Citation Nr: 1008974 Decision Date: 03/09/10 Archive Date: 03/17/10 DOCKET NO. 04-28 829 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Whether new and material evidence has been received to reopen a claim for service connection for a right shoulder disability. 2. Entitlement to service connection for a right shoulder disability. 3. Entitlement to service connection for a left shoulder disability. 4. Entitlement to service connection for a low back disability. 5. Entitlement to service connection for an eye disorder. WITNESSES AT HEARING ON APPEAL Appellant and his spouse ATTORNEY FOR THE BOARD M. Zawadzki, Associate Counsel INTRODUCTION The Veteran served on active duty from August 1975 to August 1978, with a period of service in the Georgia Army National Guard from April 1979 to April 1980, and additional service in the U.S. Army Reserve, to include several periods of active duty for training (ADT). These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2003 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta Georgia, in which the RO denied service connection for residuals of a left hip fracture, low back strain, bilateral shoulder conditions, and a bilateral eye condition. In September 2006, the Veteran testified before the undersigned sitting at the RO (Travel Board hearing). A transcript of that hearing is of record. In April 2007, the Board found that new and material evidence had been submitted sufficient to reopen the claim for service connection for a low back disability and denied service connection for a left hip disability. The Board remanded the request to reopen a claim for service connection for a right shoulder disability, and the claims for service connection for a left shoulder disability, a low back disability, and an eye disorder for further development. That development has been completed. The Board notes that, in the June 2003 rating decision and the June 2004 statement of the case (SOC), the RO addressed the claim for service connection for a right shoulder disability on the merits; however, regardless of the RO's actions, the Board has a legal duty under 38 U.S.C.A. §§ 5108, 7104 (West 2002) to address the question of whether new and material evidence has been received to reopen the claim for service connection. That matter goes to the Board's jurisdiction to reach the underlying claim and adjudicate the claim on a de novo basis. See Barnett v. Brown, 83 F. 3d 1380, 1383 (Fed. Cir. 1996). As the Board must first decide whether new and material evidence to reopen the claim has been received, the Board has characterized this matter on appeal as reflected on the title page. FINDINGS OF FACT 1. All notification and development action needed to fairly adjudicate the claims on appeal has been accomplished. 2. In a May 1982 rating decision, the RO denied service connection for a right shoulder condition; although notified of the denial in a June 1982 letter, the Veteran did not initiate an appeal. 3. Evidence associated with the claims file since the May 1982 rating decision relates to an unestablished fact necessary to substantiate the claim for service connection for a right shoulder disability and raises a reasonable possibility of substantiating that claim. 4. Bilateral acromioclavicular degenerative joint disease was first diagnosed many years after service, and the only competent, probative opinion on the question of whether there exists a medical relationship between the Veteran's right and left shoulder disabilities and service weighs against the claims for service connection. 5. Lumbosacral degenerative disc disease was first diagnosed many years after service, and the only competent, probative opinion on the question of whether there exists a medical relationship between the Veteran's low back disability and service weighs against the claim for service connection. 6. The only competent, probative opinion on the question of whether there exists a medical relationship between the Veteran's current eye disorder and service weighs against the claim for service connection. CONCLUSIONS OF LAW 1. The RO's May 1982 rating decision denying service connection for a right shoulder condition is final. 38 U.S.C.A. § 7105(c) (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.104(a), 20.302(a), 20.1103 (2009). 2. As pertinent evidence received since the May 1982 rating decision is new and material, the criteria for reopening the claim for service connection for a right shoulder disability are met. 38 U.S.C.A. §§ 5108, 7105 (West 2002); 38 C.F.R. § 3.156 (2009). 3. A right shoulder disability was not incurred in or aggravated by service, nor may service incurrence be presumed. 38 U.S.C.A. §§ 1112, 1113, 1131, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2009). 4. A left shoulder disability was not incurred in or aggravated by service, nor may service incurrence be presumed. 38 U.S.C.A. §§ 1112, 1113, 1131, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2009). 5. A low back disability was not incurred in or aggravated by service, nor may service incurrence be presumed. 38 U.S.C.A. §§ 1112, 1113, 1131, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2009). 6. An eye disorder was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. § 3.303 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) The provisions of the Veterans Claims Assistance Act of 2000 (VCAA), codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a), and as interpreted by the United States Court of Appeals for Veterans Claims (Court) have been fulfilled. In this case, the Veteran's requests to reopen his claims for service connection for a right shoulder disability and a low back disability, and his claims for service connection for a left shoulder disability and an eye disorder were received in June 2002. Thereafter, he was notified of the general provisions of the VCAA by the Appeals Management Center (AMC) in correspondence dated in April 2007, July 2009, and October 2009. These letters notified the Veteran of VA's responsibilities in obtaining information to assist him in completing his claims, identified the Veteran's duties in obtaining information and evidence to substantiate his claims, and provided other pertinent information regarding the VCAA. Thereafter, the claims were reviewed and a supplemental statement of the case (SSOC) was issued in December 2009. See 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a), Quartuccio v. Principi, 16 Vet. App. 183 (2002), Pelegrini v. Principi, 18 Vet. App. 112 (2004). See also Mayfield v. Nicholson, 19 Vet. App. 103, 110 (2005), reversed on other grounds, 444 F.3d 1328 (Fed. Cir. 2006); Mayfield v. Nicholson (Mayfield II), 20 Vet. App. 537 (2006); Kent v. Nicholson, 20 Vet. App. 1 (2006), Mayfield v. Nicholson (Mayfield III), 499 F.3d 1317 (Fed. Cir. 2007). During the pendency of this appeal, the Court, in Dingess v. Nicholson, 19 Vet. App. 473 (2006), found that the VCAA notice requirements applied to all elements of a claim. Notice as to this matter was provided in April 2007, July 2009, and October 2009. In Kent v. Nicholson, 20 Vet. App. 1 (2006), the Court clarified VA's duty to notify in the context of claims to reopen. With respect to such claims, VA must both notify a claimant of the evidence and information that is necessary to reopen the claim and notify the claimant of the evidence and information that is necessary to establish entitlement to the underlying claim for the benefit that is being sought. To satisfy this requirement, the Secretary is required to look at the bases for the denial in the prior decision and to provide the claimant with a notice letter that describes what evidence would be necessary to substantiate those elements required to establish service connection that were found insufficient in the previous denial. Given the favorable disposition of the request to reopen the claim for service connection for a right shoulder disability, the Board finds that all notification and development actions needed to fairly adjudicate this claim have been accomplished. The Veteran has been made aware of the information and evidence necessary to substantiate his claims for service connection and has been provided opportunities to submit such evidence. A review of the claims file shows that VA has conducted reasonable efforts to assist him in obtaining evidence necessary to substantiate his claims during the course of this appeal. His service treatment records from his active duty service, service personnel records, and VA and private treatment records have been obtained and associated with his claims file. The Veteran was also been provided with VA examinations to assess the current nature and etiology of his claimed disabilities. The Board has considered the fact that, while the service treatment records currently associated with the claims file include an examination for enlistment in the Army National Guard, dated in April 1979, complete service treatment records from the Veteran's National Guard and Army Reserve service have not been associated with the claims file. Pertinent to the claims on appeal, the Veteran has submitted an individual sick slip, dated in July 1984, reflecting that he sought treatment for his eyes, and an optometry appointment form from Fort Riley, reflecting that the Veteran had an appointment scheduled in July, although the year was not indicated. During the September 2006 hearing, the Veteran reported that he received treatment for his eyes at Fort Hood during his Reserve service; however, in March 2009, the Darnall Army Medical Center at Fort Hood responded that a thorough search of their records revealed no medical records for the Veteran. While records of treatment from Fort Riley have not been associated with the claims file, the Board notes that records of in-service optometry treatment could not demonstrate a nexus between a current eye disorder and service, the very matter on which the claim for service connection for an eye disorder turns. As such, a remand to obtain these records would impose unnecessary additional burdens on adjudication resources, with no benefit flowing to the Veteran, and is, thus, unnecessary. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991). In regard to the claims for service connection for right and left shoulder disabilities and a low back disability, during the September 2006 hearing, the Veteran was asked whether, during his National Guard and Reserve examinations, his back and shoulders were examined, and he responded that the only thing he was told was that he had a problem and that he could be given medication. Complaints regarding the low back, as well as the report of a bruised shoulder, are currently documented in the service treatment records currently associated with the claims file. Moreover, service treatment records from the Veteran's National Guard and Reserve service would not include medical evidence of a relationship between a current right or left shoulder or low back disability and service. As such, a remand to obtain these records is not required. See Soyini, 1 Vet. App. at 546. Finally, the Board has considered the fact that, in August 2002, the Veteran reported that he received treatment at the Decatur VA Medical Center (VAMC). While records from this facility have not been associated with the claims file, during the September 2006 hearing, he clarified that his VA treatment had been at the Augusta VAMC in 2002 and 2003. Records of treatment from this facility, dated in 2002 and 2003 were requested and records were associated with the claims file in August 2009. In July 2009, the Veteran reported that his medical services were performed at the Athens Community Based Outpatient Clinic (CBOC) and his medications came from the Augusta VAMC and, in August 2009, he reported that all his medical treatment and medications came from VA. The Board notes that the Augusta VAMC is the parent facility of the Athens CBOC, and the VA treatment records currently associated with the claims file reflect that the Veteran's current primary care team was the Athens CBOC. While the most recent VA treatment records associated with the claims file are dated in November 2003, the Veteran has not identified any more recent VA treatment; rather, in October and December 2009, he indicated that he had no other information or evidence to support his claims. As such, the Board finds that the Veteran has not identified any outstanding VA treatment records which are potentially pertinent to the claims on appeal. See 38 U.S.C.A. § 5103A(b), (c) (VA is only required to obtain evidence that is adequately identified). Furthermore, the Veteran has not identified any additional, relevant evidence that has not been requested or obtained. The Veteran has been notified of the evidence and information necessary to substantiate his claims, and he has been notified of VA's efforts to assist him. See Quartuccio v. Principi, 16 Vet. App. 183 (2002). As a result of the development that has been undertaken, there is no reasonable possibility that further assistance will aid in substantiating his claims. Law and Regulations VA may reopen and review a claim that has been previously denied if new and material evidence is submitted by or on behalf of a veteran. 38 U.S.C.A. § 5108; 38 C.F.R. § 3.156(a). See also Hodge v. West, 155 F. 3d 1356 (Fed. Cir. 1998). Regarding petitions to reopen filed on or after August 29, 2001, 38 C.F.R. § 3.156(a) defines "new" evidence as evidence not previously submitted to agency decision makers and "material" evidence as 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 final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). The provisions of 38 U.S.C.A. § 5108 require a review of all evidence submitted by or on behalf of a claimant since the last final denial on any basis to determine whether a claim must be reopened. See Evans v. Brown, 9 Vet. App. 273, 282-3 (1996). For purposes of the "new and material" analysis, the credibility of the evidence is presumed. Justus v. Principi, 3 Vet. App. 510, 512-513 (1992). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. See 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303. Service connection may be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. See 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability on the basis of the merits of such claim is focused upon (1) the existence of a current disability, (2) the existence of the disease or injury in service, and (3) a relationship or nexus between the current disability and any injury or disease during service. See Cuevas v. Principi, 3 Vet. App. 542 (1992); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Active duty includes any period of active duty for training (ADT) during which the individual concerned was disabled from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty training (INADT) during which the individual concerned was disabled from an injury incurred or aggravated in line of duty. 38 C.F.R. § 3.6 (2009) Accordingly, service connection may be granted for disability resulting from disease or injury incurred in, or aggravated, while performing ADT or from injury incurred or aggravated while performing INADT. See 38 U.S.C.A. §§ 101(24), 106, 1110 (West 2002). Service connection can be granted for certain diseases, including arthritis, if manifest to a degree of 10 percent or more within one year of separation from active service. Such diseases shall be presumed to have been incurred in service even though there is no evidence of disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Factual Background and Analysis - New and Material In February 1982, the Veteran filed a claim for service connection for a right shoulder condition. In a May 1982 rating decision, the RO denied service connection for a right shoulder condition, noting that separation examination was completely normal, with a history of a bruised shoulder, and that the Veteran's April 1979 examination on enlistment in the National Guard was completely normal. The evidence of record at the time of the May 1982 rating decision included the Veteran's service treatment records, which reflect that, on separation examination in March 1978, clinical evaluation of the upper extremities was normal. The Veteran did report that he had a bruised shoulder. On examination for enlistment in the Army National Guard in April 1979, clinical evaluation of the upper extremities was again normal. Although notified of the RO's May 1982 denial in a June 1982 letter, the Veteran did not initiate an appeal; hence, that decision is final as to the evidence then of record, and is not subject to revision on the same factual basis. See 38 U.S.C.A. § 7105(b); 38 C.F.R. §§ 3.104, 20.302, 20.1103. The Veteran sought to reopen his previously denied claim in June 2002. The provisions of 38 U.S.C.A. § 5108 require a review of all evidence submitted by or on behalf of a claimant since the last final denial on any basis to determine whether a claim must be reopened. See Evans v. Brown, 9 Vet. App. 273, 282-3 (1996). Here, the last final denial of the claim is the May 1982 rating decision. Furthermore, for purposes of the "new and material" analysis, the credibility of the evidence is presumed. Justus v. Principi, 3 Vet. App. 510, 512-513 (1992). Evidence associated with the claims file since the May 1982 rating decision includes the Veteran's September 2006 testimony that he hurt his right shoulder in the gym during service and that he had asked at the transfer point in Charleston that a note be made that his shoulder was bothering him, adding that he still had problems with his right shoulder. The Veteran was afforded a VA examination to evaluate his claimed shoulder disabilities in May 2009. The pertinent diagnosis was bilateral acromioclavicular degenerative joint disease. The foregoing evidence is new in the sense that it was not previously before agency decision makers. Further, the evidence in material, as it indicates that the Veteran has a current right shoulder disability, acromioclavicular degenerative joint disease. The Veteran's September 2006 testimony indicates a continuity of symptomatology of problems with the right shoulder since service. The Veteran is competent to report a continuity of symptomatology. See Charles v. Principi, 16 Vet. App. 370 (2002). This report of a continuity of symptomatology suggests a link between his current complaints regarding the right shoulder and service. See Duenas v. Principi,18 Vet. App. 512 (2004). As such, the foregoing evidence raises a reasonable possibility of substantiating the claim for service connection, thus, the claim must be reopened. Factual Background and Analysis - Service Connection Right and Left Shoulder Disabilities Considering the pertinent evidence of record in light of the above-noted legal authority, the Board finds that service connection for right and left shoulder disabilities is not warranted. As discussed above, service treatment records reflect that, on separation examination in March 1978, clinical evaluation of the upper extremities was normal. The Veteran did report that he had a bruised shoulder. In his Report of Medical History on enlistment in the Army National Guard in April 1979, the Veteran indicated that he did not have, nor had he ever had, a painful or "trick" shoulder or elbow. On examination, clinical evaluation of the upper extremities was again normal. Records of private treatment dated from April to November 1998 reflect complaints regarding left shoulder pain. The Veteran underwent chiropractic treatment for left shoulder pain in February and March 1998. During the September 2006 hearing, the Veteran testified that he injured his left shoulder playing basketball during service. As noted above, he also reported that he injured his right shoulder in the gym during service, and that his right shoulder continued to give him trouble. In August 2007, the Veteran asserted that he had injured his right shoulder while playing basketball during service. During private treatment in February 2007, the Veteran described right shoulder pain, adding that he slept wrong. The Veteran's shoulders were evaluated during VA examination in May 2009. The physician reviewed the claims file, including the service treatment records, and noted that the Veteran did not complain about his shoulders during service. The Veteran stated that, after separation from service, he worked in construction from 1978 to 2006. He reported that, during service, he played basketball extensively, and hurt himself playing basketball, although the examiner noted that he could not find a record of these activities. Examination of the shoulders revealed tenderness over the acromioclavicular joints. Range of motion was less than full. X-rays of the shoulders were normal as far as the glenohumeral joint was concerned. There was some sclerosis at the acromioclavicular joint. The pertinent impression was bilateral acromioclavicular degenerative joint disease. The physician opined that there was no evidence in the record that the Veteran had any problem with the shoulders during his service career, but that he started having pain in the shoulders several years after leaving service. He added that he had normal shoulder joints, and the diagnosis was degenerative joint disease of the acromioclavicular joint. He stated that this is the sort of condition that would occur in a person age 53 who is involved in construction and heavy labor. He concluded by opining that it was less likely than not that the Veteran's shoulder condition was caused by or a result of any activity during his service career. The Veteran has a current diagnosis of a bilateral shoulder disability, acromioclavicular degenerative joint disease, thus, the first element of each claim for service connection for the right and left shoulders is met. In regard to the second element, the Veteran is competent to report the history of his in-service injuries to the shoulders. See, e.g., Grottveit v. Brown, 5 Vet. App. 91, 93 (1991). In regard to the third element, a relationship or nexus between the current disability and an injury or disease during service, the Board acknowledges that the Veteran has reported, as he is competent to do, a continuity of symptomatology in regard to problems with his right shoulder since service. However, such report must be weighed against the medical evidence. Cf. Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). The only medical opinion regarding etiology of the Veteran's bilateral shoulder disability is that rendered by the May 2009 VA examiner. Significantly, the May 2009 VA examiner, who reviewed the claims file, including the service treatment records, examined the Veteran, and considered his report of injuring his shoulders while playing basketball during service, clearly opined that it was less likely than not that the Veteran's current bilateral shoulder disability is related to service. The Board highlights that the VA examiner appears to attribute the Veteran's current bilateral shoulder disability to his age and post-service employment in construction. The Board finds this opinion dispositive of the question of whether the Veteran has a current right and/or left shoulder disability which was incurred in or aggravated by service, as the examiner's findings were based on a review of the claims file, a thorough physical examination, and consideration of the Veteran's assertions. In addition, the examiner provided a rationale for his opinion. 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 Guerrieri v. Brown, 4 Vet. App. 467, 470- 71 (1993) (the probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion he reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board). Thus, the only competent, probative (persuasive) opinion on the question of whether the Veteran has a right and/or left shoulder disability that is etiologically related to service weighs against the claims for service connection. The Veteran has not presented or identified any existing, contrary medical opinion that, in fact, supports the claims for service connection. As there is no competent, persuasive medical evidence that relates the Veteran's current right or left shoulder disabilities to service, to include any period of ADT, the Veteran is not entitled to service connection for a right or left shoulder disability. The Board has considered whether service connection for right and left shoulder disabilities could be established on a presumptive basis. To establish service connection for a disability, in this case, degenerative joint disease, on a presumptive basis, the disability must manifest itself to a compensable degree within one year of the Veteran leaving active duty. See 38 C.F.R. §§ 3.307, 3.309. In this case, there is no medical evidence of degenerative joint disease within a year after separation from active duty; rather, the first medical evidence of degenerative joint disease is in May 2009. Therefore, service connection cannot be established on a presumptive basis. Moreover, the Board points out that passage of many years between discharge from active service and the objective documentation of a claimed disability is a factor that weighs against a claim for service connection. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Based on the foregoing, the Board finds that service connection for right and left shoulder disabilities is not warranted. Low Back Disability Considering the pertinent evidence of record in light of the above-noted legal authority, the Board finds that service connection for a low back disability is not warranted. Service treatment records reflect that, in February 1976, the Veteran complained of a pulled muscle in the back. On examination, there was muscle spasm in the left lower back. The assessment was back strain. In April 1976, he complained of back pain for one month. On examination, there was no tenderness, range of motion was full, and straight leg raising was negative. The impression was no definite pathology found. In March 1977, the Veteran again complained of lower back pain. Deep knee bends were accomplished without difficulty. The plan was to treat him with Robaxin, wet heat, and no PT or lifting more than 10 pounds. A September note from an unspecified year reflects that the Veteran complained of lower back pain and inhibited movement with slowed mobility. He described muscle pain in the lower lumbar region, with muscle pain and stiffness radiating to the sides. Examination for nerve root involvement was negative, with no symptoms of sciatica or paresthesias. On separation examination in March 1978, clinical evaluation of spine was normal. In his Report of Medical History on enlistment in the Army National Guard in