Citation Nr: A25035588 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 240827-468052 DATE: April 17, 2025 ISSUES 1. Entitlement to an earlier effective date, earlier than March 7, 2024 for the award of service connection for tinnitus. 2. Entitlement to service connection for bilateral hearing loss disability. 3. Entitlement to service for gastroesophageal reflux disease (GERD). 4. Entitlement to service connection for hypothyroidism. 5. Entitlement to service connection for a neck disability. 6. Entitlement to service connection for post-traumatic stress disorder (PTSD). 7. Entitlement to service connection for an acquired psychiatric disorder to include anxiety and depression. 8. Entitlement to service for degenerative disc disease of the lumbosacral spine. 9. Entitlement to service connection for osteoarthritis (hands, elbows, shoulders, knees and hips). ORDER Entitlement to an earlier effective date of September 23, 2020 service connection for tinnitus is granted, subject to the laws and regulations governing the payment of monetary benefits. Entitlement to service connection for bilateral hearing loss disability is denied. Entitlement to service for gastroesophageal reflux disease (GERD) is denied. Entitlement to service connection for hypothyroidism is denied. Entitlement to service connection for a neck disability is denied. Entitlement to service connection for post-traumatic stress disorder (PTSD) is denied. Entitlement to service connection for an acquired psychiatric disorder to include anxiety and depression is denied. REMANDED Entitlement to service for degenerative disc disease of the lumbosacral spine is remanded. Entitlement to service connection for osteoarthritis (hands, elbows, shoulders, knees and hips) is remanded. FINDINGS OF FACT 1. A claim for service connection for tinnitus was reasonably raised by the record at the time of the June 2021 Regional Office (RO) rating decision. 2. The claim for service connection for tinnitus remained pending until the July 2024 rating decision. 3. The Veteran's bilateral hearing loss disability was not shown as chronic during service and did not manifest to a compensable degree within one year after service; there was no continuity of symptomatology; and the evidence does not establish a relationship between the Veteran's hearing loss and active duty. 4. The persuasive evidence of record is against a finding that the Veteran's current gastroesophageal disease reflux disease (GERD) is related to his service. 5. The persuasive evidence of record is against a finding that the Veteran's hypothyroidism began during active service or within one year of service, or is otherwise related to an in-service injury or disease. 6. The persuasive evidence of record is against a finding that the Veteran's claimed neck disability first incurred in service, within a year of service, or is otherwise the result of active service. 7. The Veteran does not have a diagnosis of PTSD. 8. An acquired psychiatric disability, to include depression and anxiety, is not shown to be causally or etiologically related to any disease, injury, or incident in service, did not manifest within one year of service discharge, and was not caused or aggravated by a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to an earlier effective date of September 23, 2020 for service connection for tinnitus have been met. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. 2. The criteria for entitlement to service connection for bilateral sensorineural hearing loss have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385. 3. The criteria for service connection for gastroesophageal disease (GERD) have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 1116A, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for hypothyroidism have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 1116A, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for a neck disability have not been met. 38 U.S.C. §§ 1110, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 6. The criteria for entitlement to service connection for post-traumatic stress disorder (PTSD) have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 4.125. 7. The criteria for service connection for an acquired psychiatric disorder, to include anxiety and depression have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 26, 1963 to June 23, 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from June 2024 and July 2024 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). The June 2024 rating decisions denied service connection for (1) an acquired psychiatric disorder to include anxiety and depression; (2) post-traumatic stress disorder (PTSD); (3) neck condition; (4) degenerative disc disease lumbosacral spine; 4) bilateral hearing loss; (6) osteoarthritis (hands, elbows, shoulders, knees, hips); and (7) hypothyroidism. The June 2024 rating decision also determined that new and relevant evidence had been received to reopen the Veteran's previously denied claims for bilateral hearing loss, degenerative disc disease lumbosacral spine, osteoarthritis (hands, elbows, shoulders, knees, hips), and hypothyroidism and readjudicated these issues on the merits. These are favorable findings by the AOJ and the Board of Veterans' Appeals (Board) will proceed to the address the claims on the merits. See 38 U.S.C. § 5104A; 38 C.F.R. § 3.104(c). The July 2024 granted service connection for tinnitus, with an effective date of March 7, 2024, and denied service connection for GERD. The Veteran appealed the June 2024 and July 2024 rating decisions to the extent that they denied the Veteran's service connection claims. The Veteran appealed the July 2024 rating decision that awarded service connection for tinnitus with respect to the effective date assigned. The Veteran elected the Board Hearing docket. See August 27, 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement). Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90-days following the hearing. 38 C.F.R. § 20.302(a). The Veteran testified at a video conference virtual hearing before the undersigned Veterans Law Judge in November 2024. A transcript of this hearing has been associated with the record. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. Significantly, if evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision.38 C.F.R. § 20.300. If the Veteran would like VA to consider any evidence that was added to the claims file that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. This appeal has been advanced this appeal on the Board's docket pursuant to 38 C.F.R. § 20.900(c); 38 U.S.C. §7107 (a)(2). The Board discussion below will begin with (1) the Veteran's earlier effective date claim for tinnitus, followed by his entitlement to service connection claims for (2) bilateral hearing loss; (3) GERD; (4) hypothyroidism; (5) a neck disability; (6) PTSD and (7) an acquired psychiatric disorder (anxiety and depression). The Veteran's entitlement to service connection claims for a lumbar spine disability and osteoarthritis (hands, elbows, shoulders, knees and hips), are remanded to the AOJ to correct pre-decisional duty to assist errors. 38 C.F.R. § 20.802 (a). Entitlement to an earlier effective date, earlier than March 7, 2024 for the award of service connection for tinnitus. The Veteran was granted service connection for tinnitus in a July 2024 rating decision effective March 7, 2024. He contends he is entitled to an earlier effective. Generally, the effective date of an award of disability compensation based on an original claim for direct service connection is the day following separation from active service or the date entitlement arose if a claim is received within one year after separation from service. Otherwise, the effective date is the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (b)(1); 38 C.F.R. § 3.400 (b)(2)(i). VA amended its adjudication regulations on March 24, 2015 to require that all claims governed by VA's adjudication regulations be filed on standard forms prescribed by the Secretary, regardless of the type of claim or posture in which the claim arises. See 79 Fed. Reg. 57660 (Sept. 25, 2014). The amendments are effective for claims and appeals filed on or after March 24, 2015. As the claim in this case was filed after that date, the amendments are applicable in this instance and only the regulations in effect after March 24, 2015, will be applied. In Vandaveer v. Shinseki, No. 11-3144, 2012 WL 4097198 (U.S. Vet. App. Sept. 19, 2012) (mem. dec.), the United States Court of Appeals for Veterans Claims (Court) reasoned that although tinnitus and hearing loss are different diseases, lay witnesses are not expected to have the legal or medical knowledge to precisely identify the disability for which they are claiming compensation. Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain). In Vandaveer, the Court applied the reasoning of Clemons v. Shinseki, 23 Vet. App. 1 (2009) to hold that VA had in 1971 failed to properly adjudicate a claim for service connection for tinnitus in addition to the explicitly claimed service connection for hearing loss, and that the Board's determination to the contrary was clearly erroneous. Similarly, in this case, the Veteran is not expected to have the legal or medical knowledge to distinguish his hearing loss and tinnitus or precisely explain the medical symptoms for which he intended to claim compensation. Next, pursuant to the implicit denial doctrine, a claim for benefits can be deemed to have been denied, and thus finally adjudicated, even if VA did not expressly address that claim in its decision. Cogburn v. Shinseki, 24 Vet. App. 205, 210 (2010) (citing Adams v. Shinseki, 568 F.3d 956, 961 (Fed. Cir. 2009)). A reasonably raised claim remains pending until there is either a recognition of the substance of the claim in a decision from which a claimant could deduce that the claim was adjudicated or an explicit adjudication of a subsequent claim for the same disability. Ingram v. Nicholson, 21 Vet. App. 232, 243 (2007). Turning to the evidence: The Veteran filed a claim for bilateral hearing loss that was received by VA on September 23, 2020. A VA examination was conducted in January 2021. The report states that the examination was for an original claim for "hearing loss and/or tinnitus." The report contained a question whether tinnitus was present, which was answered in the affirmative. The Veteran reported it was intermittent, and that although he could not localize ringing but reports that it usually happens in the morning while in the bathroom, lasting about five to ten minutes. The examiner reported the Veteran was unable to recall the specific circumstances of tinnitus onset, but noted the date of onset, 10-15 years ago. The examiner noted that the Veteran has a diagnosis of clinical hearing loss, and his or her tinnitus is at least as likely as not, a symptom associated with the hearing loss, as tinnitus is known to be a symptom associated with hearing loss. The examiner also opined that it was less likely than not due to hazardous military noise exposure because there is no report of tinnitus in service, at separation or in the medical records until the time of the claim and that the current literature does not support the late onset, noise induced tinnitus. The June 2021 rating decision only adjudicated hearing loss. See June 2021, Rating Decision. Because the Veteran was specifically asked about his tinnitus in his examination, which he answered in the affirmative (See January 15, 2021, Hearing Loss and Tinnitus examination, pg. 8), the Board finds that a claim for service connection for tinnitus was reasonably raised by the record. Moreover, the Board finds that the June 2021 rating decision did not implicitly deny service connection for tinnitus. The four factors to be used in determining whether a claim was implicitly denied are: (1) the description of evidence considered in the VA adjudication (by the AOJ or Board); (2) the relatedness of the claims; (3) the timing of the claims, i.e., whether filed simultaneously or close together in time; and (4) whether a reasonable person would be placed on notice that the expressly denied claim also included an implicit denial of another inferred or informal claim. Adams, 568 F.3d at 961. As stated above, the June 2021 rating decision made no mention of tinnitus. Although the examiner provided a negative nexus for tinnitus, the Veteran was not placed on notice of a denial. Tinnitus is a subjective symptom often associated with hearing loss. Thus, an adjudication would need to have been made considering all evidence of record, and a reasonable person would not have been placed on notice from the June 2021 decision that such an adjudication was made. The reasonably raised claim of service connection for tinnitus was not implicitly denied in the June 2021 rating decision and, thus, remained pending on appeal from September 23, 2020 until it was adjudicated in July 2024. See Ingram, 21 Vet. App. at 243. Therefore, since the claim has been pending since the initial claim was received, the appropriate effective date is September 23, 2020. Service Connection Generally, to establish service connection 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." Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a nonservice-connected disability that is aggravated by a service-connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). Any worsening need not be chronic or permanent. Instead, any flare-ups of the claimed disorder that impair earning capacity and are due to a service-connected disability is sufficient to prove a secondary claim. In order to establish entitlement to service connection on this secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a nexus between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). Certain chronic diseases will be presumed related to service, to include sensorineural hearing loss, endocrinopathies like hypothyroidism and arthritis, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). VA regulations provide that for a veteran who has been exposed to an herbicide agent, such as that contained in Agent Orange, during military service, service connection for certain diseases will be presumed. 38 C.F.R.§ 3.309(e). A veteran who served in the Republic of Vietnam during the Vietnam era is presumed to have been exposed during service to an herbicide agent unless there is affirmative evidence to the contrary. 38 C.F.R. § 3.307(a)(6)(iii). The Vietnam era is the period beginning on February 28, 1961, and ending on May 7, 1975, for veterans who served in the Republic of Vietnam and the period beginning on February 28, 1961, and ending on May 7, 1975, in all other cases. 38 U.S.C. If a veteran was exposed to an herbicide agent (to include Agent Orange) during active military, naval or air service and contracted hypothyroidism to a degree of 10 percent or more at any time after service, he/she is entitled to a presumption of service connection even though there is no record of such disease during service. 38 U.S.C. §§ 1112, 1116 (a)(2)(k); 38 C.F.R. §§ 3.307, 3.309(e). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In other words, a presumption of service connection provided by law is not the sole method for showing causation in establishing a claim for service connection for disability due to herbicide exposure. See Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that the availability of presumptive service connection for some conditions based on exposure to Agent Orange does not preclude direct service connection for other conditions based on exposure to Agent Orange) VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). When there is an approximate balance of positive and negative evidence regarding the merits of an issue, the benefit of the doubt shall be given to the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When the evidence persuasively favors one side or the other, the benefit-of-the-doubt rule does not apply. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Entitlement to service connection for bilateral hearing loss disability. The Veteran contends he is entitled to service connection for bilateral hearing loss disability as it is related to his military service. Specifically, he contends he experienced acoustic trauma due to his military occupational specialty (MOS) as a supply specialist where he worked at or near the flight line. See November 2024, Board Hearing transcript, pgs. 7-8. The Veteran was afforded a VA medical examination in January 2021. Notably, the January 2021 examination demonstrated hearing loss of sufficient severity to be considered a "disability" for VA compensation purposes under 38 C.F.R. § 3.385. Thus, the first element required for service connection (a current diagnosis of a disability) has been met for both ears. See January 2021, Hearing Loss and Tinnitus examination. Regarding an in-service event or injury, the Veteran's military occupational specialty (MOS) was Supply Service Specialist in the United States Airforce. The Veteran has stated that his duties were carried out at or near the flight line. VA has conceded the Veterans exposure to hazardous noise during service. The Board notes that the Veteran's service treatment records (STRs) do not document any complaints from the Veteran regarding his hearing. In spite of this, the second element for establishing service connection is satisfied. It is important to note, on his August 1963 Report of Medical examination on enlistment, the Veteran's puretone thresholds at the tested frequencies of 500 1000, 2000, 3000, 4000 Hertz and 6000 were 5, 30, 25 and 15, 15 and 35, respectively in the right ear and 0, 10, 15 and 10, 20, 20, and 20, respectively in the left ear. The examiner reported hearing loss at Hertz, 2000. See August 16, 1983, Enlistment examination. The Board observes that while the examiner noted hearing loss at 2000 and 6000 Hertz, the Veteran's auditory thresholds did not meet the requirements for a hearing loss disability under 38 C.F.R. § 3.385. As a result, the presumption of soundness applies with respect to the Veteran's service connection claim for bilateral hearing loss. See McKinney v. McDonald, 28 Vet. App. 15, 29 (2016). Therefore, the question is whether there is a nexus, i.e., whether the Veteran has a current disability that is at least as likely as not began during service or is at least as likely as not related to an in-service injury, disease, or event. For chronic diseases, absent a medical nexus opinion linking the Veteran's current disability relating to his active service, the question is whether the Veteran has a current disability that is a chronic disease and manifested to a compensable degree during the applicable presumptive period, manifested during service, or produced continuity of symptomatology ever since service or this period. Turning to the medical opinion of record, the following factors are considered when evaluating the probative value of medical opinions: (1) whether the examiner is informed of the pertinent factual premises i.e., medical history of the case; (2) whether the examiner provides a fully articulable opinion, avoiding speculative language that does not provide the certainty needed for medical nexus evidence; and, (3) whether the opinion is supported by a reasonable analysis. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 303-4 (2008). As referenced above, the Veteran was afforded a VA medical examination in January 2021. The audiologist provided a negative nexus opinion. Specifically, the audiologist substantiated their opinion by explaining that there is no significant permanent shift in hearing thresholds beyond test variability from entrance to separation, which is objective evidence of no permanent auditory damage on active duty from conceded noise. The examiner also explained that there is no report of complaint/treatment for hearing decrease in the Veteran's service treatment records or at separation. The examiner also referenced the Veteran's lay statement during the examiner noting that the Veteran reports the onset of a decrease in his hearing 10 years ago, approximately 43 years post-separation after exposure to recreational and/or occupational noise. The examiner acknowledged that while noise exposure is conceded and the relationship of noise, auditory damage and hearing loss is well-established, auditory damage and hearing loss are not conceded based on noise alone. The examiner explained that there must be a nexus of auditory damage to relate current hearing loss to military noise and not another etiology. The examiner concluded that the evidence is against a nexus in this case, therefore it is less likely than not that the hearing loss is related to military noise exposure. The examiner also pointed out that the Veteran's entrance examination shows a moderate hearing loss at 1000k Hertz and 6000k Hertz as well as a mild hearing loss at 2000 Hertz in the right ear once converting thresholds to ANSI standard. The Board notes however that the examiner stated that the Veteran's separation examination shown significant improvement at aforementioned frequencies as well as normal hearing sensitivity, even after converting thresholds to ANSI standard. Hence, the examiner concluded that it is less likely as not that a pre-existing hearing loss was aggravated beyond normal progression in military service. See January 2021, Medical Opinion. See also, April 4, 1967 Separation examination, where the Veteran's puretone thresholds at the tested frequencies of 500, 1000, 2000, 3000, 4000 and 6000 Hertz were 10, 5, 0, 0, 5 and 5 respectively in the right ear and 10, 10, 10, 10, 10 and 0 respectively in the left ear; cf., August 1963 Report of Medical examination. The Board observes that the examiner reviewed the Veteran's in-service and post-service treatment records, analyzed the Veteran's in-service audiology examinations, comparing entrance and separation audiology results, while factoring the Veteran's conceded exposure to hazardous noise, combined with the Veteran's reported onset of bilateral hearing loss. The Board finds that the examiner provided well-reasoned rationale to support the conclusion reached and therefore assigns probative value to this medical opinion. See Nieves-Rodriguez v. Peake, supra; Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion must support its conclusion with an analysis the Board can consider and weight against contrary opinion"). The Board also notes that the Veteran submitted a nexus opinion from an orthopedic surgeon in February 2025, following his Board hearing. The physician indicated review of the Veteran's C-file. The physician stated that the Veteran exhibits multiple progressive diagnoses all of which have a causal nexus to his military service. The physician stated that the Veteran's medical records document coronary artery disease status post coronary artery stents, diabetes mellitus type 2, hypothyroidism, erectile dysfunction, cervical and thoracolumbar degenerative osteoarthritis, degenerative osteoarthritis of hips and knees, small joint arthritis of hands and elbows and shoulders, and bilateral hearing toss. The physician stated that exposure to dioxin congeners through inhalation, ingestion, and transdermal routes are responsible for his multiple diagnoses combined with ambient noise exposure leading to hearing loss. The Board notes however that the medical opinion does point to any evidence in the record or provide any rationale as to why or how the Veteran's bilateral hearing loss is related to service-other than to conclude that he was exposed to dioxin congeners through inhalation, ingestion and transdermal, and ambient noise. See February 11, 2025, Medical Opinion (F.G., MD., P.C.). The Board also points out that the Veteran's exposure to dioxins has not been conceded by VA. August 2021 and April 2024 VA memorandums show no finding of a toxic exposure risk activity (TERA). See August 12, 2021, VA Memorandum; see also, April 23, 2024, VA Memorandum. The Board also observes that the Veteran has never asserted that he was exposed to dioxins during service or in connection with his military occupational specialty as a supply specialist, to include JP 5 jet fuel. The Board notes that the Veteran's exposure to hazardous noise has already been conceded by VA. Because the Board finds the February 2025 opinion conclusory and based on an inaccurate factual premise, that the Veteran was exposed to dioxins during service, the Board assigns no probative value to this medical opinion. The Board acknowledges the Veteran's Board Hearing testimony that he experienced hearing loss during service but did not report hearing loss during service. The Board also emphasizes that the Veteran stated that he did not experience hearing loss until approximately 10 years prior to his VA examination for hearing loss-which is more than 4 decades post service and supports the finding that there has not been any been any lay or medical evidence of continued symptomatology after military service to establish presumptive service connection. The Board also observes that the Veteran has offered no lay statements of such continuity, and the VA treatment records do not support one either. While the Board does not doubt the sincerity of the Veteran's belief that his hearing loss is due to his military service, the Board is bound by the laws and regulations that govern VA disability benefits. Upon review of the lay and medical evidence of record, the Board finds that the Veteran's bilateral hearing loss disability was not shown as chronic during service and did not manifest to a compensable degree within one year after service; there was no continuity of symptomatology; and the evidence does not establish a relationship between the Veteran's hearing loss and active duty. In summary, the Board finds that the persuasive evidence weighs against entitlement to service connection. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the persuasiveness of the evidence is against the claim, the doctrine is not applicable. 38 C.F.R. § 3.102 (2015), Gilbert v. Derwinski, 1 Vet. App. 39, 54-56 (1990). The evidence is not in relative equipoise for service connection for bilateral hearing loss under any reasonably raised theory. There is no reasonable doubt to resolve in the Veteran's favor, and the appeal for bilateral hearing loss is denied. Entitlement to service for gastroesophageal reflux disease (GERD). The Veteran contends that his GERD is related to service. At his hearing, the Veteran testified that he had this condition when he was in the service. The Veteran testified that he had heart burn or acid reflux, but never knew what it was and thought it was just normal. The Veteran testified that he tried to eat the things that he was supposed to eat, but it was hard to keep up. The Veteran testified that he now takes omeprazole for his conduction. See November 2024, Board Hearing transcript, pg. 11. The medical evidence reflects that the Veteran has a current diagnosis of GERD. Additionally, his service treatment records (STR) reflect treatment for gastrointestinal issues on March 6, 1965, March, 7, 1965 and March 9, 1965, but do not show a diagnosis of GERD. The March 6, 1965 STR documents a diagnosis of gastroenteritis. The March 9, 1965 STR documents that the Veteran's condition has improved, stools still loose, strength improved. The Veterans April 1967 Separation Examination notes the Veteran had stomach pains associated with a bout of gastroenteritis in March 1965, and none since. The Veteran reported on his April 1967, Separation, Report of Medical History, that he had a history of stomach, liver or intestinal trouble. In a VA examination for his GERD claim, the examiner confirmed the diagnosis of GERD in 2006. On medical history, the examiner noted that the Veteran was unable to recall the details of onset. The Veteran reported he has had GERD for a very long time and that it is usually triggered by eating spicy food. See July 23, 2024, Esophageal Conditions examination. After conducting an in-person examination, reviewing the Veteran's in-service, post-service and medical history, the examiner rendered a negative nexus opinion. The examiner reasoned that based on review of the available evidence, it is less likely than not that the currently diagnosed condition is due to service as there is a lack of substantiating evidence supporting a nexus between the current diagnosis of gastroesophageal reflux disease (GERD) and military service. The examiner noted that the Veteran's service treatment record indicated that his stomach condition was for symptom related to gastroenteritis. The examiner noted however that this condition was acute and had resolved. The examiner also noted that on medical record of the record, the earliest record for GERD was in 2006, which was 39 years from separation from service. A nexus has not been established. See July 2024, Medical Opinion. The Board finds this medical opinion both adequate and probative. The Board observes that the examiner indicated review of the pertinent evidence of record and provided a reasoned analysis for the conclusion reached. The Board also finds that the examiner provided sufficient detail for the Board to make an informed decision. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (an adequate medical examination "must support its conclusions with an analysis that the Board can consider and weight against contrary opinions" and must "provide sufficient detail for the Board to make a fully informed evaluation of whether direct service connection is warranted"). Neither the Veteran or his attorney have provided any probative evidence contrary to the July 2024 Medical Opinion or any evidence that otherwise diminishes its probative weight. To this point, the Board acknowledges a December 2024 private nexus opinion submitted by the Veteran in February 2025 following his hearing from an orthopedic surgeon. The physician indicated review of the Veteran's C-file. The physician stated that the Veteran exhibits multiple progressive diagnoses all of which have a causal nexus to his military service. The physician stated that the Veteran's medical records document coronary artery disease status post coronary artery stents, diabetes mellitus type 2, hypothyroidism, erectile dysfunction, cervical and thoracolumbar degenerative osteoarthritis, degenerative osteoarthritis of hips and knees, small joint arthritis of hands and elbows and shoulders, and bilateral hearing toss. The physician stated that exposure to dioxin congeners through inhalation, ingestion, and transdermal routes are responsible for his multiple diagnoses combined with ambient noise exposure leading to hearing loss. The physician stated that dioxin congeners carried by the Aryl Hydrocarbon protein receptor after ingestion and inhalation and transdermal absorption carried the powerful dioxin toxicants into the intracellular spaces of multiple organs disrupting DNA and RNA sequencing and further disrupting telomere length at the ends of chromosomes. The physician also stated that additional toxicant exposures for this era of military service include exposure to JP5 jet fuel and its additives as well as exposure to Legacy diesel engine exhaust both with products of incomplete combustion. See February 11, 2025, Medical Opinion (F.G., MD., P.C.). The Board notes however that the physician did not point to any evidence in the record with regards the Veteran's actual exposure to dioxin congeners or specifically provide any rationale as to why or how the Veteran's diagnosed GERD is related to service. The Board also notes that the Veteran's exposure to dioxins has not been conceded by VA. Nor is there is any evidence in the claims file that the Veteran was exposed to dioxins or harmful toxins through service or in connection with his military occupational specialty as a supply services specialist, to include exposure to JP 5 jet fuel. VA memorandums issued in August 2021 and April 2024 show no finding of the Veteran participating in a toxic risk exposure activity. The August 2021 Memorandum stated that exposure to herbicides cannot be conceded as the evidence of record does not show the Veteran had duty or visitation in the Republic of Vietnam, or on its inland waterways, or nautical service in the offshore eligible waters as defined in the Blue Water Navy Vietnam Veterans Act of 2019, Public Law 116-23. The April 2024 Memorandum stated that the Veteran did not participate in a toxic risk activity during service. See August 12, 2021, VA Memorandum; see also, April 23, 2024, VA Memorandum. The Board observes that the Veteran never asserted that he participated in a toxic risk activity, even in connection with his military occupational specialty as a supply services specialist. Therefore, the Board assigns no probative value to this medical opinion. Here, the Board finds the July 2024, VA medical opinion persuasive in this adjudication. The Board has considered whether service connection for GERD could be granted presumptively. See 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Presumptive service connection is available for peptic ulcers. However, the Veteran does not have a diagnosis of peptic ulcer currently and did not receive such a diagnosis during service. Thus, presumptive service connection is not warranted. In summary, the Board finds that persuasive evidence of record is against a finding that the Veteran's current gastroesophageal disease reflux disease (GERD) is related to his service. In reaching this determination, the Board has considered the Veteran's lay statements that his GERD is due to service. In considering the Veteran's contentions, the Board notes that he is competent to observe lay symptoms but does not have the training or credentials to provide a competent opinion as to etiology, diagnosis, or the onset date of a medical disability. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Therefore, his lay contentions in this regard are thus of markedly lower probative value than, and are outweighed by, the VA examiner's opinion and the medical evidence of record. As the persuasive evidence of record is against the appeal, the benefit-of-the-doubt doctrine is not for application, and the appeal must be denied. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Entitlement to service connection for hypothyroidism. The Veteran asserts that his hypothyroidism is related to service. The Veteran's service treatment records are silent regarding any complaint, treatment or diagnosis for hypothyroidism. The Board acknowledges the Veteran served on active duty during the Vietnam era and hypothyroidism has recently been added to the list of diseases eligible for presumptive service connection based on herbicide agent exposure for Veterans who served in the Republic of Vietnam during the Vietnam era. However, there is no evidence of record to suggest that he served in Vietnam or was otherwise exposed to herbicide agents in service. He did not have active service in the Republic of Vietnam during the period beginning on February 28, 1961 and ending on May 7, 1975. 38 U.S.C. § 101(29)(A). He also did not serve between April 1, 1968, and August 31, 1971, in a unit that, as determined by the Department of Defense (DoD), operated in or near the Korean DMZ in an area in which herbicide agents are known to have been applied during that period. 38 C.F.R. § 3.307(a)(6)(iv). Further, he did not serve in Thailand, Cambodia, Laos, Guam, American Samoa, or the Johnston Atoll. See 38 U.S.C. §1116; Honoring our PACT Act of 2022, Pub. L. No117-168, §§401-402, 136 Stat.1759, 1780 (2022). Lastly, he did not serve aboard a Navy vessel. Procopio v. Wilkie, 913 F.3d 1371, 1380-81 (Fed. Cir. 2019). Personnel records should that the Veteran's foreign service was in Canada from April 8, 1966 to July 8, 1967. See Military Personnel Records. There is no record of additional foreign service. See also, August 2021 Memorandum (addressing herbicide exposure) and April 2024 VA Memorandum showing no finding of a toxic exposure risk activity (TERA). As such, service connection on a presumptive basis is not warranted. 38 U.S.C. §§ 1116, 1116A; 38 C.F.R. §§ 3.307, 3.309, 3.313. The earliest evidence of a diagnosis for hypothyroidism is in July 1998, more than 2 decades after service. See July 9, 1998 medical records. Though the Veteran has current hypothyroidism, the evidence is against a finding of a "nexus," or linkage, between the disorder and his military service. Because the Veteran did not serve in the RVN or offshore of the RVN during the Vietnam Era he is not presumed to have been exposed to an herbicide agent. Therefore, service connection for hypothyroidism cannot be awarded on a presumptive basis. 38 U.S.C. §§ 1116, 1116A; 38 C.F.R. §§ 3.307, 3.309, 3.313. The Board notes that the Veteran submitted a February 2025 private nexus opinion from an orthopedic surgeon. The physician indicated review of the Veteran's C-file. The physician stated that the Veteran exhibits multiple progressive diagnoses all of which have a causal nexus to his military service. The physician stated that the Veteran's medical records document coronary artery disease status post coronary artery stents, diabetes mellitus type 2, hypothyroidism, erectile dysfunction, cervical and thoracolumbar degenerative osteoarthritis, degenerative osteoarthritis of hips and knees, small joint arthritis of hands and elbows and shoulders, and bilateral hearing toss. The physician stated that exposure to dioxin congeners through inhalation, ingestion, and transdermal routes are responsible for his multiple diagnoses combined with ambient noise exposure leading to hearing loss. The physician stated that the metabolic disorders of diabetes mellitus type 2, hypothyroidism, and erectile dysfunction are the consequence of toxicant exposures and endocrine disruption. The physician stated that dioxin congeners carried by the Aryl Hydrocarbon protein receptor after ingestion and inhalation and transdermal absorption carried the powerful dioxin toxicants into the intracellular spaces of multiple organs disrupting DNA and RNA sequencing and further disrupting telomere length at the ends of chromosomes. The physician stated that additional toxicant exposures for this era of military service include exposure to JP5 jet fuel and its additives as well as exposure to Legacy diesel engine exhaust both with products of incomplete combustion. See February 11, 2025, Medical Opinion (F.G., MD., P.C.). The Board notes however that the Veteran's exposure to dioxins has not been conceded by VA. Nor is there is any evidence in the claims file that the Veteran was exposed to dioxins or harmful toxins through service or in connection with his military occupational specialty as a supply services specialist, to include exposure to JP 5 jet fuel. VA memorandums issued in August 2021 and April 2024 show no finding of the Veteran participating in a toxic risk exposure activity. The August 2021 Memorandum stated that exposure to herbicides cannot be conceded as the evidence of record does not show the Veteran had duty or visitation in the Republic of Vietnam, or on its inland waterways, or nautical service in the offshore eligible waters as defined in the Blue Water Navy Vietnam Veterans Act of 2019, Public Law 116-23. The April 2024 Memorandum stated that the Veteran did not participate in a toxic risk activity during service. See August 12, 2021, VA Memorandum; April 23, 2024, VA Memorandum. The Board observes that the Veteran never asserted that he participated in a toxic risk activity, even in connection with his military occupational specialty as a supply services specialist. The Board determines that this opinion is not probative, as it is based upon the inaccurate factual premise that the Veteran was exposed to harmful toxins or dioxins during service. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). The Veteran was not afforded a specific VA thyroid conditions examination. However, an examination is not required. VA will provide a medical examination or obtain a medical opinion if the evidence indicates the existence of a current disability or persistent or recurrent symptoms of a disability that may be associated with an event, injury, or disease in service, but the record does not contain sufficient medical evidence to decide the claim. 38 U.S.C. § 5103A (d)(2); 38 C.F.R. § 3.159 (c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Here, the Board finds that the claim does not meet these requirements for obtaining a VA medical opinion and that there was no pre-decisional duty to assist in not providing an examination and medical opinion. Because the weight of the probative evidence does not suggest that any hypothyroidism is due to service, no examination is needed. Waters v. Shinseki, 601 F. 3d 1274, 1278 (Fed. Cir. 2010) (noting that a veteran's conclusory generalized statement that a service illness caused his present medical problems was not enough to entitle him to a VA medical examination since all veterans could make such a statement, and such a theory would eliminate the carefully drafted statutory standards governing the provision of medical examinations and require VA to provide such examinations as a matter of course in virtually every disability case). The Veteran is not competent to link any claimed hypothyroidism to a period of service. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159. Lay evidence may be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition (i.e., when the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer); (2) the layperson is reporting a contemporaneous medical diagnosis, or; (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009) (where widow seeking service connection for cause of death of her husband, the Veteran, the Court holding that medical opinion not required to prove nexus between service-connected mental disorder and drowning which caused Veteran's death). Here, the Board finds that the Veteran is not competent to link his current hypothyroidism to service and the claim is denied. In sum, the Board finds the persuasive evidence of record is against a finding that the Veteran's hypothyroidism began during active service or within one year of service or is otherwise related to an in-service injury or disease. The evidence is not in approximate balance between that favoring the claim and against the claim. There is no reasonable doubt, and the claim is denied. Lynch v. McDonough, 999 F.3rd 1391 (2021). Entitlement to service connection for a neck disability. The Veteran contends that service connection is warranted for a neck condition. At his November 2024 Board hearing the Veteran testified that his neck condition is tied to his knees. The Veteran testified that due to the fact that VA never gave him any treatment or performed surgery for his knees, he was constantly falling. The Veteran also testified that he had heart disease and that causes constant falling. The Veteran testified that one day, he fell, hit his head against the wall, and at the same time, he couldn't get treatment after they found out he had a crack to his neck. See November 2024, Board Hearing transcript, pgs. 5-6. The Board notes that the Veteran's service treatment records are silent regarding any complaint, treatment or diagnosis for a neck or cervical spine condition. February 2023 medical records establish a diagnosis of neck-pain, degenerative disc disease/foraminal stenosis. See February 16, 2023, VA treatment records. While the Veteran has a diagnosed disability, the Board finds that there is no competent lay or medical evidence linking the Veteran's neck disability to service. To this point, the Board acknowledges a February 2025 private nexus opinion submitted by the Veteran following his hearing from an orthopedic surgeon. The physician indicated review of the Veteran's C-file. The physician stated that the Veteran exhibits multiple progressive diagnoses all of which have a causal nexus to his military service. The physician stated that the Veteran's medical records document coronary artery disease status post coronary artery stents, diabetes mellitus type 2, hypothyroidism, erectile dysfunction, cervical and thoracolumbar degenerative osteoarthritis, degenerative osteoarthritis of hips and knees, small joint arthritis of hands and elbows and shoulders, and bilateral hearing loss. In pertinent part, the physician stated that exposure to dioxin congeners through inhalation, ingestion, and transdermal routes are responsible for his multiple diagnoses combined with ambient noise exposure leading to hearing loss. See February 11, 2025, Medical Opinion (F.G., MD., P.C.). The Board notes however that the physician did not provide any rationale specifically as to why or how the Veteran's diagnosed cervical degenerative disc disease (a musculoskeletal disability), is related to service-particularly as it relates to his claimed exposure to dioxin congeners. Rather, the Board finds this February 2025 Medical Opinion conclusory and therefore, not probative. In addition, the Board note that the Veteran's exposure to dioxins has not been conceded by VA. Nor is there is any evidence in the claims file that the Veteran was exposed to dioxins or harmful toxins through service or in connection with his military occupational specialty as a supply services specialist, to include exposure to JP 5 jet fuel. VA memorandums issued in August 2021 and April 2024 show no finding of the Veteran participating in a toxic risk exposure activity. The August 2021 Memorandum stated that exposure to herbicides cannot be conceded as the evidence of record does not show the Veteran had duty or visitation in the Republic of Vietnam, or on its inland waterways, or nautical service in the offshore eligible waters as defined in the Blue Water Navy Vietnam Veterans Act of 2019, Public Law 116-23. The April 2024 Memorandum stated that the Veteran did not participate in a toxic risk activity during service. See August 12, 2021, VA Memorandum; see also, April 23, 2024, VA Memorandum. The Board observes that the Veteran never asserted that he participated in a toxic risk activity, even in connection with his military occupational specialty as a supply services specialist. In sum, the Board determines that the opinion is based upon the inaccurate factual premise that the Veteran was exposed to harmful toxins or dioxins during service. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). For the foregoing reasons, the Board assigns no probative value to this medical opinion. The Board observes that there is no competent, probative lay or medical evidence linking this Veteran's neck disability to service. The Board notes that the Veteran has not been afforded VA examinations in support of his neck disability. The VA Secretary must provide a VA medical examination when there is: (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). With respect to the third factor above, the Court of Appeals for Veterans Claims has stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and the appellant's service. The types of evidence that indicate that a current disability may be associated with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. McLendon, 20 Vet. App. 79. The Board finds that prior to the rating decision on appeal, there was no indication that the Veteran's neck disability may be related to service. Although the Veteran has evidence of a current neck disability, the Board finds that the low threshold to necessitate affording a VA examination had not been met. The Board observes that during his Board Hearing testimony, the Veteran relates to his neck disability to a fall due to the lack of VA treatment or surgery for his knees. See November 2024, Board Hearing transcript, pgs. 5-6. In sum, the Board finds that the persuasive evidence of record is against a finding that the Veteran's claimed neck disability first incurred in service, within a year of service, or is otherwise the result of active service. Accordingly, service connection is not warranted. Entitlement to service connection for post-traumatic stress disorder (PTSD). Service connection for PTSD may be established when there is: 1) a current medical diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a); (2) combat status or credible supporting evidence that the claimed in-service stressor occurred; and (3) medical evidence of a causal nexus between diagnosed PTSD and the claimed in- service stressor. 38 C.F.R. § 3.303 In this case, the Veteran did not have combat service and was not exposed to hostile military or terrorist activity; therefore, the presumptions afforded to combat veterans and veterans who allege fear of hostile military or terrorist activity are inapplicable in this case. Any alleged in-service stressors must be independently verified (corroborated) by objective credible supporting evidence. The Board notes that at his hearing, the Veteran never asserted that he had a diagnosis for PTSD. The Veteran testified that he takes medication for an anxiety disorder and that he has taken this medication for about two months. The Veteran testified that he cries a lot at night and that this keeps him awake. The Veteran testified that this is his only contention. The Veteran acknowledged during his hearing that he did not have any mental health conditions during service. See November 2024, Board Hearing transcript, pgs. 4-5. The Board notes that the Veteran's service treatment records (STRs) are absent any complaints, treatment, or diagnosis of PTSD. As for VA treatment records, there are no records on file that are within the permissible evidentiary window that document treatment for, or a diagnosis of, PTSD. The Board notes that in February 2025, the Veteran submitted a private opinion from a psychologist with regards to his claim. The psychologist conceded that the claims file does not verify a specific PTSD event, but it does verify developing service-connected medical condition stressors. The Board notes that the private opinion also did not contain a PTSD diagnosis. See February 11, 2025, Private Opinion (R.W., Psy. D.). September 2021 medical records document that the Veteran's PTSD screening test was negative. The presence of a disability at any time during the claim process can justify a grant of service connection, even when the most recent diagnosis is negative. McClain v. Nicholson, 21 Vet. App. 319 (2007). However, Congress specifically has limited entitlement to service connection for disease or injury to cases where such incidents have resulted in a current disability. Here, there is simply no competent indication in the record that the Veteran has a current PTSD disability, or that he has had any such disability at any time during the appeal period. Thus, where the evidence does not support a finding of a current disability upon which to predicate a grant of service connection, there can be no valid claim for these benefits. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The claim seeking service connection for PTSD is denied. As the evidence is persuasively against the claim, the benefit of the doubt doctrine is not for application. Entitlement to service connection for an acquired psychiatric disorder to include anxiety and depression. The Veteran asserts that he has anxiety and depressive disorder related to service, to include as due to service-connected disability. The Veteran is service connected for tinnitus. As refenced above, at his Board Hearing, the Veteran testified that he takes medications for an anxiety disorder. The Veteran testified that he has been taking medications for at least two months now. The Veteran testified that he has not had service or treatment for his knees and that he cannot walk. The Veteran also testified that the lack of care from VA makes his condition worse, which is what is causing his anxiety. The Veteran testified that he did not have any mental health conditions that he can remember during service. See November 2024, Board Hearing transcript, pgs. 4-5. The Veteran's service treatment records are silent regarding any complaints, treatment or diagnosis for any psychiatric disorder. In his April 1967 separation examination Report of Medical History, the Veteran denied experiencing past or current trouble sleeping, depression or excessive worry, or nervous trouble of any sort. On clinical evaluation, the Veteran's psychiatric system was found to be normal. The Board notes that the Veteran's medical records do not contain a diagnosis for an acquired psychiatric disorder, to include anxiety or depression. In August 2019 and October 2019 medical records, the Veteran denied depression and anxiety. The Board notes that following his November 2024 Board hearing, the Veteran submitted a private opinion from a psychologist who opined that the Veteran has an acquired psychiatric disorder to include depressive disorder with major depressive-like disorder episodes and anxiety disorder with generalized anxiety-like episodes due to another service-connected psych medical condition(s) (coronary artery disease with hypertension; hypothyroidism; degenerative joint disease, thoracic spine; right lower extremity; and chronic pain syndrome) under the current dsm-5/icd-11 diagnostic criteria. see February 11, 2025, private opinion, (R.W., Psy. D.). The board has considered this private medical opinion. However, the Veteran is not service connected for coronary artery disease with hypertension; hypothyroidism; degenerative joint disease, thoracic spine; right lower extremity; and chronic pain syndrome. Hence, as a matter of law, the claim for service connection for an acquired psychiatric disorder, to include anxiety and depression as secondary to coronary artery disease with hypertension, hypothyroidism, degenerative joint disease, thoracic spine, right lower extremity and chronic pain syndrome is without legal merit and must be denied as a matter of law. See 38 C.F.R. § 3.310(a); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). The Board also notes that the Veteran was not provided with a VA examination and opinions to assess the current nature and etiology of his claimed acquired psychiatric disorder prior to the decision on appeal. However, VA need not conduct an examination with respect to the claims on appeal, as information and evidence of record contains sufficient competent medical evidence to decide the claims. See 38 C.F.R. § 3.159(c) (4). Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), in disability compensation (service connection) claims, the VA must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. However, prior to the rating decision on appeal, the standards of McLendon are not met in this case as there was no credible evidence of currently diagnosed acquired psychiatric disorder. In addition, prior to the rating decision on appeal, there was no competent evidence suggesting that this claimed disability is otherwise associated to service or to a service connection disability. Therefore, there was no pre-decisional duty to assist error. Here, the Board finds that an acquired psychiatric disability, to include depression and anxiety, is not shown to be causally or etiologically related to any disease, injury, or incident in service, did not manifest within one year of service discharge, and was not caused or aggravated by a service-connected disability. For the reasons and bases expressed above the Board finds that the most persuasive evidence is against the Veteran's claim of entitlement to service connection. The benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b). (Continued on next page.) REASONS FOR REMAND Entitlement to service connection for degenerative disc disease of the lumbosacral spine is remanded. The Veteran contends that service connection is warranted for his back disability, diagnosed as degenerative disc disease lumbosacral spine. The Veteran asserts that his back disability stems from his work as a supply specialist, lifting and loading heavy boxes of supplies to be shipped to South Vietnam in support of armed service members fighting in various locations throughout the Vietnam War. At his Board hearing, the Veteran testified that after service he went immediately into civil service. The Veteran testified that he performed the same job after service. See May 2024, Lay statement; see also, November 2024, Board Hearing transcript, pgs. 7-8. In May 2021, the Veteran was afforded a Back Conditions examination. The Veteran was diagnosed with degenerative arthritis. After an in-person examination, review of the Veteran's service treatment records, post-service treatment records and medical history, the examiner rendered a negative nexus opinion. The examiner noted that a January 15, 2009 medical record from his primary care provider documents a complaint of chronic back pain. The examiner noted that a primary care provider documents on August 26, 2019, a complaint of low back pain. The examiner further noted that the Veteran service treatment records are silent regarding back pain. The examiner noted that a May 14, 2021 x-ray, revealed a diagnosis of degenerative disc disease L3 through S1. Based on this evidence, the examiner concluded it was less likely than not, that the Veteran's back disability was related to service. See May 17, 2021, Medical Opinion. The Board finds the opinion is inadequate. The Board observes that examiner relied on the absence of documented treatment during service and provided no supporting rationale for the conclusion reached. Barr v. Nicholson, 21 Vet. App. 31 (once VA undertakes the effort to provide an examination when developing a claim for service connection, even if not statutorily obligated to do so, it must provide an adequate one). Accordingly, the AOJ erred in failing to obtain an adequate VA medical opinion prior to the rating decision on appeal, and the claim must be remanded to correct this pre-decisional duty to assist error. The Board observes that in February 2025, following his Board hearing the Veteran submitted a positive nexus opinion from an orthopedic surgeon. The physician indicated review of the Veteran's C-file. The physician stated that the Veteran exhibits multiple progressive diagnoses all of which have a causal nexus to his military service. The physician stated that the Veteran's medical records document coronary artery disease status post coronary artery stents, diabetes mellitus type 2, hypothyroidism, erectile dysfunction, cervical and thoracolumbar degenerative osteoarthritis, degenerative osteoarthritis of hips and knees, small joint arthritis of hands and elbows and shoulders, and bilateral hearing toss. The physician stated that exposure to dioxin congeners through inhalation, ingestion, and transdermal routes are responsible for his multiple diagnoses combined with ambient noise exposure leading to hearing loss. The physician stated that the metabolic disorders of diabetes mellitus type 2, hypothyroidism, and erectile dysfunction are the consequence of toxicant exposures and endocrine disruption. The physician stated that dioxin congeners carried by the Aryl Hydrocarbon protein receptor after ingestion and inhalation and transdermal absorption carried the powerful dioxin toxicants into the intracellular spaces of multiple organs disrupting DNA and RNA sequencing and further disrupting telomere length at the ends of chromosomes. The physician stated that additional toxicant exposures for this era of military service include exposure to JP5 jet fuel and Its additives as well as exposure to Legacy diesel engine exhaust both with products of incomplete combustion. See February 11, 2025, Medical Opinion (F.G., MD., P.C.). The Board acknowledges that private opinion submitted by the Veteran. The Board observes however that the physician does not provide any rationale to support the conclusion that the Veteran's degenerative arthritis of the lumbosacral spine is related to service-other than to state that there is a causal nexus. The physician does state that Veteran was exposure to dioxin congeners during service, through inhalation, ingestion, and transdermal routes are responsible for his multiple diagnoses. Upon review, the Board finds this February 2025 Medical Opinion conclusory. Additionally, the Board observes that the VA has never conceded toxic exposure. And there is no evidence in the claims file to support the conclusion that the Veteran was exposed to dioxins or harmful toxins during service. An April 2024 VA memorandum documents that the Veteran did not participate in a Toxic Risk Activity (TERA). For the foregoing reasons, the Board does not assign any probative value to the private medical opinion. Notwithstanding, for the reasons stated above, this matter is remanded to the RO correct a pre-decisional duty to assist error. 