Citation Nr: 0005894 Decision Date: 03/03/00 Archive Date: 03/14/00 DOCKET NO. 96-44 291 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Milwaukee, Wisconsin THE ISSUES 1. Entitlement to service connection for a skin disorder involving the scalp, face, and back, to include as due to an undiagnosed illness. 2. Entitlement to service connection for obstructive sleep apnea, claimed as shortness of breath, to include as due to an undiagnosed illness. 3. Entitlement to service connection for memory loss, to include as due to an undiagnosed illness. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Douglas E. Massey, Associate Counsel INTRODUCTION The veteran served on active duty from July to November of 1975 and from January to May of 1991. The veteran served in Southwest Asia from February 7 to April 27, 1991. This matter originally came before the Board of Veterans' Appeals (Board) on appeal from a March 1996 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Milwaukee, Wisconsin. In August 1998, the Board adjudicated several of the veteran's claims, but remanded several issues for additional development. These issues included claims for service connection for a skin disorder, sleep apnea, and memory loss. That development has been completed by the RO, and the case is once again before the Board for appellate review. The March 1996 rating decision also denied service connection for sore joints, to include as due to an undiagnosed illness. Following the Board's remand, an October 1999 rating decision granted service connection for a pain disorder associated with psychological factors and general medical condition. The RO determined that this disorder encompassed the veteran's complaints of sore joints. As this determination constitutes a full grant of the benefits sought as to the claim for service connection for sore joints, it is no longer in appellate status. See Grantham v. Brown, 114 F.3d. 1156 (Fed. Cir. 1997). The Board's remand also instructed the RO to adjudicate the issue of service connection for a left shoulder disorder as separate from the issue of service connection for sore joints, although it had never been adjudicated as a separate claim. The October 1999 rating decision denied service connection for a left shoulder disorder. Since service connection for sore joints has been established, the Board finds that granting service connection for a left shoulder disorder which has already been considered would be tantamount to "pyramiding." See 38 C.F.R. § 4.14 (1999). This issue is therefore moot. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's claims has been obtained by the RO. 2. The veteran served in the Persian Gulf theater during the Persian Gulf War. 3. The veteran's skin disorder has been attributed to a known clinical diagnosis of seborrheic dermatitis, and no medical evidence or opinion relates this condition to either period of military service. 4. The veteran's complaints of shortness of breath have been attributed to a known clinical diagnosis of obstructive sleep apnea, and no medical evidence or opinion relates this condition to either period of military service. 5. The veteran's complaints of memory loss have been corroborated by a layperson; however, mental status examinations of record show no memory impairment, and no diagnosis to account for these complaints has been provided. CONCLUSIONS OF LAW 1. The claim of entitlement to service connection for a skin disorder involving the scalp, face and back is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The claim of entitlement to service connection for obstructive sleep apnea, claimed as shortness of breath, is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 3. Memory loss was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 1117, 5107 (West 1991 & Supp. 1998); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.317 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran claims that he currently suffers from a skin disorder, shortness of breath due to obstructive sleep apnea, and memory loss. He maintains that each of these symptoms is the result of an undiagnosed illness stemming from his service in the Persian Gulf. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C.A §§ 1110, 1131; 38 C.F.R. § 3.303(a). If a condition noted during service is not determined to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection. See 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. See 38 C.F.R. § 3.303(d). Statutes and regulations provide additional means for Persian Gulf veterans to qualify for service connection for a disability. See 38 U.S.C.A. § 1117; 38 C.F.R. § 3.317 (1999). The veteran's service records document that he had active service in Southwest Asia during the Persian Gulf War. Hence, the veteran is a Persian Gulf veteran for purposes of awarding VA disability compensation. See 38 U.S.C.A. § 1117; 38 C.F.R. § 3.317(d). Under 38 C.F.R. § 3.317(a)(1), compensation may be paid to a Persian Gulf veteran who "exhibits objective indications of chronic disability resulting from an illness or combination of illnesses manifested by one or more signs or symptoms," provided that such disability was manifest to a degree of 10 percent or more prior to December 21, 2001, and that it cannot, by history, physical examination, or laboratory tests, be attributed to any known clinical diagnosis. Disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a six-month period should be considered "chronic" for purposes of adjudication. See 38 C.F.R. § 3.317. "Objective indications" include both objective evidence perceptible to an examining physician and other non-medical indicators that are capable of independent verification. See 38 C.F.R. § 3.317(a)(2). In this regard, VA has stated that non-medical indicators of an illness may include evidence of time lost from work, evidence the veteran has sought medical treatment for his symptoms, and "[l]ay statements from individuals who establish that they are able from personal experience to make their observations or statements." See Compensation for Certain Undiagnosed Illnesses, 60 Fed. Reg. 6660, 6663 (1995). To fulfill the requirement of chronicity, the illness must have persisted for a period of six months. See 38 C.F.R. § 3.317, as amended by 62 Fed. Reg. 23, 139 (1997). Compensation shall not be paid under this section: if there is affirmative evidence that an undiagnosed illness was not incurred during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War; or if there is affirmative evidence that an undiagnosed illness was caused by a supervening condition or event that occurred between the veteran's most recent departure from active duty in the Southwest Asia theater of operations during the Persian Gulf War and the onset of the illness; or if there is affirmative evidence that the illness is the result of the veteran's own willful misconduct or the abuse of alcohol or drugs. See 38 C.F.R. § 3.317(c). A person who submits a claim for VA benefits has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. See 38 U.S.C.A. § 5107(a). The United States Court of Appeals for Veterans Claims (Court) has defined a well-grounded claim as a plausible claim, one which is meritorious on its own or capable of substantiation. See Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). When a veteran has presented a well-grounded claim within the meaning of 38 U.S.C.A. § 5107(a), the VA has a duty to assist the veteran in the development of his claim. See 38 U.S.C.A. § 5107(a). However, the Court has held that in the absence of evidence of a well-grounded claim, the VA is prohibited in assisting the claimant. See Morton v. West, 12 Vet. App. 477 (1999). Under a direct service-connected theory, the veteran must satisfy three elements for each of his claims for service connection to be well grounded. First, there must be competent evidence of a current disability (a medical diagnosis). Second, there must be evidence of incurrence or aggravation of a disease or injury in service, as shown through lay or medical evidence. Lastly, there must be evidence of a nexus or relationship between the in-service injury or disease and the current disorder, as shown through medical evidence. See Epps v. Gober, 126 F.3d 1464, 1468 (1997). Alternatively, a claim may be well grounded by showing a link to service based upon the application of the rule for chronicity of symptomatology, set forth in 38 C.F.R. § 3.303(b). See Savage v. Gober, 10 Vet. App. 488, 495-497 (1997). The VA General Counsel has recently held that a well-grounded claim for compensation under 38 U.S.C. § 1117(a) and 38 C.F.R. § 3.317 for disability due to undiagnosed illness generally requires the submission the following evidence: (1) active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War; (2) the manifestation of one or more signs or symptoms of undiagnosed illness; (3) objective indications of chronic disability during the relevant period of service or to a degree of disability of 10 percent or more within the specified presumptive period ("objective indications" include "'signs,' in the medical sense of objective evidence perceptible to an examining physician); and (4) a nexus between the chronic disability and the undiagnosed illness. VAOPGCPREC 4-99 (issued May 3, 1999). I. Service Connection for a Skin Disorder and Obstructive Sleep Apnea The veteran contends that he suffers from a skin disorder involving his scalp, face and back, as well as a respiratory disorder causing shortness of breath, all of which stem from an undiagnosed illness due to his service in the Persian Gulf. For the following reasons, however, the Board finds that both of these claims are not well grounded and must be denied. A. Skin disorder involving the scalp, face and back The veteran claims that his skin disorder involving his scalp, face, and back began about six months after his separation from active military service. Service medical records make no reference to any skin problems. Post-service evidence shows that the veteran was first treated for skin problems in 1992. In correspondence dated in October 1992, Kathleen S. Stokes, M.D., of Affiliated Dermatologists, stated that she initially evaluated the veteran in October 1992. At that time, the veteran described a three to four month history of markedly pruritic lesions on his scalp. He also explained that he was getting an irritated rash on his face. Dr. Stokes found that the veteran had evidence of seborrheic dermatitis on his scalp and face, but offered no opinion as to the etiology or date of onset of this condition. The veteran was afforded a VA Persian Gulf Registry examination in April 1993. The examiner observed multiple scales and lesions on the veteran's scalp and forehead consistent with seborrheic dermatitis. The examiner recorded the veteran's comments concerning multiple macular lesions of the lower back since Persian Gulf service. The examiner concluded with diagnoses of seborrheic dermatitis of the scalp and dermatitis of the back. The veteran sought VA treatment for his skin disorder from 1993 until 1995. Treatment reports during this time essentially show that the veteran was seen on several occasions for a rash on his lower back and scalp, identified as seborrheic dermatitis and acne. None of these reports includes a medical opinion relating either condition to the veteran's period of military service. At a VA dermatological examination in June 1995, the veteran related that he experienced bubbles on his back which may have been related to sun exposure. He also said that he developed a skin condition on his scalp and face, described as pink, scaly, with occasional discharge of "clear fluid." It was noted that this condition had been well controlled with medication prescribed by the Dermatology Clinic. Physical examination revealed faint erythema with fine white scales in some of the hair. The face revealed faint erythema in the beard area, as well as in the eyebrow and along the lateral aspect of the nose. No dermatosis was observed on the veteran's back. The examiner's impression was: (1) probable history of sunburns, currently an inactive problem; and (2) seborrheic dermatitis of the face and scalp which, per veteran's history, was responding nicely to what sounds like a medicated shampoo and topical cortical steroids. The examiner added that this condition was likely going to be an ongoing problem for the veteran, requiring maintenance and medication. Pursuant to the Board's remand, the veteran underwent an additional VA dermatological examination in June 1999. A report from that examination includes the veteran's history of scaliness and itchiness of the scalp, face and chest which began approximately six months after returning from the Persian Gulf. The veteran also described a rash on his lower abdomen. Physical examination revealed no dermatitis on the face or scalp, and no open sores or lesions on the head or neck. An ill-defined 4 cm. red patch was observed on the right lower abdomen. The examiner provided diagnoses of seborrheic dermatitis of the scalp and face, and tinea versus eczema of the abdomen. The examiner commented that dermatitis was a chronic condition with no known cause. He indicated that a large portion of the population suffered from this condition, and there was no reason to believe that this condition was caused by the veteran's activities in service. The examiner also opined that the rash on the veteran's abdomen was a dermatitis of undetermined etiology and was also very unlikely to have been precipitated by his exposure to the environment in the Persian Gulf War. Lay statements from various individuals were submitted in support of the veteran's claim. In a March 1995 letter, the veteran's wife stated that she first observed sores on the veteran's back and stomach, as well as peeling, dry skin on his face, approximately one year after he returned from the Persian Gulf. In correspondence dated in May 1995, Robert Long stated that the veteran developed sores and dry skin on his scalp after returning from the Persian Gulf in 1991. [redacted], in a May 1995 letter, indicated that he served with the veteran in the Persian Gulf. He claimed that the veteran developed sores on his face and scalp and small lumps on his back about one to two months after arriving in the Persian Gulf. Finally, the veteran testified at a February 1998 hearing that he first noticed skin problems sometime between October 1991 and January 1992. Applying the applicable criteria to the facts of this case, the Board finds that the veteran has not presented a well- grounded claim of entitlement to service connection for a skin disorder. Pursuant to 38 C.F.R. § 3.317, service connection may be granted for a chronic disability due to undiagnosed illnesses attributed to service in Southwest Asia during the Persian Gulf War. Since the veteran's skin disorder has been attributed to known clinical diagnoses, i.e., seborrheic dermatitis, as well as tinea versus eczema of the abdomen, the veteran's claim under the presumptive provisions afforded to Persian Gulf veterans must be denied as not well grounded. See VAOPGCPREC 8-98 (O.G.C. Prec. 8- 98), 63 Fed. Reg. 56703 (1998). The veteran must therefore present competent evidence demonstrating service connection on a direct basis if his claim is to prevail. See 38 U.S.C.A. §§ 1113(b), 1116. However, after reviewing the evidence, the Board observes that no competent (i.e., medical) evidence suggests that the veteran's diagnoses of seborrheic dermatitis and tinea versus eczema are related to either period of active military service. No skin problems were identified in the available service medical records, which is consistent with the veteran's statements that these problems began after service. More importantly, none of the post-service evidence includes an opinion from a medical professional relating the veteran's skin disorder to service. See Savage, supra. The Board recognizes that several reports include the veteran's statements that his skin disorder stemmed from his service in the Persian Gulf. However, it is clear that these statements were only a recitation of what the veteran had told medical professionals. In Leshore v. Brown, 8 Vet. App. 406, 409 (1995), the Court held that evidence which is simply a history recorded by a medical examiner, unenhanced by any additional comment by that examiner, does not constitute competent medical evidence of the nexus requirement set forth in Grottveit v. Brown, 5 Vet. App. 91, 93 (1995). Here, as no medical professional agreed with the veteran's self-reported history, none of these reports fulfills the nexus requirement between the veteran's current skin disorder and either period of military service. The only evidence relating the veteran's skin disorder to service are lay statements by the veteran, his wife and several friends. The Board notes, however, that where the determinative issue is one of medical causation or a diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. Brown, 7 Vet. App. 134, 137 (1994); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1991). Since the record does not reflect that any of these individuals possess the medical training and expertise necessary to render an opinion as to either the cause or diagnosis of a skin disorder, their statements standing alone cannot serve as a sufficient predicate upon which to find the claim for service connection to be well grounded. See Heuer v. Brown, 7 Vet. App. 379, 384 (1995) (citing Grottveit v. Brown, 5 Vet. App. 91, 93 (1993)). In conclusion, as the veteran's skin disorder has been attributed to known clinical diagnoses of seborrheic dermatitis and tinea versus eczema, and, as there is no medical evidence indicating that either condition had its onset in service, the veteran's claim of entitlement to service connection for a skin disorder must be denied as not well grounded. See e.g. Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997); Caluza v. Brown, 7 Vet. App. 498, 506 (1995). B. Obstructive sleep apnea, claimed as shortness of breath The veteran claims that he suffers from episodes of shortness of breath as a result of smoke inhalation from burning oil fields in the Persian Gulf. He states that these episodes would often occur at night and cause him to awaken while gasping for air. Dyspnea also occurred with any kind of exertion. The Board notes that the rating decision on appeal also denied service connection for bleeding sinuses, to include as due to an undiagnosed illness. That denial was upheld by the Board in its August 1998 decision. The veteran attempted to reopen his claim for that benefit on the basis of new and material evidence. In an unappealed October 1999 rating decision, however, the RO found no such evidence had been submitted to reopen this claim. As such, the issue of entitlement to service connection for a sinus condition is not before the Board. Given this procedural background, in adjudicating the claim for service connection for obstructive sleep apnea, claimed as shortness of breath, the Board shall not consider any evidence pertaining to the veteran's sinus condition. Service medical records show no complaint, treatment or finding for any respiratory problems. The veteran first informed a medical professional of his respiratory problems at his Persian Gulf Registry examination in April 1993. The veteran said he would experience shortness of breath with running since returning from the Persian Gulf. It was noted that an abnormal pulmonary function test revealed possible obstructive lung disease. The examiner therefore concluded with a diagnosis of possible obstructive pulmonary disease. In April 1993, the veteran also received treatment at a VA medical facility for complaints of chronic shortness of breath since returning from the Persian Gulf. It was noted that chronic obstructive pulmonary disease (COPD) and reactive airway disease should be ruled out. The first evidence suggesting a relationship between the veteran's shortness of breath and sleep apnea involves two VA examination reports dated in June 1995. These reports include the veteran's statements that he suffered from occasional dyspnea in the supine position. He described episodes in which he would awaken while gasping for air, as well as dyspnea on exertion during the daytime. On physical examination, no significant respiratory findings were reported. The examiner provided a diagnosis of "possible obstructive sleep apnea syndrome, although the history is somewhat atypical." The examiner also commented that the veteran had daytime dyspnea which required further work-up. A sleep study was recommended. An August 1995 VA outpatient treatment report contains a notation of shortness of breath and exposure to "oil smoke in Desert Storm." No additional comment by a medical professional was offered confirming a nexus or relationship between the veteran's shortness of breath and smoke inhalation in Desert Storm. At a December 1995 VA examination, the veteran reiterated his complaints of dyspnea on exertion and occasional episodes of awakening at night with a choking sensation. The veteran admitted that he had been a "life-long" smoker. Physical examination showed no abnormalities of the lungs, and pulmonary function studies were unremarkable. The diagnoses were chronic dyspnea with normal pulmonary function studies, and symptom complex suggestive of obstructive pulmonary disease. The examiner found no evidence of pulmonary parenchymal disease or asthma. The first confirmed diagnosis of sleep apnea is contained in a February 1996 report from the Milwaukee Sleep Disorders Center. The veteran was admitted and evaluated at that facility by Dr. Marvin R. Wooten, who diagnosed moderately severe non-postural obstructive sleep apnea syndrome. Dr. Wooten provided no opinion as to the etiology of date of onset of this condition. Subsequent evidence suggests that the veteran's complaints of dyspnea are related to deconditioning. The veteran was seen at a VA Pulmonary clinic in June 1999 for complaints of dyspnea. Most of the veteran's complaints involved low back pain and dyspnea with exertion and exercise. The physician suspected that the veteran's symptoms of exercise limitation stemmed from deconditioning as a result of musculoskeletal back pain. In June 1999, a VA examiner agreed with this conclusion and rendered a diagnosis of "dyspnea secondary to deconditioning due to pain syndrome per Pulmonary." After reviewing the pertinent evidence of record, the Board finds that the veteran's claim of entitlement to service connection for obstructive sleep apnea, claimed as shortness of breath, must be denied as not well grounded. The veteran's complaints of dyspnea and shortness of breath have been attributed to a known a clinical diagnosis of obstructive sleep apnea. Given this diagnosis, service connection may only be established with competent evidence showing that this diagnosed condition is indeed related to the veteran's period of active military service. See 38 U.S.C.A. §§ 1113(b), 1116, 1117; 38 C.F.R. § 3.317. Unfortunately, the veteran's claim also fails under a direct theory of service connection. Service medical records make no reference to any respiratory disorder, which is consistent with the veteran's assertion that this problem first appeared after his second period of military service. It is thus evident that no chronic respiratory disorder was ever present during either period of service. In addition, no medical evidence has related the veteran's sleep apnea to service. Despite statements by the veteran and his wife that his sleep apnea and dyspnea are related to his Persian Gulf service, lay assertions of medical etiology can never constitute evidence to render a claim well grounded under section 5107(a). See Grottveit, 5 Vet. App. at 93; Espiritu, 2 Vet. App. at 494-495. The Board concludes that the veteran's sleep apnea, claimed as shortness of breath, has been attributed to a known clinical diagnosis, and no opinion from a medical professional has related this condition to service. Under these circumstances, the Board can only conclude that the veteran's claim of entitlement to service connection for obstructive sleep apnea, claimed as shortness of breath, is not well grounded. See Epps, supra; VAOPGCPREC 4-99. C. Conclusion In denying both claims as not well grounded, the VA has no further duty to assist the veteran in developing the record to support these claims for service connection. See Epps, 126 F.3d at 1469 ("[T]here is nothing in the text of § 5107 to suggest that [VA] has a duty to assist a claimant until the claimant meets his or her burden of establishing a 'well grounded' claim."). The Board is also unaware of any information in this matter that would put VA on notice that any additional relevant evidence may exist which, if obtained, would well ground any of the veteran's claims. See generally, McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997); Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995). The Board views the above discussion as sufficient to inform the veteran of the elements necessary to present a well-grounded claim for each of the benefits sought, and the reasons why the current claims have been denied. Id. II. Memory Loss The Board finds that the veteran's claim for service connection is plausible and capable of substantiation and is therefore well grounded within the meaning of 38 U.S.C.A. § 5107(a). As a result, the VA has a duty to assist the veteran in developing facts that are pertinent to his claim. See 38 U.S.C.A. § 5107(a). The Board finds that all relevant facts have been properly developed, with additional evidence being added to the record by virtue of the Board's remand in August 1998, and that all evidence necessary for equitable resolution of this issue has been obtained. The veteran contends that he has been experiencing memory loss as a result of his service in the Persian Gulf. He states that he has taken notes at work because he is unable to remember tasks required for this job. He claims that he first noticed memory problems in October 1991, which have gotten progressively worse. Service medical records make no reference to memory loss. The veteran first reported memory problems at his Persian Gulf Registry examination in April 1993. During the interview, the veteran explained that he suffered from short- term memory loss since his Persian Gulf service. This report contains no findings from mental status examination. Under the diagnosis section of the report, the examiner listed memory loss "since Persian Gulf service." The veteran was examined by VA on numerous occasions since the April 1993 Persian Gulf Registry examination. Although the veteran told examiners that he experienced memory loss since his Persian Gulf service, no objective evidence of memory loss was present at any time. A report of a general medical examination performed in June 1995 notes that the veteran's memory was "grossly intact." A psychiatric examination performed at that time also notes that his memory was well preserved. At a December 1995 VA neurological examination, the veteran's memory was noted to be intact. As no objective evidence of memory loss was shown during these examinations, no diagnosis was provided to explain the veteran's complaints of memory problems. Lay statements from various individuals are of record. In his May 1995 letter, Mr. [redacted] stated that he served with the veteran in the Persian Gulf and had known him for ten years. He stated that the veteran exhibited memory loss since returning from the Persian Gulf. Mr. [redacted], however, provided no specific examples to illustrate the veteran's memory loss. Based on the diagnosis contained in the Persian Gulf Registry examination report, the Board remanded the case for further medical development to determine the exact nature and etiology of the veteran's claimed disability due to memory loss. The veteran was afforded a VA psychiatric examination in June 1999. During the interview, he reported memory problems at work and home since 1992 and 1993. He explained that he constantly had to write reminders in a notebook, and that his wife would often complain about his forgetfulness. However, no memory deficit was identified on psychological testing. The examiner concluded that, despite the veteran's subjective claims of memory problems, no memory deficit was objectively shown. She also stated that psychological factors were contributing to the veteran's pain syndrome, involving headaches and joint pain. The only Axis I diagnosis was "pain disorder associated with both psychological factors and a general medical condition, chronic." Based on the foregoing, the Board finds that the preponderance of the evidence is against the veteran's claim of entitlement to service connection for memory loss under 38 U.S.C.A. § 1117 and 38 C.F.R. § 3.317(d). The Board recognizes that no known clinical diagnosis has been provided to explain the veteran's complaints of memory loss. The April 1993 Persian Gulf Registry examination report lists memory loss "since Persian Gulf service." However, this appears to be merely a recitation of the veteran's symptoms rather than a clinical diagnosis, as no memory loss was shown on mental status examination at that time. Further, nowhere is memory loss listed as a diagnosis in the Quick Reference to the Diagnostic Criteria from DSM-IV (1994). In addition, the veteran has submitted objective evidence showing chronic memory loss during the requisite period. In this respect, Mr. [redacted] has stated that the veteran had been suffering from memory loss since returning from the Persian Gulf. Although tenuous, the Board finds that Mr. [redacted] statement fulfills the requirement of an objective indicator of a chronic disability concerning memory loss. See Compensation for Certain Undiagnosed Illnesses, 60 Fed. Reg. 6660, 6663 (objective indications of a chronic disability may include "[l]ay statements from individuals who establish that they are able from personal experience to make their observations or statements.) Under these circumstances, the Board finds that the veteran has submitted a well grounded claim for service connection for memory loss under 38 U.S.C.A. § 1117 and 38 C.F.R. § 3.317(d). The veteran's claim must nevertheless be denied under 38 C.F.R. § 3.317, as the preponderance of the evidence is against a finding that the veteran suffers from memory loss. The only evidence supporting the veteran's claim are statements provided by the veteran and Mr. [redacted], including the veteran's testimony at his February 1998 hearing. In contrast, however, the clinical evidence shows no loss of memory. Mental status examinations performed in June 1995, December 1995 and June 1999 found the veteran's memory to be within normal limits. The Board has considered the Persian Gulf Registry examination report which lists memory loss "since Persian Gulf service," in the Diagnosis section. Nonetheless, as no mental status examination was performed at that time, this notation appears to be a recitation of the veteran's self-reported history. In any event, three mental status examinations found no evidence of memory loss. The Board concludes that objective findings elicited on mental status examinations are of greater probative value than lay statements in support of the veteran's claim. See Smith v. Derwinski, 1 Vet. App. 235, 237 (1991) (determining the credibility of evidence is a function for the Board); Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994) (the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the veteran.). In conclusion, the Board finds that the preponderance of the evidence is against the veteran's claim of entitlement to service connection for memory loss under 38 U.S.C.A. § 1117 and 38 C.F.R. § 3.317. In reaching this decision, the Board has considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the veteran's claim, the doctrine is not for application. See 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet. App. at 55-56. The veteran must therefore present competent evidence demonstrating service connection on a direct basis. See 38 U.S.C.A. §§ 1113(b), 1116. As discussed above, however, the Board observes that no competent (i.e., medical) evidence establishes that the veteran suffers from a current diagnosed disability which would account for his complaints of memory loss. Accordingly, this claim must be denied as not well grounded on a direct basis. See Epps, supra; see also Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (absent "proof of a present disability there can be no valid claim"). ORDER Service connection for a skin disorder involving the scalp, face, and back, to include as due to an undiagnosed illness, is denied. Service connection for obstructive sleep apnea, claimed as shortness of breath, to include as due to an undiagnosed illness, is denied. Service connection for memory loss, to include as due to an undiagnosed illness, is denied. WARREN W. RICE, JR. Member, Board of Veterans' Appeals