April 1979, the Veteran indicated that he did not have, nor had he ever had, recurrent back pain. On examination clinical evaluation of the spine was normal. Records of post-service treatment reflect complaints regarding and treatment for low back pain. In January 1985, the Veteran presented with pain in the back. X-rays of the lumbar spine were essentially normal. The diagnosis was herniated nucleus pulposus, L5, S1, right. In March 1988, the Veteran again complained of pain in the back, adding that he had problems with this since being seen in 1985. The physician noted that the Veteran had done the stucco on his house the preceding summer and that he reported that he was able to do this work for two or three days, but then was unable to walk for two or three days. He added that he was better when he just did book work. X-ray revealed degenerative disc disease at L5/S1, where his X-ray in 1985 showed no bony abnormality. The diagnoses were herniated nucleus pulposus, L5/S1 and degenerative disc disease, lumbar spine, L5/S1. A July 1997 letter from the Veteran's private physician, Dr. Brown, reflects that he had initially treated the Veteran in March 1997, following his involvement in a February 1997 motor vehicle accident. He had pain to palpation in the lumbar area, and was diagnosed with traumatic myositis secondary to motor vehicle accident. The record reflects that the Veteran was involved in another motor vehicle accident in June 1997. The private treatment records reflect that the Veteran again consulted Dr. Brown following this motor vehicle accident, and that the diagnosis was severe traumatic myositis secondary to motor vehicle accident. In an October 2000 letter, Dr. Brown stated that the Veteran was under his care and unable to work due to traumatic myositis to the lumbar spine secondary to a motor vehicle accident. During the September 2006 hearing, the Veteran testified that his back was injured from driving a dump truck in service, as the seats had no cushion, so there was nothing to absorb the shock, and it jammed his back. On VA examination in May 2009, the examiner noted that the Veteran's service treatment records reflected his complaint of pain in the low back in February 1976. The examiner added that he was treated for this and, approximately a year later, was deemed to be a "rehabilitation success." The examiner noted that, after separation from service, the Veteran worked in construction from 1978 to 2006. The Veteran reiterated his assertion that his back was severely impacted in service every time the dump truck he drove went over a bump. He added that his recent low back problem started about 15 to 20 years earlier, stating that the recrudescence of the pain occurred because of the heavy work he had to do, including concrete work, construction, and heavy landscaping. On examination, range of motion was less than full. X-rays revealed some diminution in disc space at the L5-S1 level, with some sclerosis in the posterior joints at that level. The other disc spaces were well-maintained and normal. The pertinent impression was lumbosacral degenerative disc disease. The examiner noted that the Veteran had a back problem during his service career, but that this was taken care of, and a record indicated that his rehabilitation was successful. The examiner added that a subsequent examination indicated that the Veteran did not have any low back problems. He added that low back problems started again several decades after separation from service, and could be attributed to the heavy labor he carried out after leaving the service. The examiner opined that the type of low back pain experienced by the Veteran was the type which was very likely to occur after a career of heavy labor in a person who was 53 years old. As such, he concluded that the Veteran's low back pain was less likely than not the result of his service career. The Veteran has a current diagnosis of low back disability, lumbosacral degenerative disc disease, thus, the first element of the claim for service connection is met. Service treatment records reflect complaints regarding and treatment for the low back. Thus, the second element of the claim is also satisfied. In regard to the third element, however, the Board notes that there is no competent medical opinion of a nexus between the Veteran's current low back disability and service. Rather, the May 2009 VA examiner specifically opined that the Veteran's low back pain was less likely than not the result of his service career, but, rather, attributed the Veteran's current low back disability to his post-service career in construction. In regard to the VA examiner's statement that the Veteran's back problem was taken care of during service, and a service treatment record indicated that rehabilitation was successful, the Board notes that, while a June 1977 record of treatment reflects that the Veteran's medical evaluation was complete, and he entered follow-up as a rehabilitation success, this appears to be noted in regard to the Veteran's involvement in the Alcohol and Drug Abuse Prevention and Control Program (ADAPCP), as opposed to his complaints regarding his low back, as the same comment is made in a June 1977 ADAPCP Military Client Intake and Follow- up Record. In any event, the VA examiner's opinion was not based solely on the treatment record reflecting successful rehabilitation, but, also, on subsequent physical examinations which did not note any back problems. In this regard, the Board highlights that clinical evaluation of the spine was normal on separation examination in March 1978 and, again, on examination in April 1979. The Board finds the VA examiner's opinion dispositive of the question of whether the Veteran has a current low back disability which was incurred in or aggravated by service, as the examiner's findings were based on a review of the claims file, a thorough physical examination, and consideration of the Veteran's assertions. In addition, the examiner provided a rationale for his opinion. See Hayes, 5 Vet. App. at 69- 70. See also Guerrieri, 4 Vet. App. at 470- 71 . Thus, the only competent, probative (persuasive) opinion on the question of whether the Veteran has a current low back disability that is etiologically related to service weighs against the claim for service connection. The Veteran has not presented or identified any existing, contrary medical opinion that, in fact, supports the claim for service connection. As there is no competent, persuasive medical evidence that relates the Veteran's current low back disability to service, to include any period of ADT, the Veteran is not entitled to service connection for a low back disability. The Board has considered whether service connection for degenerative disc disease could be established on a presumptive basis. In this case, there is no medical evidence of degenerative disc disease within a year after separation from active duty; rather, the first medical evidence of degenerative joint disease is in March 1988. Therefore, service connection cannot be established on a presumptive basis. Moreover, the Board points out that passage of many years between discharge from active service and the objective documentation of a claimed disability is a factor that weighs against a claim for service connection. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Based on the foregoing, the Board finds that service connection for a low back disability is not warranted. Eye Disorder Considering the pertinent evidence of record in light of the above-noted legal authority, the Board finds that service connection for an eye disorder is not warranted. Service treatment records from the Veteran's active duty service reflect that, on examination in March 1975, distant vision was 20/20. An August 1975 statement for enlistment includes a note which states "20/30 corrected vision." On separation examination in March 1978, clinical evaluation of the eyes was normal. Distant vision was 20/25 on the right and 20/20 on the left. In his Report of Medical History on enlistment in the Army National Guard in April 1979, the Veteran indicated that he did not have, nor had he ever had, eye trouble. On examination, clinical evaluation of the eyes was normal. Distant vision was 20/20 on the right and 20/30 on the left. The Veteran has submitted a July 2, 1984 DD Form 689 (Individual Sick Slip) from his Reserve service, which notes "eyes" in the remarks section. An appointment form reflects that he had an optometry appointment scheduled for July 6th. The year of this optometry appointment is not noted. Records of post-service treatment reflect complaints regarding and treatment for the eyes. Records of private treatment dated from January to April 1998 reflect diagnoses of and treatment for open angle glaucoma. Records of private treatment from March 2003 to May 2004 reflect diagnoses of and treatment for chronic open angle glaucoma, floppy lid syndrome, and blurred visual acuity. Records of VA treatment dated in November and December 2003 include a finding of chronic glaucoma. During the September 2006 hearing, the Veteran testified that, during his Reserve service, while at Fort Hood, Texas, his eyes were watering and hurting, so he went to the infirmary and was given eye drops and plastic/paper glasses. He was told that he was getting too much sunlight in his eyes, which was causing them to hurt. He added that his vision was 20/30 in his left eye when he entered service, and that his left eye had always been worse than his right. The Veteran stated that he tried to get glasses several times while in the Army, but was told that he did not need glasses. He reported that he first got glasses while in the Reserves, around the end of 1978, from a private optometrist. He stated that he also had glaucoma, and was told that he had a lot of pressure in his eye, suspicious for glaucoma, by an eye specialist at a shopping mall in the 1980s. The Veteran was afforded a VA eye examination in May 2009. He reported that he was diagnosed with glaucoma in both eyes in the early 1990s and, since then, had been treated with eye drops. He added that there was no specific incident during his military service which he believed may have caused his current eye problems, but that he had several eye examinations during service which showed less than 20/20 vision, which he believed was an early sign of glaucoma and should have been treated. The examiner reviewed the claims file, including reports of visual acuity dated in 1978 and 1979, noting that these reports did not include formal visual field testing, eye pressures, or detailed ophthalmologic examinations. The Veteran's current complaint was chronic, progressive painless blurry vision, left worse than right. On examination, visual acuity at distance and near, uncorrected, was 20/400 in the right eye and count fingers at 6 inches in the left eye. Corrected visual acuity at distance was 20/60+ in the right eye and count fingers at 6 inches in the left eye. Corrected near visual acuity was 20/50 in the right eye and count fingers at 6 inches in the left eye. The assessment was glaucoma, left eye greater than right eye, very advanced disease in the left eye. The examiner opined that the Veterans' glaucoma was less likely as not to have occurred due to a specific incident during military service. He added that it was not known whether he began to develop glaucoma during his active duty, and he could not deduce this based on the records available. The examiner commented that, while it was certainly possible that he could have had the early stages of glaucoma during his military service, it was unlikely that this condition was the direct result of any incidents sustained during active duty. The record reflects current diagnoses of glaucoma, blurred visual acuity, and floppy lid syndrome, thus, the first element of the claim for service connection is met. There is no evidence of a diagnosis of an eye disorder, to include glaucoma, blurred visual acuity, or floppy lid syndrome, during service, nevertheless, service connection may be granted for any disease initially 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). In this case, however, there is no medical evidence or opinion indicating that the Veteran's current eye disorder is related to service. In this regard, the only opinion regarding etiology of the Veteran's current eye disorder is that of the May 2009 VA examiner, who opined that it was less likely that the Veteran's glaucoma occurred due to a specific incident during military service. The Board finds the VA examiner's opinion dispositive of the question of whether the Veteran has an eye disorder which was incurred in or aggravated by service, as the examiner's findings were based on a review of the claims file, a thorough physical examination, and consideration of the Veteran's assertions. See Hayes, 5 Vet. App. at 69-70. See also Guerrieri, 4 Vet. App. at 470- 71. The Board has also considered the fact that the same VA examiner noted that it was certainly possible that the Veteran could have had the early stages of glaucoma during his military service, but added that he could not deduce whether he began to develop glaucoma during his active duty based on the records available. This opinion, that it was "certainly possible" that the Veteran "could have had" the early stages of glaucoma during military service, is too speculative to establish a nexus. See Bostain v. West, 11 Vet. App. 124, 127-28 (1998), quoting Obert v. Brown, 5 Vet. App. 30, 33 (1993) (medical opinion expressed in terms of "may" also implies "may or may not" and is too speculative to establish a medical nexus). Thus, the only competent, probative (persuasive) opinion on the question of whether the Veteran has a current eye disorder that is etiologically related to service weighs against the claim for service connection. The Veteran has not presented or identified any existing, contrary medical opinion that, in fact, supports the claim for service connection. As there is no competent, persuasive medical evidence that relates the Veteran's current eye disorder to service, to include any period of ADT, the Veteran is not entitled to service connection for an eye disorder. All Disabilities In addition to the medical evidence, the Board also has considered the statements of the Veteran. However, to the extent that any such lay statements are being offered to answer the questions of whether the Veteran has a right or left shoulder, low back, or eye disability related to service, such evidence must fail. Such matters are within the province of trained medical professionals. Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). As the Veteran is a layperson without the appropriate medical training or expertise, he is not competent to render probative (i.e., persuasive) opinions on these medical matters. See Bostain, 11 Vet. App. at 127, citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992). See also Routen v. Brown, 10 Vet. App. 183, 186 (1997) ("a layperson is generally not capable of opining on matters requiring medical knowledge"). Consequently, the lay assertions as to the nature or etiology of the Veteran's claimed disabilities have no probative value. For all the foregoing reasons, the claims for service connection must be denied. In arriving at the decision to deny the claims, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claims, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). ORDER As new and material evidence to reopen the claim for service connection for a right shoulder disability has been received, to this limited extent, the appeal is granted. Entitlement to service connection for a right shoulder disability is denied. Entitlement to service connection for a left shoulder disability is denied. Entitlement to service connection for a low back disability is denied. Entitlement to service connection for an eye disorder is denied. ____________________________________________ D. C. Spickler Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs