Citation Nr: 1303774 Decision Date: 02/04/13 Archive Date: 02/08/13 DOCKET NO. 10-10 243 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Anchorage, Alaska THE ISSUES 1. Whether new and material evidence has been presented to reopen a claim of entitlement to service connection for residuals of left ankle fracture. 2. Entitlement to service connection for a left foot condition, claimed as secondary to a left ankle disability. 3. Entitlement to service connection for a cervical spine disability. 4. Entitlement to service connection for a right arm disability, claimed as secondary to cervical spine disability. 5. Entitlement to service connection for basal ganglion cyst. 6. Entitlement to service connection for an acquired psychiatric disorder, claimed as depression. 7. Entitlement to service connection for headaches. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD J. Barone, Counsel INTRODUCTION The Veteran had active service from June 1981 to August 1989 and from November 1989 to February 1994. This matter comes before the Board of Veterans' Appeals (Board) from an August 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Salt Lake City, Utah. Jurisdiction over the Veteran's claims file currently resides with the Anchorage, Alaska RO. The Board observes that there is a Virtual VA e-file for the Veteran. This e-file was reviewed for new or relevant information; however, a review of the e-file revealed that it contained duplicative information that is already in the file and not pertinent to the current claim. The Veteran testified before the undersigned Veterans Law Judge (VLJ) via videoconference in March 2011. A transcript of his hearing has been associated with the record. FINDINGS OF FACT 1. In an August 1994 rating decision, the RO denied service connection for left ankle fracture; the Veteran did not appeal. 2. The evidence received since the August 1994 rating decision is cumulative or redundant of evidence previously of record, and does not relate to an unestablished fact necessary to substantiate the claim of entitlement to service connection for a left shoulder disability. 3. A left foot disability is related to a service-connected disease or injury. 4. A cervical spine disability was not manifest in service and is unrelated to service. 5. A right arm disability is unrelated to a service-connected disease or injury. 6. Basal ganglion cyst was not manifest in service and is unrelated to service. 7. An acquired psychiatric disorder, to include depression, was not manifest in service and is unrelated to service. 8. A headache disability was not manifest in service and is unrelated to service. CONCLUSIONS OF LAW 1. The August 1994 rating decision is final. 38 U.S.C.A. §§ 7104, 7105 (West 2002); 38 C.F.R. §§ 3.160(d), 20.1103 (2012). 2. New and material evidence has not been received to reopen the claim of entitlement to service connection for a left ankle disability. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2012). 3. A left foot disability is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a) (2012). 4. A cervical spine disability was not incurred in or aggravated during service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. § 3.303 (2012). 5. A right arm disability is not proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a) (2012). 6. A basal ganglion cyst was not incurred in or aggravated during service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. § 3.303 (2012). 7. An acquired psychiatric disorder was not incurred in or aggravated during service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. § 3.303 (2012). 8. A headache disability was not incurred in or aggravated during service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. § 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his representative of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a) (West 2002 & Supp. 2012); 38 C.F.R. § 3.159(b) (2012); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. VCAA notice should be provided to a claimant before the initial unfavorable RO decision on a claim. See Pelegrini v. Principi, 18 Vet. App. 112 (2004); Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). On March 3, 2006, the Court of Appeals for Veterans Claims (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. The Court has also issued a decision which held that, in the context of a claim to reopen, VCAA notice must include an explanation of 1) the evidence and information necessary to establish entitlement to the underlying claim for the benefit sought; and 2) what constitutes new and material evidence to reopen the claim as determined by the evidence of record at the time of the previous final denial. See Kent v. Nicholson, 20 Vet. App. 1 (2006). The Court further explained that a notice letter must describe what evidence would be necessary to substantiate the element or elements required to establish the underlying claim that were found insufficient in the previous denial. See id. A letter dated in February 2009 discussed the evidence necessary to support a claim of entitlement to service connection on both a direct and secondary basis. The evidence of record was discussed. The Veteran was told that VA could help him obtain pertinent records. This letter also discussed the manner in which VA determines disability