Citation Nr: 1237691 Decision Date: 11/02/12 Archive Date: 11/09/12 DOCKET NO. 00-24 286 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in North Little Rock, Arkansas THE ISSUES 1. Entitlement to service connection for a left shoulder disorder. 2. Entitlement to service connection for a right knee disorder. 3. Entitlement to service connection for a back disorder. WITNESSES AT HEARING ON APPEAL Appellant and his son ATTORNEY FOR THE BOARD M. G. Mazzucchelli, Counsel INTRODUCTION The Veteran served on active duty from September 1967 to September 1969. This matter originally came before the Board of Veterans' Appeals (Board) on appeal from an August 2000 rating decision of the Department of Veterans Affairs (VA), regional office (RO) in North Little Rock, Arkansas. In January 2006, the Veteran and his son testified at a Travel Board hearing before the undersigned Veterans Law Judge; a transcript of the hearing is of record. In August 2006, the Board denied the Veteran's claims. This decision was appealed to the Court of Appeals for Veterans Claims (Court). Pursuant to a Joint Motion for Remand, the Court vacated the Board's decision and remanded the matter to the Board for compliance with the terms of the Joint Motion. The Board then remanded the Veteran's claim in April 2008 for development in compliance with the Joint Motion. In April 2009, the Board again denied the Veteran's claims. This decision was appealed to the Court. In a memorandum decision dated in February 2011, the Court, in pertinent part, vacated the Board's decision with respect to the issues of entitlement to service connection for left shoulder, right knee, and back disorders, and remanded the matter to the Board for further proceedings consistent with the Court's decision. In a December 2011 decision, the Board, in pertinent part, remanded the issues of entitlement to service connection for left shoulder, right knee, and back disorders for additional development called for in the Court's decision. FINDINGS OF FACT 1. The Veteran's current left shoulder disorder, diagnosed as acromioclavicular arthritis and sprain, began many years after service and was not caused by any incident of service. 2. The Veteran's current right knee disorder, diagnosed as chondromalacia patella and degenerative joint disease, began many years after service and was not caused by any incident of service. 3. The Veteran's in-service treatment for back pain resolved without residual disability. 4. The Veteran's current back disorder, diagnosed as sprain and degenerative disc disease, began many years after service and was not caused by any incident of service. CONCLUSIONS OF LAW 1. A left shoulder disorder was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2012). 2. A right knee disorder was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2012). 3. A back disorder was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Notice and Assistance Under applicable criteria, VA has certain notice and assistance obligations to claimants. See 38 U.S.C.A. §§ 5102 , 5103, 5103A, 5107; 38 C.F.R. §§ 3.102 , 3.156(a), 3.159, 3.326(a). Notice must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim for VA benefits and must: (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004) (Pelegrini II). With respect to service connection claims, a section 5103(a) notice should also advise a claimant of the criteria for establishing a disability rating and effective date of award. Dingess v. Nicholson, 19 Vet. App. 473, 486 (2006). Required notice was provided by a letter dated in May 2004, which informed the Veteran of all the elements required by the Pelegrini II Court as stated above. The Board finds that any defect concerning the timing of the notice requirement was harmless error. Although the notice provided to the Veteran was not given prior to the first adjudication of the claim, the Veteran has been provided with every opportunity to submit evidence and argument in support of his claim and ample time to respond to VA notices. See Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). Additionally, the Veteran's claim was readjudicated following completion of the notice requirements. See Overton v. Nicholson, 20 Vet. App. 427, 437 (2006). Furthermore, while the Veteran's case was returned to the Board by the Court, there was no allegation that the notice that had been provided was in any way inadequate. VA and private treatment records have been obtained, as were SSA records. The Veteran was also provided with a VA examination. Additionally, the Veteran testified at a hearing before the Board. VA has satisfied its duties to notify and assist, and additional development efforts would serve no useful purpose. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). In light of the denial of the Veteran's claim, no disability rating or effective date will be assigned, so there can be no possibility of any prejudice to the Veteran under the holding in Dingess v. Nicholson, 19 Vet. App. 473 (2006). Because VA's duties to notify and assist have been met, there is no prejudice to the Veteran in adjudicating this appeal. Service Connection Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). In order to prevail on the issue of service connection there must be competent evidence of a current disability; medical evidence, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Consistent with the above, a claimant may establish service connection if the claimant can demonstrate (1) the existence of a chronic disease in service and (2) present manifestations of the same disease. § 3.303(b). See Savage v. Gober, 10 Vet .App. 488 (1997). Likewise, the claimant may establish service connection by continuity of symptomatology. Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) there is post service evidence of the same symptomatology; and (3) there is medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post service symptomatology. Savage, 10 Vet. App. at 495. The Board must assess the credibility and weight of all the evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. Nevertheless, when, after considering all the evidence, a reasonable doubt arises regarding a determinative issue, the benefit of the doubt shall be given to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. Left Shoulder The Veteran is seeking service connection for a left shoulder disorder. At his January 2006 hearing before the Board, the Veteran testified that he injured his left shoulder playing football during the summer of 1968. Service treatment records are silent as to any complaints of or treatment for a left shoulder disorder; and the Veteran's upper extremities were found to be normal on his separation physical. The first post service evidence of record noting complaints of a left shoulder disorder is dated in September 1978, nine years after the Veteran's discharge from service, when the Veteran complained about neck pain on lifting and right lateral rotation since that same morning. The report also noted that the Veteran denied any previous episode or injury; and, while a physical examination revealed tightness in the muscles of the shoulders, no follow-up treatment was ordered. A treatment letter, dated in December 1993, was received from S. Thompson, M.D. In his letter, Dr. Thompson reported that the Veteran was working as an order filler at a food distribution warehouse in December 1993 when he began having trouble with his left shoulder and neck after lifting a case weighing about 30 to 40 pounds. Physical examination revealed tenderness over the cervical spinous processes and into the left trapezius; but the report did not discuss or mention any prior ongoing shoulder injury, or any in-service shoulder injury. In February 2005 X-rays of the Veteran's shoulders revealed degenerative joint disease/osteoarthritis. However, while the Veteran's in-service history of shoulder pain was noted, there was no medical opinion of record suggesting that the current arthritis was related to the Veteran's time in service. Numerous records were obtained from the Social Security Administration (SSA) and reviewed; however, the records fail to show any shoulder treatment earlier than the 1978 treatment records that have already been associated with the Veteran's claims file. Furthermore, no medical opinion was contained in the SSA records that links the arthritis in the Veteran's left shoulder to his time in service. The Veteran's wife wrote a letter dated in January 2003 indicating that since returning from service, the Veteran had complained of muscle pain, including in his left shoulder. A VA examination was conducted in March 2012. The examiner reviewed the claims folder in conjunction with the examination of the Veteran. The Veteran reported that his left shoulder had bothered him since service. He reported that his left shoulder currently bothered him if he slept on it. The examiner diagnosed acromioclavicular arthritis and left shoulder sprain. The examiner stated that it was less likely than not that the Veteran's current left should condition was secondary to, related to, or the result of military service. The examiner's rationale was that there were no documented left shoulder complaints in service; that the separation examination was negative for left shoulder complaints; that the Veteran stated that his left shoulder "got bad" around 1995 when he stopped working; and that his current left shoulder condition was as likely as not related to normal aging and use. The Veteran and his wife are competent to report that the Veteran injured his left shoulder in service and that he had shoulder problems during and after service, because this requires only personal knowledge as it comes through the senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). However, the evidence of record, which includes statements made by the Veteran during treatment and VA examinations, contradicts the Veteran's and his wife's statements that left shoulder symptoms were present since service. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Caluza v. Brown, 7 Vet. App. 498 (1995). Specifically, the Veteran denied shoulder problems at separation from service, and the only documented left shoulder complaint prior to 1996 was one finding of shoulder muscle tightness in 1978. Thus, the Board does not find these statements and contentions from the Veteran and his wife to be credible. On the other hand, a physician has reviewed the Veteran's medical records and examined the Veteran, finding that the Veteran's current left shoulder disorder, diagnosed as sprain and arthritis, was not related to service. The examiner considered the Veteran's prior medical history and examinations and described his findings in sufficient detail after performing a physical examination and interview with the Veteran. There is sufficient basis for the Board to rely on the examiner's opinion regarding the relationship between the claimed inservice injury and the current left shoulder condition. As the opinion was based upon review of the claims file and a physical examination, it is found to be persuasive. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). In reaching the conclusion that the Veteran's left shoulder disability was not related to service, the Board finds it relevant that the Veteran's post service employment was in a physically rigorous position, which runs counter to a finding of an ongoing chronic left shoulder disorder following the Veteran's discharge from the service. For example, a treatment report, dated in February 1979, noted that the Veteran worked at a Safeway warehouse, and that he got a great deal of exercise working there. A February 1982 treatment report noted that the Veteran was employed as a warehouse order filler at Safeway. At his September 1997 RO hearing, the Veteran testified that his job involved a lot of lifting, anywhere from 70 pounds down, and that he had been doing the same kind of work for the past 20 years. He also testified that he has never had a sedentary job. In a statement dated in October 2002 the Veteran indicated that he began working in the food distribution position in 1973. At a January 2003 hearing before the RO, the Veteran testified that he aggravated his in-service shoulder injury in 1993. Specifically, he indicated that a case of detergent fell approximately 30 feet landing on his outstretched arms as he tried to stop it. He testified that this made his in-service injury worse. The Board notes that the Veteran's arthritis of the left shoulder was not diagnosed until 2005. As such, service connection on a presumptive basis is not warranted. See 38 U.S.C.A. § 1112; 38 C.F.R. §§ 3.307, 3.309. The weight of the credible evidence establishes that the Veteran's current left shoulder disorder began many years after service and was not caused by any incident of service. As the preponderance of the evidence is against the claim for service connection for a left shoulder disorder, the benefit-of-the-doubt rule does not apply, and the Veteran's claim is therefore denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Right Knee The Veteran is seeking service connection for a right knee disorder. At his hearing before the Board in January 2006, the Veteran testified that he injured his left knee during service, and that his current right knee disorder may be a result of that injury. At a prior hearing before the RO in April 1998, the Veteran testified that he injured his right knee during service in a swimming pool accident. At that time, he testified that his in-service treatment records erroneously referred to his left knee instead of his right. Service treatment records revealed treatment for left knee pain from May 1968 to June 1968; but no complaints of right knee pain were indicated. Regardless, at his separation physical, the Veteran's lower extremities were found to be normal. Following his discharge from the service, the first notation of any complaints relating to either of the Veteran's knees is dated in December 1978, nine years after he was discharged from the service. The December 1978 report noted that the Veteran was hospitalized for rheumatic fever, and that he had just days earlier developed right knee arthralgia. A follow-up treatment report, dated in January 1979, noted that the Veteran was still being treated for rheumatic fever, and that he had complaints of joint pain particularly in the hands, knees and ankles. A subsequent treatment report, dated in October 1981 noted the Veteran's complaints of right knee pain and swelling for the past three days, but X-rays showed a radiographically normal right knee. The Veteran underwent a diagnostic arthroscopy of the right knee in February 1982. The operative report noted that the Veteran did not have a distinct injury, but reported that he had had marked swelling of the right knee for the past three months following an episode of bending and crouching at work. The report noted that the Veteran has had increasing symptoms with swelling and pain along the medial joint line. The report concluded with post operative diagnoses of cartilage defect with significant synovitis. In November 1996, the Veteran filed a claim seeking, in part, service connection for a right knee disorder. In March 1997 the Veteran complained of right knee pain and effusion, but X-rays of the right knee were normal. The Veteran was diagnosed with of degenerative arthritis of the right knee. In December 2001 the Veteran again complained of right knee pain; but a physical examination of the right knee revealed no effusion, full extension, and flexion to 130 degrees. All ligaments were intact and nontender to stress. There was tenderness diffusely about the right knee superior to the patella and in the pes anserinus area. The report concluded with diagnoses of pes anserine bursitis or tendonitis; and degenerative joint disease or osteoarthritis in accordance with his age. Numerous SSA records were obtained and reviewed; however, the records fail to show any knee treatment earlier than the 1978 treatment records that have already been associated with the Veteran's claims file. Furthermore, no medical opinion of record was contained in the SSA records that links the arthritis in the Veteran's right knee to his time in service. The Veteran's wife wrote a letter dated in January 2003 indicating that since returning from service, the Veteran had complained of pain, including in his right knee. In a statement dated in May 2004, D.H. Reid, a Certified Adult Nurse Practitioner, noted that she had known the Veteran since before he entered the military. She stated that "upon his discharge from the military he presented with multiple complaints," including pain in the knees, which "to my knowledge have not resolved." A VA examination was conducted in March 2012. The examiner reviewed the claims folder in conjunction with the examination of the Veteran. The Veteran reported bilateral knee pain with climbing stairs, long walks, squatting, and kneeling. The examiner diagnosed chondromalacial patella and degenerative joint disease. The examiner stated that it was less likely than not that the Veteran's current right knee condition was secondary to, related to, or the result of military service. The examiner's rationale was that there was no evidence to connect or establish a nexus between the service time and his current right knee complaints. The examiner noted that the Veteran did not seek treatment for knee pain until nearly 10 years after military service and that he worked from service separation until 1995 when his knees began to bother him as they now do. The Veteran and his wife are competent to report that the Veteran injured his right knee in service and that he had knee problems during and after service, because this requires only personal knowledge as it comes through the senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). However, the evidence of record, which includes statements made by the Veteran during treatment and VA examinations, contradicts the Veteran's and his wife's statements that right knee symptoms were present since service. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Caluza v. Brown, 7 Vet. App. 498 (1995). Specifically, the Veteran denied knee problems at separation from service, and on the December 1978 hospitalization report the Veteran reported that just days earlier he had developed right knee arthralgia. Thus, the Board does not find these statements and contentions from the Veteran and his wife to be credible. Based upon its review of the claims file, the Board concludes that the evidence is against the conclusion the Veteran has a chronic right knee disorder incurred during service. The Board also finds that the evidence of record does not support the conclusion there is a nexus or link between the Veteran's current right knee disorder and his active duty service. The VA examiner in March 2012, based upon a review of the claims folders and physical examination of the Veteran, found no correlation between the two. The examiner's conclusion is supported by the lack of any ongoing treatment for a right knee disorder for many years following the Veteran's discharge from the service. The examiner considered the Veteran's prior medical history and examinations and described his findings in sufficient detail after performing a physical examination and interview with the Veteran. There is sufficient basis for the Board to rely on the examiner's opinion regarding the relationship between the inservice injury and the current right knee condition. The statement of the nurse practitioner that the Veteran had complaints of knee pain following service which to her knowledge had not resolved, cannot constitute probative evidence of continuity of symptomatology given that she does not provide information specifying the degree of her contact with the Veteran over the years or her knowledge of his medical situation during the decades since his separation from service. Likewise, the earliest post service record of a right knee complaint was recorded in the context of the Veteran's treatment for rheumatic fever, which initially manifested with joint pain, and required hospitalization. It is reasonable to infer that during this investigation of symptoms, a notation documenting chronic right knee pain would have been made, had that been the case. Moreover, it was specifically noted that on day 4 of the hospitalization, there was complete cessation of arthralgias, which belies any contention that there was an underlying chronic orthopedic knee pain since service. The Board notes that the Veteran's arthritis of the right knee was not diagnosed until 2005. As such, service connection on a presumptive basis is not warranted. See 38 U.S.C.A. § 1112; 38 C.F.R. §§ 3.307, 3.309. The weight of the credible evidence establishes that the Veteran's current right knee disability, diagnosed as chondromalacia patella and degenerative joint disease, began many years after service and was not caused by any incident of service. The condition was not incurred in or aggravated by service. As the preponderance of the evidence is against the claim for service connection for right knee disorder, the benefit-of-the-doubt rule does not apply, and the claim is therefore denied. 38 U.S.C.A. § 5107(b) ; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Back The Veteran is seeking service connection for a back disorder. At his hearing before the Board, he testified that he injured his back while playing football during his military service. At a January 2003 hearing before the RO, the Veteran testified that he injured his back playing basketball in the service. Service treatment records reveal a single treatment for low back strain in August 1969. The report noted that the condition was to be treated with aspirin and heat. No follow up treatment for or complaints of back pain were indicated. The report of the Veteran's separation examination, performed in July 1969, noted that his neck and spine were normal. Following his discharge from the service, the first report of back pain is not shown until May 1978 when the Veteran complained of having back pain for the past 24 hours, which he first noticed after moving boxes while at work. A physical examination revealed left flank pain; and a subsequent treatment report from September 1978 noted complaints of pain in his neck and shoulder since that morning. In January 1980 the Veteran again complained that he had low back pain which had increased after going to work. In December 1986 the Veteran complained of left sided low back pain; and in September 1988, he was treated for complaints of low back pain for the past several weeks. A treatment report from S. Thompson, M.D., dated in December 1993, noted that the Veteran was an order filler, and was "lifting a case weighing about 30 to 40 pounds on 12-1-93 when he began having trouble with his left shoulder and neck area." X-rays revealed slight narrowing of the C4-C5 disc space with minimal anterior osteophyte. Dr. Thompson noted that his symptoms were suggestive of a herniated disc. A subsequent treatment report, dated in January 1994, noted that an MRI showed degenerative changes at multiple disc levels. Specifically, there were diffuse bulges at C3-C4, C4-C5, and C6-C7. At the C4-C5 level, there appeared to be a left paracentral disc herniation, and the report noted that he was symptomatic on the left side. A treatment report, dated in September 1995, noted the Veteran's complaints of low back pain. The report concluded with an impression of a herniated disc at L4-L5 on the right side, with definite neurological findings. At a physical therapy evaluation in June 1996 the Veteran was diagnosed with chronic neck and low back pain. The report noted that the pain in the cervical and right shoulder region had its onset in December 1993 after a work related injury involving picking up a case of bleach. The report also noted the Veteran's complaints of low back pain, which radiated into the right lower extremity. An MRI of the lumbar spine from September 1996 revealed degenerative changes at L2-L3 and L3-L4, with some bulging of the discs at that level but no evidence of nerve root impingement. A hospitalization report, dated in April 1997, noted the Veteran's complaints of back, neck and shoulder pain for the past couple years; and he was diagnosed with chronic low back pain with radiculopathy. A July 1997 decision by the SSA granted the Veteran disability benefits, effective from May 1995. The decision noted medically determinable impairments, including bulging disc at C6-C7; bulging disc at L2-L3; numbness in hands, arms, and legs. However, there was no indication that the Veteran's back and neck injuries were the product of his time in service. Numerous SSA records, in addition to the 1997 decision, were obtained and reviewed; however, the medical records fail to show any back treatment earlier than the 1978 treatment records that have already been associated with the Veteran's claims file. Furthermore, no medical opinion of record was contained in the SSA records that links the Veteran's current back disorder to his time in service. An MRI in April 2002 showed degenerative disc disease involving the C3-C4, C4-C5, C5-C6 and C6-C7 disc levels; multilevel degenerative changes, including uncovertebral osteophytes and facet changes of the cervical spine; mild interval progression of degenerative disk disease at L1-L2; and stable early degenerative changes at L2-L3. The Veteran's wife wrote a letter dated in January 2003 indicating that since returning from service, the Veteran had complained of pain, including in his back area. In a statement dated in May 2004, D.H. Reid, a Certified Adult Nurse Practitioner, noted that she had known the Veteran since before he entered the military. She stated that "upon his discharge from the military he presented with multiple complaints," including pain in the low back, which "to my knowledge have not resolved." A VA examination was conducted in March 2012. The examiner reviewed the claims folder in conjunction with the examination of the Veteran. The Veteran reported a back injury in service, with back pain present since service that had worsened since the 1990s. The examiner diagnosed sprain and degenerative disc disease, with radiculopathy to the right leg. The examiner stated that it was less likely than not that the Veteran's current low back condition was secondary to, related to, or the result of military service. The examiner's rationale was that there was no evidence to connect or establish a nexus between the service time and his current low back complaints. The Veteran and his wife are competent to report that the Veteran injured his back in service and that he had back problems during and after service, because this requires only personal knowledge as it comes through the senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). However, the evidence of record, which includes statements made by the Veteran during treatment and VA examinations, contradicts the Veteran's and his wife's statements that back symptoms were present since service. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Caluza v. Brown, 7 Vet. App. 498 (1995). Specifically, when the Veteran first sought treatment for back pain following service, in May 1978, he complained of having back pain for the past 24 hours, which he first noticed after moving boxes while at work. Thus, the Board does not find these statements and contentions from the Veteran and his wife to be credible. Based upon its review of the claims file, the Board finds that the evidence is against the conclusion the Veteran has a chronic low back disorder incurred during service. The Board also finds that the evidence of record does not support the conclusion there is a nexus or link between the Veteran's current low back disorder and his active duty service. The VA examiner in March 2012, based upon a review of the claims folders and physical examination of the Veteran, found no correlation between the two. The examiner's conclusion is supported by the lack of any ongoing treatment for a back disorder for many years following the Veteran's discharge from the service, or credible account of on-going symptoms since service. The examiner considered the Veteran's prior medical history, including his report of ongoing back pain during and subsequent to service, and examinations, and described his findings in sufficient detail after performing a physical examination and interview with the Veteran. There is sufficient basis for the Board to rely on the examiner's opinion regarding the relationship between the inservice injury and the current low back condition. The statement of the nurse practitioner that the Veteran had complaints of back pain following service which to her knowledge had not resolved, cannot constitute probative evidence of continuity of symptomatology given that she does not provide information specifying the degree of her contact with the Veteran over the years or her knowledge of his medical situation during the decades since his separation from service. Likewise, the earliest post service record of a back complaint was recorded after a work-related injury in 1978. The Board notes that the Veteran's arthritis of the lumbar spine was not diagnosed until 1996. As such, service connection on a presumptive basis is not warranted. See 38 U.S.C.A. § 1112; 38 C.F.R. §§ 3.307, 3.309. The weight of the credible evidence establishes that the Veteran's current back disability, diagnosed as degenerative disc disease and sprain, began many years after service and was not caused by any incident of service. The condition was not incurred in or aggravated by service. As the preponderance of the evidence is against the claim for service connection for a back disorder, the benefit-of-the-doubt rule does not apply, and the claim is therefore denied. 38 U.S.C.A. § 5107(b) ; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Service connection for a left shoulder disorder is denied. Service connection for a right knee disorder is denied. Service connection for a back disorder is denied. ____________________________________________ MICHAEL E. KILCOYNE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs