Citation Nr: 0810539 Decision Date: 03/31/08 Archive Date: 04/09/08 DOCKET NO. 05-34 006 ) DATE ) MERGED APPEAL ) ) On appeal from the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUES 1. Whether new and material evidence has been obtained to reopen a claim of entitlement to service connection for a left knee disorder, and if so, whether service connection is warranted for the claimed disability. 2. Whether new and material evidence has been obtained to reopen a claim of entitlement to service connection for traumatic organic brain syndrome (claimed as radiation burns on the front of the brain), to include as secondary to radiation exposure, and if so, whether service connection is warranted for the claimed disability. 3. Entitlement to service connection for leukocytosis, to include as secondary to radiation exposure. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Stephanie L. Caucutt, Associate Counsel INTRODUCTION The veteran had active military service from May 1977 to October 1978. This matter comes before the Board of Veterans' Appeals (Board) on appeal from October 2004 and April 2006 rating determinations of a Regional Office (RO) of the Department of Veterans Affairs (VA) in Muskogee, Oklahoma. Although the veteran requested a hearing before the Board, he failed to attend his hearing scheduled for October 2007. His request for a Board hearing is considered withdrawn. 38 C.F.R. § 20.704(d) (2007). The veteran's accredited representative asserts in the February 2008 Appellant's Brief that the issue of entitlement to service connection for traumatic organic brain syndrome (claimed as radiation burns on the front of the brain), to include as secondary to radiation exposure, was improperly adjudicated as a request to reopen a previously disallowed claim on this same issue. However, a review of the claims folder reveals that the veteran was denied service connection for traumatic organic brain syndrome, to include as a residual of radiation exposure, by RO rating decision dated in March 1989. As such, the Board concludes that the issue on appeal was properly characterized as a request to reopen a previously disallowed claim under 38 C.F.R. § 3.156 (2007) and that the RO properly adjudicated it as such. FINDINGS OF FACT 1. A March 1989 rating decision denied the veteran's claims of entitlement to service connection for a left knee disorder and traumatic organic brain syndrome (claimed as radiation burns on the front of the brain), to include as secondary to radiation exposure. The veteran was notified of his appellate rights, but did not file a notice of disagreement with respect to either of these issues. 2. Evidence received since the March 1989 rating decision relates to an unestablished fact necessary to substantiate the veteran's previously disallowed claim of entitlement to service connection for a left knee disorder. 3. Evidence received since the March 1989 rating decision is cumulative of the evidence of record at the time of the prior denial and does not relate to an unestablished fact necessary to substantiate the claim of entitlement to service connection for traumatic organic brain syndrome (claimed as radiation burns on the front of the brain), to include as secondary to radiation exposure. 4. The competent and credible evidence of record fails to demonstrate that the veteran's current degenerative arthritis of the left knee manifested during service, manifested within one year of service separation, or is otherwise related to military service. 5. The competent evidence fails to demonstrate that the veteran has a current disability manifested by or related to chronic leukocytosis. CONCLUSIONS OF LAW 1. The March 1989 rating decision which denied the veteran's claims of entitlement to service connection for a left knee disorder and traumatic organic brain syndrome (claimed as radiation burns on the front of the brain), to include as secondary to radiation exposure, is final. 38 U.S.C.A. § 7105(c) (West 2002); 38 C.F.R. § 20.1003 (2007). 2. Evidence received since the March 1989 rating decision in connection with veteran's claim of entitlement to service connection for a left knee disorder is new and material and the claim is reopened. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2007). 3. Evidence received since the March 1989 rating decision in connection with veteran's claim of entitlement to service connection for traumatic organic brain syndrome (claimed as radiation burns on the front of the brain), to include as secondary to radiation exposure, is not new and material. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2007). 4. A left knee disorder was not incurred in or aggravated by the veteran's active duty service, nor may it be presumed to have been incurred in or aggravated by the veteran's active duty service. 38 U.S.C.A. §§ 1101, 1112, 1131, 1137, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2007). 5. Leukocytosis was not incurred in or aggravated by the veteran's active duty service. 38 U.S.C.A. §§ 1131, 5107 (West 2002); 38 C.F.R. § 3.303 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VA's Duties to Notify and Assist Under the Veterans Claims Assistance Act (VCAA), when VA receives a complete or substantially complete application for benefits, it must notify the claimant of the information and evidence not of record that is necessary to substantiate a claim, which information and evidence VA will obtain, and which information and evidence the claimant is expected to provide. 38 U.S.C.A. § 5103(a) (West 2002). VA must request that the claimant provide any evidence in the claimant's possession that pertains to a claim. 38 C.F.R. § 3.159 (2007). See also Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004) (Pelegrini II). With respect to the veteran's requests to reopen previously disallowed claims of entitlement to service connection for a left knee disorder and traumatic organic brain syndrome (claimed as radiation burns on the front of the brain), to include as secondary to radiation exposure, the Board observes that the Court of Appeals for Veterans Claims (Court) has prescribed additional notice requirements. Specifically, in Kent v. Nicholson, 20 Vet. App. 1 (2006), the Court held that in order to successfully reopen a previously and finally disallowed claim, the law requires the presentation of a special type of evidence - evidence that is both new and material. The terms "new" and "material" have specific, technical meanings that are not commonly known to VA claimants. Because these requirements define particular types of evidence, when providing the notice required by the VCAA it is necessary, in most cases, for VA to inform claimants seeking to reopen a previously and finally disallowed claim of the unique character of evidence that must be presented. This notice obligation, however, does not modify the requirements discussed above. See Dingess v. Nicholson, 19 Vet. App. 473 (2006). In other words, VA must notify a claimant of the evidence and information that is necessary to reopen the claim and VA must notify the claimant of the evidence and information that is necessary to establish his or her entitlement to the underlying claim for the benefit sought. In the present case, the Board finds that VA provided the veteran with necessary and proper VCAA notice regarding all of his claims on appeal. In this regard, letters sent to the veteran in August 2004 and January 2006 notified him of the evidence and information necessary to establish entitlement to his original and underlying claims to service connection for left knee disorder, traumatic organic brain syndrome, and leukocytosis. Moreover, the August 2004 letter provided appropriate notice regarding what constituted new and material evidence, and specifically informed him what evidence and information was necessary to reopen his previously disallowed claims. The August 2004 and January 2006 letters also advised the veteran of the types of evidence VA would assist him in obtaining as well as his own responsibilities with regard to identifying relevant evidence. See Quartuccio v. Principi, 16 Vet. App. 183 (2002); Charles v. Principi, 16 Vet. App. 370 (2002). Finally, these letters expressly informed the veteran of the need to submit any pertinent evidence in his possession. The Board notes that the veteran was not provided with notice regarding the disability rating and effective date in accordance with the Court's recent holding in Dingess v. Nicholson, 19 Vet. App. 473, 484 (2006). Nevertheless, the Board finds this error to be nonprejudicial to the veteran. See Mayfield v. Nicholson, 19 Vet. App. 103 (2005). In this regard, the Board has concluded that a preponderance of the evidence is against all of his claims on appeal. Any questions as to the appropriate disability rating or effective date to be assigned have therefore been rendered moot, and the absence of notice on these two elements of a service connection claim should not prevent a Board decision. Finally, the Board observes that the August 2004 and January 2006 letters were sent to the veteran prior to the October 2004 and April 2006 rating decisions, respectively. Thus, VCAA notice with respect to the elements addressed in this letter was timely. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). The Board finds that there has also been substantial compliance with the assistance provisions set forth in the law and regulations. In this regard, relevant service medical records are associated with the claims folder, as well as all relevant and available VA and private treatment records identified by the veteran. The veteran indicated during this appeal that he was treated for his claimed disabilities at the VA Medical Centers (MC) in Tampa, Florida between 1978 and 1979 and Phoenix, Arizona between 1979 and 1981. However, a request for such records returned negative responses from both facilities. The veteran was notified of the unavailability of these records in an August 2005 statement of the case. Under such circumstances, the Board finds that further attempts to obtain such records would be futile and that that VA has fulfilled its duty to assist the veteran in obtaining these outstanding treatment records. See 38 C.F.R. § 3.159(c)(2). In addition to the above VA treatment records, the veteran asserted that he was seen at the Dallas VAMC during the early 1980s for left knee pain. Records from the Dallas VAMC dated 1988 are already of record; nevertheless, the RO made two requests in April and June 2005 for all records pertaining to the veteran from this facility for the period from 1981 through 1988. In response to the RO's request, the Dallas VAMC sent an appointment list showing treatment during 1988. Thus, it appears that treatment records before 1988 do not exist. Since the 1988 clinical records are already associated with the claims folder, there is no need to remand this appeal. The veteran has not identified any additional relevant, outstanding records that need to be obtained before deciding his claims. The Board notes that the veteran reported that he is in receipt of disability benefits from the Social Security Administration (SSA) at an April 2005 VA examination. The Board has considered whether a remand is necessary to obtain records pertaining to the veteran's SSA disability claim; however, the veteran indicated that these benefits pertain to a low back disability. As the issue of service connection for a low back disability is not on appeal, such records are not relevant to the Board's inquiry. No remand is therefore necessary. The veteran was provided a VA examination in conjunction with his claimed left knee disorder; however, no VA examinations were provided with respect to the veteran's claimed leukocytosis and traumatic organic brain syndrome. VA is under no duty to provide a VA examination when a veteran is requesting that a previously disallowed claim be reopened. 38 C.F.R. § 3.159(c)(4)(C)(iii) (2007). Yet, because the veteran's claim of entitlement to service connection for leukocytosis is an original claim for service connection, the Board must consider whether a VA examination is warranted by the evidence of record. In the present case, the Board finds that a VA examination is not required because there is sufficient competent medical evidence to decide this claim. See 38 C.F.R. § 3.159(c)(4) (2007). VA has a duty to provide a VA examination when the record lacks evidence to decide the veteran's claim and there is evidence of (1) a current disability, (2) an in-service event, injury, or disease, and (3) some indication that the claimed disability may be associated with the established event, injury, or disease. Id.; see also McLendon v. Nicholson, 20 Vet. App. 79 (2006). As discussed in more detail below, leukocytosis is not a disability in and of itself. Moreover, the current record contains no competent diagnosis of a disability manifested by or related to the veteran's laboratory findings of chronic leukocytosis. Thus, the veteran has not presented evidence to satisfy the first McLendon requirement. VA is therefore not required to provide him with a VA examination in conjunction with his claim. Under the circumstances of this case, "the record has been fully developed," and "it is difficult to discern what additional guidance VA could have provided to the veteran regarding what further evidence she should submit to substantiate his claim." Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). Therefore, the Board is satisfied that VA has complied with the duty to assist requirements of the VCAA and the implementing regulations and the record is ready for appellate review. Analysis I. New and Material Evidence Generally, an unappealed RO denial is final. However, the veteran may request that VA reopen his claim upon the receipt of 'new and material' evidence. 38 U.S.C.A. § 5108 (West 2002). If new and material evidence is presented or secured with respect to a claim that has been disallowed, VA must reopen the claim and review its former disposition. Id. See also Hodge v. West, 155 F.3d 1356, 1362 (Fed. Cir. 1998). According to 38 C.F.R. § 3.156(a) (2007), 'new and material' evidence means existing evidence that by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. Id. A. Left Knee Disorder The veteran was previously denied entitlement to service connection for a left knee disorder, namely, bursitis, by a March 1989 rating decision on the basis that the competent medical evidence failed to show that the veteran had a current left knee disability. The evidence of record at the time of this denial consisted of the veteran's service medical records, Dallas VAMC treatment records dated July 1988 through September 1988, a December 1988 VA examination report, and private treatment records from HCA Medical Center of Plano, Texas. The RO denied the veteran's June 2004 request to reopen this previously disallowed claim in October 2004; the veteran received notice of the decision and timely appealed it. With respect to the evidence submitted since the March 1989 rating decision, of note is a January 2005 MRI of the veteran's left knee which reflects findings of mild degenerative changes of the knee. Also pertinent to the veteran's request to reopen his previously disallowed claim is the April 2005 VA examination report which provides a diagnosis of "symptomatic left knee with mild degenerative arthritis." The Board finds such evidence to be both new and material. See Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). In this regard, the evidence presented was not available at the time of the prior decision; therefore, it is new. Moreover, the evidence discussed above is material because it indicates that the veteran has a current left knee disorder, which was the basis for the prior RO denial. The Board therefore holds that the newly submitted evidence is so significant that it must be considered in order to fairly decide the merits of this claim, and as such, the claim for entitlement to service connection for a left knee disorder must be reopened for full review. 38 C.F.R. § 3.156(a). B. Traumatic Organic Brain Syndrome (claimed as radiation burns to the front of the brain) The veteran was previously denied entitlement to service connection for traumatic organic brain syndrome (most recently claimed as radiation burns to the front of the brain) as secondary to radiation exposure during service by a March 1989 rating decision. The claim was denied on the basis that the evidence of record at the time, which consisted of service medical records, Dallas VAMC treatment records dated July 1988 through September 1988, a December 1988 VA examination report, and private treatment records from HCA Medical Center of Plano, Texas, did not show any exposure to radiation during service which led to the development of a traumatic organic brain syndrome. Additionally, the competent evidence of record at the time indicated that the veteran's traumatic organic brain syndrome was related to a June 1985 severe head injury, and not any injury or incident of military service. In June 2004 the veteran filed to reopen his claim. An October 2004 RO rating decision denied the veteran's application to reopen due to a lack of new and material evidence. The veteran was again notified of his appellate rights, and perfected an appeal of this issue. New evidence received since the March 1989 rating decision includes more statements from the veteran, copies of the veteran's personnel records, treatment records from the Oklahoma City and Muskogee VAMCs dated from 1988 through April 2007, and private treatment records from the Dallas Pain Center, the Head and Spine Institute of Texas, CT Radiology Associates, Ltd., the Texas Pain Institute, and Dr. Carr of Denton, Texas. A review of this newly received evidence reflects that the veteran has continued to received treatment for "significant neuropsychological deficits likely related to [the] 1985 accident." See e.g., VA Neuropsychological Testing Report dated December 29, 1988; see also VA Hospital Summary for period from September 13, to September 19, 1989. Records also show that CT scans and MRIs reflect multiple areas of infarction involving the right hemisphere as well as deep frontal lobe white matter as well as a left lateral orbital fracture related to the June 1985 head injury. See MRI of Brain dated September 19, 1991; CT scan dated September 11, 1992; VA Hospital Summary for period from September 13, to September 19, 1989. Finally, of record is a description of the claimed radiation exposure experienced by the veteran. After careful consideration, the Board concludes that this newly received evidence does not raise a reasonable possibility of substantiating the veteran's claim; thus, it is not material. In this regard, the above mentioned evidence, while new, does not suggest that the veteran's traumatic organic brain syndrome is related to any in-service incident or injury, including possible radiation exposure. Instead, the veteran's post-service medical records continue to discuss all of the veteran's neurological and psychological problems in the context of his June 1985 severe head injury in which his head was crushed between two trucks. Since none of this newly submitted evidence pertains to the reasons for the prior denial nor raises a reasonable possibility of substantiating the veteran's underlying claim, the Board concludes that the veteran's request to reopen the previously disallowed claim of entitlement to service connection for traumatic organic brain syndrome (claimed as radiation burns to the front of the brain) must be denied. 38 C.F.R. § 3.156(a). II. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. § 3.303(a) (2007). That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 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. 38 C.F.R. § 3.303(d). Additionally, certain chronic disabilities, such as arthritis, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. §§ 1101, 1112, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2007). A. Left Knee Disorder The veteran asserts that he is entitled to service connection for a left knee disorder as such disability is related to an in-service left knee injury. Records show that he reports left knee pain continuous since service. See, e.g., VA Orthopedic Note dated May 12, 1995 (veteran reported a sixteen year history of pain with increased intensity and locking). After careful consideration of all the evidence of record, the Board concludes that service connection for a left knee disorder is not warranted. In this regard, although the veteran did experience a left knee injury during service, the weight of the competent and credible evidence fails to show a diagnosis of degenerative arthritis of the left knee within one year of service separation or a relationship between the veteran's currently diagnosed degenerative arthritis of the left knee and his in-service injury. 38 U.S.C.A. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. The veteran's service medical records show that he was involved in an automobile accident during service and treated for traumatic prepatellar bursitis. See Service Clinical Record dated July 17, 1978. Following five days of hospital bed rest, the veteran was released to duty with no restrictions. See Service Record dated July 23, 1978. He was evaluated approximately two months later for service separation, at which time it was noted that he was treated with "good results" in July 1978 for prepatellar bursitis of the left knee. The September 1978 examination report indicates that a clinical examination of the veteran's left knee was normal and that the veteran did not report any "trick" knee, locked knee, or knee joint problems on his medical history form. Following service, the veteran's medical records reflect evaluation for complaints of left knee pain beginning in March 1986. These records, however, do not demonstrate evidence of a left knee disability until January 2005. See MRI Report dated January 31, 2005; see also April 2005 VA Examination Report. Prior to January 2005, the veteran's medical records show evaluation for complaints of knee pain and instability, ultimately diagnosed as left knee pain (or patellofemoral pain). See, e.g., VA Clinical Records dated February 26, 1992, May 12, 1995, and November 6, 1997. "Left knee pain," by itself, is not a disability for the purposes of service connection. See Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999), appeal dismissed, 259 F.3d 1356 (Fed. Cir. 2001). The Board acknowledges that a March 1986 orthopedic clinical record notes a diagnosis of "probable" degenerative joint disease of the left knee. This diagnosis, however, was never confirmed or continued in the veteran's medical records. Furthermore, X-rays taken of the veteran's left knee between March 1986 and January 2005 were all normal. See VA Clinical Records and X-ray Reports dated March 5, 1986, February 26, 1992, March 31, 1992, May 12, 1995, December 2, 1997, and December 1, 1998. In January 2005, the veteran underwent an MRI of the left knee. The report indicates findings of degenerative changes of the left knee. In April 2005, a VA examiner relied on these findings in providing a diagnosis of "symptomatic left knee with mild degenerative arthritis." The examiner also provided an opinion regarding the etiology of the veteran's current left knee disability based on an interview with the veteran, a physical examination, and a review of the veteran's claims folder, including service medical records. Specifically, following a review of the veteran's records, the examiner indicated that the veteran's in-service injury was "acute," and did not result in a "chronic knee condition." The examiner also noted that a clinical examination of the veteran's left knee at a December 1988 VA examination was normal. Therefore, in light of the lack of clinical evidence of degenerative changes until January 2005, it was the examiner's opinion that "it is less likely than not that the veteran's current left knee condition is due to his military service." The Board notes that many of the veteran's post-service medical records were not associated with the claims folder until after the April 2005 VA examination. Nevertheless, the Board finds the opinion provided in this report probative as to the issue of a medical nexus. In this regard, the veteran reported at the April 2005 VA examination that he was seen for recurrent symptoms of left knee pain and instability since the 1980s, but that treatment for something other than knee pain did not occur until recently (examiner noted that an orthotic sleeve was prescribed in January 2005). Such statements are consistent with the contemporaneous medical evidence of record which, as already discussed, show normal clinical evaluations of the veteran's left knee with a diagnosis of left knee pain until January 2005. Under these circumstances, it is difficult to conclude how a review of the veteran's VA medical records would significantly alter the VA examiner's April 2005 conclusions. Thus, the April 2005 VA examination report and medical opinion remains probative to the Board's determination. In addition to the negative VA nexus opinion, the Board finds that evidence of an intercurrent left knee injury weighs against the veteran's claim. Post-service medical records show that the veteran's left knee was struck by a moving vehicle in March 1992. See VA Emergency Department Record dated March 31, 1992. Although there is evidence of complaints of left knee pain prior to these injuries, the Board finds additional injury to the left knee pertinent in light of the significant period of time between the veteran's in-service injury and the first evidence of degenerative arthritis. The Board has considered the veteran's own lay statements that his left knee degenerative arthritis is related to his in-service left knee injury. This determination, however, is not a matter for an individual without medical expertise. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Thus, while the Board has considered such lay evidence in accordance with Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006), it cannot be considered competent evidence. The Board has also considered the veteran's assertions that he has experienced left knee problems since service as such lay evidence is relevant to the issue of continuity of symptomatology. Despite a lack of contemporaneous evidence of left knee problems prior to March 1986, the Board finds the veteran competent to report that he has experienced left knee pain since his 1978 in-service injury. However, as discussed above, these complaints of pain were not associated with a clinical diagnosis of a disability or disease until January 2005. See Sanchez-Benitez, supra. Moreover, despite the veteran's competency to report left knee pain since service, the Board finds that these statements are not credible. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (it is the responsibility of the Board to assess the credibility and weight to be given the evidence) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). See also Buchanan, supra. In adjudging the credibility of the veteran's assertions of continuity of symptomatology since service, the Board notes that he failed to make any mention of left knee pain at his September 1978 separation examination. Additionally, when the veteran applied for VA benefits in November 1979 he made no mention of any left knee disability, despite recent statements that he was experiencing left knee pain at such time. In fact, it was not until October 1988 that the veteran first applied for VA compensation for a left knee disorder. The timing of this claim is relevant in light of evidence that he was involved in a relatively serious on-the- job accident in June 1985 in which he was pinned/crushed between two trucks with trailers. This accident resulted in numerous injuries, including a fractured skull, loss of consciousness, extensive facial injuries, and paralyzation of the left side of his body. See December 1988 VA Examination Report; see also Dr. Carr Treatment Report dated February 6, 1987. Although no specific injury to the left knee is mentioned in the veteran's medical records, there is some indication that the left side of his body was injured. Finally, despite reportedly seeking treatment at VAMCs in Florida and Texas in the years immediately following service, attempts to locate these alleged records yielded negative results. The Tampa VAMC system reported that there was no record of the veteran in its system and the Dallas VAMC system was unable to locate any record of appointments except for the year 1988. The Board finds the above evidence directly contradicts the veteran's lay statements of record regarding left knee problems since service, thereby rendering such statements not credible. It therefore appears that the first evidence of left knee problems/pain following service is March 1986. This is nearly a decade following service. The Board concludes that such evidence weighs against the veteran's claim. . See Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); see also Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002) (en banc) (the Board may, and will, consider in its assessment of a service connection the passage of a lengthy period of time wherein the veteran has not complained of the maladies at issue). In sum, the competent and credible evidence of record demonstrates that the veteran experienced an acute left knee injury during service. Approximately ten years following service, and less than one year after an accident which paralyzed the left side of his body, he began to experience left knee pain without pathology. Subsequent to another left knee injury in 1992 and more than a decade of continued complaints of pain, the veteran was diagnosed with degenerative arthritis in 2005. Such disability, according to the probative April 2005 VA examination report, is less likely than not related to the veteran's acute in-service injury. With consideration of the probative VA examiner's report, the length of time following service prior to evidence of left knee problems, an intercurrent left knee injury prior to a diagnosis of degenerative arthritis, and the absence of any medical opinion suggesting a causal link to the veteran's service, the Board finds that a preponderance of the evidence is against the veteran's claim of service connection for a left knee disorder. 38 C.F.R. §§ 3.303, 3.307, 3.309. Consequently, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). B. Leukocytosis The veteran contends that he is entitled to service connection for leukocytosis as secondary to radiation exposure during service. His current medical records show that he has a history of stable, mild, chronic luekocytosis. See, e.g., Primary Care Clinic Note dated June 29, 2004. Leukocytosis is defined as an "increase in the number of leukoctyes [white blood cells] in the blood." Dorland's Medical Illustrated Dictionary, 1021 (30th ed. 2003). As noted above, service connection can only be granted for a disability resulting from disease or injury. See also Brammer v. Derwinski, 3 Vet. App. 223 (1992) (in the absence of proof of a present disability, there can be no valid claim for service connection as Congress has specifically limited entitlement to service connection to cases where such incidents have resulted in a disability). Leukocytosis is a laboratory finding. As such, it is not a disability within the meaning of the law granting compensation benefits. The Board has carefully reviewed the evidence of record, including the veteran's February 2005 statement that his VA doctor noted that he had "leukemia mild and stable." However, there is no competent medical evidence of any symptoms, clinical findings, disease or disability associated with the veteran's leukocytosis. Leukemia is not a simple diagnosis; therefore, in the absence of any supporting evidence in the veteran's medical records, the veteran's February 2005 lay statement is insufficient to establish a diagnosis. See Espiritu, supra; see also Jandreau v. Nicholson, No. 2007-7029 (Fed. Cir. July 3, 2007). The Board acknowledges that chronic leukocytosis is present; however, despite such finding, the record does not contain competent evidence of disability manifested by or related to leukocytosis. In the absence of proof of a current disability from leukocytosis, service connection for leukocytosis is not warranted. Id. ORDER The veteran's request to reopen his previously disallowed claim of entitlement to service connection for traumatic organic brain syndrome (claimed as radiation burns on the front of the brain), to include as secondary to radiation exposure, is denied. New and material evidence having been submitted, the claim of entitlement to service connection for a left knee disability is reopened, and to this extent the claim is granted. Entitlement to service connection for a left knee disorder is denied. Entitlement to service connection for leukocytosis is denied. ____________________________________________ MILO H. HAWLEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs