Citation Nr: 23037932 Decision Date: 07/10/23 Archive Date: 07/10/23 DOCKET NO. 19-13 423 DATE: July 10, 2023 ORDER Service connection for a cholesterol condition is denied. Service connection for an undiagnosed illness due to exposure to Gulf War environmental hazards is denied. Service connection for a left knee disability, to include degenerative arthritis, is denied. Service connection for a right knee disability, to include right knee degenerative arthritis, is denied. Service connection for a lumbar spine disability, to include degenerative arthritis, is denied. Service connection for hypertension is denied. Service connection for gastroesophageal reflux disease (GERD) is denied. Service connection for fibromyalgia with bilateral leg pain is denied. Service connection for a headache disorder is granted. Service connection for skin rash of the face and head is denied. Service connection for athlete's foot is denied. Service connection for sleep apnea is denied. Service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD), depressive disorder, and insomnia is denied. REMANDED Entitlement to service connection for diabetes mellitus is remanded. Entitlement to a total disability rating for individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran had active service in the Southwest Asia theater of operations during his period of service from 2001 to 2003. 2. The Veteran does not have any ascertainable disability manifested by hyperlipidemia or high cholesterol. 3. The Veteran did not have an unspecified "undiagnosed illness" at the time of his October 2016 claim for benefits and has not had one at any time since. 4. The Veteran's left and right knee and lumbar spine degenerative arthritis, hypertension, GERD, skin rash of the face and head (diagnosed as irritant contact dermatitis), athlete's foot, and obstructive sleep apnea are clinically diagnosed conditions; they are not diagnosed illnesses without conclusive pathophysiology or etiology, characterized by overlapping symptoms and signs with features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. 5. The Veteran's left and right knee and lumbar spine degenerative arthritis, hypertension, GERD, skin rash of the face and head (diagnosed as irritant contact dermatitis), athlete's foot, and obstructive sleep apnea did not begin in service, are not the result of in-service exposure to sand/dust or smoke from oil fire or other toxins, and are not related to service in any other way. 6. The Veteran did not have fibromyalgia at the time of his October 2016 claim for benefits and has not had any such disability at any time since. 7. The Veteran has a headache disorder that is a chronic disability resulting from an undiagnosed illness or a medically unexplained chronic multisymptom illness. 8. The Veteran has not at any time during the claim period had PTSD, a depressive disorder, or any other mental disorder aside from insomnia, and such insomnia did not begin in service and is not otherwise related to service. CONCLUSIONS OF LAW 1. There is no legal basis for service connection for a cholesterol condition. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. 2. The criteria for service connection for an undiagnosed illness due to exposure to Gulf War environmental hazards are not met. 38 U.S.C. §§ 1110, 1117, 5107; 38 C.F.R. §§ 3.303, 3.317. 3. The criteria for service connection for a left knee disability, to include degenerative arthritis, are not met. 38 U.S.C. §§ 1110, 1117, 1119, 1168, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317. 4. The criteria for service connection for a right knee disability, to include degenerative arthritis, are not met. 38 U.S.C. §§ 1110, 1117, 1119, 1168, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317. 5. The criteria for service connection for a lumbar spine disability, to include degenerative arthritis, are not met. 38 U.S.C. §§ 1110, 1117, 1119, 1168, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317. 6. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1117, 1119, 1168, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317. 7. The criteria for service connection for GERD are not met. 38 U.S.C. §§ 1110, 1117, 1119, 1168, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317. 8. The criteria for service connection for fibromyalgia with bilateral leg pain are not met. 38 U.S.C. §§ 1110, 1117, 1119, 1168, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317. 9. The criteria for service connection for headache disability are met. 38 U.S.C. §§ 1110, 1117, 1119, 1168, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317. 10. The criteria for service connection for skin rash of the face and head are not met. 38 U.S.C. §§ 1110, 1117, 1119, 1168, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317. 11. The criteria for service connection for athlete's foot are not met. 38 U.S.C. §§ 1110, 1117, 1119, 1168, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317. 12. The criteria for service connection for sleep apnea are not met. 38 U.S.C. §§ 1110, 1117, 1119, 1168, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317. 13. The criteria for service connection for a psychiatric disorder, to include PTSD, depressive disorder, and insomnia are not met. 38 U.S.C. §§ 1110, 4.125(a), 5107; 38 C.F.R. §§ 3.303, 3.304(f). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1998 to March 1999 and November 2001 to August 2003. This appeal is before the Board of Veterans' Appeals (Board) from a June 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office. The Board remanded the issues on appeal to the agency of original jurisdiction (AOJ) in February 2020. SERVICE CONNECTION Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303(a). Service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). In addition, for certain chronic diseases, such as hypertension and arthritis, a presumption of service connection arises if the disease is manifested to a degree of 10 percent within one year following discharge from service. 38 C.F.R. §§ 3.307, 3.309(a). When a chronic disease is not shown within one year after service, under 38 C.F.R. § 3.303(b) 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. When the fact of chronicity in service is not adequately supported, a showing of continuity after discharge is required to support a claim for such diseases; however, such continuity of symptomatology may only support a claim for those chronic diseases listed under 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Generally, lay evidence is competent with regard to identification of a disease with unique and readily identifiable features which are capable of lay observation. See Barr v. Shinseki, 21 Vet. App. 303, 308 (2007). A lay person may speak to etiology in some limited circumstances in which nexus is obvious merely through observation, such as sustaining a fall leading to a broken leg. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir 2007). Lay persons may also provide competent evidence regarding a contemporaneous medical diagnosis or a description of symptoms in service which supports a later diagnosis by a medical professional. However, a lay person is not competent to provide evidence as to more complex medical questions, i.e., those which are not capable of lay observation. Lay statements are not competent evidence regarding diagnosis or etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); Jandreau, at 1377, n. 4 ('sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer'); 38 C.F.R. § 3.159(a)(2). Service connection may be granted for a Persian Gulf veteran with a qualifying chronic disability. 38 U.S.C. § 1117(a)(1). A qualifying chronic disability is a chronic disability resulting from an undiagnosed illness or a medically unexplained chronic multisymptom illness (MUCMI) (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs or symptoms. 38 U.S.C. § 1117(a)(2); 38 C.F.R. § 3.317(a)(2)(i). The term MUCMI refers to a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. 38 C.F.R. § 3.317(a)(2)(ii). A multisymptom illness is a MUCMI where either the etiology or pathophysiology of the illness is inconclusive. Stewart v. Wilkie, 30 Vet. App. 383, 389-90 (2018). A multisymptom illness is not a MUCMI where both the etiology and the pathophysiology of the illness are partially understood. Id. The determination of whether a MUCMI is "medically unexplained," that is, the etiology and pathophysiology of the multisymptom illness, must be particular to the claimant's case. Id. at 291. Signs or symptoms that may be manifestations of undiagnosed illness or medically unexplained chronic multisymptom illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders. 38 U.S.C. § 1117(g); 38 C.F.R. § 3.317(b). In the case of claims based on undiagnosed illness under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317, unlike those for "direct service connection," there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004). Further, lay persons are competent to report objective signs of illness. Id. Here, the Veteran had active service in the Southwest Asia theater of operations, including in Kuwait, during his period of service from 2001 to 2003. Therefore, he is considered a Persian Gulf veteran. 38 C.F.R. § 3.317(e). Also, on August 10, 2022, the "Honoring our PACT Act of 2022" was enacted. Pub. L. No. 117-168 (2022). Among other things, the "PACT Act" established the presumption of in-service exposure to substances, chemicals, and airborne hazards, including from burn pits, for certain covered veterans, including those who had service in Kuwait on or after August 2, 1990. 38 U.S.C. § 1119; see also 38 C.F.R. § 3.320(a)(4) (2022). Furthermore, for any such Veterans who have evidence of a disability for which they seek service connection and who participated in a toxic exposure risk activity in service, VA must, as part of its duty to assist under 38 U.S.C. § 5103A(d), provide a medical examination and obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the toxic exposure risk activity. 38 U.S.C. § 1168(a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. 38 U.S.C. § 5107. Factual Background In his October 2016 claim for benefits, the Veteran asserted that he had hypertension, bilateral athlete's foot, "severe recurring skin rashes [of the] head and face," and GERD, as well as disabilities of the back and knees, including "Extreme back/muscle joint pain," "fibromyalgia [of] both legs," and degenerative arthritis, all of which began during his Reserve active-duty service in 1998 and continued to the present. He also asserted that his back and knee disabilities were due to environmental hazard exposure during the Gulf War. On June 9, 2003, Post-Deployment Health Assessment, the Veteran reported being in very good health, with no medical problems developing during his deployment. The Veteran denied having at that time, or having developed during deployment, back pain, muscle aches, swollen, stiff or painful joints, skin diseases or rashes, or frequent indigestion. There was noted not to be a need for further evaluation for any medical problem, including dermatologic, gastrointestinal, cardiac, or orthopedic. He did, however, report being "often"-as opposed to "sometimes" or never"-exposed to smoke from oil fire and sand/dust, but denied any other exposures. The earliest post-service medical records are private treatment records, dated from July 2014 to December 2016, reflecting the noted ongoing health conditions of type II diabetes mellitus, hyperlipidemia, hypertension, and severe obesity. 1. Service connection for a cholesterol condition is denied. In his October 2016 claim for benefits, the Veteran indicated that he was seeking service connection for "cholesterol cond[ition]." The record reflects a medical history of hyperlipidemia since at least July 2014. However, it does not reflect, and the Veteran has not asserted, any ascertainable disability manifested by hyperlipidemia or high cholesterol. Hyperlipidemia and elevated cholesterol are considered to be laboratory results and not disabilities for VA compensation purposes. See 61 Fed. Reg. 20,440, 20,445 (May 7, 1996) (stating that diagnoses such as hyperlipidemia, elevated triglycerides, and elevated cholesterol are actually laboratory results and are not, in and of themselves, disabilities, and are not appropriate entities for the rating schedule). Accordingly, service connection for a cholesterol condition must be denied for lack of entitlement under the law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). 2. Service connection for an undiagnosed illness due to exposure to Gulf War environmental hazards is denied. The Veteran, in October 2016, claimed service connection for "Afghanistan [and] Kuwait undiagnosed illness." In his February 2018 notice of disagreement, the Veteran asserted that his "[u]ndiagnosed illness is directly or indirectly related to my military [service], secondary to PTSD and adjustment issues." While the Veteran has claimed service connection for many other disabilities, most of which have been considered as possibly being a "qualifying chronic disability" resulting from "an undiagnosed illness" under the provisions of 38 U.S.C. § 1117 and 38 C.F.R. § 3.317, the Veteran has not further identified what type of undiagnosed illness he separately seeks service connection for, or what type of disability it results in. The record does not otherwise indicate what "undiagnosed illness" the Veteran might have for which he seeks service connection. Thus, the persuasive weight of the evidence reflects that the Veteran did not have an unspecified "undiagnosed illness" at the time of his October 2016 claim for benefits and has not had one at any time since. Therefore, there can be no valid service connection claim for such disability, and the claim must be denied. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). 3. Service connection for a left knee disability, to include degenerative arthritis, is denied. 4. Service connection for a right knee disability, to include right knee degenerative arthritis, is denied. 5. Service connection for a lumbar spine disability, to include degenerative arthritis, is denied. While private medical treatment records dated from July 2014 to December 2016 reflect the noted ongoing health conditions of type II diabetes mellitus, hyperlipidemia, hypertension, and severe obesity, they reflect no complaints or findings related to the right knee or lumbar spine. However, they reflect that, in July 2014, the Veteran was seen for a complaint of left knee pain that had been occurring for three days. X-rays revealed "Patellar enthesophytes" and "Possible joint effusion." On June 2017 VA knee examination, the diagnoses were right and left knee strain and bilateral degenerative arthritis. X-rays revealed mild degenerative change of the knees, left greater than right. The Veteran reported that he injured his knee during basic training in service, and that the constant running contributed to the knee injuries, but that he did not remember seeking treatment for the knee pain. On June 2017 VA lumbar spine examination, the diagnoses were lumbar strain and degenerative arthritis of the lumbar spine. July 2017 X-ray revealed multilevel degenerative discogenic disease of the thoracolumbar spine. The Veteran reported at that time that he injured his back during advanced individual training in service, when he was lifting heavy equipment and developed back pain, and that he did not remember seeking treatment at the time, was not prescribed medicines or physical therapy, was not given a profile, and self-treated. He stated that he continued to have daily lower back pain described as an ache. In its February 2020 remand, the Board noted that no VA examiner to date had opined as to whether the Veteran's reported knee and lumbar spine disabilities were "due to in-service injury and/or exposure to Gulf War environmental hazards-as reported in the July 2003 Post-Deployment Health Assessment-specifically, being 'often' exposed to sand/dust and smoke from oil fire." It therefore requested VA examinations and opinions to remedy this. On February 2020 VA examination of the knees, the Veteran reported injury to his knees during basic training, with constant running with heavy gear resulting in knee pain, but not going to sick call, due to his drill sergeant refusing to let him go to medical for treatment. He reported ongoing knee pain, but no current treatment. On February 2020 VA lumbar spine examination, the Veteran reported first experiencing symptoms of back pain with physical training, ruck sack marches, carrying heavy gear, lifting weights, and playing basketball, but not going to medical for treatment. He further reported that his pain continued after active duty with no relief and receiving no current treatment. He stated that his lower back pain was tightness and squeezing pain, mild in severity. The VA examiner, after reviewing the record, opined that the Veteran's current knee and back disabilities were unlikely to be related to service, including his in-service exposures, or to be chronic disability resulting from an undiagnosed illness or a MUCMI. The examiner explained that the Veteran's knee and lumbar spine symptoms were indicative of, and attributable to, the clinically diagnosed disorder of degenerative arthritis. The examiner noted that, in addition to the Veteran's active-duty medical records being silent for complaints, treatment and diagnoses of the knees or lumbar spine, and the temporal gap of many years from the time of service to the first medical records of a knee or lumbar spine problem, there was no medical literature supporting the proposition that exposure to sand/dust or smoke from oil fires caused degenerative arthritis of knees or lumbar spine. The Veteran, furthermore, had no objective indications of a chronic disability resulting from an undiagnosed illness, as established by history, physical examination, and radiographic images. Rather, according to the examiner, the Veteran's bilateral knee and lumbar degenerative arthritis was the natural progression of aging, in accordance with the medical literature. Per the medical literature, with aging, the water content of the cartilage increases, and the protein makeup of cartilage degenerates as a function of biologic processes. Eventually, cartilage begins to degenerate by flaking or forming tiny crevasses. The Board finds the February 2020 VA examiner's opinion probative, as it was based on a complete examination of the Veteran, consideration of his reported history, and review of the record, including review of X-ray evidence revealing the nature and progression his degenerative arthritis, and a review of the medical literature, including that pertaining to the process and expected nature and progression of degenerative arthritis of a person his age and physical condition. It was also supported by a clear rationale that cited to, and was consistent with, the record and the cited medical literature. Moreover, the VA examiner's nexus opinion is not contradicted by any probative, or even competent, evidence, such as a contrary medical opinion. The Board notes the Veteran's assertions on VA examination of first injuring, or experiencing symptoms of pain in, the knees and/or lumbar spine in service in the course of his regular physical duties including running, carrying heavy gear, and lifting. However, such reports of injury and symptoms occurring in service and continuing to the present are not credible. Initially, the Board notes that, in first claiming knee and lumbar spine disabilities in October 2016, the Veteran asserted that such back and knee disabilities were due to environmental hazard exposure during the Gulf War, rather than to any asserted in-service injury or physical activity. Also, even considering the assertion that his sergeant prevented him from reporting any knee or back problems for medical treatment, the Veteran's June 2003 Post-Deployment Health Assessment, in which he denied having at that time, or having developed during deployment, back pain, muscle aches, swollen, stiff or painful joints, contradicts the contention that his knee and back pain began in training and continued through and after service to the present. Furthermore, again, private medical treatment records dated from July 2014 to December 2016 contain no complaints or findings related to the right knee or lumbar spine and reflect that, in July 2014, the Veteran was seen for a complaint of left knee pain that had been occurring for three days, which contradicts the Veteran's report of his knee pain beginning in service and continuing to the present. Given the above, the persuasive weight of the evidence shows that the Veteran has the diagnosed conditions of left and right knee degenerative and lumbar spine arthritis with at least partially explained pathophysiology and etiology, which have no indications of overlapping symptoms and signs with features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. It is also against a finding that any knee or lumbar spine disability is related to an in-service injury, disease, or event, to include in-service exposure to sand/dust, smoke from oil fire, or other such toxins. Accordingly, service connection for right and left knee and lumbar spine disabilities must be denied. 6. Service connection for hypertension is denied. Private medical treatment records dated from July 2014 to December 2016 reflect treatment for hypertension. In July 2014, the Veteran reported "family [history] of high blood pressure." In August 2014, it was noted that the Veteran was "diagnosed at 35" with hypertension (the Veteran, at that time, was 35). In August 2014, his private physician assessed that the Veteran "most likely has essential hypertension given his strong family history of hypertension as well as his obesity." In its February 2020 remand, the Board noted that no VA examiner to date had opined as to whether the Veteran's hypertension was "due to exposure to Gulf War environmental hazards-as reported in the July 2003 Post-Deployment Health Assessment-specifically, being 'often' exposed to sand/dust and smoke from oil fire." It therefore requested a VA examination and opinion to address this. On February 2020 VA examination, the Veteran reported developing hypertension from the exposure of sand/dust and smoke from oil fire during deployment in Kuwait. He further reported a diagnosis of hypertension in 2005 after returning from Kuwait. The examiner opined that the Veteran's hypertension was not related to service, to include being often exposed to sand/dust and smoke from oil fire, noting that, during service, there was no diagnosed hypertension condition, and no evidence of chronicity of care from service, and a temporal gap between service and the first instance of diagnosis and treatment of many years. Rather, the Veteran's medical records contained a notation of a diagnosed hypertension condition in July 2014 with an etiology of "Hypertension with a Family History." The Board finds the VA examiner's opinion probative. The examiner reviewed the entire record, considered the Veteran's subjective history, and gave a clear rationale for the opinion; there is no contrary medical opinion or other such competent evidence of record contradicting the VA examiner's opinion, or otherwise suggesting that the Veteran's hypertension is related to in-service exposure or to service in any other way. The examiner's rationale, moreover, is consistent with the private treatment records, which indicate an initial diagnosis of hypertension in 2014, and a likely etiology of family history and obesity. In this regard, to the extent that the Veteran asserted on February 2020 VA examination being diagnosed with hypertension in 2005, the Board does not find the assertion credible; the private medical record, as noted above, reflects that he was initially diagnosed in 2014, and he did not in any treatment record report any earlier hypertension diagnosis or treatment. Moreover, even if the Veteran had first been diagnosed with hypertension in 2005, the diagnosis would have been more than one year following his separation from service in 2003. The persuasive weight of the evidence, therefore, shows that the Veteran has the diagnosed condition of hypertension with at least partially explained pathophysiology and etiology, which has no indications of overlapping symptoms and signs with features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. It is also against any finding that hypertension began during or is otherwise related to service, to include in-service exposures. Accordingly, service connection for hypertension must be denied. 7. Service connection for GERD is denied. On June 2017 VA examination, the Veteran reported current acid reflux, with heart burn and indigestion, feeling like he needed to vomit, and a burning sensation in the back of the throat. He stated that his symptoms occurred a few times per month, that he did not require daily medications for the reflux, and that his symptoms began in his early twenties. He reported taking over-the-counter Nexium for the problem, and that he had not sought treatment with his primary care physician for the acid reflux. The diagnosis was GERD. The VA examiner stated that "[t]he veteran's claimed disability pattern represents a disease with a clear and specific etiology and diagnosis." The examiner opined that "[t]he veteran's claimed disability pattern, acid reflux disease, is less likely than not related to a specific exposure event experienced by the veteran during service in Southwest Asia []," as "[t]here presently is no medical literature to support a correlation between acid reflux disease and Gulf War exposures." The Board finds the VA examiner's opinion probative. The examiner was a physician who reviewed the record and examined the Veteran, and provided an assessment of his gastrointestinal disability/GERD and clear rationale for the opinion that it was not related to his in-service exposures in Southwest Asia. There is, furthermore, no probative or competent evidence, such as a medical opinion, contradicting the VA examiner's opinion or otherwise indicating that GERD might be related to service. As the Veteran's disability is diagnosed as GERD, it is a diagnosed condition and cannot be considered an undiagnosed illness. 38 C.F.R. § 3.317(a)(1)(ii). Moreover, GERD is a structural gastrointestinal disorder and therefore not considered a MUCMI. 38 C.F.R. § 3.317(a)(2)(i)(B)(3); 76 Fed. Reg. 41,696 (Jul. 15, 2011); see Atencio v. O'Rourke, 30 Vet. App. 74, 83 (2018). Thus, presumptive service connection for GERD under § 3.317 is not warranted. Furthermore, the evidence does not show that GERD began during or is related to service. While the Veteran, on VA examination, reported generally that his GERD symptoms first started in his early 20s, again, on June 9, 2003, Post-Deployment Health Assessment, the Veteran denied having at that time, or having developed during deployment, frequent indigestion, and there was noted not to be a need for further evaluation for any medical problem, including gastrointestinal. Private medical treatment records dated from July 2014 to December 2016 reflect the noted ongoing health conditions of type II diabetes mellitus, hyperlipidemia, hypertension, and severe obesity, but no GERD or other gastrointestinal symptoms; in July 2014, he denied such symptoms as "abdominal or flank pain," "nausea or vomiting," and dysphagia." Furthermore, as discussed above, the VA examiner opined that the Veteran's GERD was not related to his in-service exposures while serving in Southwest Asia, and the Board finds the opinion persuasive. There is no other indication or suggestion of how GERD might be related to the Veteran's service. Therefore, the Board finds that the evidence weighs persuasively against a finding that GERD began during, or is otherwise related to, service, including any in-service exposures. Accordingly, service connection for GERD must be denied. 8. Service connection for fibromyalgia with bilateral leg pain is denied. In his October 2016 claim for benefits, the Veteran asserted that he had "fibromyalgia [of] both legs," which began in service in 1998 and continued to the present. In his February 2018 notice of disagreement, he again reported having "Fibromyalgia widespread muscular skeletal pain and tender points, daily pain." Again, on June 9, 2003, Post-Deployment Health Assessment, the Veteran reported being in very good health, with no medical problems developing during his deployment, and denied having at that time, or having developed during deployment, muscle aches, or swollen, stiff or painful joints. Post-service private and VA treatment records beginning in July 2014 reflect no complaints, diagnoses, or findings related to fibromyalgia. As noted above, private medical treatment records dated from July 2014 to December 2016 reflect a complaint of left knee pain that had been occurring for three days, and X-rays revealed "Patellar enthesophytes" and "Possible joint effusion." While it was noted at the time of evaluation for VA intake to establish primary care in June 2017 that the Veteran's family history included that his mother had fibromyalgia, no history of fibromyalgia or symptoms of such were noted for the Veteran. On February 2020 VA examination for fibromyalgia, it was noted that the "Veteran report[ed] no Fibromyalgia," no "course or onset Fibromyalgia condition," "no current symptoms of Fibromyalgia condition," and "no subjective symptoms of Fibromyalgia on day of exam." There was noted to be "no objective evidence supporting a Fibromyalgia diagnosis in [the Veteran's] current medical records," and objective examination of the Veteran was normal. The record therefore reflects that the Veteran does not have fibromyalgia or the symptoms thereof. The Veteran is competent to report matters within his own personal knowledge, and lay evidence may be competent with regard to a disease with "unique and readily identifiable features" that is "capable of lay observation." See Barr v Nicholson, 21 Vet. App. 303, 308-09 (2007); Layno v. Brown, 6 Vet. App. at 465, 469 (1994). However, despite the Veteran's general assertions of fibromyalgia and widespread musculoskeletal pain affecting the legs in statement to VA in connection with his claim for benefits, he has never reported any such symptoms on medical evaluation, even while reporting that his mother had a history of fibromyalgia, and specifically denied any such condition or symptoms on February 2020 VA examination. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (indicating that contemporaneous evidence has greater probative value than reported history); see also Harvey v. Brown, 6 Vet. App. 390, 394 (1994) (Board decision properly assigned more probative value to a private hospital record that included lay history that was made for treatment purposes than to subsequent statements made for compensation purposes); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (in analyzing credibility, the Board is justified in taking into account multiple factors, including lack of contemporaneous medical evidence, possible bias, and inconsistencies within the record). To the extent that the Veteran has experienced lower extremity pain, the record reflects that he has reported this to medical providers, most specifically left knee pain in July 2014, at which time he was evaluated and diagnosed after X-ray as "Patellar enthesophytes" and "Possible joint effusion." Thus, the Board finds the Veteran's assertions of fibromyalgia, widespread muscle and joint pain, and any other such related symptoms inconsistent with the record as a whole and not credible. The persuasive weight of the evidence, therefore, reflects that the Veteran did not have fibromyalgia at the time of his October 2016 claim for benefits and has not had any such disability at any time since. Accordingly, there can be no valid service connection claim for such disability, and service connection for fibromyalgia must be denied. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). 9. Service connection for skin rash of the face and head is denied. In his October 2016 claim for benefits, the Veteran asserted that he had "severe recurring skin rashes [of the] head and face," which began in service in 1998 and continued to the present. In his February 2018 notice of disagreement, he again reported having "severe skin rashes on face and head, dry, scaly." Again, On June 9, 2003, Post-Deployment Health Assessment, the Veteran reported being in very good health, with no medical problems developing during his deployment, and denied having at that time, or having developed during deployment, skin diseases or rashes. Post-service private and VA treatment records beginning in July 2014 reflect no complaints, diagnoses, or findings related to skin rash of the face or head. On August 2014 private treatment, the Veteran reported having no rashes. On June 2017 VA skin examination, the Veteran reported "that he has a recurrent rash on his forehead and cheeks" that "began after he returned form [sic] Afghanistan," and "describe[d] the rash as papular and dry" but "not itchy." It was noted that the Veteran did not use a specific product on the rash and had not sought medical treatment for it, that the rash occurred intermittingly 1 to 2 times per month, and that triggers for the rash had not been identified, but that the Veteran stated that "he does use soap and products with fragrance on his face." On physical examination, the Veteran had a scaling papular rash on the forehead and upper cheeks with some erythema. The diagnosis was irritant contact dermatitis. The VA examining physician stated that the Veteran's claimed disability pattern with represented a disease with a clear and specific etiology and diagnosis, and opined that such claimed disability pattern, which was irritant contact dermatitis, was less likely than not related to a specific exposure event experienced by the Veteran during service in Southwest Asia, as there presently was no medical literature to support a correlation between irritant contact dermatitis and Gulf War exposures. The examiner further noted that the Veteran used soap and products with fragrance on the face. The Board finds the February 2020 VA examining physician's examination report and opinion probative. The examiner diagnosed the Veteran's claimed skin disability of the head and neck as irritant contact dermatitis-a condition of understood pathology and etiology-suggesting that the irritant causing the condition was soap and products with fragrance on the face; the condition is therefore not a qualifying chronic disability under 38 U.S.C. § 1117(a) and 38 C.F.R. § 3.317(a). The examiner's assessment and opinion that the Veteran's dermatitis was unlikely to have been the result of in-service exposure was based on an examination of the Veteran's skin condition, consideration of his reported history, and review of the record, and a review of the medical literature. Such opinion is not contradicted by any probative, or even competent, evidence, such as a contrary medical opinion. The Board notes the Veteran's assertion in October 2016 and February 2018 of "severe recurring skin rashes [of the] head and face," which began in service in 1998 and continued to the present, and his report rashes dating back to service on July 2017 VA examination. However, again, on June 9, 2003, Post-Deployment Health Assessment, the Veteran reported being in very good health, with no medical problems developing during his deployment; he denied having at that time, or having developed during deployment, skin diseases or rashes, and post-service private and VA treatment records beginning in July 2014 reflect no complaints, diagnoses, or findings related to skin rash of the face or head. Particularly considering the Veteran's characterization of his rash condition as "severe" both in 2016 and in 2018, the lack of any notation in the medical record of rashes-other than the Veteran's denial of having them-undermines his assertion of rashes beginning in service and continuing to the present which he felt were "severe," and his affirmative denial of skin diseases or rashes in June 2003 plainly contradicts this assertion. Given the above, the evidence weighs persuasively against a finding that the Veteran's skin rash of the face and head, diagnosed as irritant contact dermatitis, began during, or is otherwise related to, service, including any in-service exposures. Accordingly, service connection for skin rash of the face and head must be denied. 10. Service connection for a headache disability is granted. The Veteran denied headache on January 2016, May 2016, and November 2016 private treatment, and was noted to be negative for headache on June 2017 VA evaluation. In a February 2018 statement submitted with his notice of disagreement, the Veteran asserted that he had "Severe headaches and migraines secondary to PTSD." On February 2020 VA hypertension examination, the examiner noted that the Veteran reported "when not taking medication he experiences headaches," and "[h]e reports current treatment with some results in reducing headaches caused by uncontrolled hypertension." On February 2020 VA examination for headaches, the Veteran reported headaches during active duty that occurred with being in the heat during ruck marches. He reported experiencing throbbing headaches requiring rest to reduce symptoms, and no sick call treatment for head pain despite headaches continuing. The Veteran reported throbbing headaches, sharp on the left side above the eye, with any activity. He further reported headaches sometimes upon awakening in the morning from sleep. The VA examiner noted that the Veteran's headache symptoms were subjective reports only and there was no objective evidence of a chronic headache condition, and that the medical records were silent for a headache condition with no treatment or complaints of any headache condition. The examiner stated that the Veteran's headaches could not "be ascribed to a known clinical diagnosis because current medical records are silent for treatment, complaints of headache condition during or post 1 year after active duty periods." The examiner further opined that there was no nexus between any headache condition and the Veteran's service. While the medical record reflects that the Veteran did not report, and in fact denied, any headache condition on treatment in 2016 and 2017, he did report headaches on February 2020 hypertension and headache examinations. Furthermore, while the Veteran has variously asserted that his headache condition is related to PTSD and to not taking his hypertension medications, at the time of the February 2020 hypertension examination, it was noted that "[h]e reports current treatment with some results in reducing headaches caused by uncontrolled hypertension," the Veteran's reported headache condition has not been medically attributed to any etiology. That examination report further reflects that the Veteran's headaches could not "be ascribed to a known clinical diagnosis," and that there was no objective or physical findings associated with the Veteran's headaches; they were purely subjective. 11. Lay evidence is competent with regard to identification of a disease with unique and readily identifiable features which are capable of lay observation such as headaches. See Barr v. Shinseki, 21 Vet. App. 303, 308 (2007). While the headaches have been observed as subjective, "headache" is considered a sign or symptom that may be a manifestation of undiagnosed illness or MUCMI under 38 U.S.C. § 1117(g) and 38 C.F.R. § 3.317(b). Affording the Veteran the benefit of the doubt, the Board finds that he has a headache disorder that is a qualifying chronic disability under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317. Accordingly, service connection for a headache disorder is granted. 12. Service connection for athlete's foot is denied. Post-service private and VA treatment records, while reflecting health conditions of type II diabetes mellitus, hyperlipidemia, hypertension, and severe obesity, do not contain any notations of tinea pedis or athlete's foot. On February 2020 VA examination, the Veteran reported developing athlete's foot during basic training in service, noticing a lot of skin peeling from both feet, but not going for treatment at the time. He reported that his athlete's foot continued unresolved. He reported ongoing athlete's foot with skin peeling in between toes and at the bottom of feet and using Epson salt to soak his feet twice a month. Examination of the feet was normal. After examining the Veteran and reviewing the record, the examiner determined that the Veteran's athlete's foot was not etiologically related to service, to include being often exposed to sand/dust and smoke from oil fire. The examiner noted that the medical records were silent for a diagnosed foot condition, treatment or complaints, but given the Veteran's subjective reports, the examiner stated that the Veteran's athlete's foot condition could be ascribed to a known clinical diagnosis of tinea pedis, the signs and symptoms of which included a scaly rash that usually caused itching, stinging, and burning. Referencing medical literature regarding athlete's foot, the examiner stated that athlete's foot (tinea pedis) is a fungal infection that usually begins between the toes, which commonly occurred in people whose feet have become very sweaty while confined within tight fitting shoes. In this case, the evidence is against a finding that any athlete's foot is related to service. Initially, the condition is a diagnosed medical disorder with understood pathophysiology and etiology, as discussed by the February 2020 VA examiner. See 38 U.S.C. § 1117(a); 38 C.F.R. § 3.317(a). While the medical treatment record is completely silent as to any athlete's food condition, that the Veteran has reported never having been treated for the condition, and that the condition has never been objectively verified or diagnosed on evaluation, the Veteran is competent to report the signs and symptoms of a scaly rash of the foot that causes itching and peeling. See Layno, 6 Vet. App. at 469; Barr, 21 Vet. App. at 308-09. However, the Veteran's assertions of noticing a lot of skin peeling from both feet in service conflicts with his report on June 2003 evaluation of having no skin or symptoms currently or during deployment; given this, and the lack of any other support for the Veteran's assertions, the Board finds his assertion not credible. Furthermore, as discussed by the February 2020 VA examiner, athlete's foot was a fungal infection relating to sweat and shoe-wear, and not related to the Veteran's in-service exposures to sand/dust and smoke from oil fire. Given the above, the persuasive weight of the evidence is against a finding that athlete's foot began during, or is otherwise related to, service, including any in-service exposures. Accordingly, service connection for athlete's foot must be denied. 13. Service connection for sleep apnea is denied. On June 9, 2003, Post-Deployment Health Assessment, the Veteran reported not having, and not having developed during deployment, the symptom of still feeling tired after sleeping. On June 2017 VA examination, the Veteran reported "that he snores at night, that "[h]is wife has observed snoring and pauses in his breathing" and "will shake the veteran and he wil [sic] resume breathing," but that "[h]e has not had a sleep study performed." It was noted, "The snoring has been a problems since 2007." He was noted by the VA physician to have possible sleep apnea. On June 2020 VA examination, the diagnosis was obstructive sleep apnea with date of onset 2007. The Veteran reported that a sleep study was pending, as well as minimal daytime sleepiness and an inability to fall asleep. The VA examiner opined that the Veteran had the diagnosis of sleep apnea, but that sleep apnea was unlikely to be related to service, as the relevant literature did not show any correlation between obstructive sleep apnea and sand/dust and smoke form oil fires. The Board notes that, while the examiner stated that "[t]here are no known causes for the claimant's sleep apnea," the examiner went on to explain the etiology and pathophysiology of sleep apnea as "an obstruction in the airway secondary to muscles relaxing, a large tongue and the soft palate blocking the airway. Risk increase if one is obese, has a neck circumference of 17 inches or greater, nasal congestion, and a narrowed airway," which would not be "secondary to southwest Asia"; private and VA medical records from 2014 to 2017, reviewed by the examiner, repeatedly reflect assessments of severe or morbid obesity. An April 2021 sleep study revealed loud snoring with severe obstructive sleep apnea and hypopneas observed with associated desaturations and arousals, and associated reduced air saturation. The impression was severe obstructive sleep apnea with excessive daytime somnolence likely secondary, and exogenous obesity, likely contributory to obstructive sleep apnea. Given the above, the evidence does not show that sleep apnea is related to the Veteran's service. Initially, the record does not reflect that sleep apnea symptoms began in service. On June 2017 VA examination, the Veteran reported that his "snoring has been a problems since 2007"; there is no indication of any earlier symptoms in the record. Also, the record does not reflect that any later onset sleep apnea may be related to an in-service event. As explained by the VA examiner, obstructive sleep apnea has not been shown to be etiologically related to sand/dust and smoke form oil fires, and instead has been shown to be related to factors such as obesity, neck circumference, narrowed airway and nasal congestion leading to airway blockage. The Board again notes that, while the VA examiner commented that the cause of the Veteran's sleep apnea was unknown, the examiner went on to specifically explain the etiology and pathophysiology of sleep apnea, as discussed above. See Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole, and the Board is permitted to draw inferences based on the overall report so long as the inference does not result in a medical determination). Furthermore, in this regard, the April 2021 sleep study assessment also included the impression that the Veteran's obesity was likely an etiological factor in his sleep apnea. Moreover, there is no indication that the Veteran's diagnosed obstructive sleep apnea has at any point been characterized by overlapping symptoms and signs and having features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities, as required for presumptive service connection as a MUCMI under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317. On the contrary, diagnostic findings on April 2021 sleep study were consistent with the Veteran's severe obstructive sleep apnea. Given the above, the persuasive weight of the evidence is against a finding that obstructive sleep apnea began during, or is otherwise related to, service, including any in-service exposures, or is a qualifying chronic disability under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317. Accordingly, service connection for athlete's foot must be denied. 14. Service connection for a psychiatric disorder, to include PTSD, depressive disorder, and insomnia is denied. Service connection for PTSD requires (1) medical evidence establishing a diagnosis of the condition in accordance with the provisions of 38 C.F.R. § 4.125(a); (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). The Veteran reported in a December 2016 statement in support of his claim for PTSD that, when serving in Afghanistan, he felt fear for his life, as they slept in regular houses without physical protection, that he slept with a gun under his pillow due to fear, and also felt fear driving back and forth from his place of work to his home living with local families. In his February 2018 notice of disagreement, the Veteran reported having "Severe Post Traumatic Stress, anxiety, night sweats, Bad dreams," as well as "Depressive, adjustment disorder related to Post traumatic stress [condition], sleep apnea, headaches, bad dreams" Post-service private medical records reflect that, in June 2014, the Veteran denied "anxiety, depression, problems concentrating, irritability, mood swings, or suicidal ideations," as well as "sleep disturbance." On mental status evaluation, mood behavior, speech, motor activity, and thought processes were normal. In August 2014, he reported having "no depression, no anxiety." On April 2017 VA examination, the Veteran was noted to have had a constricted and mildly depressed mood and affect, and was noted to have symptoms of depressed mood and chronic sleep impairment. After evaluation, it was found that he did not meet the diagnostic criteria for PTSD, but that his examination revealed mild depressive symptoms, such as increased irritability, depressed mood, sleep changes, and social isolation. The diagnosis was unspecified depressive disorder. On June 2017 VA examination, the Veteran reported insomnia, with difficulty falling asleep, usually taking him at least an hour and dreams/nightmares. He reported that the difficulty with sleeping had been a problem since he returned from Afghanistan. On another June 2017 VA mental health examination, the Veteran reported his military history including his claimed in-service stressors. On examination, the MCMI 3 (Millon Clinical Multiaxial Inventory-III assessment of personality disorders & clinical syndromes) was administered; it was noted that, while the profile was deemed to be valid, there was a noted tendency toward defensiveness, suggesting some guardedness in responding, but that, in spite of this apparent guardedness and caution, there was noted elevation on a scale indicating anxiety, tension, and apprehension. There was also evidence of social detachment and emotional withdrawal, suggesting impaired interpersonal functioning. However, it was determined by the examining psychologist that, "Based on this examination and a review of the records, there is no evidence of a DSM-5 diagnosis." The examiner explained that "[t]he anxiety identified by the MCMI3 does not reflect a sufficient degree of distress to warrant a diagnosis." It was further noted by the psychologist that "[t]he claimed sleep disturbance is likely a reflection of the Veteran's rotating shift work." On June 2017 evaluation to establish VA primary care, PTSD screening test was negative. The Veteran was given another VA psychology examination in March 2020. On examination, it was determined that the Veteran did not meet the diagnostic criteria for PTSD. The Veteran completed the Beck Depression Inventory II and the Symptom Checklist 90 as part of the examination, and scored in the low distress range on both questionnaires. The only diagnosis was unspecified insomnia disorder. The examining psychologist opined that such condition was not related to service, but rather was due to factors not related to service including poor sleep hygiene (sometimes sleeping for an entire day, for example), excessive use of alcohol on weekends, morbid obesity, probable lack of exercise, and untreated obstructive sleep apnea. The persuasive weight of the evidence in this case reflects that the Veteran has not had a mental health disorder, aside from his unspecified insomnia disorder. The Veteran has consistently been found not to meet the diagnostic criteria for a diagnosis of PTSD. While, on April 2017 VA examination, the Veteran was assessed as having unspecified depressive disorder, the Board finds the June 2017 and March 2020 assessments more probative. In contrast to the April 2017 examination, those later VA examinations employed psychological testing tools-the MCMI 3, Beck Depression Inventory II and the Symptom Checklist 90-and both reached the same conclusion-that the Veteran's symptoms did not rise to the level of a clinical diagnosis of a depressive disorder-based on the results. In this regard, the symptoms noted on April 2017 VA examination were also noted on the subsequent examinations-including anxiety, tension, and apprehension, as well as social detachment and emotional withdrawal suggesting impaired interpersonal functioning-but, based in large part to the testing instruments used, it was determined that such symptoms were not to a sufficient degree to warrant a clinical diagnosis. Moreover, the June 2017 and March 2020 examination results were consistent with the treatment record, which reflects that the Veteran denied mental health problems such as anxiety and depression and had a normal mental status evaluation. While unspecified insomnia disorder was diagnosed in March 2020, such condition was related to factors not related to service including poor sleep hygiene (sometimes sleeping for an entire day, for example), excessive use of alcohol on weekends, morbid obesity, probable lack of exercise, and untreated obstructive sleep apnea; as discussed above, the Veteran's sleep problems have since been attributed to his diagnosed severe obstructive sleep apnea, with the assessment on April 2021 sleep study including that excessive daytime somnolence was likely secondary to such sleep apnea. There is no competent evidence, such as a medical opinion, linking any such sleep problems to service. The Board notes the Veteran's assertions that his sleep problems began after returning from service in Afghanistan. However, despite post-service treatment records beginning in 2014, there is no indication of any such sleep problems prior to 2016; rather, he denied the symptom of "sleep disturbance" in June 2014. Therefore, any assertion of insomnia or sleep problems beginning in service and continuing until the present is not credible. Given the above, the persuasive evidence weighs against a finding either that the Veteran has at any time during the claim period had PTSD, a depressive disorder, or any other mental disorder aside from insomnia, or that such insomnia began in service or is otherwise related to service. Accordingly, service connection for a psychiatric disorder, to include PTSD, depressive disorder, and insomnia must be denied. REASONS FOR REMAND 1. Entitlement to service connection for diabetes mellitus is remanded. In its February 2020 remand, the Board requested an examination by an appropriate clinician to determine the nature and etiology of any diabetes mellitus, to include an opinion as to whether such disability was the result of being "often" exposed to sand/dust and smoke from oil fire during the Veteran's service in Southwest Asia. On February 2020 VA examination, the examiner determined that the Veteran did not have an A1c of 6.5% or greater on 2 or more occasions, noting A1c values in June and July 2017, and therefore assessed that the Veteran did not have a diagnosis of diabetes, and did not provide an adequate nexus opinion. In light of this, in its April 2021 supplemental statement of the case, the AOJ denied service connection for diabetes mellitus on the basis that "[a] VA examination showed that there is no current official diagnosis of diabetes and that you do not meet criteria for a diagnosis of diabetes. There is no current treatment for diabetes." However, initially, as noted above, there are no VA treatment records since December 2017 associated with the file. Furthermore, following several diagnoses of prediabetes, a July 2017 VA treatment record reflects an assessment of "New onset [diabetes mellitus]," and a lab report dated the day after the VA examiner's opinion reflects an A1c level of 7.4, which was noted to be greater than the level required to show diabetes, and also greater than the level required to show glycemic control for adults with diabetes. Therefore, the claim for service connection for diabetes mellitus must again be remanded for an adequate medical opinion providing the information requested by the Board in its February 2020 remand. 2. Entitlement to a TDIU is remanded. As the outcome of the Veteran's service connection claim may impact his TDIU claim, the service connection issue is inextricably intertwined with the TDIU issue, and the TDIU issue must be remanded as well. See Henderson v. West, 12 Vet. App. 11, 20 (1998); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are therefore REMANDED for the following action: 1. Obtain an addendum opinion by an appropriate clinician as to whether any current diabetes mellitus is at least as likely as not related to an in-service injury, event, or disease, to include being "often" exposed to sand/dust and smoke from oil fire (see July 2003 Post-Deployment Health Assessment). If the requested opinion cannot be provided without another examination of the Veteran, schedule such an examination. The examiner should note the July 2017 VA treatment record reflecting an assessment of "New onset [diabetes mellitus]," and the February 2020 lab report reflecting an A1c level of 7.4. 2. After completing the above and any other necessary development, readjudicate the issues remaining on appeal. If any benefit sought remains denied, provide a supplemental statement of the case to the Veteran. [SIGNATURE ON NEXT PAGE] JONATHAN B. KRAMER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kramer, Jonathan 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.