Citation Nr: A26040887 Decision Date: 04/30/26 Archive Date: 04/30/26 DOCKET NO. 250707-562728 DATE: April 30, 2026 ORDER Service connection for a traumatic brain injury (TBI) or head injury is denied. Service connection for chronic fatigue syndrome is denied. Service connection for pes planus is denied. Service connection for gastroesophageal reflux disease (GERD) (claimed as acid reflux) is denied. Service connection for asthma is denied. Service connection for a left hand condition is denied. Service connection for a right hand condition is denied. Service connection for sleep apnea is denied. Service connection for gout is denied. REMANDED Service connection for a lumbosacral strain is remanded. Service connection for a left knee strain is remanded. Service connection for a right knee strain is remanded. FINDINGS OF FACT 1. The evidence of record persuasively weighs against finding that the Veteran has had a traumatic brain injury (TBI) at any time during or approximate to the pendency of the claim. 2. The evidence of record persuasively weighs against finding that the Veteran has had chronic fatigue syndrome at any time during or approximate to the pendency of the claim. 3. The evidence of record persuasively weighs against finding that a preexisting pes planus increased in severity during service or had onset in active service or is otherwise causally connected to an in service-injury, event or disease. 4. The Veteran's GERD is not secondary to service-connected chronic bronchitis, PTSD, or headaches, and is not otherwise related to an in-service injury or disease. 5. The evidence of record persuasively weighs against finding that the Veteran has had asthma at any time during or approximate to the pendency of the claim. 6. The evidence of record persuasively weighs against finding that the Veteran has had a left hand condition at any time during or approximate to the pendency of the claim. 7. The evidence of record persuasively weighs against finding that the Veteran has had a right hand condition at any time during or approximate to the pendency of the claim. 8. The evidence of record persuasively weighs against finding that the Veteran has had sleep apnea at any time during or approximate to the pendency of the claim. 9. The evidence of record persuasively weighs against finding that the Veteran has had gout at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for TBI are not met. 38 U.S.C. §§ 1110, 1111, 1131, 1153; 38 C.F.R. § 3.303, 3.304. 2. The criteria for entitlement to service connection for chronic fatigue syndrome are not met. 38 U.S.C. §§ 1110, 1111, 1131, 1153; 38 C.F.R. § 3.303, 3.304. 3. The criteria for entitlement to service connection for pes planus are not met. 38 U.S.C. §§ 1110, 1111, 1131, 1153; 38 C.F.R. § 3.303, 3.304. 4. The criteria for service connection for gastroesophageal reflux disease (GERD) are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for asthma are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for a left hand condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for a right hand condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for sleep apnea are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for service connection for gout are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served from September 2001 to September 2004. The rating decisions on appeal were issued in October 2024 and March 2025, and constitute initial decisions; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the July 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the October 2024 and March 2025 agency of original jurisdiction (AOJ) decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was submitted 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. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. However, because the Board is remanding the claims of service connection for low back and bilateral knee disabilities, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii). Service Connection 1. Service connection for TBI head injury The Veteran seeks service connection for TBI. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). As outlined above, the first element of service connection is the requirement of a current disability. Such a requirement is satisfied if the disability is present at any point proximate to the claim, during the claim, or to the appeal period. See McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2014). If there is no evidence of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). There must be a demonstration of symptoms proximate to, or since, the time the application is filed. Gilpin v. West, 155 F.3d 1353, 1356 (Fed. Cir. 1998). Additionally, the Board recognizes that in Saunders v. Wilkie, 886 F.3d 1356, 1361-62 (2018), the Federal Circuit concluded that pain alone could serve as a disability for VA compensation purposes if the pain results in functional impairment that affects earning capacity. Id. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Veteran was afforded a VA examination in December 2024. The Veteran reported that he fell and hit his head while in Korea. The examiner concluded that the Veteran does not have a current diagnosis associated with any claimed conditions listed above. The examiner determined that the Veteran's symptoms were likely due to other disabilities, to include PTSD and chronic sleep impairment, and that there was no TBI diagnosis supported by the medical record. The examiner opined that the Veteran's claimed TBI condition was less likely related to active service. The examiner explained that no diagnosis was warranted. The examiner elaborated that there was no complaint or treatment for TBI or head injury during service, and that the exam was within normal limits. The Board concludes that the Veteran does not have a current diagnosis of TBI and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Veteran was afforded a VA medical opinion regarding his claimed TBI condition. The examiner concluded that the record does not substantiate a diagnosis of TBI. As such, the examiner rendered a negative nexus based upon the lack of diagnosis. While the Veteran believes there is a current diagnosis of a TBI, the Veteran is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for a TBI is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Service connection for chronic fatigue syndrome The Veteran seeks service connection for chronic fatigue syndrome. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). As outlined above, the first element of service connection is the requirement of a current disability. Such a requirement is satisfied if the disability is present at any point proximate to the claim, during the claim, or to the appeal period. See McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2014). If there is no evidence of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). There must be a demonstration of symptoms proximate to, or since, the time the application is filed. Gilpin v. West, 155 F.3d 1353, 1356 (Fed. Cir. 1998). Additionally, the Board recognizes that in Saunders v. Wilkie, 886 F.3d 1356, 1361-62 (2018), the Federal Circuit concluded that pain alone could serve as a disability for VA compensation purposes if the pain results in functional impairment that affects earning capacity. Id. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Veteran submitted a September 2024 disability benefits questionnaire (DBQ) in support of his claim. The Veteran reported chronic fatigue symptoms for ten years, including difficulty getting out of bed, excessive sleepiness, and loss of active days due to fatigue. The clinician diagnosed chronic fatigues syndrome. However, as noted in the October 2024 VA examination, the private DBQ relied primarily on the Veteran's lay reports of symptoms and did not conduct a physical work up that met the criteria for a diagnosis of chronic fatigue syndrome. The Veteran was afforded a VA examination in October 2024. The Veteran reported chronic fatigue syndrome after military training since 2002. The examiner concluded that the Veteran does not have a current diagnosis of chronic fatigue syndrome. The examiner explained that the claims file was silent for any work-up that met VA criteria for a diagnosis of chronic fatigue syndrome. The examiner further indicated that symptoms at the VA examination were subjective only, and were not consistent with a diagnosis of chronic fatigue syndrome. Thus, the examiner found that no diagnosis of chronic fatigue syndrome was warranted. The Board concludes that the Veteran does not have a current diagnosis of chronic fatigue syndrome and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Veteran was afforded a VA medical opinion regarding his claimed chronic fatigue syndrome condition. The examiner concluded that the record does not substantiate a diagnosis of chronic fatigue syndrome. As such, the examiner rendered a negative nexus based upon the lack of diagnosis. While the Board acknowledges the private DBQ, the Board gives greater weight to the October 2024 VA opinion which found that the claims record did not reveal any workup that met the criteria for a diagnosis of chronic fatigue syndrome. The Board has also considered Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the Federal Circuit held that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. However, the Veteran has not made any statements regarding pain or functional impairment related to chronic fatigue syndrome disability beyond the bare assertion of filing a claim for entitlement to service connection for this condition. While the Veteran believes there is a current diagnosis of a chronic fatigue condition, the Veteran is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for chronic fatigue syndrome is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 3. Service connection for pes planus The Veteran seeks service connection for pes planus. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). A preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153. If a condition is noted upon entrance into service, in order to establish entitlement to compensation benefits, the burden falls on the veteran to show an increase in disability in service. 38 U.S.C. § 1153; Wagner, 370 F.3d at 1096. If the veteran satisfies this burden, the preexisting condition will be presumed to have been aggravated by service. Wagner, 370 F.3d at 1096. The question of whether a preexisting defect or injury underwent an increase in severity "must be answered in the affirmative before the presumption of aggravation attaches." Verdon v. Brown, 8 Vet. App. 529, 538 (1996); see also Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991) (holding "that temporary or intermittent flare-ups during service of a preexisting injury or disease are not sufficient to be considered 'aggravation in service' unless the underlying condition, as contrasted to symptoms, is worsened"). The burden falls on the government to rebut the presumption of aggravation by clear and unmistakable evidence that the demonstrated increase in disability was the result of the natural progress of the condition. Wagner, 370 F.3d at 1096. Service treatment records reflect mild pes planus at enlistment. At the July 2001 enlistment examination, the service treatment records reflected pes planus, mild, asymptomatic. The Veteran was afforded a VA examination in September 2024. The examiner diagnosed pes planus. The examiner opined that the claimed condition, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. The examiner noted that the enlistment examination showed a diagnosis of pes planus. However, after reviewing the medical claims file records, the examiner found there was no evidence of complaints or symptoms of pes planus during active military service. The examiner explained that IF this was aggravated beyond its natural progression, there would be some documentation regarding this claim during active military services. Thus, the examiner concluded that the claimed condition, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. The Board concludes that, while the Veteran has a current diagnosis of pes planus, and evidence shows that mild and asymptomatic pes planus was noted at enlistment, the evidence of record persuasively weighs against finding that the Veteran's diagnosis of pes planus was aggravated by service. The September 2024 VA examiner opined that the Veteran's pes planus, which clearly and unmistakably preexisted service, was not aggravated during the Veteran's active military service. The examiner explained that there was no evidence of complaints or symptoms of pes planus during military service. The examiner continued, explaining that if the Veteran's pes planus had been aggravated, there would be some documentation regarding this claim during active military service. Overall, the VA examiner opined that the claimed pes planus was not aggravated beyond its natural progression by an in-service injury as there is no documentation of permanent aggravation of symptoms. The Board has considered the Veteran's assertions, but in the absence of any probative medical evidence supporting this assertion, his lay statements alone are not sufficient to find such a nexus, and his statements are outweighed by the more probative opinion of the VA examiner. Overall, the evidence of record persuasively weighs against finding that the Veteran's pes planus was incurred in or otherwise the result of his active service nor was his preexisting pes planus that was aggravated by service. Thus, the claim is denied. 4. Service connection for gastroesophageal reflux disease (GERD) (claimed as acid reflux) The Veteran seeks service connection for acid reflux. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Veteran was afforded a VA examination in December 2023. The Veteran reported heart and throat burn since 2023. The examiner diagnosed gastroesophageal reflux disease (GERD). The Veteran was afforded a VA examination in September 2024. The examiner diagnosed GERD. The examiner opined that the Veteran's GERD is less likely than not proximately due to or the result of his service-connected PTSD. The examiner explained that GERD is an entirely separate entity from PTSD, and that a thorough review of the medical literature failed to demonstrate a causal relationship. The examiner opined that the Veteran's GERD is less likely than not proximately due to or the result of his service-connected headaches. The examiner explained that GERD is an entirely separate entity from headaches, and that a thorough review of the medical literature failed to demonstrate a causal relationship. The examiner opined that the Veteran's GERD is less likely than not proximately due to or the result of his service-connected bronchitis. The examiner explained that GERD and acute bronchitis with bronchospasm are not medically related. A thorough review of medical literature failed to demonstrate a causal relationship The Board concludes that, while the Veteran has a current diagnosis of GERD, the evidence of record persuasively weighs against finding that the Veteran's diagnosis of GERD began during service or is otherwise related to an in-service injury, event, or disease. The September 2024 VA examiner opined that the Veteran's GERD is not at least as likely as not related to an in-service injury, event, or disease, including secondary to PTSD, chronic bronchitis, or headaches. The examiner explained that the Veteran's service-connected disabilities are not medically related to GERD, and that a thorough review of medical literature failed to demonstrate a causal relationship. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran believes the claimed GERD is related to an in-service injury, event, or disease. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of pathology and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that the Veteran has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the September 2024 VA examination. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for GERD is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 5. Service connection for asthma The Veteran seeks service connection for asthma. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). As outlined above, the first element of service connection is the requirement of a current disability. Such a requirement is satisfied if the disability is present at any point proximate to the claim, during the claim, or to the appeal period. See McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2014). If there is no evidence of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). There must be a demonstration of symptoms proximate to, or since, the time the application is filed. Gilpin v. West, 155 F.3d 1353, 1356 (Fed. Cir. 1998). Additionally, the Board recognizes that in Saunders v. Wilkie, 886 F.3d 1356, 1361-62 (2018), the Federal Circuit concluded that pain alone could serve as a disability for VA compensation purposes if the pain results in functional impairment that affects earning capacity. Id. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Veteran was afforded a VA examination in December 2023. The Veteran reported chronic bronchitis, shortness of breath, cough, and wheezing due to asthma. The examiner diagnosed chronic bronchitis, for which the Veteran is already service connected. The examiner concluded that the Veteran does not have a current diagnosis of asthma. Physical examination with respect to asthma was not indicated. Thus, the examiner found that no diagnosis of asthma was warranted. The Board concludes that the Veteran does not have a current diagnosis of asthma and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Veteran was afforded a VA medical opinion regarding his claimed asthma condition. The examiner concluded that the record does not substantiate a diagnosis of an asthma condition, and instead diagnosed chronic bronchitis. As such, the examiner rendered a negative nexus based upon the lack of diagnosis. The Board has also considered Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the Federal Circuit held that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. However, the Veteran has not made any statements regarding pain or functional impairment related to an asthma disability beyond the bare assertion of filing a claim for entitlement to service connection for this condition. While the Veteran believes there is a current diagnosis of an asthma condition, the Veteran is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for asthma is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 6. Service connection for left hand condition 7. Service connection for right hand condition The Veteran seeks service connection for a bilateral hand condition. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). As outlined above, the first element of service connection is the requirement of a current disability. Such a requirement is satisfied if the disability is present at any point proximate to the claim, during the claim, or to the appeal period. See McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2014). If there is no evidence of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). There must be a demonstration of symptoms proximate to, or since, the time the application is filed. Gilpin v. West, 155 F.3d 1353, 1356 (Fed. Cir. 1998). Additionally, the Board recognizes that in Saunders v. Wilkie, 886 F.3d 1356, 1361-62 (2018), the Federal Circuit concluded that pain alone could serve as a disability for VA compensation purposes if the pain results in functional impairment that affects earning capacity. Id. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Veteran was afforded a VA examination in September 2024. The Veteran reported bilateral hand pain and swelling. The examiner concluded that the Veteran does not have a current diagnosis associated with his hands. Physical examination was noted as normal at the examination, and symptoms were subjective only. The claims file also was silent for any hand complaints or treatment. Thus, the examiner found that no diagnosis was warranted. The Board concludes that the Veteran does not have a current diagnosis of a bilateral hand condition and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Veteran was afforded a VA medical opinion regarding his claimed bilateral hand condition. The examiner concluded that the record does not substantiate a diagnosis of a bilateral hand condition. As such, the examiner rendered a negative nexus based upon the lack of diagnosis. The Board has also considered Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the Federal Circuit held that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. However, the Veteran has not made any statements regarding pain or functional impairment related to a bilateral hand disability beyond the bare assertion of filing a claim for entitlement to service connection for this condition. While the Veteran believes there is a current diagnosis of a bilateral hand condition, the Veteran is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for a bilateral hand condition is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 8. Service connection for sleep apnea The Veteran seeks service connection for sleep apnea. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). As outlined above, the first element of service connection is the requirement of a current disability. Such a requirement is satisfied if the disability is present at any point proximate to the claim, during the claim, or to the appeal period. See McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2014). If there is no evidence of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). There must be a demonstration of symptoms proximate to, or since, the time the application is filed. Gilpin v. West, 155 F.3d 1353, 1356 (Fed. Cir. 1998). Additionally, the Board recognizes that in Saunders v. Wilkie, 886 F.3d 1356, 1361-62 (2018), the Federal Circuit concluded that pain alone could serve as a disability for VA compensation purposes if the pain results in functional impairment that affects earning capacity. Id. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Veteran was afforded a VA examination in August 2024. The Veteran reported gout. The examiner concluded that the Veteran does not have a current diagnosis associated with sleep apnea. The examiner noted that the Veteran declined to schedule a sleep study. The examiner opined that the Veteran's claimed condition was less likely related to toxic exposure risk activities during service. The examiner explained that the Veteran does not have a confirmed diagnosis of sleep apnea. The examiner elaborated that although the Veteran's Gulf War service and potential exposures are considered, without the sleep study, there is no clinical basis to definitively determine the presence of sleep apnea. The Board concludes that the Veteran does not have a current diagnosis of sleep apnea and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Veteran was afforded a VA medical opinion regarding his claimed sleep apnea condition. The examiner concluded that the record does not substantiate a diagnosis of sleep apnea. As such, the examiner rendered a negative nexus based upon the lack of diagnosis. The Board has also considered Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the Federal Circuit held that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. However, the Veteran has not made any statements regarding pain or functional impairment related to a sleep apnea disability beyond the bare assertion of filing a claim for entitlement to service connection for this condition. While the Veteran believes there is a current diagnosis of sleep apnea, the Veteran is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for sleep apnea is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 9. Service connection for gout The Veteran seeks service connection for gout. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). As outlined above, the first element of service connection is the requirement of a current disability. Such a requirement is satisfied if the disability is present at any point proximate to the claim, during the claim, or to the appeal period. See McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2014). If there is no evidence of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). There must be a demonstration of symptoms proximate to, or since, the time the application is filed. Gilpin v. West, 155 F.3d 1353, 1356 (Fed. Cir. 1998). Additionally, the Board recognizes that in Saunders v. Wilkie, 886 F.3d 1356, 1361-62 (2018), the Federal Circuit concluded that pain alone could serve as a disability for VA compensation purposes if the pain results in functional impairment that affects earning capacity. Id. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Veteran was afforded a VA examination in December 2023. The Veteran reported gout. The examiner concluded that the Veteran does not have a current diagnosis associated with any claimed conditions listed above. The examiner opined that the Veteran's claimed condition was less likely related to toxic exposure risk activities during service. The examiner explained that no diagnosis was warranted. The examiner elaborated that there was no complaint or treatment for gout, and that the exam was within normal limits. The Board concludes that the Veteran does not have a current diagnosis of gout and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Veteran was afforded a VA medical opinion regarding his claimed gout condition. The examiner concluded that the record does not substantiate a diagnosis of gout. As such, the examiner rendered a negative nexus based upon the lack of diagnosis. The Board has also considered Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the Federal Circuit held that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. However, the Veteran has not made any statements regarding pain or functional impairment related to a gout disability beyond the bare assertion of filing a claim for entitlement to service connection for this condition. While the Veteran believes there is a current diagnosis of gout, the Veteran is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for gout is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Service connection for lumbosacral strain is remanded. The Veteran seeks service connection for a back disability. The Veteran was afforded a VA examination in September 2024. The Veteran reported low back pain since 2003, during active-duty service while carrying rucksacks during road marches. The examiner diagnosed lumbosacral strain. The examiner opined the claimed condition is less likely than not related to service. The examiner indicated that the claim file was silent for any knee complaints. Without chronicity during or after service, the examiner concluded that a plausible direct service connection opinion could not be rendered. The Board finds the September 2024 VA examination inadequate. The examiner's opinions are basically predicated on the lack of any documented treatment. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). As such, the issue must be remanded to correct the above noted pre-decisional duty to assist error by obtaining an adequate medical opinion. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 2. Service connection for left knee strain is remanded. 3. Service connection for right knee strain is remanded. The Veteran seeks service connection for left and right knee disabilities. The Veteran was afforded a VA examination in September 2024. The Veteran reported bilateral knee pain since 2002, during active-duty service. The examiner diagnosed bilateral knee strain. The examiner opined the claimed condition is less likely than not related to service. The examiner indicated that the claim file was silent for any knee complaints. Without chronicity during or after service, the examiner concluded that a plausible direct service connection opinion could not be rendered. The Board finds the September 2024 VA examination inadequate. The examiner's opinions are basically predicated on the lack of any documented treatment. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). As such, the issue must be remanded to correct the above noted pre-decisional duty to assist error by obtaining an adequate medical opinion. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's back condition is at least as likely as not related to marching injury during active-duty service. The examiner is asked to provide a response to the following: Is the back condition at least as likely as not related to service, including claimed back injury during active service? Provide a rationale to support the opinion(s). In providing the requested opinion, consider the Veteran's description of the in-service injury and symptoms as well as post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of the current disability, this should be noted. Stated another way, do the Veteran's reports about the symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's bilateral knee condition is at least as likely as not related to wear and tear injury during active-duty service. The examiner is asked to provide a response to the following: Is the bilateral knee condition at least as likely as not related to service, including claimed knee injury during active service? Provide a rationale to support the opinion(s). In providing the requested opinion, consider the Veteran's description of the in-service injury and symptoms as well as post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of the current disability, this should be noted. Stated another way, do the Veteran's reports about the symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? M. MILLS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Lauritzen 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.