Case A26040339

B.T. KNOPE · 2026 · Case ID: A26040339

DENIED

Summary

The veteran, who served from December 2001 to December 2002, September 2008 to September 2009, and April 2001 to September 2001 (ACDUTRA), appeals the denial of service connection for obstructive sleep apnea, headaches, and erectile dysfunction, and seeks an increased rating for irritable bowel syndrome (IBS). The veteran withdrew claims for chronic fatigue syndrome, a bilateral foot skin condition, and a stomach condition at a hearing. For IBS, the veteran contended his condition warranted an increased rating due to frequent diarrhea, abdominal distress, and fear of accidents, but the Board found the evidence did not support severe IBS under the pre-amended criteria, noting inconsistencies between his testimony and medical records regarding symptom severity. For obstructive sleep apnea, headaches, and erectile dysfunction, the veteran claimed they were related to service or secondary to PTSD and other service-connected conditions. The Board found no evidence of these conditions during service or continuous symptoms thereafter. While the VA examiner noted possible links for erectile dysfunction and questioned the nexus for sleep apnea, the Board found these opinions insufficient. Private medical opinions suggesting a link to PTSD were deemed not probative as they did not apply research to the veteran's specific circumstances. Service connection for all three conditions was denied.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210609-165028

Full Decision Text

Citation Nr: A26040339
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 210609-165028
DATE: April 29, 2026

ORDER

Entitlement to service connection for chronic fatigue syndrome is dismissed without prejudice.

Entitlement to service connection for a bilateral foot skin condition, characterized as left foot tinea pedis/xerosis cutis, is dismissed without prejudice.

Entitlement to service connection for a stomach condition is dismissed without prejudice.

An initial disability rating in excess of 10 percent for irritable bowel syndrome/functional diarrhea (IBS) is denied.

Service connection for obstructive sleep apnea is denied.

Service connection for headaches is denied.

Service connection for erectile dysfunction is denied.

FINDINGS OF FACT

1. At the January 2025 Board hearing, the Veteran knowingly testified that he wished to withdraw the issues of entitlement to service connection for chronic fatigue syndrome, a bilateral foot skin condition, and a stomach condition.

2. The Veteran's IBS has not been severe IBS manifested by diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress.

3. The Veteran's obstructive sleep apnea, headaches, and erectile dysfunction were not shown in service or for many years thereafter and are not otherwise etiologically related to his active duty service, and are not proximately due to, are not the result of, and have not been aggravated by his service-connected disabilities.

CONCLUSIONS OF LAW

1. The criteria for withdrawal of the Veteran's claims of entitlement to service connection for chronic fatigue syndrome, a bilateral foot skin condition, and a stomach condition have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

2. The criteria for an initial disability rating in excess of 10 percent for IBS have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.114, Diagnostic Code (DC) 7319.

3. The criteria for service connection for obstructive sleep apnea have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.304, 3.307, 3.309, 3.310.

4. The criteria for service connection for headaches have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.304, 3.307, 3.309, 3.310.

5. The criteria for service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.304, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from December 2001 to December 2002, and September 2008 to September 2009. The Veteran also had a period of active duty from training (ACDUTRA) from April 2001 to September 2001.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2021 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In June 2021, VA received the Veteran's Form 10182 Notice of Disagreement (Notice of Disagreement). In the Notice of Disagreement, he elected the Hearing docket. Therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal and any evidence submitted by the Veteran or her representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a).

In January 2025, the Veteran testified at a hearing before a Veterans Law Judge. A transcript of the hearing is of record.

Withdrawal

The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.205. Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 20.205.

1. Entitlement to service connection for chronic fatigue
.302(a).

In January 2025, the Veteran testified at a hearing before a Veterans Law Judge. A transcript of the hearing is of record.

Withdrawal

1. Entitlement to service connection for chronic fatigue syndrome

2. Entitlement to service connection for a bilateral foot skin condition, characterized as left foot tinea pedis/xerosis cutis

3. Entitlement to service connection for a stomach condition

At the Veteran's January 2025 Board hearing, he knowingly testified that he wished to withdraw his claims of entitlement to service connection for chronic fatigue syndrome, a left foot skin condition, a right foot skin condition, and a stomach condition. The Veterans Law Judge presiding over his hearing explained the consequence of withdrawal, and the Veteran indicated that he understood such consequences. Given the Veteran's expressed desire, the Board concludes that his intent was to withdraw these claims and further action concerning these claims is not appropriate.

By virtue of the foregoing, the Board no longer has jurisdiction over his claims of entitlement to service connection for chronic fatigue syndrome, a left foot skin condition, a right foot skin condition, and a stomach condition, and must dismiss the appeal as to these issues.

Increased Ratings

Disability evaluations are determined by the application of a schedule of ratings that is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. See 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities.

Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3.

4. Entitlement to an initial disability rating in excess of 10 percent for IBS

The Veteran contends that an initial disability rating in excess of 10 percent is warranted for his IBS. Specifically, he contends that an increased disability rating is warranted because he uses the bathroom multiple times per day and can have five to six episodes of diarrhea with abdominal distress per day, travels with an extra set of clothes due to prior accidents and the fear of a future accident occurring, and experiences abdominal discomfort, bloating, cramping, and constipation.

As a preliminary matter, the Board notes that the criteria for rating disabilities of the digestive system were amended effective May 19, 2024. See Schedule for Rating Disabilities; The Digestive System, 89 Fed. Reg. 19,735 (March 20, 2024).

Where a law or regulation changes during the pendency of a claim for an increased rating, the Board should first determine whether application of the revised version would produce retroactive results. In particular, a new rule may not extinguish any rights or benefits the claimant had prior to enactment of the new rule. VAOPGCPREC 07-03 (November 19, 2003).

However, if the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110; Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991), overruled in part, Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Given that the Veteran's claim was received prior to the effective date of the regulation changes, the Board must consider the Veteran's IBS under both the old and new rating criteria, and must apply the old rating criteria if the result is more favorable to the Veteran. Id.

Here, the Board finds that the pre-amended criteria for rating IBS under 38 C.F.R. § 4.114, DC
U.S.C. § 5110; Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991), overruled in part, Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Given that the Veteran's claim was received prior to the effective date of the regulation changes, the Board must consider the Veteran's IBS under both the old and new rating criteria, and must apply the old rating criteria if the result is more favorable to the Veteran. Id.

Here, the Board finds that the pre-amended criteria for rating IBS under 38 C.F.R. § 4.114, DC 7319 are more favorable to the Veteran because the pre-amended criteria allow for consideration of the proper rating under terms such as "moderate" and "severe." In contrast, the amended criteria are more limited given that the amended criteria require a claimant to show specific symptoms in order to receive a compensable rating. Thus, the pre-amended criteria will be applied in this case.

As noted above, the Veteran's IBS has been assigned a noncompensable disability rating under 38 C.F.R. § 4.114, DC 7319. Under the pre-amended DC 7319, the maximum 30 percent disability rating is assigned when the evidence shows severe irritable colon syndrome with diarrhea or alternating diarrhea and constipation with more or less constant abdominal distress. 38 C.F.R. § 4.114, DC 7319.

Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as "moderate," and "severe." Sellers v. Wilkie, 30 Vet. App. 157 (2018). It should also be noted that use of terminology such "moderate" by VA examiners or other physicians, although an element of evidence to be considered by the Board, is not dispositive of an issue. Rather than applying a mechanical formula, the Board must instead evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6.

In the absence of guidance in the rating criteria itself, the Board will consider the dictionary definitions of these subjective adjectives. "Moderate" is defined as limited in scope or effect; and "severe" as very painful or harmful, or of a great degree. Meriam Webster College Dictionary (11th ed. 2007).

After a review of the evidence of record, the Board concludes that an initial disability rating in excess of 10 percent is not warranted for the Veteran's IBS.

Here, the January 2021 VA examination report reflects that the Veteran reported diarrhea and occasional constipation and that without medication he would have up to give watery bowel movements per day. The examination report further reflects that continuous medication was required for control of his IBS, that he had three soft bowel movements per day with some abdominal discomfort, that he did not have episodes of bowel disturbance with abdominal distress, exacerbations, or attacks of the intestinal condition, that he did not have weight loss or malnutrition due to IBS, that he did not have benign or malignant neoplasms or metastases related to IBS, and that his IBS had no impact on his ability to work. Given that the examination report reflects that he did not have episodes of bowel disturbance with abdominal distress, exacerbation, or attacks of the intestinal condition, did not have weight loss or malnutrition due to IBS, and that the examiner determined that the Veteran's IBS did not impact his ability to work, the examination report fails to show severe irritable colon syndrome with diarrhea or alternating diarrhea and constipation with more or less constant abdominal distress sufficient to warrant the assignment of a 30 percent disability rating.

The Board acknowledges that the Veteran testified that the examiner improperly determined that he did not have abdominal distress or abdominal pain with diarrhea. The Board finds that the Veteran's contention lacks merit. Specifically, an October 2018 treatment record reflects that he denied nighttime awakening for bowel movements or with incontinence, weight loss, abdominal pain, and cramping. July 2021, February 2022, and April 2022 treatment records reflect that he was not experiencing nausea or diarrhea. A March 2021 treatment record reflects that he was not experiencing nausea or diarrhea and had no abdominal pain. These treatment records render his testimony that he had experienced five to six episodes of diarrhea with abdominal distress per day, traveled with an extra set of clothes due to prior accidents and the fear of a future accident occurring, and experienced abdominal discomfort, bloating, cramping, and constipation not credible. Thus, the medical evidence, including the January
8 treatment record reflects that he denied nighttime awakening for bowel movements or with incontinence, weight loss, abdominal pain, and cramping. July 2021, February 2022, and April 2022 treatment records reflect that he was not experiencing nausea or diarrhea. A March 2021 treatment record reflects that he was not experiencing nausea or diarrhea and had no abdominal pain. These treatment records render his testimony that he had experienced five to six episodes of diarrhea with abdominal distress per day, traveled with an extra set of clothes due to prior accidents and the fear of a future accident occurring, and experienced abdominal discomfort, bloating, cramping, and constipation not credible. Thus, the medical evidence, including the January 2021 VA examination report and the treatment records, fails to show irritable colon syndrome with diarrhea or alternating diarrhea and constipation with more or less constant abdominal distress sufficient to warrant the assignment of a 30 percent disability rating for his IBS.

In considering the appropriate disability rating for the Veteran's IBS, the Board has considered the Veteran's statements that his IBS is worse than the rating he currently receives. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990).

Competency of evidence differs from weight and credibility. Although the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of his IBS according to DC 7319. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify").

On the other hand, such competent evidence concerning the nature and extent of the Veteran's IBS has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with their evaluations. The medical findings of the January 2021 VA examiner (as provided in the examination report) and the findings documented by the treatment records directly address the criteria under which his IBS is evaluated. Specifically, although he has asserted that the symptoms of his IBS warrant an increased disability rating, the impact of his IBS was discussed and addressed by the January 2021 VA examiner and in the foregoing treatment records, and the Board finds that the examiners assessments are of greater probative weight and that the Veteran's testimony lacks credibility.

By virtue of the foregoing, the Board concludes that an initial disability rating in excess of 10 percent is not warranted for the Veteran's IBS.

Service Connection

Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995).

Certain chronic diseases may be presumed to have been incurred during service if they become manifested to a compensable degree within one year from separation from service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). This presumption is rebuttable by affirmative evidence to the contrary. Id. Additionally, evidence of continuous symptoms since active duty is a factor for consideration as to whether a causal relationship exists between an in-service injury or incident and the current disorder as is contemplated under 38 C.F.R. § 3.303(a).

Service connection is also warranted for a disability that is aggravated by, is proximately due to, or is the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Any additional impairment of earning capacity resulting from
. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). This presumption is rebuttable by affirmative evidence to the contrary. Id. Additionally, evidence of continuous symptoms since active duty is a factor for consideration as to whether a causal relationship exists between an in-service injury or incident and the current disorder as is contemplated under 38 C.F.R. § 3.303(a).

Service connection is also warranted for a disability that is aggravated by, is proximately due to, or is the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). Accordingly, when service connection is established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id.

5. Entitlement to service connection for obstructive sleep apnea

6. Entitlement to service connection for headaches

7. Entitlement to service connection for erectile dysfunction

The Veteran contends that service connection is warranted for obstructive sleep apnea, headaches, and erectile dysfunction.

The Veteran contends that service connection is warranted for his headaches because his headaches began during his deployment to Uzbekistan where he was exposed to dust storms and chemical contaminants. Alternatively, he contends that service connection is warranted for his headaches because his headaches are proximately due to, are the result of, or have been aggravated by his service-connected posttraumatic stress disorder (PTSD). He contends that service connection is warranted for erectile dysfunction because the January 2021 VA examiner stated that his erectile dysfunction was possibly due to his comorbid conditions such as obesity, sleep apnea, a lack of physical exercise, and hypertension. He contends service connection for obstructive sleep apnea is warranted because his obstructive sleep apnea has been caused by his PTSD and/or the weight gain he has experienced, which he attributes to his other service-connected disabilities.

After a review of the evidence of record, the Board finds that service connection is not warranted for the disorders on appeal. Initially, the Veteran's service treatment records fail to establish that the disorders on appeal began during or are otherwise etiologically related to his active duty service. With respect to erectile dysfunction and obstructive sleep apnea, his service treatment records do not reflect that he was diagnosed with, reported symptoms of, or sought treatment for these disorders. Accordingly, the service treatment records fail to establish that his erectile dysfunction and obstructive sleep apnea began during or are otherwise etiologically related to his active duty service.

With respect to headaches, an April 2001 treatment record reflects that he reported headaches during a period of ACDUTRA. A March 2002 treatment record reflects that during his active duty service, he reported headaches, which the treating physician attributed to dehydration and a viral syndrome. Neither of these treatment records reflect chronic headaches or that his headaches began during active duty service. Indeed, an August 2002 report of medical assessment reflects that he had no questions or concerns about his health and did not report experiencing headaches. Additionally, an August 2009 post-deployment health assessment reflects that he did not attend sick call for bad headaches and indicated that his health was very good in the month prior to the assessment. Accordingly, his service treatment records fail to establish that his headaches began during or are otherwise etiologically related to his active duty service.

Next, the post-service evidence fails to show that the Veteran has experienced continuous symptoms related to the disorders on appeal. In this case, the objective medical evidence does not show a diagnosis of, any symptoms of, or any treatment for symptoms that could be related to headaches until April 2019, more than nine years after his separation from service. Moreover, numerous treatment records, including October 2018, November 2019, and January 2020 treatment records, reflect that he did not have headaches or denied headaches. Given the significant gap between his separation from service and when he first sought treatment for headaches and the post-service treatment records reflecting that he has denied or did not have headaches, a continuity of symptoms based upon the clinical evidence is not sufficient to support a direct nexus, including for purposes of the chronic disease presumption under 38 C.F.R. § 3.307(a)(3).

With respect to erectile dysfunction, the objective medical evidence does not show a diagnosis of, any symptoms of, or any treatment for symptoms that could be related to erectile dysfunction until 2020, more than 10 years after his separation from service. With respect to sleep apnea
2020 treatment records, reflect that he did not have headaches or denied headaches. Given the significant gap between his separation from service and when he first sought treatment for headaches and the post-service treatment records reflecting that he has denied or did not have headaches, a continuity of symptoms based upon the clinical evidence is not sufficient to support a direct nexus, including for purposes of the chronic disease presumption under 38 C.F.R. § 3.307(a)(3).

With respect to erectile dysfunction, the objective medical evidence does not show a diagnosis of, any symptoms of, or any treatment for symptoms that could be related to erectile dysfunction until 2020, more than 10 years after his separation from service. With respect to sleep apnea, the objective medical evidence does not show a diagnosis of, any symptoms of, or any treatment for symptoms that could be related to sleep apnea until April 2019, more than nine years after his separation from service. Again, given the significant gap between his separation from service and when he first sought treatment for headaches, a continuity of symptoms based upon the clinical evidence is not sufficient to support a direct nexus. Moreover, the Veteran has primarily contended that his erectile dysfunction is secondary to his PTSD and hypertension and is not truly asserting that he has experienced continuous symptoms of erectile dysfunction.

Finally, service connection may be granted when the evidence establishes a medical nexus between active duty service and the current diagnosis or that the current diagnosis is proximately due to, is the result of, or has been aggravated by a service-connected disability. However, there is not sufficient evidence in the medical records to demonstrate a nexus between the Veteran's active duty service and headaches, erectile dysfunction, and obstructive sleep apnea or that his erectile dysfunction and obstructive sleep apnea are proximately due to, are the result of, or have been permanently aggravated by his service-connected disabilities. Indeed, there is no objective evidence linking his sleep apnea to an event during his active duty service or his service-connected disabilities.

Initially, the Board acknowledges that the January 2021 VA examiner provided an opinion concerning aggravation of the Veteran's headaches despite his soundness at entry. Notwithstanding that the opinion concerns aggravation, the examiner opined that there was no evidence that the Veteran's headaches were aggravated beyond their normal progression due to his active duty service. The Board finds that the fact that this opinion addressed aggravation does not require it to remand this claim. Indeed, this opinion could be equally addressed to direct service connection because, as discussed above, the Veteran's service treatment records do not show that his headaches began during or are otherwise etiologically related to his active duty service because they do not show chronic headaches and his post-service treatment records do not show continuous symptoms of headaches. Given the lack of objective evidence to support a nexus between his active duty service and his headaches, the Board finds that the evidence does not show an etiological relationship between his active duty service and his headaches.

With respect to erectile dysfunction, the Board acknowledges that the January 2021 VA examiner opined that the Veteran's erectile dysfunction was "possibly due to his other comorbid conditions such as obesity, sleep apnea, lack of physical exercise, and hypertension." However, this opinion does not establish that the Veteran's erectile dysfunction is proximately due to, is the result of, or has been aggravated by his hypertension. It merely states a possible relationship, which is not sufficient to establish that service connection is warranted for erectile dysfunction as secondary to hypertension.

With respect to obstructive sleep apnea, the January 2021 VA examiner opined that his sleep apnea was less likely to be related to his exposures during his active duty service in Southwest Asia and more likely due to his morbid obesity. Although the Veteran testified that his service-connected disabilities caused him to gain weight, the objective evidence does not show that his PTSD, IBS, hypertension, or left testicular cyst prevented him from exercising. Accordingly, this opinion is adequate and does not show an etiological relationship between the Veteran's active duty service and his obstructive sleep apnea or that his obstructive sleep apnea is proximately due to, is the result of, or has been aggravated by his service-connected disabilities.

The Board acknowledges that the Veteran submitted a series of private opinions concerning the disorders on appeal that were submitted during the evidentiary window following his hearing. The April 2025 medical opinion considered whether the Veteran's headaches, erectile dysfunction, and obstructive sleep apnea were secondary to his PTSD. With respect to headaches, the physician opined that it was at least as likely as not that the Veteran's headaches, erectile dysfunction, and sleep apnea were secondary to his PTSD based upon current scientific research. The Board finds that these opinions are not probative and do not establish that the Veteran's headaches, erectile dysfunction, and obstructive sleep apnea are proximately due to or the result of his PTSD. Indeed, none of these opinions applied the research that the private physician cited to the Veteran's specific circumstances. Moreover, although the cited research may show a correlation between individuals with headaches, erectile dysfunction, and sleep apnea and individuals with PTSD, the research does not show a causative or aggravating relationship. Given that the research was not applied to the Veteran's particular circumstances and that it does not show a causative or aggravating relationship between PTSD and these disorders, the opinions lack probative value and fail to show that these disorders are proximately due to, are the result of, or have been aggravated by his PTSD such that the grant of service connection would be warranted.

The Board has also considered the statements made by the Veteran relating the disorders on appeal to his active duty service and/or his service-connected disabilities. The Federal Circuit has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007)).

In this case, although the Veteran can provide competent testimony regarding his headache, erectile dysfunction, obstructive sleep apnea symptoms, the diagnoses of dysfunctions and disorders, and their respective etiologies, are medical determinations and generally must be established by medical findings and opinion. See Jandreau, 492 F.3d at 1377, n.4. Thus, to the extent that the Veteran believes that these disorders are etiologically related to his active duty service and/or are proximately due to, are the result of, or have been aggravated by his service-connected disabilities, he is a lay person without the appropriate medical training and expertise to provide a medical diagnosis and etiological opinion.

By virtue of the foregoing, the Board concludes that service connection is not warranted for headaches, erectile dysfunction, and obstructive sleep apnea. 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.

B.T. KNOPE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M.C., Counsel

Analyze in VA Law Explorer