Citation Nr: 21032042 Decision Date: 05/25/21 Archive Date: 05/25/21 DOCKET NO. 17-03 037 DATE: May 25, 2021 ORDER Service connection for diabetes mellitus is denied. Service connection for gout is denied. Service connection for peripheral neuropathy of the upper extremities is denied. Service connection for peripheral neuropathy of the lower extremities is denied. Service connection for a skin condition, including seborrheic keratosis is denied. Service connection for hypertension is denied. Service connection for erectile dysfunction is denied. Special monthly compensation (SMC) based on loss of use of a creative organ is denied. FINDINGS OF FACT 1. The Veteran did not serve in a unit stationed in the Korean Demilitarized Zone (DMZ) from September 1, 1967 to August 31, 1971, and herbicide agent exposure is not presumed. 2. The Veteran was not actually exposed to an herbicide agent during active service. 3. The Veteran's diabetes mellitus did not begin during active service, manifest to a compensable degree within one year of active service, or otherwise related to an in-service injury or disease. 4. The Veteran's gout did not begin during active service, manifest to a compensable degree within one year of active service, or otherwise related to an in-service injury or disease. 5. The Veteran did not have peripheral neuropathy of the upper extremities or any related disability at any time during or approximate to the pendency of the claim. 6. The Veteran did not have peripheral neuropathy of the lower extremities or any related disability at any time during or approximate to the pendency of the claim. 7. The Veteran's seborrheic keratosis did not begin during active service, or is otherwise related to an in-service injury or disease 8. The Veteran's hypertension did not begin during active service, manifest to a compensable degree within one year of active service, or otherwise related to an in-service injury or disease. 9. The Veteran's erectile dysfunction is not secondary to a service-connected disability or otherwise related to an in-service injury or disease. 10. The Veteran's anatomical loss or loss of use of one or more creative organs is not a result of service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 2. The criteria for service connection for gout have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 3. The criteria for service connection for peripheral neuropathy of the upper extremities have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 4. The criteria for service connection for peripheral neuropathy of the lower extremities have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 5. The criteria for service connection for a skin condition, including seborrheic keratosis have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 6. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 4.104. 7. The criteria for service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 8. The criteria for SMC based on loss of use of a creative organ have not been met. 38 U.S.C. §§ 1114 (k), 1155, 5107; 38 C.F.R. § 3.350 (a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from September 1970 to September 1972. He also had service in the Air National Guard and Air Force Reserve from 1980 until 2001, with a period of active duty from August 1990 to April 1991. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript is associated with the claims folder. In January 2020, the Board remanded the claims for hypertension, erectile dysfunction, SMC, and a skin condition. The Board also denied the claims of service connection for diabetes mellitus, gout, peripheral neuropathy of the upper extremities, and peripheral neuropathy of the lower extremities. The Veteran appealed the denials to the United States Court of Appeals for Veterans Claims (Court). In a September 2020 Joint Motion for Partial Remand (JMPR), the Court vacated the Board's decision to deny those issues and remanded them for action consistent with the terms of the JMPR. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases, including arthritis, diabetes mellitus, and peripheral neuropathy, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The term active military service includes active duty, any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty for training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident which occurred during such training. 38 C.F.R. § 3.6 (a). ACDUTRA includes full-time duty in the Armed Forces performed by Reserves for training purposes, while INACDUTRA includes duty (other than full-time duty) prescribed for Reserves, as well as duty (other than full-time duty) performed by a member of the National Guard of any State. 38 C.F.R. § 3.6 (c), (d). Presumptive periods for service connection do not apply to ACDUTRA or INACDUTRA. Biggins v. Derwinski, 1 Vet. App. 474 (1991). Claims based on a period of ACDUTRA or INACDUTRA are never entitled to the presumption of service connection outlined in 38 C.F.R. § 3.307 and § 3.309. Smith v. Shinseki, 24 Vet. App. 40 (2010). Appellants who established Veteran status for a prior period of service may be entitled to the presumption of soundness for a subsequent period of service under certain conditions. Id. at 45-46. For claims based on aggravation of a pre-existing condition during a period of ACDUTRA or INACDUTRA, the appellant must generally show that the condition worsened beyond its natural progression during the period of training and that the worsening was caused by the training. Id. at 48. Herbicide Agent Exposure The Veteran asserts that he was exposed to Agent Orange while serving in Korea. In his testimony at the August 2019 Board hearing, the Veteran reported that he was stationed near the Demilitarized Zone (DMZ) and would occasionally go the DMZ as part of his duties. In addition, the Veteran testified that herbicide agents were sprayed at the base, requiring him to stay in the barracks for 6 to 8 hours, and put on chemical gear before being cleared to come out. A veteran who, during active military, naval, or air service, served between April 1, 1968 and August 31, 1971, in a unit that, as determined by the Department of Defense (DOD), operated in or near the Korean DMZ in an area in which herbicide agents were known to have been applied during that period, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307 (a)(6)(iv). If the presumption is not applicable, herbicide agent exposure may still be established on a facts-found basis. Initially, the Board finds that the Veteran is not presumed to have been exposed to herbicide agents pursuant to 38 C.F.R. § 3.307 (a)(6)(iv). Generally, the Veteran asserts that he worked in proximity to and operated within the DMZ. In an October 2020 correspondence, the Veteran indicated that he was stationed at Camp Casey in Korea, along the DMZ, in 1971. See also June 2015 VA Form 21-4138 (reporting exposure at Camp Casey, Korea from 1968 to 1971). However, the Veteran's personnel records show he served in Korea from October 1971 until March 1972. He was attached to Headquarters, A company, 702nd Maintenance Battalion, 2nd Infantry Division. His military occupational specialty was clerk typist. The Veteran's personnel records are more probative and demonstrate that he did not have service in Korea during the dates enumerated in 38 C.F.R. § 3.307 (a)(6)(iv). The Veteran has provided inconsistent statements regarding the time period that he was stationed in Korea, and contrary to his recollection of events that occurred decades ago, his service records indicate that he is not shown to have arrived in Korea until October 1971. Therefore, in-service exposure to herbicide agents is not presumed. In addition, herbicide agent exposure on a facts-found basis is not supported by the weight of the probative and credible evidence. The available service personnel records do not show that the Veteran served along or near the DMZ in Korea. A March 2015 VA memorandum concluded that information required to verify herbicide agent exposure during military service is insufficient to send to the U.S. Army and Joint Services Records Research Center (JSRRC) or the National Archives Records Administration. The determination was based on the Veteran's response to requests for information on exposure to herbicide agents during military service, his military personnel file, and service treatment records. Moreover, the memorandum noted that the Veteran was not assigned to a unit recognized to have had herbicide agent exposure. While the Veteran is competent to report on his in-service experiences, his lay statements must be weighed against the breadth of competent, objective, and credible evidence in his own service medical and personnel records. The Veteran's military personnel records do not establish herbicide agent exposure, including via service along the DMZ. There is no confirmation that the Veteran was in a unit known to have operated in or near the Korean DMZ. In the September 2020 JMPR, the parties found the Board's January 2020 decision did not address Veteran's testimony that herbicide agents were sprayed at the base and barracks, and that he was required to stay in the barracks for eight to six hours at a time. In this regard, the Veteran's general assertions as to spraying at his base and barracks, on their own, are not sufficient to establish exposure. Bardwell v. Shinseki, 24 Vet. App. 36, 40 (2010). The Board acknowledge that the Veteran is competent to relate what he personally observed. Layno v. Brown, 6 Vet. App. 465, 469-470 (1994). However, the Veteran did not provide any information to allow the Board to assess how he knew that the substance which was sprayed was an herbicide agent. Similarly, the identification of herbicide agents such as Agent Orange based on mere observation of the substance requires highly specialized knowledge. As the Veteran is not otherwise shown to have expertise or knowledge in this matter, he has not established competency to be able to independently identify the substance as herbicide agents. Finally, the Veteran reporting donning chemical gear, presumably to protect him from exposure, and remaining in the barracks for many hours until cleared to come out. Thus, even were the Board to believe that it was herbicide agents were being sprayed, the Veteran's testimony indicates that he did not ever came into direct contact with such substance. For the above reasons, the Board does not find that the Veteran's lay testimony is competent or probative evidence as to whether he was actually exposed to herbicide agents. Based on the foregoing, the Board finds that the most competent and credible evidence does not support the conclusion that the Veteran was stationed in or near the Korean DMZ. In addition, there is no other credible or competent evidence of actual exposure to herbicide agents. For the purpose of efficiency and brevity, the Board herein incorporates the factual background above as it relates to herbicide agent exposure, both actual and presumed for the issues discussed herein, as it relates to herbicide agent exposure. 