ratings and effective dates. An April 2009 letter discussed the meaning of new and material evidence and advised the Veteran of the basis for the previous final denial of his claim. The evidence of record was listed and the Veteran was told how VA would assist him in obtaining additional relevant records. In May 2009 the Veteran was advised of the status of his claim. The content of the notice provided to the Veteran fully complied with the requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) regarding VA's duty to notify. The Veteran has been provided with every opportunity to submit evidence and argument in support of his claim and to respond to VA notices. Further, the Board finds that the purpose behind the notice requirement has been satisfied because the Veteran has been afforded a meaningful opportunity to participate effectively in the processing of his claim. With respect to VA's duty to assist, the Board notes service treatment records as well as VA and private treatment records are also associated with the claims file. The Veteran has not identified any additional evidence or information which could be obtained to substantiate his claim. The Board is also unaware of any such outstanding evidence or information. The Board acknowledges that the Veteran has not been afforded a VA medical examination with respect to his cervical spine, ganglion cyst, right arm, depression, and headache claims. In that regard, the Board finds that a VA examination is not necessary. There are two pivotal cases which address the need for a VA examination, Duenas v. Principi, 18 Vet. App. 512 (2004) and McLendon v. Nicholson, 20 Vet App. 79 (2006). In McLendon, the Court held that in disability compensation claims, the Secretary must provide a VA medical examination when there is: (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. Id. at 81. In Duenas, the Court held that a VA examination is necessary when the record: (1) contains competent evidence that the Veteran has persistent or recurrent symptoms of the claimed disability and (2) indicate that those symptoms may be associated with his active military service. The Veteran's service treatment records are entirely negative regarding any diagnosis, complaint, or abnormal finding pertaining to the claimed disabilities. Moreover, there is no reliable evidence that the claimed disabilities might be associated with service or with a service-connected disease or injury. In this regard, as will be discussed below in the Board's analysis, the Board has reviewed the Veteran's lay statements as they relate to evidence establishing a relationship to service and has determined that the Veteran's statements are not credible. Moreover, to the extent that the Board is denying entitlement to service connection for a cervical spine disability, an examination is not warranted to obtain an etiology opinion for the secondary right arm disability, as there is no legal basis for a grant of service connection for that disability. Accordingly, the Board has concluded that VA examinations are not warranted with respect to these claims. Moreover, the Board observes that with respect to a previously denied claim, until a claim is reopened, VA does not have a duty to provide a medical examination or obtain a medical opinion. See 38 C.F.R. § 3.159(c)(1). With respect to the Veteran's petition to reopen the claim of entitlement to service connection for a left ankle disability, the Board notes the case of Woehlaert v. Nicholson, 21 Vet. App. 456 (2007), wherein the appellant argued that the Board was obligated to reopen his claim because the RO had arranged for an examination, and that the examination in question was inadequate. In that decision, the Court held that the Board was not obligated to reopen a claim merely because the RO reopened the claim and undertook development such as obtaining a new examination or opinion. Furthermore, in Woehlaert, the Court also held that the adequacy of any such examination or opinion is moot if the Board determines that new and material evidence has not been presented, although the Board must certainly consider the results of such an examination or opinion as it would any evidence of record. Here, a VA foot and ankle examination was conducted in March 2009, but the examiner did not provide an opinion regarding the etiology of any currently present left ankle disability. However, even if the VA examination was inadequate, any such inadequacies are moot as the Board is finding that new and material evidence has not been received to reopen the left ankle claim. Finally, the Board notes that the Veteran also was afforded a hearing before the undersigned during which he presented oral argument in support of his service connection claim. In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the Court held that 38 C.F.R. § 3.103(c)(2) (2012) requires that the VLJ or Decision Review Officer who chairs a hearing fulfill two duties to comply with the above the regulation. These duties consist of (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. Here, the VLJ fully explained the issues on appeal during the hearing and asked questions specifically regarding the elements necessary to establish the benefits sought. Significantly, neither the Veteran nor his representative has asserted that VA failed to comply with 38 C.F.R. § 3.103(c)(2) , nor has he identified any prejudice in the conduct of the Board hearing. By contrast, the hearing focused on the evidence necessary to substantiate the claim, and the Veteran, through his testimony, demonstrated that he had actual knowledge of the evidence necessary to substantiate his claim. As such, the Board finds that, consistent with Bryant, the VLJ complied with the duties set forth in 38 C.F.R. § 3.103(c)(2). For the foregoing reasons, it is not prejudicial to the appellant for the Board to proceed to a final decision in this appeal. Analysis New and Material Evidence Generally, a claim which has been denied in an unappealed RO decision or an unappealed Board decision may not thereafter be reopened and allowed. 38 U.S.C.A. §§ 7104(b), 7105(c) (West 2002). The exception to this rule is 38 U.S.C.A. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. New evidence means existing evidence not previously submitted to agency decisionmakers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence, although not its weight, is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). But see Duran v. Brown, 7 Vet. App. 216 (1994) ("Justus does not require the Secretary [of VA] to consider the patently incredible to be credible"). As noted, service connection for a left ankle disability was denied in an August 1994 rating decision. The RO noted the Veteran's report during service that he had sustained a fractured left ankle in 1976, approximately five years prior to entrance onto active duty. It also noted that there was a complaint of a twisted left ankle in July 1992, but that there were no further complaints of left ankle problems in service. The RO determined that the condition existed prior to service and was not aggravated by service. The evidence of record at the time of the August 1994 rating decision included the Veteran's service treatment records. They show that on enlistment examination in March 1981, he reported a left foot injury in 1973. The foot and lower extremity examination was normal and the Veteran was found to be qualified for enlistment. On separation examination in June 1989 the Veteran's lower extremities and feet were normal. At that time, he reported that he fractured his left ankle in 1976. During reenlistment examination in September 1989, the Veteran reported that he fractured his left ankle in 1975. He complained of left ankle pain in July 1992, after twisting it playing basketball. First degree strain was assessed. He complained of bilateral ankle pain in August 1992 and reported that he had fractured his left ankle at 14 years of age. On separation examination in December 1993, the Veteran's lower extremities and feet were normal. At that time, he reported that he had fractured his left ankle in 1974. The record also included VA examination reports. On joints examination in April 1994, the Veteran reported having sustained a fractured left ankle in 1974 and noted that he had instability of the ankles and recurrent spraining. The Veteran had dorsiflexion of the ankles to 30 degrees, plantar flexion to 60 degrees, inversion to 45 degrees, and eversion to 25 degrees. There was no crepitation and no palpable deformity or increased opening of the ankle mortise. The assessment was weak ankle syndrome. Evidence added to the record since the August 1994 rating decision includes private podiatry records. They show that the Veteran was assessed with paresthesia in the toes of both feet. The report of a March 2009 VA examination was also added to the record. At the time of examination, the Veteran reported that he fractured his left ankle at age 14. The diagnosis was bilateral intermittent medial ankle arthralgia without any obvious instability. The examiner noted that there were no other ankle diagnoses given the negative examination. Finally, the Veteran's contentions and hearing testimony have been added to the record. During his March 2011 hearing the Veteran testified that he broke his left ankle in approximately 1974. He argued that the vigorous activities in service aggravated the condition and caused further injury to the ankle. Upon close review of the evidence pertaining to this claim, the Board has concluded that new and material evidence has not been submitted to reopen the claim of entitlement to service connection for a left ankle disability. As discussed, the RO denied the Veteran's claim of entitlement to service connection for a left ankle disability because it determined that the condition preexisted service and was not aggravated by service. Since the August 1994 rating decision, there has been no competent evidence added to the record showing that the Veteran experienced a permanent worsening of his left ankle disability in service. Notably, such contentions were considered by the RO in August 1994 and any further assertions are cumulative. Medical evidence added to the record does not pertain to the question of whether there was permanent worsening of the left ankle disability; thus, such evidence is not material to the case at hand. In sum, the evidence received since the August 1994 rating decision does not offer any new, probative information pertaining to the Veteran's claim. Accordingly, the Board concludes that new and material evidence has not been presented, and the defect that existed at the time of the August 1994 rating decision has not been cured. Therefore, the claim may not be reopened. Service Connection Entitlement to VA compensation may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C.A. §§ 1110 (wartime service), 1131 (peacetime service); 38 C.F.R. § 3.303. To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"-the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). However, "[a] determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service." Watson v. Brown, 4 Vet. App. 309, 314 (1993). Service incurrence or aggravation of arthritis and diseases of the central nervous system may be presumed to have been incurred or aggravated if it is manifested to a compensable degree within a year of the Veteran's discharge from service. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be granted for a disability that is proximately due to or the result of an established service-connected disability. 38 C.F.R. § 3.310 (2012). This includes disability made chronically worse by service- connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). The Board notes that there was an amendment to the provisions of 38 C.F.R. § 3.310 during the pendency of this appeal. See 71 Fed. Reg. 52744-47 (Sept. 7, 2006). The amendment sets a standard by which a claim based on aggravation of a non-service-connected disability by a service-connected one is judged. The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). In Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C.A. § 7104(a). Moreover, the Court has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b) (West 2002). Left Foot A May 2009 record from a private podiatrist indicates the Veteran's chief complaint of constant numbness in the toes of both feet. Paresthesia was assessed, and the provider concluded that the loss of sensation related to a low back problem. At his March 2011 hearing, the Veteran asserted that his claimed left foot disability was related to his left ankle disability. He stated that his ankle shifted because of the break, and that caused pinching of the nerves in the foot. He stated that his doctor had told him that the pinched nerve was due to an abnormal gait. He indicated that he was first diagnosed with the nerve problem two years previously, in 2009. As discussed above, the Board has determined that the claim of entitlement to service connection for residuals of a left ankle fracture may not be reopened. The Veteran has specifically stated that he seeks service connection for a left foot disability as secondary to the claimed left ankle disability. He has not asserted that this disability is otherwise related to service. As the claim for a left ankle fracture may not be reopened, there is no legal basis for the grant of service connection for a left foot disability as secondary to the left ankle fracture. However, as noted, a private podiatrist assessed paresthesia and related it to a low back problem. The Board observes that the Veteran is currently in receipt of service connection for a low back disability. The opinion is based on an examination of the Veteran, and is not contradicted by the medical evidence of record. As such, the Board finds this opinion highly probative. In light of a medical opinion relating left foot symptoms to the service-connected low back disability, the Board concludes that service connection for the claimed left foot disability is warranted. Cervical Spine and Right Arm The Veteran seeks service connection for a cervical spine disability on a direct basis, and for a right arm disability as secondary to the cervical spine disability. Service treatment records are negative for any diagnosis, complaint, or abnormal finding pertaining to the Veteran's cervical spine. On separation examination in June 1989 the Veteran's spine was normal. He denied recurrent back pain. On reenlistment examination in September 1989 the Veteran again denied recurrent back pain; his spine was normal on examination. On separation examination in December 1993, the Veteran reported recurrent back pain but specified that he referred to low back pain. His spine was normal. The Board notes that service connection has since been established for a lumbar spine disability. The Veteran submitted a claim for VA benefits in March 1994; while this claim included numerous disabilities, it did not mention any problems with his cervical spine. A March 1994 Annual Medical Certificate for National Guard service indicates that the Veteran denied any current medical problems, and any such problems since his last periodic physical examination. He noted that he received 10 percent VA disability for his low back. He made the same certification in November 1995. In October 1996 the only change was that the Veteran had received dental treatment. In December 1997 the Veteran noted that a thumbnail was torn off; the information otherwise remained the same. In March 1998, with respect to current medical problems, the Veteran indicated that he had a cold. In December 1998, he denied any current medical problems, and any such problems since his last periodic physical examination. He noted that he received 10 percent VA disability for his low back. In August 1999, the Veteran denied current medical problems and indicated that he had received fillings. In December 2000 he denied any current medical problems, and any such problems since his last periodic physical examination. He noted that he received 10 percent VA disability for his low back. In June 2002 he stated that he had current medical problems and indicated arthritis of the knee, low back, and neck. Private treatment records indicate that the Veteran was seen on initial consultation in May 2008 with complaints of headaches of two months' duration. Physical examination showed a supple neck with full range of motion. Strength and reflexes were normal. When the Veteran was seen subsequently in May 2008 he complained of neck pain. An MRI revealed bony hypertrophic changes of the disc space level at C3-4 and C4-5. The provider also noted mild to moderate impingement on the right neural foramina. A June 2008 EMG report notes evidence of median nerve entrapment consistent with carpal tunnel syndrome and evidence of cervical radiculopathy. At his March 2011 hearing, the Veteran asserted that he had a cervical spine disability due to service. He maintained that road marches during service caused soreness and symptoms that felt like muscle fatigue. He stated that he had been diagnosed in approximately 2008, and that a doctor said that a bone scan showed bone fractures that were 18 months old. He denied having received treatment in service for his neck. He specified that his right arm disability was related to his cervical spine disability, as the result of bulging discs. Having carefully reviewed the record, the Board concludes that service connection is not warranted for a cervical spine disability. In that regard the Board notes that the service treatment records are negative for any diagnosis, complaint, or abnormal finding pertaining to the cervical spine. Moreover, the first indication of post-service complaints referable to the cervical spine dates to June 2002, when he identified arthritis of the neck on an annual medical certificate. The Board also observes that the first clinical findings pertaining to the cervical spine date to a May 2008 MRI report. In sum, the record reflects a remote, post-service onset of complaints referable to the Veteran's cervical spine. Lay evidence concerning continuity of symptoms after service, if credible, is ultimately competent, regardless of lack of contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The Veteran has argued to VA that he experienced symptoms related to his neck during and since service. However, the Veteran's current recollection is contradicted by the available service treatment records. Those records for the Veteran's initial periods of service are negative, and medical certifications for National Guard service do not reflect a report of neck problems until 2002. Indeed, the Veteran specifically denied current medical problems in March 1994, November 1995, October 1996, December 1998, August 1999, and December 2000. One would expect that, if the Veteran did have a history of neck problems dating to initial periods of serivce, such history would be reflected in his subsequent medical certifications. His repeated denial of current medical problems in the years following the initial periods of active service is negative evidence. The Board therefore concludes that the Veteran's current assertions of symptoms in service and thereafter are not credible and cannot serve to establish onset of his claimed cervical spine disability. The grant of service connection requires competent and credible evidence to establish a diagnosis and relate the diagnosis to the Veteran's service. While the record contains evidence referable to the Veteran's cervical spine, it does not include reliable evidence which relates this claimed disability to any injury or disease in service. The Board finds that the lack of findings of a chronic cervical spine disability during service and for years following separation is more probative and credible than the Veteran's more recent statements. Furthermore, to the extent that the Veteran has asserted that his claimed cervical spine disability is related to injury in service, the Board notes that in this instance such assertions are beyond his competence as a layperson. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Gleaning the cause of degenerative processes in the joints is categorically different from gleaning the cause of readily observable injuries such as a broken leg or dislocated shoulder. In this case, there is no competent nexus evidence. Absent reliable lay or medical evidence relating the claimed disabilities to service, the Board concludes that the claim of entitlement to service connection for a cervical spine disability must be denied. Regarding the right arm disability, the Board again notes that the Veteran has specified that this claimed disability is due to the cervical spine disability. As the Board has determined that service connection for a cervical spine disability is not warranted, there is no legal basis upon which to grant secondary service connection for the claimed right arm disability. The preponderance of the evidence is against the Veteran's claim and the doctrine of reasonable doubt is not applicable in the instant appeal. Gilbert v. Derwinski, 1 Vet. App. 49, 58 (1990); 38 C.F.R. § 3.102 (2012). Accordingly, service connection for a cervical spine disability and a right arm disability must be denied. Basal Ganglion Cyst, Depression, and Headaches Service treatment records are negative for any diagnosis, complaint, or abnormal finding suggestive of basal ganglion cyst or depression. They reflect that in August 1983, the Veteran was seen in an emergency room after passing out from the heat. An oral temperature was 98.1 degrees. He reported feeling "ok" but tired. He was given water and did not experience vomiting. He was discharged to duty and advised to avoid exertion and drink plenty of fluids. On separation examination in June 1989 the Veteran denied frequent or severe headache, dizziness or fainting spells, depression or excessive worry, and nervous trouble of any sort. He was psychiatrically and neurologically normal. On reenlistment examination in September 1989, the Veteran was again psychiatrically and neurologically normal. He denied frequent or severe headache, dizziness or fainting spells, depression or excessive worry, and nervous trouble of any sort. In October 1992, the Veteran was seen with complaints of dizziness of three days' duration. He stated that he passed out after wrestling around with his children, and that he remained dizzy for 15 minutes after waking up. The assessment was vasovagal episode secondary to sinus bradycardia. On separation examination in December 1993, the Veteran endorsed frequent headaches and reported that he had them twice per week. He also endorsed dizziness and fainting spells, and the examiner noted that the Veteran had fainted in October 1992. Clinically, the Veteran was psychiatrically and neurologically normal. The examiner did not make any comment regarding the reported headaches. A March 1994 Annual Medical Certificate for National Guard service indicates that the Veteran denied any current medical problems, and any such problems since his last periodic physical examination. He noted that he received 10 percent VA disability for his low back. He made the same certification in November 1995. In October 1996 the only change was that the Veteran had received dental treatment. In December 1997 the Veteran noted that a thumbnail was torn off; the information otherwise remained the same. In March 1998, with respect to current medical problems, the Veteran indicated that he had a cold. In December 1998, he denied any current medical problems, and any such problems since his last periodic physical examination. He noted that he received 10 percent VA disability for his low back. In August 1999, the Veteran denied current medical problems and indicated that he had received fillings. In December 2000 he denied any current medical problems, and any such problems since his last periodic physical examination. He noted that he received 10 percent VA disability for his low back. In June 2002 he stated that he had current medical problems and indicated arthritis of the knee, low back, and neck. Private treatment records indicate that the Veteran was seen on initial consultation in May 2008 with complaints of headaches of two months' duration. He denied a history of head injuries. Physical examination showed a supple neck with full range of motion. Strength and reflexes were normal. When the Veteran was seen subsequently in May 2008 he complained of neck pain. An MRI revealed a bony hypertrophic change of the disc space level at C3-4 and C4-5. The provider also noted mild to moderate impingement on the right neural foramina. A June 2008 note indicates that a brain MRI showed a small cystic structure adjacent to the right basal ganglia, most likely a small lacunar or even a diverticulum of the surpa sellar cistern area. The provider noted that these findings might also demonstrate an isolated congenital arachnoid cyst. He advised the Veteran that he might be having referred pain from his cervical disc disease causing some headaches. A June 2008 EMG report notes evidence of median nerve entrapment consistent with carpal tunnel syndrome and evidence of cervical radiculopathy. In a November 2009 statement, the Veteran described an incident that occurred in 1983, while he was stationed at Giessen, Germany. He indicated that he suffered from heat stroke and was treated in an emergency room. He noted that he was given intravenous fluids and that his temperature was as high as 106 degrees. He stated that because of medication he took for his various disabilities he did not have a problem with headaches enough to seek medical treatment. He noted that it was not until his physical routine changed and he stopped taking pain medication that he sought treatment for the headaches. Also submitted with this statement was the Veteran's exact statement, placed on letterhead and dated in November 2009, signed by the Veteran's private neurologist. This document contains no comments from the private physician. At his March 2011 hearing, the Veteran testified that he suffered from heat stroke in service. He asserted that the basal ganglion, headaches, and depression were all related to the heat stroke in service. He stated that his neurologist had indicated that it was possible that the basal ganglia were related to heat stroke, but that he did not explain his reasoning. He stated his belief that his depression was related to heat stroke because the extreme heat affected the chemical balance of his brain although it was not apparent at the time of heat stroke. He indicated that he was first diagnosed with depression in 2007 by a counselor at Hill Air Force Base. He also indicated his belief that his headaches were related to the heat stroke in service. He also indicated that his cervical spine condition could trigger a migraine. He denied having received treatment in service for headaches. He indicated that while he was in the National Guard, he stopped taking medication for his knees and back so he could perform the physical training test, and he started having more headaches as a result. Having carefully reviewed the record, the Board concludes that service connection is not warranted for basal ganglion, depression, or headaches. In that regard the Board notes that the service treatment records are negative for any diagnosis, complaint, or abnormal finding pertaining to basal ganglion or depression. Moreover, while the Veteran endorsed headaches in December 1993, no diagnosis was made and he was neurologically normal on clinical examination. Numerous medical certifications made by the Veteran during his subsequent National Guard service are negative for any report of a chronic headache disability or other symptoms suggestive of basal ganglion or an acquired psychiatric disorder. The first indication of post-service complaints referable to headaches dates to May 2008, when the Veteran reported headaches of two months' duration. The claimed basal ganglion was noted in June 2008. The Veteran's testimony indicates that depression was diagnosed in 2007. In sum, the record reflects a remote, post-service onset of these claimed disabilities. The grant of service connection requires competent and credible evidence to establish a diagnosis and relate the diagnosis to the Veteran's service. While there is evidence referable to these claimed disabilities, the record does not contain reliable evidence relating them to any injury or disease in service, to include the documented heat exhaustion. The Board finds that the lack of findings of any chronic disability characterized by basal ganglion, depression or headaches during service and for years following separation is more probative and credible than the Veteran's more recent statements. Furthermore, to the extent that the Veteran has asserted that these claimed disabilities are related to heat stroke in service, the Board notes that such assertions are beyond his competence as a layperson. See Jandreau. In particular, relating a cyst, headaches, and depression to purported chemical changes in the brain which have not been confirmed by the medical evidence of record is well beyond a lay person's expertise. Lay evidence concerning continuity of symptoms after service, if credible, is ultimately competent, regardless of lack of contemporaneous medical evidence. Buchanan. To the extent that the Veteran might assert that he experienced symptoms during in service and in the years thereafter, the Board notes that such complaints are contradicted by the available service treatment records. Rather, records for the Veteran's initial periods of service are negative with respect to the basal ganglion and depression, and include only one notation regarding headaches, which the Veteran reported on separation in 1993. Moreover, his medical certifications for National Guard service do not reflect any related complaints, despite his reporting of various other maladies, including reports of dental treatment, trauma to a thumbnail, and a cold. In light of those reports, one would expect that, if the Veteran did have a history of problems suggestive of basal ganglion, depression, or headaches dating to initial periods of service, such history would be reflected in his subsequent medical certifications. His repeated declarations denying medical problems, when otherwise affirmatively speaking, constitutes negative evidence. The Board therefore concludes that any assertions of symptoms in service and thereafter are not credible and cannot serve to establish onset of his claimed disabilities. Absent reliable lay or medical evidence relating the claimed disabilities to service, the Board concludes that the claim of entitlement to service connection for a basal ganglion, depression, and headaches must be denied. The preponderance of the evidence is against the Veteran's claim and the doctrine of reasonable doubt is not applicable in the instant appeal. Gilbert; 38 C.F.R. § 3.102 (2012). Accordingly, service connection for a cervical spine disability and a right arm disability must be denied. ORDER New and material evidence having not been received, the petition to reopen the claim of entitlement to service connection for residuals of left ankle fracture is denied. Entitlement to service connection for a left foot disability is granted. Entitlement to service connection for a cervical spine disability is denied. Entitlement to service connection for a right arm disability is denied. Entitlement to service connection for basal ganglion cyst is denied. Entitlement to service connection for an acquired psychiatric disorder is denied. Entitlement to service connection for headaches is denied. ______________________________________________ BETHANY L. BUCK Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs