Citation Nr: 22017175 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 17-64 203 DATE: March 24, 2022 ORDER Entitlement to service connection for fatigue, to include as due to an undiagnosed illness, is denied. Entitlement to service connection for a gastrointestinal order (also claimed as constipation and irritable colon syndrome), to include as due to an undiagnosed illness, is denied. Entitlement to service connection for a respiratory disorder (also claimed as pleurisy) is denied. Entitlement to service connection for scars of the trunk and extremities is denied. FINDINGS OF FACT 1. The Veteran does not have a chronic disability manifested by fatigue, to include as due to an undiagnosed illness or a medically unexplained chronic multi-symptom illness such as chronic fatigue syndrome. His sleep impairment and resulting symptoms of fatigue have been attributed to his service-connected PTSD, and there are no additional symptoms that manifested in service or are otherwise related thereto. 2. The Veteran does not have a chronic disability manifested by digestive symptoms, to include constipation, to include as due to an undiagnosed illness or a medically unexplained chronic multi-symptom illness such as irritable colon syndrome, and there are no additional symptoms that manifested in service or are otherwise related thereto. 3. The Veteran does not have a chronic disability manifested by respiratory symptoms, to include pleurisy, to include as due to an undiagnosed illness or a medically unexplained chronic multi-symptom illness, and there are no additional symptoms that manifested in service or are otherwise related thereto. 4. Scars of the trunk and extremities did not manifest in service and are not otherwise etiologically or causally related to service. CONCLUSIONS OF LAW 1. Chronic fatigue syndrome or any other disability manifested by fatigue, to include as due to an undiagnosed illness, was not incurred in active service. 38 U.S.C. §§ 101(24), 1110, 1117, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.317. 2. Irritable colon syndrome or any other disability manifested by gastrointestinal complaints or constipation, to include as due to an undiagnosed illness, was not incurred in active service. 38 U.S.C. §§ 101(24), 1110, 1117, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.317. 3. Pleurisy or any other disability manifested by respiratory problems, to include as due to an undiagnosed illness, was not incurred in active service. 38 U.S.C. §§ 101(24), 1110, 1117, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.317. 4. Scars of the trunk and extremities were not incurred in service. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.303, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 2011 to January 2012. He had additional service in the United States Army Reserve and the Kentucky Army National Guard. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. The Board remanded the case for further development in November 2019. That development was completed, and the case has since been returned to the Board for appellate review. Law and Analysis Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist with regard to the issue decided herein. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The disorders at issue are not considered chronic diseases for VA compensation purposes. As such, the provisions of 38 C.F.R. § 3.303(b) for chronic diseases are not for application in this case. 38 C.F.R. §§ 3.303(b), 3.307, 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Because the Veteran served in the Southwest Asia Theater of operations during the Persian Gulf War, service connection may also be established under 38 C.F.R. § 3.317. Under that section, service connection may be warranted for a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active military, naval or air service in the Southwest Asia Theater of operations during the Persian Gulf War. For disability due to undiagnosed illness and medically unexplained chronic multi-symptom illness, the disability must have been manifest either during active military service in the Southwest Asia Theater of operations or to a degree of 10 percent or more not later than December 31, 2026. 38 C.F.R. § 3.317(a)(1); 86 Fed. Reg. 51,000 (Sept. 14, 2021). There are three types of qualifying chronic disabilities: (1) an undiagnosed illness; (2) a medically unexplained chronic multi-symptom illness; and (3) a diagnosed illness that VA determines in regulations warrants a presumption of service connection. 38 C.F.R. § 3.317(a)(2). An undiagnosed illness is a condition that, by history, physical examination, and laboratory tests, cannot be attributed to a known clinical diagnosis. 38 C.F.R. § 3.317(a)(1). To fulfill the requirement of chronicity, the illness must have persisted for six months. 38 U.S.C. § 1117, 38 C.F.R. § 3.317. Signs or symptoms which may be manifestations of undiagnosed illness include, but are not limited to: fatigue, signs or symptoms involving skin, headache, muscle pain, joint pain, neurologic signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper or lower), sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. 38 C.F.R. § 3.317(b). A medically unexplained chronic multi-symptom illness is defined by a cluster of signs or symptoms and specifically includes chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders (excluding structural gastrointestinal diseases), as well as any other illness that VA determines meets the criteria in paragraph 3.317(a)(2)(ii) of this section for a medically unexplained chronic multi-symptom illness. A medically unexplained chronic multi-symptom illness means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; Lynch v. McDonough, No. 2020-2067, 2021 U.S. App. LEXIS 37307, 37312 (Fed. Cir. Dec. 17, 2021) (benefit-of-the-doubt rule not for application when evidence persuasively favors one side or the other). Fatigue In considering the evidence of record under the laws and regulations as set forth above, the Board finds that the Veteran is not entitled to service connection for fatigue. During the June 2019 hearing, the Veteran contended that he developed fatigue during his 2011 deployment to Iraq as a result of manning and living near burn pits and ingesting harmful chemicals through his airways. See Bd. Hrg. Tr., p. 8. Initially, the Board notes that the Veteran has not been diagnosed with chronic fatigue syndrome at any time during the appeal period. For VA purposes, the diagnosis 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. There are no treatment records showing a diagnosis or treatment of chronic fatigue syndrome, and a February 2020 VA examiner specifically found that the Veteran did not meet the criteria for chronic fatigue syndrome. The Board has also considered the Veteran's claim more broadly as fatigue, but finds that fatigue did not manifest in service and is not otherwise related thereto. The Veteran's service treatment records are negative for any complaints, diagnosis, or treatment of fatigue. In a December 2011 post-deployment health assessment, the Veteran denied any exposures in Iraq, and the report documented no complaints of fatigue. During a May 2016 VA sleep apnea examination, the Veteran stated that he was not claiming fatigue or sleep disturbances as possibly due to environmental exposure from service in Southwest Asia, and he reported that they were symptoms of his service-connected posttraumatic stress disorder (PTSD). He noted that his fatigue was related to decreased sleep duration, as he typically only slept for three to three and one-half hours per night due to nightmares and hypervigilance. An April 2017 VA Gulf War examiner noted that the Veteran had no complaints of fatigue in service and that physical health assessments dated in 2011, 2012, 2013, and 2014 were negative for chronic medical conditions. She also indicated that a December 2011 post-deployment health assessment documented no complaints. The examiner further observed that the Veteran's initial physical examination at the Louisville VA Medical Center did not show any complaints of fatigue in 2016. The examiner stated that there was no diagnosed or undiagnosed chronic fatigue condition. In a February 2020 VA Disability Benefits Questionnaire (DBQ), the examiner indicated that the Veteran did not currently have chronic fatigue syndrome. In addition, he noted that the Veteran did not have, nor had he ever had any findings, signs, and symptoms attributable to chronic fatigue syndrome. The examiner stated that, based on his examination, the Veteran's testimony, and medical records review, the Veteran did not have any diagnosed chronic fatigue condition that could be classified as either a diagnosable chronic multi-symptom illness with a partially explainable etiology or a disease with a clear and specific etiology and diagnosis. Therefore, the examiner opined that it was less likely than not that the Veteran's claimed chronic fatigue syndrome was likely related to his military service, to include environmental exposures therein. The Board does acknowledge that the Veteran has occasionally complained of insomnia, fatigue, and chronic sleep impairment; however, the Veteran has been treated for nightmares and insomnia related to his service-connected PTSD. As the rating criteria for PTSD already contemplates sleep impairment, service connection for such fatigue would constitute pyramiding. The rating schedule generally prohibits pyramiding (evaluating the same disability under different diagnostic codes), and the United States Court of Appeals for Veterans Claims (Court) has held that pyramiding is disfavored "unless the regulation expressly provides otherwise." Cullen v. Shinseki, 24 Vet. App. 74, 84 (2010) and 38 C.F.R. § 4.14; see also Esteban v. Brown, 6 Vet. App. 259, 262 (1994) (separate evaluations may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not "duplicative of or overlapping with the symptomatology" of the other condition). There is no medical opinion otherwise indicating that the Veteran has fatigue that is not attributable to his PTSD and otherwise related to his military service. The Board has also considered the Veteran's lay statements regarding his fatigue. Although lay persons are competent to provide opinions on some medical issues, as to the specific issues in this case, the diagnosis and etiology of chronic fatigue syndrome falls outside the realm of common knowledge of a lay person, particularly in light of other disorders, such as sleep apnea and PTSD. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Indeed, 38 C.F.R. § 4.88a sets forth specific diagnostic criteria that must be met, including the exclusion, by history, physical examination, and laboratory tests, of all other clinical conditions that may produce similar symptoms. Moreover, even assuming the Veteran's lay assertions regarding a diagnosis or etiology are competent, the Board nevertheless finds the April 2017 and February 2020 VA examiners' opinions to be more probative, as they are based on a review of the record, an examination, and the examiners' own medical expertise, training, and knowledge. For the foregoing reasons, the Board finds that the claim for service connection for fatigue, to include as due to a qualifying chronic disability pursuant to 38 U.S.C. § 1117, must be denied. The evidence of record shows that the Veteran does not have chronic fatigue syndrome or any other fatigue that is related to his miliary service other than the symptoms that are already contemplated in the rating for his service-connected PTSD. Gastrointestinal Disorder In considering the evidence of record under the laws and regulations as set forth above, the Board finds that the Veteran is not entitled to service connection for a gastrointestinal disorder, to include irritable colon syndrome or constipation. During the June 2019 hearing, the Veteran contended that he developed constipation during his 2011 deployment to Iraq as a result of manning and living near burn pits and ingesting harmful chemicals through his airways. See Bd. Hrg. Tr., p. 11. However, he stated that he had been unable to get a physician to diagnose him with irritable colon syndrome. Id. The Veteran's service treatment records document one complaint of constipation in July 2011. It was noted that Veteran had reported that he had bowel movements every three to seven days and that he had some abdominal pain when constipated. An examination of the Veteran revealed a soft, non-tender abdomen. He was diagnosed with constipation and prescribed mag citrate for future use and recommended increased fiber. In a December 2011 post-deployment health assessment, the Veteran denied any exposures in Iraq, and the report documented no gastrointestinal complaints. An April 2017 VA Gulf War examination report examiner noted that the Veteran had no complaints of a digestive condition in service and that physical health assessments dated in 2011, 2012, 2013, and 2014 were negative for chronic medical conditions. She also indicated that a December 2011 post-deployment health assessment showed no complaints. The examiner further observed that the Veteran's initial physical examination at the Louisville VA Medical Center did not show any complaints of digestion problems in 2016. The examiner stated that there was no diagnosed or undiagnosed gastrointestinal condition. In a February 2020 VA DBQ, the examiner indicated that the Veteran did not currently have an intestinal condition. The examiner noted that the Veteran reported that he had issues with bowel movements and that he indicated that he could sometimes go for a week without bowel movements unless he took laxatives. The Veteran noted that he had not been tested by his providers and that no condition had been diagnosed. The examiner stated that, based upon his examination, the Veteran's testimony, and medical records review, the Veteran did not have any intestinal condition that could be classified as either a diagnosable chronic multi-symptom illness with a partially explainable etiology or a disease with a clear and specific etiology and diagnosis. He further indicated that no diagnosis was warranted based on the Veteran's medical history because the Veteran was not specific. Therefore, the examiner opined that the Veteran's claimed intestinal disorder was less likely than not causally or etiologically related to his military service, to include environmental exposures therein. There is no medical opinion otherwise indicating that the Veteran has a gastrointestinal disorder that is otherwise related to his military service. The Board has also considered the Veteran's lay statements regarding his gastrointestinal symptoms. Although lay persons are competent to provide opinions on some medical issues, as to the specific issues in this case, the diagnosis and etiology of irritable colon syndrome or another gastrointestinal disorder falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Moreover, even assuming the Veteran's lay assertions regarding a diagnosis or etiology are competent, the Board nevertheless finds the February 2020 VA examiner's opinion to be more probative, as it is based on a review of the record, an examination, and the examiner's own medical expertise, training, and knowledge. For the foregoing reasons, the Board finds that the claim for service connection for a gastrointestinal disorder, to include as due to a qualifying chronic disability pursuant to 38 U.S.C. § 1117, must be denied. The evidence of record shows that the Veteran does not have a gastrointestinal disorder that is related to his miliary service. Respiratory Disorder In considering the evidence of record under the laws and regulations as set forth above, the Board finds that the Veteran is not entitled to service connection for a respiratory disorder, to include pleurisy. During the June 2019 hearing, the Veteran contended that he developed respiratory problems and difficulty breathing late during his 2011 deployment to Iraq as a result of manning and living near burn pits and ingesting harmful chemicals through his airways. See Bd. Hrg. Tr., p. 20. Likewise, during a March 2015 VA PTSD examination, the Veteran reported that he believed that his lungs were damaged during his 2011 deployment to Iraq as a result of breathing the air from fire pits on base. The Veteran's service treatment records are negative for any complaints, diagnosis, or treatment of respiratory problems. In a December 2011 post-deployment health assessment, the Veteran denied any exposures in Iraq, and the report documented no respiratory complaints. In the March 2015 VA PTSD examination, the Veteran stated that he had trouble breathing deeply and that he has been unable to get a diagnosis confirmed by VA doctors. In a March 2016 VA pulmonary function test (PFT) report, the interpreting physician noted that the PFT results were not credible and did not reflect the Veteran's breathing capacity. The physician indicated that the Veteran had questionable or poor effort during testing, and it did not appear that he was blowing hard or fast enough. In a follow-on VA note, the pulmonary lab coordinator explained that the Veteran had trouble triggering the machine for flow loops, which was usually caused by not blowing fast enough. A May 2016 VA respiratory examiner noted that the Veteran did not have a current respiratory condition, nor had he ever been diagnosed with a past respiratory condition. During the examination, the Veteran reported that he initially complained of symptoms of shortness of breath to his VA provider in 2012 and that he had no treatment or testing. The examiner noted that the Veteran again mentioned his intermittent shortness of breath to his VA provider in 2016 and that he was referred for a PFT, which was non-diagnostic due to poor and questionable effort. X-rays showed no acute cardiopulmonary process. The examiner reported that there was no objective medical evidence at present to warrant a diagnosis of an acute or chronic respiratory condition. The examiner noted that a prior PFT was non-diagnostic due to poor or questionable effort and that a chest x-ray was normal. The examiner also indicated that the Veteran was not short of air during the VA examination or as noted during the PFT. The examiner opined that the Veteran's subjective report of shortness of breath symptoms do not represent an undiagnosed illness, as his PFT did not accurately refect his respiratory capacity. In a July 2016 VA primary care record, the Veteran complained of shortness of breath on exertion since December 2011. He stated that it started in Iraq while working in the burn pit. He described shortness of breath when walking across a parking lot or up a flight of stairs. He denied having chest pain. An examination showed no respiratory distress, and his oxygen saturation was 100 percent. His chest had good air entry. The diagnosis was chronic shortness of breath. During a September 2016 VA pulmonary consultation, the Veteran reported that he suffered from shortness of breath and dyspnea on exertion since his return from Iraq in 2011. He stated that his shortness of breath progressed enough in 2012 that he was unable to do cardio training, but he indicated that he has been able to continue weight training. He stated that, since his return from Iraq, he also had allergy symptoms. He further indicated that he had symptoms of near syncope, but he denied any chest pain or other cardiac symptoms. The pulmonologist noted that a past PFT showed mild obstruction and that an echocardiogram was within normal limits. The pulmonologist indicated that the Veteran's symptoms were mostly exertional, and the near syncope was concerning for a cardiac source of his shortness of breath and dyspnea on exertion. The pulmonologist noted that the Veteran had flat flow volume loops on his PFT, which may be a reason for his wheezing but did not explain his near syncope. The Veteran was prescribed an inhaled corticosteroid to see if there was improvement with his shortness of breath, dyspnea on exertion, and wheezing. In an October 2016 VA pulmonary consultation record, the Veteran stated that he had been becoming progressively more dyspneic with exertion. He had no history of asthma or reactive airway disease as a child. He reported exposure to sandstorms and burn pits in Iraq in 2011. The pulmonologist noted that the Veteran was previously trialed on an inhaled corticosteroid, which did not make any changes in his symptoms. He also indicated that the Veteran reported instability if he did not stand with his feet wide apart and dizziness with changing positions from sitting or lying down to standing. He was referred to neurology. In an October 2016 VA addendum following a neurology evaluation, a pulmonologist indicated that he had reviewed the Veteran's labs and imaging studies. He stated that the Veteran was having dyspnea with activity, chest pain, palpitation, and lightheadedness. He noted that the lightheadedness was reproducible with the neurologic examination. He also stated that the Veteran's symptoms were not likely pulmonary because his PFTs were normal and he did not improve with inhaled corticosteroids. In a December 2016 VA pulmonary record, the Veteran stated that he was a body builder and that he had decreased exercise capacity and wheezing when climbing stairs. He also reported episodes of near syncope. His oxygen saturation at rest was 99 percent, and his PFTs showed no obstruction or restriction. He had a normal cardiac stress test. The pulmonologist noted possible reactive airway disease, possible vocal cord dysfunction, possible bronchiolitis, and possible vasovagal syncope. He was referred to cardiology for a tilt table test, to ENT to check his vocal cords, and for a CT of the chest for possible bronchiolitis. During a January 2017 VA otolaryngology consultation, the Veteran complained of shortness of air with light exertion after he was deployed to Iraq and worked in the burn pits in 2011. He stated that he had noisy breathing with inhalation and exhalation. He reported that he felt like he had a hard time taking a breath into his lungs and that he had a chronic cough, which consisted of a coughing fit every other day. He also stated that he had intermittent hoarseness two to three times per week and some difficulty swallowing some foods. An examination of the Veteran's pharynx showed an anterior shelf in subglottis, which was concerning for subglottic stenosis. A CT of the Veteran's neck was ordered. The otolaryngologist noted that exercise-induced laryngoscopy may be considered. In March 2017, the Veteran reported to a VA emergency department for complaints of chest pain and shortness of air. He stated that he had chronic dull chest pain that had increased to a sharp, stabbing pain that worsened with breathing. Cardiovascular and pulmonary examinations were normal. His pain lessened, and he was discharged home. He was diagnosed with pleurisy and dehydration. The Veteran was encouraged to drink more fluids and to return to the pulmonary clinic. In March 2017, the Veteran returned to the VA emergency department less than one week later due to elevated creatine levels. He reported that he had continued intermittent chest and pleurisy pain. The nurse practitioner noted that the Veteran continued to take the medications that he was discharged with, but that he also took an extensive amount of vitamin supplements, protein powders, and fat burners with his workout regimen. An April 2017 VA Gulf War examiner noted that the Veteran had recently undergone an extensive cardiopulmonary workup for shortness of air complaints. She indicated that an echo, PFTs, a chest CT, a sleep study, a neck CT, a stress echo, and lab tests were all normal. During a September 2017 VA pulmonary evaluation, the Veteran reported that he had extensive exposure to burn pits and smoke in Afghanistan and that he developed dyspnea on exertion in Afghanistan. The Veteran indicated that he was a personal trainer at the gym and that he was now unable to do cardio for extended periods of time. He stated that he became short of breath on the elliptical, but he was able to do 18 minutes with varying degrees of resistance. The pulmonologist noted that the Veteran had undergone an extensive work-up, including an echocardiogram and a stress test, which were both negative. The pulmonologist stated that there was a disconnect between the Veteran's body habitus, his workout routine, and his complaints. The pulmonologist indicated that the Veteran is very physically fit and that he was able to do 18 minutes on the elliptical, but he still complained about dyspnea on exertion and shortness of breath. In a March 2018 VA medical opinion, the examiner noted that a review of the VA treatment records showed no diagnosis of asthma. She indicated that the Veteran was diagnosed with obstructive sleep apnea. The examiner also observed that the Veteran's service treatment records showed treatment for an upper respiratory infection in November 2009. The examiner opined that it was less likely than not that the Veteran had a diagnosis of a lung condition that was caused by or was incurred by an upper respiratory tract infection in service. However, the Board notes that the November 2009 treatment for an upper respiratory infection pre-dated the Veteran's period of active service in 2011. In addition, the examiner noted that, since service, the Veteran had not been found to have a pulmonary condition other than sleep apnea, which was diagnosed in November 2017 and at least five years after service. Therefore, she opined that service did not cause the Veteran's obstructive sleep apnea. Further, she noted that the Veteran had a negative VA sleep study in August 2016. In a February 2020 VA DBQ, the examiner noted that the Veteran did not have, nor had he ever had, a diagnosed respiratory condition. The examiner noted that the Veteran reported breathing issues since he returned from Iraq in 2012. The examiner indicated that the Veteran was in charge of burn pits where he was exposed to various chemical hazards. The examiner noted, however, that the Veteran had not been diagnosed with any specific respiratory condition and that he did not take medications. In an associated PFT, the findings were interpreted as normal, and there was no diagnosis due to poor effort. A chest x-ray showed also no acute pulmonary process. The examiner found that, based on his examination, the Veteran's testimony, and medical records review, the Veteran did not have any diagnosed pulmonary condition. He noted that, although the PFT had poor effort, not all findings require a diagnosis. However, there was no diagnosis because the findings were non-specific. He indicated that bronchodilator testing is only warranted for obstructive lung disease. The examiner also stated that the Veteran did not have a diagnosed pulmonary condition that could be classified as either a diagnosable multi-symptom illness with a partially explainable etiology or a disease with a clear and specific etiology and diagnosis. He noted that the Veteran's PFT showed non-specific mild restriction, but the Veteran's effort was poor and may have affected the result. Therefore, he opined that the claimed respiratory disorder was less likely than not incurred in or caused by service. There is no medical opinion otherwise indicating that the Veteran has a respiratory disorder that is otherwise related to his military service. The Board has also considered the Veteran's lay statements regarding his respiratory symptoms. Although lay persons are competent to provide opinions on some medical issues, as to the specific issues in this case, the diagnosis and etiology of a respiratory disorder falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Moreover, even assuming the Veteran's lay assertions regarding a diagnosis or etiology are competent, the Board nevertheless finds the February 2020 VA examiner's opinion to be more probative, as it is based on a review of the record, an examination, and the examiner's own medical expertise, training, and knowledge. For the foregoing reasons, the Board finds that the claim for service connection for a respiratory disorder, to include as due to a qualifying chronic disability pursuant to 38 U.S.C. § 1117, must be denied. The evidence of record shows that the Veteran does not have a respiratory disorder that is related to his miliary service. Scars In considering the evidence of record under the laws and regulations as set forth above, the Board finds that the Veteran is not entitled to service connection for scars of the trunk and extremities. During the June 2019 hearing, the Veteran contended that he developed scars from being blown up several times during his 2011 service in Iraq. He stated that pieces of concrete, metal, and sand caused lacerations and resulted in scars. See Bd. Hrg. Tr., p. 9. The Veteran's service treatment records are negative for any complaints, diagnosis, or treatment of any lacerations. In a December 2011 post-deployment health assessment, the report documented no complaints related to lacerations or scarring. In a February 2020 VA DBQ, the examiner noted that the Veteran had one scar on his right leg that measured 1 centimeter by 0.1 centimeter. The examiner indicated that the Veteran reported that he had RPG-related scars on his body from minor incidents in 2010. He stated that they were treated with first aid and healed well. He denied any problems with the scars on examination. The examiner opined that the scar was less likely than not incurred in or caused by service. The examiner noted that the Veteran did have a small scar on his right leg; however, a review of the service treatment records and deployment records did not show that the Veteran suffered any injury that could have resulted in that scar. There is no medical opinion otherwise indicating that the Veteran has scars that are otherwise related to his military service. The Board has also considered the Veteran's lay statements and photographs that he submitted in March 2018 regarding his scars. However, the photographs did not show the etiology of the scars. Moreover, the Board nevertheless finds the February 2020 VA examiner's opinion to be more probative, as it is based on a review of the record, an examination, and the examiner's own medical expertise, training, and knowledge. For the foregoing reasons, the Board finds that the claim for service connection for scars of the trunk and extremities must be denied. The evidence of record shows that the Veteran does not have scars that are related to his miliary service. J.W. ZISSIMOS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Osegueda, 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.