1. Service connection for diabetes mellitus is denied. The Veteran seeks service connection for diabetes mellitus, to include as due to herbicide agent exposure while serving in Korea. See August 2014 VA 21-4138. At the August 2019 Board hearing, the Veteran testified that he had elevated glucose levels in the 1980s and he was first diagnosed with diabetes mellitus in the 1990s by a private clinician. The Veteran has also submitted an Air Force memorandum from July 2000 noting an elevated glucose level. Given the Board's finding that the Veteran was not exposed to herbicide agents in service, service connection for diabetes mellitus may not be presumed. The Board must now consider whether direct service connection is warranted. Initially, the Board notes that diabetes mellitus was not shown during service or within one year thereafter. Service treatment records are silent for complaints, diagnosis or treatment related to diabetes. In an April 2009 letter, the Veteran was noted to have slightly high blood sugar and mild glycemia. The clinician recommended that retesting be performed in three months. By August 2013, the Veteran was noted to have a diagnosis of diabetes mellitus with noted risk factors including face, family history, and age. A November 2016 VA diabetic retinopathy evaluation noted a past medical history of diabetes mellitus of six or more years and a possible diagnosis in 2009, although the exact date of diagnosis is unknown. An August 2014 private treatment record noted that diabetes mellitus had onset in January 2011. In his Board testimony, the Veteran indicated that he had elevated glucose levels in the 1980s and his diabetes mellitus was diagnosed in the 1990s. However, the Board notes that this is inconsistent with his prior statements and the clinical records. For instance, the Veteran indicated that diabetes mellitus had onset in 2009 in his September 2013 VA 21-526. The Board accords more probative weight to the statements made during the Veteran's treatment and the clinical findings in private and VA treatment records. Thus, the Board concludes that, while the Veteran's diabetes mellitus is a chronic disease under 38 C.F.R. § 3.309 (a), it was not shown as chronic in service or within a presumptive period. Further, there is no evidence demonstrating that it manifested to a compensable degree within a year from discharge from active service. To the extent the Veteran contends that his elevated glucose levels in July 2000 treatment records constitute an initial diagnosis while the Veteran was still enlisted in the Air National Guard, diabetes mellitus is a disease, not an injury, and therefore it must be shown that such a condition either began during or was otherwise caused by a period of active duty or ACDUTRA. See 38 U.S.C. § 101 (24). As noted above, the probative clinical findings indicate that the Veteran was not actually diagnosed with diabetes mellitus until the late 2000s. Although there may have been some elevated glucose readings prior to that time, the most probative evidence establishes that the Veteran's diabetes mellitus was diagnosed many years after any period of active duty or ACDUTRA. As to the whether the Veteran's diabetes mellitus is otherwise related to service, there is no evidence to support a causal relationship or "nexus" between the present disability and service. As noted, service treatment records are silent for diabetes mellitus. In addition, the Veteran did not have a diagnosis for many years after service. Furthermore, private clinicians have noted that the Veteran has several risk factors for diabetes mellitus which are unrelated to service and include race, family history of the disease, and age. See e.g. May 2014 private treatment records. Although the Veteran believes his diabetes mellitus is proximately due to service, the Veteran is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and knowledge of an almost entirely internal process and pathology. The record does not show that the Veteran has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Accordingly, there is no competent evidence that supports a causal link between the Veteran's diabetes mellitus and service. Ultimately, the competent evidence fails to show diabetes mellitus during service or within a year of discharge from active service. The evidence also fails to show that the disease is etiologically related to service, to include by claimed exposure to herbicide agents. As the preponderance of evidence is unfavorable to the claim, there is no reasonable doubt to be resolved. Service connection for diabetes mellitus is not warranted. See 38 U.S.C. § 5107 (b). 2. Service connection for gout is denied. The Veteran contends his gout is related to herbicide agent exposure. See August 2019 Board hearing. The Veteran also testified that he was diagnosed with gout in the 1990s and prior to activation for Desert Storm/Shield with symptoms in his knees and big toes. See also September 2013 VA 21-526. Initially, the Board notes that there is an established diagnosis. See May 2013 private treatment records (noting a current diagnosis of gout). Gout, as a form of arthritis, is a "chronic disease" listed under 38 C.F.R. § 3.309 (a). As such, the first question before the Board is whether service connection may be presumed pursuant to 38 C.F.R. § 3.303 (b). However, review of the evidence shows that the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. Treatment records while in active service or within one year of active service are silent for complaints, diagnosis, or treatment for gout. Rather, the Veteran's periodic examination in relation to his Air National Guard service noted no abnormality related to gout. In the periodic medical examination of August 1990, the clinician checked "normal" for the Veteran's upper extremities, feet, and lower extremities. Examinations in June 1995 and June 2000 contained similar findings. In an August 1990 report of medical history, the Veteran did not disclose a diagnosis or symptoms of gout. The Veteran also checked "no" to arthritis, rheumatism, bursitis, foot trouble, and bone, joint, or other deformity. Other National Guard records show that in the June 2000, the clinical provider noted hypertension and kidney stones in the Veteran's medical history. Gout and any related complaints were omitted from the Veteran's medical history. Private laboratory testing showed uric acid levels within normal range as late as April 2012. By November 2012, private treatment records show that the Veteran's gout was managed by the medication, allopurinol. See also August 2013 private treatment record. While the evidence of record does not establish the exact date of the Veteran's gout diagnosis, the evidence is clear that his gout was not diagnosed within one year of active service. Although the Veteran reports a diagnosis in 1990, treatment records from the Veteran's Air National Guard service do not support this contention. Moreover, the Veteran's testimony that his symptoms and condition manifested in service are inconsistent with his other statements of record. Of note, he did not include gout in his disclosed medical conditions in his medical history despite endorsing other conditions. In this regard, the Board affords more probative weight to the objective treatment records and the Veteran's report of medical history made outside the context of a VA claim. Further, to the extent the Veteran asserts that any symptoms were manifestations of gout, he is not competent to do so as the Veteran has not demonstrated the necessary medical expertise. The issue is medically complex, as the symptoms of joint pain is not exclusive to gout and requires specialized medical and diagnostic testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Moreover, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran's gout and any in-service injury, event or disease, including herbicide agent exposure. As previously noted, the evidence does not support that exposure to herbicide agents, including Agent Orange, occurred during service. As such, service connection on the basis that gout is related to in-service herbicide agent exposure is not warranted. There is no competent or probative evidence to support a nexus to service otherwise. In sum, service treatment records and the clinical evidence does not suggest a causal nexus as they are silent for complaints, diagnosis, or treatment for gout until many years after active service. As noted, the Veteran is not competent to render such an etiological determination. Moreover, his lay statements, alone, are not sufficient to trigger VA's duty to assist in substantiating the claim by providing a medical examination or opinion. McLendon v. Nicholson, 20 Vet. App. 79 (2006). 3. Service connection for peripheral neuropathy of the upper extremities is denied. 4. Service connection for peripheral neuropathy of the lower extremities is denied. The Veteran seeks service connection for peripheral neuropathy of the lower and upper extremities. See June 2015 VA Form 21-4138. At the August 2019 Board hearing, the Veteran testified that he began to have tingling in his arms and toes in the 1990s. The Veteran also testified that his symptoms include swelling of the lower extremities. Conversely, in September 2013 VA 21-526, the Veteran asserted that the conditions had onset in 2009. The initial question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of peripheral neuropathy of the lower or upper extremities, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). VA treatment records do not contain a diagnosis of peripheral neuropathy of the lower or upper extremities. In the June 2019 VA problem list, the Veteran's assessment includes numerous conditions such as hypertension, diabetes mellitus, chronic kidney disease, hematuria, dyslipidemia, gout, calculus of the kidney and benign melanocytic nevi. See also January 2015 VA primary care note. It does not include peripheral neuropathy. In addition, the report of prior medical history does not include peripheral neuropathy or similar conditions. This is consistent with other VA treatment records. Furthermore, the private treatment records do not contain evidence of a diagnosis of peripheral neuropathy. See e.g. August 2013 private treatment record. A diagnosis of peripheral neuropathy is absent from both the historical problems list described by the Veteran and assessments made by the clinician. While the Veteran reported musculoskeletal joint swelling and weakness, and disturbance of gait in an August 2014 private treatment record, the clinician did not include peripheral neuropathy in the assessments rendered. Ultimately, treatment records do not contain a diagnosis of peripheral neuropathy. The private and VA clinicians who evaluated the Veteran have the training, education, and experience necessary to evaluate the claimed peripheral neuropathy. Furthermore, the assessments and diagnosis appear to be based on the Veteran's lay statements and a review of the Veteran's medical history. Consequently, the Board gives probative weight to these findings. To the extent that the Veteran asserts that he has a current diagnosis of peripheral neuropathy of the lower or upper extremities, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires knowledge of nervous system and is often diagnosed using complicated diagnostic testing such as nerve conduction studies, electromyography, or physical tests to evaluate weakness or sensation of the extremities involved. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Veteran has not been shown to have the necessary background to provide a competent opinion on the matter. Consequently, the Board gives more probative weight to the competent medical evidence. Lastly, the Board has considered the Court's holding in Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. In this case, the Veteran has not asserted that he suffers any functional impairment of earning capacity due to symptoms of his claimed peripheral neuropathy. The evidence does not otherwise show a functional impairment in earning capacity. Accordingly, the preponderance of the evidence weighs against finding that a current disability of peripheral neuropathy existed during or approximate to this claim. As such, the benefit of the doubt doctrine does not apply, and service connection is not warranted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 5. Service connection for a skin condition, including seborrheic keratosis is denied. The Veteran seeks service connection for a skin condition. At the August 2019 Board hearing, the Veteran testified that his skin condition had onset during his first period of active service when he returned from Korea. Upon questioning, the Veteran indicated that the lesions did not resolve, have since spread, and worsened. See also October 2020 correspondence. The Veteran also contends that the skin condition is due to herbicide agent exposure. See June 2015 VA Form 21-4138. Initially, the Board notes that the Veteran was treated for a rash in March 1971 service treatment records. The clinician observed small lumps on the right groin with scaly rash. The clinical impression was of regional lympadermitis. However, the remaining service treatment records are silent for residuals of this condition or any other skin complaints, diagnosis or treatment. In the June 1979 periodic examination, the Veteran was not shown to have a skin condition other than pseudofolliculitis barbae. See also June 1978 private treatment records (for left flank pain where skin examination showed no active lesions). In the June 1979 report of medical history, the Veteran checked no to having had or currently having skin diseases. A similar absence of symptoms, diagnosis or treatment for seborrheic keratosis was evident in examination in August 1982 and July 1986. In the August 1990 enlistment examination upon entrance to his second period of active service, the Veteran's skin disorder was not noted. In the accompanying August 1990 periodic physical, the Veteran was noted to be qualified for worldwide duty. Likewise, he denied having a skin disease in the August 1990 report of medical history. Post-service, the Veteran was first seen for black papules to the trunk and scalp in May 2014. At a dermatological consultation in July 2014, the Veteran reported that the dark papules had been present for years. The diagnosis was seborrheic keratoses. In an October 2020 VA examination for skin diseases, the examiner noted a diagnosis of seborrheic keratosis. The Veteran reported noticing black papules on his neck and chest around 1973 with gradual spread and eventual diagnosis in 2014. In the October 2020 medical opinion, the VA examiner negatively opined as to whether the Veteran's seborrheic keratosis was related to service. The examiner noted that the medical literature on this condition reveals multiple risk factors, albeit with inconsistent evidence, such as genetic predisposition, cumulative UV radiation exposure, and human papillomavirus (HPV) infection. While the Veteran was treated for a rash in service, the examiner did not indicate a relationship between that acute rash and the Veteran's diagnosis of seborrheic dermatitis many decades later. Ultimately, there is no clear evidence that the Veteran's current diagnosis is related to service. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There are no competent opinions to the contrary. While the Veteran is competent to report having experienced symptoms since service, he is not competent to determine that these symptoms were manifestations of his current diagnosis or provide an etiological opinion. The issue is medically complex, as it requires knowledge of the pathology of skin diseases. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Further, the Veteran's statements are inconsistent with the clinical evaluations after his initial period of active service, which are silent for such skin disorders. These evaluations included examination of the Veteran's skin, and at time noted other skin diseases or marks. In addition, the Veteran provided inconsistent statements in the June 1979 and August 1990 report of medical history where he denied skin disease. Given those circumstances, the affirmative contemporaneous treatment records are weighed against the probative value of the Veteran's statements that seborrheic keratosis lesions existed at the time of his service in Korea and since then. See Kahana v. Shinseki, 24 Vet. App. 428, 440 (2011). Although the Veteran related the condition to his in-service herbicide agent exposure, the Board has found that the evidence does not support that exposure to herbicide agents. Thus, service connection on the basis is not warranted. In sum, the evidence shows a current diagnosis of seborrheic keratosis. However, the preponderance of the evidence weighs against a nexus between the Veteran's disability and active military service. Accordingly, the benefit of the doubt doctrine does not apply. Service connection is not warranted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 6. Service connection for hypertension is denied. The Veteran seeks service connection for hypertension, to include as due to herbicide agent exposure. See June 2015 VA Form 21-4138. In support of this claim, the Veteran has asserted that his hypertension had onset in the 1980's. See September 2013 VA 21-526 (asserting that hypertension had onset in 1988). At the August 2019 Board hearing, the Veteran testified that he was first told he had high blood pressure and began medication when he was joining the Air Guard/Reserves. In an October 2020 correspondence, the Veteran reported that he began medication for hypertension prior to activation for Desert Storm/ Shield from August 1990 to April 1991. For VA rating purposes, the term "hypertension" means that the diastolic blood pressure is predominantly 90 mm Hg or greater. The term "isolated systolic hypertension" means that the systolic blood pressure is predominantly 160 mm Hg or greater with a diastolic blood pressure of less than 90 mm Hg. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). For VA purposes, hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. By way of history, the Veteran served on active duty between September 1970 to September 1972, and from August 1990 to April 1991. The Veteran also served from 1980 until 2001 with the Air National Guard. During the Veteran's periods of active duty, the service treatment records revealed no complaints, diagnosis, or treatment regarding hypertension. In two separate April 1971 service treatment records, the Veteran was noted to have blood pressure readings of 126/84 and 132/74. In the August 1990 enlistment examination for his second period of active service, a current diagnosis of hypertension was not noted. The accompanying physical evaluation found him qualified for worldwide service. In the August 1990 report of medical history, the Veteran checked "no" to having had high or low blood pressure. At a follow up August 1990 evaluation due to abnormal readings on an EKG, the Veteran blood pressure reading was 130/88 with no history of heart disease or hypertension. In February 1991, the Veteran had a blood pressure reading of 136/75 and he denied taking any current medication. In treatment records related to his service in the Air National Guard, the Veteran was noted to be taking blood pressure medication in August 1992. In October 1992, his blood pressure reding was 120/90. In the June 1995 report of medical history, the Veteran endorsed having had high or low blood pressure. In June 2000, the Veteran reported that he had began blood pressure medication since his last physical in 1995. In an August 2014 VA examination for hypertension, the examiner negatively opined as to whether the Veteran's hypertension was due to or caused by military service. In doing so, the examiner found that the Veteran's hypertension arose between his two periods of active duty. The Board previously noted that this finding was based on the Veteran's unsubstantiated report of onset. Pursuant to the Board's remand, the Veteran was afforded another VA examination in May 2020. The examiner noted a diagnosis of hypertension in August 1992. The Veteran reported onset in the 1990s, with the approximate date of diagnosis in August 1992. He also reported that he was prescribed medication (nifedipine) in the 1990s. In the May 2020 opinion, the examiner noted that there is no objective evidence of record for a diagnosis of hypertension during active service. Further, it did not manifest within one year after discharge from active service. There was no chronicity of care until August 1992 and a nexus has not been established. Although the examiner indicated that the condition clearly and unmistakably existed prior to service and was clearly and unmistakably not aggravated by service, the examiner also noted that there is no evidence of a preexisting diagnosis of hypertension. Based upon the above evidence, the Board finds that service connection is not warranted. Initially, the Board notes that hypertension was not shown during service. Service treatment records are silent for complaints, diagnosis or treatment related to hypertension. Further, it did manifest to a compensable degree within one year of service. At earliest, the Veteran was noted to be on medication for hypertension in August 1992. This is also the date of diagnosis noted by the May 2020 VA examiner. Although the Board is aware that a reasonable presumption arises that the Veteran was on this medication prior to the August 1992 treatment record, there is no evidence indicating that it arose within one year after his last period of active service ended in April 1991. Further, the Veteran was also shown to have a blood pressure reading of 120/90. Diagnostic Code 7101 provided that for hypertensive vascular disease, a 10 percent rating required diastolic pressure predominantly 100 or more, or continuous medication with a history of diastolic blood pressure predominantly 100 or more. 38 C.F.R. § 4.104, Diagnostic Code 7101 (1997). Neither is shown in this case. Ultimately, the presumption of service connection based on 38 C.F.R. § 3.307 is not for application. The Board now turns to whether hypertension is related to an in-service injury or disease. Given the Board's finding above that the Veteran was not exposed to herbicide agents in service, service connection based on herbicide agent exposure may not be granted. The Board must now consider whether direct service connection is warranted under another theory of entitlement. On this matter, the May 2020 VA opinion indicates that there is no etiological link between service and the Veteran's current hypertension. This is consistent with May 2014 private treatment records which note that the Veteran has numerous non-service related risk factors for hypertension, including his race, family history, other comorbidities, gender and age. The Board finds the May 2020 VA opinion to be probative as the examiner the appropriate training, expertise and knowledge to evaluate the claimed disability. The examiner provided a clear rationale, which included consideration of the Veteran's reported symptoms, and the clinical history. To the extent the Veteran asserts that his hypertension manifested within one year of active service or is otherwise related to service, the Veteran has been inconsistent and unreliable in his timeline of the condition. Of note, he has reported multiple, different dates for the onset for his condition. In the September 2013 VA 21-526, the Veteran reported that his hypertension had onset in 1988. The Veteran also reported that hypertension had onset prior to August 1990, and activation in Desert Storm/Shield in an October 2020 correspondence. The Veteran also reported onset in 2005 and 2009 in May 2014 and August 2014 private treatment records. While the Veteran is competent to report what he observes with his own senses, to include contemporaneous diagnosis, his reports are largely not credible due to internal inconsistency and inconsistency with other evidence in the record. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Further, the Veteran is not competent to opine on the etiology of his hypertension to active service. He possesses neither the medical training nor expertise to comment on the etiology of hypertension as it relates to any circumstance of his active service. See Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007). Rather, this is a complex medical question beyond simple observations and requires knowledge of multiple organ systems. See Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010). Accordingly, the Veteran's lay opinion on the complex medical question of whether there is a causal relationship between his hypertension and service is not probative. To the extent the Veteran contends that hypertension manifested to a compensable degree while the Veteran was still enlisted in the Air National Guard, there is no showing that the condition either began during or was otherwise caused by a period of active duty or ACDUTRA. See 38 U.S.C. § 101 (24). Moreover, there is no showing that the condition worsened beyond its natural progression during any period of training and that the worsening was caused by any training. Smith v. Shinseki, 24 Vet. App. 40, 48 (2010). Ultimately, the competent evidence does not show that hypertension began during active service or manifested to a compensable degree within a year of discharge from active service. The evidence also fails to show that the Veteran's hypertension is etiologically related to service, to include by exposure to herbicide agents. As the preponderance of evidence weighs against the claim, there is no reasonable doubt to be resolved. Service connection for hypertension is not warranted. See 38 U.S.C. § 5107 (b). 7. Service connection for erectile dysfunction is denied. The Veteran seeks service connection for erectile dysfunction as secondary to diabetes mellitus or hypertension. See August 2019 Board hearing. In addition, the Veteran asserts that his erectile dysfunction is due to herbicide agent exposure. See June 2015 VA Form 21-4138. As previously noted, the evidence does not support that exposure to herbicide agents on a facts-found or presumptive basis. Therefore, service connection on the basis of in-service herbicide agent exposure is not warranted. The Veteran has not offered another theory by which his erectile dysfunction would be directly related to service. Of note, the Veteran has not asserted, and the competent evidence does not show that this disability had onset in service. In fact, the Veteran testified that the disability manifested in the 1980s, between his two periods of active service. In addition, his former spouse indicated that the Veteran's symptoms had onset after his diagnosis of diabetes mellitus. See April 2014 correspondence. As there is no competent evidence to otherwise show that the disability had onset in service or are otherwise attributable to active service, service connection on a direct basis is not warranted. Finally, entitlement to secondary service connection is not warranted. The Veteran asserts that his erectile dysfunction is secondary to his diabetes mellitus or hypertension. Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. However, the Board has presently denied the Veteran's claim for service connection for diabetes mellitus and hypertension. As such, there is no basis for service connection secondary to diabetes mellitus or hypertension, a nonservice-connected disability, as a matter of law. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). 8. SMC based on loss of use of a creative organ is denied. SMC is provided under 38 U.S.C. § 1114 (k) if a veteran, as a result of service-connected disability, has suffered the anatomical loss or loss of use of one or more creative organs. Because service connection for erectile dysfunction is denied, SMC for loss of use of a creative organ is not warranted, and the appeal is denied. See U.S.C. § 1114(k); 38 C.F.R. § 3.350 (a). D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Vuong, 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.