Citation Nr: 22021300 Decision Date: 04/10/22 Archive Date: 04/10/22 DOCKET NO. 16-40 758A DATE: April 10, 2022 ORDER Entitlement to service connection for a corneal abrasion of the right eye with amblyopia claimed as a right eye disorder other than dry eye syndrome is granted. Entitlement to service connection for a pulmonary disorder, to include emphysema and chronic obstructive pulmonary disease (COPD), is denied. Entitlement to service connection for constipation is denied. Entitlement to service connection for erectile dysfunction is denied. Entitlement to service connection for a prostate disorder is denied. Entitlement to service connection for shingles/herpes zoster is denied. Entitlement to service connection for a cerebrovascular accident/stroke is denied. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and substance dependence, is denied. REMANDED Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for a right ankle disorder is remanded. Entitlement to service connection for a left ankle disorder is remanded. Entitlement to service connection for a sinus disorder is remanded. FINDINGS OF FACT 1. A corneal abrasion of the right eye with amblyopia claimed as a right eye disorder other than dry eye syndrome is reasonably shown to have had onset in service. 2. The Veteran's claimed pulmonary disorder, to include emphysema and COPD was not manifest during active service; and the evidence fails to establish that a current pulmonary disorder is etiologically related to service. 3. The Veteran does not have a disability manifested by constipation. 4. The evidence of record is against a finding that the Veteran has a diagnosis of erectile dysfunction. 5. The evidence of record is against a finding that the Veteran has a diagnosis of a prostate disorder. 6. The evidence establishes that the Veteran does not have shingles which were incurred in or are otherwise causally related to his active service. 7. The evidence is against finding that stroke had its onset during or is otherwise related to the Veteran's period of active service. 8. The Veteran does not have a current diagnosis of PTSD. 9. The Veteran's in-service substance abuse was misconduct and not shown to be secondary to any service-connected disability or injury. CONCLUSIONS OF LAW 1. Resolving doubt in the Veteran's favor, the criteria for entitlement to service connection for a corneal abrasion of the right eye with amblyopia claimed as a right eye disorder other than dry eye syndrome have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for a pulmonary disorder, to include emphysema and COPD, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. 3. The criteria for entitlement to service connection for constipation have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. 4. The criteria for entitlement to service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. 5. The criteria for entitlement to service connection for a prostate disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. 6. The criteria for entitlement to service connection for shingles/herpes zoster have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. 7. The criteria for entitlement to service connection for a cerebrovascular accident/stroke have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. 8. The criteria for entitlement to service connection for an acquired psychiatric disorder, to include PTSD and substance dependence have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.304(f). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from June 1979 to March 1987. These matters were last before the Board of Veterans' Appeals (Board) in January 2021 when they were remanded to a Department of Veterans Affairs (VA) Regional Office (RO) for additional development. In interim rating decisions service connection was granted for resolved rectal hemorrhoid with residual redundant anal tissue, pseudofolliculitis barbae, intervertebral disc syndrome with degenerative arthritis, spinal stenosis and spondylolisthesis, left and right upper extremities radiculopathy claimed as carpal tunnel syndrome, traumatic brain injury, and mixed tension-migraine headaches. As these represent full grants of the benefits sought on appeal, those claims are no longer before the Board for appellate consideration. The record contains a diagnosis other than emphysema. The Board has therefore expanded the issue on appeal to include all pulmonary disorders, to include COPD, consistent with the holding in Clemons v. Shinseki, 23 Vet. App. 1 (2009). SERVICE CONNECTION Service connection is granted on a direct basis when there is competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 38 U.S.C. § 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). 1. Entitlement to service connection for a corneal abrasion of the right eye with amblyopia claimed as a right eye disorder other than dry eye syndrome At the February 2019 Board hearing, the Veteran testified that he injured his right eye in service while chiseling a wheel bearing off a truck and when it broke, shrapnel went in his eye. Since that injury, his right eye vision has deteriorated. The Veteran's December 1978 Report of Medical Examination at service enlistment shows his eyes were normal on clinical evaluation. On distant vision testing, his right eye, uncorrected, was 20/40. Service treatment records show that the Veteran sought treatment for tearing of his right eye in November 1984 after a chisel with which he was working splintered and a piece of metal flew into his eye. On examination no foreign body was seen, and no abrasions were revealed. The impression was irritation from foreign body; an eye patch until morning was prescribed. In a subsequent treatment report dated one day later, a right eye corneal abrasion was diagnosed, and the Veteran was prescribed an eye patch with Neosporin ointment. In February 1987, the Veteran was treated in-service for a watery eye, and diagnosed with conjunctivitis. On January 2014 VA eye conditions examination, the Veteran report that, when he enlisted in the military in December 1978, his uncorrected right eye vision acuity was 20/40 and the left eye was 20/20. He stated he injured his right eye in November 1984 when a chip from a chisel struck his right eye, and a diagnosis of corneal abrasion was rendered. On examination, his uncorrected and corrected distance visual acuity of the right and left eyes were both 20/40 or better. His uncorrected near visual acuity of the right eye was 20/200 and the left was 20/50. His corrected near visual acuity of the right and left eyes were 20/40 or better. The diagnoses were right eye corneal abrasion and right eye refractive amblyopia. The examiner opined that the Veteran's vision problem of reduced acuity of the right eye was not as least as likely as not caused by or related to his in-service eye injury. The rationale for the opinion was the Veteran's minor decrease in acuity of the right eye that existed on enlistment is unexplained. There was no evidence of ocular injury or disease to account for the decreased right eye vision. There were no signs of sequelae of a right eye injury in service on November 29, 1984. On May 2021 VA-contract eye conditions examination, the Veteran reported that in November 1984 he had corneal abrasion on the right eye secondary to trauma (a piece of metal hit the eye in service while working). Right eye amblyopia had its onset in 2014. The Veteran reported symptoms of decreased vision. On examination of visual acuity his uncorrected distance and near vision was 20/70 bilaterally; corrected distance and near vision in the right eye was 20/40 and the left eye was 20/20 or better. The diagnosis was right eye amblyopia. The examiner opined that a nexus was established between the Veteran's claimed right eye disorder and service. The examiner indicated that the Veteran's right eye amblyopia was not present prior to service entrance, noting that the Veteran's amblyopia clearly and unmistakably occurred during service. The examiner reasoned that there is clear documentation that the Veteran had injury to the right eye. He had right eye corneal abrasion in 1984, a history of a head trauma in 1985, and a history of conjunctivitis in 1987. Right eye amblyopia was diagnosed in January 2014 and there is clear documentation of right eye amblyopia being associated with the eye. While the examiner noted earlier that the Veteran's right eye amblyopia clearly and unmistakably occurred during service, he subsequently noted in the same report that the Veteran's prior existing amblyopia has likely worsened beyond its natural progression due to constant eye straining and irritation from being exposed to harsh, dry air environments. Notably, the Board asked if the Veteran's right eye amblyopia disorder existed prior to service. In a January 2022 VA-contract addendum report, a medical opinion provider noted that after review of all medical records there is insufficient evidence to support evidence of amblyopia prior to or after service. The medical opinion provider noted further that it is clear there is no precise amblyopia noted after reviewing all medical records. The Board notes that right eye amblyopia is documented as diagnosed in January 2014. The medical opinion provider's data is therefore inaccurate, and the opinion is inadequate for deciding this matter. Because the Veteran's entrance examination was silent for any right eye disorder, he is presumed sound upon entrance. The presumption of soundness applies only when a disease or injury not noted upon entry to service manifests in service, and a question arises as to whether it preexisted service. As there is no clear and unmistakable evidence of a right eye disorder pre-existing service, the presumption of soundness is not rebutted, and the Veteran's claim is considered as one for service connection, rather than one based on aggravation of a pre-existing condition. Resolving doubt in the Veteran's favor, the Board finds that service connection for right eye amblyopia is warranted. 2. Entitlement to service connection for a pulmonary disorder, to include emphysema and COPD The Veteran contends he currently has a pulmonary disorder related to his active duty service. Specifically, at the February 2019 Board hearing, the Veteran attributed his emphysema and COPD to exposure to petroleum products, such as diesel fuel, gasolines and exhaust fumes, while performing duties as a mechanic in service. His service treatment records are negative for complaints, diagnosis and treatment for a pulmonary disorder. A pulmonary function test taken in service in April 1986 shows the Veteran's FVC [forced vital capacity] and FEV [forced expiratory volume]/VC [vital capacity] were within normal limits. Post service treatment records are devoid of any mention of a pulmonary disorder including related symptoms until May 2006 when the Veteran was seen by a private physician and diagnosed with having COPD. He was seen by his private physician in January 2008. It was noted in the report that the Veteran continues to smoke cigarettes. The diagnoses were ongoing tobacco abuse and COPD. March 2013 chest x-rays revealed the Veteran had underlying chronic lung disease including bullous emphysema. There is a 29-year gap between service separation from active duty and the earliest evidence of record of pulmonary symptoms. This is evidence which weighs heavily against the claim. At the hearing, the Veteran related that as a mechanic in service, he was exposed to petroleum products, such as diesel fuel and gasolines and exhaust fumes, which may have attributed to his pulmonary disorders. While the Veteran believes his pulmonary disorder may be caused by his exposure to exhaust fumes, petroleum and fuels in service, the Board readily acknowledges that the Veteran is competent to report perceived symptoms of his pulmonary disorder, to the extent they are identifiable by observation. However, he has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that he received any special training or acquired any medical expertise in evaluating pulmonary disorders. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). Additionally, the record contains medical records both private and VA, and no medical professional of record has ever linked the Veteran's pulmonary disorders to his active military service. At the hearing the Veteran related that he was told by a doctor that his pulmonary diseases could be from the exhaust fumes and the petroleum products that he worked with. The Board finds that a layperson's account of what a doctor purportedly said, filtered as it was through a layman's sensibilities, is simply too attenuated and inherently unreliable to hold any probative value. Robinette v. Brown, 8 Vet. App. 69 (1995). The Board acknowledges that the Veteran has not been afforded a VA examination for his pulmonary disorder. However, an examination is not warranted, as the duty to assist has not been triggered. See McClendon v. Nicholson, 20 Vet. App. 79 (2006); 38 C.F.R. § 3.159(c)(4). Although McClendon sets a low bar, that bar has not been met here, as there is no competent indication of a link between the Veteran's current condition and his active service. The Veteran's pulmonary disorder was diagnosed in 2006; 29 years after active service. The only evidence of a possible connection between the Veteran's current pulmonary disorders and his service is the Veteran's own broad and conclusory statements that the disorder is related to service, and such a statement is not sufficient to trigger VA's obligation to obtain an examination or opinion. Based on the foregoing, the Board finds the evidence is against finding that the Veteran's pulmonary disorder, to include emphysema and COPD, was caused by an incident in service. The claim is denied. 3. Entitlement to service connection for constipation At the February 2019 Board hearing, the Veteran proffered no additional evidence regarding the service connection claim for constipation. He opted to rely on the evidence of record and any additional evidence he provides after the hearing. The medical evidence of record includes the Veteran's service treatment records, which are negative for any complaints, diagnoses, or treatment for constipation. A post-service treatment report in January 2012 shows the Veteran was admitted to a VA substance abuse treatment program, and, on review of systems, he stated he felt good. On gastrointestinal observation, he denied nausea, vomiting, diarrhea, constipation, hematemesis, and pain. In April 2013, the Veteran had a gastrointestinal consult by a private physician, and constipation was active at that time. However, in May 2014, the Veteran had a VA gastroenterology consult and denied having any abdominal pain, nausea, vomiting, dyspepsia, dysphagia, diarrhea, constipation, melena, or change in bowel movements. In June 2018 the Veteran had a VA nutrition assessment and had constipation at that time. He did not have nausea, vomiting, or diarrhea, although it was noted that he had a "bad" appetite. The Board notes that in this instance, the Veteran has not been afforded a VA examination for constipation, and an examination is not warranted because the duty to assist has not been triggered and in such a case, VA has no obligation to obtain an examination or opinion. See McClendon, supra. Furthermore, the Board finds there is no chronic disability manifested by constipation. The Board observes that constipation is a symptom and is not a diagnosis. The presence of symptoms alone, without an established pathology to account for the symptoms, is generally not sufficient to award service connection. A factor that is equally significant is that there is no disease or injury in service to which the current constipation may be related. However, VA law requires a disease or injury in service, not just the presence of symptoms or the use of the term "chronic" in association with the description of symptoms. The Veteran is not competent to provide such a diagnosis. See Jandreau v. Nicholson, supra. The presence of a disability at any time during the claim process can justify a grant of service connection, even where the most recent diagnosis is negative. However, the U.S. Congress has specifically limited entitlement to service-connection to cases where such in-service disease or injury has resulted in disability. Where the evidence does not support a finding of current disability upon which to predicate a grant of service connection, there can be no valid claim for that benefit. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board concludes that such is the case with the claimed constipation. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the evidence is persuasively against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 4. Entitlement to service connection for erectile dysfunction 5. Entitlement to service connection for a prostate disorder At the February 2019 Board hearing, the Veteran proffered no additional evidence regarding the service connection claims for erectile dysfunction and prostate disorder and opted to rely on the evidence of record and any additional evidence he provides after the date of the hearing. The Board has fully and sympathetically reviewed the entire evidence of record, including but not limited to the Veteran's complete service treatment records and all relevant post-service medical records. There is no evidence that the Veteran has a diagnosis of erectile dysfunction or prostate disorder. In an August 2012 VA primary care telephone encounter note, the Veteran requested medication for erectile dysfunction. There is no competent evidence of record showing he had a diagnosis of it, and, as noted above, the Veteran is not competent to provide a diagnosis or render an etiology opinion. In July 2013, the Veteran completed an intake form at a VA medical center and indicated that a doctor or nurse told him he had prostate concerns. The Board notes that a layperson's account of what a doctor purportedly said, filtered as it was through a layman's sensibilities, is simply too attenuated and inherently unreliable to hold any probative value. Robinette, 8 Vet. App. 69. Moreover, in August 2016 and June 2018 the Veteran a had PSA [prostatic specific antigen] screening test for prostate cancer, and his results were normal. The Veteran has not been afforded a VA examination for erectile dysfunction or prostate disorder, and an examination is not warranted because the duty to assist has not been triggered and in such cases, VA has no obligation to obtain an examination or opinion. See McClendon, supra. The existence of a current disability is the cornerstone of a claim for VA disability compensation. The current disability requirement is satisfied when a claimant "has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim "or" when the record contains a recent diagnosis of disability prior to filing a claim for benefits based on that disability." In the absence of proof of a current disability, there can be no valid claim. Brammer, 3 Vet. App. at 225. The Board acknowledges the United States Court of Appeals for Veteran's Claims (Court)'s holding in Saunders but does not find a basis for determining that there is functional impairment related to a diagnosis, or even complaints, of any genitourinary disorders. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In addition, the record does not reflect, and the Veteran has not alleged, that he suffers from impairment of earning capacity due to his claimed impairments that is of similar severity, frequency, and duration as those VA has determined by regulation would cause impaired earning capacity in an average person. Wait v. Wilkie, 33 Vet. App. 8 (2020). Therefore, as the competent evidence of record shows the Veteran does not have a currently diagnosed erectile dysfunction or prostate disorder, the Board concludes that service connection is not warranted, and no further discussion of the remaining elements is necessary. Accordingly, the Board finds that the evidence is persuasively against the claims for service connection for erectile dysfunction and prostate disorder, and as such the claims must be denied. 38 U.S.C. § 5107(b). 6. Entitlement to service connection for shingles/herpes zoster At the February 2019 Board hearing, the Veteran proffered no additional evidence regarding the service connection claim for shingles/herpes zoster and opted to rely on the evidence of record and any additional evidence he provided after the hearing. The Veteran filed a claim for service connection for shingles in July 2013. The medical evidence of record includes the Veteran's service treatment records, which are negative for any complaints, diagnoses, or treatment for shingles. Post-service VA treatment records in June 2012 show that the Veteran had a shingles outbreak in May 2012, with residual itching and some neuropathic pain at T12/L1 dermatomes on the left. Subsequent VA treatment records in June 2013, October 2013, December 2013, May 2014, and June 2014 show a history of shingles. In a December 2020 VA outpatient clinic note herpes zoster without mention of complication is shown under "Problem list[.]" It was noted that the Veteran declined a shingles vaccination for 2020. The evidence is against finding that the claimed shingles is related to the Veteran's service. The first medical evidence of shingles was in May 2012, 25 years after the Veteran's separation from service. The Veteran has not asserted that he continues to have residual pain in the area where he suffered a rash caused by shingles. The Veteran is competent to report his experienced skin symptoms. However, the Veteran is not competent to determine that he has a current diagnosable shingles disability. The record does not indicate the Veteran has the requisite medical expertise or training; his lay opinion that he has a current shingles disability is of little probative value. See Jandreau, 492 F.3d 1372. Based on the foregoing, the evidence is against finding that the Veteran's shingles are relate to service. Here, the negative in-service examination reports, as well as the post-service medical records demonstrating an onset of his shingles in 2012, represent probative evidence against the claim. Furthermore, VA is not required to provide a medical opinion in this case, as there is no competent evidence indicating the Veteran's shingles may be related to a disease or injury incurred in service. See McLendon, 20 Vet. App. 79. Without competent and credible evidence of an association between the Veteran's shingles and his active duty service, service connection is not warranted. The benefit-of-the-doubt doctrine does not apply, as the evidence is persuasively against the claim. 38 C.F.R. § 3.102. 7. Entitlement to service connection for residuals of cerebrovascular accident/stroke At the February 2019 Board hearing the Veteran proffered no additional evidence regarding the service connection claim for stroke and opted to rely on the evidence of record and any additional evidence he provided after the hearing. The medical evidence of record includes the Veteran's service treatment records, which are negative for any complaints, diagnosis of a stroke or stroke-related symptoms, or treatment for stroke. The evidence shows the Veteran had a stroke in April 2003, more than 15 years after separation from service. He does not contend otherwise. He has consistently reported having a stroke in 2003. (See VA outpatient treatment records dated in December 2013, and July 2018). A VA examination was not provided in conjunction with the Veteran's claim for stroke, and the Board notes that the evidence of record does not warrant one. See McLendon, 20 Vet. App. 79. There is no evidence of complaints, or a diagnosis of stroke or related symptoms, or treatment during service and the Veteran has not identified evidence demonstrating that stroke had its onset in or is otherwise related to service. Accordingly, the Board finds that the duty to provide an examination has not been triggered. In light of the foregoing, the Board finds that the weight of the competent and probative evidence is against finding that the Veteran's stroke had its onset during or is otherwise related to service. See 38 C.F.R. § 3.303. Specifically, the Board notes there is no evidence of complaints, or a diagnosis of stroke or related symptoms, or treatment in service; and the Veteran first experienced a stroke many years after service in April 2003. In arriving at the decision to deny the claim, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the evidence is persuasively against the claim, that doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 8. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD and substance dependence The Veteran asserts he has PTSD and substance abuse as a result of various in-service stressors. Service connection for PTSD requires a medical diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). Initially, the Board notes that, while the Veteran is competent to report symptoms of a psychiatric disorder, he has not demonstrated the requisite medical training or experience needed to self-diagnose a psychiatric disorder, let alone opine as to the etiology of a specific disorder. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that a lay person is not competent to diagnose PTSD. See Young v. McDonald, 766 F.3d 1348 (Fed. Cir. 2014). Accordingly, the Veteran's opinion regarding the presence and etiology of a current psychiatric disorder carries no probative weight. In cases such as these, the Board looks to expert medical opinions to ascertain the nature and etiology of a complex psychiatric disorder. At his February 2019 Board hearing, the Veteran identified PTSD stressors such as being overworked by his supervisor in Germany and collecting dead bodies in body bags in Grenada. In further support of his claim, the Veteran submitted a statement received in May 2019, wherein he described several stressors which he attributed to his current psychiatric symptoms: (1) general stress associated with supervising 27 soldiers in his capacity as a motor maintenance supervisor while stationed with the 245th Air Traffic Control Squadron at Fort Bragg, North Carolina; (2) the fear of being in range of East German missiles while stationed in West Germany in 1981; (3) fear associated with flying into Grenada in full combat gear but without ammunition on a patrol mission to recover dead bodies as part of the U.S. invasion of Grenada in 1983, at which time they received gunfire to their Lockheed C-130 Hercules transport aircraft upon landing; and (4) fear associated with flying over Libya following the U.S. bombing of Muammar Gaddafi's compound as part of Operation El Dorado Canyon (although the Veteran attributed this event to 1984, Operation El Dorado Canyon occurred in 1986). A review of the Veteran's service records confirms that he was stationed with the 324th Signal Company in Germany from August 1981 to June 1983. However, his personnel records do not reflect any additional overseas service (to include any service in Grenada and/or Libya). His personnel records also confirm that he served in the capacity of a wheeled vehicle mechanic supervisor while stationed with the 245th Air Traffic Control Squadron at Fort Bragg, North Carolina, from 1985 to 1986. On the June 2021 VA-contract initial PTSD examination, the Veteran reported symptoms of anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a work like setting, and impaired impulse control, such as unprovoked irritability with periods of violence. He described a stressor as having had a lot of problems in the military. He stated, "They kept us on green ramp for deployment all of the time and was away from my family all of the time. I started drinking in Germany to deal with it. I deployed into Grenada in April 1983, I forgot exactly when, but I had no ammunition, and we were in an air traffic control facility. I still can't understand that to this day. We went down there to patrol and had to pick up dead bodies. They called it a black op mission, nobody knows about it, but I know about it." The examiner noted that the Veteran's stressor did not meet Criterion A because he did not clearly describe fear of hostile military or terrorist activity in Grenada, noting his unit was there after the U.S. invasion. Neither was the stressor related to in-service personal assault. The Veteran did not meet any of Criteria A, B, C, H, or I. He met one of the criterion in Criterion D persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). He met three of the criteria in Criterion E irritable behavior and anger outbursts, problems with concentration and sleep disturbance. Criterion F duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. Criterion G the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The examiner concluded that the Veteran does not have a diagnosis of PTSD that conforms to DSM-5 criteria [American Psychiatric Association 's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition] based on the present evaluation. The Veteran's mental disorder diagnosis is severe alcohol use disorder. Further, regarding the two stressors provided by the Veteran, general stress associated with supervising 27 soldiers in this capacity as a motor maintenance supervisor while stationed with the 245th Air Traffic Control Squadron at Fort Bragg, North Carolina and fear of being in range of East German missiles while stationed in West Germany in 1981. The examiner responded that the Veteran did not report fear of being attacked by East German missiles as a stressor during the examination. The general stress of supervising 27 soldiers as a motor maintenance supervisor while stationed with the 245th Air Traffic Control Squadron at Fort Bragg, North Carolina did not meet the DSM-V stressor A criterion. The examiner noted that the previously diagnosed cocaine dependence had resolved. The Veteran did not report fear of being attacked by East German missiles as a stressor at this examination. The general stress of supervising 27 soldiers as a motor maintenance supervisor while stationed with the 245th ATC Squadron at Fort Bragg, North Carolina does not meet DSM-V stressor A criterion. Veteran's symptoms are not likely caused by reported stressors, but rather alcohol dependence. The DSM-V does not recognize acquired psychiatric disorder as a diagnosable condition. However, the Veteran does not meet DSM-V criteria for PTSD. The Veteran is diagnosed with severe alcohol use disorder. Based on the foregoing, the Board finds that the most probative evidence of record indicates that the Veteran does not have a current diagnosis of PTSD for the entire appeal period. Accordingly, the evidence is persuasively against the Veteran's claim of entitlement to service connection for PTSD, and the benefit of the doubt doctrine is therefore inapplicable to the instant claim, which must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The examiner diagnosed the Veteran's current psychiatric disorder as severe alcohol use disorder. The Board acknowledges the Veteran was discharge from active duty for misconduct associated with drug abuse. (See Veteran's DD-214 ). Generally, injuries due to in-service misconduct cannot be service-connected, and compensation cannot be awarded pursuant to 38 U.S.C. §§ 105, 1131 either for a primary drug abuse disability incurred during service or for any secondary disability that resulted from primary drug abuse during service. Allen v. Principi, 237 F.3d 1368, 1376 (Fed. Cir. 2001). VA's General Counsel has confirmed that direct service connection for a disability that is a result of a Veteran's own abuse of alcohol or drugs is precluded for purposes of all VA benefits for claims filed after October 31, 1990. See VAOPGCPREC 7-99 (1999), published at 64 Fed. Reg. 52,375 (June 9, 1999); VAOPGCPREC 2-98 (1998), published at 63 Fed. Reg. 31,263 (February 10, 1998). Secondary service connection is available for drug and alcohol abuse if such abuse is found to be secondary to a service-connected disease or injury. Allen, 237 F.3d 1368. The Veteran has not shown or alleged his alcohol abuse is due to any service-connected disease or injury, and further discussion is thus not required. The Veteran's current psychiatric disorder is severe alcohol use disorder. The examiner opined that the diagnosed alcohol use disorder, severe is known to be a primary condition and is therefore "less than at least as likely as not" due to military service. The examiner noted that although the Veteran reported anxiety symptoms as well as poor sleep, paranoia and history of auditory hallucinations, per DSM-V it is not possible to diagnose mood or other mental health related disorders in the presence of active substance use disorders. This is because chronic alcohol use is well known to cause and or aggravate anxiety, depression, reduced memory and concentration, and correlates with isolation, and is associated with anger-irritability and sleep disturbances, and there is no way to be certain whether reported symptoms and functional impairments are due to the Veteran's daily alcohol use or a mental disorder. Accordingly, the Board finds that the evidence is persuasively against the claim for service connection for an acquired psychiatric disorder to include PTSD and alcohol abuse disorder and the claim must be denied. 38 U.S.C. § 5107. REASONS FOR REMAND Entitlement to service connection for a left knee disorder Entitlement to service connection for a right knee disorder Entitlement to service connection for a right ankle disorder Entitlement to service connection for a left ankle disorder Although the Board sincerely regrets the delay, an additional remand is required to comply with the January 2021 Board remand instructions with regard to the issues of service connection for right and left knee and ankle disorders. Stegall v. West, 11 Vet. App. 268 (1998). The January 2021 Board remand asked the examiner to specifically address the Veteran's testimony that his knee and ankle symptoms were due to the trauma associated with the 126 parachute jumps he made while in service. His DD Form 214 reflects that his military occupational specialty was wheel vehicle/power generation mechanic and power generation equipment repairer. He was awarded the Parachute Badge and Canadian Parachute Badge. Service personnel records confirm he completed 3 weeks of Basic Airborne training from September 1979 to October 1979 and was subsequently assigned to the 1st Battalion, 508th Infantry of the 82d Airborne Division. It may readily be conceded that he sustained various musculoskeletal system trauma from multiple jumps/jump landings, therein. A medical nexus opinion that does not include consideration of the effects of such trauma is inadequate for rating purposes. As noted, the April 2021 VA examiner did not provide an adequate rationale for all conclusions reached, or adequately considered the effects of multiple parachute jumps and jump landings on the knees and ankles. Accordingly, adequate opinions in these matters are necessary. Entitlement to service connection for a sinus disorder is remanded. A July 1980 service treatment record notes the Veteran was sensitive over his sinuses and he had a history consistent with chronic sinusitis. A February 2009 private treatment record shows the Veteran had allergic rhinosinusitis. In a January 2012 VA outpatient report, it was noted he reported a history of sinusitis since military service. He has a current diagnosis of chronic sinusitis. (See September 2016 VA physical medicine rehabilitation long-term care consult report). The Veteran has not been afforded a VA examination for the claimed sinus disorder. Because of the possible association between the claimed disorder and active duty service, such is sufficient to satisfy the low threshold standard in McClendon, 20 Vet. App. 27. Remand is thus warranted to obtain a VA examination and nexus opinion. The matters are REMANDED for the following action: 1. Contact the same examiner who conducted the April 2021 VA knee and lower leg conditions and ankle conditions examinations for an addendum opinion, or another individual if that examiner is unavailable. The relevant documents in the record should be made available to the examiner, including a copy of this Remand. Based on review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (an approximate balance of positive and negative evidence) that any disability of the knees and/or ankles began in service, was caused by service, or is otherwise etiologically related to active service. In providing these opinions, the examiner is asked to specifically address the Veteran's testimony that his knee and ankle symptoms were due to trauma associated with the 126 parachute jumps/landings he made while in service; the Veteran's receipt of the Parachute Badge and Canadian Parachute Badge, as well as his completion of 3 weeks of Basic Airborne training in 1979; service treatment records demonstrating ankle sprains in March 1981 and May 1983, as well as treatment for pain in the bilateral lower extremities which was diagnosed as shin splints in February 1987; and VA treatment records showing diagnosis of knee arthralgia. If there is any clinical or medical basis for corroborating or discounting the credibility of the history provided by the Veteran, then the examiner must so state, with a complete explanation in support of such a finding. All opinions must be supported by a thorough rationale. 2. Schedule the Veteran for an examination with an appropriate VA clinician to determine the nature and etiology of his claimed sinus disorder. The claims file should be made available to and reviewed by the examiner and all necessary tests should be performed. All findings should be reported in detail. (a) The examiner should interview the Veteran about his history concerning in-service and any current sinus symptoms. Identify, with specificity, all current diagnoses pertinent to the Veteran's claimed sinus disorder. (b) For each diagnosed disorder, the examiner should opine as to whether it is at least as likely as not (an approximate balance of positive and negative evidence) that a sinus disorder is related to an in-service incident or injury or caused by or otherwise etiologically related to the Veteran's active duty service. All opinions must be supported by a thorough rationale. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Young, Counsel 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.