Citation Nr: 23055165 Decision Date: 10/05/23 Archive Date: 10/05/23 DOCKET NO. 17-66 260 DATE: October 5, 2023 ORDER Entitlement to service connection for a back disability is denied. Entitlement to service connection for sciatica is denied. Entitlement to service connection for acid reflux is denied. Entitlement to service connection for diabetes mellitus is denied. Entitlement to service connection for an acquired psychiatric disability is denied. FINDINGS OF FACT 1. A back disability was not noted during military service or manifest within one year of separation from military service; a continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 2. Sciatica was not noted during military service or manifest within one year of separation from military service; a continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease, or caused or aggravated by a service-connected disability. 3. The appellant does not have acid reflux which was incurred in or is otherwise causally related to his active service. 4. The evidence of record contains no indication that diabetes mellitus, type II, was present during service, manifest to a compensable degree within one year of separation, or that any current diabetes mellitus, type II, or pre-diabetes, may be associated with an in-service injury or disease. 5. A psychiatric disability was not noted during the appellant's active service or manifest to a compensable degree within the first post-service year; and the most probative evidence indicates that the appellant does not currently have any acquired psychiatric disability which is causally related to an in-service disease or injury, or caused or aggravated by a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for a back disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for sciatica have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 3. The criteria for service connection for acid reflux have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant served on active duty in the United States Army from July 1976 to July 1979. This matter comes before the Board of Veterans' Appeals (Board) from a September 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) which, in pertinent part, determined that new and material evidence had not been received to reopen a previously denied claim of service connection for arthritis of the back (previously claimed as spinal surgery and back pain), and denied service connection for sciatica, acid reflux, diabetes mellitus, and mental illness with depression and bipolar disorder. The appellant filed a timely Notice of Disagreement (NOD), received in October 2015. A Statement of the Case (SOC) was issued in October 2017. A timely substantive appeal was received in December 2017 The appellant was afforded a virtual hearing before the undersigned Veterans Law Judge (VLJ) in August 2021. A transcript is of record. In February 2022, the Board, in pertinent part, reopened the previously denied claim of service connection for a back disability and remanded that claim, as well as the additional claims set forth above, for additional development. Following completion of the ordered development, the RO issued a Supplemental Statement of the Case (SSOC) in January 2023. Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty from active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that which is pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). "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." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (citing Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection for certain chronic diseases, including arthritis, diabetes mellitus, psychoses, and other organic diseases of the nervous system, such as peripheral neuropathy, may also be established on a presumptive basis by showing that such a disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307(a) (3), 3.309(a). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307(a). To establish service connection under this provision, there must be: evidence of a chronic disease shown as such in service (or within an applicable presumptive period under 38 C.F.R. § 3.307), and subsequent manifestations of the same chronic disease; or if the fact of chronicity in service is not adequately supported, by evidence of continuity of symptomatology after service. The provisions of 38 C.F.R. § 3.303(b) relating to continuity of symptomatology, however, can be applied only in cases involving those conditions explicitly enumerated under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may be granted for a disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). Additional disability resulting from the aggravation of a nonservice-connected disability by a service-connected disability is also compensable under 38 C.F.R. § 3.310(a). Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). 1. Entitlement to service connection for a back disability. 2. Entitlement to service connection for sciatica. For the reasons that follow, service connection for a back disability and/or sciatica is not warranted. Service treatment records reveal that, in February 1977, the appellant was seen for viral gastritis. In March 1977, he was seen for swelling and pain to palpation in the right pectoral muscle. There had been no trauma. The assessment was gynecomastia. He was also seen for a chest cold with sore throat that month. In April 1977, the appellant was seen for a possible right middle finger sprain, in addition to bilateral foot soreness from movement. He complained of a stiff neck in May 1977, at which time was assessed as an acute muscle sprain. In September 1977, the appellant sprained his right ankle during a basketball game. He complained of foot pain in March 1978, which had been off and on for four months. In August 1978, the appellant complained of colds, headaches, and neck pain. The assessment was flu syndrome. In October 1978, he was seen for left thigh pain which had been present for three months. The assessment was muscle spasms. In November 1978, the appellant complained of three months of left leg soreness. X-ray was negative. He was subsequently assessed with a hamstring strain. He was seen again for left hamstring complaints in December 1978. In March 1978 and May 1979, the appellant denied sugar diabetes on a dental medical history form. In May 1979, the appellant was seen for complaints of a pulled upper left femur muscle and sore throat. That month, he also complained of chest pain (heart area) with deep breaths or exercise. Examination revealed no abnormalities, however. In June 1979, he complained of stomach cramps. The appellant's April 1979 separation examination was within normal limits. The spine, musculoskeletal, mouth and throat, abdomen and viscera, psychiatric, neurologic, and endocrine systems were examined and found to be normal. Urinalysis was negative for sugar or albumin. He was qualified for separation. On the accompanying Report of Medical History, the appellant stated that he was in great health. He denied having, or having had, swollen or painful joints, pain or pressure in chest, chronic cough, frequent indigestion, stomach/liver/intestinal trouble, broken bones, frequent or painful urination, sugar or albumin in urine, arthritis/rheumatism/bursitis, bone/joint/other deformity, lameness, recurrent back pain, neuritis, frequent trouble sleeping, depression or excessive worry, or nervous trouble of any sort. The appellant subsequently certified that there had been no change in his medical condition in July 1979. The appellant's service personnel records reflect that his primary military occupational specialty was Infantry Indirect Fire Crewman. His assignments included light vehicle driver, ammo bearer, and assistant gunner. He completed basic training and Advanced Individual Training. This records contain no indication of airborne or parachute training or duties. In a December 2010 statement, the appellant reported that he injured his back multiple times in service, from all of the bending, jumping, lifting, and other physical tasks he had to complete. He also stated that he incurred a pinched nerve in the left hamstring. A March 2014 medical statement of J.M., a VA clinician, is of record. Such states that the appellant's low back pain, status post 1993 laminectomy, had a poor prognosis. Additionally, it was noted that back pain started while the appellant served in the infantry, which included jumping out of aircraft. The appellant was afforded a contracted back examination in November 2014. The claims file was reviewed. Following examination of the appellant and review of the claims file, degenerative osteoarthropathy with right lumbar radiculitis was diagnosed. The appellant reported that his back pain began in 1977 with repetitive, high-impact physical training exercises and heavy lifting and loading associated with his job working in the mortar platoon. He denied any history of traumatic spinal injuries. Over the years, the back pain recurred with greater frequency and intensity as the appellant worked almost two decades in a concrete construction job, aged, became more physically deconditioned, and gained weight. His pain increased and began to radiate down the legs by the early 1990s. He subsequently underwent a lumbar laminectomy in 1993. His radicular pain resolved. By 2010, his back pain began to increase again and the radiating pin returned to the right leg. He endorsed a continuity of symptomatology in the form of intermittent, recurring back pain, with an increasing frequency of recurrences over the years. The clinician offered a negative opinion on the basis that the appellant's degenerative lumbar joint disease with radiculitis was not related to any remote back or hamstring strains, as such would have resolved decades ago. His current disability was due to decades of working heavy labor after separation, aging, gradual physical deconditioning, and weight gain. Received in October 2015 was a statement from the appellant, in which he disagreed with the negative opinion regarding his back and sciatica. He contended that he was not checked for arthritis in service and, similar to NFL players being diagnosed with brain damage well after retirement, this meant his reported in-service activities caused the subsequent development of arthritis even if examinations during service were normal. He emphasized that the work he was doing in service was physically grueling and caused a high degree of stress, resulting in the development of a psychiatric disability, in addition to musculoskeletal and neurologic disabilities. He expanded on these contentions on his October 2015 NOD, noting that his job entailed a lot of walking, bending, lifting, running, jumping, crawling, climbing, swimming, and hearing. This was both physically and mentally stressful. He stated that going to sick call was a privilege, not a right, so he did not get any time off to heal from his injuries properly. He noted that he was taught to enjoy pain and ask for more of it. An April 2017 VA clinical note states that the appellant had experienced low back pain since 1978 while serving in the infantry. He was noted to have undergone a lumbar laminectomy in 1973, which appears to be a typographical error as the other clinical and lay evidence of record indicates that the surgery occurred after service, specifically in 1993. During the August 2021 hearing before the undersigned, the appellant testified that he first received VA treatment in 1980 or 1981. He attributed his current back disability to physical tasks in service, including jumping, running, bending, "shooting it up and down," playing war games, and trying to sleep on the ground. Received in December 2022 was a copy of a May 2016 letter from a VA physician, who had been the appellant's primary care provider since July 2012. The physician opined that it was at least as likely as not that the appellant's degenerative disc disease was caused by repetitive high-impact