Citation Nr: 23011727 Decision Date: 02/24/23 Archive Date: 02/24/23 DOCKET NO. 16-20 547 DATE: February 24, 2023 ORDER Entitlement to a compensable non-initial rating for bilateral hearing loss is denied. Entitlement to service connection for bilateral plantar fasciitis, to include as secondary to service-connected bilateral tibial stress fracture, is denied. Entitlement to service connection for left posterior tibial tendon dysfunction, to include as secondary to service-connected bilateral tibial stress fracture, is denied. Entitlement to service connection for right posterior tibial tendon dysfunction, to include as secondary to service-connected bilateral tibial stress fracture, is denied. Entitlement to service connection for diabetes mellitus, type II, to include as due to herbicide exposure and environmental chemical exposure, is denied. Entitlement to service connection for prostate cancer, to include as due to herbicide exposure and environmental chemical exposure, is denied. Entitlement to service connection for glaucoma, to include as secondary to diabetes mellitus, type II, is denied. Entitlement to service connection for cataracts, to include as secondary to diabetes mellitus, type II, is denied. Entitlement to service connection for allergic rhinitis is granted. Entitlement to service connection for an adrenal gland abnormality, to include as secondary to prostate cancer, is denied. Entitlement to service connection for right upper extremity neuropathy, to include as secondary to diabetes mellitus, type II, is denied. Entitlement to service connection for left upper extremity neuropathy, to include as secondary to diabetes mellitus, type II, is denied. Entitlement to service connection for right lower extremity neuropathy, to include as secondary to diabetes mellitus, type II, is denied. Entitlement to service connection for left lower extremity neuropathy, to include as secondary to diabetes mellitus, type II, is denied. Entitlement to service connection for a lesion on the spleen, to include as secondary to prostate cancer, is denied. Entitlement to service connection for urinary incontinence, to include as secondary to prostate cancer, is denied. Entitlement to service connection for a cyst on the right kidney, to include as secondary to prostate cancer, is denied. Entitlement to service connection for erectile dysfunction (ED), to include as secondary to diabetes mellitus, type II, is denied. Entitlement to service connection for left leg periarticular osteopenia, to include as secondary to service-connected bilateral tibial stress fracture, is denied. Entitlement to service connection for hypothyroidism, to include as due to herbicide exposure and environmental chemical exposure, is denied. REMANDED Entitlement to service connection for right wrist osteoarthritis, to include as secondary to service-connected right wrist ganglion cyst, is remanded. Entitlement to service connection for a right arm injury is remanded. Entitlement to service connection for a left arm injury is remanded. FINDINGS OF FACT 1. The audiometric evidence has shown the Veteran's hearing acuity is manifested by, at worst, a Level I in the right ear and Level I in the left ear. 2. The evidence persuasively weighs against finding that bilateral plantar fasciitis began during active service or within one year of service, is otherwise related to an in-service injury, event, or disease, or is caused or aggravated by service-connected bilateral tibial stress fracture. 3. The evidence persuasively weighs against finding that bilateral posterior tibial tendon dysfunction began during active service or within one year of service, is otherwise related to an in-service injury, event, or disease, or is caused or aggravated by service-connected bilateral tibial stress fracture. 4. The evidence persuasively weighs against finding that diabetes mellitus, type II, began during active service or within one year of service, is otherwise related to an in-service injury, event, or disease, to include exposure to herbicide agents or environmental chemicals. 5. The evidence persuasively weighs against finding that prostate cancer began during active service or within one year of service, is otherwise related to an in-service injury, event, or disease, to include exposure to herbicide agents or environmental chemicals. 6. The evidence persuasively weighs against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of glaucoma. 7. The evidence persuasively weighs against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of cataracts. 8. The Veteran's allergic rhinitis began during active service. 9. The evidence persuasively weighs against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of an adrenal gland abnormality. 10. The evidence persuasively weighs against finding that bilateral upper extremity neuropathy began during active service or within one year of service, is otherwise related to an in-service injury, event, or disease, or is caused or aggravated by a service-connected disability. 11. The evidence persuasively weighs against finding that bilateral lower extremity neuropathy began during active service or within one year of service, is otherwise related to an in-service injury, event, or disease, or is caused or aggravated by a service-connected disability. 12. The evidence persuasively weighs against finding that a lesion on the spleen began during active service or within one year of service, is otherwise related to an in-service injury, event, or disease, or is caused or aggravated by a service-connected disability. 13. The evidence persuasively weighs against finding that urinary incontinence began during active service or within one year of service, is otherwise related to an in-service injury, event, or disease, or is caused or aggravated by a service-connected disability. 14. The evidence persuasively weighs against finding that a cyst on the right kidney began during active service or within one year of service, is otherwise related to an in-service injury, event, or disease, or is caused or aggravated by a service-connected disability. 15. The evidence persuasively weighs against finding that ED began during active service or within one year of service, is otherwise related to an in-service injury, event, or disease, or is caused or aggravated by a service-connected disability. 16. The evidence persuasively weighs against finding that left leg periarticular osteopenia began during active service or within one year of service, is otherwise related to an in-service injury, event, or disease, or is caused or aggravated by a service-connected bilateral tibial stress fracture. 17. The evidence persuasively weighs against finding that hypothyroidism began during active service or within one year of service, is otherwise related to an in-service injury, event, or disease, to include exposure to herbicide agents or environmental chemicals. CONCLUSIONS OF LAW 1. The criteria for a compensable evaluation for bilateral hearing loss have not been met. 38 U.S.C. §§ 1115, 5107; 38 C.F.R. §§ 4.7, 4.85, 4.86, Diagnostic Code 6100. 2. The criteria for service connection for bilateral plantar fasciitis due to service or service-connected bilateral tibial stress fracture are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for left posterior tibial tendon dysfunction due to service or service-connected bilateral tibial stress fracture are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for service connection for right posterior tibial tendon dysfunction due to service or service-connected bilateral tibial stress fracture are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 5. The criteria for service connection for diabetes mellitus, type II, are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 6. The criteria for service connection for prostate cancer are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 7. The criteria for service connection for glaucoma are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for cataracts are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for service connection for allergic rhinitis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 10. The criteria for service connection for an adrenal gland abnormality are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 11. The criteria for service connection for right upper extremity neuropathy due to service or service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 12. The criteria for service connection for left upper extremity neuropathy due to service or service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 13. The criteria for service connection for right lower extremity neuropathy due to service or service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 14. The criteria for service connection for left lower extremity neuropathy due to service or service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 15. The criteria for service connection lesion on the spleen due to service or service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 16. The criteria for service connection for urinary incontinence due to service or service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 17. The criteria for service connection for cyst on the right kidney due to service or service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 18. The criteria for service connection for ED due to service or service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 19. The criteria for service connection for left leg periarticular due to service or service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 20. The criteria for service connection for hypothyroidism are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from January 1968 to March 1975. These issues, along with the issue of entitlement to service connection for hypertension, were remanded by March 2017 and August 2020 Board decisions for further development. As a result of the development in relation to the August 2020 Board decision, the agency of original jurisdiction (AOJ) granted service connection for hypertension in an April 2021 rating decision. As this is a grant of the full benefit sought on appeal, this issue is no longer before the Board for review. The remaining issues are returned to the Board for appellate review. 1. Entitlement to a non-initial compensable rating for bilateral hearing loss is denied. The Veteran is currently assigned a noncompensable rating for bilateral hearing loss. The Veteran asserts that his bilateral hearing loss is more severe than the rating assigned. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran's medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence "used to decide whether an original rating on appeal was erroneous." Fenderson v. West, 12 Vet. App. 119, 126 (1999). In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Fenderson, 12 Vet. App. at 126; Hart v. Mansfield, 21 Vet. App. 505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings). When adjudicating a claim for an increased initial evaluation, the relevant time period is from the date of the claim. Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), rev'd in irrelevant part, Moore v. Shinseki, 555 F.3d 1369 (2009). The Veteran is currently assigned a noncompensable disability rating for his service-connected bilateral hearing loss. It is his assertion that a compensable disability rating is warranted for that disability. The appropriate disability rating for hearing impairment is determined under the criteria in 38 C.F.R. §§ 4.85, 4.86. The Rating Schedule provides a table for rating purposes (Table VI) to determine a Roman numeral designation (I through XI) for hearing impairment, based on testing (by a state-licensed audiologist) including puretone thresholds and speech discrimination (Maryland CNC test). See 38 C.F.R. § 4.85. Where there is an exceptional pattern of hearing impairment (as defined in 38 C.F.R. § 4.86) the rating may be based solely on puretone threshold testing. See 38 C.F.R. § 4.85, Table VIa. One exceptional pattern of hearing impairment occurs when the puretone thresholds in each of the four frequencies (1,000, 2,000, 3,000 and 4,000 Hertz) are 55 decibels or greater. Another occurs when the puretone threshold at 1000 hertz is 30 decibels or less, and the threshold at 2000 hertz is 70 decibels or more. See 38 C.F.R. § 4.86 (a) (b). Table VII is used to determine the rating assigned by combining the Roman numeral designations for hearing impairment of each ear. Table VIa, Numeric Designation of Hearing Impairment Based Only on Puretone Threshold Average, is used to determine a Roman numeral designation (I through XI) for hearing impairment based only on the puretone threshold average. Table VIa will be used when the examiner certifies that use of the speech discrimination test is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc., or when indicated under the provisions of § 4.86. 38 C.F.R. § 4.85. Ratings for hearing impairment are derived by the mechanical application of the Rating Schedule to the numeric designations assigned after audiometry evaluations are rendered. Lendenmann v. Principi, 3 Vet. App. 345 (1992). The December 2012 VA audiological examination found puretone thresholds in decibels as: HERTZ 1000 2000 3000 4000 Avg RIGHT 20 15 15 25 19 LEFT 20 15 20 30 21 The average puretone thresholds were 19 decibels in the right ear and 21 in the left ear. Speech audiometry revealed speech recognition ability of 100 percent in the right ear and 94 percent in the left ear. The September 2014 VA audiological examination found puretone thresholds in decibels as: HERTZ 1000 2000 3000 4000 Avg RIGHT 25 30 30 40 31 LEFT 25 25 35 40 31 The average puretone thresholds were 31 decibels in the right ear and 31 in the left ear. Speech audiometry revealed speech recognition ability of 100 percent in the right ear and 100 percent in the left ear. The Veteran stated that he is unable to understand others and responds incorrectly during conversation. The June 2017 VA audiological examiner stated that the Veteran's results were inconsistent. Therefore, the examiner stated the examination is not valid for rating purposes. The November 2020 VA audiological examination found puretone thresholds in decibels as: HERTZ 1000 2000 3000 4000 Avg RIGHT 35 35 40 50 40 LEFT 35 35 45 50 41 The average puretone thresholds were 40 decibels in the right ear and 41 in the left ear. Speech audiometry revealed speech recognition ability of 96 percent in the right ear and 96 percent in the left ear. The Board finds that a compensable evaluation is not warranted for bilateral hearing loss. The December 2012 VA examination results in a Roman numeral designation Level I for the right ear and Level I for the left ear. Taken together, that is a zero percent evaluation. See 38 C.F.R. § 4.85, Table VII. The September 2014 VA examination results in a Roman numeral designation Level I for the right ear and Level I for the left ear. Taken together, that is a zero percent evaluation. Id. The November 2020 VA examination results in a Roman numeral designation Level I in the right ear and Level I in the left ear. Taken together that is a zero percent evaluation. Id. Based on the foregoing information, the Board does not find that, at any point in time during the appeal period, the Veteran's bilateral hearing loss disability warranted a compensable disability rating. Accordingly, the claim is denied. Service Connection 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, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran 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 - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially 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 addition, service connection for certain chronic diseases, including arthritis, may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Secondary service connection is warranted where a disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Briefly, the threshold legal requirements for a successful secondary service connection claim are: (1) evidence of a current disability for which secondary service connection is sought; (2) a disability for which service connection has been established; and (3) competent evidence of a nexus between the two. The Veteran has provided an alternative theory of entitlement to service connection for an adrenal gland disorder, diabetes mellitus, prostate cancer, and hypothyroidism, which is that these disorders are due to herbicide exposure and environmental chemical exposures in service. Specifically, the Veteran asserts that he was exposed to Agent Orange during service in Japan and his other posts. Also, the Veteran stated with a military occupational specialty (MOS) as an aviation ordinance technician, he was exposed to hazardous chemicals. The law provides that, if a veteran was exposed to an herbicide agent during service, certain listed diseases shall be service connected if the requirements of 38 U.S.C.§ 1116 and 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113 and 38 C.F.R. § 3.307(d) are also satisfied. The list of diseases afforded this presumption was expanded by August 2010 amendment to 38 C.F.R. § 3.309(e) to include chronic B-cell leukemias, Parkinson's disease, and ischemic heart disease. Ischemic heart disease includes, but is not limited to, "acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina." This amendment is applicable to claims received by VA on or after August 31, 2010, and to claims pending before VA on that date, as well as certain previously denied claims. See 75 Fed. Reg. 52,202 (Aug. 31, 2010). In addition to exposure within the Republic of Vietnam, exposure to Agent Orange has been noted to have occurred in various places, including Thailand. However, the Veteran's military personnel records do not demonstrate that the Veteran served in the Republic of Vietnam or Thailand. In a July 2013 correspondence, the Veteran stated his claims for exposure to various chemicals during service caused his prostate cancer, hypothyroidism, and diabetes. He stated that he was also exposed to herbicides when he was stationed in Arizona in 1969. The Veteran asserts that the mist of herbicides was coming off of the 'choppers' returning from Vietnam. He also contends that herbicide was used, transported, and stored at Camp Hansen in Okinawa and Marine Corps Air Station (MCAS) Futenma. He stated he was exposed to Trichloroethylene (TCE) at every base he was assigned to. He further stated that he cleaned the bombs, missile racks, and gun pods. He stated that when he was assigned to ammunition storage area in El Toro, there was defoliant that was sprayed along the roads. The Veteran also stated that he flew into Nam Phong in Thailand to aid one of the downed aircraft in 1970. He stated he also went to Udorn and U-Tapao to help aircraft that were not operational in 1970. He stated that there were no orders, they simply flew there and left after three days. In an August 2013 correspondence, the Veteran stated that he was possibly exposed to herbicides when stationed in Iwakuni, Japan. He stated he worked on aircraft that were in Vietnam. He stated that during this time it is possible that herbicides were in the cockpits and in the various access panels that had to be repaired. The Veteran asked this be considered in relation to his claims for prostate cancer and diabetes. In an April 2017 statement, the Veteran stated there are no orders of travel or buddy statements to show his in-service assignments to Thailand. He stated that because attempts to verify this service have been unsuccessful, he will assert that exposure to various chemicals during his service as an aviation ordinance technician caused his claimed disorders. In November 2020 correspondence, the Department of Defense (DOD) stated they have not identified any location on the island of Okinawa where Agent Orange was used, tested, stored, or transported. DOD stated that Agent Orange was developed for jungle combat operations in Vietnam and was used there from 1962 to early 1971. DOD stated there were no combat operations in Okinawa during those years and so there was no need for Agent Orange use in that locations. DOD stated Okinawa was on the Agent Orange shipping supply line, which went directly from storage at Mobile, Alabama or Gulfport, Mississippi, to South Vietnam via merchant ships. DOD stated that all evidence shows that any herbicide uses the claimant observed, or was associated with, was the commercial variety, not Agent Orange. In an August 2022 memorandum, VA stated there was no evidence located to support documentation of herbicide exposure during service in Japan or other bases served by the Veteran. In a September 2022 VA memorandum, VA stated that the Veteran's military occupation specialty (MOS) is sufficient to presume exposure to military occupational hazards, to include exposure to environmental and occupational hazards. As VA has investigated the Veteran's contentions and have conceded the Veteran's exposure to environmental and occupational hazards, the Board will consider the Veteran's chemical exposures. However, as VA found the Veteran to not have been exposed to herbicides during service in Japan or his other posts, the Board finds that presumptive service connection due to herbicide exposure does not apply to the Veteran. See 38 C.F.R. § 3.307. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert. v. Derwinski, 1 Vet. App. 49, 55 (1990). 1. Entitlement to service connection for bilateral plantar fasciitis, to include as secondary to service-connected bilateral tibial stress fracture, is denied. The Veteran asserts that he is entitled to service connection for bilateral plantar fasciitis on a secondary basis. However, as outlined below, the evidence persuasively weighs against finding that the Veteran's bilateral plantar fasciitis manifested during, within the year following, as a result of service, or was caused or aggravated by service-connected bilateral tibial stress fracture. As such, service connection cannot be established on a direct or secondary basis. In a January 2012 private treatment record, the Veteran complained of an ache in the right heel. He stated there was no injury. He stated he is on his feet all day and has gained about 20 pounds since 2010. The medical provider assessed the Veteran to have plantar fasciitis. In a March 2013 VA treatment record, the Veteran complained of chronic plantar fasciitis of the left foot that began one year ago. In the September 2013 private workers' compensation evaluation, the Veteran stated that in November 2010, he was injured at work while performing his usual duties as a district manager for a car parts retailer. He stated that while at work, he was helping a customer with a purchase when he tripped and ran into a plastic blast door that sliced his right thigh above the knee. The Veteran stated his employment required constant standing, walking, and lifting with frequent bending, kneeling, and climbing. He also stated that he, on average, lifted 40 pounds. In a September 2013 private workers' compensation evaluation, the Veteran stated that his bilateral feet symptoms were constant sharp and achy pain with burning and symptoms more severe in the right. The Veteran stated the pain is better with heat, ice, and rest. He stated the pain worsens with use. On examination, the medical provider observed the Veteran had difficulty walking. The medical provider also found tenderness over the plantar fascias. The medical provider noted the Veteran has an antalgic gait on the right. The medical provider assessed the Veteran to have plantar fasciitis. After review of the Veteran's self-reported history of injury, the Veteran's symptomatology, and findings on this examination, the medical provider opined that the Veteran's current symptoms and objective findings are a direct result of the industrial injury in November 2010. On the August 2014 VA foot examination, the examiner indicated the Veteran has a diagnosis of plantar fasciitis. The Veteran stated he has a significant history of pain to the foot. The Veteran stated that the pain is mostly located in the heel with ambulation. In an August 2014 VA medical opinion, the examiner opined that the Veteran's bilateral plantar fasciitis is less likely than not due to a service-connected disability. The examiner reasoned that the Veteran's plantar fasciitis with bone spurs cannot be proximately connected to service-connected stress fracture of the left tibia based on natural history and etiology. The examiner stated that plantar fasciitis most likely represents a separate clinical entity, making it less likely than not that it was due to the stress fracture of the left tibia. The examiner further stated that the diagnosis from the chart reads possible stress fracture, and no definitive fracture was identified via radiographs or nuclear medicine through chart review. On a June 2017 VA foot examination, the examiner indicated the Veteran has bilateral plantar fasciitis. The Veteran stated he did not experience any symptoms until 2012. The Veteran stated he has been treated with bilateral inserts, ankle braces, and a cane to assist ambulation. He stated he is limited by the pain. The June 2017 VA examiner opined that the Veteran's bilateral plantar fasciitis is less likely than not aggravated beyond its normal progression by service-connected bilateral tibial stress fracture. The examiner reasoned that there are no service treatment records during service or medical records after separation from service pertaining to the Veteran's bilateral foot disorder to be aggravated beyond normal progression due to the bilateral tibial stress fractures. The examiner stated that the Veteran's bilateral plantar fasciitis did not occur until 2012, which is 37 years after separation from service. The examiner stated that the Veteran's morbid obesity is most likely a contributing factor. The examiner stated that with medical records provided, the Veteran's bilateral plantar fasciitis has no association to be aggravated beyond a normal progression by the bilateral tibial stress fractures. On the November 2020 VA foot examination, the examiner indicated the Veteran has a diagnosis of bilateral plantar fasciitis. The Veteran stated the condition began in 2009 and he was unable to stand or walk due to pain. He stated he experiences foot pain and spasms. In a November 2020 VA medical opinion, the examiner opined that the Veteran's bilateral plantar fasciitis is less likely than not caused by service-connected right tibial stress fracture. The examiner reasoned that the medical records and physical examination show that repetitive stress associated with standing upright and weight bearing cause small tears on the plantar fascia causing its stretching leading to the inflammation and pain. The examiner stated that tibial stress fracture does not cause additional stress to the feet because gravity is directed downwards. Therefore, the examiner stated that the feet receive the same amount of force regardless of pathology on the leg. The examiner stated that all evidence considered, it is less likely than not that the Veteran's left plantar fasciitis is caused by service-connected right tibial stress fracture. On the November 2020 VA medical opinion, the examiner opined that it is less likely than not that the Veteran's right foot plantar fasciitis is caused by his service connected right tibial stress fracture. The examiner reasoned that plantar fasciitis is associated with repetitive stress from standing upright and weight bearing that causes small tears on the plantar fascia causing its stretching leading to the inflammation and pain. The examiner stated that tibial stress fractures do not cause additional stress to the feet because gravity is directed downwards. Therefore, the examiner stated that the feet receive the same amount of force regardless of a pathology on the leg. Based on the foregoing, the Board finds that there is no evidence that the Veteran's bilateral plantar fasciitis was manifested in service or to a compensable degree in the first year following his separation from service. Consequently, service connection for bilateral plantar fasciitis on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), is not warranted. Notably, the Veteran has not submitted competent evidence to show that he has suffered from bilateral plantar fasciitis continuously since service. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495-96 (1997). There is also no evidence that the Veteran's bilateral plantar fasciitis is otherwise related to service. The Veteran's post-service treatment records are silent for an opinion relating his bilateral plantar fasciitis to service. The only competent evidence in the record that addresses this question is the September 2013 private workers' compensation evaluation, which stated that the Veteran's bilateral plantar fasciitis was caused by a November 2010 industrial accident. There is also no evidence that the Veteran's bilateral plantar fasciitis is secondary to service-connected bilateral tibial stress fracture. The Veteran's post-service treatment records are silent for an opinion relating his bilateral plantar fasciitis to service-connected bilateral tibial stress fracture. The only competent evidence in the record that addresses this question are the June 2017 and November 2020 VA medical opinions, which stated that the Veteran's bilateral plantar fasciitis is not caused or aggravated by his service-connected bilateral tibial stress fracture. As there is no other evidence to the contrary, and the June 2017 and November 2020 VA medical opinions were based on a full review of the record as well as an interview and examination of the Veteran, the Board finds them persuasive. Further, the Veteran's own statements relating his bilateral plantar fasciitis to service-connected bilateral tibial stress fracture are not competent evidence, as he is a layperson and lacks the training to provide adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether bilateral plantar fasciitis is related to a service-connected disability. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court). Also, plantar fasciitis is a disease of the musculoskeletal system, and the record does not show that the Veteran has training or education in this medical field; therefore, lay evidence of the etiology is not competent nexus evidence as it is not capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno v. Brown, 6 Vet. App. 465, 469-70. Thus, the Veteran is not competent or qualified, as a layperson, to render an opinion on medical causation. In light of the foregoing, the Board concludes that the evidence persuasively weighs against the Veteran's claim of entitlement to service connection for bilateral plantar fasciitis, to include as secondary to service-connected bilateral tibial stress fracture. Accordingly, it must be denied. 2. Entitlement to service connection for left posterior tibial tendon dysfunction, to include as secondary to service-connected bilateral tibial stress fracture, is denied. 3. Entitlement to service connection for right posterior tibial tendon dysfunction, to include as secondary to service-connected bilateral tibial stress fracture, is denied. The Veteran asserts that he is entitled to service connection for bilateral posterior tibial tendon dysfunction on a secondary basis. However, as outlined below, the evidence persuasively weighs against finding that the Veteran's bilateral tibial tendon dysfunction manifested during, within the year following, as a result of active service, or was caused or aggravated by service-connected bilateral tibial stress fracture. As such, service connection cannot be established on a direct or secondary basis. In a May 2013 VA treatment record, the medical provider assessed the Veteran to have bilateral posterior tibial tendon dysfunction, with the right worse than the left. In an August 2014 VA medical opinion, the examiner opined that the Veteran's posterior tibial tendon dysfunction is less likely than not due to a service-connected disability. The examiner reasoned that the Veteran's posterior tibial tendon dysfunction cannot be proximately connected to service-connected stress fracture of the left tibia based on natural history and etiology. The examiner stated that posterior tibial tendon dysfunction most likely represents a separate clinical entity, making it less likely than not that it was due to the stress fracture of the left tibia. The examiner further stated that the diagnosis from the chart reads possible stress fracture, and no definitive fracture was identified via radiographs or nuclear medicine through chart review. On the June 2017 VA knee and leg examination, the examiner indicated the Veteran has a diagnosis of bilateral leg stress fracture. The June 2017 VA knee and leg examiner opined that the Veteran's bilateral leg stress fractures are less likely than not aggravated by the bilateral posterior tibial tendon dysfunction. The examiner reasoned that there are no medical records pertaining to his bilateral stress fractures being aggravated by bilateral posterior tibial tendon dysfunction. The examiner stated that the Veteran has osteoarthritis documented in a prior 2014 VA examination and imaging from 2017, which has caused a progression toward his bilateral stress fractures. The examiner stated that the Veteran's bilateral stress fractures were not likely caused or aggravated by bilateral posterior tibial tendon dysfunction. In a May 2018 addendum VA medical opinion, the examiner opined that the Veteran's bilateral leg posterior tibial tendon dysfunction is not aggravated beyond natural progression by service-connected bilateral stress fractures. The examiner reasoned that the June 2017 VA knee examiner indicates the Veteran's bilateral stress fractures are status post fracture and are therefore no longer active. The examiner stated that history states the stress fractures developed in 1973, which is 40 years prior to the diagnosis of bilateral posterior tibial tendon dysfunction in August 2013. The examiner found that in consideration of bilateral tibial stress fracture being no longer active and the 40 years until diagnosis of the bilateral leg posterior tibial tendon dysfunction, a nexus cannot be established between bilateral tendon dysfunction and service-connected bilateral stress fracture, and the evidence thus shows that it is less likely than not that the bilateral tibial tendon dysfunction is aggravated beyond the natural progression by service-connected bilateral stress fracture. On the November 2020 VA knee examination, the examiner remarked that the Veteran does not have a diagnosis of bilateral posterior tibial tendon dysfunction because there are no findings, signs, or symptoms to support a diagnosis. On the November 2020 VA knee medical opinion, the examiner stated there is no evidence of posterior tibial tendon dysfunction. Based on the foregoing, the Board finds that there is no evidence that the Veteran's bilateral posterior tibial tendon dysfunction was manifested in service or to a compensable degree in the first year following his separation from service. Consequently, service connection for a bilateral posterior tibial tendon dysfunction on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), is not warranted. Notably, the Veteran has not submitted competent evidence to show that he has suffered from the bilateral posterior tibial tendon dysfunction continuously since service. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495-96 (1997). There is also no evidence that the Veteran's bilateral posterior tibial tendon dysfunction is otherwise related to service. The Veteran's post-service treatment records are silent for an opinion relating his bilateral posterior tibial tendon dysfunction to service. There is also no evidence that the Veteran's bilateral posterior tibial tendon dysfunction is secondary to service-connected bilateral tibial stress fracture. The only competent evidence in the record that addresses this question is the August 2014 and May 2018 VA medical opinions, which stated that the Veteran's bilateral posterior tibial tendon dysfunction was not caused or aggravated by his service-connected bilateral tibial stress fracture. As there is no other evidence to the contrary, and the August 2014 and May 2018 VA medical opinions were based on a full review of the record as well as an interview and examination of the Veteran, the Board finds them persuasive. Further, the Veteran's own statements relating his bilateral posterior tibial tendon dysfunction to service-connected bilateral tibial stress fracture are not competent evidence, as he is a layperson and lacks the training to provide adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether a tendon dysfunction is caused or aggravated by a service-connected disability. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court). Also, tendon dysfunction is a disease of the musculoskeletal system, and the record does not show that the Veteran has training or education in this medical field; therefore, lay evidence of the etiology is not competent nexus evidence as it is not capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno v. Brown, 6 Vet. App. 465, 469-70. Thus, the Veteran is not competent or qualified, as a layperson, to render an opinion on medical causation. In light of the foregoing, the Board concludes that the evidence persuasively weighs against the Veteran's claim of entitlement to service connection for a bilateral posterior tibial tendon dysfunction, to include as secondary to service-connected bilateral tibial stress fracture. Accordingly, it must be denied. 4. Entitlement to service connection for diabetes mellitus, type II, to include as due to herbicide exposure and environmental chemicals, is denied. The Veteran asserts that he is entitled to service connection for diabetes on a direct and presumptive basis. However, as outlined below, the evidence persuasively weighs against finding that the Veteran's diabetes manifested during, within the year following, or as a result of active service, to include herbicide exposure and environmental chemical exposure. As such, service connection cannot be established on a direct or presumptive basis. As an initial matter, as previously stated, the Board has found that the Veteran was not exposed to herbicides during service in Japan or other duty stations. However, the Board concedes that due to the Veteran's MOS, he was exposed to other environmental chemicals. In an October 2016 VA treatment record, the Veteran's current active problem list shows the Veteran to have diabetes mellitus, type 2, with diabetic polyneuropathy. On the March 2018 VA medical opinion, the examiner opined that the Veteran's diabetes is less likely than not caused by service, to include as due to chemical exposure. The examiner reasoned those medical records contain no clinical evidence to connect diabetes to alleged exposure of various agents at various bases in the remote past for a span of a couple of months to one to two years, and no evidence of other chronic diseases such as prostate cancer or diabetes developing from exposure to the latter agents. The examiner further stated that current medical literature has reported that those who smoke have a 30 to 40 percent higher likelihood of developing diabetes than non-smokers. Also, the examiner stated that risk factors for diabetes include age over 40 years, lifestyle, physical activity, and weight, for which the Veteran has morbid obesity, is over 40, and has a sedentary lifestyle and lacks physical activity all of which increased his risk for developing diabetes, to include smoking. On the November 2020 VA diabetes examination, the examiner indicated the Veteran has a diagnosis of diabetes mellitus, type II, from 2007. The November 2020 VA examiner opined that it is less likely than not that the Veteran's diabetes is caused by service. The examiner reasoned that medical literature has not established a direct causation between certain chemicals and diabetes. The examiner stated that causal relationships have not been established as the studies are small and are not randomized or controlled trials, which are the gold standard for medical research. The examiner concluded that it is less likely than not that the Veteran's diabetes is incurred in or caused by exposure to industrial chemicals and solvents. In a November 2022 VA addendum medical opinion, the examiner opined that the Veteran's diabetes is less likely than not caused by service. The examiner reasoned that it is unlikely for diabetes to develop from exposure in service that happened more than 30 years prior. However, the examiner stated that diabetes can be related to later changes related to lifestyle, type and amount of food consumed, genetics, or autoimmune theories. Specifically, the examiner noted that the Veteran's father and siblings have a history of autoimmune diseases in the family. Based on the foregoing, there is no evidence that the Veteran's diabetes was manifested in service or to a compensable degree in the first year following his separation from service. Consequently, service connection for diabetes on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), is not warranted. Notably, the Veteran has not submitted competent evidence to show that he has suffered from diabetes continuously since service. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495-96 (1997). There is also no evidence that the Veteran's diabetes is otherwise related to service. The Veteran's post-service treatment records are silent for an opinion relating his diabetes to service. The only competent evidence in the record that addresses this question is the March 2018, November 2020, and November 2022 VA medical opinions, which stated that the Veteran's diabetes was not related to his service, to include environmental chemical exposure. As there is no other evidence to the contrary, and the March 2018, November 2020, and November 2022 VA medical opinions were all based on a full review of the record as well as an interview and examination of the Veteran, the Board finds them persuasive. Further, the Veteran's own statements relating his diabetes to service are not competent evidence, as he is a layperson and lacks the training to provide adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether diabetes, in the absence of credible evidence of continuity, as here, is related to environmental chemical exposure in service. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court). Also, diabetes is a disease of the endocrine system, and the record does not show that the Veteran has training or education in this medical field; therefore, lay evidence of the etiology is not competent nexus evidence as it is not capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno v. Brown, 6 Vet. App. 465, 469-70. Thus, the Veteran is not competent or qualified, as a layperson, to render an opinion on medical causation. In light of the foregoing, the Board concludes that the evidence persuasively weighs against the Veteran's claim of entitlement to service connection for diabetes mellitus, type II. Accordingly, it must be denied. 5. Entitlement to service connection for prostate cancer, to include as due to herbicide exposure and environmental chemical exposure, is denied. The Veteran asserts that he is entitled to service connection for prostate cancer on a direct and presumptive basis. However, as outlined below, the evidence persuasively weighs against finding that the Veteran's prostate cancer manifested during, within the year following, or as a result of active service, to include herbicide exposure and environmental chemical exposure. As such, service connection cannot be established on a direct or presumptive basis. As an initial matter, as previously stated, the Board has found that the Veteran was not exposed to herbicides during service in Japan or other duty stations. However, the Board concedes that due to the Veteran's MOS, he was exposed to environmental chemicals. In a November 2004 private treatment record, the medical provider indicated the Veteran has prostate cancer. In an August 2014 VA treatment record, the Veteran is diagnosed with prostate cancer. In an October 2016 VA treatment record, the medical provider stated the Veteran has recurrence of prostate cancer since October 2014 with increasing prostate-specific antigen (PSA). In a March 2018 VA medical opinion, the examiner opined that the Veteran's prostate cancer is less likely than not caused by service. The examiner reasoned that the medical records contain no clinical evidence to connect prostate cancer to alleged exposure to various agents at various bases in the remote past for a span of a couple of months to one to two years and there is no evidence of other personal suffering from chronic diseases such as prostate cancer or diabetes from exposure to chemical agents. The examiner stated that the Veteran is one of many ordinance techs in the military and there are simply no studies of any such exposure by ordinance techs that have resulted in chronic disease to date. The examiner stated that the Veteran has an extensive smoking history of 45 pack-years of tobacco smoking as recorded by private treatment records that is a well-known risk factor for various cancers such as aggressive prostate cancer, for which the Veteran is currently being treated. On the November 2020 VA prostate cancer examination, the examiner indicated the Veteran has a diagnosis of prostate cancer from 2003. The Veteran stated the condition started in 2003. The Veteran stated his current symptoms are erectile dysfunction and neurogenic bladder. He stated he has prescribed injections every six months. On the November 2020 VA medical opinion, the examiner opined that the Veteran's prostate cancer is less likely than not caused by service. The examiner reasoned that there are studies regarding prostate cancer that show that prostate cancer is due to age, family history, and ancestry. The examiner noted that the Veteran's mother has uterine cancer. The examiner stated that several studies have been done to identify environmental or industrial causes for prostate cancer, however, the studies only found limited suggestive evidence. The examiner concluded that it is less likely than not that the Veteran's prostate cancer was incurred in or caused by service, to include exposure to industrial chemicals and solvents. In a December 2021 report of general information, the Veteran stated that he stopped smoking in 1976. On the November 2022 VA addendum medical opinion, the examiner opined that it is less likely than not that the Veteran's prostate cancer is caused by service. The examiner reasoned that there are no STRs found that noted prostate condition or cancer. The examiner stated that the earliest record of prostate cancer in in July 2011 with radiation completed in 2004. The examiner stated that it is unlikely for prostate cancer to develop from unknown exposure in service that happened more than 30 years prior. Based on the foregoing, there is no evidence that the Veteran's prostate cancer was manifested in service or to a compensable degree in the first year following his separation from service. Consequently, service connection for prostate cancer on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), is not warranted. Notably, the Veteran has not submitted competent evidence to show that he has suffered from prostate cancer continuously since service. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495-96 (1997). There is also no evidence that the Veteran's prostate cancer is otherwise related to service. The Veteran's post-service treatment records are silent for an opinion relating his prostate cancer to service. The only competent evidence in the record that addresses this question is the November 2020 and November 2022 VA medical opinions, which stated that the Veteran's prostate cancer was not related to his service, to include environmental chemical exposure. As there is no other evidence to the contrary, and the November 2020 and November 2022 VA medical opinions were based on a full review of the record as well as an interview and examination of the Veteran, the Board finds them persuasive. Further, the Veteran's own statements relating his prostate cancer to service are not competent evidence, as he is a layperson and lacks the training to provide adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether prostate cancer, in the absence of credible evidence of continuity, as here, is related to environmental chemical exposure in service. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court). Also, prostate cancer is a disease of the male reproductive system, and the record does not show that the Veteran has training or education in this medical field; therefore, lay evidence of the etiology is not competent nexus evidence as it is not capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno v. Brown, 6 Vet. App. 465, 469-70. Thus, the Veteran is not competent or qualified, as a layperson, to render an opinion on medical causation. In light of the foregoing, the Board concludes that the evidence persuasively weighs against the Veteran's claim of entitlement to service connection for prostate cancer. Accordingly, it must be denied. 6. Entitlement to service connection for glaucoma is denied. 7. Entitlement to service connection for cataracts is denied. The Veteran asserts that he has glaucoma and cataracts. The question for the Board is whether the Veteran has a current disability that began during service, is at least as likely as not related to an in-service injury, event, or disease, or is caused or aggravated by a service-connected disability. The Board concludes that the Veteran does not have a current diagnosis of glaucoma or cataracts and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The STRs and post-service treatment records are silent for complaint, treatment, or diagnosis of glaucoma or cataracts. While the Veteran believes he has a current diagnosis of glaucoma and cataracts, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). Evidence must show that the Veteran currently has glaucoma or cataracts, or any eye disorder for which benefits are being claimed. Because the evidence simply does not establish that the Veteran has glaucoma, cataracts, or any other eye disability, either in-service or post-service, the Board finds that the Veteran is not entitled to service connection for glaucoma or cataracts. The claims must be denied. 8. Entitlement to service connection for allergic rhinitis is granted. The Veteran asserts that his allergic rhinitis began in service. The Board concludes that the Veteran has a current diagnosis of allergic rhinitis that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). In the November 1967 STR report of medical history, the Veteran indicated he had or has had hay fever. On the November 1967 STR enlistment examination, the medical provider found the Veteran's sinus to be normal and did not make a finding of any pre-existing hay fever. On the October 1970 STR report of medical history, the Veteran reported that he experienced hay fever. On the September 1973 STR report of medical history, the Veteran indicated he has or has had hay fever. The Veteran indicated he was unsure if he had sinusitis. In an October 2013 VA treatment record, the medical provider assessed the Veteran's allergic rhinitis to not be optimally controlled and prescribed medication for better control of the Veteran's persistent symptoms. In an August 2015 VA treatment record, the medical provider assessed the Veteran to have allergic rhinitis that is stable, and the Veteran is to continue the prescribed medication. On the June 2017 VA sinusitis examination, the examiner indicated the Veteran has a diagnosis of allergic rhinitis. The Veteran stated he has experienced recurrent nasal congestion since service after 1970. He stated the symptoms have continued and are worse in the spring. He stated he has used over the counter mediation to treat the allergic rhinitis. The June 2017 examiner opined that it is less likely than not that the Veteran's allergic rhinitis is caused by service. The examiner reasoned that after review of the claims file, there were no service treatment records during service or post-service treatment records regarding allergic rhinitis to be aggravated or otherwise etiologically related to military service The examiner stated there is one medical record from 2011 that shows the Veteran to have no nasal drainage. The examiner stated that the Veteran's allergic rhinitis is an acute condition that occasionally occurs during certain seasons after his military service. The examiner stated that with review of the medical records provided, the Veteran's allergic rhinitis has no association to be aggravated or etiologically related to his military service. In a December 2017 correspondence, the Veteran stated that in October 1970 and September 1973, he reported that he experienced hay fever. On the November 2020 VA sinusitis examination, the examiner indicated the Veteran has a diagnosis of allergic rhinitis. The Veteran stated the condition started in 1967. The Veteran stated he had occasional seasonal bouts with "hay fever" prior to enlistment after recruit training and after aviation ordinance school. He stated the condition begins with symptoms of a runny nose and clear discharge. The Veteran stated he currently experiences stuffy nose, sinus buildup, and headaches. The Veteran stated he uses medication daily. On the November 2020 VA medical opinion, the examiner opined that it is less likely than not that the Veteran's allergic rhinitis arose during service or is otherwise related to service. The examiner reasoned that allergic rhinitis is the medical term for hay fever. The examiner stated that the records show that during the Veteran's enlistment examination, he admitted to having hay fever. The examiner stated that the Veteran continued to report that he has hay fever. The examiner stated that allergic rhinitis is an intermittent and chronic condition that exacerbates when exposed to known allergens. The examiner stated that the remainder of the available medical records are limited in providing objective evidence that the conditions manifested unusually. Upon review of the record, the Board finds that the most probative evidence of record establishes that the Veteran's allergic rhinitis is related to his active service. The Veteran's STRs reveal that he experienced hay fever during service. Also, the Veteran stated that he experienced hay fever during service, and he continues to use medication daily. Further, the November 2020 VA examiner clarified that allergic rhinitis is the medical term for hay fever. The Board notes that the Veteran stated he experienced hay fever prior to service, however, as it was not noted on the enlistment examination, the Board finds that the Veteran's hay fever did not pre-exist service. See 38 U.S.C. § 1111. Therefore, the Veteran was in sound condition when examiner, accepted, and enrolled for service. Id. The Board finds that the Veteran, as a lay person, is competent to assert experiencing symptoms of hay fever during service. See Layno v. Brown, 6 Vet. App. at 470. Moreover, there is no evidence to doubt the Veteran's credibility. The STRs, Veteran's statements, and explanations by the November 2020 VA examiner regarding symptoms of hay fever while in service are consistent. The Veteran's statements also reflect a continuity of symptomatology of allergic rhinitis, as the records reflect the Veteran experienced hay fever during service and continues to take medication for the ame symptoms, currently diagnosed as allergic rhinitis, from that time to the present. Accordingly, the Board assigns great probative weight to the Veteran's statements regarding the persistence of his allergic rhinitis. 38 C.F.R. § 3.303(b). Although the November 2020 VA examination confirmed a current diagnosis of allergic rhinitis, the examiner found that the Veteran's allergic rhinitis was less likely than not related to service. There is no evidence to doubt the examiner's credibility. Nonetheless, the examiner provided an opinion that is contradictory, as the opinion states that the Veteran experienced allergic rhinitis during service, but there is no evidence that it manifested unusually. Unfortunately, this opinion and reasoning are inadequate as the examiner did not provide clarity on the etiology of the Veteran's hay fever. Therefore, the Board finds the November 2020 VA opinion to be inadequate with respect to the question of nexus. Accordingly, the Board assigns less probative weight to the opinion. As such, based on the most persuasive evidence of record, the Board finds that the Veteran's allergic rhinitis is related to active service. Therefore, service connection for allergic rhinitis is warranted. 9. Entitlement to service connection for an adrenal gland abnormality, to include as secondary to prostate cancer, is denied. The Veteran asserts that he has an adrenal gland abnormality. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of an adrenal gland abnormality and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). In a July 2003 private diagnostic imaging report, the report stated the Veteran's adrenal glands are unremarkable. In a June 2014 VA treatment record, imaging revealed a non-enlarged left adrenal gland that displays minimally lobulated contours, likely benign, and an unremarkable right adrenal gland. In a July 2014 statement, the Veteran stated that June 2014 imaging showed him to have an abnormality on his adrenal glands. In an October 2016 VA treatment record, imaging showed minimal non-specific prominence of the left adrenal gland is unchanged. While the Veteran believes he has a current diagnosis of an adrenal gland disorder, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Post-service treatment records show the Veteran's adrenal glands to be unremarkable and unchanged. Consequently, the Board gives more probative weight to the competent medical evidence. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). Evidence must show that the Veteran currently has an adrenal gland abnormality, for which benefits are being claimed. Because the evidence does not establish that the Veteran has an adrenal gland abnormality, either in-service or post-service, the Board finds that the Veteran is not entitled to service connection for an adrenal gland abnormality. The claim must be denied. 10. Entitlement to service connection for right upper extremity neuropathy, to include as secondary to service-connected right wrist ganglion cyst and nonservice-connected diabetes mellitus, type II, is denied. 11. Entitlement to service connection for left upper extremity neuropathy, to include as secondary service-connected right wrist ganglion cyst and nonservice-connected diabetes mellitus, type II, is denied. The Veteran asserts that he is entitled to service connection for bilateral upper extremity neuropathy on a direct and secondary basis. However, as outlined below, the evidence persuasively weighs against finding that the Veteran's bilateral upper extremity neuropathy manifested during, within the year following, as a result of active service, or was caused or aggravated by service-connected disability. As such, service connection cannot be established on a direct or secondary basis. In an April 2009 private treatment record, the Veteran complained of a right thumb ache with no injury. In a July 2011 VA treatment record, the Veteran stated his right wrist ganglion cyst has progressed into carpal tunnel. He stated that he has pain in the wrist that goes into the thumb. In an October 2011 VA treatment record, the Veteran requested a brace for his right ganglion cyst with carpal tunnel. On the December 2012 VA peripheral nerve examination, the examiner indicated the Veteran has a diagnosis of right wrist carpal tunnel syndrome. The Veteran stated that this condition began with symptoms of hand spasms with flexion, pain, and loss of grip impacting the thumb at the first joint. The Veteran stated the condition has worsened since 2000. In a December 2012 VA medical opinion, the examiner opined that the Veteran's carpal tunnel is less likely than not caused by service-connected right wrist ganglion cyst. The examiner reasoned that there is no way that the ganglion cyst located on the right wrist dorsal aspect can cause median nerve compression which is located in the volar aspect of the right wrist. On the March 2013 notice of disagreement (NOD), the Veteran stated that his carpal tunnel is a result of an injury in service and service-connected right wrist ganglion cyst. In an October 2016 VA treatment record, the Veteran's current active problem list shows the Veteran to have diabetes mellitus, type 2, with diabetic polyneuropathy. On the November 2020 VA diabetes examination, the examiner remarked that the Veteran's peripheral nerves were normal. On the November 2020 VA peripheral nerves examination, the examiner indicated the Veteran has a diagnosis of bilateral carpal tunnel syndrome. The Veteran stated that he is not sure of how the condition began. He stated he started experiencing a tingling in his hands and feet. He then stated he began to have intermittent loss of feeling (numbness) and alternating spasms in the arms and legs. The November 2020 VA peripheral nerve examiner opined that the Veteran's right hand carpal tunnel disorder is not caused by service. The examiner reasoned that an April 1971 STR shows the Veteran experienced right arm strain after lifting weights. The examiner stated that this is a muscle sprain on the forearm that appears to have resolved uneventfully as there were no subsequent complaints regarding it. The examiner stated that the current right hand carpal tunnel syndrome is not known to result from a forearm muscle strain. The examiner explained that carpal tunnel syndrome is due to impingement of the median nerve. On the November 2020 VA medical opinion, the examiner opined that the Veteran's right-hand condition is less likely than not caused by service-connected disability. The examiner stated that the Veteran's peripheral conditions are consistent with bilateral carpal tunnel syndrome and diabetic peripheral neuropathy of the bilateral feet. The examiner noted that a July 1972 STR shows that the Veteran was considered to have a ganglion cyst on the right wrist. The examiner stated that carpal tunnel syndrome is not known to result from a ganglion cyst. The examiner stated that carpal tunnel syndrome is due to impingement of the median nerve. The examiner stated there is no other diagnosis for the right arm upper extremity. Therefore, the examiner opines that it is less likely than not that the Veteran's current right-hand condition arose during service or is otherwise related to service. On the November 2020 VA medical opinion, the examiner opined that the Veteran's left-hand carpal tunnel is less likely than not caused by service. The examiner reasoned that an April 1971 STR shows that the Veteran experienced right arm strain after lifting weights. The examiner stated that this is a muscle sprain on the forearm and appears to have resolved uneventfully as there were no subsequent complaints regarding it. The examiner stated there are no complaints regarding the left arm in service. The examiner stated that the current left hand carpal tunnel syndrome is not known to result of a forearm strain. The examiner stated carpal tunnel syndrome is due to impingement of the median nerve. Therefore, the examiner concluded that it is less likely than not that the Veteran's left-hand condition arose during service or is otherwise related to service. On the November 2020 VA peripheral nerve medical opinion, the examiner opined that the Veteran's left-hand disorder is less likely than not caused by service or is otherwise related to service. The examiner stated that upon review of the medical records and physical examination, the Veteran's peripheral conditions are consistent with bilateral carpal tunnel syndrome and diabetic peripheral neuropathy of the bilateral feet. The examiner stated that a July 1972 STR shows the Veteran was considered to have a ganglion cyst on the right wrist. The examiner stated that the current left-hand carpal tunnel syndrome is not known to result from a right-sided ganglion cyst. The examiner stated that carpal tunnel syndrome is due to the impingement of the median nerve. The examiner stated there are no other diagnosis of the left arm upper extremity. On another November 2020 VA peripheral nerve medical opinion, the examiner opined that the Veteran's right-hand disorder is less likely than not aggravated beyond its natural progression by service-connected right wrist ganglion cyst. The examiner reasoned that the Veteran's peripheral conditions are consistent with bilateral carpal tunnel syndrome and diabetic peripheral neuropathy of the bilateral feet. The examiner stated that a July 1972 STR shows the Veteran was considered to have a ganglion cyst on the right wrist. The examiner stated that the current right hand carpal tunnel syndrome is not known to result from a ganglion cyst. The examiner stated that a ganglion cyst does not aggravate or increase the symptoms of carpal tunnel syndrome. The examiner stated that carpal tunnel syndrome is due to impingement of the median nerve. The examiner stated there are no other diagnosis noted for the right arm upper extremity. The November 2020 VA examiner opined that it is less likely than not that the Veteran's left hand carpal tunnel syndrome is aggravated beyond its natural progression by service-connected right wrist ganglion cyst. The examiner reasoned that the Veteran's left hand carpal tunnel syndrome is not known to result from a right sided ganglion cyst. The examiner stated that a ganglion cyst does not aggravate or increase the symptoms of carpal tunnel syndrome. The examiner explained that carpal tunnel syndrome is due to the impingement of the median nerve. Based on the foregoing, the Board finds that there is no evidence that the Veteran's bilateral carpal tunnel syndrome was manifested in service or to a compensable degree in the first year following his separation from service. Consequently, service connection for bilateral carpal tunnel syndrome on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), is not warranted. Notably, the Veteran has not submitted competent evidence to show that he has suffered from carpal tunnel syndrome continuously since service. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495-96 (1997). There is also no evidence that the Veteran's bilateral carpal tunnel syndrome is otherwise related to service. The Veteran's post-service treatment records are silent for an opinion relating his bilateral carpal tunnel syndrome to service. The only competent evidence in the record that addresses this question is the November 2020 VA medical opinion, which stated that the Veteran's bilateral carpal tunnel syndrome is not related to his service. As there is no other evidence to the contrary, and the November 2020 VA medical opinion was based on a full review of the record as well as an interview and examination of the Veteran, the Board finds it persuasive. There is also no evidence that the Veteran's bilateral carpal tunnel syndrome is caused or aggravated by service-connected right wrist ganglion cyst. The Veteran's post-service treatment records are silent for an opinion relating his bilateral carpal tunnel syndrome to a service-connected disability. The only competent evidence in the record that addresses this question is the November 2020 VA medical opinion, which stated that the Veteran's bilateral carpal tunnel syndrome is not caused or aggravated by service-connected right wrist ganglion cyst. As there is no other evidence to the contrary, and the November 2020 VA medical opinion was based on a full review of the record as well as an interview and examination of the Veteran, the Board finds it persuasive. Further, the Veteran's own statements relating his bilateral carpal tunnel syndrome to service, or a service-connected disability, are not competent evidence, as he is a layperson and lacks the training to provide adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether carpal tunnel syndrome, in the absence of credible evidence of continuity, as here, is related to an incident in service or a service-connected disability. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court). Also, carpal tunnel syndrome is a disease of the peripheral nervous system and the musculoskeletal system, and the record does not show that the Veteran has training or education in these medical fields; therefore, lay evidence of the etiology is not competent nexus evidence as it is not capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno v. Brown, 6 Vet. App. 465, 469-70. Thus, the Veteran is not competent or qualified, as a layperson, to render an opinion on medical causation. In light of the foregoing, the Board concludes that the evidence persuasively weighs against the Veteran's claim of entitlement to service connection for right and left wrist carpal tunnel syndrome. Accordingly, it must be denied. 12. Entitlement to service connection for right lower extremity neuropathy, to include as secondary to non-service-connected diabetes mellitus, type II, is denied. 13. Entitlement to service connection for left lower extremity neuropathy, to include as secondary to nonservice-connected diabetes mellitus, type II, is denied. The Veteran asserts that he is entitled to service connection for bilateral lower extremity neuropathy on a secondary basis. However, as outlined below, the evidence persuasively weighs against finding that the Veteran's bilateral lower extremity neuropathy manifested during, within the year following, as a result of active service, or was caused or aggravated by a service-connected disability. As such, service connection cannot be established on a direct or secondary basis. The Veteran's STRs are silent for any complaint, treatment, or diagnosis of bilateral lower extremity neuropathy. In an October 2016 VA treatment record, the Veteran's current active problem list shows the Veteran to have diabetes mellitus, type II, with diabetic polyneuropathy. On the November 2020 VA diabetes examination, the examiner remarked that the Veteran's peripheral nerves were normal. On the November 2020 VA diabetes peripheral neuropathy examination, the examiner indicated the Veteran has a diagnosis of peripheral neuropathy of the bilateral feet. The Veteran stated he began to have tingling in the hands and feet. He stated he then began to have loss of feeling (numbness) and alternating spasms in the arms and legs. Based on the foregoing, there is no evidence that the Veteran's bilateral lower extremity neuropathy was manifested in service or to a compensable degree in the first year following his separation from service. Consequently, service connection for bilateral lower extremity peripheral neuropathy on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), is not warranted. Notably, the Veteran has not submitted competent evidence to show that he has suffered from bilateral lower extremity peripheral neuropathy continuously since service. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495-96 (1997). There is also no evidence that the Veteran's bilateral lower extremity peripheral neuropathy is otherwise related to service. The Veteran's post-service treatment records are silent for an opinion relating his bilateral lower extremity peripheral neuropathy to service. There is also no evidence that the Veteran's bilateral lower extremity peripheral neuropathy is caused or aggravated by any service-connected disability. The Veteran's post-service treatment records are silent for an opinion demonstrating that the Veteran's bilateral lower extremity peripheral neuropathy is related to any service-connected disabilities. The only competent evidence in the record that addresses bilateral lower extremity peripheral neuropathy and its relationship to any of the Veteran's diagnosed disorders is the October 2016 VA treatment record, which indicated the Veteran has a diagnosis of diabetic polyneuropathy, and the November 2020 VA diabetes examination finding that the Veteran has bilateral lower extremity peripheral neuropathy. Unfortunately, as outlined above, the Board has found that service connection for diabetes mellitus, type II, is not warranted. Therefore, the secondary service connection for bilateral lower extremity neuropathy is not warranted. Further, the Veteran's own statements relating his bilateral lower extremity neuropathy to service or a service-connected disability are not competent evidence, as he is a layperson and lacks the training to provide adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether peripheral neuropathy is related to a service-connected disability. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court). Also, peripheral neuropathy is a disease of the peripheral nervous system, and the record does not show that the Veteran has training or education in this medical field; therefore, lay evidence of the etiology is not competent nexus evidence as it is not capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno v. Brown, 6 Vet. App. 465, 469-70. Thus, the Veteran is not competent or qualified, as a layperson, to render an opinion on medical causation. In light of the foregoing, the Board concludes that the evidence persuasively weighs against the Veteran's claim of entitlement to service connection for bilateral lower extremity neuropathy, to include as secondary to a service-connected disability. Accordingly, it must be denied. 14. Entitlement to service connection for a lesion on the spleen, to include as secondary to prostate cancer, is denied. The Veteran asserts that he is entitled to service connection for a lesion on the spleen on a secondary basis. However, as outline below, the evidence persuasively weighs against finding that the Veteran's lesion on the spleen manifested during, within the year following, as a result of active service, or was caused or aggravated by a service-connected disability. As such, service connection cannot be established on a direct or secondary basis. The STRs are silent for any imaging, findings, or diagnosis of a lesion on the spleen. In a July 2003 private diagnostic imaging report, the report stated the Veteran's spleen is normal. In a June 2014 VA treatment record, imaging of the pelvis revealed a low-attenuation lesion on the spleen that is probably a cyst. In a July 2014 statement, the Veteran stated that June 2014 imaging showed a lesion on the spleen. In a February 2017 VA treatment record, imaging showed stable cyst or hemangioma at the spleen. Based on the foregoing, there is no evidence that the Veteran's lesion on the spleen was manifested in service or to a compensable degree in the first year following his separation from service. Consequently, service connection for a lesion on the spleen on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), is not warranted. Notably, the Veteran has not submitted competent evidence to show that he has suffered from the lesion on the spleen continuously since service. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495-96 (1997). There is also no evidence that the Veteran's lesion on the spleen is otherwise related to service. The Veteran's post-service treatment records are silent for an opinion relating his lesion on the spleen to service. There is also no evidence that the Veteran's lesion on the spleen is caused or aggravated by any service-connected disability. The Veteran's post-service treatment records are silent for an opinion relating the lesion on the spleen to any service-connected disability. The Board acknowledges that the Veteran contends the lesion on the spleen is caused or aggravated by his diagnosed prostate cancer. However, as outlined above, the Veteran is not entitled to service connection for prostate cancer. Further, the Veteran's own statements relating his lesion on the spleen to service or a service-connected disability are not competent evidence, as he is a layperson and lacks the training to provide adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether a lesion on the spleen is caused or aggravated by a service-connected disability. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court). Also, a lesion on the spleen is a disease of the lymphatic system, and the record does not show that the Veteran has training or education in this medical field; therefore, lay evidence of the etiology is not competent nexus evidence as it is not capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno v. Brown, 6 Vet. App. 465, 469-70. Thus, the Veteran is not competent or qualified, as a layperson, to render an opinion on medical causation. In light of the foregoing, the Board concludes that the evidence persuasively weighs against the Veteran's claim of entitlement to service connection for a lesion on the spleen. Accordingly, it must be denied. 15. Entitlement to service connection for urinary incontinence, to include as secondary to prostate cancer, is denied. The Veteran asserts that he is entitled to service connection for urinary incontinence on a secondary basis. However, as outlined below, the evidence persuasively weighs against finding that the Veteran's urinary incontinence manifested during, within the year following, as a result of active service, or was caused or aggravated by a service-connected disability. As such, service connection cannot be established on a direct or secondary basis. The STRs are silent for any complaints, treatment, or diagnosis of urinary incontinence. In a June 2014 VA treatment record, The Veteran stated he has been leaking urine since February 2014. The medical provider assessed the Veteran to have incontinence. In a July 2014 statement, the Veteran stated that he has experienced urinary incontinence since February 2014. In a May 2016 VA treatment record, the medical provider assessed the Veteran to have urinary incontinence post treatment for prostate cancer. In an October 2016 VA treatment record, the medical provider stated the Veteran has total incontinence. In a February 2017 VA treatment record, the medical provider stated the Veteran has total incontinence. In a July 2020 VA treatment record, the medical provider stated the Veteran still has urinary incontinence. Based on the foregoing, there is no evidence that the Veteran's urinary incontinence was manifested in service or to a compensable degree in the first year following his separation from service. Consequently, service connection for urinary incontinence on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), is not warranted. Notably, the Veteran has not submitted competent evidence to show that he has suffered from the urinary incontinence continuously since service. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495-96 (1997). There is also no evidence that the Veteran's urinary incontinence is otherwise related to service. The Veteran's post-service treatment records are silent for an opinion relating his urinary incontinence to service. There is also no evidence that the Veteran's urinary incontinence is caused or aggravated by any service-connected disability. The Veteran's post-service treatment records are silent for an opinion relating the urinary incontinence to any service-connected disability. The Board acknowledges that the Veteran contends that the urinary incontinence is caused or aggravated by his diagnosed prostate cancer. However, as outlined above, the Veteran is not entitled to service connection for prostate cancer. Further, the Veteran's own statements relating his urinary incontinence to a service-connected disability are not competent evidence, as he is a layperson and lacks the training to provide adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether urinary incontinence is caused or aggravated by a service-connected disability. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court). Also, urinary incontinence is a disease of the urinary tract, and the record does not show that the Veteran has training or education in this medical field; therefore, lay evidence of the etiology is not competent nexus evidence as it is not capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno v. Brown, 6 Vet. App. 465, 469-70. Thus, the Veteran is not competent or qualified, as a layperson, to render an opinion on medical causation. In light of the foregoing, the Board concludes that the evidence persuasively weighs against the Veteran's claim of entitlement to service connection for urinary incontinence. Accordingly, it must be denied. 16. Entitlement to service connection for a cyst on the right kidney, to include as secondary to nonservice-connected prostate cancer, is denied. The Veteran asserts that he is entitled to service connection for a cyst on the right kidney on a secondary basis. However, as outlined below, the evidence persuasively weighs against finding that the Veteran's cyst on the right kidney manifested during, within the year following, as a result of active service, or was caused or aggravated by a service-connected disability. As such, service connection cannot be established on a direct or secondary basis. The STRs are silent for any imaging, treatment, or diagnosis of a cyst on the right kidney. In a July 2003 private diagnostic imaging report, the report stated that a tiny subcentimeter nonspecific low-density lesion is seen on the right kidney, otherwise, Veteran's kidneys are unremarkable. In a June 2014 VA treatment record, imaging of the pelvis revealed a cyst in the right kidney. In a July 2014 statement, the Veteran stated that a June 2014 scan showed him to have a cyst on his right kidney. In an October 2016 VA treatment record, imaging revealed two cysts on the right kidney. In a February 2017 VA treatment record, imaging revealed possible cysts in the kidney. In a July 2020 VA treatment record, the Veteran stated the previous lesions of the right kidney have healed. Based on the foregoing, the Board finds that there is no evidence that the Veteran's cyst on the right kidney was manifested in service or to a compensable degree in the first year following his separation from service. Consequently, service connection for a cyst on the right kidney on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), is not warranted. Notably, the Veteran has not submitted competent evidence to show that he has suffered from the cyst on the right kidney continuously since service. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495-96 (1997). There is also no evidence that the Veteran's cyst on the right kidney is otherwise related to service. The Veteran's post-service treatment records are silent for an opinion relating his cyst on the right kidney to service. There is also no evidence that the Veteran's cyst on the right kidney is caused or aggravated by any service-connected disability. The Veteran's post-service treatment records are silent for an opinion relating the cyst on the right kidney to any service-connected disability. The Board acknowledges that the Veteran contends that the cyst on the right kidney is caused or aggravated by his diagnosed prostate cancer. However, as outlined above, the Veteran is not entitled to service connection for prostate cancer. Further, the Veteran's own statements relating his cyst on the right kidney to a service-connected disability are not competent evidence, as he is a layperson and lacks the training to provide adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether a cyst on the right kidney is caused or aggravated by a service-connected disability. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court). Also, cyst on the right kidney is a disease of the renal system, and the record does not show that the Veteran has training or education in this medical field; therefore, lay evidence of the etiology is not competent nexus evidence as it is not capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno v. Brown, 6 Vet. App. 465, 469-70. Thus, the Veteran is not competent or qualified, as a layperson, to render an opinion on medical causation. In light of the foregoing, the Board concludes that the evidence persuasively weighs against the Veteran's claim of entitlement to service connection for a cyst on the right kidney. Accordingly, it must be denied. 17. Entitlement to service connection for erectile dysfunction (ED), to include as secondary to nonservice-connected diabetes mellitus, type II, and prostate cancer, is denied. The Veteran asserts that he is entitled to service connection for ED on a secondary basis. However, as outline below, the evidence persuasively weighs against finding that the Veteran's ED manifested during, within the year following, as a result of active service, or was caused or aggravated by a service-connected disability. As such, service connection cannot be established on a direct or secondary basis. The STRs are silent for any complaints, treatment, or diagnosis of ED. The Veteran's VA treatment records show a diagnosis of ED. In a March 2013 correspondence, the Veteran stated that he has experienced sexual dysfunction from treatment for prostate cancer and use of prescribed medication and from the effects of PTSD. He stated he has experienced ED for over 20 years. In a June 2014 VA treatment record, the Veteran stated he has erectile dysfunction. Based on the foregoing, the Board finds that there is no evidence that the Veteran's ED was manifested in service or to a compensable degree in the first year following his separation from service. Consequently, service connection for ED on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), is not warranted. Notably, the Veteran has not submitted competent evidence to show that he has suffered from ED continuously since service. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495-96 (1997). There is also no evidence that the Veteran's ED is otherwise related to service. The Veteran's post-service treatment records are silent for an opinion relating his ED to service. There is also no evidence that the Veteran's ED is caused or aggravated by any service-connected disability. The Veteran's post-service treatment records are silent for an opinion demonstrating that the Veteran's ED is related to any service-connected disabilities. The only competent evidence in the record that addresses ED to any of the Veteran's diagnosed disorders is the March 2013 statement from the Veteran stating he has ED caused by prostate cancer. Unfortunately, as outline above, service connection for diabetes mellitus, type II, and prostate cancer is not warranted. Therefore, the secondary service connection for ED is not warranted. Further, the Veteran's own statements relating his ED to a service-connected disability are not competent evidence, as he is a layperson and lacks the training to provide adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether ED is related to a service-connected disability. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court). Also, ED is a disease of the male reproductive system, and the record does not show that the Veteran has training or education in this medical field; therefore, lay evidence of the etiology is not competent nexus evidence as it is not capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno v. Brown, 6 Vet. App. 465, 469-70. Thus, the Veteran is not competent or qualified, as a layperson, to render an opinion on medical causation. In light of the foregoing, the Board concludes that the evidence persuasively weighs against the Veteran's claim of entitlement to service connection for ED, to include as secondary to a service-connected disability. Accordingly, it must be denied. 18. Entitlement to service connection for left leg periarticular osteopenia, to include as secondary to service-connected bilateral tibial stress fracture, is denied. The Veteran asserts that he is entitled to service connection for left leg periarticular osteopenia on a secondary basis. However, as outlined below, the evidence persuasively weighs against finding that the Veteran's left leg periarticular osteopenia manifested during, within the year following, as a result of service, or was caused or aggravated by service-connected bilateral tibial stress fracture. As such, service connection cannot be established on a direct or secondary basis. On the June 2009 VA examination, the diagnostic tests showed the Veteran to have left periarticular osteopenia. In an August 2014 VA medical opinion, the examiner opined that the Veteran's left leg periarticular osteopenia is less likely than not due to a service-connected disability. The examiner reasoned that the Veteran's left leg periarticular osteopenia cannot be proximately connected to service-connected stress fracture of the left tibia based on natural history and etiology. The examiner stated that left leg periarticular osteopenia most likely represents a separate clinical entity, making it less likely than not that it was due to the stress fracture of the left tibia. The examiner further stated that the diagnosis from the chart reads possible stress fracture, and no definitive fracture was identified via radiographs or nuclear medicine through chart review. The June 2017 VA examiner opined that it is less likely than not that the Veteran's bilateral stress fractures are aggravated by the left periarticular osteopenia. The examiner reasoned that there are no service treatment records during service or medical records after separation from service pertaining to his bilateral stress fractures to be aggravated by the left periarticular osteopenia. The examiner stated that based on examination, there were only objective findings of the Veteran's bilateral stress fractures and degenerative joint disease (DJD). The examiner stated that the Veteran's bilateral stress fractures have no association to be aggravated by left periarticular osteopenia. On the May 2018 addendum medical opinion, the examiner opined that it is less likely than not that the Veteran's left leg periarticular osteopenia was aggravated beyond natural progression by service-connected bilateral stress fracture. The examiner reasoned that the June 2017 VA examination states that the Veteran's bilateral stress fracture is no longer an active disorder. The examiner stated that the fractures occurred in 1973, which is 36 years prior to the June 2009 examination finding of left periarticular osteopenia. Therefore, the examiner stated that because the bilateral fractures being no longer active and temporal relationships of diagnosis, a nexus cannot be established between nonservice connected left periarticular osteopenia and service-connected bilateral stress fracture. The examiner concluded it is less likely than not that left periarticular osteopenia is aggravated by service-connected bilateral stress fracture. On the November 2020 VA knee examination, the examiner indicated the Veteran's has a diagnosis of bilateral knee osteoarthritis. The Veteran stated that his left leg periarticular osteopenia began in 1974. He stated that he believes that it began with his altered gait due to the tibial stress fractures, thus putting stress on various angles at the knee and ankles. The Veteran stated that he began to have symptoms of instability, constant pain, an inability to stand or walk for over 30 to 45 minutes. He stated he is unable to run. He stated he has been treated with physical therapy, braces, and medication. Based on the foregoing, the Board finds that there is no evidence that the Veteran's left leg periarticular osteopenia was manifested in service or to a compensable degree in the first year following his separation from service. Consequently, service connection for a left leg periarticular osteopenia on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), is not warranted. Notably, the Veteran has not submitted competent evidence to show that he has suffered from the left leg periarticular osteopenia continuously since service. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495-96 (1997). There is also no evidence that the Veteran's left leg periarticular osteopenia is otherwise related to service. The Veteran's post-service treatment records are silent for an opinion relating his left leg periarticular osteopenia to service. There is also no evidence that the Veteran's left leg periarticular osteopenia is secondary to service-connected bilateral tibial stress fracture. The only competent evidence in the record that addresses this question is the August 2014 and May 2018 VA medical opinions, which stated that the Veteran's left leg periarticular osteopenia was not caused or aggravated by his service-connected bilateral tibial stress fracture. As there is no other evidence to the contrary, and the August 2014 and May 2018 VA medical opinions were based on a full review of the record as well as an interview and examination of the Veteran, the Board finds them persuasive. Further, the Veteran's own statements relating his left leg periarticular osteopenia to service-connected bilateral tibial stress fracture are not competent evidence, as he is a layperson and lacks the training to provide adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether left leg periarticular osteopenia is caused or aggravated by a service-connected disability. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court). Also, left leg periarticular osteopenia is a disease of the musculoskeletal system, and the record does not show that the Veteran has training or education in this medical field; therefore, lay evidence of the etiology is not competent nexus evidence as it is not capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno v. Brown, 6 Vet. App. 465, 469-70. Thus, the Veteran is not competent or qualified, as a layperson, to render an opinion on medical causation. In light of the foregoing, the Board concludes that the evidence persuasively weighs against the Veteran's claim of entitlement to service connection for left leg periarticular osteopenia, to include as secondary to service-connected bilateral tibial stress fracture. Accordingly, it must be denied. 19. Entitlement to service connection for hypothyroidism, to include as due to herbicide exposure and environmental chemical exposure, is denied. The Veteran asserts that he is entitled to service connection for hypothyroidism on a direct and presumptive basis. However, as outlined below, the evidence persuasively weighs against finding that the Veteran's hypothyroidism manifested during, within the year following, or as a result of active service, to include as due to environmental chemical exposure. As such, service connection cannot be established on a direct or presumptive basis. As an initial matter, as previously stated, the Board has found that the Veteran was not exposed to herbicide agents during service in Japan or other duty stations. However, the Board concedes that due to the Veteran's MOS, he was exposed to environmental chemicals. A July 2006 private treatment record shows the Veteran was on thyroid medication. In an August 2015 VA treatment record, the medical provider stated the hypothyroidism is stable and the Veteran is to continue the current dose of medication. In a March 2018 VA medical opinion, the examiner opined that the Veteran's hypothyroidism is less likely than not caused by service. The examiner reasoned that the medical records contain no clinical evidence to connect hypothyroidism to alleged exposure to various agents at various bases in the remote past for a span of a couple months to one to two years and there is no evidence of other personal suffering from chronic diseases such as prostate cancer, hypothyroidism, or diabetes from exposure to the chemical agents. On the November 2020 VA thyroid examination, the examiner indicated the Veteran has a diagnosis of hypothyroidism from 2003. The Veteran stated that the condition began in 2003. He stated he would not have energy half through the day and did not know why. He stated he started to gain weight. On the November 2020 VA medical opinion, the examiner opined that the Veteran's hypothyroidism is less likely than not caused by service. The examiner reasoned that genetic association is the biggest risk factor in developing thyroid problems. The examiner stated that the Veteran reported that his father and two brothers have thyroid conditions. The examiner stated that current medical literature does acknowledge the role of environmental hazards in autoimmune thyroid diseases. The examiner stated, however, that the effect of environmental toxins to the tyroid is immediate as these chemicals or particles mimic the thyroid hormone structure. Therefore, the examiner stated that symptoms would manifest at the time of exposure to the toxins and not decades later. The examiner stated that the Veteran's diagnosis of hypothyroidism was noted around 2003. Therefore, the examiner opined that it is less likely than not that the Veteran's hypothyroidism is incurred in or caused by service, to include exposure to industrial chemical solvents. On the November 2022 VA addendum medical opinion, the examiner opined that it is less likely than not that the Veteran's hypothyroidism is caused by service. The examiner reasoned that there are no STRs that note a thyroid or hypothyroid condition. The examiner noted that the first record of a diagnosis occurred in July 2011. The examiner indicated that the Veteran has a family history from his father and siblings of hypothyroidism. The examiner stated that it is unlikely for hypothyroidism to develop from exposure in service that occurred more than 30 years prior. However, the examiner stated that hypothyroidism can be related to the Veteran's positive family history of hypothyroidism. Based on the foregoing, the Board finds that there is no evidence that the Veteran's hypothyroidism was manifested in service or to a compensable degree in the first year following his separation from service. Consequently, service connection for hypothyroidism on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), is not warranted. Notably, the Veteran has not submitted competent evidence to show that he has suffered from hypothyroidism continuously since service. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495-96 (1997). There is also no evidence that the Veteran's hypothyroidism is otherwise related to service. The Veteran's post-service treatment records are silent for an opinion relating his hypothyroidism to service. The only competent evidence in the record that addresses this question are the November 2020 and November 2022 VA medical opinions, which stated that the Veteran's hypothyroidism was not related to his service, to include environmental chemical exposure. As there is no other evidence to the contrary, and the November 2020 and November 2022 VA medical opinions were based on a full review of the record as well as an interview and examination of the Veteran, the Board finds them persuasive. Further, the Veteran's own statements relating his hypothyroidism to service are not competent evidence, as he is a layperson and lacks the training to provide adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether hypothyroidism, in the absence of credible evidence of continuity, as here, is related to environmental chemical exposure in service. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court). Also, hypothyroidism is a disease of the endocrine system, and the record does not show that the Veteran has training or education in this medical field; therefore, lay evidence of the etiology is not competent nexus evidence as it is not capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno v. Brown, 6 Vet. App. 465, 469-70. Thus, the Veteran is not competent or qualified, as a layperson, to render an opinion on medical causation. In light of the foregoing, the Board concludes that the evidence persuasively weighs against the Veteran's claim of entitlement to service connection for hypothyroidism. Accordingly, it must be denied. REASONS FOR REMAND 1. Entitlement to service connection for right wrist osteoarthritis, to include as secondary to service-connected right wrist ganglion cyst, is remanded. Unfortunately, there has not been substantial compliance with the Board's previous remand directive regarding the issue of entitlement to service connection for right wrist osteoarthritis as secondary to service-connected right wrist ganglion cyst. And another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). In a July 1972 STR the Veteran complained of knot on the right wrist for the prior couple of months. On examination, the medical provider observed the right wrist to be non-tender. The medical provider questioned if the Veteran had a ganglion cyst and recommended imaging to rule out a fracture and recommended the use of wrist support. In a September 1973 STR examination, the medical provider noted the Veteran to have a small ganglion cyst on the right wrist. In a May 2016 VA treatment record, the Veteran complained of right wrist pain. In a May 2016 VA treatment record, the medical provider assessed wrist imaging to show likely degenerative changes. In a December 2017 correspondence, the Veteran stated that in July 1972, he was treated for wrist pain, and he was diagnosed with ganglion cyst. The Veteran reported that he was recommended a wrist support to be worn to support the wrist joint. On the November 2020 VA wrist examination, the examiner indicated the Veteran has right wrist degenerative arthritis. The Veteran stated that the condition began in 1969. The Veteran stated that the condition began when he was loading an armed bomb to an aircraft. He stated that he experienced increase in painful motion after repetitive use and constant dull aching pain. He stated that when the condition began, he also experienced ganglion cyst, pain, spasms, and loss of grip. On the November 2020 VA medical opinion, the examiner opined that the Veteran's right wrist arthritis is less likely than not caused by service-connected right wrist ganglion cyst. The examiner reasoned that the Veteran was first identified to have mild osteoarthritis of the right wrist in 2009, when the Veteran was about 60 years old. The examiner stated that osteoarthritis is common in elderly individuals as it is a degenerative condition. The examiner stated that all joints in the body are subject to time-related wear and tear, and they usually manifest during the sixth to seventh decade of life. Here, the August 2020 Board decision directed the Regional Office (RO) to provide a medical opinion that addressed whether the Veteran's right wrist osteoarthritis was caused or aggravated by service-connected right wrist ganglion cyst. However, the November 2020 VA examiner did not address whether the Veteran's right wrist osteoarthritis was aggravated beyond its natural progression by service-connected right wrist ganglion cyst. As a result, remand is required. Also, remand is necessary to obtain an addendum VA opinion, or a new VA examination if necessary. When VA undertakes to obtain an opinion, it must ensure that the opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is considered adequate "where it is based on consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Here, at the November 2020 VA examination, the Veteran has asserted that his right wrist pain began in-service and continued since separation from service. As a result, an addendum VA opinion, or a new VA examination, if necessary, is required for a medical opinion addressing direct service connection. Therefore, a remand is required to obtain an addendum VA opinion, or to provide an additional VA examination if found necessary. 2. Entitlement to service connection for a right arm injury is remanded. 3. Entitlement to service connection for a left arm injury is remanded. Remand is necessary to obtain an addendum VA opinion, or a new VA examination if necessary. When VA undertakes to obtain an opinion, it must ensure that the opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is considered adequate "where it is based on consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Here, in an April 1971 STR, the Veteran complained of pain in the right arm, possibly a pulled muscle in the triceps that is tender after weightlifting. In July 2013 correspondence, the Veteran stated that damage to his bilateral arms may have occurred in 1969 when he was loading a 500-pound bomb. He stated that as they were loading the bomb, the bomb rolled out and he was holding the bomb alone until the others could reset the rack. He stated that after this he was unable to feel any sensation from his elbows down. He stated he regained feeling in the arms after two weeks. He stated that the grip in both hands decreased after the injury. He stated he has continued to have an aching pain in the bilateral arms from the mid-forearm down with cramps in the thumb and index finger area. In a December 2017 correspondence, the Veteran stated that in April 1971 he was treated for right arm pain, and he was prescribed medications. On the November 2020 VA shoulder and arm examination, the examiner indicated the Veteran has a diagnosis of bilateral arm or shoulder arthritis. The Veteran stated that the bilateral arm disorder began in 1969. The Veteran stated that he believes the injury occurred in 1969 when he was assisting in carrying a 500-pound bomb. He stated the bomb rolled back on him and he was holding it for ten minutes. The Veteran stated that when the conditions began, the symptoms were loss of feeling from the elbow down for two weeks. The Veteran stated he currently experiences loss of ability to maintain grip and muscle spasms. He stated he currently wears a wrist brace. The November 2020 VA examiner remarked that for the Veteran's claim for bilateral arm condition status post damage, there is no diagnosis because there are no findings, signs, or symptoms to support a diagnosis. The November 2020 VA examiner stated, in the right and left wrist carpal tunnel medical opinions, that there is no other diagnosis of the right or left arm upper extremity. The Board finds, however, that the November 2020 VA examiner's examination report and medical opinion are unclear. The VA examination shows the Veteran has a diagnosis of bilateral arthritis; however, there is no clarification if that arthritis is related to the arms or shoulders. Within the examination, the Veteran reports flare-ups of the bilateral shoulders. Then in the medical opinion, the examiner states there is no diagnosis of the bilateral arms, excluding bilateral wrist carpal tunnel syndrome. Therefore, a remand is required to obtain an addendum VA opinion, or to provide an additional VA examination if necessary, to determine the nature and etiology of any arm disorder. The matters are REMANDED for the following action: 1. Obtain an addendum opinion, and if necessary, an additional VA examination, from an appropriate clinician to determine the nature and etiology of the Veteran's right wrist osteoarthritis. The examiner must opine whether it is at least as likely as not that the right wrist osteoarthritis is caused or related to the Veteran's service. The examiner must also opine as to whether it is at least as likely as not that the Veteran's right wrist osteoarthritis was aggravated beyond its natural progression by his service-connected right wrist ganglion cyst. 2. Obtain an addendum opinion, and if necessary, an additional VA examination, from an appropriate clinician to determine the nature an etiology of any right and/or left arm disorder found to be present. For each disorder diagnosed, the examiner must specify if the bilateral arthritis, excluding any findings of bilateral wrist carpal tunnel syndrome, is of the arms or shoulders. Then the examiner must opine whether it is at least as likely as not that any diagnosed right and/or left arm disorderto include arthritis of the shoulders and armsis related to service, to specifically include an in-service injury during the transport of a 500-pound bomb. The examiner must thoroughly consider and discuss the Veteran's lay statements in the context of any negative opinion. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Thompson, 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.