Citation Nr: 21041595 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 16-00 188A DATE: July 9, 2021 ORDER Entitlement to service connection for chronic fatigue syndrome (CFS) is denied. Entitlement to service connection for a condition manifested by fatigue and hyperhidrosis (night sweats) is denied. Entitlement to service connection for a headache condition is denied. REMANDED The issue of entitlement to service connection for gastroesophageal reflux disease (GERD), claimed as a condition manifested by nausea and dysgeusia, is remanded. The issue of entitlement to service connection for burning and tingling of both feet is remanded. The issue of entitlement to service connection for burning and tingling of both hands is remanded. FINDINGS OF FACT 1. The Veteran served in Southwest Asia from December 1990 to May 1991. 2. The preponderance of the evidence is against a finding that the Veteran has a current diagnosis of chronic fatigue syndrome. 3. Symptoms of fatigue and hyperhidrosis have been attributed to non-service connected sleep apnea. 4. A headache condition was not manifested during service or for many years after service, and the preponderance of the evidence is against a finding that the Veteran's headache condition is related to an event, injury, or disease in service. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for chronic fatigue syndrome have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.317. 2. The criteria for establishing entitlement to service connection for a condition manifested by fatigue and hyperhidrosis (night sweats) have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.317. 3. The criteria for establishing entitlement to service connection for a headache condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.317. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1989 to January 1992. These matters come before the Board of Veterans' Appeals (Board) on appeal from a September 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which, in pertinent part, denied entitlement to service connection for the issues on appeal. The Veteran timely perfected an appeal. See November 2014 Notice of Disagreement; November 2015 Statement of the Case; January 2016 VA Form 9. In July 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge, a transcript of which is of record. In November 2019, the Board remanded this matter for additional development. Service Connection Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 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 in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table); 38 C.F.R. § § 3.303. Service connection may also be granted for any disease diagnosed after the military discharge, when all the evidence, including that pertinent to the period of military service, establishes that the disease was incurred during the active military service. 38 U.S.C. § § 1113 (b); 38 C.F.R. § § 3.303 (d). Service connection may be established on a presumptive basis for a Persian Gulf Veteran who exhibits objective indications of chronic disability resulting from undiagnosed illness that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021, and which by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a) (1). In claims based on undiagnosed illness, unlike those for "direct service connection," there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004). Notably, laypersons are competent to report objective signs of illness. Id. The term "Persian Gulf Veteran" means a Veteran who served on active military, naval, or air service in the Southwest Asia Theater of operations during the Persian Gulf War. 38 C.F.R. § 3.317(e) (1). A "qualifying chronic disability" for purposes of 38 U.S.C. § 1117 is a chronic disability resulting from (A) an undiagnosed illness, (B) a medically unexplained chronic multisymptom illness (such as chronic fatigue syndrome, fibromyalgia, or a functional gastrointestinal disorder) that is defined by a cluster of signs or symptoms, or (C) any diagnosed illness that the Secretary determines in regulation prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection. 38 U.S.C. § 1117(a)(2); 38 C.F.R. § 3.317(a)(2)(i)(B). Chronic fatigue syndrome is a qualifying chronic disability for purposes of 38 U.S.C. § 1117. See 38 C.F.R. § 3.317 (a)(2)(i)(B). Objective indications of such a chronic disability include both "signs" in the medical sense of objective evidence perceptible to an examining physician, and other non-medical indicators capable of independent verification. 38 C.F.R. § 3.317 (a)(2)(ii)(3). Disabilities that have existed for at least 6 months and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. 38 C.F.R. § 3.317 (a)(2)(ii)(4). Signs or symptoms which may be manifestations of an undiagnosed illness or medically unexplained chronic multi-symptom illness include, but are not limited to, fatigue, signs or symptoms involving skin, headaches, muscle pain, joint pain, neurological signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper or lower), sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, or menstrual disorders. 38 C.F.R. § 3.317 (b). Even where service connection cannot be presumed, service connection may still be established on a direct basis. Stefl v. Nicholson, 21 Vet. App. 120 (2007); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the Veteran. A. Chronic Fatigue Syndrome The Veteran contends that he has chronic fatigue syndrome (CFS) related to service, including as due to an undiagnosed illness. In the present case, the Veteran served in the Southwest Asia Theater of Operations during the Gulf War as shown by service personnel records. Thus, the Board finds that the Veteran is a "Persian Gulf Veteran" for the purposes of 38 C.F.R. § 3.317. See 38 C.F.R. § 3.317(e)(1). For VA purposes, the diagnosis of chronic fatigue syndrome requires: (1) the new onset of debilitating fatigue severe enough to reduce daily activity to less than 50 percent of the usual level for at least 6 months, and (2) the exclusion, by history, physical examinations, and laboratory tests, of all other clinical conditions that may produce similar symptoms, and (3) 6 or more of the following: (i) acute onset of the condition, (ii) low grade fever, (iii) nonexudative pharyngitis, (iv) palpable or tender cervical or axillary lymph nodes, (v) generalized muscle aches or weakness, (vi) fatigue lasting 24 hours or longer after exercise, (vii) headaches (of a type, severity or pattern that is different from headaches in the pre-morbid state), (viii) migratory joint pains, (ix) neuropsychologic symptoms, and (x) sleep disturbance. 38 C.F.R. § 4.88a. While chronic fatigue syndrome is listed as one of the qualifying chronic disabilities in section 3.317, the Board finds that the weight of the evidence does not demonstrate that the Veteran has a current diagnosis of this condition. In this regard, VA and private treatment records do not reflect a diagnosis of chronic fatigue syndrome. Rather, treatment records show that the Veteran's complaints relating to fatigue have been attributed to other diagnosed conditions, including sleep apnea, hypertension, and low testosterone. An April 2011 private treatment record shows that the Veteran reported fatigue. His testosterone levels were noted to be low. Later in April 2011, the Veteran reported that his fatigue had improved after testosterone injections, and his treating physician indicated that his fatigue was secondary to his low testosterone. The Veteran was afforded a VA chronic fatigue syndrome examination in August 2014. He reported easy fatigability and night sweats since 2007. The examiner indicated that the Veteran did not have a diagnosis of chronic fatigue syndrome and diagnosed the Veteran with sleep hyperhidrosis and fatigue. A September 2016 VA primary care record shows that the Veteran reported severe fatigue for the past year and a half. It was noted that the Veteran "never did get a sleep study despite a history of snoring and apneic episodes per wife." He was diagnosed with fatigue "likely from sleep apnea," and he was referred for a sleep study. A November 2017 VA treatment record shows that the Veteran reported feeling very tired. He reported that his outside physician checked his testosterone, which was low, and that he felt better after receiving testosterone supplements. He reported that he had not had any testosterone supplements in the past four to five months. He also reported night sweats. His testosterone levels were noted to be low. He was diagnosed with uncontrolled hypertension and "[t]esticular hypofunction by history of fatigue." A July 2018 VA treatment record shows that the Veteran reported daytime fatigue. He also reported snoring. The treating provider noted that the Veteran had been referred for a sleep study in 2017 but that he did not comply with scheduling. He was referred for a sleep study to rule out sleep apnea. A September 2018 VA treatment record shows that the Veteran reported feeling tired and headache for two weeks. His blood pressure was 172/112, and he reported that he had been "doubling up on HCTZ." A November 2018 VA treatment record shows that the Veteran reported increased fatigue. The treating provider again noted that the Veteran failed to schedule a sleep study. A January 2019 VA treatment record shows that the Veteran reported continuing fatigue. He also reported that he thought his testosterone level was low. A March 2019 VA treatment record shows that the Veteran reported fatigue. His testosterone level was low for the second time, and testosterone replacement was requested. It was noted that the Veteran once again did not complete a sleep study. The Veteran was afforded a VA chronic fatigue syndrome examination in January 2020. He reported low energy, nightly night sweats, metallic taste in mouth, burning/itching to palms and sole of feet, muscle aches and weakness, migraines, intermittent sore throat, nightmares, and fatigue. The examiner indicated that the Veteran did not meet the criteria for chronic fatigue syndrome and noted that none of the Veteran's reported symptoms were supported by medical records. Regarding fatigue, the examiner noted that the Veteran had never been diagnosed with chronic fatigue syndrome and that probable causes for his fatigue have been mentioned in his treatment records. The examiner noted that the Veteran's fatigue had been routinely suspected to be due to sleep apnea but that the Veteran had repeatedly failed to complete a sleep study. The examiner also noted that the Veteran's fatigue had been associated with low testosterone on several occasions. The examiner opined that the Veteran "has a likely diagnosis of sleep apnea that is a disease with a clear and specific etiology." A March 2021 private sleep study report shows that the Veteran was diagnosed with severe obstructive sleep apnea. In a March 2021 opinion, a VA examiner indicated that the Veteran had been diagnosed with obstructive sleep apnea with symptoms including daytime fatigue and night sweats. The Veteran is competent to report his symptoms, but he is not competent as a lay person to diagnose chronic fatigue syndrome or attribute his symptoms to an undiagnosed illness related to his active duty service in the in Southwest Asia theater of operations during the Persian Gulf War. See Davidson v. Nicholson, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (providing an example at footnote 4 that a layperson would be competent to diagnose a simple condition such as a broken leg but not to diagnose a form of cancer). Here, providing a diagnosis of chronic fatigue syndrome and/or the etiology of chronic fatigue is a complex question that involves an assessment of symptoms and application of professional judgment outside of the realm of knowledge of a layperson using his/her senses. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Thus, the Veteran's opinion that he has CFS is beyond the scope of his competency and is of no probative value. In cases where a veteran applies for service connection under 38 C.F.R. § 3.317 but is found to have a disability attributable to a known diagnosis, further consideration under the direct service connection provisions of 38 U.S.C. §§ 1110 and 1131 is warranted. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). However, where the issue involves a question of medical diagnosis or causation, as presented here, a claimant must establish the existence of a disability and a connection between the Veteran's service and the disability. As there is no evidence of a current diagnosis of chronic fatigue syndrome, the first element of service connection is not satisfied. As such, service connection for chronic fatigue syndrome is denied. B. Condition Manifested by Fatigue and Hyperhidrosis Here, the record reflects that the Veteran served in Southwest Asia from December 1990 to May 1991. Accordingly, the Veteran is a Persian Gulf War veteran, and he qualifies for consideration for presumptive service connection for disabilities resulting from undiagnosed illness or unexplained chronic multi-symptom illness. Here, however, the Veteran's symptoms of fatigue and hyperhidrosis have been attributed to known diagnoses. Specifically, the Veteran has been diagnosed with severe obstructive sleep apnea, and multiple treating providers and VA examiners have opined that his symptoms of fatigue and hyperhidrosis are related to sleep apnea. In addition to the evidence discussed above, in a December 2020 addendum report, the January 2020 VA examiner indicated that the Veteran should have also been given a diagnosis of sleep hyperhidrosis based on his reports of night sweats. The examiner noted that the Veteran's night sweats have been related to his severe snoring and apnea episodes in treatment records. The examiner indicated that sleep apnea could be a possible cause for the Veteran's sleep hyperhidrosis; however, the examiner was unable to proffer an opinion because the Veteran had not yet completed a sleep study. The examiner also noted that alcohol use could also cause night sweats. The examiner concluded that based on treatment records and medical literature, the Veteran's sleep hyperhidrosis and fatigue "have a likely etiology or are multifactorial in nature," and that it was therefore less likely as not that the Veteran's dysgeusia, sleep hyperhidrosis, and fatigue are part of a medically unexplained chronic multi-symptom illness. In an April 2021 opinion, a VA examiner noted that the Veteran had been diagnosed with severe obstructive sleep apnea. The examiner opined that the Veteran's hyperhidrosis was "clearly linked" to his sleep apnea. The examiner indicated that there were documented links between hyperhidrosis and sleep apnea and that hyperhidrosis was a common symptom of the disease process. The examiner cited to a study regarding the relationship between sleep apnea and hyperhidrosis. Accordingly, the evidence of record does not support the claim for service connection on a presumptive basis as an undiagnosed illness. The Veteran is therefore not entitled to invoke these presumptions for a condition manifested by fatigue and hyperhidrosis, but his claim is still considered under traditional service connection principles. See Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed. Cir. 1994). However, in this case, the Board notes that the Veteran was denied entitlement to service connection for sleep apnea in an unappealed November 2016 rating decision. Accordingly, that issue is not currently before the Board, and the Board has no jurisdiction to consider whether service connection is warranted to sleep apnea. The Board therefore finds that the preponderance of the evidence is against the claim, and it is denied. In reaching the conclusion above, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 U.S.C. § 5107 (b). C. Headache Condition The Veteran asserts that he developed headaches as a result of his Persian Gulf environmental exposures. A September 1989 service treatment record shows that the Veteran reported headache and sinus congestion, and he was diagnosed with sinusitis. An August 1991 service treatment record shows that the Veteran reported sore throat, cough, and headache, and he was diagnosed with strep throat. During the Veteran's January 1992 separation examination, he denied frequent or severe headaches, and the associated examination report is essentially normal. A November 2012 VA treatment record shows that the Veteran sought to reestablish VA care. He reported a metal taste in his mouth with associated nausea for about five years. He also reported night sweats. He denied headaches. During a December 2012 visit to establish VA primary care, the Veteran reported a metal taste in his mouth. During a review of systems, he reported headache, but he denied fatigue, night sweats, nausea, vomiting, and paresthesias. After examination, he was diagnosed with, inter alia, uncontrolled hypertension and dysgeusia. A February 2013 VA primary care record shows that the Veteran reported a metallic taste in his mouth for five years. He also reported a three to four-month history of night sweats, as well as "severe snoring and apnea episodes per wife." He denied headaches. The Veteran was afforded a VA headache conditions examination in August 2014. He reported that his headaches started in 2007. He was diagnosed with migraine. An October 2017 VA treatment record shows that the Veteran reported a large lump on the bottom of his lip and a headache since he noticed the lump. His blood pressure was 153/104, and the Veteran reported that he stopped taking his blood pressure medication because it upset his stomach. He reported a headache associated with his hypertension. He also reported drinking 24 beers per week. A September 2018 VA treatment record shows that the Veteran reported feeling tired and headache for two weeks. His blood pressure was 172/112, and he reported that he had been "doubling up on HCTZ." During the July 2019 Board hearing, the Veteran testified that he first had headaches during the Gulf War. The Veteran also testified that he was currently receiving medications for migraines through the VA. The Veteran was afforded a VA headache examination in January 2020. He reported that he started noticing intermittent headaches while on deployment to Saudi Arabia "due to daily exposures to contaminated areas and oil burns." He reported that the headaches became consistent in 2007. The examiner noted a diagnosis of migraine in 2014. The examiner opined that the Veteran's headaches were not related to service. The examiner noted that there were no complaints of headaches at service separation. The examiner also noted that post-service complaints of headaches have been attributed to other conditions, to include elevated blood pressure, sinus congestion, and a motor vehicle accident. The examiner also indicated that the only diagnosis related to headaches was given during the September 2014 VA examination and that despite regular VA treatment, no diagnosis related to headaches has ever been offered. Here, the record reflects that the Veteran served in Southwest Asia from December 1990 to May 1991. Accordingly, the Veteran is a Persian Gulf War veteran, and he qualifies for consideration for presumptive service connection for disabilities resulting from undiagnosed illness or unexplained chronic multi-symptom illness. However, the Veteran's headache condition has been attributed to known diagnoses as noted by VA treatment records and the January 2020 VA examiner. Specifically, the Veteran has been diagnosed with a migraine headache condition, and his headaches have also been attributed to hypertension and sinus problems. Thus, his headache condition is a clinically diagnosed disorder, and it is therefore not subject to the undiagnosed illness provisions found at 38 C.F.R. § 3.317 (a)(1)(ii). Therefore, the evidence of record does not support the claim for service connection for a headache condition on a presumptive basis as an undiagnosed illness. The Veteran is therefore not entitled to invoke these presumptions for a headache condition, but his claim is still considered under traditional service connection principles. See Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed. Cir. 1994). As an initial matter, the Board notes that the Veteran has been diagnosed with migraine headaches. As such, the Board finds the current disability element is established. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Additionally, the record supports a finding that the Veteran was exposed to Gulf War environmental hazards. As such, there is evidence of an event, injury, or disease in service. Id. Accordingly, the issue turns upon whether there is evidence of a nexus between the in-service injuries and the present disability. Upon review of the foregoing evidence, the Board concludes that the evidence of record is against a finding that the Veteran's currently headache condition is related to his military service or is of service origin. The Board finds the January 2020 VA opinion to be highly persuasive to the issue of whether the Veteran's headache condition is related to service. The Board places great probative weight on the VA opinion in this case, as it is consistent with the evidence of record and based upon medical knowledge and skill, as well as a review and analysis of the Veteran's specific disability picture. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (a medical report must be read as a whole in the context of the claim and, even an opinion lacking in detail may be provided some probative value based upon the amount of information and analysis contained therein); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record). Specifically, the January 2020 VA examiner opined that the Veteran's current headache condition was not related to service because the Veteran did not report any symptoms at service separation and because the first post-service mention of headaches was many years after service discharge. Although the examiner emphasized the length of time before the Veteran sought treatment after service, this does not render the opinion inadequate. A VA examiner must consider the Veteran's lay statements regarding the incurrence of a disorder and the continuity of symptomatology. Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007). However, in the present case, as discussed in detail below, the Board finds that the Veteran's lay statements regarding onset and continuity of his current headache symptoms to be less than credible. Implicit in the examiners' rationale was that if the Veteran's headache symptoms had been significant, he would have sought post-service treatment earlier. Moreover, "there is no reasons or bases requirement imposed on examiners." Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012). Rather, an adequate medical report must rest on correct facts and reasoned medical judgment so as to inform the Board on a medical question and facilitate the Board's consideration and weighing of the report against any contrary reports. See Nieves-Rodriguez, 22 Vet. App. at 304 (2008) (holding, in the context of weighing one medical opinion with another, that "[i]t is the factually accurate, fully articulated, sound reasoning for the conclusion... that contributes probative value to a medical opinion"). Overall, the opinion of record is supported by an explanation, based on a review of the claims folder and examination of the Veteran, and supported by the Veteran's medical records. There are no contrary medical opinions of record. The Board acknowledges the Veteran's assertions that his current headache condition is related to service. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, the etiology of a headache condition falls outside the realm of common knowledge of a lay person. In this regard, while the Veteran can competently report his symptoms, any opinion regarding whether his diagnosed headache condition is related to his military service requires medical expertise that the Veteran has not demonstrated. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376 (2007). As such, the Board assigns no probative weight to the Veteran's assertions that his current headache condition is related to service. The Board also acknowledges the Veteran's assertions that he has suffered from headache symptoms since service. The Veteran is certainly competent to report headache symptoms. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Layno v. Brown, 6 Vet. App. 465, 469 (1994). In the present case, the Board finds that the statements regarding onset and continuity of the Veteran's current headache symptoms, while competent, are not fully credible. In this regard, the recent lay contentions that the Veteran has suffered from continuous headache symptoms since service are inconsistent with other evidence of record. See Gardin v. Shinseki, 613 F.3d 1374, 1379 (Fed. Cir. 2010) (upholding Board finding that vague and inconsistent lay statements were not credible because they were in direct contradiction to the more credible, competent, reliable, and clearly documented medical evidence). As detailed above, the Veteran specifically denied frequent headaches upon separation from service, and the first medical evidence of any headache symptoms after active service was in 2011, almost 20 years after the Veteran's discharge. The absence of post-service findings, diagnosis, or treatment for many years after service is one factor that tends to weigh against a finding of continuous knee symptoms after service separation. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (holding that the Board may weigh the absence of contemporaneous medical evidence as one factor in determining credibility of lay evidence, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of many years between discharge from active service and the medical documentation of a claimed disability is one factor to consider as evidence against a claim of service connection). Additionally, the Veteran has made inconsistent and contradictory statements regarding the onset of his current symptoms. See Gardin v. Shinseki, 613 F.3d 1374, 1379 (Fed. Cir. 2010) (upholding Board finding that vague and inconsistent lay statements were not credible because they were in direct contradiction to the more credible, competent, reliable, and clearly documented medical evidence). Specifically, in during the August 2014 VA examination, the Veteran reported that his headache symptoms started in 2007. However, during the July 2019 Board hearing and at the January 2020 VA examination, the Veteran reported that his headache symptoms started in service and continued to the present day. See Cromer v. Nicholson, 19 Vet. App. 215 (2005) (upholding Board's denial of service connection and finding that a veteran's recent post-service account of in-service events was not credible because the Veteran had previously given other histories and theories that did not mention the alleged in-service event, and first "came up with the story" years after service and in connection with the compensation claim). Further, when the Veteran did report headache symptoms in 2011, he did not discuss a service origin. See Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (ascribing heightened credibility to statements made to clinicians for the purpose of treatment); Williams v. Gov. of Virgin Islands, 271 F.Supp.2d 696, 702 (V.I.2003) (noting that statements made for the purpose of diagnosis or treatment "are regarded as inherently reliable because of the recognition that one seeking medical treatment is keenly aware of the necessity for being truthful in order to secure proper care"). It is important to point out that the Board does not find that the Veteran's lay statements lack credibility merely because they are unaccompanied by contemporaneous medical evidence. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009) (quoting Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) ("[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence."). Rather, the current lay statements are found to lack credibility because they are inconsistent and directly contradicted by other lay and medical evidence of record, including the Veteran's own statements, showing that the Veteran did not experience chronic headache symptoms until over decades after service. See Madden, 125 F.3d at 1481 (finding Board entitled to discount the credibility of evidence in light of its own inherent characteristics and its relationship to other items of evidence); Caluza v. Brown, 7 Vet. App. 498, 512 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (upholding Board's finding that a Veteran was not credible because lay evidence about a wound in service was internally inconsistent with other lay statements that he had not received any wounds in service). While the Board is sympathetic to the Veteran's claims, taking into account all of the relevant evidence of record, the preponderance of the evidence is against a finding of an etiological relationship between the Veteran's current headache condition and his military service. Accordingly, the Board finds that the claim of entitlement to service connection for a headache condition must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). REASONS FOR REMAND The Veteran seeks service connection for a condition manifested by nausea and dysgeusia, which he contends is related to his environmental exposures during his Southwest Asia service. The Veteran was afforded a VA stomach and duodenal conditions examination in January 2020. He reported that his nausea started around the same time that he noticed a metallic taste in his mouth. He also reported that his nausea comes and goes but that it is more pronounced with the worsening of dysgeusia. The examiner diagnosed the Veteran with dysgeusia and nausea associated with dysgeusia. The examiner opined that the Veteran's nausea was less likely as not related to service because there was no mention of nausea in service, to include during the Veteran's separation examination, and because there was only one mention of nausea in the post-service medical record, indicating that it was an acute condition. The examiner concluded that the Veteran's "exposure to environmental hazards during the Gulf War are not the cause of the 1 episode of nausea, a nexus is not established." In a December 2020 addendum report, the January 2020 VA examiner noted that dysgeusia and nausea/vomiting were common side effects of GERD, with which the Veteran was diagnosed in 2014. To date, the Veteran has not been afforded a VA examination regarding GERD. In light of his competent testimony that he first experienced symptoms in service, the Board finds that a VA examination and medical opinion is required to determine the nature and etiology of the Veteran's GERD. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159; see McClendon v. Nicholson, 20 Vet. App. 79 (2006). The Veteran also seeks service connection for a condition manifested by burning and tingling of his hands and feet. The Veteran was afforded a VA peripheral nerves conditions examination in August 2014. He reported intermittent tingling and itching in his hands and feet. The examiner diagnosed the Veteran with dysesthesias. The Veteran was afforded a VA peripheral nerves conditions examination in January 2020. The examiner noted that the Veteran had symptoms of attributable to a peripheral nerve condition, to include moderate paresthesias and/or dysesthesias of the bilateral upper and lower extremities. However, despite this finding, the examiner indicated that the Veteran did not have a peripheral nerve condition. The examiner opined that therefore, it was less likely as not that the claimed burning and tingling of both hands and feet was related to service. The Board finds that this opinion is inadequate for several reasons. As an initial matter, the requirement of the existence of a current disability is satisfied when a Veteran has a disability at any time during the pendency of his claim, even if the disability resolves prior to adjudication of the claim. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Board notes that the Veteran's claim has been pending since 2013 and that the Veteran was diagnosed with dysesthesias during the August 2014 VA examination. The Board notes that any such valid diagnosis could constitute a current disability for purposes of service connection, even if resolved at the time of the January 2020 VA examination. Id. Moreover, despite finding that the Veteran had symptoms of a peripheral nerve condition, the examiner opined that the Veteran did not have a peripheral nerve condition. See Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board's duty to return an inadequate examination report "if further evidence or clarification of the evidence...is essential for a proper appellate decision"); 38 C.F.R. § 4.2 (noting that if the examination report does not contain sufficient detail, it is incumbent upon the rating board to return the report as inadequate for evaluation purposes). In light of the foregoing, a supplemental opinion is necessary which addresses whether the Veteran has had a peripheral nerve condition at any time since his August 2013 claim and, if so, whether such disability is related to service. The matters are REMANDED for the following action: 1. Obtain and associate with the Veteran's claims file all outstanding VA treatment records documenting treatment for the issues on appeal. The Veteran should also be provided an opportunity to identify and/or submit any relevant private treatment records. 2. After all available records have been associated with the claims file, afford the Veteran an appropriate VA examination to determine the nature, onset, and likely etiology of the Veteran's GERD. The entire claims file and a copy of this Remand must be made available to the examiner and the examiner shall indicate in the report that the claims file was reviewed. Any tests or studies deemed necessary should be conducted, and the results should be reported in detail. After reviewing the record and examining the Veteran, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's GERD had its onset in service or is related to any in-service disease, event, or injury, to include as due to environmental hazards in the Persian Gulf. The examiner's report must reflect consideration of the Veteran's entire documented medical history and assertions and all lay evidence. Any opinion expressed by the VA examiner should be accompanied by a complete rationale. If the VA examiner is unable to offer an opinion without resorting to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided. 3. After all available records have been associated with the claims file, obtain an addendum opinion regarding the etiology of the Veteran's peripheral nerve condition affecting the bilateral hands and feet. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. The claims file and a copy of this Remand must be made available to the reviewing examiner, and the examiner shall indicate in the addendum report that the claims file was reviewed. After reviewing the record and, if necessary, examining the Veteran, the examiner should identify all peripheral nerve condition diagnosed during the pendency of this appeal, i.e. since 2013, to specifically include dysesthesias. For EACH peripheral nerve condition diagnosed during the pendency of this appeal, the examiner should render an opinion as to whether it is at least as likely as not (i.e., 50 percent probability or greater) incurred in, caused by, or is otherwise related to, the Veteran's military service, to include his service in the Southwest Asia Theater of Operations. The examiner's report must reflect consideration of the Veteran's entire documented medical history and assertions and all lay evidence. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered. (Continued on the next page) 4. Following the completion of the foregoing, and any other development deemed necessary, the AOJ should readjudicate the Veteran's claim. If the claim is denied, supply the Veteran and his representative with a supplemental statement of the case and allow an appropriate period of time for response. Thereafter, the claims folder should be returned to the Board for further appellate review, if otherwise in order. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Kipper, 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.