maneuvers during active service. This was based on the appellant reporting his first back injury in 1976, followed by a motor vehicle accident and a 1993 laminectomy. Also received in December 2022 was a copy of the report of a November 1989 VA imaging study of the low back. It was noted that the appellant had a six-week history of persistent low back pain with right sciatic radiation, accompanied by urinary urgency, frequency, and nocturia. The impression was mild levoscoliosis either idiopathic or secondary to right paraspinal muscle spasms, and mild left unilateral pseudo arthritis between the lateral mass of L5 with opposing S1, with the spine and SI joints otherwise normal. The service treatment records show that arthritis of the back or sciatica was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. Although the appellant now recalls that his back pain began during active duty, the Board finds that the appellant's reports of symptoms are not credible. They are inconsistent with his contemporaneous denials of pertinent complaints at separation and the objectively normal medical examination at that time. The Board has considered the appellant's contentions to the effect that he did not seek treatment for back pain because going to sick call was a privilege, not a right, but finds that this is not credible as the appellant was seen during service for multiple complaints but these did not include back pain. While the absence of evidence does not by itself warrant a negative inference, if the appellant had indeed experienced back symptoms while on active duty, as he now contends, the Board finds that he would have reported such during his numerous visits for medical treatment during active service when he sought treatment for a wide range of complaints, including gastritis, sore throat, right middle finger sprain, acute neck sprain, right ankle injury, flu, left leg muscle spasms, left hamstring, and left femur, as detailed above. The appellant's contentions that he did not seek treatment for reported injuries because the military discouraged reporting injuries, are not credible, given that he sought treatment on multiple occasions as delineated above. Further, the objective medical examination at separation was essentially normal and negative for any pertinent symptoms. Finally, at separation, the appellant personally denied having or ever having had pertinent history such as recurrent back pain. As such, the Board finds the appellant's lay contentions are not credible. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (citing Fed. R. Evid. 803 (7) for the proposition that "the absence of an entry in a record may be evidence against the existence of a fact if it would ordinarily be recorded"); see also Kahana v. Shinseki, 24 Vet. App. 428, 438-41 (2011) (Lance, J., concurring) (discussing the distinction between cases in which there is a complete absence of any evidence to corroborate or contradict the testimony, as opposed to cases in which there is evidence that is relevant either because it speaks directly to the issue or allows the Board, as factfinder, to draw a reasonable inference). As delineated above, the appellant sought, and received, medical treatment for numerous complaints during his active service. The objective, officially-created service treatment records outweigh the appellant's recent contentions that he had continuing symptoms during and since service, but was discouraged from seeking treatment at sick call, made in the context of a claim for monetary benefits. As noted above, the appellant sought VA medical treatment in November 1989 for what he described as six weeks of persistent low back pain with right sciatic radiation and urinary urgency, frequency, and nocturia. The Board notes that statements made to medical providers solely for treatment purposes are inherently more credible than those made in conjunction with a claim for disability compensation benefit. See Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care); see also Buchanan v. Nicholson, 451 F.3d at 1331 (lack of contemporaneous medical records does not, in and of itself, render lay testimony not credible). Although McLendon v. Nicholson, 20 Vet. App. 79 (2006), was triggered in the Board's February 2022 reopening of the previously denied back disability claim, it was the result of the presumption that the appellant's lay contentions were credible, as required under Justus v. Principi, 3 Vet. App. 510, 513 (1992). This presumption is limited to the question of whether a previously denied claim should be reopened. Now addressing the issue of service connection on the merits, the Board finds that the evidence is persuasively against the appellant's lay contentions being credible. As such, the Board will not remand this matter for an additional examination or medical opinion. In any event, the RO already afforded the appellant an examination and obtained a medical opinion in the development of the instant appeal. The Board further finds that the evidence of record persuasively weighs against finding that a medical nexus exists between the Veteran's current back disability and sciatica and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. The Board finds the November 2014 contracted examiner's opinion highly probative because it was based on a clinical examination of the appellant, a review of the claims file, consideration of the relevant medical history, and the opinion was accompanied by a detailed rationale and is consistent with the probative evidence of record. The March 2014 and May 2016 opinions are based in large part upon the appellant's lay-provided history. The Board notes that mere transcription of lay history as reported by a veteran, unenhanced by any additional comment by that examiner, does not become competent medical evidence merely because the transcriber is a medical professional. See LeShore v. Brown, Vet. App. 406, 409 (1995). Additionally, neither opinion was supported by a rationale. There is no indication that either clinician reviewed the claims file, in particular the service treatment records, which reveal that the appellant was examined and found to be normal at separation and the appellant himself denied pertinent symptomatology. Additionally, as explained above, the Board has found the appellant's recent recollections, made in the context of a claim for monetary benefits, to not be credible. To the extent the appellant asserts that the reported symptoms in service were manifestations of his current back disability with sciatica, he is not competent to determine that these symptoms were manifestations of arthritis or an organic disease of the nervous system as the appellant has not demonstrated the necessary medical expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Although the appellant argues that his current disabilities are the result of the strenuous activities he performed while on active duty, he is not competent to provide a nexus opinion in this case. Consequently, the Board gives more probative weight to the competent medical evidence. As service connection for a back disability has been denied, service connection on a secondary or aggravation basis for sciatica is not for application. 38 C.F.R. § 3.310. As the evidence is not in approximate balance and is persuasively against the appellant's contentions, the benefit of the doubt rule is inapplicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 3. Entitlement to service connection for acid reflux. For the reasons that follow, service connection for acid reflux is not warranted. Service treatment records reveal that, in February 1977, the appellant was seen for viral gastritis. In June 1979, he complained of stomach cramps. No complaints or findings of acid reflux were noted on either occasion. The appellant's April 1979 separation examination was within normal limits. The appellant's mouth and throat, abdomen and viscera were examined and found to be normal. On the accompanying Report of Medical History, the appellant stated that he was in great health. He denied having, or having had, pain or pressure in his chest, chronic cough, frequent indigestion, or stomach/liver/intestinal trouble. The appellant subsequently certified that there had been no change in his medical condition in July 1979. In a statement received in December 2017, the appellant described a tight, painful feeling in the chest. During the August 2021 hearing before the undersigned, the appellant contended that his acid reflux was the result of being exposed to gas during training, performing physical activities, and eating dinner in the morning and breakfast in the night and staying up all night. He testified that he experienced burning sensations, or heartburn, after eating, in service. He also endorsed chest pains and hoarseness. He was pressured not to go to sick call and was trained to enjoy pain. He had the symptoms after service as well. The Board finds that the appellant's reports of in-service symptoms are not credible. They are inconsistent with his contemporaneous denials of pertinent complaints at separation and the objectively normal medical examination at that time. Additionally, there is no evidence, other than the appellant's lay contentions, made decades after the fact and in the context of a claim for monetary benefits, in support of an in-service injury or disease. While the absence of evidence does not by itself warrant a negative inference, if the appellant had indeed experienced acid reflux/digestive symptoms while on active duty, as he now contends, the Board finds that he would have reported such during his numerous visits for medical treatment during active service when he sought treatment for a wide range of complaints, including gastritis, sore throat, right middle finger sprain, acute neck sprain, right ankle injury, flu, left leg muscle spasms, left hamstring, and left femur, as detailed above. The appellant's contentions that he did not seek treatment for reported injuries because the military discouraged reporting injuries, are not credible, given that he sought treatment on multiple occasions as delineated above. Further, the objective medical examination at separation was essentially normal and negative for any pertinent symptoms. The appellant personally denied pertinent history or complaints at that time. As delineated above, the appellant sought, and received, medical treatment for numerous complaints during his active service. The objective, officially-created service treatment records heavily outweigh the appellant's recent contentions that he had continuing symptoms during and since service, but was discouraged from seeking treatment at sick call. The Board thus finds that the appellant's lay contentions are not credible. Buczynski, supra; Kahana, supra. A mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). Therefore, the Board finds that a medical opinion regarding service connection is not necessary to decide the claim. Rather, there is sufficient medical evidence upon which to base a decision. See Locklear v. Nicholson, 20 Vet. App. 410 (2006). As the evidence is not in approximate balance and is persuasively against the appellant's contentions, the benefit of the doubt rule is inapplicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 4. Entitlement to service connection for diabetes mellitus. For the reasons that follow, service connection for diabetes mellitus is not warranted. Service treatment records are entirely negative for complaints or findings of diabetes. In March 1978 and May 1979, the appellant denied sugar diabetes on a dental medical history form. The appellant's April 1979 separation examination was within normal limits. The appellant's endocrine system was examined and found to be normal. Urinalysis was negative for sugar or albumin. Additionally, on the accompanying Report of Medical History, the appellant stated that he was in great health. He denied having, or having had, frequent urination or sugar or albumin in urine. In a statement received in December 2017, the appellant stated that his service records did not show diabetes mellitus is because they did not test him for such at entry and did not perform a separation examination. He stated that he could have had it all of his life, but it was never checked. During the August 2021 hearing before the undersigned, the appellant testified that he participated in VA research in 2005, when he was noted to be 0.1 point away from being diabetic. He was placed on vitamin D and had been taking it for the past 18 or 19 years. During service, he endorsed increased thirst, increased urination frequency, unexplained weight loss, fatigue, and irritability. He also indicated that he had previously been told his glucose levels were elevated but he was not treated for such. He indicated that he had not been treated or tested for diabetes since being placed on vitamin D. In May 2022, the appellant called VA asking to remove his contention of diabetes from his claim based upon an April 2022 blood test. In a January 2023 letter, it was explained to the appellant that this could not be accepted as a withdrawal of the claim because withdrawals need to be in writing. As set forth above, the service treatment records reflect that diabetes mellitus was not present during service. There is no indication, nor is it contended, that diabetes mellitus manifest to a compensable degree within one year of separation; and continuity of symptomatology is not established. 38 C.F.R. §§ 3.307, 3.309. There is no indication, aside from the appellant's lay contentions, that any current diabetes mellitus type II may have been incurred in or otherwise causally related to active service. The Board has considered the appellant's statements that he was not tested for diabetes during active duty so he may have had diabetes in service. As delineated above, however, the service treatment records show that a urinalysis was negative for sugar or albumin at separation; and the appellant denied sugar or albumin in the urine on his separation Report of Medical History. The Board has considered the appellant's statements to the effect that he experienced symptoms such as frequent urination during active duty. To the extent the appellant contends that any in-service symptoms were indicative of the onset of diabetes, the Board finds such contentions are not competent. A mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). Therefore, the Board finds that a medical opinion regarding service connection is not necessary to decide the claim. Rather, there is sufficient medical evidence upon which to base a decision. See Locklear v. Nicholson, 20 Vet. App. 410 (2006). In fact, there is no competent evidence of a current diagnosis of diabetes mellitus. As delineated above, the appellant has been assessed with pre-diabetes. The appellant indicated this himself when he contacted VA in May 2022. Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C. § 1131. Thus, where the collective lay and medical evidence indicates that, fundamentally, the appellant does not have a current disability for which service connection is sought, there can be no valid claim for service connection. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Gilpin v. West, 155 F.3d 1353, 1356 (Fed. Cir. 1998). The Board notes that "disability" as defined in 38 U.S.C. §§ 1110 and 1131 refers to the functional impairment of earning capacity, not the underlying cause of said disability, and that pain alone can reach the level of a functional impairment of earning capacity. Saunders v. Wilkie, 866 F.3d 1356 (2018). In this case, however, there is no indication, nor is it contended, that the appellant experiences any symptoms of diabetes mellitus, or pre-diabetes, which cause a functional impairment in earning capacity. In summary, the Board finds that the most probative evidence shows that the appellant does not currently have sdiabetes mellitus and the record contains no indication that any currently claimed diabetes mellitus, or pre-diabetes, was incurred in active service or is otherwise causally related to active service. Thus, the claim of service connection must be denied at this time. See 38 C.F.R. §§ 3.102, 3.303; McClain v. Nicholson, 21 Vet. App. 319 (2007) (the requirement that a current disability be present is satisfied "when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim... even though the disability resolves prior to the Secretary's adjudication of the claim."); Brammer, supra. As the evidence is not in approximate balance and is persuasively against the appellant's contentions, the benefit of the doubt rule is inapplicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 5. Entitlement to service connection for an acquired psychiatric disability. For the reasons that follow, service connection for an acquired psychiatric disorder is not warranted. Service treatment records are entirely negative for complaints or findings of a psychiatric disability or symptoms. The appellant's April 1979 separation examination was within normal limits. His psychiatric system was examined and found to be normal. On the accompanying Report of Medical History, the appellant stated that he was in great health. He denied having, or having had, frequent trouble sleeping, depression or excessive worry, or nervous trouble of any sort. The appellant subsequently certified that there had been no change in his medical condition in July 1979. In a December 2010 statement, the appellant contended that the Army drove him to mental illness because he was court-martialed for something that was the fault of a platoon mate. Received in October 2015 was a statement from the appellant, in which he emphasized that the work he was doing in service was physically grueling and caused a high degree of stress, resulting in the development of a psychiatric disability. He described his nerves as "shot to pieces." He expanded on these contentions on his October 2015 NOD, noting that his