Citation Nr: 0006831 Decision Date: 03/14/00 Archive Date: 03/17/00 DOCKET NO. 98-07 600 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Portland, Oregon THE ISSUES 1. Entitlement to service connection for hypothyroidism. 2. Entitlement to service connection for hemorrhoids. 3. Entitlement to service connection for a bilateral eye disability. 4. Entitlement to service connection for a bilateral shoulder disability. 5. Entitlement to service connection for a bilateral knee disability. 6. Entitlement to service connection for asthma. 7. Entitlement to service connection for a low back disability. 8. Entitlement to service connection for hypoglycemia. 9. Entitlement to service connection for a bilateral hand disability. 10. Entitlement to service connection for a bilateral ankle disability. 11. Entitlement to service connection for a gastrointestinal disability. 12. Entitlement to service connection for an acquired cognitive disorder, manifested by various cognitive deficits, involving visual memory, mental tracing, visual motor speed, organization and planning, and verbal fluency and abstraction. 13. Entitlement to service connection for lupus erythematosus. 14. Entitlement to service connection for rheumatoid arthritis. 15. Entitlement to service connection for residuals of Epstein-Barr virus infection, with claimed manifestations of arthralgia, myalgia, myositis, sleep disturbance, body temperature swings, frequent urination with dribbling, weight loss, hair loss, poor circulation, dizziness, thirst and extreme fatigue. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Artur F. Korniluk, Associate Counsel INTRODUCTION The veteran had active air service from September 1981 to September 1985. This matter comes to the Board of Veterans' Appeals (Board) from the Department of Veterans Affairs (VA) Portland Regional Office (RO) January 1997 rating decision which denied service connection for the disabilities at issue herein. To the extent that the veteran has attempted to file additional service-connection claims, the Board notes that only the issues decided herein are properly in appellate status. The veteran has submitted various statements concerning numerous other disabilities and symptoms. These potential claims are referred to the RO to clarify with the veteran, as may be appropriate. FINDING OF FACT There is not a reasonable possibility of valid claims concerning whether hypothyroidism, hemorrhoids, a bilateral eye disability, a bilateral shoulder disability, a bilateral knee disability, asthma, a low back disability, hypoglycemia, a bilateral hand disability, a bilateral ankle disability, a gastrointestinal disability, an acquired cognitive disorder, (manifested by various cognitive deficits, involving visual memory, mental tracing, visual motor speed, organization and planning, and verbal fluency and abstraction), lupus erythematosus, rheumatoid arthritis, or residuals of Epstein- Barr virus infection (with claimed manifestations of arthralgia, myalgia, myositis, sleep disturbance, body temperature swings, frequent urination with dribbling, weight loss, hair loss, poor circulation, dizziness, thirst and extreme fatigue) were incurred in, or aggravated by, service. CONCLUSION OF LAW Well-grounded claims of entitlement to service connection for hypothyroidism, hemorrhoids, a bilateral eye disability, a bilateral shoulder disability, a bilateral knee disability, asthma, a low back disability, hypoglycemia, a bilateral hand disability, a bilateral ankle disability, a gastrointestinal disability, an acquired cognitive disorder, (manifested by various cognitive deficits, involving visual memory, mental tracing, visual motor speed, organization and planning, and verbal fluency and abstraction), lupus erythematosus, rheumatoid arthritis, and residuals of Epstein-Barr virus infection (with claimed manifestations of arthralgia, myalgia, myositis, sleep disturbance, body temperature swings, frequent urination with dribbling, weight loss, hair loss, poor circulation, dizziness, thirst and extreme fatigue) have not been presented. 38 U.S.C.A. § 5107 (West 1991). REASONS AND BASES FOR FINDING AND CONCLUSION I. Facts On enlistment medical examination in June 1981, the veteran reported a history of having fractured both his left femur and left forearm nine years earlier. He indicated that he had sustained head trauma in a motor vehicle accident in 1971, requiring hospitalization. Objectively, uncorrected distant vision in both eyes was 20/200, correctable to 20/30; near vision was 20/20 bilaterally. Defective depth perception and defective vision were diagnosed. On medical examination in September 1981, it was indicated that at age nine he had been hit by a truck, and had been hospitalized three months. In May 1982, and on occasions thereafter in service, the veteran completed an occupational health questionnaire for work as an entomologist--which included work involving the handling of insecticides--and he did not report experiencing any pertinent symptoms or impairment. Service personnel records show that the veteran worked with insecticides as an entomology specialist. A September 1982 evaluation of his work noted "outstanding performance." His duties included inspecting and operating spraying equipment. Service medical records show that in May 1983, the veteran reported having a skin rash and having an impetiginous lesion over the left lower lip; the impression was impetigo. In July 1983, the veteran reported having arthritis of the hands and shoulders; he noted having been involved in an automobile accident two years earlier. Objective evaluation revealed no abnormalities. The assessment of possible traumatic arthritis was deferred. Follow-up evaluation later that month indicated that his shoulder pain was gone. In December 1983 the veteran reported taking Motrin(r) for "arthritis." The examiner noted that there was no entry in the chart indicating a diagnosis of arthritis, but noted--by history-- the veteran's involvement in an automobile accident from four years earlier. The veteran indicated that he had pain in his shoulders and hands. The examiner doubted that the veteran had arthritis. In December 1983 the veteran underwent an examination of the eyes, but diseases or injuries involving the eyes were not found. On a January 1984 occupational health examination questionnaire, he reported a history of asthma, hay fever or allergies, history of serious illness or injury, having been informed of an abnormal breathing test, pain in the arms, legs, feet, or hands, nose bleeding and discharge, recurrent colds and productive cough, chest pain and tightness, pain and stiffness in the joints, and back pain. In February 1984 the veteran underwent psychological testing, which reportedly showed no signs of decreased intelligence quotient. In March 1984, he received emergency room treatment due to mid-epigastric pain and vomiting. The clinical impression was acute gastroenteritis. In August 1984, he complained of tearing and discharge from the eyes and right eye swelling, but did not remember getting anything in his eyes in conjunction with his duties as an entomologist. The impression was contact allergic conjunctivitis. In August 1984 the veteran was also treated for dermatitis of the hands, probably secondary to exposure or gloves. Follow-up in October 1984 revealed that he was "doing better" with this condition; he was diagnosed with mild dermatitis and mild acne. A June 1985 eye consultation evaluation revealed that ocular health was within normal limits. In letters to the RO, the veteran indicated that he experienced a multitude of symptoms and chronic disabilities. He suggested that some of his problems developed as a result of inservice exposure to various chemicals and herbicides, including Agent Orange. In October 1988, according records from Columbia Memorial Hospital, the veteran had fallen from a 20-foot high scaffolding, landing on his right side and injuring the right shoulder and thigh. On medical examination, he complained of right shoulder pain and thigh bruising; he denied past history of significant medical problems or surgical procedures. On clinical evaluation there was no evidence of head injury, loss of consciousness, neck pain, or other injury. X-ray study of the right shoulder showed a non- displaced scapular fracture. Right anterior thigh hematoma and non-displaced right scapula fracture were diagnosed. In July 1991, he was provided emergency room treatment for symptoms of vomiting, pain the mid-epigastrium, and partial paralysis of the left leg. On medical examination in May 1994 by a private physician, a history of leukopenia, arthralgia, frequent rectal bleeding, and a non-specific fatigue syndrome were diagnosed. Later that month, hypothyroidism was diagnosed and the examiner suggested that most or all of the veteran's symptoms were related to his significant hypothyroidism. A colonoscopy report from a St. John's Hospital that month was essentially negative. The veteran's might have had small internal hemorrhoids. His gastritis was likely from his anti- inflammatory drugs. It was indicated that another medication, an H2 blocker, could heal these lesions. An upper endoscopy had revealed mild duodenitis. Medical records from John Briggs, M.D., from July 1995 to January 1996 reveal a history of numerous symptoms reported by the veteran, including gastrointestinal difficulty, sleep problems, joint stiffness, pain and "asthma." The veteran was receiving thyroid medication. He complained of asthma, but in July 1995, an evaluation revealed that asthma was reduced or non-existent. The records document the veteran's complaints, but little therein confirms the complaints the veteran asserted. On VA orthopedic examination in August 1996, the veteran reported having been exposed to herbicides. The examiner indicated that the veteran was a poor historian. It was impossible to determine how the veteran [allegedly] became contaminated, but apparently it was to have been from walking around contaminated soil. The veteran indicated that he experienced joints problems including pain, stiffness, swelling, locking, impaired motion, crepitus, and functional impairment--particularly involving the hands, knees, shoulders, ankles and back. On examination, chronic lumbosacral strain, bursitis of both shoulders, and patellofemoral pain syndrome involving both knees were diagnosed, but there was no evidence of impairment or abnormality involving the hands or ankles. The examiner believed that the veteran did not have rheumatoid arthritis. It was stated that the veteran may have had systemic lupus, but that this diagnosis was essentially deferred to the internal medical examiner. The veteran was provided a VA "Agent Orange" medical examination in August 1996, at which time he indicated experiencing various symptoms and impairments including gastrointestinal problems, lupus, hypothyroidism, asthma, fatigue, lead poisoning and sensitivity to various chemicals since service, sleep dysfunction and forgetfulness. Reportedly, he had been involved in a motor vehicle accident in 1972 resulting in multiple injuries and memory impairment. Objectively, the lungs were clear to auscultation. There was brawny discoloration of the ankles and the tops of the feet. The veteran had marked memory and cognitive deficits. The examiner diagnosed the veteran as having had head trauma, status post a motor vehicle accident, resulting in cognitive deficits. X-ray study of the lungs was negative, x-ray study of the shoulders and knees showed some focal sclerosis. A radiological study of the lumbar spine showed spina bifida occulta at S1, but radiological studies of the hands and ankles were normal. In a November 1996 addendum to the examination report, the examiner indicated that clinical studies were consistent with hypothyroidism but did not support the veteran's other complaints. On VA ophthalmologic examination in August 1996, the veteran was unable to provide a coherent history because he claimed to have died and forgotten pertinent facts. An objective evaluation revealed probable myopia. In October 1996 the veteran was provided a VA neuropsychology consultation. He had complaints of memory impairment, allegedly related to a motor vehicle accident in 1972. He indicated that as a result of the accident he had been rendered unconscious, but he was unsure about the details of any head injuries. Reportedly, he sustained a fall in 1989. Testing revealed that the veteran's intelligence was in the average range, consistent with his educational background. Objectively, he demonstrated scattered neuropsychological problems, performing below expectation in areas of visual memory, mental tracking and visual motor speed, organization and planning, verbal fluency and abstraction, and a block design construction task. The explanation, it was concluded, for these cognitive problems was not totally clear. Although the veteran apparently had had a significant head injury at age nine, he reportedly did well in school thereafter-- suggesting that he did not have any permanent or significant residuals from that injury. The examiner opined that if indeed the veteran had a history of lead poisoning and chemical sensitivity, it was possible that his current cognitive deficits were associated with these conditions. Private medical records from July 1987 to July 1997, including records from the Social Security Administration, reveal a July 1987 complaint of infection of the fifth finger of the veteran's right hand. Objectively, cellulitis of the fifth digit was diagnosed; x-ray studies of both hands revealed no abnormalities. An October 1996 Social Security Administration psychological evaluation report, by Daryl Birney, Ph.D., notes several limitations with respect to the veteran's ability to work. The date of onset of these limitations was stated to be 1994. The veteran reported the history of the childhood truck accident. The examiner noted the veteran's report of inservice exposure chemicals: "While in service he worked with herbicides and 'got chemical contamination, lupus, [and] acute blood poisening [sic].' " The examiner found that the veteran had a dysfunctional and abusive childhood. The veteran had sleep dysfunction and chronic fatigue. Currently his thoughts were scattered and his affect, blunted. He was a poor historian with a poor long-term memory. He complained of poor short-term memory, but did well on objective testing. The examiner opined that the veteran clearly had a thought disorder but stated, "...it is not clear to me to what extent that may or may not be related to his exposure to chemicals." Diagnoses included: cognitive disorder, possibly due to chemical exposure (provisional), and a psychotic disorder, not otherwise specified. A November 1996 VA clinical evaluation report notes the veteran's complaints of physical symptoms, but states that there was little evidence of disease except for hypothyroidism. Somatic anxiety and neuropsychiatric deficits were noted too. In a January 1997 psychological evaluation report by Dr. Birney, supplementing his October 1996 evaluation, it was stated that the veteran had a preoccupation with somatic problems, some of which may have been delusional or bizarre. The veteran appeared to have a delusional disorder, and at least some of his physical complaints were the result thereof. His cognitive functioning was spotty and judgment was poor, but concentration, attention, and memory were intact. Diagnoses were of a delusional disorder and multiple medical an physical complaints--of questionable validity. In April 1998, the veteran submitted to the RO several articles describing various symptoms, impairment, and suspected causes associated with systemic and neuropsychiatric lupus. One article suggests a relationship between a person's exposure to various toxic chemicals--in sufficient concentration--with subsequent onset of symptoms associated with the disease. Another article generally discusses the manifestations and treatment of lupus. A third article, apparently by a non-physician, contains a discussion of a personal experience with lupus. At a May 1998 informal RO conference, the veteran contended that the majority of his claimed disabilities, including hypothyroidism, hemorrhoids, probable myopia claimed as vision problems, hypoglycemia, numerous cognitive deficits, lupus erythematosus, rheumatoid arthritis, residuals of Epstein-Barr virus infection, and asthma, were etiologically related to his exposure to chemicals in service. He indicated that he occasionally had worked around chemicals without protective clothing, and that the claimed musculoskeletal disabilities had their onset as a result of heavy lifting during service. II. Law and analysis Service connection will be granted for disabilities resulting from personal injury suffered or disease contracted, or for aggravation of a preexisting injury suffered or disease contracted, in line of duty. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303. Service connection may also be allowed on a presumptive basis for arthritis, progressive muscular atrophy, systemic lupus erythematosus, organic diseases of the nervous system, psychoses and peptic ulcers, if the pertinent disability becomes manifest to a compensable degree within one year after a veteran's separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. For a 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, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required when the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (1999). See Savage v. Gober, 10 Vet. App. 488 (1997). Mere congenital or developmental defects, absent, displaced or supernumerary parts, refractive error of the eye, personality disorder and mental deficiency are not diseases or injuries in the meaning of applicable legislation for disability compensation purposes. 38 C.F.R. §§ 3.303(c), 4.9. The VA general counsel has held, however, that service connection may be granted for diseases--but not defects--of congenital, developmental or familial origin if the evidence as a whole shows that the manifestations of the disease in service constituted "aggravation" of the disease within the meaning of applicable VA regulations. VAOPGCPREC 82-90; 38 C.F.R. §§ 3.303(c), 3.306. Title 38 U.S.C.A. § 1116 provides that a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, and has one or more certain specified diseases, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to the contrary. See McCartt v. Brown, 12 Vet. App. 164 (1999). See 38 U.S.C.A. § 1116(a) and 38 C.F.R. § 3.309(e) (regarding specific Agent-Orange presumptive diseases). In order for a service-connection claim to be well grounded, there generally must be a medical diagnosis of a current disability, medical or sometimes lay evidence of incurrence or aggravation of a disease or injury in service, and a medical nexus between the inservice injury or disease and the current disability. The nexus requirement may be satisfied by a presumption that certain diseases manifesting themselves within certain prescribed periods are related to service. Caluza v. Brown, 7 Vet. App. 498 (1995), aff'd per curiam, 78 F.3d 604 (Fed.Cir. 1996) (table). The truthfulness of evidence is generally presumed in determining whether a claim is well grounded. Meyer v. Brown, 9 Vet. App. 425, 429 (1996). The presumption of credibility does not extend to evidence that is inherently incredible. See King v. Brown, 5 Vet. App. 19 (1993); Robinette v. Brown, 8 Vet. App. 69 (1995). Where the determinative issue involves a question of medical diagnosis or causation, competent medical evidence to the effect that the claim is plausible is required to establish a well-grounded claim. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Libertine v. Brown, 9 Vet. App. 521, 522 (1996); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). A lay person is generally not competent to make a medical diagnosis or to relate a medical disorder to a specific cause. See Grivois v. Brown, 6 Vet. App. 136, 140 (1994). Thus, lay statements regarding a medical diagnosis or causation do not constitute evidence sufficient to establish a well-grounded claim under 38 U.S.C.A. § 5107(a). In this case, as the veteran admits, he did not serve in the Republic of Vietnam. Thus, the presumptive Agent Orange regulations are not for application despite the veteran's alleged inservice exposure to that substance. This does not preclude him, however, from attempting to establish service connection for any chronic disability on a direct basis based on exposure to chemical agents including Agent Orange. 38 C.F.R. § 3.303(d). Compare Combee v. Brown, 34 F.3d 1039 (Fed.Cir. 1994) (a radiogenic disease not listed in the presumptive service provisions precluded service connection on a presumptive basis, but did not preclude service connection on a direct basis). The veteran does have current diagnoses of hypothyroidism and "hemorrhoids." He had no such diagnoses in service, however, and no medical evidence in the record links either disability with service or with any claimed inservice chemical exposure. The veteran is not qualified to proffer such an opinion. Espiritu v. Derwinski, 2 Vet. App. 492 (1992); see Heuer; Grivois, supra. To the extent the veteran is claiming service connection for myopia, i.e. refractive error of the eyes, such is not considered a disability and cannot be service connected. 38 C.F.R. §§ 3.303(c); 4.9. Service medical records clearly and repeatedly show no ocular disability as defined by VA regulations. There is no evidence of any current ocular disability, much less of any link to service for such claimed condition. Thus, the claim of service connection for this condition is entirely implausible, or not well grounded. The veteran does have current diagnoses involving the shoulders and the knees: bursitis and patellofemoral pain syndrome, respectively. Both sets of joints have also displayed focal sclerosis, postservice. Aside from some inconsistent history reported in the service medical records as to when the veteran's motor vehicle accident may have occurred, there is no actual evidence of such an accident occurring during service. Moreover, none of these postservice diagnoses have been linked to service by medical evidence, and the veteran is not qualified to provide such a nexus himself. The service-connection claims for these disabilities are not well grounded. The veteran does not have a clear diagnosis of current asthma, and never had such a diagnosis in service. Even if he were to have current asthma, none of his postservice respiratory complaints have been medically linked to service- -whether to the alleged inservice chemical exposure or otherwise. Thus, the claim of service connection for this disability is not well grounded. There is no evidence in service of a low back disability. Aside from the question of the postservice spina bifida being a congenital condition, no medical evidence links it or any other low back condition to service. Specifically, veteran's postservice chronic lumbosacral strain has not been medically linked to service. Thus, the service-connection claim for a low back disability is not well grounded. Service medical records show no inservice diagnosis of hypoglycemia, and the veteran has provided no medical evidence of a current diagnosis, much less any medical evidence of a nexus of such an alleged condition to service. The service-connection claim for hypoglycemia thus is not well grounded. The veteran has no current orthopedic disability of the hands. Although he has had numerous complaints of arthritis thereof, no medical evidence confirms this. Inservice findings ultimately did not indicate such a diagnosis was warranted, and no arthritis has been shown to a compensable degree within a year of service. The veteran did have dermatitis of the hands in service, but the condition was treated and improved. In any event, recent postservice medical evidence reveals no dermatitis of the hands. The postservice cellulitis of the one finger has not been medically related to service. Without any such evidence, the service-connection claim for a disability of the hands is not well grounded. There is no evidence of an orthopedic disability of the ankles either from service or thereafter. Although there was a postservice finding of brawny discoloration of the ankles, this was not shown in service and no medical evidence links this finding to service either. Therefore, the claim of service connection for a bilateral ankle disability is not well grounded. The veteran has provided medical evidence of some recent gastrointestinal findings. These findings generally show acute gastritis due to his medication; a condition that reportedly can be treated with an H2 blocker. Neither this condition, nor veteran's postservice duodenitis, have been medically linked to service. Since the veteran is not qualified to proffer such a medical opinion, as with the other disabilities at issue in this case, the claim of service connection for a gastrointestinal disability is not well grounded. Regarding the veteran's service-connection claim for a cognitive disorder, no such diagnosis was ever rendered in service. The veteran claims, however, that he was exposed to Agent Orange and perhaps other toxic chemicals, and that this resulted in his cognitive deficits. Although he has been diagnosed postservice with a cognitive disorder, the psychologist who indicated in late 1996 that this disability may or may not be linked to alleged inservice chemical exposure, based that opinion on an inaccurate history provided by the veteran. In particular, the veteran indicated that he had worked in service with herbicides, becoming contaminated, incurring blood poisoning and lupus. Aside from the lack of any documentation that the veteran was exposed to any particular herbicide, the Board stresses that there is no competent medical evidence whatsoever that the veteran ever incurred any such residuals such as "blood poisoning" from any chemical in service. The only evidence of a possible inservice chemical effect was dermatitis of the hands, which, as indicated, has not been recently shown; nor did the psychologist note that particular condition. The veteran's complaints of any inservice chemical injury beyond that are not supported by the service medical records. Therefore, to the extent that the psychologist relied on the veteran's inaccurate report of the inservice medical history- -such as chemical exposure strong enough to cause blood poisoning or lupus--the psychologist's opinion cannot well ground this claim. See Godfrey v. Brown, 8 Vet. App. 113, 121 (1995) (the Board is not required to accept physicians' opinions that are based upon an appellant's recitation of medical history); LeShore v. Brown, 8 Vet.App. 406 (1995); (a bare transcription of a lay history is not transformed into "competent medical evidence" merely because the transcriber happens to be a medical professional); cf. Black (Patrick) v. Brown, 10 Vet. App. 279, 284 (1997). In Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992), when an examiner stated that a disability "may" have been related to service, this implied that it also "may not" have been; such a claim was therefore not well grounded. This is essentially what the psychologist in this case stated. Moreover, the psychologist here provided nothing, other than the veteran's inaccurate reported history, to support the provisional finding. See Bloom v. West, 12 Vet. App. 185 (1999) (where no clinical support or other rationale for a physician's opinion was proffered, and there was nothing otherwise in the record that would give it substance, the claim was not well grounded). Finally, in any event, in January 1997, the same psychologist changed the veteran's diagnosis to a delusional disorder, noting that the veteran had somatic complaints--of questionable validity--as a result thereof. Likewise the October 1996 VA neuropsychology consultation report indicates that the cognitive deficits might be due to lead poisoning and chemical sensitivity, if such were shown. The Board finds, however, that nothing in the record supports any such finding of lead poisoning and chemical sensitivity, and thus the nexus opinions which relied on such inaccurate history are not sufficient to well ground the claim. The Board finds, therefore, that the veteran's service- connection claim for a cognitive disorder, manifested by various cognitive deficits, involving visual memory, mental tracing, visual motor speed, organization and planning, and verbal fluency and abstraction, is not well grounded. The veteran has only an equivocal diagnosis of current lupus erythematosus. Current records frequently note that he asserts he has the disability, but do not generally support this with any clinical findings or actual diagnoses. The one examiner who noted it in August 1996, deferred to another VA examiner--apparently the one who conducted the "Agent Orange" examination--who did not, in turn, render such a diagnosis of lupus. In fact, no other medical expert has confirmed the diagnosis. Nonetheless, if the Board presumes for the purposes of determining well groundedness that the veteran does have a current diagnosis of lupus erythematosus, he never had such a diagnosis in service, or to a compensable degree within a year of service. Further, no physician of record has actually linked such presumed current lupus erythematosus to service or to alleged inservice chemical exposure. The veteran has submitted a few medical articles that generally discuss lupus, but these articles are of a general nature. The service medical and personnel records do not demonstrate that the veteran was exposed to any particular chemical in service that any of these articles identify, and in any event, nothing in the articles appears to relate in any way to his particular medical situation. Since these articles do not pertain to this veteran, they cannot serve to well ground this service-connection claim for lupus erythematosus. Sacks v. West, 11 Vet. App. 314 (1998); compare Wallin v. West, 11 Vet. App. 509 (1998) (where much more specific treatise evidence--that linked a particular risk group to which that claimant objectively belonged to a specific disability that had been diagnosed--helped to well ground the claim). The veteran has submitted no evidence whatsoever that he has rheumatoid arthritis or was ever infected by the Epstein Barr virus--either in service or postservice. As noted, while there was some assertion in service by the veteran that he had arthritis, this diagnosis was ultimately dismissed. In any event, he has no current diagnosis of rheumatoid arthritis--postservice testing for this disability has been negative. None of the veteran's subjective complaints of arthralgia, myalgia, myositis, sleep disturbance, body temperature swings, frequent urination with dribbling, weight loss, hair loss, poor circulation, dizziness, thirst or extreme fatigue--whether associated with claimed Epstein-Barr "syndrome" or otherwise--have been related to any diagnosis shown in service or medically linked to service. The veteran is not qualified to proffer a medical diagnosis for his complaints or to provide such a nexus to service. The service-connection claims for these disabilities/symptoms is not well grounded. See generally, Sanchez-Benitez v. West, 13 Vet. App. 282 (1999) (pain alone, without a diagnosed or identifiable underlying malady or condition, usually does not in and of itself constitute a disability for which service connection may be granted). Accordingly, the foregoing claims must be denied. Edenfield v. Brown, 8 Vet. App. 384 (1995). The RO has advised the veteran of the evidence necessary to establish a well-grounded claim. While there may be additional medical records available pertaining to this veteran, nothing in the record indicates that such records could well ground these claims. The Board consequently finds that there is no duty under 38 U.S.C.A. § 5103 to obtain any additional records. Robinette v. Brown, 8 Vet. App. 69 (1995). Since the issues in this case are held as not well grounded, the benefit-of-the-doubt rule does not apply. Holmes v. Brown, 10 Vet. App. 38 (1997). ORDER Entitlement to service connection for hypothyroidism, hemorrhoids, a bilateral eye disability, a bilateral shoulder disability, a bilateral knee disability, asthma, a low back disability, hypoglycemia, a bilateral hand disability, a bilateral ankle disability, a gastrointestinal disability, an acquired cognitive disorder, (manifested by various cognitive deficits, involving visual memory, mental tracing, visual motor speed, organization and planning, and verbal fluency and abstraction), lupus erythematosus, rheumatoid arthritis, and residuals of Epstein-Barr virus infection, (with claimed manifestations of arthralgia, myalgia, myositis, sleep disturbance, body temperature swings, frequent urination with dribbling, weight loss, hair loss, poor circulation, dizziness, thirst and extreme fatigue) is denied. Mark Chestnutt Acting Member, Board of Veterans' Appeals