat strokes. The Veteran was afforded VA examinations in March 2017 and in June 2020, which provided nexus opinions regarding direct service connection and whether his edema was caused by in-service heat strokes. At the March 2017 examination, the Veteran reported that he started getting pain in his calves and thighs after walking around 2007 and he noticed mild spider and varicose veins. He denied any current issues with his veins. After an in-person examination and a review of the Veteran's claims file, the examiner did not find a diagnosis for any vascular diseases, but noted the presence of spider veins. The examiner noted some leg numbness, but reported that it may be from a low back condition. The examiner also provided a negative nexus opinion regarding direct service connection. The examiner explained that the Veteran denied any current issues with arteries and veins and the condition did not exist in service. The March 2017 VA examiner provided an addendum opinion in June 2020. After a review of the Veteran's claims file, the examiner provided a negative nexus opinion, regarding whether it was due to his reported in-service heat strokes. The examiner reiterated that the Veteran did not report any edema or vein issues at the March 2017 VA examination. The examiner further explained that spider veins were less likely than not due to his reported in-service heat stroke because heat strokes are not known a known cause of spider veins. To the extent that the Veteran believes that his edema and/or spider veins are due to his active duty service, or is his reported in-service heat strokes, such medical opinions require medical expertise, and those determinations cannot simply be made by lay observation alone; and the Veteran is not considered competent (meaning medically qualified by training or experience) to provide a diagnosis or a medical opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). A VA examination was ordered to address the medical and lay evidence of record. Unfortunately, the VA examiner who provided their medical opinions in March 2017 and June 2020, provided negative nexus opinions, regarding whether his claimed lower extremity vascular condition was due to his active duty service or his reported in-service heat strokes. The Board notes that the Veteran has not offered any competent medical opinions that would otherwise undermine the findings and conclusions of the March 2017 or June 2020 VA examiner. Here, there are only two competent medical opinions of record, provided by a VA examiner in March 2017 and in June 2020. This is the must probative evidence, and as such the weight of the evidence is against the Veteran's claim. Accordingly, service connection for lower extremity edema, to include spider veins, is denied. 17. Service connection for headaches and service connection for neurological effects is denied. The Veteran is seeking service connection for headaches and neurologic issues which he believes are due to his active duty service, to include his two reported in-service heat strokes. This claim was previously before the Board in March 2017, at which time it was noted that the Veteran had testified in July 2008 that he did not have headaches or neurological deficits, including memory loss and vertigo, until after a fall off of a roof after service. The Board noted that he was afforded a VA examination in February 2011, where he was diagnosed with headaches, that were then attributed to his post-service head injury. He was also noted to have a diagnosis of neurological deficit for memory loss, but that was attributed to alcohol abuse. He was afforded another VA examination December 2011, at which he reported that his vertigo had resolved in 2010 when he stopped working. After an examination, the examiner provided a negative nexus opinion regarding direct service connection for headaches because the onset of the headaches was three years after his post-service fall. In addition, the examiner noted that causes of memory loss ranged from aging to alcoholism, drug use, long-term smoking, head trauma, lack of physical fitness and cognitive diseases. The Board found that the December 2011 nexus opinion regarding headaches was inadequate because it focused on neck pain and not entirely on headaches and noted that additional treatment records were obtained and remanded to afford the Veteran a new VA examination. Regarding neurological deficits, the Board found that the nexus opinion was inadequate because the examiner's rationale only provided potential causes of memory loss. The Board remanded the service connection claims for headaches and neurological deficits, to include vertigo, for direct service connection nexus opinions and for opinions regarding whether the claimed conditions were caused or aggravated by his reported in-service heat strokes. The Veteran was afforded VA examinations in March 2017 and an addendum opinion was provided in June 2020, which provided nexus opinion regarding direct service connection and whether his headaches and neurologic deficits were caused by in-service heat strokes. At the March 2017 VA examination, the examiner reported that the Veteran was alert and oriented and was able to recall dates and times of previous injuries. The Veteran reported that his short-term memory was poor and would have to go to the store several times to get everything he needed because he would forget some of the items he needed. Diagnostic testing was reviewed, which showed no acute intracranial abnormality. The examiner noted that he was diagnosed with tension headaches. After an in-person examination and a review of the Veteran's claims file, the examiner provided a negative nexus opinion. The examiner acknowledged the Veteran's report of in-service headaches, although documentation in his STRs was not present. The examiner attributed the Veteran's headaches to his post-service fall. Regarding vertigo, the examiner also attributed it to his post-service fall because vertigo did not start until after the incident and concluded that it was less likely as not related to his military service or his reported in-service heat strokes. In June 2020, the same examiner provided an addendum opinion that was negative. The examiner observed that the Veteran's current problem list did not include headaches as a condition he was being treated for. The examiner noted that the Veteran reported that his headaches started in 1998, when he sustained an in-service head injury, but the contemporaneous treatment records did not show headache complaints, until 2002 when he fell off of a roof. The examiner also noted a December 2011 treatment note, where the Veteran reported issues with headaches after a fall from a roof in 2002. To the extent that the Veteran believes that his headaches and neurologic deficits are due to his active duty service, or is his reported in-service heat strokes, such medical opinions require medical expertise, and those determinations cannot simply be made by lay observation alone; and the Veteran is not considered competent (meaning medically qualified by training or experience) to provide a diagnosis or a medical opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Multiple medical opinions were sought to address the etiology of the Veteran's claimed headaches, but the opinions consistently concluded that the Veteran did not have a headache disorder as a result of his service. (continued on next) The medical opinions are found to be the most probative evidence of record. Accordingly, service connection for headaches and service connection for neurological deficits is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals KEITH W. ALLEN Veterans Law Judge Board of Veterans' Appeals K. A. BANFIELD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. FU, Associate 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.