Citation Nr: 21032386 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 14-01 398 DATE: May 26, 2021 ORDER Entitlement to service connection for diabetes mellitus, to include as a result of exposure to ionizing radiation in service, is denied. Entitlement to service connection for bilateral hearing loss disability is denied. Entitlement to service connection for tinnitus is denied. Entitlement to service connection for residuals of a cold injury of the left shoulder is denied. Entitlement to service connection for residuals of a cold injury of the right shoulder is denied. Entitlement to service connection for residuals of a cold injury of the left elbow is denied. Entitlement to service connection for residuals of a cold injury of the right elbow is denied. Entitlement to service connection for residuals of a cold injury of the left hip is denied. Entitlement to service connection for residuals of a cold injury of the right hip is denied. Entitlement to service connection for residuals of a cold injury of the lumbar spine is denied. Entitlement to service connection for residuals of a cold injury of the left knee is denied. Entitlement to service connection for residuals of a cold injury of the right knee is denied. Entitlement to service connection for residuals of a cold injury of the left ankle is denied. Entitlement to service connection for residuals of a cold injury of the right ankle is denied. Entitlement to service connection for vertigo is denied. Entitlement to service connection for chronic obstructive airway disease is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for a gall bladder disability, to include as a result of exposure to ionizing radiation in service, is denied. Entitlement to service connection for kidney disease, to include as a result of exposure to ionizing radiation in service, is denied. Entitlement to service connection for peripheral neuropathy, claimed as secondary to diabetes mellitus, is denied. REMANDED Entitlement to service connection for a psychiatric disability, claimed as posttraumatic stress disorder (PTSD), is remanded. FINDINGS OF FACT 1. Diabetes mellitus did not onset as a result of incident or event of his period of service, to include any exposure to ionizing radiation. 2. Tinnitus did not onset due to acoustic trauma sustained during a period of service. 3. Bilateral hearing loss disability did not onset due to acoustic trauma sustained during a period of service. 4. A left shoulder disability is not attributable to disease or cold injury sustained during his period of service. 5. A right shoulder disability is not attributable to disease or cold injury sustained during his period of service. 6. A left elbow disability is not attributable to disease or cold injury sustained during his period of service. 7. A left hip disability is not attributable to disease or cold injury sustained during his period of service. 8. A right elbow disability is not attributable to disease or cold injury sustained during his period of service. 9. A lumbar spine disability is not attributable to disease or cold injury sustained during his period of service. 10. A right hip disability is not attributable to disease or cold injury sustained during his period of service. 11. A left knee disability is not attributable to disease or cold injury sustained during his period of service. 12. A right knee disability is not attributable to disease or cold injury sustained during his period of service. 13. A left ankle disability is not attributable to disease or cold injury sustained during his period of service. 14. A right ankle disability is not attributable to disease or cold injury sustained during his period of service. 15. Vertigo did not have onset due to injury sustained during a period of service. 16. The Veteran has not presented evidence of a current chronic obstructive airway disease. 17. Hypertension is not shown to have onset during service or within a year of his discharge. 18. The Veteran has not presented evidence of a current gall bladder disability. 19. The Veteran has not presented evidence of a current kidney disease. 20. Peripheral neuropathy was not caused or aggravated by a service-connected disability and is not related to service or any incident of service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.311. 2. The criteria for entitlement to service connection for tinnitus have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for a bilateral hearing loss disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.385. 4. The criteria for entitlement to service connection for residuals of a cold injury to the left shoulder have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for entitlement to service connection for residuals of a cold injury to the right shoulder have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for entitlement to service connection for residuals of a cold injury to the left elbow have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for entitlement to service connection for residuals of a cold injury to the left hip have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for entitlement to service connection for residuals of a cold injury to the right elbow have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for entitlement to service connection for residuals of a cold injury to the lumbar spine have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303. 10. The criteria for entitlement to service connection for residuals of a cold injury to the right hip have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303. 11. The criteria for entitlement to service connection for residuals of a cold injury to the left knee have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303. 12. The criteria for entitlement to service connection for residuals of a cold injury to the right knee have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303. 13. The criteria for entitlement to service connection for residuals of a cold injury to the left ankle have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303. 14. The criteria for entitlement to service connection for residuals of a cold injury to the right ankle have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303. 15. The criteria for entitlement to service connection for vertigo have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303. 16. The criteria for entitlement to service connection for chronic obstructive airway disease have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303. 17. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 18. The criteria for entitlement to service connection for a gall bladder disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.311. 19. The criteria for entitlement to service connection for kidney disease have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.311. 20. The criteria for entitlement to service connection for peripheral neuropathy have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1969 to November 1972. These matters came before the Board of Veterans' Appeals (Board) on appeal from a September 2012 rating decision issued by Agency of Original Jurisdiction. The Veteran testified at a hearing before the undersigned in July 2014. A transcript of the hearing is of record. In January 2018, the Board remanded these issues on appeal for development. Specifically, the Board requested any outstanding private and VA treatment records be obtained; attempts be made to obtain records associated with a Social Security Administration (SSA) disability benefits application and decision; attempts be made to verify the Veteran's claimed exposure to ionizing radiation during service; the Veteran be scheduled for a VA examination to evaluate the nature and etiology of his claimed residuals of cold injury disabilities; an addendum opinion be obtained as to the etiology of bilateral hearing loss, tinnitus, and vertigo; and an addendum opinion be obtained as to etiology of a psychiatric disability. In September 2019, SSA reported it had no medical records related to the Veteran. The RO attempted to verify the Veteran's claim of exposure to ionizing radiation during service. After several unsuccessful attempts, in November 2020, the RO notified the Veteran that records could not be located and were therefore unavailable for review. In September 2019 and February 2020, VA examiners offered opinions as to the etiology of the claimed residuals of cold injury, hearing loss, tinnitus, vertigo, and psychiatric disabilities. The requested development has been completed and the case has been returned to the Board for appellate disposition. Service Connection Service connection will be established if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of incurrence or aggravation of a disease or injury in service; and (3) evidence of a relationship between the claimed disease or injury in service and the present disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir.2004); Caluza v. Brown, 7 Vet. App. 498 (1995); 38 C.F.R. § 3.303. In addition, for Veterans who have served 90 days or more of active service during a period of war or after December 31, 1946, certain chronic disabilities, including diabetes mellitus, hypertension, peripheral neuropathy, tinnitus, cardiovascular-renal disease, psychoses, arthritis, and sensorineural hearing loss are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. §§ 3.303 (b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Diabetes mellitus, hypertension, peripheral neuropathy, tinnitus, cardiovascular-renal disease, psychoses, arthritis, and sensorineural hearing loss are chronic diseases and presumptive service connection must be considered. 38 U.S.C. § 1101; 38 C.F.R. § 3.303(b). Additionally, if a veteran participated in a radiation risk activity while serving on active duty or while a member of a reserve component of the Armed Forces during a period of active duty for training or inactive duty training and has contracted an enumerated disease, the veteran is entitled to a presumption of service connection even though there is no record of such disease during service. 38 U.S.C. § 1112; 38 C.F.R. § 3.309 (d). The enumerated diseases are leukemia; cancer of the thyroid; cancer of the breast; cancer of the pharynx; cancer of the esophagus; cancer of the stomach; cancer of the small intestines; cancer of the pancreas; multiple myeloma; lymphomas; cancer of the bile ducts; cancer of the gall bladder; primary liver cancer; cancer of the salivary gland; cancer of the urinary tract; bronchiolo-alveolar carcinoma; cancer of the bone; cancer of the brain; cancer of the colon; cancer of the lung; and cancer of the ovary. 38 U.S.C. § 1112(c)(2); 38 C.F.R. § 3.309(d). Regulations also provide that service connection may be established for any disease diagnosed after separation from service, when all evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). When it is determined that a veteran was exposed to ionizing radiation as a result of participation in the atmospheric testing of nuclear weapons; the occupation of Hiroshima or Nagasaki, Japan, from September 1945 until July 1946; or other activities and the veteran develops a radiogenic disease that first became manifested five years or more after exposure (except for bone cancer (must become manifest within 30 years); leukemia (may become manifest at any time after exposure); and, posterior subcapsular cataracts (must become manifest 6 months or more after exposure)), the claim will be referred to the Under Secretary for Benefits for further consideration. The enumerated radiogenic diseases are all forms of leukemia; thyroid cancer; breast cancer; lung cancer; bone cancer; liver cancer; skin cancer; esophageal cancer; stomach cancer; colon cancer; pancreatic cancer; kidney cancer; urinary bladder cancer; salivary gland cancer; multiple myeloma; posterior subcapsular cataracts; non-malignant thyroid nodular disease; ovarian cancer; parathyroid adenoma; tumors of the brain and central nervous system; cancer of the rectum; lymphomas other than Hodgkin's disease; prostate cancer; and, any other cancer. 38 C.F.R. § 3.311. Service connection is also warranted 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 is also warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(b); Allen v. Brown, 7 Vet. App. 439 (1995). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107(b). 1. Entitlement to service connection for diabetes mellitus The Veteran contends that radiation exposure in service caused diabetes mellitus. He reported that he was a mechanic technician, responsible for repairing and providing technical maintenance of Hercules Nuclear Missiles. He claimed radiation exposure from those duties. The service personnel records confirm that the Veteran was a Hercules Missile Mechanic in C Battery, 4th Battalion, 62nd Artillery. The service medical records contain no complaints of, treatment for, or diagnosis of diabetes mellitus. A December 2009 private treatment record noted that the Veteran had a history of diabetes. A March 2012 VA treatment record shows a diagnosis of diabetes mellitus. The Veteran has not participated in a radiation risk activity and has not contracted an enumerated disease specific to radiation-exposed veterans. Thus, service connection for diabetes mellitus is not warranted on a presumptive basis due to exposure to ionizing radiation. 38 C.F.R. § 3.309(d). There is also no evidence of diabetes mellitus shown in service. To determine that a chronic disease was shown in service, the disease identity must be established. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). No examiner at the time, or since, has established that there was a finding sufficient to establish diabetes mellitus during service. The characteristic manifestations sufficient to identify diabetes mellitus were not noted. Additionally, there is no assertion of continuity of or evidence of diabetes mellitus within one year of separation from service. Thus, service connection cannot be established on a presumptive basis due to diabetes shown within one year following separation from service. 38 U.S.C. § 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. § 3.303(b), 3.307, 3.309. Regardless of whether the Veteran was exposed to ionizing radiation during service, diabetes mellitus is not a radiogenic disease. Although the Veteran has a diagnosis of diabetes mellitus, the preponderance of the competent evidence is against a finding of a relationship between the onset of diabetes mellitus and service, to include any radiation exposure during service. The Veteran was not provided a specific diabetes mellitus examination. However, based on the facts of this case, the Board finds that an examination is not required. VA will provide a medical examination or obtain a medical opinion if the evidence indicates the existence of a current disability or persistent or recurrent symptoms of a disability that may be associated with an event, injury, or disease in service, but the record does not contain sufficient medical evidence to decide the claim. 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the claims do not meet the requirements for obtaining a VA medical opinion. Because the weight of the evidence demonstrates no current radiogenic disease or that diabetes mellitus is due to any event or incident in service, to include any radiation exposure during service, no examination is required. The Veteran is generally competent to report symptoms but as a lay person he is not competent to establish that diabetes mellitus is related to service or any event, injury, or disease during a service, to include any radiation exposure. Lay evidence may be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition (such as when the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer); (2) the layperson is reporting a contemporaneous medical diagnosis; or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Veteran is not competent to offer an opinion as to etiology of the diabetes mellitus. The question regarding the etiology of diabetes mellitus is a complex medical issue that cannot be addressed by a layperson. Therefore, the lay allegations are non-specific and are no more than conjecture and do not constitute competent evidence. The claim of entitlement to service connection for diabetes mellitus must be denied. The preponderance of the evidence is against the claim and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for tinnitus 3. Entitlement to service connection for bilateral hearing loss disability Impaired hearing is considered a disability for VA purposes when the auditory threshold in any of the frequencies of 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; the thresholds for at least three of those frequencies are 26 or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Veteran asserts that noise exposure from small arms fire, grenades, air evacuation systems for nuclear missile buildings, diesel engines, helicopters, and missiles in service caused bilateral hearing loss disability and tinnitus. A February 1969 enlistment examination found that on audiometric testing, the pure tone thresholds, in decibels, were: HERTZ 500 1000 2000 3000 4000 RIGHT 5 0 0 0 5 LEFT 5 0 0 0 10 An October 1972 separation examination found that on audiometric testing, the pure tone thresholds, in decibels, were: HERTZ 500 1000 2000 3000 4000 RIGHT 5 0 0 0 5 LEFT 5 0 0 0 10 Thus, the service medical records show no complaints or findings indicative of hearing loss disability. However, the absence of in-service evidence of hearing loss disability is not fatal to a claim for service connection for hearing loss disability. Ledford v. Derwinski, 3 Vet. App. 87 (1992). Evidence of a current hearing loss disability meeting the requirements of 38 C.F.R. § 3.385 and a medically sound basis for attributing that hearing loss disability to service may serve as a basis to establish service connection for hearing loss. Hensley v. Brown, 5 Vet. App. 155 (1993). An August 2012 VA audiometric examination detected the following pure tone thresholds in decibels: HERTZ 500 1000 2000 3000 4000 RIGHT 20 30 30 40 55 LEFT 20 30 25 45 60 Speech audiometry found speech recognition ability of 96 percent in the right ear and 96 percent in the left ear. Those findings demonstrate bilateral hearing loss disability for VA purposes. The VA examination report also shows a diagnosis of recurrent tinnitus. The audiologist noted the diagnosed hearing loss disability and opined the Veteran's tinnitus was at least as likely as not a symptom associated with the hearing loss as tinnitus was known to be a symptom associated with hearing loss. The audiologist noted that the Veteran had normal bilateral hearing acuity across all frequencies at entrance to service in 1969 with no changes in hearing acuity at separation from service in 1972. The Veteran reported noise exposure from small arms fire, grenades, air evacuation systems for nuclear missile buildings, diesel engines, helicopters, and missile launches, but stated hearing protection devices were used. After service, the Veteran worked as a mill wright in a nuclear power plant and used hearing protection devices. Recreationally, he used chain saws and various other wood working saws with hearing protection devices. The audiologist opined that it was less than likely that the Veteran's hearing loss and tinnitus were created or aggravated by hazardous service noise exposure. The audiologist reiterated that there were no changes in hearing acuity during service. In the January 2018 remand, the Board requested the RO to schedule the Veteran for a VA examination to evaluate the etiology of hearing loss and tinnitus. Specifically, the Board requested that the examiner must comment on the impact on the opinion of the line of research conducted by Dr. Sharon G. Kujawa. A February 2020 VA audiometric examination found the following pure tone thresholds in decibels: HERTZ 500 1000 2000 3000 4000 RIGHT 35 45 55 65 80 LEFT 35 45 60 70 90 Speech audiometry found speech recognition ability of 90 percent in the right ear and 88 percent in the left ear. Those findings demonstrate bilateral hearing loss disability for VA purposes. The VA examination report also documents a diagnosis of recurrent tinnitus. The Veteran reported that the tinnitus manifested approximately 50 years earlier after he left service. The Veteran could not recall any specific precipitating factors. He reported that tinnitus was constant. The otolaryngologist opined that the bilateral hearing loss disability was not at least as likely as not caused by or a result of an event in service. The otolaryngologist explained that on entrance and separation examinations, respectively, audiometric testing to 4000 Hertz was normal bilaterally. The otolaryngologist noted that after service the Veteran worked in noise-related jobs from approximately 1972 to 2000. The otolaryngologist concluded that any determination as to the basis for hearing loss to a 50 percent probability would not be accurate. Accordingly, the otolaryngologist concluded the bilateral hearing loss disability was less likely than not related to service. As to the tinnitus, the otolaryngologist opined that the tinnitus was less likely than not caused by or a result of service noise exposure. The otolaryngologist explained that there was no objective documentation to support the claim that the Veteran's tinnitus was related to service. Subjectively, the Veteran reported that he began experiencing difficulty with tinnitus and hearing loss within three to four months of separation from service. However, the otolaryngologist explained that when coupled with a long history of civilian work-related noise exposure, the determination that tinnitus was due to noise exposure in service was less likely than not. The otolaryngologist reported that consideration of the line of research conducted by Dr. Sharon G. Kujawa did not help clarify the etiology but rather provided a "possible basis." Although the Veteran has current diagnoses of bilateral sensorineural hearing loss and tinnitus, the Board finds that the preponderance of the evidence is against a finding of a relationship between those disabilities and service. Rather, the evidence shows that it is less likely than not that current bilateral hearing loss disability and tinnitus are etiologically related to acoustic trauma in service. Also, those disabilities are first document many years after service. The audiologist in August 2012 explained that that the Veteran had normal bilateral hearing acuity across all frequencies at entrance to service in 1969 with no changes in hearing acuity on separation from service in 1972. Noting the use of hearing protection devices, the audiologist opined that it was less than likely that the Veteran's hearing loss and tinnitus were created or aggravated by hazardous service noise exposure. The otolaryngologist in February 2020 explained that the Veteran worked in noise-related jobs from approximately 1972 to 2000 and concluded that any determination as to the basis for hearing loss and tinnitus to a 50 percent probability would not be accurate. The otolaryngologist reported that consideration of the line of research conducted by Dr. Sharon G. Kujawa did not help clarify the etiology but rather provided a "possible basis." Accordingly, to the extent that the line of research conducted by Dr. Sharon G. Kujawa can be viewed as positive evidence supporting the Veteran's claim, they are speculative at best and conjectural or speculative opinions which suggest no more than some remote possibility of an etiological relationship are insufficient to support a grant of service connection. 38 C.F.R. § 3.102; Stegman v. Derwinski, 3 Vet. App. 228 (1992); Tirpak v. Derwinski, 2 Vet. App. 609 (1992) (medical evidence which merely indicates that the alleged disability "may or may not" exist or "may or may not" be related, is too speculative to establish the presence of the claimed disorder or any such relationship). There is no competent or credible evidence or opinion that suggests that there is a medical relationship, or nexus, between any current hearing loss disability and tinnitus and service. The Veteran has not submitted any competent medical evidence which supports the claim. Additionally, there is no evidence of sensorineural hearing loss disability in service. To determine that a chronic disease was shown in service, the disease identity must be established. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). No examiner in service, or since, has established chronicity or an underlying chronic disease process in service. In sum, characteristic manifestations sufficient to identify the disease (other organic disease of the nervous system) entity were not noted. Further, there is no demonstration of continuity of symptomatology or evidence of sensorineural hearing loss disability within one year of separation from service. Thus, service connection cannot be awarded on a presumptive basis. 38 U.S.C. § 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. § 3.303(b), 3.307, 3.309. The Veteran is competent to state that he sustained acoustic trauma in service. However, he is a lay person and is not competent to establish that current bilateral hearing loss disability and tinnitus onset as a result of any in-service-acoustic trauma. The Veteran is not competent to offer opinion as to etiology of any current bilateral hearing loss disability or tinnitus. The question regarding the etiology of those disabilities is a complex medical issue that cannot to be addressed by a layperson. For these reasons, his allegations are non-specific and are no more than conjecture and do not constitute competent evidence. To the extent that the Veteran alleges a continuity of symptomatology, the Board finds that is less likely as the evidence does not document any symptoms or complaints of tinnitus or hearing loss for many years following separation from service. The claims of entitlement to service connection for bilateral hearing loss disability and tinnitus must be denied. The Board finds that the preponderance of the evidence is against the claims and the claims must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to service connection for residuals of a cold injury of the bilateral shoulders, bilateral elbows, bilateral hips, bilateral knees, bilateral ankles, and lumbar spine The Veteran contends that he has current left shoulder, right shoulder, left elbow, right elbow, lumbar spine, left hip, right hip, right knee, left knee, left ankle, and right ankle disabilities that are related to cold weather injuries incurred in service. He reports that while stationed in Germany, he was exposed to extreme cold temperatures while performing duties of repairing and providing technical maintenance for Hercules Nuclear Missiles. The service personnel records confirm that the Veteran was a Hercules Missile Mechanic in C Battery, 4th Battalion, 62nd Artillery and that he had foreign service in Germany. The service medical records contain no complaints of, treatment for or diagnoses of left shoulder, right shoulder, left elbow, right elbow, lumbar spine, left hip, right hip, right knee, left knee, left ankle, and right ankle disabilities. After service, a November 2006 VA treatment record notes that the Veteran's left knee was still painful. A July 2010 private treatment record shows the Veteran was involved in a motor vehicle accident (MVA) and sustained low back and cervical spine injuries. The findings of a July 2010 lumbar spine MRI showed degenerative disc disease (DDD), most pronounced at L4-L5. An August 2010 VA treatment record shows that the Veteran was involved in a motor vehicle accident and experienced an exacerbation of low back pain. He described the pain as a constant pain with radiation down the right leg through the buttock to the knee. A September 2012 private x-ray report shows that the Veteran was being evaluated for severe right hip pain after a fall. Findings of the right hip showed osteoarthritis. A September 2012 private MRI of the right hip found two cortical defects in the right femoral head with a moderate amount of edema and inflammation extending through the femoral head into the neck. The defects were nonspecific, but may have been related to arthritis and chondromalacia. An October 2012 private treatment record found that the Veteran sustained injury when he got caught between a utility trailer and had worsening, severe pain in the groin and over the sacroiliac joint. The Veteran underwent right total hip arthroplasty (THA) in January 2013. The findings of an October 2012 lumbar spine MRI showed very mild degenerative change of the lumbar spine. A November 2013 VA treatment record shows that the Veteran had lumbar pain with palpation with radiation into the right leg lateral to the knee or groin to knee when ascending and descending stairs. May and June 2017 VA treatment records document the Veteran's complaint of burning low back pain with radiation to the buttock and down to the posterior knees with ambulation. A September 2019 lumbar spine x-ray found grade I anterior spondylolisthesis of L3 on L4 without an obvious pars defect and mild diffuse degenerative disc changes of the lower thoracic and lumbar spine. September 2019 bilateral knee x-ray findings were negative. September 2019 bilateral shoulder x-ray findings showed moderate left and mild to moderate right sided osteoarthritic changes of the glenohumeral joints. September 2019 bilateral elbow x-ray findings showed large left and tiny right sided olecranon spurs. September 2019 bilateral hip x-ray findings showed status post right THA, and an otherwise negative bilateral hip examination. September 2019 bilateral ankle x-ray findings showed possible intra-articular loose bodies involving the right tibiotalar joint. A September 2019 VA cold injury residuals examination diagnosed cold injury of the right and left foot, and cold injury of the right and left hand. The Veteran reported that he experienced a cold injury in 1972 while he was stationed in Germany during service. The Veteran reported that he experienced constant pain, loss of motion, and stiffness. He did not receive any treatment for a cold injury during service. He complained that he continued to experience constant pain with loss of motion in the joints. He reported that he had not received any treatment for cold injury residuals since separation from service. The physician reviewed the evidence of record, considered the Veteran's report of sustaining a cold injury in service and acknowledged the Veteran's report that he continued to experience constant pain with loss of motion in the joints. The physician noted that the Veteran had not received any treatment for residuals of a cold injury since separation from service. The examiner explained that on current examination, the Veteran exhibited bilateral shoulder, bilateral elbow, bilateral hip, bilateral knee, bilateral ankle, and lumbar spine pain and tenderness and documented the x-ray and MRI findings. The physician was unable to find evidence of any cold injury condition being diagnosed and therefore was unable to make a diagnosis of any cold injury of the left shoulder, right shoulder, left elbow, right elbow, lumbar spine, left hip, right hip, right knee, left knee, left ankle, or right ankle. The physician opined that current left shoulder, right shoulder, left elbow, right elbow, lumbar spine, left hip, right hip, right knee, left knee, left ankle, and right ankle disabilities were less likely than not incurred in and or caused by exposure to cold in Germany during service. Though the Veteran has current left shoulder, right shoulder, left elbow, right elbow, lumbar spine, left hip, right hip, right knee, left knee, left ankle, and right ankle disabilities, the Board finds that the preponderance of the evidence is against a finding of any relationship between the onset of the disabilities and a period of service. Rather, the preponderance of the evidence is against a finding that any current left shoulder, right shoulder, left elbow, right elbow, lumbar spine, left hip, right hip, right knee, left knee, left ankle, and right ankle disabilities are related to service, or any incident of service, to include a cold injury in service in Germany. A July 2010 private treatment record suggests that the Veteran's lumbar spine disability manifested after a motor vehicle accident after service. September and October 2012 private treatment records suggest that a right hip disability manifested after a trailer accident after service. The Veteran is competent to state that he sustained a cold injury in service, and service connection has been established for cold injury residuals of the feet and hands. However, he is a lay person and is not competent to provide a competent opinion that any current left shoulder, right shoulder, left elbow, right elbow, lumbar spine, left hip, right hip, right knee, left knee, left ankle, or right ankle disabilities are the result of a cold injury in service. The Veteran is not competent to offer opinion as to etiology of any current left shoulder, right shoulder, left elbow, right elbow, lumbar spine, left hip, right hip, right knee, left knee, left ankle, and right ankle disabilities. The question regarding the etiology of those disabilities is a complex medical issue that cannot to be addressed by a layperson. Therefore, his allegations are non-specific and do not constitute competent evidence. The Veteran has not submitted any competent medical evidence relating any shoulder, elbow, hip, knee, ankle, or lumbar spine disabilities to service or any incident of service. The Board finds that the preponderance of the evidence is against the claims of entitlement to service connection left shoulder, right shoulder, left elbow, right elbow, lumbar spine, left hip, right hip, right knee, left knee, left ankle, and right ankle disabilities, and the claims must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 5. Entitlement to service connection for vertigo The Veteran asserts that he sustained trauma to the head during service that led to the onset of current vertigo. He reported that he was the victim of an unprovoked attack while walking down the street. As a result of the attack, he reported that he sustained a concussion, hematoma with blunt trauma to the head, and loss of cognitive function due to blunt trauma to the head. A September 1969 service medical record shows that the Veteran hit his head on the end of an upper bunk in the barracks causing a superficial laceration on the right side of the forehead. He received three sutures to close the laceration. A subsequent September 1969 service medical record shows that the sutures were removed, and the laceration was healing well. A June 1970 service medical record shows the Veteran was hit in the mouth by a beer bottle thrown from a passing car. A December 2009 private treatment record notes the Veteran's vertigo had its onset in approximately 1999. The Veteran reported that he did not know what caused his vertigo. A February 2020 VA ear conditions examination diagnosed peripheral vestibular disorder. The Veteran reported that the problems with spinning dizziness began around Halloween in 1999 while he was driving from Idaho to Washington. He pulled over to the side of the road and began experiencing severe nausea and vomiting. He began to drive again after approximately two hours. Over the next two weeks he experienced several more episodes. He received treatment at a private facility and the ear nose and throat (ENT) physician opined that the right ear was not functioning properly and was creating the imbalance. An ENT physician referred him to a physician that specialized in imbalance problems. The Veteran reported that he continued to experience a vague state of imbalance and spinning episodes with infrequent vomiting. Noting that the Veteran sustained a blow to the head during service in 1970, but that the vertigo manifested suddenly 27 years later, the otolaryngologist opined that it was less likely than not than not that any current vertigo was related to a blow to the head sustained during service. The otolaryngologist explained that the latency of the vertigo was too substantial and would not warrant a positive opinion. Although the Veteran has a current diagnosis of peripheral vestibular disorder, the Board finds that the preponderance of the evidence is against a finding of a relationship between the onset of the disability and service or any incident of service. The Board finds that the preponderance of the evidence is against a finding that current peripheral vestibular disorder which manifested many years following separation from service is etiologically related to service, or head trauma during service. The otolaryngologist in February 2020 opined that it was less likely than not than not that current vertigo was related to a blow to the head sustained during service, explaining that the latency of the vertigo was too substantial and would not warrant a positive opinion. That opinion that the vertigo was too remote in time to support a causal relationship to any head injury sustained in service years earlier is the most persuasive opinion of record because of the training of the examiner and the examination and file review by the examiner. There is no competent or credible evidence or opinion of record that suggests that there exists a medical relationship, or nexus, between any current vertigo and head injury sustained during a period of the Veteran's service, or any other incident of service. The Veteran has not submitted any competent medical evidence relating any current vertigo to service or any incident of service. The Veteran is competent to state that he sustained head trauma in service, and that is corroborated by the service records. However, he is a lay person and is not competent to establish that current peripheral vestibular disorder is the result of any incident of service, to include a head injury. The Veteran is not competent to offer an opinion as to etiology of any current peripheral vestibular disorder. The question regarding the etiology of vertigo is a complex medical issue that cannot to be addressed by a layperson. Therefore, the Veteran's allegations are non-specific and are no more than conjecture and do not constitute competent evidence. The Board finds that the preponderance of the evidence is against the claim and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 6. Entitlement to service connection for chronic obstructive airway disease The Veteran reported that he was a mechanic technician, responsible for repairing and providing technical maintenance of the Hercules Nuclear Missiles. He claimed he was exposed to chemicals and solvents in the performance of duties that led to the onset of chronic obstructive airway disease. The service personnel records confirm that the Veteran was a Hercules Missile Mechanic in C Battery, 4th Battalion, 62nd Artillery. The service medical records contain no complaints of, treatment for, or diagnosis of chronic obstructive airway disease or any similar respiratory disability. Regardless of whether the Veteran was exposed to chemicals and solvents during his period of service, he has presented no evidence that shows a current chronic obstructive airway disease. Thus, there can be no valid claim for service connection. Gilpin v. West, 155 F.3d 1353 (Fed. Cir.1998); Brammer v. Derwinski, 3 Vet. App. 223 (1992). The Veteran was not provided a VA respiratory conditions examination. However, based on the facts of this case, the Board finds that an examination is not required. VA will provide a medical examination or obtain a medical opinion if the evidence indicates the existence of a current disability or persistent or recurrent symptoms of a disability that may be associated with an event, injury, or disease in service, but the record does not contain sufficient medical evidence to decide the claim. 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the claim does not meet the requirements for obtaining a VA medical opinion. Because the weight of the evidence shows no current chronic airway disease or related respiratory disability, no examination is required. The Veteran is a lay person and is not competent to establish that he has a current airway disease. The Veteran is not competent to diagnose or offer opinion as to etiology of any current airway disease. The question regarding the diagnosis and etiology of respiratory disabilities is a complex medical issue that cannot to be addressed by a layperson. Therefore, the Veteran's allegations are non-specific and are no more than conjecture and do not constitute competent evidence. The Board finds that the preponderance of the evidence is against the claim of entitlement to service connection for chronic airway disease, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 7. Entitlement to service connection for hypertension The Veteran contends that hypertension had its onset during service. A May 1972 service annual examination shows that the Veteran's blood pressure readings were 136/100, 150/104, and 148/98. Recheck blood pressure readings were 128/92, 134/88, and 134/94. The examiner indicated that the Veteran's blood pressure should be re-checked in six weeks. A subsequent May 1972 service medical records shows that the Veteran's blood pressure readings were 138/100, 136/102, 156/96 (right arm), and 130/100 (left arm). A July 1972 service medical record shows that the Veteran's blood pressure readings were 124/86, 124/86, and 124/86. An August 1972 service medical record shows that the Veteran's blood pressure reading was 130/90. An October 1972 separation examination report found that the Veteran's blood pressure readings were 130/84 and 125/80. A March 2012 VA treatment record shows the Veteran's blood pressure reading was 150/90. The assessment was essential hypertension. An August 2012 VA hypertension examination diagnosed hypertension. The Veteran reported that he had some elevated blood pressure readings in service. However, there was no diagnosis or treatment for hypertension during service. Hypertension was initially diagnosed in 1978. The examiner opined that it was less likely than not that the Veteran's hypertension was incurred in or caused by the claimed injury, illness, or event in service. The examiner explained that the Veteran did not have hypertension diagnosed in service and he was not diagnosed or started on medication until 1978. The examiner noted that the Veteran's blood pressure reading at separation was 125/80 and concluded that blood pressure reading was normal. Although the Veteran has current hypertension, the preponderance of the evidence is against a finding of a relationship between the onset of the hypertension and service. The evidence shows that the Veteran had isolated elevated blood pressure readings during service, it was less likely as not that current hypertension had its onset during service, because blood pressure reading at separation were normal. Hypertension was noted to have onset in 1978 in August 2012. That conclusion is probative as it is based on facts presented by both the service medical records and the assertions made by the Veteran at the time of the VA examination. Also, notably, there is no competent or credible evidence or opinion that suggests that there exists a medical relationship, or nexus, between the current hypertension and a period of the Veteran's service. The Board finds that the VA examination opinion is the most persuasive evidence in this case. The Veteran has not submitted any competent medical evidence relating current hypertension to service. Additionally, there is no evidence of a diagnosis of hypertension in service, and after review of the record, the VA examiner did not find that elevated readings in service were indicative of hypertension. To determine that a chronic disease was shown in service, the disease identity must be established. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). No examiner in service, or since, has established chronicity or an underlying chronic disease process in service. Characteristic manifestations sufficient to identify hypertension were not noted. As the service medical records lack the documentation of the combination of manifestations sufficient to identify hypertension and sufficient observation to establish chronicity during service, then a showing of continuity of symptomatology is another way to establish service connection. 38 C.F.R. § 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). However, the Board does not find the Veteran's assertions as to continuity of symptomatology credible. There is no corroborating evidence to support the any claim that the Veteran has experienced hypertension continuously since service. An August 2012 VA hypertension examination noted that the Veteran's hypertension was diagnosed in 1978, though he had some isolated elevated blood pressure readings during service. Thus, the any statements as to continuity of symptomatology since service are not credible and are assigned less probative value. Therefore, service connection for hypertension cannot be awarded on a presumptive basis. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303(b), 3.307, 3.309. The Veteran is competent to state that he had isolated elevated blood pressure readings during service, and that is corroborated by the service records. However, the Veteran is a lay person and is not competent to opine that current hypertension had its onset during or as a result of service. The Veteran is not competent to offer opinion as to etiology of hypertension. The question regarding the etiology of hypertension, and when a diagnosis of hypertension is appropriate, is a complex medical issue that cannot to be addressed by a layperson. Therefore, the Veteran's allegations are non-specific and are no more than conjecture and do not constitute competent evidence. The Board finds that the preponderance of the evidence is against the claim and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 8. Entitlement to service connection for a gall bladder disability 9. Entitlement to service connection for kidney disease The Veteran contends that radiation exposure in service caused claimed gall bladder disability and kidney disease. The Veteran reported that he was a mechanic technician, responsible for repairing and providing technical maintenance of Hercules Nuclear Missiles. He claims radiation exposure from those duties. The service personnel records confirm that the Veteran was a Hercules Missile Mechanic in C Battery, 4th Battalion, 62nd Artillery. The service medical records contain no complaints of, treatment for, or diagnosis of a gall bladder disability or kidney disease. Regardless of whether the Veteran was exposed to ionizing radiation during service, he has presented no evidence that shows a current gall bladder disability or kidney disease. Thus, there can be no valid claim for service connection. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223 (1992). The Veteran was not provided specific VA kidney or gall bladder examinations. However, on the facts of this case, the Board finds that examinations are not required. VA will provide a medical examination or obtain a medical opinion if the evidence indicates the existence of a current disability or persistent or recurrent symptoms of a disability that may be associated with an event, injury, or disease in service, but the record does not contain sufficient medical evidence to decide the claim. 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the claims do not meet these requirements for obtaining a VA medical opinion. Because the weight of the evidence shows no current gall bladder disability or kidney disease, the Board finds that no examinations are required. The Veteran is a lay person and is not competent to establish or opine that he has a current gall bladder disability or kidney disease. The Veteran is not competent to diagnose or offer opinion as to etiology of any current gall bladder disability or kidney disease. The question regarding the diagnosis and etiology of gall bladder and kidney disabilities is a complex medical issue that cannot to be addressed by a layperson. Therefore, the Veteran's allegations are non-specific and are no more than conjecture and do not constitute competent evidence. The Board finds that the preponderance of the evidence is against the claims and the claims must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 10. Entitlement to service connection for peripheral neuropathy The Veteran contends that he has current peripheral neuropathy that onset secondary to his diabetes mellitus. The service medical records contain no documentation of complaints of or treatment for peripheral neuropathy. After service, an April 2019 VA treatment record shows a diagnosis of mild diabetic neuropathy. A June 2019 VA treatment record shows a diagnosis of diabetic neuropathy. As service connection is not established for diabetes mellitus, the claim of service connection for peripheral neuropathy, claimed as secondary to a service-connected disability must be denied. Congress has specifically limited entitlement to service connection for disabilities that are proximately due to or aggravated by service-connected disability. 38 C.F.R. § 3.310. Where service connection has not been established for the claimed primary disability, service connection cannot be established for the claimed secondary disability. The evidence does not show that peripheral neuropathy is related to service or any service-connected disability. The evidence shows that peripheral neuropathy is related to nonservice-connected diabetes mellitus. The Board finds that an examination is not needed because peripheral neuropathy has been attributed to a known causation of a nonservice-connected disability. The Veteran is a lay person and is not competent to establish that current peripheral neuropathy had its onset because of service or a service-connected disability. The Veteran is not competent to offer an opinion as to etiology of any current peripheral neuropathy. The question regarding the etiology of such a disability is a complex medical issue that cannot to be addressed by a layperson. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). The Board finds that the preponderance of the evidence is against the claim and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for a psychiatric disability, claimed as PTSD, is remanded. A claim for service connection for PTSD was received in January 2012. The Veteran reported that an unprovoked attack in service was the cause of PTSD. An August 2012 VA PTSD examination noted that the Veteran's symptoms and found that the symptoms did not meet the diagnostic criteria for PTSD under DSM-IV criteria. Anxiety disorder was diagnosed. The Veteran complained of problems with temper, sleep impairment, anxiety concerns about his grandchildren, and worsening memory and concentration. He reported that his mental health concerns began after separation from service. The psychologist opined that it was less likely than not that anxiety disorder was caused or exacerbated by service stressors. A January 2018 Board remand noted the lack of rationale for the etiology opinion, and found that the August 2012 examination was incomplete for adjudication purposes. The Board concluded that additional opinion to address the nature and etiology of a psychiatric disability was necessary. A September 2019 VA PTSD examination found that the Veteran did not have a diagnosis of PTSD that conformed to the DSM-5 criteria. The psychologist determined that the Veteran did not have a mental disorder that conformed with DSM-5 criteria. The psychologist explained that an opinion for the claim of service connection for a psychiatric disability could not be made because there was no current pathology to support a diagnosis. The psychologist reiterated that the Veteran did not meet the DSM-5 criteria for the diagnosis of any mental health disorder. Therefore, no diagnosis was made and an opinion as to etiology was not offered. The psychologist explained that there were no symptoms of any mental health disorder and concluded that as there was no etiology or rationale for a diagnosis, the diagnosis for anxiety disorder was unfounded. The Board finds that an opinion is needed as to whether anxiety disorder, which was diagnosed during the appeal period, is related to service. Remand is required to provide the Veteran a VA examination to determine whether he has a psychiatric disability, to include but not limited to anxiety disorder or had a psychiatric disability at any time during the course of this appeal from January 2012, when he filed a claim for service connection for PTSD. McClain v. Nicholson, 21 Vet. App. 319 (2007); Clemons v. Shinseki, 23 Vet. App. 1 (2009). The matter is REMANDED for the following action: Schedule the Veteran for a VA mental disorders examination with a psychiatrist or psychologist who has not previously examined the Veteran in conjunction with this claim, to determine the nature and likely etiology of any psychiatric disability, to specifically include anxiety disorder. The examiner must review the claims file and should note that review in the report. The examiner should discuss the Veteran's documented medical history and assertions. After reviewing the entire record and interviewing and examining the Veteran, the examiner should diagnose all mental disorders present and should specifically state whether or not each criterion for a diagnosis of PTSD is met. The examiner should specifically opine whether or not a diagnosis of anxiety disorder is warranted, and should explain that finding in detail and reconcile that finding with the previous VA examination. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any current mental disorder, or any mental disorder shown during the pendency of this claim, to specifically include anxiety disorder, is related to service or any incident of service. The examiner must review the record in conjunction with providing the requested opinion and should specifically consider the August 2012 VA PTSD examination documents that diagnosed anxiety disorder, but did not find PTSD; and the September 2019 VA PTSD examination documents that found that the Veteran did not meet the criteria for a diagnosis of PTSD or any other mental disorder, and that the previous diagnosis of anxiety disorder was unfounded. A thorough explanation should be provided for the opinion. Harvey P. Roberts Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Jackson 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.