Citation Nr: 21040126 Decision Date: 07/02/21 Archive Date: 07/02/21 DOCKET NO. 17-62 450A DATE: July 2, 2021 ORDER The claim for entitlement to an effective date earlier than March 30, 2014 for the grant of service connection for Posttraumatic Stress Disorder (PTSD) with Major Depressive Disorder and Alcohol Use Disorder is dismissed. Entitlement to a 70 percent rating and no higher for PTSD with Major Depressive Disorder and Alcohol Use Disorder (PTSD) from March 30, 2014 to August 1, 2017 is granted. A total disability rating based on individual unemployability due to service-connected disability (TDIU) from August 1, 2014, but no earlier, to August 1, 2017 is granted. Service connection for glucose-6-phosephate dehydrogenase deficiency (G6PD deficiency) is denied. Service connection for attention deficit hyperactivity disorder is denied. FINDINGS OF FACT 1. Prior to the promulgation of a decision in the appeal, the Board received notification from the appellant, through his authorized attorney-representative, that a withdrawal of this appeal is requested as to the issue of entitlement to an effective date prior to March 30, 2014 for the award of service connection for PTSD. 2. From March 30, 2014 to August 1, 2017, the severity, frequency, and duration of the Veteran's PTSD symptoms more closely approximate occupational and social impairment with deficiencies in most areas; at all times relevant to the decision, the severity, frequency, and duration of the Veteran's PTSD symptoms do not more closely approximate total occupational and social impairment. 3. From August 1, 2014 to August 1, 2017, and not prior to August 1, 2014, the Veteran was unable to secure and follow a substantially gainful occupation as a result of his service-connected disabilities. 4. The Veteran's G6PD deficiency is a congenital or developmental defect not subject to compensation within the meaning of applicable legislation; there is no evidence of any superimposed disease or injury during service affecting the Veteran's G6PD deficiency. 5. ADHD did not have its onset during service, and is not shown to be causally or etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for withdrawal of an appeal by the appellant have been met as to the issue of entitlement to an effective date prior to March 30, 2014 for the award of service connection for PTSD. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The criteria for a disability rating of 70 percent, and no more, for PTSD are met from March 30, 2014 to August 1, 2017; the criteria for a 100 percent rating are not met or approximated at any time. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. 3. The criteria for TDIU are met from August 1, 2014 to August 1, 2017; prior to that time, the criteria are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.16. 4. Entitlement to service connection for G6PD deficiency is precluded by law. G6PD deficiency is not a disease or injury. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 4.9. 5. The criteria for service connection for ADHD have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who served on active duty from August 2008 to August 2013, appeals rating decisions that denied these claims. He testified before the undersigned Veterans Law Judge (VLJ) at a November 2020 Board hearing. At the hearing, the undersigned clarified issues on appeal and made inquiry as to the existence of outstanding evidence relevant to the issues being decided. The VLJ accepted the request for withdrawal of the issue of an earlier effective date as to service connection for PTSD. The actions of the VLJ comply with 38 C.F.R. § 3.103. The appellant's attorney did not offer argument nor was there testimony as to the service connection issues for G6PD or ADHD, as the attorney noted that she would likely withdraw these claims. She was granted an additional 30 days to submit evidence and argument as to these claims or to clarify that they were withdrawn. No additional evidence and argument or other communication was received thereafter by the Board. The Board thus does not find that the Veteran's attorney withdrew these claims. We note that an oral withdrawal of an appeal at a Board hearing is effective only where it is (i) explicit, (ii) unambiguous, and (iii) done with full understanding of the consequences of such action on the part of the claimant. See DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011) (outlining factors for oral withdrawal at Board hearing); Acree v. O'Rourke, 891 F.3d 1009, 1014 (Fed. Cir. 2018) (holding that DeLisio standard only applies to oral withdrawals at a Board hearing). Also at the hearing, the Veteran, through his attorney, limited his appeal inasmuch as it was established that the appeal as to TDIU would be satisfied with the assignment of an effective date in August 2014, when he stopped full-time work, and the PTSD increased rating appeal would be satisfied with the assignment of a 70 percent rating from March 30, 2014, the current effective date for service connection and a 50 percent rating for PTSD. The attorney clarified that they did not seek a 100 percent rating for PTSD. A Veteran may limit his appeal to a particular disability rating which is less than the maximum allowed by law. See A.B. v. Brown, 6 Vet. App. 35 (1993). Dismissal 1. Entitlement to an effective date earlier than March 30, 2014 for the grant of service connection for PTSD is dismissed. The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. A substantive legacy appeal may be withdrawn in writing by an appellant or authorized representative at any time before the Board promulgates a decision and is effective upon receipt by the Board. 38 C.F.R. §§ 19.55 (a), (b)(3). The Board received the Veteran's withdrawal of the present appeal as to this issue at the hearing, before the Board promulgated a decision, at which time it became effective and there remained no allegations of errors of fact or law for appellate consideration. The Board does not have jurisdiction to review the appeal as to this issue, and it is dismissed as to this issue. 38 C.F.R. § 19.55. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity resulting from disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for the higher evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as "staged" ratings." Fenderson v. West, 12 Vet. App. 119, 126-127 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 2. Entitlement to a 70 percent rating for PTSD from March 30, 2014 to August 1, 2017 is granted. A September 2015 rating decision granted service connection for this disability and assigned a 50 percent rating effective from March 30, 2014, a year prior to the date of receipt of claim. A 70 percent rating was granted effective August 1, 2017, the date of a VA examination. The Veteran seeks an initial 70 percent rating prior to August 1, 2017 consistent with the theories raised at the hearing before the undersigned, generally, it is asserted that he meets the criteria for a 70 percent rating from March 30, 2014, due to the fact that the serious symptoms of PTSD, to include suicidal ideation and serious social and occupational impairment due to anxiety and depression, have been constant since that time and did not simply increase August 1, 2017. Upon review of the evidence, with specific emphasis on the complaints contained in the treatment record coupled with the detailed testimony and attorney argument at the hearing, the Board finds that the Veteran's disorder warrants a rating of 70 percent for the period on appeal prior to August 1, 2017. While we acknowledge that that the Veteran has limited his appeal to seeking 70 percent prior to August 1, 2017, we observe that the preponderance of the evidence is against finding that the criteria for a rating in excess of 70 percent are met any time relevant to the claim. The Veteran's PTSD rated assigned under Diagnostic Code 9411. 38 C.F.R. § 4.130. The disability is rated using the General Rating Formula for Mental Disorders (General Formula). A 70 percent disability rating is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. The June 2015 VA examination for PTSD which was the basis for the 50 percent rating was largely focused on whether the Veteran had psychiatric disorder, if so which one, and was it related to service. The VA examination in August 2017 details that the Veteran's PTSD manifestations cause significantly greater occupational and social impairment. PTSD symptoms noted in that report support occupational and social impairment estimated to produce deficiencies in most areas, highlighted by intermittent suicidal ideation, impaired impulse control and intermittent ability to perform ADLs. See, generally, August 2017 VA PTSD examination. Difficulty in adapting to stressful circumstances was also noted. At the actual examination, he denied current suicidal or homicidal ideation, but judgement and insight were poor. Consistent with this report, the Veteran testified before the undersigned that his symptoms of PTSD in the appeal period prior to August 1, 2017 included severe depression and intermittently feeling like a solution to his problems is to kill himself. It was discussed that he did not always report such feelings when he reported for VA examinations and treatment during that period. A suicide attempt in service was noted. He stated that these feelings came and went but were recurring and related to stress in his daily life. He reported that when his wife came with him to appointments, which she often did prior to divorce, he did not feel comfortable reporting his true feelings. His recorded behavior suggested problems at these encounters though; it was noted that at a May 2015 encounter he felt very uncomfortable with the examiner, refused to take off his dark glasses and questioned if he was in a real office. He noted that during the period on appeal he relied on his then-wife to do everything for him, such as contacting other people for him, paying bills and making food. She functioned like a therapist. He noted that he was extremely irresponsible with money and was engaged in excessive drinking of alcohol. He was erratic. He had to abandon school due to his PTSD and anxiety symptoms. Panic attacks occurred multiple times a week. He stated he had twin infant sons that were in the hospital at the time as they were premature. His attorney argued his behavior as reflected in the record was evidence of inability to adapt to stressful circumstances beginning long before August 1, 2017. The Veteran further testified that his wife left him and he became homeless during that period. He had been working in security at Columbia College until August 2014 but had to go to 20 hours at that time due to his inability to deal with people and stressful circumstances. Nightmares due to PTSD limited sleep and frequent migraines also limited his ability to work. The people he worked for thought he was lying about his problems. Thereafter he worked until October 2014 only. He also stated that initially during the period on appeal prior to August 1, 2017, he under-reported symptoms because he was afraid of being institutionalized. Resolving reasonable doubt in the Veteran's favor, the severity, frequency, and duration of the Veteran's PTSD more closely approximate occupational and social impairment with deficiencies in most areas for the period on appeal prior to August 1, 2017. We note that the effective date of service connection is March 30, 2014. We find the detailed testimony to be of greatest probative weight as it provides an illuminating narrative as to the severity of the condition since March 30, 2014 and is consistent with the record. A 70 percent rating is warranted form that date through August 1, 2017. Again, there is no argument that the Veteran's disability meets or more nearly approximates the criteria for a higher rating than 70 percent at any time. Specifically, a 100 percent rating is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name, warrants the maximum, 100 percent disability rating. The "such symptoms as" language means "for example," and does not represent an exhaustive list of symptoms that must be found before granting the rating of that category. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). The list of examples provides guidance as to the severity of symptoms contemplated for each rating. Id. However, this fact does not make the provided list of symptoms irrelevant. See Vasquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). The Veteran must still demonstrate either the particular symptoms associated with the rating sought, or other symptoms of similar severity, frequency, and duration. Id. at 117. There has been no endorsement of total occupational and social impairment or relevant signs of the 100 percent rating criteria. He himself (through his attorney) has estimated that his rating should be 70 percent. Thus, although the record overall reflects severe impairment, it does not remotely suggest total impairment as required for a 100 percent rating. The criteria for a 100 percent rating under DC 9411 are not met or approximated. TDIU It is the established policy of VA that all Veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16. A finding of total disability is appropriate "when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation." 38 C.F.R. §§ 3.340 (a)(1), 4.15. "Substantially gainful employment" is that employment "which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the Veteran resides." Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). Marginal employment shall not be considered substantially gainful employment. 38 C.F.R. § 4.16 (a). The Moore court cited the following language from Timmerman v. Weinberger, 510 F.2d 429 (8th Circuit 1975), in which United States Court of Appeals for the Eighth Circuit addressed unemployability in the Social Security disability context: The question must be looked at in a practical manner, and mere theoretical ability to engage in substantial gainful employment is not a sufficient basis to deny benefits. The test is whether a particular job is realistically within the physical and mental capabilities of the claimant. The determination of unemployability is to be made by a VA adjudicator and is not a medical question. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). Consideration may be given to the Veteran's education, special training, and previous work experience, but not to his or her age or to the impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19; Hatlestad v. Derwinski, 1 Vet. App. 164, 168. Neither the term substantially gainful occupation nor the term inability to secure and follow such an occupation are defined. However, the Court has held that substantially gainful employment contains economic and noneconomic components; the economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person and the noneconomic component requires consideration of a veteran's ability to secure or follow that type of employment. Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). Regarding these noneconomic components, in determining whether a veteran can secure and follow a substantially gainful occupation, attention must be given to a veteran's history, education, skill, and training, and whether a veteran has the physical ability (both exertional and nonexertional) to perform the type of activities (e.g., sedentary, light, medium, heavy, or very heavy) required by the occupation at issue. Id. Factors that may be relevant include, but are not limited to, a veteran's limitations, if any, concerning lifting, bending, sitting, standing, walking, climbing, grasping, typing, and reaching, as well as auditory and visual limitations; and whether the veteran has the mental ability to perform the activities required by the occupation at issue. Id. Factors that may be relevant include, but are not limited to, a veteran's limitations, if any, concerning memory, concentration, ability to adapt to change, handle work-place stress, get along with coworkers, and demonstrate reliability and productivity. Id. 3. TDIU from August 1, 2014, but no earlier, to August 1, 2017 is granted. The Veteran contends that his service-connected disabilities render him unemployable prior to August 1, 2017, the current effective date of the award for TDIU. He filed his VA form 21-8940 in November 2015 indicating that he stopped working full-time in August 2014. Prior to that time, he worked full-time but he reports he had to take time off related to service-connected disabilities. The Board agrees TDIU is warranted from August 1, 2014 to August 1, 2017. We find he meets the economic and non-economic components of TDIU during that time period from August 1, 2014 to August 1, 2017. This TDIU is a part of the Veteran's claim for increased rating for PTSD, and thus an effective date of the award from date of receipt of that claim is for consideration. Rice v. Shinseki, 22 Vet. App. 447 (2009). Here, we note that service connection and initial staged ratings for PTSD were granted with an effective date of March 30, 3014 based on a date of claim of March 30, 2015. As he was working full-time during the period prior to August 1, 2014, the preponderance of the evidence is against the TDIU claim for the period on appeal prior to August 1, 2014. Based on the increased rating to 70 percent from March 30, 2014 for PTSD granted herein, the Veteran meets the basic schedular rating criteria to be considered for TDIU set forth at 38 C.F.R. § 4.16 (a) from March 30, 2014. It is not in dispute that, for the period prior to August 1, 2017, he worked full-time up to August 2014 and then went part-time, then stopped working. The other service-connected disability impacting his ability to work was identified as migraine headaches, which are rated noncompensable prior to September 23, 2014, 30 percent from that date and 50 percent from April 6, 2020. Also, service connection for tinnitus, rated 10 percent, is in effect from August 14, 2013. At the hearing, the Veteran provided considerable testimony regarding the fact that the occupational impact of his service-connected psychiatric and headache disorders may have waxed and waned but overall remained relatively constant since August 2014 when he switched to part-time work at Columbia College and then ultimately to no work from October 2014 through August 1, 2017. He noted that the PTSD resulted in erratic behavior such as excessive drinking and spending as well as blowing up at others at times which has made it impossible for him to work as of August 2014. He reported that his wife was effectively taking care of him full-time until his divorce. He has experienced periodic homelessness which he attributes to his psychiatric disorder. His headaches also were stabbing at times and he would have to stop work. He was forced to reduce to 20 hours a week from August to October 2014, when he stopped work within the applicable time period. The Board finds the testimony as to the impact of PTSD and headache-related problems on the Veteran's work ability from August 1, 2014 to August 1, 2017 to be reasonable and not inconsistent with the documented record. First, it is noted again that PTSD symptoms cause occupational and social impairment estimated to produce deficiencies in most areas as noted above. Additionally, August 2017 VA headaches examination reflects that the impact of headaches was pain, sensitivity to light and sound and changes in vision. He reported he takes Sumatriptan for his migraines, but the migraine only dwindles, never goes away. It is certainly not in dispute that this Veteran has an education and has previous work experience. He reported in his 8940 that he had 2 years of college and was in VA vocational rehabilitation in 2015. Later vocational rehabilitation records, which show he has since August 1, 2017 restarted, reflect that he stopped this initial training. He explained in his hearing that he could not continue due to the impact of his psychiatric disorder. Upon consideration of the testimony of the Veteran and the findings in the record, the Board finds that the evidence is approximately balanced for and against this claim as to the period from August 1, 2014 to August 1, 2017. The fact that he worked for a long period of time and reduced to 20 hours in August 2014 then stopped in October 2014 is consistent with finding TDIU for this period. This matter must be looked at practically. As observed by the undersigned at the hearing, the part time work from August to October 2014 appears to not have been substantially gainful employment. We are presented with a Veteran with significant psychiatric impairment and headache issues. The Board finds that he indeed meets the criteria for TDIU from August 1, 2014 to August 1, 2017. Accordingly, TDIU is granted for that time period. For the period on appeal prior to August 1, 2014, it is uncontroverted that the Veteran was working full time, and could engage in substantial and gainful employment. The appeal as to that time period is denied. His current work activity and vocational rehabilitation status, as reflected in VA vocational records dated in 2021, are not the subject of this appeal. Service Connection Veterans are entitled to compensation from VA if they develop a disability "resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty." 38 U.S.C. § 1110 (wartime service), 1131 (peacetime service). To establish a right to compensation for a present disability, a veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"-the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). In evaluating a claim, the Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1335 (2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159 (a); Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence can also be competent and sufficient evidence of a diagnosis if (1) the medical issue is within the competence of a layperson, (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. Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). If the evidence is competent, the Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this regard, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511-12 (1995). For a medical opinion (i.e., medical evidence) to be given weight, it must be: (1) based upon sufficient facts or data; (2) the product of reliable principles and methods; and (3) the result of principles and methods reliably applied to the facts. See Nieves-Rodriquez v. Peake, 22 Vet. App. 295, 302 (2008). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). Service records do not indicate that the Veteran was in combat and he does not assert that these disabilities are related to combat. As such, 38 U.S.C. § 1154 (b) is not applicable. 4. Service connection for glucose-6-phosephate dehydrogenase deficiency (G6PD deficiency) is denied. The Veteran offers no testimony or argument as to how G6PD deficiency is attributable to active service. After review of the evidence, the Board finds that service connection is not warranted. Service connection may be established based on aggravation of a pre-existing condition, presuming that the pre-existing condition is shown to have been aggravated beyond natural progression by active service. A veteran will be considered to have been in sound condition when examined and accepted for service, except as to disorders noted on entrance into service, or when clear and unmistakable evidence demonstrates that the disability existed prior to service and was not aggravated by service. Only such conditions as are recorded in examination reports are to be considered as noted. 38 U.S.C. § 1111; 38 C.F.R. § 3.304 (b). A preexisting injury or disease will be considered to have been aggravated by service where there is an increase in disability during service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. The burden falls on VA to rebut the presumption of soundness by clear and unmistakable evidence that the disability was both preexisting AND not aggravated by service. Wagner v. Principi, 370 F.3d 1089 (2004). In order to support a finding of aggravation, the evidence must establish that the underlying disability underwent an increase in severity; the occurrence of symptoms, in the absence of an increase in the underlying severity, does not constitute aggravation of the disability. Davis v. Principi, 276 F.3d 1341 (Fed. Cir. 2002). As an initial matter, the Board acknowledges that the Veteran has an in-service finding of G6PD deficiency. Indeed, the condition was clearly noted during a medical evaluation in August 2008, at the time of his entrance to service. A glucose-6-dehydrogenase deficiency is defined as the most common inborn error of metabolism; an X-linked enzyme deficiency. See Dorland's Illustrated Medical Dictionary 790 (32nd ed. 2012). Hence, the evidence shows that the condition not only preexisted service but is in fact a hereditary condition. In general, service connection may not be granted for congenital or developmental defects such as G6PD deficiency, as they are not considered a disease or injury for the purpose of service connection. See 38 C.F.R. § 3.303 (c), 4.9. For VA purposes, a "defect" is defined as a structural or inherent abnormality or condition which is more or less stationary in nature and is generally incapable of improvement or deterioration. However, service connection may be granted for any additional disability that results where a congenital or developmental defect is subject to, or aggravated by, a superimposed disease or injury. See VAOPGCPREC 82-90 (July 18, 1990); VAOPGCPREC 67-90 (July 18, 1990). There is no argument as to how service connection is warranted for the condition, he has never disputed the fact that the condition preexisted service nor has he ever alleged any other superimposed disability. Moreover, review of the Veteran's post-service treatment records does not show any complaints or diagnoses of disabilities of G6PD deficiency, nor any superimposed disabilities. The Veteran's congenital G6PD deficiency is not subject to service connection except under specific circumstances not shown in this case (such as superimposed injury). Congenital or developmental defects are not diseases or injuries for the purposes of service connection. 38 C.F.R. §§ 3.303 (c), 4.9. There is nothing in this case that establishes that G6PD deficiency is a disease or residual of an injury. Thus, service connection for the G6PD deficiency cannot be granted as a matter of law. See Winn v. Brown, 8 Vet. App. 510, 516 (1996); Beno v. Principi, 3 Vet. App. 439 (1992). In summary, the record contains no probative evidence that the Veteran's G6PD deficiency is due to in-service trauma or was subject to a superimposed disease or injury during service. As such, it is not a disease or injury for purposes of VA disability compensation and service connection is not warranted. 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 5. Service connection for attention deficit hyperactivity disorder (ADHD) is denied. The Veteran offers no testimony or argument as to how ADHD, first noted in 2015 VA treatment records with reference to seeking treatment in 2013, is attributable to active service. After review of the evidence, the Board finds that service connection is not warranted. ADHD was not present in service or for years following service and is not otherwise related to service. Here, ADHD/ADD is initially reported in VA treatment records dated many years after service. In April 2015, he reported that he was diagnosed with ADD (attention deficit disorder) by a provider at Lemoore facility in June 2013. However, he reportedly was not prescribed any medication. He was unable to state whether he underwent formal testing for ADD. He reported difficulty focusing, was planning to attend school (West Hill college) and wanted to start on medication. It was noted that he was not diagnosed with ADD as a child and he attended regular school and graduated from high school with good grades. In 2015, according to his wife, he always zones out, was unable to complete projects, would pace a lot and have extreme trouble waiting in a line. Treatment records from that point show sporadic complaints and treatment for ADHD. VA mental health examinations associated with the PTSD claim herein fail to show a diagnosis of either ADHD or ADD, but we accept that the condition has been diagnosed in the treatment record since 2015. We note that the available service treatment records are negative for any complaints, findings or treatment related to ADD/ADHD or attention issues. There is no argument that this condition was present in service. The treatment record showing the condition since not prior to 2015 is highly persuasive evidence against finding a nexus to service. The Veteran has offered no competent evidence of a nexus. The preponderance of the evidence is against finding that a nexus exists between current sleep apnea and service. 38 U.S.C. § 1110; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d). Current symptoms have not been attributed by any competent evidence to service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. The preponderance of the evidence weighs against the claim, and it is denied. H. N. SCHWARTZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. RIPPEL, 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.