Citation Nr: 1018499 Decision Date: 05/19/10 Archive Date: 06/04/10 DOCKET NO. 03-13 284 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Milwaukee, Wisconsin THE ISSUES 1. Entitlement to service connection for lipomatosis, claimed as due to exposure to herbicides. 2. Entitlement to service connection for congenital complete heart block, status post pacemaker implantation. 3. Entitlement to service connection for a chronic bronchial disability. REPRESENTATION Appellant represented by: Wisconsin Department of Veterans Affairs ATTORNEY FOR THE BOARD Elizabeth Jalley, Associate Counsel INTRODUCTION The Veteran served on active duty from July 28, 1982, to September 22, 1982. This case comes before the Board of Veterans' Appeals (Board) on appeal from an October 2002 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Milwaukee, Wisconsin. In his May 2003 substantive appeal, the Veteran requested a hearing at a local VA office before a Member of the Board. His representative withdrew this request in lieu of a local hearing before a Hearing Officer at his local RO. In January 2008, the Veteran testified at a personal hearing before a Decision Review Officer (DRO) at the Milwaukee RO. A transcript of this hearing was prepared and associated with the claims file. The Veteran again requested a Board hearing in writing in May 2008. He withdrew this request in writing in March 2010. The Board hearing request is therefore deemed to have been withdrawn. FINDINGS OF FACT 1. The Veteran did not exhibit lipomatosis in service, and lipomatosis is not etiologically related to any injury, disease, or exposure during the Veteran's active service. 2. The Veteran's congenital complete heart block is not a disability for which service connection may be awarded and it has not been shown to have been subject to a superimposed disease or injury in service, or to otherwise have been aggravated by service. 3. The Veteran did not exhibit symptoms of a chronic bronchial disability in service, and a chronic bronchial disability is not etiologically related to any injury or disease during the Veteran's active service. CONCLUSIONS OF LAW 1. Lipomatosis was not incurred in or aggravated by service and cannot be presumed to have been incurred therein. 38 U.S.C.A. §§ 1112, 1113, 1131, 1137, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2009). 2. The Veteran's congenital complete heart block, status post pacemaker implantation, is not a disease that was incurred in or aggravated by service. 38 U.S.C.A. §§ 1131, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.159, 3.303(c), 4.9 (2009). 3. A chronic bronchial disability was not incurred as a result of the Veteran's active military service. 38 U.S.C.A. §§ 1131, 5107 (West 2002); 38 C.F.R. § 3.303 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Preliminary Matters The Veterans Claims Assistance Act of 2000 (VCAA), Public Law No. 106-475, 114 Stat. 2096 (2000), substantially amended the provisions of chapter 51 of title 38 of the United States Code, concerning the notice and assistance to be afforded to claimants in substantiating their claims. VCAA § 3(a), 114 Stat. 2096, 2096-97 (2000) (now codified as amended at 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2009)). In addition, VA published regulations, which were created for the purpose of implementing many of the provisions of VCAA. See 66 Fed. Reg. 45,620 (Aug. 29, 2001) (now codified, in pertinent part, at 38 C.F.R. § 3.159 (2009)). The notice requirements of the VCAA require VA to notify the veteran of any evidence that is necessary to substantiate a claim, as well as the evidence VA will attempt to obtain and which evidence the veteran is responsible for providing. Quartuccio v. Principi, 16 Vet. App. 183 (2002). The requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between the veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Such notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction. Id; see also Pelegrini v. Principi, 18 Vet. App. 112 (2004). The VCAA notice requirements, however, may be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. See Dingess, supra; Pelegrini, supra. The Board finds that the notification requirements of VCAA have been satisfied in this case. In this regard, the Board notes evidentiary development letters dated in May 2001, May 2003, and December 2007 in which the RO advised the appellant of the evidence needed to substantiate his service connection claims. These letters also notified the Veteran how to establish service connection based on in-service herbicide exposure. The May 2003 and December 2007 letters advised the Veteran of his and VA's responsibilities under VCAA, to include what evidence should be provided by him and what evidence should be provided by VA. A March 2006 letter and the December 2007 letter further advised the Veteran as to the type of evidence needed to substantiate both the disability rating and effective date elements of his claims, pursuant to the Court's holding in Dingess, supra. The Board notes that the May 2003, March 2006, and December 2007 letters were was not issued prior to the initial adjudication of the Veteran's claims in October 2002. His claims, however, were readjudicated following the issuance of one or more of these letters in a March 2003 statement of the case and in supplemental statements of the case that were issued in November 2004, May 2008, October 2008, and January 2009. Thus, any deficiencies in the content or timeliness of these notice letters would not be prejudicial. The Board further finds that the duty to assist requirements of VCAA have also been satisfied in this case. 38 U.S.C.A. §§ 5103 and 5103A. Specifically, the Board finds that all obtainable evidence identified by the Veteran relative to the issues on appeal has been obtained and associated with the claims folder. In particular, the Board notes that the RO obtained the Veteran's available service treatment records, service personnel records, his Social Security Administration (SSA) records, and his identified private medical records. The Veteran was notified of all of the RO's efforts to verify the Veteran's claimed herbicide exposure with the Department of Defense and the National Personnel Records Center (NPRC). The Veteran was also notified of VA's attempts and inability to obtain records at Moncrief Army Hospital at Ft. Jackson, South Carolina. Under such circumstances, where service records have been lost or destroyed through no fault of the Veteran, the Court has held that there is a heightened obligation on the part of VA to explain findings and conclusions and to consider carefully the benefit-of-the- doubt rule. Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). The Board's analysis has been undertaken with the heightened obligation set forth in Cuevas and O'Hare in mind. It is noted, however, that the case law does not lower the legal standard for proving a claim for service connection, but rather increases the Board's obligation to evaluate and discuss in its decision all of the evidence that may be favorable to the claimant. See Russo v. Brown, 9 Vet. App. 46 (1996). Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), in initial service connection claims, the VA must provide a VA medical examination where there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service; (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service; and (4) insufficient competent medical evidence on file for VA to make a decision on the claim. The Board notes that the Veteran has not been provided a VA examination for the disabilities at issue. However, the Board finds that examinations are not necessary to decide these claims as there is no credible lay evidence or competent medical evidence suggesting an association between any of the disabilities at issue and the Veteran's military service. Specifically, as will be discussed in greater detail below, there is no credible evidence of in-service dioxin exposure, no credible or competent evidence of a continuity of symptomatology between any current cardiac symptoms and military service, and no credible or competent evidence of a chronic bronchial disability in service. The Board therefore finds that VA examinations are not warranted. The evidence of record provides sufficient information to adequately evaluate the claims. Therefore, no further assistance to the Veteran with the development of evidence is required, nor is there notice delay or deficiency resulting in any prejudice to the Veteran. 38 U.S.C.A. § 5103A(a)(2); 38 C.F.R. § 3.159(d); see Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). II. Service Connection In general, applicable laws and regulations state that service connection may be granted for disability resulting from a disease or injury incurred in or aggravated by military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. That a condition or injury occurred in service alone is not enough; there must be disability resulting from that condition or injury. See Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992); Brammer v. Derwinski, 3 Vet. App. 223 (1992). Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In certain circumstances, service connection may also be granted for chronic disabilities if such is shown to have been manifested to a compensable degree within one year after the veteran was separated from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. While it does not appear that any of the Veteran's claimed disabilities is chronic, the Board notes that presumptive service connection based on chronic disabilities is only available for veterans who have served for 90 days or more during a war period or after December 31, 1946. 38 C.F.R. § 3.307(a)(1) (2009). Because the Veteran in this case does not have 90 days of service, he is not entitled to presumptive service connection for a chronic disability. For VA purposes congenital or developmental defects are not diseases or injuries within the meaning of the applicable legislation. See 38 C.F.R. §§ 3.303(c), 4.9; see also Winn v. Brown, 8 Vet. App. 510, 516 (1996). VAOPGCPREC 82-90 (July 18, 1990) (a reissue of General Counsel opinion 01-85 (March 5, 1985)) in essence held that a disease considered by medical authorities to be of familial (or hereditary) origin by its very nature preexists a claimant's military service, but could be granted service connection if manifestations of the disease in service constituted aggravation of the condition. Congenital or developmental defects, as opposed to diseases, could not be service-connected because they are not diseases or injuries under the law; however, if superimposed injury or disease occurred, the resultant disability might be service-connected. The specific statute pertaining to claimed Agent Orange exposure is 38 U.S.C.A. § 1116. Regulations issued pursuant thereto stipulate the diseases for which service connection may be presumed due to an association with exposure to herbicide agents. The specified diseases are chloracne or other acneform disease consistent with chloracne, type 2 diabetes, Hodgkin's disease, multiple myeloma, non-Hodgkin's lymphoma, acute and subacute peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), and soft-tissue sarcoma. 38 C.F.R. §§ 3.307(a)(6), 3.309(e). Unlike presumptive service connection for chronic disabilities, 38 C.F.R. § 3.307(a)(1) expressly states that presumptive service connection based on herbicide exposure is available for veterans whose service does not meet the 90-day service requirement listed above. The Board notes that a presumption of service connection based on exposure to herbicides is not warranted for any condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. See Health Outcomes Not Associated With Exposure to Certain Herbicide Agents, 72 Fed. Reg. 32,395 (June 12, 2007). Veterans who served in the Republic of Vietnam are presumed to have been exposed to Agent Orange 38 C.F.R. § 3.307(a)(6)(iii). Veterans who were otherwise exposed to such herbicides may also take advantage of those presumptive health effects. However, unlike Vietnam veterans, they are required to prove that they were, in fact, exposed to herbicides during their military service. That is, they do not have the benefit of a presumption of exposure as do Vietnam veterans. Notwithstanding the above, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that when a veteran is found not to be entitled to a regulatory presumption of service connection for a given disability the claim must nevertheless be reviewed to determine whether service connection can be established on a direct basis. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Thus, the fact that the veteran may not meet the requirements of a presumptive regulation would not in and of itself preclude him from establishing service connection as he may, in the alternative, establish service connection by way of proof of actual direct causation. A. Lipomatosis In the case at hand, the Veteran does not contend, and the evidence does not show, that he had service in the Republic of Vietnam. Rather, he maintains that he was exposed to Agent Orange during basic training in approximately August 1982 while serving at Fort Jackson, South Carolina. At his January 2008 DRO hearing, the Veteran described loading black barrels with orange lines on them onto a truck. Regardless of whether Agent Orange exposure may be demonstrated by the evidence of record, the Veteran is not eligible for presumptive service connection based on his claimed Agent Orange exposure for lipomatosis, as this disability is not listed under 38 C.F.R. § 3.309(e). Therefore, the Board next turns to whether direct service connection for lipomatosis may be established for this claim. In order to establish direct service connection, the competent evidence of record must demonstrate that the Veteran's lipomatosis occurred as a result of his military service. Consideration of whether direct service connection is warranted also contemplates whether it may be demonstrated that the Veteran's lipomatosis was actually caused by in- service Agent Orange exposure. The Board will first address the question of whether the Veteran's lipomatosis may be directly related to his military service other than as a result of in-service herbicide exposure. The Board notes that the Veteran's March 1982 enlistment examination report does not reflect any pertinent abnormality, including of the skin and lymphatics or of any pertinent body part on which lipomatosis has been found. The Veteran also reported no history of or current symptomatology suggestive of lipomatosis on his March 1982 enlistment medical history report. Specifically, the Veteran denied any past or current skin disease or tumor, growth, cyst, or cancer. The Veteran's service treatment records do not otherwise reflect that he ever complained of or sought treatment for symptoms associated with lipomatosis. In terms of post-service symptomatology, the Veteran reported on his March 2001 claim form that his lymphatic cysts began in 1984. He testified at his January 2008 DRO hearing that he developed the lipomas following his separation from service, and that this occurred shortly after he and some other service members had concluded they had been exposed to Agent Orange. An August 2000 private medical record reflects that the Veteran reported having had multiple lipomas to his arms and abdomen since 1994. In terms of contemporaneous medical records, the earliest evidence of the Veteran having received treatment for lipomas is from May 1994. The Board recognizes that there are instances in which lay testimony can provide probative evidence in medical matters. A lay person may be competent to offer testimony on certain medical matters, such as describing symptoms observable to the naked eye, or even diagnosing simple conditions such as a dislocated shoulder. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (explaining in footnote 4 that a veteran is competent to provide a diagnosis of a simple condition such as a broken leg, but not competent to provide evidence as to more complex medical questions). In this case, the Board finds that the Veteran is competent to testify that he developed lipomas on his extremities and abdomen. The Board notes, however, that the Veteran has not asserted that he developed these lipomas during service. Therefore, in the absence of competent medical or lay evidence that he suffered from lipomatosis during service, direct service connection that is not based on herbicide exposure must be denied. The Board will next determine whether direct service connection based on exposure to herbicides in service may be granted. First, the Board must determine whether in-service herbicide exposure may be established. As noted above, service connection may still be granted if it is determined that the Veteran was exposed to herbicides in service and there is competent medical evidence of record linking this exposure to the subsequent development of lipomatosis. The Board notes that neither the Veteran's service treatment records nor his service personnel records indicate Agent Orange exposure. VA therefore sought verification of Agent Orange exposure through inquiries to the NPRC and the Department of Defense. A 2001 inquiry to the NPRC found that the Veteran's file contained no records of exposure to herbicides. A June 2008 message from the Department of Defense notes review of a Department of Defense list containing 71 sites within the United States and abroad where herbicide use or testing is acknowledged. The list did not contain any references to routine base maintenance activities such as range management, brush clearing, or weed killing. However, it was noted that there is no Department of Defense record of any Agent Orange or other herbicide use, testing, or storage at Fort Jackson or anywhere else in South Carolina. It concluded that the Veteran's claim "appears to have no factual basis," as the "[u]se of tactical herbicides, such as [Agent Orange], was terminated in 1971." It further noted that "Remaining stores from Vietnam were transferred to Johnston Island in the Pacific and incinerated at sea in 1977. Tactical herbicides have not been used by the military since then." The only contrary suggestion of Agent Orange exposure comes from the Veteran himself. On his March 2001 claims form, the Veteran stated that he "was involved in late Aug or early Sept 1982 at Ft. Jackson rolling & handling barrels (black or grayish) which were rather damp. We were told that they contained Agent Orange. This only took a few minutes, & I do not recall whom I was with at the time." The Board notes that the Veteran did not specify by whom he had been told he was handling Agent Orange. In fact, according to his January 2008 DRO hearing testimony, the Veteran was never told by anyone in service that he was, in fact, moving Agent Orange; rather, he testified that he and service members he talked to after his separation from service figured they were probably moving Agent Orange. Under these circumstances, the Board finds the determination made by the Department of Defense with respect to the absence of herbicides at Fort Jackson, South Carolina, from August 1982 through September 1982 to be far more credible than the Veteran's testimony as to the matter of whether he was exposed to Agent Orange in service. Finally, the Board will address the medical evidence discussing the laboratory findings associated with the December 2000 removal of several lipomas from the Veteran's body. The Board notes, in particular, a July 2001 letter from Dr. W.J.S., a private physician, and a September 2001 lab report. According to the July 2001 letter, samples collected in December 2000 were tested for "Agent Orange (dioxin)" and found to contain "extremely high levels of this compound." The September 2001 lab report notes that the specific dioxin that was found in lipomas removed in September 2001 was 2,3,7,8-TCDD. The Board notes that 2,4-D and 2,4,5-T and its contaminant TCDD (tetrachlorodibenzo-p- dioxin (2,3,7,8-TCDD)) are identified as herbicide agents in 38 C.F.R. § 3.307(a)(6). The Board notes, however, that 2,3,7,8-TCDD is not specific to Agent Orange. Thus, the presence of 2,3,7,8-TCDD does not establish that the Veteran was exposed to Agent Orange, to include during military service, nor do these findings otherwise establish a link between any in-service chemical exposure and the finding of 2,3,7,8-TCDD in the Veteran's lipomas. Specifically, the fact that the Veteran was exposed to a dioxin at some point in his life does not demonstrate that he was exposed to a dioxin (including Agent Orange) during his two months of military service, particularly in light of the service department findings discussed above. In short, the Board finds that in-service Agent Orange exposure cannot be presumed and service connection based on Agent Orange exposure or otherwise based on the Veteran's military service is not warranted. The Board has considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, for the reasons stated above, the Veteran's claim must be denied. B. Congenital Complete Heart Block, Status Post Pacemaker Implantation The Veteran has also claimed entitlement to service connection for congenital complete heart block, status post pacemaker implantation. He essentially contends that this congenital condition was aggravated during service. As noted above, congenital or developmental defects are not diseases or injuries within the meaning of the applicable legislation, and service connection may only be granted if subject to a superimposed disease or injury in service, or if manifestations of the disease in service constituted aggravation of the condition. The Board finds that service connection for congenital complete heart block, status post pacemaker implantation, must be denied because a preponderance of the evidence of record is against finding that the Veteran's disability was subject to any superimposed injury or disease in service, or was otherwise aggravated by service. The Veteran's service treatment records reflect that he never complained of or was treated for a heart condition during service. While he has submitted several records in connection with his appeal that demonstrate he was diagnosed with a congenital heart condition shortly following his birth, his March 1982 entrance examination report reflects that his heart was clinically normal upon his entrance into service. Furthermore, he reported no history of or current heart problems on his entrance medical history report from that same month. The Veteran's service treatment records do not otherwise reflect that he complained of or sought treatment for symptoms that have been associated with a heart condition during service. The Veteran's March 2001 claims form reflects the Veteran's contention that his congenital heart condition was aggravated during service in August 1982. He reported that he passed out three or four times. He stated that this was initially thought to be due to bronchial problems but that he was later told by a doctor that it was due to heart blockage. The Veteran testified at his January 2008 hearing that he was discharged because his heart condition and asthma rendered him unable to complete basic training and that he was told he would be able to come back to service within two years if he wanted "due to the fact that I was in the hospital there with a cold thing that was lingering on and my asthma was kicking up." However, the Board has thoroughly reviewed the Veteran's service personnel records and can find no indication that the Veteran experienced heart difficulties during service or that his separation from service was related to a heart condition. A September 1982 memorandum on the proposal to discharge the Veteran from service lists poor attitude, poor motivation, poor self-discipline, and a lack of self confidence as the reasons for his substandard performance. Counselling records from August and September 1982 corroborate that the Veteran's separation from service was due to performance and attitude rather than a medical condition. An August 7 initial counselling report notes that the Veteran "seemed motivated and willing to complete Basic Training. [He] stated he had no problems, medical or personnel [sic], that would prevent him from completing basic training." An August 25 counselling record observes that the Veteran "may be trying to manipulate us into agreeing to discharge by telling us of his temper, which caused problems for him in civilian life." It was noted that based on "his lackluster performance and some of the questionable statements he makes, we feel that [he] would have to immediately indicate a big turnaround in words and actions upon his return to his unit in order to justify his retention." A September 1 counselling summary describes the Veteran as having "shown lack of motivation, negative attitude, poor learning ability, and shown no will to become a productive soldier." It was noted he had not shown improvement despite having been given several opportunities to do so. For example, the Veteran "was given a recycle interview, claimed to be ready to train, got to new unit and simply quit during [Physical Training]." (An August 19 Physical Readiness Training form reflects that the Veteran quit running after 1.5 laps. It does not indicate a medical explanation for the Veteran's actions.) The counselor felt "this individual would be a waste of time and money to keep and try to train." A September 2 counselling record notes that the Veteran "states that he is not motivated because he really wants to go home." In summary, the Veteran's service personnel records reflect that he was discharged due to a poor attitude, lack of motivation, and difficulty adjusting to military life. There is no indication that the Veteran experienced symptoms of a heart disability during service, especially symptoms of disability so severe as to cause him to pass out three or four times in less than two months of service. The counselling narratives do not mention that the Veteran was hospitalized for a medical condition during this period of service. No such medical condition is noted in the Veteran's counselling records as causing, contributing, or even being relevant to his in-service difficulties. Nor do the Veteran's post-service medical records support the Veteran's assertion that his congenital heart condition was aggravated by his military service. An October 1989 cardiologist's letter to the Veteran's physician states that "As you know, he has a history of congenital complete heart block. Apparently, he has done well from the same and was also in the air force for about six months in the early 1980's. However, he has been complaining of increased fatigue over the last year or so.... He has no history of syncope; although, he does get dizzy after heavy work." A report from the Veteran's October 1989 permanent pacemaker implantation procedure notes that "On the whole [the Veteran] has done quite well over the last several years despite his congenital complete heart block, however, he started feeling excessively fatigued and these symptoms have progressed over the last several months." While the first of these two statements is somewhat unclear, the Board notes that it appears to be indicating that the Veteran had been doing well with his congenital heart problem, despite having served in the military. Both physicians indicate that the Veteran had been experiencing increased fatigue over the past year, which would correspond to approximately six years following his separation from service. A March 1990 private medical record reports that the Veteran mentioned he had syncopal episodes while in the service when he was upright for prolonged periods of time. Normally, the Board recognizes that statements made directly to a health care provider during the course of treatment are inherently more credible given the patient's incentive to be as truthful as possible. In this instance, however, the Board must also consider the more contemporaneous, and very detailed, service records describing the nature and circumstances of the problems that led to his discharge. As noted, those records contain numerous findings demonstrating that he was discharged due to a poor attitude, lack of motivation, and difficulty adjusting to military life, and there is no indication that the Veteran experienced symptoms of a heart disability during service, especially symptoms of disability so severe as to cause him to pass out three or four times in less than two months of service. Furthermore, as discussed above, the 1989 medical records specifically indicate that the symptoms necessitating the pacemaker originated in approximately 1988. Given the substantial evidence of record weighing against the Veteran's claim of having had symptoms in service, the Board finds the history reported in 1990 not credible. In short, as the most credible lay and medical evidence of record does not demonstrate that his congenital heart block was subject to a superimposed disease or injury in service, or otherwise aggravated by service, the Board finds that entitlement to service connection for aggravation of congenital complete heart block, status post pacemaker implantation, is not warranted. Because the preponderance of the evidence of record is against the Veteran's claim, the benefit-of- the-doubt doctrine is inapplicable. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert, supra. Therefore, service connection must be denied. C. Bronchial Disability The Veteran has also requested service connection for a bronchial disability that he believes arose during his military service. He contends that an August 20, 1982, service treatment record indicating that he was being treated for a cold actually documented the onset of a chronic bronchial condition. The Veteran's March 1982 enlistment examination report reflects that his lungs and chest were clinically normal. He noted on his March 1982 enlistment medical history report that he had no history of or current ear, nose, or throat trouble; asthma; or shortness of breath. He again noted no asthma or respiratory problems on a March 1982 medical prescreening form. The only service treatment record of potential relevance to the Veteran's claim is the August 20 record noted above. This record reflects that the Veteran had sought treatment for cold symptoms 1.5 weeks earlier. He had been given medications that provided no relief. On examination, the Veteran's throat was red with slight swelling and no exudate. His tympanic membranes and chest were clear. The assessment was that the Veteran had acute respiratory disease and that the examination was essentially normal. He was given a cold pack and returned to full duty. The Board finds that this record does not establish that the Veteran had a chronic bronchial disability during service, as it clearly does not diagnose a chronic condition. At his January 2008 hearing, the Veteran testified that he was given inhalers by a private doctor in October, November, or December 1982. These records, however, are unavailable. Nevertheless, even presuming such treatment occurred, it was administered months after his separation from service, and several decades prior to filing his claim. Evidence of a prolonged period without medical complaint, and the amount of time that elapsed since military service, can be considered as evidence against the claim. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The earliest post-service evidence documenting a bronchial condition is a May 1994 medical assessment on which the Veteran reported that he has asthma, which is more than eleven years following his separation from service. Furthermore, the Veteran has not submitted a medical professional's opinion linking the in-service complaints to a chronic bronchial condition. While he testified that his current doctor had opined that his bronchial condition was probably aggravated by his military service, he has submitted no such medical opinion to this effect. The only opinion of record linking the Veteran's bronchial condition to his military service comes from the Veteran himself. Specifically, the Veteran advocated this theory of entitlement at his January 2008 hearing. As a lay person, however, the Veteran is not competent to offer an opinion on a matter clearly requiring medical expertise, such as establishing that he has a current bronchial condition that originated during his military service, especially when such a condition was not diagnosed by the medical personnel who treated him in service. See Jandreau, supra. Therefore, this is not a case in which the appellant's lay beliefs alone can serve to establish entitlement to service connection for a chronic bronchial condition. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992); Moray v. Brown, 5 Vet. App. 211 (1993). In short, the Board concludes that the preponderance of the evidence is against granting entitlement to service connection for a chronic bronchial disability. As the evidence preponderates against the claim, the benefit-of-the- doubt doctrine is inapplicable, and service connection must be denied. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert, supra. ORDER Entitlement to service connection for lipomatosis, claimed as due to exposure to herbicides, is denied. Entitlement to service connection for congenital complete heart block, status post pacemaker implantation, is denied. Entitlement to service connection for a chronic bronchial disability is denied. ____________________________________________ MICHAEL LANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs