Citation Nr: 0812552 Decision Date: 04/15/08 Archive Date: 05/01/08 DOCKET NO. 04-37 138 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Eligibility for VA medial care and related benefits provided by 38 U.S.C. Chapter 17 for treatment of a right ankle disability. 2. Eligibility for VA medial care and related benefits provided by 38 U.S.C. Chapter 17 for treatment of a left ankle disability. 3. Eligibility for VA medial care and related benefits provided by 38 U.S.C. Chapter 17 for treatment of a back disability. 4. Eligibility for VA medial care and related benefits provided by 38 U.S.C. Chapter 17 for treatment of a left foot disability. REPRESENTATION Appellant represented by: Texas Veterans Commission ATTORNEY FOR THE BOARD A. Barone, Associate Counsel INTRODUCTION The appellant in this case had active service from February 1978 to August 1979. The appellant's discharge has been determined to have been issued under dishonorable conditions. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2003 rating determination of a Regional Office (RO) of the Department of Veterans Affairs (VA). This matter was previously before the Board in December 2006, when it was remanded to obtain the claimant's records in the custody of the Social Security Administration (SSA). FINDINGS OF FACT 1. The appellant's discharge was issued under dishonorable conditions. 2. The November 1978 in-service right ankle injury was acute in nature and resolved without residual chronic disability. 3. A chronic right ankle disability is not shown to have manifested during the claimant's active duty or for many years thereafter, nor is any current right ankle disability shown to be otherwise related to service. 4. The March 1979 in-service left ankle injury was acute in nature and resolved without residual chronic disability. 5. A chronic left ankle disability is not shown to have manifested during the claimant's active duty or for many years thereafter, nor is any current left ankle disability shown to be otherwise related to service. 6. The February 1979 in-service back injury was acute in nature and resolved without residual chronic disability. 7. A chronic back disability is not shown to have manifested during the claimant's active duty or for many years thereafter, nor is any current back disability shown to be otherwise related to service. 8. The March 1979 in-service left foot injury was acute in nature and resolved without residual chronic disability. 9. A chronic left foot disability is not shown to have manifested during the claimant's active duty or for many years thereafter, nor is any current left foot disability shown to be otherwise related to service. CONCLUSIONS OF LAW 1. Eligibility for VA medial care and related benefits provided by 38 U.S.C. Chapter 17 for treatment of a right ankle disability is not warranted. 38 U.S.C.A. §§ 105, 1131, 1701-1754 (West 2002); 38 C.F.R. §§ 3.1, 3.303, 3.304, 3.360 (2007). 2. Eligibility for VA medial care and related benefits provided by 38 U.S.C. Chapter 17 for treatment of a left ankle disability is not warranted. 38 U.S.C.A. §§ 105, 1131, 1701-1754 (West 2002); 38 C.F.R. §§ 3.1, 3.303, 3.304, 3.360 (2007). 3. Eligibility for VA medial care and related benefits provided by 38 U.S.C. Chapter 17 for treatment of a back disability is not warranted. 38 U.S.C.A. §§ 105, 1131, 1701- 1754 (West 2002); 38 C.F.R. §§ 3.1, 3.303, 3.304, 3.360 (2007). 4. Eligibility for VA medial care and related benefits provided by 38 U.S.C. Chapter 17 for treatment of a left foot disability is not warranted. 38 U.S.C.A. §§ 105, 1131, 1701- 1754 (West 2002); 38 C.F.R. §§ 3.1, 3.303, 3.304, 3.360 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 The Board acknowledges the Veterans Claims Assistance Act of 2000 (VCAA). 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107 (West 2002). This legislation provides, among other things, for notice and assistance to claimants under certain circumstances. VA has issued final rules to amend adjudication regulations to implement the provisions of VCAA. See 38 C.F.R §§ 3.102, 3.156(a), 3.159 and 3.326(a). The intended effect of the regulations is to establish clear guidelines consistent with the intent of Congress regarding the timing and the scope of assistance VA will provide to a claimant who files a substantially complete application for VA benefits, or who attempts to reopen a previously denied claim. After reviewing the claims folder, the Board finds that the claimant has been notified of the applicable laws and regulations which set forth the necessary criteria for the benefits currently sought. In letters sent in June 2004 and November 2006, the claimant was informed of the information and evidence necessary to warrant entitlement to the benefits sought. Moreover, the appellant was advised 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). The Board notes that the June 2004 and November 2006 letters were sent to the appellant prior to the most recent RO readjudication of this claim in association with the issuance of the September 2007 supplemental statement of the case. The VCAA notice was therefore effectively timely. See Pelegrini v. Principi, 18 Vet.App. 112 (2004). The Board also notes that the June 2004 and November 2006 letters expressly notified the appellant of the need to submit any pertinent evidence in the appellant's possession. Therefore, the requirements of 38 C.F.R. § 3.159(b)(1) have been met. The Board finds that all notices required by VCAA and implementing regulations were furnished to the appellant and that no useful purpose would be served by delaying appellate review to send out additional VCAA notice letters. During the pendency of this appeal, on March 3, 2006, the Court issued a decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet.App. 473 (2006), which held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: 1) veteran status; 2) existence of a disability; 3) a connection between the veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. The Court held that upon receipt of an application for a service-connection claim, 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim as reasonably contemplated by the application. Id. at 486. Additionally, this notice must include notification that a disability rating and an effective date for the award of benefits will be assigned if the benefits are awarded. Id. at 488. In the present appeal, there has been timely notice of the types of evidence necessary to establish a disability rating and an effective date for any rating that may be granted. The RO furnished the appellant with a letter in March 2006, and another in November 2006, which directly explained how VA determines disability ratings and effective dates. This notice was provided to the appellant prior to the most recent RO readjudication of this case and issuance of a supplemental statement of the case in September 2007. Furthermore, the Board finds that there has been substantial compliance with the assistance provisions set forth in the law and regulations. The record as it stands includes sufficient competent evidence. All available pertinent records, in-service, private, and VA, have been obtained and the claimant has been afforded VA orthopedic and podiatric examinations to evaluate the etiology of his claimed disabilities; two July 2006 VA examination reports are of record. The Board notes that, in accordance with the Board's December 2006 remand, records have been obtained from the Social Security Administration and associated with the claims-file. The Board finds that the record as it stands includes adequate competent evidence to allow the Board to decide the case and no further action is necessary. See generally 38 C.F.R. § 3.159(c)(4). No additional pertinent evidence has been identified by the claimant as available and relevant to the issues on appeal. Under these circumstances, no further action is necessary to assist the claimant with this claim. Analysis In order to qualify for VA benefits, a claimant must be a 'veteran.' Frasure v. Principi, 18 Vet.App. 379, 385 (2004); see also Cropper v. Brown, 6 Vet.App. 450, 452 (1994); Aguilar v. Derwinski, 2 Vet.App. 21, 23 (1991). Section 101(2) of the U.S. Code defines a 'veteran' as, inter alia, a person 'who was discharged or released [from service] under conditions other than dishonorable.' 38 U.S.C.A. § 101(2). A claimant receiving a discharge under other than honorable conditions may be considered to have been discharged under dishonorable conditions in certain circumstances. See 38 U.S.C.A. § 5303; 38 C.F.R. § 3.12. An other than honorable- conditions discharge accepted to escape trial by general court-martial is considered to have been issued under dishonorable conditions. See 38 C.F.R. § 3.12(d)(1). Where VA determines that a person's discharge from service was under dishonorable conditions, the payment of pension, compensation or dependency and indemnity compensation, based on that period of service, is barred. See Cropper, 6 Vet.App. at 452-53; 38 C.F.R. § 3.12. RO administrative decisions dated April 1980 and August 2003 held that that the appellant's discharge was a bar to all benefits, other than health care as authorized by 38 U.S.C. Chapter 17, because it was issued under dishonorable conditions due to the fact that it was issued to avoid a court-martial on AWOL charges following three periods of AWOL status. The laws describing the provision of VA hospital, nursing home, domiciliary and medical care for veterans are contained in 38 U.S.C.A. §§ 1701 to 1754, or 'Chapter 17.' The health-care and related benefits authorized by Chapter 17 shall be provided to certain former service persons with administrative discharges under other than honorable conditions, for any disability incurred or aggravated during active military, naval, or air service in line of duty. 38 C.F.R. § 3.360(a). With certain exceptions such benefits are furnished for any disability incurred or aggravated during a period of service that is terminated by a discharge under other than honorable conditions. However, such benefits may not be furnished for any disability incurred or aggravated during a period of service terminated by a bad conduct discharge or when one of the bars listed in 38 C.F.R. § 3.12(c) applies. 