DIABETES MELLITUS

Summary

The veteran, who served from March 1972 to March 1973, appeals the denial of service connection for diabetes mellitus, kidney disease, hypertension, acid reflux, bilateral foot pain, bilateral leg pain, and a nerve disability. All conditions were claimed as primary and, where applicable, secondary to diabetes mellitus, kidney disease, or hypertension. The Board denied service connection for all conditions. For diabetes mellitus, the Board found that while the veteran has a current diagnosis, the preponderance of the evidence did not establish onset in service, manifestation within the presumptive period, or continuity of symptomatology. Private treatment records indicated a diagnosis approximately 18 years prior to 2012, placing it well outside the one-year presumptive period. The veteran's spouse alleged a diagnosis over 30 years prior, also outside the presumptive period. Service treatment records and the separation examination were negative for diabetes. For kidney disease, hypertension, acid reflux, bilateral foot pain, bilateral leg pain, and a nerve disability, the Board denied service connection, finding the preponderance of the evidence against direct service connection and, where applicable, against secondary service connection due to the lack of service connection for the primary conditions. The Board noted that for kidney disease and hypertension, private records suggested diagnoses decades after service. For acid reflux, the evidence was unclear regarding current diagnosis and onset. For foot pain, leg pain, and nerve disability, the Board cited Saunders v. Wilkie, emphasizing that subjective pain alone, without a diagnosed condition or functional impairment of earning capacity, does not establish a disability. The Board found no competent evidence to establish a nexus to service for any of the claimed conditions.

Rationale

Preponderance of evidence against onset in service or within presumptive period.; Private records suggest diagnosis ~18 years prior to 2012 (outside presumptive period).; Service treatment records and separation exam negative for diabetes.

Full Decision Text

Citation Nr: 18138917
Decision Date: 09/26/18	Archive Date: 09/26/18

DOCKET NO. 16-20 097
DATE:	September 26, 2018
ORDER
1. Entitlement to service connection for diabetes mellitus is denied.
2. Entitlement to service connection for kidney disease, to include as secondary to diabetes mellitus, is denied.
3. Entitlement to service connection for hypertension, to include as secondary to diabetes mellitus, is denied.
4. Entitlement to service connection for acid reflux, to include as secondary to kidney disease, is denied.
5. Entitlement to service connection for pain in the bilateral feet, to include as secondary to diabetes mellitus, is denied.
6. Entitlement to service connection for pain in the bilateral legs, to include as secondary to diabetes mellitus, is denied.
7. Entitlement to service connection for a nerve disability, to include as secondary to diabetes mellitus, is denied.
FINDINGS OF FACT
1. Diabetes mellitus did not have its onset in service; did not manifest to a compensable degree within one year of service discharge; continuity of symptomatology is not established; and the disability is not otherwise related to service.
2. Kidney disease did not have its onset in service; did not manifest to a compensable degree within one year of service discharge; continuity of symptomatology is not established; and the disability is not otherwise related to service or a service-connected disability.
3. Hypertension did not have its onset in service; did not manifest to a compensable degree within one year of service discharge; continuity of symptomatology is not established; and the disability is not otherwise related to service or a service-connected disability.
4. The preponderance of the evidence is against finding that acid reflux began during active service, or is otherwise related to service or a service-connected disability.
5. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis associated with pain in his bilateral feet.
6. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis associated with his pain in his bilateral legs.
7. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of a nerve disability.
CONCLUSIONS OF LAW
1. The criteria for entitlement to service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)–(b), (d), 3.307, 3.309(a).
2. The criteria for entitlement to service connection for kidney disease, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107(b); 38 C.F.R. §§ 3.102, 3.307, 3.309(a), 3.310(a).
3. The criteria for entitlement to service connection for hypertension, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)–(b), (d), 3.307, 3.309(a), 3.310.
The criteria for entitlement to service connection for acid reflux, to include as secondary to kidney disease, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a).
4. The criteria for entitlement to service connection for pain in the bilateral feet, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a).
5. The criteria for entitlement to service connection for pain in the bilateral legs, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a).
6. The criteria for entitlement to service connection for a nerve disability, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C
 in the bilateral feet, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a).
5. The criteria for entitlement to service connection for pain in the bilateral legs, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a).
6. The criteria for entitlement to service connection for a nerve disability, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran served on active duty from March 1972 to March 1973.
Service Connection
Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. 
When the disorder at issue is a “chronic disease” listed under 38 C.F.R. § 3.309(a), 38 C.F.R. § 3.303(b) applies.  Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).  Diabetes mellitus, hypertension, and renal disease are all chronic diseases.  Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. For the showing of “chronic” disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time.  With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes.  If a condition noted during service is not shown to be chronic, then generally, a showing of “continuity of symptoms” after service is required for service connection.  38 C.F.R. § 3.303(b).  
Additionally, where a Veteran served 90 days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service.  38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a).  While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time.  Id.
Service connection is also warranted 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). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(b).
The Board must analyze the credibility and probative value of the evidence, account for the evidence it finds persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the Veteran. This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record. 
A lay person is competent to report to the onset and continuity of his symptomatology. Moreover, lay evidence may be competent and sufficient evidence of a diagnosis or nexus if (1) the particular condition at issue is the type of condition that is within the competence or common knowledge of a lay person, (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, 1376–77 (Fed. Cir. 2007). The Board must determine
 Veteran. This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record. 
A lay person is competent to report to the onset and continuity of his symptomatology. Moreover, lay evidence may be competent and sufficient evidence of a diagnosis or nexus if (1) the particular condition at issue is the type of condition that is within the competence or common knowledge of a lay person, (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, 1376–77 (Fed. Cir. 2007). The Board must determine on a case-by-case basis whether a particular condition is the type of condition that is within the competence of a lay person. 
A Veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. In making its ultimate determination, the Board must give a Veteran the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. 
1. Entitlement to service connection for diabetes mellitus
The question for the Board is whether the Veteran has a chronic disease that manifested in service, manifested to a compensable degree within the applicable presumptive period, or whether continuity of symptomatology has existed since service.
The Board concludes that, while the Veteran has a current diagnosis of diabetes mellitus, which is a chronic disease under 38 C.F.R. § 3.309(a), the preponderance of the evidence is against a finding that the Veteran’s diabetes mellitus manifested in service or to a compensable degree within the one-year presumptive period, and continuity of symptomatology is not established. Private treatment records document that the Veteran was diagnosed with diabetes mellitus 18 years prior to 2012, which is approximately 20 years after his service discharge and outside the one-year presumptive period.  Thus, presumptive service connection is not warranted. 
While the Veteran alleges that he was diagnosed with diabetes mellitus within one year of his discharge from active duty service, the Board gives more probative weight to the 2012 to 2014 private treatment records, which note the Veteran had a history of diabetes mellitus diagnosed approximately 18 years prior, which suggests that he was diagnosed with diabetes mellitus in approximately 1994, which is more than 20 years after the Veteran’s discharge from active duty service.
In a September 2014 statement, the Veteran’s spouse wrote that the Veteran had been a diabetic for more than 30 years, which would place the diagnosis in approximately 1984—more than 10 years following service discharge.  Regardless, the Board finds that the most probative evidence as to the onset of diabetes is the private medical evidence.  Statements made in connection with treatment tend to be highly credible, and thus, the private physician’s 2012 notation that the Veteran had diabetes for 18 years is considered credible and accurate.
Service connection for diabetes mellitus may still be granted on a direct basis; however, the preponderance of the evidence is against finding that there is a nexus between the Veteran’s diabetes mellitus and service.  The Veteran’s service treatment records (STRs) do not show symptoms or a diagnosis of diabetes mellitus in service. Furthermore, the Veteran’s health was noted to be good at separation, and the Veteran’s separation examination in March 1973 did not document any clinical abnormalities or diagnosis of diabetes mellitus.  There is no competent evidence of a relationship between the post service diagnosis of diabetes mellitus and service.  Accordingly, service connection for diabetes mellitus is denied.
2. Entitlement to service connection for kidney disease, to include as secondary to diabetes mellitus 
The Veteran contends that his kidney disease is secondary to his diabetes mellitus. As the Veteran is not service connected for diabetes mellitus, as determined above, service connection for kidney disease cannot be granted on a secondary basis.
The remaining question for the Board is whether the Veteran has a chronic disease that manifested in service, manifested to a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service.
The Board concludes that, while the Veteran has a current diagnosis of kidney disease, which is a chronic disease under 38 C.F.R. § 3.309(a), the preponderance of the evidence is against a finding that the Veteran’s kidney disease manifested in service or to a compensable degree within the one-year presumptive period, and continuity of symptomatology is not established. It is unclear when kidney disease was diagnosed, but the earliest it is shown in the medical evidence of record is in December 2012, which is almost 40 years after service discharge and outside the one-year presumptive period. 
 a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service.
The Board concludes that, while the Veteran has a current diagnosis of kidney disease, which is a chronic disease under 38 C.F.R. § 3.309(a), the preponderance of the evidence is against a finding that the Veteran’s kidney disease manifested in service or to a compensable degree within the one-year presumptive period, and continuity of symptomatology is not established. It is unclear when kidney disease was diagnosed, but the earliest it is shown in the medical evidence of record is in December 2012, which is almost 40 years after service discharge and outside the one-year presumptive period.  Thus, presumptive service connection is not warranted. 
As to direct service connection, the Board concludes that the preponderance of the evidence is against a finding that it began during active service, manifested to a compensable degree within one year following service discharge, or is otherwise related to service.  
There is no competent evidence that kidney disease had its onset in service or that it manifested to a compensable degree within one year following service discharge.  The Board is aware that the Veteran has alleged he had it within one year following service, but the medical evidence does not support this.  For example, the private medical records do not show that the Veteran was diagnosed with kidney disease from 2005 to 2011.  When the Veteran is seen in December 2012, a past medical history of high blood pressure, diabetes, and “other visual problem” was documented.  The examiner wrote that the Veteran had been sent there for “evaluation of an elevated creatine” and entered an assessment of chronic kidney injury in association with diabetes and hypertension.  This does not establish a nexus to service.
The Veteran’s STRs are silent for a diagnosis of kidney disease in service, and the Veteran’s separation examination in March 1973 showed that clinical evaluations of all systems were normal.  There is no competent evidence of a nexus between the post service diagnosis of kidney disease and service.  As the preponderance of the evidence is against a finding that the Veteran’s kidney disease began during active service or is otherwise related to service, service connection for kidney disease is denied.
3. Entitlement to service connection for hypertension, to include as secondary to diabetes mellitus
The Veteran contends that his hypertension is secondary to his diabetes mellitus. As the Veteran is not service connected for diabetes mellitus, as determined above, service connection for hypertension cannot be granted on a secondary basis.
Additionally, the Board concludes that, while the Veteran has a current diagnosis of hypertension, which is a chronic disease under 38 C.F.R. § 3.309(a), the preponderance of the evidence is against a finding that the Veteran’s hypertension manifested in service or to a compensable degree within the presumptive period, and continuity of symptomatology is not established. It is unclear when the Veteran was diagnosed with hypertension.  An April 2005 private treatment record shows that the Veteran was not reporting a history of hypertension like he reported diabetes mellitus.  There was a family history noted of hypertension, but the examiner did not enter a diagnosis of hypertension, despite noting a diagnosis of diabetes mellitus.  The Veteran’s blood pressure was 140/76 at that time.  In an August 2005 private medical record from the same physician, it shows the Veteran’s blood pressure was 140/100, and, this time, the examiner entered a diagnosis of hypertension (along with diabetes mellitus).  Thus, it would appear that hypertension may have been diagnosed in 2005, which is more than 30 years following service discharge and decades outside of the applicable presumptive period.  Thus, presumptive service connection is not warranted. 
While the Veteran has reported that he was diagnosed with hypertension within one year of his discharge from active duty service, the Board gives more probative weight to the Veteran’s private treatment records, which appear to show that hypertension was diagnosed in 2005, which, again, is more than 30 years following service discharge.  
Service connection for hypertension may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s hypertension and service, as the Veteran’s STRs do not show that the Veteran had hypertension in service. The Veteran’s blood pressure on his separation examination shows it was 120/68 and clinical evaluations of the heart and vascular system were normal.  Furthermore, the Veteran wrote that he was in good health on the separation examination report.  
There is no competent evidence of a nexus between the post service diagnosis of hypertension and service.  As the preponderance of the evidence is against a finding that the Veteran’s hypertension began during active service or is otherwise related to service, service connection for
 for hypertension may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s hypertension and service, as the Veteran’s STRs do not show that the Veteran had hypertension in service. The Veteran’s blood pressure on his separation examination shows it was 120/68 and clinical evaluations of the heart and vascular system were normal.  Furthermore, the Veteran wrote that he was in good health on the separation examination report.  
There is no competent evidence of a nexus between the post service diagnosis of hypertension and service.  As the preponderance of the evidence is against a finding that the Veteran’s hypertension began during active service or is otherwise related to service, service connection for hypertension is denied.
4. Entitlement to service connection for acid reflux, to include as secondary to kidney disease
The Veteran contends that his acid reflux is secondary to his kidney disease. As the Veteran is not service connected for kidney disease, as determined above, service connection for acid reflux cannot be granted on a secondary basis.
The remaining question for the Board is whether the Veteran has a current disability that began during service or is otherwise related to service.
It is unclear whether the Veteran currently has a current diagnosis of acid reflux disease. The Veteran’s private treatment records indicate that he was hospitalized for acid reflux in September 2008, prior to the period on appeal. The Veteran’s private treatment records since that time do not mention an ongoing disability. However, in a statement submitted by the Veteran’s spouse in September 2014, she wrote that the Veteran was taking medication to treat symptoms of acid reflux.
Regardless, even assuming the Veteran has a current diagnosis of acid reflux, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to service.  The Veteran’s allegation that it either had its onset in service or soon thereafter, is insufficient to establish a nexus to service, as that would require more than just an allegation that it started within one year following service discharge.  The earliest medical evidence in the file is from 2005, and the Veteran was not reporting acid reflux at that time, which the Board finds tends to show that acid reflux, assuming the Veteran has it, manifested decades after service.  
The Veteran’s STRs are silent for a diagnosis of acid reflux in service, and the Veteran’s separation examination in March 1973 did not indicate any clinical abnormalities or symptoms or a diagnosis of acid reflux prior to the Veteran’s discharge from service. As the preponderance of the evidence is against a finding that the Veteran’s acid reflux that began during active service or is otherwise related to service, service connection for acid reflux is denied.
5. Entitlement to service connection for pain in the bilateral feet, to include as secondary to diabetes mellitus
The Veteran contends that the pain in his feet is secondary to his diabetes mellitus. As the Veteran is not service connected for diabetes mellitus, as determined above, service connection for bilateral feet pain cannot be granted on a secondary basis.
The remaining question for the Board is whether the Veteran has a current disability that began during service or is otherwise related to service.
The Board concludes that the Veteran does not have a current diagnosis related to pain in his feet separate from any diabetic neuropathy and has not had a disability at any time during the pendency of the claim or recent to the filing of the claim.  While the Veteran is competent to report pain in his feet, he is not competent to provide a diagnosis in this case. His allegations of foot pain are general.  In Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) held that “‘disability’ in § 1110 refers to the functional impairment of earning capacity” and “pain in the absence of a presently-diagnosed condition can cause functional impairment,” en route to its conclusion that “pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability.”  886 F.3d at 1363, 1368, 1369. However, the Federal Circuit also made clear that a veteran cannot “demonstrate service connection simply by asserting subjective pain—to establish a disability, the Veteran’s pain must amount to a functional impairment. To establish the presence of a disability, a Veteran will need to show that [his or] her pain reaches the level of a functional impairment of earning capacity.”  Id. at 1367-68.
Here, the Veteran has not provided this evidence.  Thus, he cannot satisfy the basic compensation statutes.  A claim for pain alone is an insufficient factual showing that the pain derives from an in-service disease or injury.  Consequently, the Board does not have evidence to establish that the Veteran has a current disability manifested by pain in
1369. However, the Federal Circuit also made clear that a veteran cannot “demonstrate service connection simply by asserting subjective pain—to establish a disability, the Veteran’s pain must amount to a functional impairment. To establish the presence of a disability, a Veteran will need to show that [his or] her pain reaches the level of a functional impairment of earning capacity.”  Id. at 1367-68.
Here, the Veteran has not provided this evidence.  Thus, he cannot satisfy the basic compensation statutes.  A claim for pain alone is an insufficient factual showing that the pain derives from an in-service disease or injury.  Consequently, the Board does not have evidence to establish that the Veteran has a current disability manifested by pain in the feet (other than diabetic neuropathy) that is related to service.  Absent a current disability, service connection is not warranted.
6. Entitlement to service connection for pain in the bilateral legs, to include as secondary to diabetes mellitus
The Veteran contends that his leg pain is secondary to his diabetes mellitus. As the Veteran is not service connected for diabetes mellitus, as determined above, service connection for bilateral leg pain cannot be granted on a secondary basis.
The remaining question for the Board is whether the Veteran has a current disability that began during service or is otherwise related to service.
The Board concludes that the Veteran does not have a current diagnosis related to pain in his legs separate from any diabetic neuropathy and has not had one at any time during the pendency of the claim or recent to the filing of the claim.  While the Veteran is competent to report pain in his legs, he is not competent to provide a diagnosis in this case. His allegations of leg pain are general.  In Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the Federal Circuit held that “‘disability’ in § 1110 refers to the functional impairment of earning capacity” and “pain in the absence of a presently-diagnosed condition can cause functional impairment,” en route to its conclusion that “pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability.” 886 F.3d at 1363, 1368, 1369.  However, the Federal Circuit also made clear that a veteran cannot “demonstrate service connection simply by asserting subjective pain—to establish a disability, the Veteran’s pain must amount to a functional impairment. To establish the presence of a disability, a Veteran will need to show that [his or] her pain reaches the level of a functional impairment of earning capacity.” Id. at 1367-68.
Here, the Veteran has not provided this evidence.  Absent a disease or injury incurred during service, the Veteran cannot satisfy the basic compensation statutes.  A claim for pain alone is an insufficient factual showing that the pain derives from an in-service disease or injury. Consequently, the Board does not have evidence to establish that the Veteran has a current disability manifested by pain in the legs (other than diabetic neuropathy) that is related to service. Absent a current disability, service connection is not warranted.
7. Entitlement to service connection for a nerve disability, to include as secondary to diabetes mellitus
The Veteran contends that his nerve disability is secondary to his diabetes mellitus. As the Veteran is not service connected for diabetes mellitus, as determined above, service connection for a nerve disability cannot be granted on a secondary basis.
The remaining question for the Board is whether the Veteran has a current disability that began during service or otherwise related to service.
The Board concludes that the Veteran does not have a current diagnosis of a nerve disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim.  
While the Veteran may believe he has a current diagnosis of a nerve disability he is not competent to provide a diagnosis in this case.  His allegations of nerve pain are general.  In Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the Federal Circuit held that “‘disability’ in § 1110 refers to the functional impairment of earning capacity” and “pain in the absence of a presently-diagnosed condition can cause functional impairment,” en route to its conclusion that “pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability.”  886 F.3d at 1363, 1368, 1369.  However, the Federal Circuit also made clear that a veteran cannot “demonstrate service connection simply by asserting subjective pain—to establish a disability, the veteran’s pain must amount to a functional impairment.  To establish the presence of a disability, a veteran will need to show that her pain reaches the level of a functional impairment of earning capacity.”  Id. at 136
 1110 refers to the functional impairment of earning capacity” and “pain in the absence of a presently-diagnosed condition can cause functional impairment,” en route to its conclusion that “pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability.”  886 F.3d at 1363, 1368, 1369.  However, the Federal Circuit also made clear that a veteran cannot “demonstrate service connection simply by asserting subjective pain—to establish a disability, the veteran’s pain must amount to a functional impairment.  To establish the presence of a disability, a veteran will need to show that her pain reaches the level of a functional impairment of earning capacity.”  Id. at 1367-68.
Here, the Veteran has not provided this evidence.  Absent a disease or injury incurred during service, the Veteran cannot satisfy the basic compensation statutes.  A claim for pain alone is an insufficient factual showing that the pain derives from an in-service disease or injury.  Consequently, the Board gives more probative weight to the competent medical evidence, which does not support a diagnosis of a nerve disability or any other psychiatric disability. Absent a current diagnosis, service connection is not warranted.
 
A. P. SIMPSON
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. Keninger, Associate Counsel