job entailed a lot of walking, bending, lifting, running, jumping, crawling, climbing, swimming, and hearing. This was both physically and mentally stressful. During the August 2021 hearing before the undersigned, the appellant testified that VA hospital personnel told him that his inability to hear was what caused his PTSD. The appellant testified that he first sought treatment in or about 2005 for his mental health, and after six to seven years, the appropriate medication was found to treat his symptoms. He later contended that it was his tinnitus that caused him to develop PTSD. As set forth above, the service treatment records reflect that a psychiatric disability did not have its onset in service. No psychiatric disability or symptoms were noted during service, psychiatric evaluation at separation was normal, and the appellant denied having or ever having had psychiatric symptoms at that time. There is no indication, nor is it contended, that a psychosis was noted as chronic in service, manifest to a compensable degree within one year of separation; and continuity of symptomatology has not been established. 38 C.F.R. §§ 3.307, 3.309. Additionally, the Board finds that the record contains no indication that any current psychiatric disability is causally related to an in-service disease or injury or to a service-connected disability. The Board has considered the appellant's contentions to the effect that his in-service duties were stressful and that the Army drove him to mental illness because he was court-martialed for something that was the fault of a platoon mate. The Board observes that the appellant was disciplined under the provisions of Article 15, Uniform Code of Military Justice (UCMJ), in June 1979 for concealing stolen property and being an accessory after the fact. For this misconduct, he received a reduction in grade to E-1, forfeiture of $209 per month for two months, extra duty for 45 days, and restriction of movement for 45 days. The appellant requested the punishment be set aside in April 1983, but his request was denied by the Board for Correction of Military Records. The appellant has contended that his Fourth Amendment rights were violated by the search which turned up the stolen property and that being punished for something he did not do caused him to develop mental illness. See e.g. December 2010 statement. Questions of credibility notwithstanding, the Board notes that it was determined that the appellant's behavior, which merited the punishment, was misconduct. 38 C.F.R. § 3.1(m), (n). There is no indication, nor is it contended, that the appellant was insane at the time of the offense. In any event, the appellant is not competent to provide an opinion that the in-service court martial or the stressful nature of his duties led to his current psychiatric disability, as he lacks the necessary medical expertise. A mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). Therefore, the Board finds that a VA medical opinion regarding service connection is not necessary to decide the claims. Rather, there is sufficient medical evidence upon which to base a decision. See Locklear v. Nicholson, 20 Vet. App. 410 (2006). While the appellant testified in August 2021 that VA medical personnel told him that his hearing loss was the cause of his psychiatric disability, the Board finds that such statements are not credible. The record on appeal contains clinical records spanning several decades, many of which describe mental health diagnoses and treatment, yet none of these records contains any indication that the appellant's current psychiatric disability is associated with his hearing loss. Rather, these records show that in November 2005, the appellant was noted to have an 18 year history of cocaine dependence. Mental health problems associated with such use included depression, anxiety, mania, and impulse control. Subsequent clinical records include notations of continued mental health treatment, but none attribute the current disabilities to an in-service disease, injury or event or date the onset of the disabilities to service. In that regard, a December 2020 VA clinical note states that the appellant reported that he witnessed the death of comrades when a plane exploded in service. However, he denied it negatively affecting him at present and indicated that he did not think about it often. He also noted that he was court-martialed for holding stolen property on behalf of another. During that evaluation, the examiner noted that although the appellant reported a prior diagnosis of posttraumatic stress disorder (PTSD) by history, he did not exhibit any overt symptoms of PTSD. A diagnosis of unspecified depressive disorder was noted, as well as rule out stimulant use disorder (cocaine), likely in sustained remission. The clinician did not attribute the appellant's current disability to service or to a service-connected disability. (Continued on the next page) ? The Board has considered the appellant's lay history of symptomatology related to his claimed disorder throughout the appeal period. He is competent to report such symptoms and observations because this requires only personal knowledge as it comes through an individual's senses. Layno v. Brown, 6 Vet. App. 465, 470 (1994). The appellant in this case is not competent to determine the cause of his symptoms because it would involve medical inquiry into biological processes, anatomical relationships, and physiological functioning. Such internal physical processes are not readily observable and are not within the competence of the appellant in this case, who has not been shown by the evidence of record to have medical training or skills. As the evidence is not in approximate balance and is persuasively against the appellant's contentions, the benefit of the doubt rule is inapplicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). K. Conner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Behlen, 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.