38 C.F.R. § 20.802 (a). Entitlement to service connection for osteoarthritis (hands, elbows, shoulders, knees and hips) is remanded. The Veteran asserts that his osteoarthritis stems from his work as a supply specialist, lifting and loading heavy boxes of supplies to be shipped to South Vietnam in support of armed service members fighting in various locations throughout the Vietnam War. At his Board hearing, the Veteran testified that after service he went immediately into civil service. The Veteran testified that he performed the same job after service. See May 2024, Lay statement; see also, November 2024, Board Hearing transcript, pgs. 7-8. In May 2021, the Veteran was afforded multiple VA examinations (Knee and Lower Leg, Shoulder and Arm Condition, Elbow & Forearm Conditions and Hand and Finger). The Veteran has been diagnosed with degenerative arthritis of the right knee, bilateral hands, right elbow. The Veteran has also been diagnosed with a bilateral shoulder strain, left knee strain and left elbow strain. After an in-person examination, review of the Veteran's service treatment records, post-service treatment records and medical history, the examiner rendered a negative nexus opinion. The examiner reasoned that the Veteran's service treatment records are silent for the claim of osteoarthritis in the elbows, shoulders, hands, back, and Knees. The examiner noted that x-rays dated May 14, 2021 revealed degenerative arthritis right elbow. For the right hand the examiner noted destructive arthritis change PIP and DIP joints of the index finger. The examiner noted that the left hand showed degenerative joint disease throughout all IP and MP joints of left hand. The examiner noted that degenerative disc disease L3 through S1Moderately advanced degenerative joint disease throughout the right knee. The examiner noted, negative left knee and normal x-ray for the shoulders. The examiner concluded that degenerative arthritis lumbosacral spine, right knee, bilateral hands and right elbow are less likely than not caused by service. The examiner noted that the Veteran does not have degenerative arthritis of the left knee, left elbow and bilateral shoulders. See May 2021, Medical Opinion. The Board finds the opinion is inadequate. The Board observes that examiner relied solely on the absence of documented treatment during service and provided no supporting rationale for the conclusion reached. The Board also observes that while the Veteran did not have a diagnosis for degenerative arthritis of the left knee, left elbow or bilateral shoulders, the examiner did not render an opinion with respect to the Veteran's left knee strain, left elbow strain and bilateral shoulder strain. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Board also observes that the examiner did not render an opinion with respect to the Veteran's hips, which is encompassed in the Veteran's osteoarthritis claim (hands, elbows, shoulders, knees and hips). The Board also finds this is a pre-decisional duty to assist error. See Barr v. Nicholson, 21 Vet. App. 31 (once VA undertakes the effort to provide an examination when developing a claim for service connection, even if not statutorily obligated to do so, it must provide an adequate one). Accordingly, the AOJ erred in failing to obtain an adequate VA medical opinion, and the claim must be remanded to correct this pre-decisional duty to assist error. As referenced above, the Veteran did submit a positive nexus opinion in February 2025, following his Board hearing the Veteran submitted a positive nexus opinion from an orthopedic surgeon. The physician indicated review of the Veteran's C-file. The physician stated that the Veteran exhibits multiple progressive diagnoses all of which have a causal nexus to his military service. The physician stated that the Veteran's medical records document coronary artery disease status post coronary artery stents, diabetes mellitus type 2, hypothyroidism, erectile dysfunction, cervical and thoracolumbar degenerative osteoarthritis, degenerative osteoarthritis of hips and knees, small joint arthritis of hands and elbows and shoulders, and bilateral hearing toss. In relevant part, the physician stated that exposure to dioxin congeners through inhalation, ingestion, and transdermal routes are responsible for his multiple diagnoses combined with ambient noise exposure leading to hearing loss. See February 11, 2025, Medical Opinion (F.G., MD., P.C.). While the Board has considered the private opinion submitted by the Veteran, the Board observes that the physician does not provide any rationale to support the conclusion that the Veteran's osteoarthritis (hands, elbows, shoulders, knees and hips) or any shoulder, knee, hip or elbow disability is related to service-other than to state that there is a causal nexus. As referenced above, the physician does state that Veteran was exposed to dioxin congeners during service, through inhalation, ingestion, and transdermal routes are responsible for his multiple diagnoses. However, the Board observes that the VA has never conceded toxic exposure. And there is no evidence in the claims file to support the claim that the Veteran was exposed to dioxins or harmful toxins during service. An April 2024 VA memorandum documents that the Veteran did not participate in a Toxic Risk Activity (TERA). Therefore, the Board does not assign any probative value to the private medical opinion. Notwithstanding, this matter is remanded to correct a pre-decisional duty to assist error. 38 C.F.R. § 20.802 (a). Accordingly, these matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of the Veteran's lumbar spine disability. The examiner must be provided with the claims folder, including a copy of this remand, for review. The examiner should provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher), that the Veteran's lumbar spine disability is related to any injury, disease, or event incurred in service and explain why or why not. The examiner is advised that the Veteran is competent to report his symptoms and history. Such reports, and all other lay evidence of record, including those of continuity of symptomatology, must be acknowledged and considered in formulating any opinion. 2. Schedule the Veteran for a VA examination (s) to determine the nature and etiology of the Veteran's osteoarthritis (hands, elbows, shoulders, knees and hips) or any diagnosed disability pertaining to the hands, elbows, shoulders, knees and hips, i.e., examiner left shoulder strain, bilateral shoulder strain, left knee strain. The examiner must be provided with the claims folder, including a copy of this remand, for review. The examiner should provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's osteoarthritis (hands, elbows, shoulders, Knees and hips) or any diagnosed disability pertaining to the hands, elbows, shoulders, knees and hips, is related to any injury, disease, or event incurred in service and explain why or why not. The examiner is advised that the Veteran is competent to report his symptoms and history. Such reports, and all other lay evidence of record, including those of continuity of symptomatology, must be acknowledged and considered in formulating any opinion. 3. Readjudicate the claims. Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Little, Calvin 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.