Citation Nr: 21030877 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 17-10 834A DATE: May 19, 2021 ORDER Entitlement to service connection for a left hand disability is denied. Entitlement to service connection for a bilateral eye disability, to include as due to a service-connected disability, is denied. REMANDED Entitlement to service connection for obstructive sleep apnea, to include as due to a service-connected disability and environmental hazards, is remanded. FINDINGS OF FACT 1. The weight of the competent and credible evidence is against finding that the Veteran has, or has had at any time during the appeal, a left hand disability. 2. The weight of the competent and credible evidence is against finding that the Veteran has, or has had at any time during the appeal, a bilateral eye disability. CONCLUSIONS OF LAW 1. The criteria for service connection for a left hand disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 2. The criteria for service connection for a bilateral eye disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Navy from August 1993 to August 1995 with service in Southwest Asia. The Veteran testified at a Board video conference hearing before the undersigned Veterans' Law Judge in August 2019. A transcript of the hearing has been associated with the claims file. Previously, the claims were before the Board in December 2019 and were remanded for additional development. The prior development has been completed as to the Veteran's claims for entitlement to service connection for a left hand disability and service connection for a bilateral eye disability. As such, the Board finds that the prior remand directives have been substantially complied with, and the matters are again before the Board. See Stegall v. West, 11 Vet. App. 268, 271 (1998). During the course of the appeal in a October 2020 rating decision service connection was granted for a left knee disability, for a low back disability and for a skin disability, effective August 26, 2014. As such represents a full grant of benefits sought on appeal these issues are no longer before the Board. SERVICE CONNECTION A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C. §§ 1110. 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" - the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 Fed. Cir. (2004). 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, as distinguished from merely isolated findings or a diagnosis including the word "Chronic." When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection for a recognized chronic disease can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303 (b), 3.309. In addition, the Veteran served in the Southwest Asia theater of operations in support of the Persian Gulf War. 38 C.F.R. § 3.317(e). Under those provisions, 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. Signs or symptoms which may be manifestations of undiagnosed illness include, but are not limited to: fatigue, signs or symptoms involving skin, headache, muscle pain, joint pain, neurologic signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper or lower), sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. 38 C.F.R. § 3.317(b). There must be objective signs that are perceptible to an examining physician and other non-medical indicators that are capable of independent verification. There must be a minimum of a six-month period of chronicity. There must be no affirmative evidence that relates the illness to a cause other than being in the Southwest Asia Theater of operations during the Persian Gulf War. If signs or symptoms have been medically attributed to a diagnosed (rather than undiagnosed) illness, the Persian Gulf War presumption of service connection does not apply. VAOPGCPREC 8-98 (Aug. 3, 1998). For purposes of this section, a qualifying chronic disability means a chronic disability resulting from any of the following (or any combination of the following): (A) an undiagnosed illness; (B) the following medically unexplained chronic multisymptom illnesses that are defined by a cluster of signs or symptoms: (1) chronic fatigue syndrome; (2) fibromyalgia; (3) irritable bowel syndrome; or (4) any other illness that the Secretary determines meets the criteria in paragraph (a)(2)(ii) of this section for a medically unexplained chronic multisymptom illness; or (C) any diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117 (d) warrants a presumption of service-connection. 38 C.F.R. § 3.317 (a)(2)(i). For purposes of this section, the term medically unexplained chronic multisymptom 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. Chronic multisymptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317 (a)(2)(ii). For purposes of this section, "objective indications of chronic disability" include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317 (a)(3). Compensation shall not be paid under this section, however, if there is affirmative evidence that an undiagnosed illness was not incurred during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War; or if there is affirmative evidence that an undiagnosed illness was caused by a supervening condition or event that occurred between the Veteran's most recent departure from active duty in the Southwest Asia theater of operations during the Persian Gulf War and the onset of the illness; or if there is affirmative evidence that the illness is the result of the Veteran's own willful misconduct or the abuse of alcohol or drugs. 38 C.F.R. § 3.317 (c). A disability which is proximately due to or the result of a service connected disease or injury shall be service connected. 38 C.F.R. § 3.310 (a). Any increase in severity of a non-service connected disease or injury that is proximately due to or the result of a service connected disease or injury, and not due to the natural progress of the nonservice connected disease or injury will be service connected. 38 C.F.R. § 3.310 (b). 1. Entitlement to service connection for a left hand disability The Veteran contends that service connection is warranted for a left hand disability. The Veteran reports that his ongoing symptomology of left finger and hand pain is related to service and an in-service injury. In August 2019 the Veteran testified to an in-service injury while working in the engine room aboard USS Constellation where his finger was smashed while trying to clamp and shut a valve. The Veteran reported that he never regained full motion on his finger and has had ongoing pain in his hand and difficulty bending. The Veteran is competent to describe his ongoing symptoms, in-service duties and the occurrence of ongoing symptoms since service, and to this extent, his statements are credible. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The question for the Board is whether the Veteran has a current left hand disability that began during service or is at least as likely as not related to an in-service injury, event or disease. The Board concludes that the Veteran does not have a current left hand disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. See 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); McKinney v. McDonald, 28 Vet. App. 15 (2016); 38 C.F.R. § 3.303(a), (d). Under 38 U.S.C. § 1110, there must be a disability due to an identified personal injury suffered or disease or injury, contracted in-service. Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir., 2018). Herein, even if the Board considered the Veteran's reports of left hand and finger pain and reduced range of motion to broadly encompass general reports of pain, there is no functional limitation. Further, not all pain results in a disability, as in here, or rises to the level of impairment of working ability. The Veteran's service treatment records (STRs) and service personnel records have been associated with the claims file. The Veteran served on an aircraft carrier deployment to Southwest Asia during the applicable time period. STRs note the Veteran was seen in January 1994 for left hand second digit pain. The Veteran reported smashing his finger in a vice. Physical examination noted no erythema with positive ecchymosis to the nail bed, decreased range of motion secondary to tenderness was noted with mild edema. A neurology evaluation was within normal limits as was a sensory and motor evaluation. Diagnosis was noted to be a left hand second digit contusion. The Veteran was recommended to use Motrin for 5 days, remain on light duty for two days, use of a finger splint and then to return for care if needed. Examination noted trauma to the left hand and second digit in February 1994 with no evidence of fracture seen on the radiologic report. At separation in July 1995 on the report of medical examination clinical evaluation of the upper extremities and musculoskeletal system was normal. Further, at separation in July 1995 on the report of medical history the Veteran reported swollen or painful joints but denied arthritis, bone, joint or other deformity, and loss of finger. The Veteran reported a swollen and painful right shoulder and swollen right knee on examination, which the examiner attributed to the Veteran's reports of swollen or painful joints. As such the Board finds an in-service event, based on the Veteran's statements and in-service treatment for a left hand injury, but without a clear clinical confirmation of ongoing symptoms or a definitive diagnosis. The question for the Board is whether the Veteran has a current left hand disability, then if so, if such is related to an in-service event, injury or illness. The Veteran was afforded a VA hand and finger conditions examination in May 2015. The Veteran reported that approximately 7 months ago, he began having pain in the second digit of his left hand. The Veteran reported waking up in pain and that he did not remember a specific injury. The examiner noted that the Veteran does not have a current diagnosis associated with any claimed condition relating to his hand or finger. The examiner noted review of the Veteran's claims file and relevant information in the electronic record. The examiner noted review of the STRs and that the Veteran was seen in-service in January 1994 for pain to the second digit of his left hand after smashing his finger. X-ray imaging in-service after the Veteran's left hand injury was within normal limits. Then at separation his left hand was normal. The Veteran currently denied flare ups of his hand, finger or thumb joints. The Veteran reports functional loss with decreased range of motion of the second finger of the left hand. Range of motion testing of the left hand was normal. There was no gap between the pad of his thumb and finger, or between the finger and proximal transverse crease of the hand on maximal finger flexion. There was no evidence of pain with use of the hand, nor was there objective evidence of localized tenderness or pain on palpation. Repetitive use testing did not result in any additional loss of range of motion or functional loss. Muscle strength testing was 5/5, with no muscle atrophy. There was no left hand ankylosis. The examiner noted no pertinent physical findings, complications, conditions or signs or symptoms related to any conditions of the left hand or fingers. Imaging noted no abnormal findings and no significant diagnostic test findings. The examiner noted no functional impact related to the Veteran's reported left hand and finger symptoms and such does not impact his ability to perform occupational tasks. The examiner noted that no left hand or finger condition was found, X-rays were normal as was the clinical examination. Further, there was no sensory or motor deficit of the left hand second digit. The VA examiner found that it was less likely than not that the Veteran's claimed left hand/finger condition was incurred in or caused by the claim in-service injury, event or illness. The examiner noted a thorough review of the Veteran's STRs and treatment in January 1994 for care due to an injury to the second digit of the left hand after smashing his finger. X-ray imaging in-service was normal, and clinical examination was normal at separation from service. The examiner noted that while there was an in-service injury, this condition resolved. Since service the Veteran did not report symptomology until 20 years after service and there is no evidence of treatment for his finger. As such the examiner found no chronicity relating to a left hand or finger disability. The examiner found that it was less likely than not that the Veteran's claimed left hand and finger disability was incurred in or caused by the claimed in-service injury, event or illness. VA and private treatment records have been associated with the claims file. May 2015 X-ray imaging noted no significant traumatic or arthritic manifestations are defined in either hand. September 2017 VA treatment records note reports of joint pain in his hands with no specific swelling. VA treatment records consistently note normal range of motion with no muscle atrophy and normal muscle strength of the left hand. The Board has considered the Veteran's representative's contentions in March 2021 correspondence. Specifically, the Veteran's representative contends that service connection is warranted for left hand pain. The Board has considered the Veteran's and his representative contentions however, VA benefits may not be granted based on speculative opinions. Rather, opinions must be made by competent professionals and be based on a rationale that is clear to the Board. The Veteran's representative is not competent to provide a medical opinion. Furthermore, even if the representative was found to be a competent source of opinion, evidence favorable to a veteran's claim that does little more than suggest a possibility that his illnesses might have been caused by service or a service-connected disability is insufficient to establish service connection. See Stegman v. Derwinski, 3 Vet. App. 228, 230 (1992). Lastly, the benefit of the doubt rule is for application when the evidence is in equipoise, which occurs only when there is an approximate balance between the positive and negative evidence. 38 C.F.R. § 3.102. That evidence must be both competent and credible. Here, there is no such balance of evidence. The weight of the competent and credible evidence is against the Veteran's claim for service connection for a left hand disability. While the Veteran believes that his symptoms and in-service exposures are indicative of an ongoing left hand disability and related to his service, he is not competent to provide a nexus opinion in this case. The record does not reflect that he has the requisite training or expertise to offer a medical opinion diagnosing a left hand disability and linking current symptoms, if any, to an in-service injury and as such he is not competent to provide an opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board finds that the medical evidence is more probative and more credible than the lay opinions of record. As to the Veteran's general contentions of ongoing symptoms and manifestations the Veteran is competent to report his ongoing symptomology. However, the Board assigns low credible weight to the Veteran's reports because the Veteran had opportunities to report these symptoms at numerous times at discharge and during his ongoing VA primary care and treatment, and follow-up but no continuing left hand symptoms were reported. The May 2015 VA examiner noted no pertinent physical findings, complications, conditions or signs or symptoms related to any conditions of the left hand or fingers. Imaging noted no abnormal findings and no significant diagnostic test findings. The examiner noted no functional impact related to the Veteran's reported left hand and finger symptoms and such does not impact his ability to perform occupational tasks. The examiner noted that no left hand or finger condition was found, X-rays were normal as was the clinical examination. Further, there was no sensory or motor deficit of the left hand second digit. The VA examiner found that it was less likely than not that the Veteran's claimed left hand/finger condition was incurred in or caused by the claim in-service injury, event or illness. The examiner noted a thorough review of the Veteran's STRs and treatment in January 1994 for care due to an injury to the second digit of the left hand after smashing his finger. X-ray imaging in-service was normal, and clinical examination was normal at separation from service. The examiner noted that the while there was an in-service injury, this condition resolved. Since service the Veteran did not report symptomology until 20 years after service and there is no evidence of treatment for his finger. As such the examiner found no chronicity relating to a left hand or finger disability. As such the examiner found that it was less likely than not that the Veteran's claimed left hand and finger disability was incurred in or caused by the claimed in-service injury, event or illness. Further, VA treatment records consistently note no symptoms, manifestations or reports of a left hand disability. Thus, the more probative evidence of record indicates that the Veteran does not have a current left hand disability, and as such service connection is not warranted. In addition, although the Veteran served in Southwest Asia during the applicable time period, he cannot establish service connection for an undiagnosed illness under 38 C.F.R. § 3.317, because there is no indication of a chronic disability, or ongoing symptomatology of a disability. The May 2015 VA examiner noted that there is no confirmed diagnosis of any chronic left hand condition which requires ongoing care, evaluation, and treatment and as such there can be no associated connection to any unknown Gulf War environmental exposures. The claimed condition has not been shown to be undiagnosed or part of a medically unexplained chronic multi symptom illness. As such, the Board finds that service connection for a left hand disability is not warranted. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990); 38 C.F.R. § 3.102. For these reasons, the claim for entitlement to service connection for a left hand disability is denied. 2. Entitlement to service connection for a bilateral eye disability, to include as due to a service-connected disability The Veteran contends that service connection is warranted for a bilateral eye disability, specifically ongoing light sensitivity and headaches related to service and an in-service injury. In August 2019 the Veteran testified to experiencing light sensitivity and headaches while going outdoors. He reported that this began while working in the engine room in-service and not going topside for several weeks. The Veteran and associated lay statements have reported that if not wearing sunglasses outside he gets headaches and has significant sensitivity to light. The Veteran has reported that in-service he was exposed to sand, dust and paint and JP-4 while serving aboard the USS Constellation which at different items got into his eyes. He reports a gradually worsening of his eyesight and increased sensitivity and difficulty with light and being outside without sunglasses. The Veteran is competent to describe his ongoing symptoms, in-service duties and the occurrence of ongoing symptoms since service, and to this extent, his statements are credible. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The question for the Board is whether the Veteran has a current bilateral eye disability that began during service or is at least as likely as not related to an in-service injury, event or disease. The Board concludes that the Veteran does not have a current bilateral eye disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. See 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); McKinney v. McDonald, 28 Vet. App. 15 (2016); 38 C.F.R. § 3.303(a), (d). Under 38 U.S.C. § 1110, there must be a disability due to an identified personal injury suffered or disease or injury, contracted in-service. Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir., 2018). Herein, even if the Board considered the Veteran's reports of a bilateral eye disability with sensitivity to light and headaches to broadly encompass general reports of pain, there is no functional limitation. Further, not all pain results in a disability, as in here, or rises to the level of impairment of working ability. The Veteran's STRs and service personnel records have been associated with the claims file. The Veteran served in Southwest Asia during the applicable time period. At separation in July 1995 on the report of medical examination clinical evaluation of the eyes, ophthalmoscopic, pupils and ocular motility were normal. Further, at separation in July 1995 on the report of medical history the Veteran denied eye trouble and reporting having vision in both his eyes. As such the Board finds an in-service event, based on the Veteran's statements, but without a clear clinical confirmation of ongoing symptoms or a definitive diagnosis. The question for the Board is whether the Veteran has a current bilateral eye disability, then if so, if such is related to an in-service event, injury or illness. The Veteran was afforded a VA headaches examination in May 2015. The Veteran reported that he began having migraine headaches in early 1995 while working in the engine room in-service and for 3 weeks not seeing sunlight. The Veteran reported that it was so bright when he went outside and since then he has headaches with light. The examiner noted that the Veteran has not been or ever been diagnosed with a headache condition. The examiner noted a thorough review of the Veteran's claims file. The examiner noted that the Veteran does not experience headache pain, or symptoms associated with headaches or prostrating attacks of headache pain. No pertinent physical findings, complications, conditions, signs or symptoms related to any conditions has occurred. The examiner noted that the Veteran does not have a headache condition which impacts his ability to work. The examiner noted that the Veteran's claimed condition was not found in the present exam. There was no subjective condition which was found, and such is not related or due to exposure to environmental hazards during service in Southwest Asia. The examiner noted that the present examination was within normal limits. Further, there is not a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology. The examiner noted that he Veteran's exposure time in Southwest Asia was extremely very short to be noxious. In addition, the Veteran was afforded a VA eye examination in February 2016. The examiner noted that the Veteran does not now nor has he ever been diagnosed with an eye condition. Physical examination was normal. The VA examiner noted that there is no eye condition which is causing the Veteran's reported symptoms of light sensitivity. The Veteran reports his light sensitivity causes headaches if he is not wearing sunglasses. The examiner noted a review of the STRs and noted no eye profile for sunglasses wear while in-service. VA and private treatment records have been associated with the claims file. VA treatment records consistently note extraocular muscles were intact with pupils equally reactive to light. Treatment records note no eye or vision changes or double vision, but the Veteran consistently reports chronic light sensitivity. The Board has considered the Veteran's representative's contentions in March 2021 correspondence. Specifically, the Veteran's representative contends that service connection is warranted. The Board has considered the Veteran's and his representative contentions however, VA benefits may not be granted based on speculative opinions. Rather, opinions must be made by competent professionals and be based on a rationale that is clear to the Board. The Veteran's representative is not competent to provide a medical opinion. Furthermore, even if the representative was found to be a competent source of opinion, evidence favorable to a veteran's claim that does little more than suggest a possibility that his illnesses might have been caused by service or a service connected disability is insufficient to establish service connection. See Stegman v. Derwinski, 3 Vet. App. 228, 230 (1992). Lastly, the benefit of the doubt rule is for application when the evidence is in equipoise, which occurs only when there is an approximate balance between the positive and negative evidence. 38 C.F.R. § 3.102. That evidence must be both competent and credible. Here, there is no such balance of evidence. The weight of the competent and credible evidence is against the Veteran's claim for service connection for a bilateral eye disability. While the Veteran believes that his symptoms and in-service exposures are indicative of a bilateral eye disability and related to his service, he is not competent to provide a nexus opinion in this case. The record does not reflect that he has the requisite training or expertise to offer a medical opinion diagnosing a bilateral eye disability, and linking current symptoms, if any, to an in-service injury or exposures, and as such he is not competent to provide an opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board finds that the medical evidence is more probative and more credible than the lay opinions of record. As to the Veteran's general contentions of ongoing symptoms and manifestations the Veteran is competent to report his ongoing symptomology. However, the Board assigns low credible weight to the Veteran's reports because the Veteran had opportunities to report these symptoms at numerous times during his discharge physical examination and ongoing VA primary care and treatment; follow-up and treatment but no continuing bilateral eye symptoms were reported. The May 2015 VA examination noted an extensive review of the Veteran's claims file and noted examiner noted that the Veteran does not experience headache pain, or symptoms associated with headaches or prostrating attacks of headache pain. No pertinent physical findings, complications, conditions, signs or symptoms related to any conditions has occurred. The examiner noted that the Veteran does not have a headache condition which impacts his ability to work. The examiner noted that the Veteran's claimed condition was not found in the present exam. There was no subjective condition which was found, and such is not related or due to exposure to environmental hazards during service in Southwest Asia. The examiner noted that the present examination was within normal limits. Additionally, the VA examiner in February 2016 noted that the Veteran does not now or has he ever been diagnosed with an eye condition. Physical examination was normal. The VA examiner noted that there is no eye condition which is causing the Veteran's reported symptoms of light sensitivity. Further, VA treatment records consistently noted no symptoms, manifestations or reports of a bilateral eye disability. Thus, the more probative evidence of record indicates that the Veteran does not have a current bilateral eye disability, and as such service connection is not warranted. In addition, although the Veteran served in Southwest Asia during the applicable time period, he cannot establish service connection for an undiagnosed illness under 38 C.F.R. § 3.317, because there is no indication of a chronic disability, or ongoing symptomatology of a disability. The May 2015 VA examiner noted the present examination was within normal limits. Further, there is not a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology. The examiner noted that he Veteran's exposure time in Southwest Asia was extremely very short to be noxious. There is no confirmed diagnosis of any chronic left hand condition which requires ongoing care, evaluation, and treatment and as such there can be no associated connection to any unknown Gulf War environmental exposures. The claimed condition has not been shown to be undiagnosed or part of a medically unexplained chronic multi symptom illness. Then as to the Veteran's claims that secondary service connection is warranted for a bilateral eye disability, the Board finds that secondary service connection is not for consideration as the Veteran does not have a current bilateral eye disability. Thus, secondary service connection is not warranted. As such, the Board finds that service connection for a bilateral eye disability is not warranted. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990); 38 C.F.R. § 3.102. For these reasons, the claim for entitlement to service connection for a bilateral eye disability is denied. REASONS FOR REMAND 1. Entitlement to service connection for obstructive sleep apnea, to include as due to a service-connected disability and environmental hazards The Veteran contends that service connection is warranted for sleep apnea, to include as due to his service-connected posttraumatic stress disorder (PTSD) and major depressive disorder and as due to in-service exposures. The Board finds that a remand is warranted for a supplemental VA opinion. The Veteran contends that service connection is warranted for his sleep apnea and specifically that his service connected PTSD and major depressive disorder have caused or aggravated his sleep apnea. The Board cannot make a fully informed decision on the issue of service connection because no VA examiner has fully opined as to secondary service connection, specifically aggravation. The Veteran was afforded a VA examination and opinions in February 2016 and October 2020. The February 2016 VA examiner noted that it is less likely than not that the Veteran's obstructive sleep apnea is proximately due to or the result of his service-connected major depressive disorder. Further, the VA examiner in October 2020 noted that the Veteran's obstructive sleep apnea was less likely than not incurred in or caused by the claimed in-service injury, event or illness including environmental hazards and exposures. However, neither VA examiner fully address secondary service connection and specifically aggravation. As such a remand is warranted for a supplemental VA opinion. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's obstructive sleep apnea and whether: (a.) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's obstructive sleep apnea was caused by his service connected PTSD and major depressive disorder? (b.) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's obstructive sleep apnea was aggravated (worsened beyond its natural progression) by his service connected PTSD and major depressive disorder? Review of the entire claims file is required. The examiner must provide a complete rationale for all findings and opinions, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Attention is invited to the February 2016 VA examination noting that it is less likely than not that the Veteran's obstructive sleep apnea is proximately due to or the result of his service-connected major depressive disorder. Further, the VA examiner in October 2020 noted that the Veteran's obstructive sleep apnea was less likely than not incurred in or caused by the claimed in-service injury, event or illness including environmental hazards and exposures. In addition, the Veteran and his representative contend that his sleep apnea has been caused or aggravated by his service connected PTSD and major depressive disorder and secondary service connection. J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.R. Kardian, 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.