DIABETES MELLITUS

TIMOTHY COTHREL · 2025 · Case ID: A25084473

MIXED

Summary

The Veteran served in the U.S. Army from March 1970 to January 1972. The Veteran's spouse was substituted as Appellant after the Veteran's passing. The Veteran claimed service connection for diabetes mellitus and hypertension, asserting exposure to herbicides during Vietnam service. He also claimed peripheral neuropathy, erectile dysfunction, cataracts, and residuals of a stroke, all secondary to diabetes mellitus. Additionally, he claimed service connection for tinnitus and an acquired psychiatric disorder. The Board denied service connection for diabetes mellitus, hypertension, peripheral neuropathy, erectile dysfunction, cataracts, residuals of a stroke, and acquired psychiatric disorder. The Board found insufficient evidence of Vietnam service to trigger herbicide presumptions, and no in-service event or nexus for the claimed conditions. For tinnitus, the Board granted service connection, inferring in-service onset based on the Veteran's description of intermittent symptoms and applying the benefit of the doubt doctrine due to lack of definitive evidence and the VA's failure to obtain a detailed history or specific nexus opinion. The Board noted the Veteran's statements regarding his conditions but found them insufficient to establish service connection without medical expertise or corroborating evidence, accordinging greater weight to objective medical records.

Rationale

No in-service event or injury documented; No evidence of causal relationship to service; Service treatment records silent for renal condition

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

230331-517043

Full Decision Text

Citation Nr: A25084473
Decision Date: 10/01/25 Archive Date: 10/01/25

DOCKET NO. 230331-517043
DATE: October 1, 2025

ORDER

Entitlement to service connection for diabetes mellitus, to include as due to herbicide exposure, is denied.

Entitlement to service connection for peripheral neuropathy of the upper extremities, to include as secondary to diabetes mellitus, is denied.

Entitlement to service connection for erectile dysfunction, to include as secondary to diabetes mellitus, is denied.

Entitlement to service connection for cataracts, to include as secondary to diabetes mellitus, is denied.

Entitlement to service connection for residuals of a stroke, to include as secondary to diabetes mellitus, is denied.

Entitlement to service connection for hypertension, to include as due to herbicide exposure, is denied.

Entitlement to service connection for tinnitus is granted.

Entitlement to service connection for an acquired psychiatric disorder is denied.

FINDINGS OF FACT

1. The most probative evidence of record persuasively weighs against a finding that the Veteran's diabetes mellitus had its onset in or is otherwise etiologically related to a disease or injury during military service.

2. Diabetes mellitus was not manifested to a compensable degree within one year of separation from active-duty service and is not otherwise etiologically related to service.

3. The Veteran did not have an upper extremity peripheral neuropathy condition, to include functional impairment as due to peripheral neuropathy symptoms, within the relevant appeal period.

4. The Veteran did not have an erectile dysfunction condition, to include functional impairment as due to erectile dysfunction symptoms, within the relevant appeal period.

5. The Veteran did not have a cataract condition, to include functional impairment as due to cataract symptoms, within the relevant appeal period.

6. The most probative evidence of record persuasively weighs against a finding that the Veteran's residuals of a stroke had its onset in or is otherwise etiologically related to a disease or injury during military service.

7. Residuals of a stroke were not manifested to a compensable degree within one year of separation from active-duty service and is not otherwise etiologically related to service.

8. The most probative evidence of record persuasively weighs against a finding that the Veteran's hypertension condition had its onset in or is otherwise etiologically related to a disease or injury during military service.

9. A hypertension condition was not manifested to a compensable degree within one year of separation from active-duty service and is not otherwise etiologically related to service.

10. The Veteran had recurring tinnitus that began during military service.

11. The Veteran did not have an acquired psychiatric disorder, to include functional impairment as due to psychiatric symptoms, within the relevant appeal period.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for diabetes mellitus, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

2. The criteria for entitlement to service connection for peripheral neuropathy upper extremities, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

3. The criteria for entitlement to service connection for erectile dysfunction, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

4. The criteria for entitlement to service connection for cataracts, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

5. The criteria for entitlement to service connection for residuals of a stroke, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

6. The criteria for entitlement to service connection for hypertension, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F
0, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

6. The criteria for entitlement to service connection for hypertension, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

7. The criteria for entitlement to service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.-

8. The criteria for entitlement to service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the U.S. Army from March 1970 to January 1972.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). Following June and December 2022 claims for service connection, this timely appeal of the denials followed.

In the March 2023 notice of disagreement, the Veteran opted for a hearing with a Veterans Law Judge. Unfortunately, the Veteran passed away during the pendency of the appeal. His spouse was duly substituted as the Appellant. In March 2025 correspondence, her accredited representative withdrew the request for a Board hearing.

The matters are now before the Board for consideration.

This case has been advanced on the docket pursuant to 38 U.S.C § 7107(b) and 38 C.F.R. § 20.902(c).

Service Connection

There are various paths to establishing service connections. Without a disability, however, there can be no service connection, regardless of the particular theory. See 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.309, 3.320. See also, e.g., Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009) (direct service connection); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc) (secondary service connection); Walker v. Shinseki, 708 F.3d 1331, 1335 (Fed. Cir. 2013) (presumptive service connection). Thus, if the Board finds no disability exists where one is claimed, no other element of service connection need be addressed, as service connection must be denied.

The simplest way to establish service connection is commonly referred to as "direct service connection." Direct service connection can be established two ways: showing that a disability initially manifested during service, or that a disability initially manifesting after service resulted from an in-service injury or disease.

If a disability initially manifested during service, the evidence need show nothing more-it is per se service connected. 38 C.F.R. § 3.303(a). See also, Flynn v. Brown, 6 Vet. App. 500, 503 (1994) (noting "the element of cause and effect has been totally by-passed in favor of a simple temporal relationship between the incurrence of the disability and the period of active duty").

If the disability initially manifested after service, the evidence must show three key facts, or elements: (1) the disability existed during the pendency of the claim; (2) the Veteran had an in-service disease or injury; and, (3) the in-service disease or injury caused the disability. 38 C.F.R. § 3.303(d); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Another possible pathway is secondary service connection, which occurs when a service-connected disability causes (or aggravates) another disability. Thus, the evidence must show: (1) the claimed disability existed during the pendency of the claim; (2) the Veteran had a service-connected disability; and (3) the service-connected primary disability caused (or aggravated) the claimed disability. 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

Additionally, service connection may be established as a matter of law as opposed to by evidence by applying a presumption. The required evidence for presumptive service connection varies considerably depending on the particular presumption in question, but the existence of a disability during the pendency of the claim is a threshold element, regardless of the presumption in question.

Here, the Veteran's contention that he had boots-on-the-ground time in Vietnam as a medic raises the possibility that a presumption of service connection applies-specifically, that he was exposed to herbicides while in Vietnam, and that his exposure to herbicides caused his diabetes mellitus and hypertension. 38 C.F.R. §§ 3.307, 3.309(e). As a threshold issue, the Board must consider whether there is sufficient evidence that the Veteran was physically present in Vietnam.

In making findings and rendering decisions, the Board employs a balancing test of positive and negative evidence. When they are approximately balanced or nearly equal, the benefit-of-the-doubt doctrine entitles the veteran to the benefit of the doubt, and the Board finds in the veteran's favor. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F.3d 131, 1365 (Fed. Cir. 2001).

Conversely, if the Board finds the evidence tending to disprove a fact or claim predominates to the point the overall evidentiary picture is persuasively against the veteran, reasonable doubt is extinguished, the benefit-of-the-doubt doctrine does not apply, and the Board finds accordingly. See, e.g., Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021); Mattox v. McDonough, 56 F.4th 1369, 1378-79 (Fed. Cir. 2023).

There is no question the Veteran served during the Vietnam conflict, but there is no documentary evidence-i.e., personnel records, pay records, medical records, or mail, photographs, or witness statements-corroborating his presence in the Republic of Vietnam, to include in its offshore waters, as defined by the Blue Water Navy Vietnam Veterans Act of 2019 (PL 116-23), save his own statements to that effect.

Specifically, service records for the Veteran appear complete and include orders of assignment (see March 1970 Special Orders), orders of transfer to the Reserves (see January 1972 Special Orders), orders for transfer between Reserve control groups (see October 1974 Letter Orders), orders for MOS action (see February 1975 Unit Orders), orders of separation from the National Guard (see August 1975 Special Orders), and orders of discharge from the Reserves (see February 1976 Letter Orders).

Unfortunately, neither the orders for assignment or transfer nor the personnel records list of assignments include a billet in the Republic of Vietnam. See Veteran Military Personnel Record and DA Form 20, Enlisted Qualification Record, Record of Assignments. The Veteran received no award or decorations consistent with service in Vietnam. See DD-214.

In support of his contention that he had boots-on-the-ground service in the Republic of Vietnam, the Veteran provided several statements:

" "In 1971, towards the last few months, I was sent TDY to Vietnam. I spent approximately 4 weeks there. I was sent over as a medic..." September 2022 VA Form 21-4138, Statement in Support of Claim);

" "I was sent TDY to Vietnam in 1971 when I was stationed in Germany...." October 2022 VA Form 21-413
Record and DA Form 20, Enlisted Qualification Record, Record of Assignments. The Veteran received no award or decorations consistent with service in Vietnam. See DD-214.

In support of his contention that he had boots-on-the-ground service in the Republic of Vietnam, the Veteran provided several statements:

" "In 1971, towards the last few months, I was sent TDY to Vietnam. I spent approximately 4 weeks there. I was sent over as a medic..." September 2022 VA Form 21-4138, Statement in Support of Claim);

" "I was sent TDY to Vietnam in 1971 when I was stationed in Germany...." October 2022 VA Form 21-4138, Statement in Support of Claim);

" "The[] Army chose to send people through medical records training[,] and then they would be given on-the-job medic training once they arrived within the unit. This is what I did...." December 2022 VA Form 21-4138, Statement in Support of Claim).

" "In the fall of 1971, I volunteered to be sent to Vietnam on TDY orders to help with medical evacuations of patients who were being sent home or to other hospitals. I spent about 4 weeks on these TDY orders and was discharged early in January of 1972." June 2022 VA 21-0781, Statement in Support of Claim for PTSD.

Also, the Appellant's representative provided a "full copy of [Veteran's] DFAS pay records, and noted there was a travel itinerary in the records that purportedly showed "it is clear [Veteran] was in fact in the Republic of Vietnam." See March 2025 American Legion Correspondence).

Unfortunately, the document referenced by the representative, a November 1970 "Travel Itinerary," does include the reference to four locations: "Cam Rahn," "Da Nang," and "Bien Hoa," all of which were in Vietnam, as well as "Kimpo," which was in Korea, but the form does not show the Veteran was ever at those locations.

The form in question includes preprinted references to locations in Korea and Vietnam as illustrative examples of the information the individual filling out the form should include if they went to Korea or Vietnam. Notably, the fields associated with those locations remain blank, but did there is handwritten information concerning travel from Texas (where the Veteran was sent for military training) to North Dakota (his home of record), from North Dakota to South Carolina, and from South Carolina to Germany (where the Veteran was stationed). See November 1970 Travel Itinerary.

These travel locations handwritten in the November 1970 itinerary are corroborated by the November 6, 1970, "Travel Voucher," which requests reimbursement for identical travel locations, and dates, within the United States and terminating in Germany. No similar document seeks reimbursement for travel to Vietnam.

Thus, while at first glance, it is unquestionably reasonable to conclude the Veteran traveled to Vietnam based on the preprinted information, when read more closely, and when read together with the voucher, it becomes clear this document is in fact a record of travel within the United States, and then Germany.

Because the Veteran's decorations do not reflect service in Vietnam, the Veteran's pay and travel records do not reflect service in Vietnam, no "buddy statements" or mementoes or photographs reflect service in Vietnam, the Board is left with only the Veteran's statements as evidence of his physical presence in Vietnam, and absent a substantial history of prior consistent statements, or significant contextual details about the Veteran's time in country (e.g., a specific unit of attachment or precise dates of service) the Board finds the Veteran's statement standing cannot in and of itself bring the positive evidence to the point of approximate balance with or near equality to the negative evidence on this issue.

Therefore, the benefit of the doubt does not apply, and the Board adjudicated the Veteran's appeal on the basis that he was not in Vietnam, and a result did not qualify for the presumption of exposure to herbicide and service connection resulting from exposure to herbicide in 38 C.F.R. §§ 3.307 and 3.309.

That does not mean the Appellant cannot prevail on a claim for service connection, however, because veterans who are not entitled to a presumption of service connection may instead establish service connection on a "facts found" basis. 38 C.F.R. § 3.303 (service connection may be established by "affirmatively showing inception or aggravation during service or through the application of statutory presumptions"). See also, Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994) (a presumption is intended to provide veterans with an alternative means of proof rather
herbicide in 38 C.F.R. §§ 3.307 and 3.309.

Therefore, in analyzing the issues below, the Board considered direct and secondary service connection, but having already determined there is insufficient evidence to find the Veteran had qualifying service, the Board did not consider the presumptions in 38 C.F.R. §§ 3.307 and 3.309.

1. Entitlement to service connection for diabetes mellitus.

Concerning the Veteran's claim for service connection, he was diagnosed with a disability. See December 2013 Sanford Broadway Clinic Office Visit. The first element of service connection is satisfied.

Addressing an in-service event, service treatment records for the Veteran are silent for complaints of, treatment for, or a diagnosis related to a renal condition. See March 1970 to January 1972 Veteran service treatment records, November 1971 Report of Medical Examination, November 1971 Report of Medical History, January 1972 Statement of Medical Condition, July 1974 Report of Medical Examination, and July 1974 Report of Medical History. The Veteran never contended that he experienced symptoms of, was treated for, or was diagnosed relating to a renal condition during service. The Board finds the second element of service connection has not been established.

The Board is aware the Veteran was never provided with a VA medical examination for this disability. However, a VA medical opinion is only necessary when there is evidence establishing that an event, injury, or disease occurred in service and 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. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Therefore, no examination was required in this instance.

In conclusion, there is no evidence of an in-service disease or injury, nor is there evidence of a causal relationship between the Veteran's service and his diabetes.

This appeal is denied.

2. Entitlement to service connection for peripheral neuropathy upper extremities, to include as secondary to diabetes mellitus.

3. Entitlement to service connection for erectile dysfunction, to include as secondary to diabetes mellitus.

4. Entitlement to service connection for cataracts, to include as secondary to diabetes mellitus.

Service treatment records are silent for complaints of, treatment for, or a diagnosis related to cataracts. See March 1970 to January 1972 Veteran service treatment records, November 1971 Report of Medical Examination, November 1971 Report of Medical History, January 1972 Statement of Medical Condition, July 1974 Report of Medical Examination, and July 1974 Report of Medical History.

According to the record, the Veteran had a "low-risk procedure" to remove a "Cataract Early Stages" in July 2017. See May 2017 Sanford Internal Medicine and July 2017 Sanford Urgent Care Office Visits.

More importantly, the available record indicates that the Veteran's cataract was resolved in July 2017, years prior to his claim for service connection. See July 2019 Sanford Physical Therapy Provider and April 2022 Sanford Medical Center Provider Notes and April 2019, July 2019, and July 2020 Sanford Neuroscience Office Visits.

Further, the available record does not indicate that the Veteran experienced any functional impairment from his reported condition. The record does not include treatment for any symptoms. There is no evidence of missed work or marked or substantial interference with work due to a reported peripheral neuropathy condition.

Therefore, the first element of service connection has not been established. The Board cannot award disability benefits where a disability does not exist. In the absence of proof of a current disability for which service connection may be granted, there can be no valid claim. Without evidence of a disease or injury for which service connection is an available remedy, including as due to evidence of functional impairment, there is no need for the Board to address the remaining elements of or pathways to entitlement, including secondary or presumptive service connection.

Conclusion

In summary, the evidence of record persuasively weighs against a finding that the Veteran is entitled to service connection for cataracts. Evidence of a
marked or substantial interference with work due to a reported peripheral neuropathy condition.

Conclusion

In summary, the evidence of record persuasively weighs against a finding that the Veteran is entitled to service connection for cataracts. Evidence of a diagnosis or any functional impairment during the relevant period on appeal is lacking in the available record. The Board cannot award disability benefits where a disability does not exist.

Diagnosing cataracts requires the expertise of a medical professional, particularly when there has been a significant passage of time without any documentation of symptomatology, which is the case here. While the Veteran can report symptoms that he experiences, he does not have the necessary training to offer medical opinions. An opinion regarding service connection from the Veteran is of no probative value because he lacks the medical expertise needed to diagnose cataracts or to attribute it to active military service.

Therefore, the objective medical evidence of record, including service treatment records, private treatment records, and VA treatment records, has been accorded greater probative value and weight. See Guerrieri, supra ("[t]he probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches... the credibility and weight to be attached to these opinions [are] within the province of the adjudicator.").

Having considered all of the relevant evidence, including the Veteran's statements, the Board sympathizes with the Veteran. However, the most probative evidence of record is not sufficient to warrant a grant of service connection or a determination that further development of the evidence is required. The evidence of record, aside from all of the relevant evidence, including the Veteran's statements in support of this claim, persuasively weighs against the claim for service connection. Therefore, service connection is not warranted, and the claim must be denied.

In reaching this conclusion, the Board considered the applicability of the benefit-of-the-doubt doctrine. However, as the evidence persuasively weighs against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Ortiz, 274 F.3d at1365; Lynch, 21 F.4th at 781-82; Mattox, 56 F.4th at 1378-79.

5. Entitlement to service connection for residuals of a stroke, to include as secondary to diabetes mellitus.

Analysis

The Veteran has been diagnosed with a disability. See November 2016 Sanford Medical Center Neurology Inpatient Consult, November 2016 Sanford Medical Center Provider Note, November 2016 Sanford Eating Disorder Weight Loss Management Office Visit, April 2019, July 2019, and July 2020 Sanford Neuroscience Office Visits, and April 2022 Sanford Medical Center Provider Note. The first element of service connection is satisfied.

Regarding an in-service event, service treatment records are silent for complaints of, treatment for, or a diagnosis related to a cerebrovascular event. See March 1970 to January 1972 Veteran service treatment records, November 1971 Report of Medical Examination, November 1971 Report of Medical History, January 1972 Statement of Medical Condition, July 1974 Report of Medical Examination, and July 1974 Report of Medical History.

However, the Veteran is claiming secondary service connection. Unfortunately, the Veteran was not service connected for any conditions at the time of his passing, and he does not meet the requirements for service connection of diabetes mellitus.

Regarding a nexus to service, the Veteran has not been provided with a VA medical examination. Despite evidence of a current disability, there is no evidence of an event, injury, or disease incurred during service or an indication that the disability may be associated with the Veteran's service. Further, the evidence of record is sufficient to decide the claim. Therefore, a VA medical examination is not required in this instance. See McLendon, supra.

Addressing presumptive service connection, there is no indication that the Veteran had a blood clot per se, but the Board recognizes the Veteran's history of interrupted blood flow to the brain and the prescribed regimen of Coumadin anticoagulant. While his condition may be included on the list of chronic diseases enumerated in 38 C.F.R. § 3.
been provided with a VA medical examination. Despite evidence of a current disability, there is no evidence of an event, injury, or disease incurred during service or an indication that the disability may be associated with the Veteran's service. Further, the evidence of record is sufficient to decide the claim. Therefore, a VA medical examination is not required in this instance. See McLendon, supra.

Concerning continuity of symptomatology, a cerebrovascular condition was not present during service, and the first indication of such is a private treatment record dated November 2016. See November 2016 Sanford Medical Center Neurology Inpatient Consult ("history of 2 episodes of expressive aphasia (one a month ago that was brief, one 8 years ago that was more prolonged, closer to an hour or so), who was in USOH yesterday when he walked to a mailbox and had mail in left hand and couldn't lift it suddenly to put it into the mailbox.").

The Board notes that statements provided in a patient-to-provider context are considered particularly reliable, credible, and probative because of the obvious motive to be truthful, accurate, and complete when seeking medical diagnosis or treatment, to the extent there is a hearsay exception for such statements in Federal Rule of Evidence 803(4). Given the objective medical evidence of record, the Veteran does not meet the requirements for presumptive service connection.

Conclusion

In summary, the most probative evidence of record persuasively weighs against a finding that the Veteran meets the criteria for service connection for residuals of a stroke. While the Veteran has evidence of a current diagnosis, the most probative evidence of record persuasively weighs against the in-service and nexus elements of service connection. In addition, the Veteran does not meet the requirements for presumptive service connection.

In reaching the above conclusions, the Board has not overlooked the Veteran's statements regarding the severity of his disability. In this regard, the Veteran is competent to report on factual matters of which he has firsthand knowledge. See Layno, supra. In keeping with the provisions of 38 U.S.C. § 1154(a), 38 C.F.R. § 3.303(a), and 38 C.F.R. § 3.307(b), the Board has not overlooked the Veteran's statements regarding the severity of his condition.

The Veteran's reported symptomatology has been noted, and the Board considered the Veteran's reports with respect to this decision. The Veteran contends that his claimed disability exists and is related to his active service. This opinion is of no probative value because he lacks the medical expertise needed to diagnose a urinary condition or to attribute it to military service. See Jandreau, supra; Clemons, supra.

In conclusion, the most probative evidence of record is not sufficient to warrant a grant of service connection or a determination that further development of the evidence is required. Therefore, service connection is not warranted, and the claim for service connection must be denied.

In reaching the conclusions stated above, the Board considered the applicability of the benefit of the doubt doctrine. The rule does not apply when the Board finds that the evidence persuasively weighs against the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Ortiz, 274 F.3d at1365; Lynch, 21 F.4th at 781-82; Mattox, 56 F.4th at 1378-79.

6. Entitlement to service connection for hypertension.

Concerning the Veteran's claim for service connection, he has been diagnosed with a disability. See June 2012 Sanford Fargo Internal Medicine Office Visit. The first element of service connection is satisfied.

Addressing an in-service event, service treatment records for the Veteran are silent for complaints of, treatment for, or a diagnosis related to a cardiovascular condition. See March 1970 to January 1972 Veteran service treatment records, November 1971 Report of Medical Examination, November 1971 Report of Medical History, January 1972 Statement of Medical Condition, July 1974 Report of Medical Examination, and July 1974 Report of Medical History. While the Veteran contends that his hypertension is due to herbicide exposure, he does not contend that he experienced symptoms of, was treated for, or was diagnosed relating to a cardiovascular
. See June 2012 Sanford Fargo Internal Medicine Office Visit. The first element of service connection is satisfied.

Finally, hypertension is included on the list of chronic diseases enumerated in 38 C.F.R. § 3.309(a). However, hypertension for VA purposes was not shown in service or within 1 year of service separation.

Further, hypertension is included on the list of conditions for which presumptive service connection is authorized under the Promise to Address Comprehensive Toxics (PACT) Act of 2022, Pub. L. 117-168. Unfortunately, as detailed previously, the Veteran does not qualify as a "covered veteran" because he did not have service in any of the duty stations enumerated in the PACT Act.

Looking at continuity of symptomatology, hypertension was not present during service, and the first indication of a hypertension history is a June 2012 private treatment record. See June 2012 Sanford Fargo Internal Medicine Office Visit ("feeling very good he is currently not taking any blood pressure medications which has been running fine [sic]....").

Conclusion

In summary, the most probative evidence of record persuasively weighs against a finding that the Veteran meets the criteria for service connection for hypertension. While the Veteran has evidence of a current diagnosis, the most probative evidence of record persuasively weighs against the in-service and nexus elements of service connection. In addition, the Veteran does not meet the requirements for presumptive service connection.

The Veteran's reported symptomatology has been noted, and the Board considered the Veteran's reports with respect to this decision. The Veteran contends that his claimed disability exists and is related to his active service. This opinion is of no probative value because he lacks the medical expertise needed to diagnose a cardiovascular condition or to attribute it to military service. See Jandreau, supra; Clemons, supra.

7. Entitlement to service connection for tinnitus.

The Veteran reported "intermittent bilateral tinnitus for the past 6 years or so" during August 2017 VA treatment. See August 2017 VA Audiology Note.

, the Board considered the applicability of the benefit of the doubt doctrine. The rule does not apply when the Board finds that the evidence persuasively weighs against the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Ortiz, 274 F.3d at1365; Lynch, 21 F.4th at 781-82; Mattox, 56 F.4th at 1378-79.

7. Entitlement to service connection for tinnitus.

The Veteran reported "intermittent bilateral tinnitus for the past 6 years or so" during August 2017 VA treatment. See August 2017 VA Audiology Note.

Tinnitus is, by definition, "a noise in the ears, such as ringing, buzzing, roaring, or clicking. It is usually subjective in type." See Dorland's Illustrated Medical Dictionary, 1914 (30th ed. 2003). Because it is "subjective," there is no test for or other means of confirming the existence of tinnitus-it is diagnosed based exclusively on the description of symptoms provided by the claimant. Thus, the first element of service connection is established. Furthermore, though they did not pinpoint it with any specificity, the VA conceded "a qualifying event, injury, or disease had its onset during your service." See March 2023 Rating Decision Narrative. This establishes the second element.

There is no evidence pertaining to the final element, a causal nexus between in-service acoustic trauma and the Veteran's tinnitus. However, this was in large part because the VA did not develop the issue (e.g., by obtaining a detailed patient history concerning other possible causes). Additionally, there is no discussion in the rating decision concerning the possible role played by a temporary mild hearing loss the Veteran suffered during service, as noted in the November 2022 VA Hearing Loss and Tinnitus examination report.

While the Board could dub this a duty to assist error and remand the issue to the AOJ, instead the Board will vigorously apply common sense and the benefit of the doubt doctrine in the absence of any evidence of another cause for the Veteran's recurrent tinnitus, and with the realization because there can be never be "positive proof" of what caused the Veteran's tinnitus.

Fortunately, American jurisprudence has long recognized the need to "resort to circumstances as the means of ascertaining the truth" when no direct observational evidence is available, and even when the circumstances are independently inconclusive, the finder of fact may determine they "constitute conclusive proof" based on "their number and joint operation, especially when corroborated by moral coincidences." Slavers, 69 U.S. 383, 401 (1865). See also, Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011) (making inferences from evidence is the "heart" of the Board's adjudicatory role).

Additionally, when deciding whether there is sufficient proof of a material fact, like any fact finder in any forum, the Board performs a balancing test between the favorable and unfavorable evidence, and then evaluates the results in light of the governing standard of proof. As the Supreme Court has explained, the standard of proof instructs the fact finder as to two key matters: 1) the "degree of confidence" they should feel in the correctness of the finding; and 2) the allocation of the risk of error-in other words, where to assign the benefit of the doubt. Addington v. Texas, 441 U.S. 418, 423 (1979); Santosky v. Kramer, 455 U.S. 745, 754-55 (1982).

In American jurisprudence, there is a "wide spectrum" of standards, and the VA's "benefit of the doubt" doctrine lies at "the farthest end of the spectrum...." Gilbert v. Derwinski, 1 Vet. App. 49, 53-54 (1990). That is, no party in any forum is entitled to greater deference in establishing their case than a veteran who has brought an appeal to the Board.

This is a matter not only of precedent, but of legislative intent and moral logic: in recognition of the nation's great debt to its veterans, Congress created an intentionally generous standard of proof unique in American jurisprudence to be applied to veterans' appeals, culminating in the benefit of the doubt doctrine. Wise v. Shinseki, 26 Vet. App. 517, 531 (2014).

The Veteran clearly explained that his tinnitus was intermittent, but still recurring (meaning it has occurred multiple times) because, as he put it, "it comes and goes." He contended his exposure to excessive noise in the military from artillery fire,
in establishing their case than a veteran who has brought an appeal to the Board.

The Veteran clearly explained that his tinnitus was intermittent, but still recurring (meaning it has occurred multiple times) because, as he put it, "it comes and goes." He contended his exposure to excessive noise in the military from artillery fire, small arms fire, and ambulance sirens caused him to have tinnitus.

In light of the benefit-of-the-doubt doctrine, the Board infers the Veteran's reference to tinnitus that "comes and goes" was a reference to in-service onset of the disability. This appeal is granted.

8. Entitlement to service connection for an acquired psychiatric disorder.

Analysis

Service treatment records are silent for complaints of, treatment for, or a diagnosis related to an acquired psychiatric disorder. See March 1970 to January 1972 Veteran service treatment records, November 1971 Report of Medical Examination, November 1971 Report of Medical History, January 1972 Statement of Medical Condition, July 1974 Report of Medical Examination, and July 1974 Report of Medical History.

More importantly, the available record does not indicate that the Veteran has ever been diagnosed with an acquired psychiatric disorder. See November 2016 Sanford Medical Center Neurology Inpatient Consult, July 2019 Sanford Physical Therapy Provider, and April 2022 Sanford Broadway Clinic Urology Notes and April 2014 Sanford Professional Building, May 2017, September 2018, and December 2018 Sanford Internal Medicine, and April 2019, July 2019, and July 2020 Sanford Neuroscience Office Visits.

To the contrary, in the various Sanford records, there are several notations affirmatively attesting to the Veteran's normal findings concerning his mental state, as well as notations explicitly stating that he did not have any sign of depression or anxiety. These notations span several years, being made on dates including October 1, 2013, November 13, 2013, April 10, 2015, December 22, 2016, November 28, 2018, and June 19, 2020.

Conclusion

In summary, the evidence of record persuasively weighs against a finding that the Veteran is entitled to service connection for an acquired psychiatric disorder. Evidence of a diagnosis or any functional impairment during the relevant period on appeal is lacking in the available record. The Board cannot award disability benefits where a disability does not exist.

Diagnosing an acquired psychiatric disorder requires the expertise of a medical professional, particularly when there has been a significant passage of time without any documentation of symptomatology, which is the case here.

While the Veteran can report symptoms that he experiences, he does not have the necessary training to offer medical opinions. An opinion regarding service connection from the Veteran is of no probative value because he lacks the medical expertise needed to diagnose an acquired psychiatric disorder or to attribute it to active military service.

The evidence of record, aside from all of the relevant evidence, including the Veteran's statements in support of this claim, persuasively weighs against the claim for service connection. Therefore, service connection is not warranted, and the claim must be denied.

Timothy Cothrel

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Small, B. (BVA)

The Board's decision in this case is binding only with respect to

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