38 C.F.R. § 3.360(b). In making determinations of health-care eligibility, the same criteria will be used as are applicable to determinations of 'service incurrence' and 'in line of duty' when there is no character- of-discharge bar. 38 C.F.R. § 3.360(c). Preliminarily, the Board notes that the record reflects the appellant's AWOL status, as discussed in the April 1980 and August 2003 RO administrative decision, was reportedly 101 days of lost time. The Board observes that this amount of lost time does not implicate the particular bar to Chapter 17 benefits detailed in 38 C.F.R. § 3.360(c) and 38 C.F.R. § 3.12(c)(6); that bar to Chapter 17 benefits applies only when there have been at least 180 days of AWOL status. The Board also notes that the appellant is not contesting, for the purposes of this appeal, the character of his discharge or the associated limitations upon his benefit eligibility. In this regard, the appellant explained in January 2004 that his claim is "for treatment only, not for compensation...." In October 2004, the appellant explained "I never asked for any type of compensation. All that has been asked for is medical treatment...." Thus, the Board will proceed to consideration of whether the claimed disabilities are shown to be service connected to warrant entitlement to the treatment sought. Once again the Board notes that, in making these determinations, the same criteria will be used as are applicable to determinations of 'service incurrence' and 'in line of duty' when there is no character-of-discharge bar. 38 C.F.R. § 3.360(c). Applicable law provides that service connection will be granted if it is shown that the veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury or disease in line of duty, in the active military, naval, or air service. 38 U.S.C.A. §§ 1131; 38 C.F.R. § 3.303. 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). Additionally, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, 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; 38 C.F.R. §§ 3.307, 3.309. 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). A November 1978 service medical record shows that the appellant was treated for a right ankle sprain at that time. The appellant reported that he injured the ankle when he stepped into a hole 3 days earlier. There was no skin discoloration noted upon examination and the appellant was treated with an analgesic balm and an ace wrap. The November 1978 treatment record contains no suggestion of any suspicion of chronic residuals and there is no indication in the service medical records that any follow-up treatment was ever sought or required. This strongly suggests that the appellant's November 1978 right ankle sprain was an acute injury, transitory in nature, which resolved with treatment. The appellant's service medical records reflect that the appellant was treated for a back injury during service in February 1979. The injury was described as occurring while the appellant was lifting heavy items, three weeks prior to treatment. Pain was reported in the lumbar region, radiating upwards. A full range of motion was noted, with mild bilateral paraspinal spasms noted in the lumbar region. There was tenderness noted, but no edema and no ecchymosis. The medical assessment was "back strain," and the appellant was prescribed a balm, heat, and Parafon Forte to treat the injury. The February 1979 treatment record contains no suggestion of any suspicion of chronic residuals and there is no indication in the service medical records that any follow- up treatment was ever sought or required. This strongly suggests that the appellant's February 1979 back strain was an acute injury, transitory in nature, which resolved with treatment. The appellant's service medical records document that the appellant was treated during service for a left ankle sprain in March 1979. At that time, the appellant reported that his left ankle was injured in a car accident. The left ankle was clinically observed to be "slightly swollen" with "no redness, discoloration." Some limitation of motion was noted, and a "moderate amount of pain" indicated. A sprain was diagnosed and the prescribed treatment was aspirin and a heating pad with a 3 day profile. The March 1979 treatment record contains no suggestion of any suspicion of chronic residuals and there is no indication in the service medical records that any follow-up treatment was ever sought or required. This strongly suggests that the appellant's March 1979 left ankle sprain was an acute injury, transitory in nature, which resolved with treatment. The appellant's service medical records reflect that in March 1979, the appellant was also treated for a left foot injury during service. The left foot injury was reported to be, like the left ankle injury from the same month, due to an automobile accident. The appellant reported pain around the in step of the left foot. The foot was clinically observed to be "a little" swollen with some pain on motion. The appellant was prescribed treatment featuring an analgesic balm and an ace wrap. The March 1979 treatment record contains no suggestion of any suspicion of chronic residuals and there is no indication in the service medical records that any follow-up treatment was ever sought or required. This strongly suggests that the appellant's March 1979 left foot injury was an acute injury, transitory in nature, which resolved with treatment. Moreover, the appellant's July 1979 service separation examination report is of record and is of great significance in this case. The July 1979 separation examination report shows that the appellant was medically evaluated and found to be clinically normal in all pertinent respects, including his spine, feet, and lower extremities. There is no clinical suggestion of any pertinent disability detected at that time. Additionally, the attached July 1979 medical history questionnaire shows that the appellant himself denied any history of "recurrent back pain" and denied any history of "foot trouble" at that time. The appellant reported only problems with frequent colds, hayfever, and ear/nose/throat symptoms; there is no suggestion in this report of any complaints related to his back, ankles, or left foot. Thus, the July 1979 separation examination strongly suggests that neither a trained medical professional, nor the appellant himself, believed that any disability of the back, ankles, or left foot was present at the conclusion of his active duty military service. This is highly probative evidence weighing against the claims, as it reflects a competent medical assessment indicating the appellant did not have the claimed disabilities at separation and it presents the appellant's own contemporaneous statements denying pertinent symptoms or disabilities at that time. The Board notes that the appellant has submitted a private medical record, a "Disability Certificate" dated January 2004, which indicates that the appellant is receiving treatment for disabilities including "DJD of ankles & lumbar spine." The Board accepts this as competent medical evidence indicating current diagnoses of disabilities of the ankles and the appellant's back. The Board further notes, however, that the January 2004 certificate does not suggest that any disability is etiologically related to the appellant's active duty service nearly 25 years earlier. The Board observes that the January 2004 private medical certificate is the earliest contemporaneous medical evidence of record which shows a diagnosis of an ankle disability following service. Back pain was documented in an earlier July 2003 medical record, obtained among the appellant's Social Security Administration records, and a diagnosis of "musculoskeletal lower back pain" was given at that time. The July 2003 record contains a discussion of the appellant's reported history of back pain dating back to his military service. The Board notes, in passing, that the report actually cites a "history of back pain since he was in the army in 1983," but the record reflects that the appellant was discharged from active duty service in August 1979, including as indicated on Form DD214. In any event, the Board notes that the July 2003 medical record contains no medical analysis of etiology nor any review of the appellant's service medical records; the July 2003 medical record merely transcribes the appellant's description of his symptom history. Although the appellant is competent to report his history of back pain, this lay account does not become medical evidence of diagnostic etiology simply because it is transcribed in a medical record. The medical record's recitation of a reported history of back pain does not carry the same probative weight as medical evidence because it relies upon the appellant's own layperson account of the history of his back pain. Unenhanced reports of history transcribed by a medical examiner do not constitute competent medical evidence. Wood v. Derwinski, 1 Vet.App. 190, 191-192 (1991) (an opinion may be discounted if it materially relies on a layperson's unsupported history as the premise for the opinion); see LeShore v. Brown, 8 Vet.App. 406, 409 (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). The appellant's Social Security Administration records also include an April 2005 private medical report which somewhat addresses the appellant's claimed back, ankle, and foot disabilities. The April 2005 private report notes the appellant's complaints of degenerative joint disease and "arthritis," but comments that "It appears that his 'arthritis' symptoms are likely related to neuropathy." The Board notes that the appellant is diagnosed with diabetes mellitus which may be associated with neuropathy. After a thorough physical inspection of the appellant, the doctor concluded in his April 2005 report that the appellant's "report of 'DJD' probably represents a significant neuropathy based on testing reported above." However, the doctor also commented that "Back pain is a clinical finding. [The appellant's] examination would support his report of symptoms." The Board notes that the July 2003 private medical record is the earliest medical record documenting any pertinent complaints of joint or back pain. Even if the Board were to accept this record as demonstrating symptoms in both ankles, the left foot, and the back, this would still leave a period of nearly 24 years following service without contemporaneous evidence of pertinent symptoms or diagnosis. This lengthy period without contemporaneous evidence of symptoms or diagnosis weighs against the claim. See Maxson v. Gober, 230 F.3d 1330 (Fed.Cir. 2000). The appellant was provided with a pair of VA examinations in July 2006 to evaluate his claimed disabilities. With regard to the appellant's ankles, the July 2006 VA orthopedic examination report shows that the appellant was clinically diagnosed with "Incidental note of right ankle radiographic changes" which are expressly noted to not be etiologically related to the appellant's ankle sprains during service. The orthopedic examiner expressly acknowledged the appellant's documented in-service ankle sprains, but clearly explains that the current right ankle "radiographic changes" are not believed to be etiologically related. With regard to the appellant's back, the July 2006 VA orthopedic examination report shows that the appellant was clinically found to currently carry a diagnosis of "Incidental note of degenerative disk disease of lumbosacral spine, with facet arthropathy...." The examiner further assesses that the in-service report of back pain was "Acute lower back strain in service, RESOLVED, WITHOUT residual or sequelae." Concerning the appellant's left foot, a July 2006 VA podiatry examination report finds that the appellant "may have low grade chronic sprain (grade I) of the anterior talofibular ligament versus factitious complaint ...." The appellant was also apparently observed to currently have "mycotic nail disease" considered to have "no relationship to military service." The report also identifies that the appellant has a "bilateral symmetric pes planus foot type" but clearly identifies this as "of hereditary origin without advancement through military service beyond normal life progression." The examiner also observed that the appellant "has mild bilateral symmetric lateral ankle joint swelling which may at least as likely as not be related to dependency/inactivity than overtly attributable to active acute phase or chronic inflammatory process." Further, "His gait is slow and cautious but not overtly pathologic.... I am unclear whether this is a true physical limitation or factitious." The examiner acknowledges the foot complaint noted in the appellant's service medical records, but comments that "There is no evidence of residual focal foot pathology." The Board notes that the VA examination reports present a clear diagnosis of a current chronic back pathology, while there is a lack of clarity as to whether the appellant has any diagnosed chronic pathologies of his ankles or his left foot. Nevertheless, even assuming that the appellant has current disabilities for all the claims on appeal, the VA examination reports weigh against the claims because they clearly indicate that there is no etiological link between any claimed current disabilities and the appellant's military service. The July 2006 VA orthopedic examination report explains that the examiner's review of the service medical records indicates that the in-service ankle sprains and in-service back injury "RESOLVED, WITHOUT residual or sequelae." The examiner goes on to elaborate upon his rationale in discussing that there was only a single episode of care for complaint of pain in each ankle, and pain in the back, with only conservative treatment required and "NO documented residual or sequelae for the remainder of service," and pertinent residuals were "NOT noted on his separation/Chapter 10 Report of Medical History and physician examination 7/79." Furthermore, the July 1979 VA orthopedic examiner acknowledges that the appellant provided a private physician's disability statement dated January 2004, but cites that there is "NO documented evidence of any evaluation or treatment for the alleged claimed conditions subsequent to service except for the single statement discussed above." Further, the examiner found that "Additional care described by the appellant on this occasion is NOT supported in the evidence of record." The orthopedic examiner finds that the claimed disabilities are not likely etiologically related to service and that "More likely etiologies for the appellant's current diagnoses include (but are not limited to) post service occupations, injuries, age, chronic deconditioning, co- morbidities, etc." Thus, the examiner concludes that "The current conditions are NOT related to service or any incident of service." The Board finds the July 2006 VA orthopedic examination report is significantly probative evidence because it contains a competent medical opinion from a specialist, informed by review of the claims folder and examination of the appellant, with a thorough discussion of a persuasive rationale. Thus, the July 2006 VA orthopedic examination probatively weighs against the appellant's contention that he currently has ankle and back disabilities etiologically related to his military service. The July 2006 VA podiatry examination report weighs significantly against the appellant's contention that he currently has a left foot disability etiologically related to his military service. In this regard, the examiner explained that, after a review of the claims folder, "I believe the event referred to in March 1978 resolved uneventfully without evidence of sequelae, limitation or disability." The examiner clearly explains that the appellant's current pes planus and mycotic nail disease have no etiological relationship to his military service. The podiatrist's opinions are shown to be informed not only by a thorough examination and interview of the appellant, but also by review of the claims-file. The podiatrist explains that, even if the appellant currently has a current chronic left foot sprain rather than a factitious injury, there is "in any case no evidentiary support to link said complaint pattern or diagnostic entity specifically to military service in the absence of support in the service medical record." The Board finds the July 2006 VA podiatry examination report is significantly probative evidence because it contains a competent medical opinion from a specialist, informed by review of the claims folder and examination of the appellant, with a discussion of a persuasive rationale. Because the significance of the July 2006 VA examination reports stems from finding no nexus between any current disabilities and service, the reports remain adequate in this case despite the subsequent addition of the appellant's SSA records to the claims-folder. In this regard, the Board notes that no contrary etiology opinions were contained in the SSA records. To the extent that some of the SSA records suggest treatment for the appellant's claimed current disabilities, there is no information which contradicts the rationales provided in the July 2006 VA examination reports nor is there information which contradicts any evidence relied upon as the basis for the etiology opinions provided in July 2006. The Board acknowledges that, in advancing this claim, the appellant asserts that he currently suffers from disabilities of the back, the ankles, and the left foot which are causally linked to his service. However, while the appellant as a lay person is competent to provide evidence regarding injury and symptomatology, he is not competent to provide evidence regarding diagnosis or etiology. See Espiritu v. Derwinski, 2 Vet.App. 492 (1992). Only a medical professional can provide evidence of a diagnosis or etiology of a disease or disorder. In any event, the Board finds that the evidence against these claims carry more probative weight than the appellant's assertions supporting his claims. The Board acknowledges that the appellant was treated in service for one instance of left ankle pain and left foot pain, one instance of right ankle pain, and one instance of back pain. The appellant is competent to testify as to his recollections of these experiences and to testify that there has been a continuity of symptomatology following service. However, the appellant's recollections of events from more than 23 years ago is less probative than contemporaneous records from the pertinent period of time in question. It is significant that the appellant's service medical records show no follow-up complaints of symptoms during service after the individual incident of injury in each body part, and no pertinent diagnoses or symptoms were clinically noted during his separation examination in July 1979. Furthermore, the appellant expressly denied experiencing pertinent symptoms at his separation examination and there is no contemporaneous evidence of the appellant reporting pertinent symptoms for many years after service. The contemporaneous documentation of medical findings and the appellant's statements from the pertinent period of time, especially in light of the subsequent analysis by competent VA medical specialists, carries more probative weight than the appellant's recent testimony of his recollection of experiences from more than 23 years prior to the filing of these claims for benefits. Thus, in this case, the Board does not find that the appellant's lay testimony is sufficient to demonstrate service incurrence of the claimed chronic disabilities in light of the substantially probative contrary evidence of record. As the most probative evidence regarding this critical period of time weighs against the claims, any assertions otherwise regarding chronicity of symptoms in the following decades cannot demonstrate that service connection is warranted. The absence of contemporaneous evidence of any pertinent chronic disability during service, the absence of any pertinent symptoms or diagnoses at the separation examination, and the absence of any medically documented symptoms or diagnoses for many years after service strongly support a finding that the appellant's individual injuries during service were acute and transitory in nature, resolving without residual chronic disability. The competent medical opinions finding no etiological link between the appellant's service and any current disabilities of the ankles, left foot, and back, constitute significantly probative evidence against the claims. There is no competent medical evidence in the record indicating a causal link between the appellant's current claimed disabilities and his service. The Board is presented with an evidentiary record which shows no pertinent chronic disability during service or for at least 23 years following service. With all of the competent medical evidence weighing against finding a causal link between the appellant's current disabilities and his service, and considering the length of time following service prior to any medical evidence of pertinent chronic disability, the Board finds that the preponderance of the evidence is against the appellant's claims. Consequently, the benefit-of-the-doubt rule does not apply, and the claims must be denied. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet.App. 49, 55 (1990). ORDER The appeal is denied as to all issues. ____________________________________________ ALAN S. PEEVY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs