Citation Nr: 1318824 Decision Date: 06/10/13 Archive Date: 06/21/13 DOCKET NO. 11-32 523 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to service connection for a lumbar spine disability. 2. Entitlement to service connection for a cervical spine disability. 3. Entitlement to service connection for a right knee disability. 4. Entitlement to service connection for a left knee disability. 5. Entitlement to service connection for a bilateral shoulder disability. 6. Entitlement to service connection for a right Achilles tendon disability. 7. Entitlement to service connection for a right foot disability. 8. Entitlement to a rating higher than 10 percent for residuals of a fracture to the second and fourth toes of the left foot (a "left foot disability"). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD D. Schechner, Counsel INTRODUCTION The Veteran served on active duty from August 1950 to August 1953. These matters come to the Board of Veterans' Appeals (Board) on appeal from a July 2011 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded these matters in February 2013. Additional evidence was received at the Board in May 2013. However, the evidence consists of duplicate copies of evidence already of record. The issues of service connection for bilateral hip disability and bilateral leg disability were raised by the Veteran in a March 2012 statement, but have not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over them, and they are referred to the AOJ for appropriate action. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). The matter of an increased rating for left foot disability is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. A chronic lumbar spine disability was not manifested during the Veteran's active duty service or for many years thereafter, nor is a chronic lumbar spine disability otherwise causally related to service. 2. A chronic cervical spine disability was not manifested during the Veteran's active duty service or for many years thereafter, nor is a chronic cervical spine disability otherwise causally related to service. 3. A chronic right knee disability was not manifested during the Veteran's active duty service or for many years thereafter, nor is a chronic right knee disability otherwise causally related to service. 4. A chronic left knee disability was not manifested during the Veteran's active duty service or for many years thereafter, nor is a chronic left knee disability otherwise causally related to service. 5. A chronic bilateral shoulder disability was not manifested during the Veteran's active duty service or for many years thereafter, nor is a chronic bilateral shoulder disability otherwise causally related to service. 6. A chronic right Achilles tendon disability was not manifested during the Veteran's active duty service or for many years thereafter, nor is a chronic right Achilles tendon disability otherwise causally related to service. 7. A chronic right foot disability was not manifested during the Veteran's active duty service or for many years thereafter, nor is a chronic right foot disability otherwise causally related to service. CONCLUSIONS OF LAW 1. A chronic lumbar spine disability was not incurred in or caused by the Veteran's active duty service, nor may it be presumed to have been incurred in such service. 38 U.S.C.A. §§ 1110, 1112, 1113, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2012). 2. A chronic cervical spine disability was not incurred in or caused by the Veteran's active duty service, nor may it be presumed to have been incurred in such service. 38 U.S.C.A. §§ 1110, 1112, 1113, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2012). 3. A chronic right knee disability was not incurred in or caused by the Veteran's active duty service, nor may it be presumed to have been incurred in such service. 38 U.S.C.A. §§ 1110, 1112, 1113, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2012). 4. A chronic left knee disability was not incurred in or caused by the Veteran's active duty service, nor may it be presumed to have been incurred in such service. 38 U.S.C.A. §§ 1110, 1112, 1113, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2012). 5. A chronic bilateral shoulder disability was not incurred in or caused by the Veteran's active duty service, nor may it be presumed to have been incurred in such service. 38 U.S.C.A. §§ 1110, 1112, 1113, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2012). 6. A chronic right Achilles tendon disability was not incurred in or caused by the Veteran's active duty service, nor may it be presumed to have been incurred in such service. 38 U.S.C.A. §§ 1110, 1112, 1113, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2012). 7. A chronic right foot disability was not incurred in or caused by the Veteran's active duty service, nor may it be presumed to have been incurred in such service. 38 U.S.C.A. §§ 1110, 1112, 1113, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS A. Veterans Claims Assistance Act of 2000 (VCAA) Under the Veterans Claims Assistance Act of 2000 (VCAA), codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107 and 5126; see also 38 C.F.R. §§ 3.102, 3.156(a), and 3.326(a), VA has a duty to notify the claimant of any information and evidence needed to substantiate and complete a claim, and of what part of that evidence is to be provided by the claimant and what part VA will attempt to obtain for the claimant. 38 U.S.C.A. § 5103(a); 38 C.F.R § 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). Duty to Notify Upon receipt of a complete or substantially complete application, VA must notify the claimant of the information and evidence not of record that is necessary to substantiate a claim, which information and evidence VA will obtain, and which information and evidence the claimant is expected to provide. 38 U.S.C.A. § 5103(a). The notice requirements apply to all five elements of a service connection claim: 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. Dingess v. Nicholson, 19 Vet. App. 473 (2006). The notice must be provided to a claimant before the initial unfavorable adjudication by the RO. Pelegrini v. Principi, 18 Vet. App. 112 (2004). The notice requirements may be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). By May 2010, August 2010, November 2010, March 2011, April 2011, and May 2011 letters, the Veteran was informed of the information and evidence necessary to warrant entitlement to the benefits sought on appeal and was also advised of the types of evidence VA would assist him in obtaining as well as his own responsibilities with regard to identifying relevant evidence. See Quartuccio v. Principi, 16 Vet. App. 183 (2002); Charles v. Principi, 16 Vet. App. 370 (2002). These letters also informed the Veteran of disability rating and effective date criteria. In sum, the Veteran has received all essential notice, has had a meaningful opportunity to participate in the development of his claims, and is not prejudiced by any technical notice deficiency along the way. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). In any event, the Veteran has not demonstrated any prejudice with regard to the content of the notice. See Shinseki v. Sanders, 129 S. Ct. 1696 (2009) (reversing prior case law imposing a presumption of prejudice on any notice deficiency, and clarifying that the burden of showing that an error is harmful, or prejudicial, normally falls upon the party attacking the agency's determination); Mayfield v. Nicholson, 444 F.3d 1328, 1333-34 (Fed. Cir. 2006). Duty to Assist The VCAA also provides that VA has a duty to assist claimants in obtaining evidence needed to substantiate a claim. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). In this case, the Veteran's VA and private treatment records are associated with the claims file and the Veteran has not identified any pertinent evidence that remains outstanding. Documentation in the claims file indicates that the Veteran's service treatment records (STRs) are unavailable. When service treatment records are lost or missing, VA has a heightened obligation to satisfy the duty to assist. The United States Court of Appeals for Veterans Claims (Court) has held that VA has a heightened duty "to consider the applicability of the benefit of the doubt rule, to assist the claimant in [otherwise] developing the claim, and to explain its decision when the veteran's medical records have been destroyed." Cromer v. Nicholson, 19 Vet. App. 215, 217-18 (2005) citing Russo v. Brown, 9 Vet. App. 46, 51 (1996). However, no presumption, in favor of the claimant or against VA, arises when there are lost or missing service records. See Cromer v. Nicholson, 19 Vet. App. 215, 217-18 (2005). The RO arranged for a VA examination in June 2011. The examination was adequate as the examiner considered the evidence of record and the reported history of the Veteran, conducted a thorough examination of the Veteran, noting all findings necessary for proper adjudication of the matters, and explained the rationale for the opinions offered. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (VA must provide an examination that is adequate for rating purposes). The Board concludes that VA's duties to the Veteran have been fulfilled with respect to the issues on appeal. Overall, there is no evidence of any VA error in notifying or assisting the Veteran that reasonably affects the fairness of this adjudication. B. Legal Criteria, Factual Background, and Analysis Service connection Applicable law provides that service connection will be granted if it is shown that the Veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Certain chronic disabilities, such as arthritis, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. The Veteran describes, as documented in the treatment and examination reports associated with the development of this appeal, that he incurred the disabilities claimed on appeal during his service. Specifically, he contends that jumping out of an airplane with a parachute caused his current disabilities. His service personnel records indicate that he was awarded the Parachute Badge, he completed an airborne division basic medical technician course, and he was assigned to an airborne medical battalion. As noted above, his service treatment records are largely unavailable. A February 1951 morning report showed that the Veteran was hospitalized at Fort Campbell with a post parachute injury to the left foot. On August 1953 service separation examination, no disabilities were noted to the upper extremities, feet, lower extremities, or spine. On January 1987 VA general medical examination, the musculoskeletal system was normal. On August 1993 VA treatment, the Veteran reported a 2 year history of right shoulder pain, which was assessed as arthritis. On April 1997 treatment, the Veteran reported severe pain to the left knee. X-rays of both knees showed findings of moderate degenerative joint disease bilaterally with a questionable joint effusion on the left knee. On May 1997 VA treatment, severe degenerative joint disease of the left knee was noted. A total left knee replacement had been recommended about 5 to 6 years earlier. The Veteran reported increased pain and swelling and wished to be considered for knee replacement surgery. On January 1998 treatment, the Veteran complained of pain to the left shoulder with limited range of motion since a fall the previous evening. An X-ray of the left shoulder showed findings of mild degenerative joint disease. On March 2000 VA treatment, the Veteran complained of pain in the right shoulder tendon; the area was injected with Kenalog. On March 2004 VA treatment, the Veteran reported that he fell off his tractor the day before and landed on his left hip and knee. Some localized tenderness was noted to the left knee, and X-rays showed no significant abnormalities; the assessment was minor trauma to the left hip and knee. On February 2005 VA treatment, the Veteran reported that he had been getting a pain pill for years for arthritis of the shoulders and arms. The treating physician was unable to find any arthritis medication after searching through treatment records since 1998. The Veteran reported that he was once briefly prescribed codeine many years earlier but had otherwise taken Tylenol. He reported mostly having soreness of the shoulders at night. On April 2005 VA treatment, the Veteran reported that taking Darvon had helped with the arthritis in his knees. The assessments included arthritis, chronic, mostly knees. On May 2005 VA pre-operative screening prior to cataract surgery, the Veteran denied having any problems of the back or neck. Degenerative joint disease of both knees was noted. July 2005 X-rays of the knees showed marked degenerative osteoarthritis of both knees, primarily involving the medial joint spaces; considerable progression since April 1997 was noted. On September 2007 treatment, the Veteran was noted to have a long history of progressive arthritis and problems with the knees, and he was contemplating bilateral knee replacement. X-ray results showed tricompartmental bone-on-bone as well as large osteophytes about the patellae bilaterally. The impression was advanced arthritis. July 2008 X-rays of the knees showed advanced bilateral degenerative changes within the knees largely in the medial compartment, greater in the left knee than the right. December 2009 X-rays of the right shoulder showed a mild degree of chronic superior subluxation of the head of the humerus suggesting impingement, and minimal degenerative changes of the glenohumeral joint. December 2009 X-rays of the cervical spine showed degenerative disc disease of the mid and lower cervical spine, particularly marked at the 5/6 and C/7, with moderately marked spondylosis of the mid and lower cervical spine. On April 2010 VA treatment, the Veteran complained of right shoulder and neck pain most days. The assessments included chronic knee pain and chronic neck and shoulder pain. On May 2010 physical therapy, December 2009 X-rays of the cervical spine and right shoulder were noted to show degenerative disc disease of the mid and lower cervical spine, particularly marked at the C-5/6 and 6/7; moderately marked spondylosis of the mid and lower cervical spine; a mild degree of chronic superior subluxation of the head of the right humerus suggesting impingement; and minimal degenerative changes at the glenohumeral joint. The Veteran reported that he had had the neck and right shoulder pains for years, and he had had a cervical fusion. On August 2010 private treatment, the Veteran reported having arthritic type complaints in both knees since he was in service from jumping out of airplanes. On physical examination, he was noted to have bilateral crepitant knees with decreased joint space as well as degenerative arthritis of the lumbar spine and the cervical spine. September 2010 X-rays of both feet showed moderate degenerative changes of the metatarsophalangeal joints of both great toes, moderate valgus of the left fourth toe, healed fractures of the neck of the proximal phalanx of the left fourth toe and the distal aspect of the proximal phalanx of the left second toe, slight degenerative changes in the interphalangeal joints and intertarsal joints, slight to moderate arterial calcification, and small bilateral Achilles calcaneal spurs, with a small plantar calcaneal spur on the left foot. October 2010 X-rays of both knees showed stable severe bilateral degenerative changes of both knees. On October 2010 private treatment, the Veteran brought some X-rays of his knees, right shoulder, and neck. Dr. Simpson noted that the X-rays showed severe medial compartment arthritis of both knees with obliteration of his medial compartments bilaterally; mild acromioclavicular joint changes and subluxation of the right shoulder with no glenohumeral joint arthritis; and disc disease at C5-6 and C6-7 primarily of his neck. Dr. Simpson stated that it would be very difficult for him to say one hundred percent that the Veteran's injuries are service connected but noted the Veteran's reports of several jumping injuries, one of which was to the right shoulder when the parachute did not deploy, and the second of which was to his right Achilles tendon for which he was in the hospital for about a month. Dr. Simpson opined that certainly the impact to the Veteran's knees from the jumping incident and to his shoulder could be a major contributing force to the knee arthritis, but it is difficult to quantitate the percentage. Dr. Simpson noted upon looking through the Veteran's chart that he had previous doctors who stated that the osteoarthritis of the knees was service connected. The Veteran submitted an October 2010 buddy statement from an individual who served with the Veteran and witnessed his injuries incurred while in jump school in 1951. The buddy statement indicated that the Veteran injured his heel and leg and was hospitalized at Fort Benning due to this injury, which delayed his graduation from jump school. The Veteran reported back to Fort Campbell walking on crutches. The buddy statement also noted a routine night jump during which the Veteran had a malfunction with the parachute, causing him to fall faster than normal and land on his shoulder. The Veteran complained of pain since these accidents in service. On November 2010 private treatment, the Veteran complained of pain and diminished range of motion to the right shoulder and left knee. He stated that his injuries in the past were due to service connected injuries incurred in service and that he had jumping injuries on several occasions. He reported that he injured his Achilles tendon and left knee during multiple jumps. X-ray results showed mild acromioclavicular arthropathy of the right shoulder; there was no significant glenohumeral arthritis. Severe medial compartment arthropathy was shown in both knees; the patellofemoral joints were maintained, but there was near obliteration and bone-on-bone configuration of the medial compartment bilaterally. The impressions were probable rotator cuff tear of the right shoulder, and severe medial medial compartment arthritis in both knees. The evaluating physician's assistant stated that the shoulder and knee issues could certainly have a relation to the Veteran's rigors in service, although the exact percentage or degree would be difficult to ascertain; the physician's assistant believed the Veteran had a considerable amount of wear and tear due to the history of injuries in service. June 2011 X-rays of the cervical spine showed moderate chronic multilevel degenerative disc disease from C2 through C7 with moderate neural foraminal encroachment on the right at C3-4, resulting from posterior facet arthrosis and uncinate spurring. There was minimal retrolisthesis noted at the C5-6 without significant neural foraminal encroachment. June 2011 X-rays of the ankles showed mild degenerative changes of both ankles. June 2011 X-rays of the shoulders showed bilateral high riding humeral heads, markedly narrowing the subacromial space, which could be seen with rotator cuff impingement; and mild degenerative osteoarthritis involving both the glenohumeral joints and acromioclavicular joints. June 2011 X-rays of the lumbar spine showed mild chronic degenerative disc disease noted throughout all levels of the lumbar spine, and posterior facet arthrosis at L4-5 and L5-S1. On June 2011 VA examination, the Veteran reported that he was hospitalized while in service over 15 times for all of the claimed disabilities. He reported that most of his military papers were burned. He stated that he was a parachutist and could not complain in service; he did what he was told. He took codeine, ibuprofen, and acetaminophen for pain treatment. He related his claimed disabilities to an airplane jump in 1951 that resulted in an injured heelstrap and a parachute jump in 1953. The examiner cited X-ray results from September 2010, October 2010, and June 2011. Following physical examinations of the feet, ankles, shoulders, knees, ankles, and spine, as well as a thorough review of the extensive claims file, the examiner's diagnoses included degenerative joint disease of the right foot; severe degenerative joint disease of the bilateral knees; degenerative joint disease of the bilateral shoulders, with bilateral rotator cuff impingement and markedly decreased range of motion to both shoulders with pain throughout motion; degenerative disc disease of the lumbosacral spine with multilevel lumbar sacral degenerative changes and no evidence of radiculopathy; and degenerative disc disease of the cervical spine, with radiological evidence of moderate chronic multilevel degenerative disc disease, and decreased range of motion with pain. No right Achilles tendon condition was found. Regarding the Veteran's right foot, the June 2011 VA examiner opined that it is less likely as not that the current right foot disability (less than 50/50 probability) is related to parachute jumps during military service. The examiner noted that the August 1953 separation examination was negative for any abnormality, there was no evidence of right foot injury or treatment in service, and post-service the Veteran has degenerative changes that are likely associated with the aging process. Regarding a right Achilles tendon condition, the June 2011 VA examiner opined that it is less likely as not that the Veteran's current right Achilles tendon condition (less than 50/50 probability) is related to parachute jumps during military service. The examiner noted that there was no diagnosis of a right Achilles tendon condition in service or post service, and his physical assessment was negative for Achilles tendonitis. The Veteran denied pain with range of motion of his feet and the physical examination of the right ankle was unremarkable. Regarding both knees, the June 2011 VA examiner opined that it is less likely as not that the Veteran's current bilateral knee disability (less than 50/50 probability) is related to parachute jumps during service. The examiner noted that the Veteran's separation examination was negative for complaints of either knee, and the evidence reflects that his knee complaints began 30 years after military service. The examiner noted there are many risk factors for arthritis which include age, obesity, and sedentary or physically strenuous occupation. The examiner opined that the Veteran's knee complaints are less likely from his in-service parachuting. Regarding both shoulders, the June 2011 VA examiner opined that it is less likely as not that the Veteran's current bilateral shoulder condition (less than 50/50 probability) is related to parachute jumps during military service. The examiner noted that there were no shoulder complaints on service separation examination. The Veteran had documented normal range of motion of both shoulders on February 2005 private treatment. The examiner opined that it is most likely that the Veteran's shoulder condition is age related in addition to likely recent injury after service. Regarding the lumbar spine, the June 2011 VA examiner opined that it is less likely as not that the Veteran's current back condition (less than 50/50 probability) is related to parachute jumps during military service. The examiner noted no in-service record of back complaints and noted that a review of the primary care treatment records was negative for complaints or treatment for a back disability until 2010, over 50 years after military service. Regarding the cervical spine, the June 2011 VA examiner opined that it is less likely as not that the Veteran's current neck condition (less than 50/50 probability) is related to parachute jumps during military service. The examiner noted that the service separation examination was negative for any neck complaints. The examiner further noted February 2005 treatment for complaints of tight shoulders documented soreness without any mention of neck pain. On August 2011 private evaluation of both knees, Dr. Fahey noted that he had seen the Veteran in the past and cared for his arthritis. The Veteran was noted to have some degree of progressive debility, progressive pain and difficulty. He took ibuprofen and used a walker to get around; he had previously received injections. He was not felt to be a surgical candidate due to his cardiac history. He reported that he incurred multiple injuries to his knees while in service as a paratrooper. He reported one jump at Fort Benning in which he injured his foot as well as his knee and was in a long-leg cast; he reported another jump at Fort Campbell when his chute did not deploy appropriately, injuring his knees and being treated in service. Following a physical examination and review of X-rays from 2009 and 2010, the impression was severe tricompartmental arthritis in both knees. Dr. Fahey stated that there is no way to distinctively say that this is a result of the Veteran's parachute jumping, but opined that without a doubt the past history of multiple injuries to his knees in association with those jumps would lead him to conclude that a fair amount of this does correlate with his military service and military injuries. August 2011 X-rays of the left ankle and of the left tibia and fibula were negative. August 2011 X-rays of the left knee showed advanced osteoarthritis of the medial joint compartment with bone-on-bone joint space narrowing and chondrocalcinosis. In a September 2011 medical opinion letter, Dr. Cummings noted that he had met with the Veteran and reviewed his medical record, including documentation the Veteran had provided from non-VA sources. The Veteran reported injuries from paratrooper activities including a nighttime parachute jump. Dr. Cummings opined that, based on a review of records, the situation proposed by the Veteran is plausible, but he could not determine specifically that the Veteran's current status is or is not related to his military activities; such determination could be accomplished with more certitude if the military medical records were available. In a November 2011 medical opinion letter, Dr. Fahey noted that he had treated the Veteran for significant arthritis in both knees and his lumbar spine. Dr. Fahey stated that the Veteran clearly relates parachuting injuries back in the 1950s and he opined that it is as likely as not that these are posttraumatic conditions related to his duties and injuries associated with parachuting. He had not evaluated the Veteran for cervical spine, shoulder, or Achilles tendon injuries. The Veteran submitted a brief November 2011 medical opinion from internist Dr. Cochran, who stated that there is high probability that the Veteran's present condition is related to parachute injury in 1951. No further explanation or rationale was offered. In a February 2012 medical opinion letter, Dr. Justice noted that the Veteran presented as his own historian with a compilation of medical information including letters, records, and copies of X-ray films. The Veteran reported that he was a former paratrooper in service with a parachute injury in 1951, which occurred as a result of a nighttime jump when the parachute failed to open. Dr. Justice noted that the documentation of the failed parachute could not be produced. Dr. Justice opined that the Veteran has bilateral knee injuries, severe low back pain, bilateral foot disability, and shoulder and neck complaints, all of which are a result of the parachute injury. Dr. Justice stated that, while the Veteran does not have hospital records to provide the dates and injuries, there would be no question about his disabilities resulting from the injury, although he noted that without the necessary service treatment records, a definitive determination could not be made. In a February 2012 medical opinion letter, Dr. Walker stated that the Veteran sustained back and knee injuries in service when his parachute failed to open. In reviewing his history, X-rays and physical findings, Dr. Walker opined that the Veteran certainly does have bilateral knee injuries, severe low back pain, bilateral foot disability, and shoulder and neck complaints, all of which stemmed from the parachute injury. Dr. Walker did note that the Veteran does not have any medical records documenting this, but that if he did there would be no question about his disabilities resulting from the injury. The Veteran submitted lay statements from two sisters and several friends describing his neck, back, shoulder, knee, feet, and right ankle symptoms. Additional VA treatment records through March 2013 further document the Veteran's complaints of pain and other symptoms of the cervical and lumbar spine, both shoulders, both knees, the right foot, and the right Achilles tendon without otherwise presenting any pertinent etiological information or further detail concerning pertinent history. The Board finds that the available contemporaneous STRs presenting competent medical findings and the Veteran's own symptom reports are highly probative evidence concerning that period. The Board finds that these records reflect that the Veteran was hospitalized for a post parachute injury to the left foot, with no reports of symptoms or treatment specific to the cervical or lumbar spine, either shoulder, either knee, or the right foot or Achilles tendon. No such disabilities were noted on his service separation examination There is no contemporaneous evidence of symptoms or treatment concerning disabilities of the lumbar spine, cervical spine, left or right knee, left or right shoulder, right foot, or right ankle/Achilles tendon for more than 40 years following service (from separation in August 1953, to the first treatment record for pain of the right shoulder in August 1993, and the first treatment for pain to the back, neck, left shoulder, knees, and right foot and ankle in subsequent years). The VA examiner clearly concluded that the Veteran's current disabilities of the lumbar and cervical spine, shoulders, knees, right foot, and right Achilles tendon are not caused by or a result of his military service. The Board finds that the June 2011 VA examination report is highly probative in this case. The report (which is found to be adequate) contains competent medical opinions addressing the pertinent etiological questions with clear conclusions and analytical rationales; it is informed by review of the claims file, interview of the Veteran, and direct medical inspection of the Veteran's disabilities on appeal. The Board has reviewed the entirety of the evidence of record but finds that there is no persuasive evidence of record which probatively contradicts the findings presented in the most probative evidence discussed above with regard to the matters on appeal. The Board acknowledges that the claims file contains a quantity of other medical records, but none of the information in these records pertinently contradicts the conclusions or cited rationales of the evidence found to be most probative in the discussion above. The Board also acknowledges the private medical opinions cited above pertaining to the disabilities on appeal, these opinions generally suggest that the parachuting could cause the claimed disorders. As such, they are to large degree merely speculative. Other supporting statements from community leaders and officials attest to the Veteran's upstanding character. The Board does not doubt the Veteran's character in any way. However, these statements from community leaders do not speak to the medical questions involved in this case. The Board has paid particular attention to statements from the Veteran's sisters dated in December 2010. These statements, fifty some years after the Veteran's service, attest to the fact that the Veteran injured his foot in 1951 in a parachuting incident. The Board stresses that VA has accepted the fact of such injury as shown by the fact that service connection has been awarded for left foot disability. It is highly significant in the Board's view that the statements from these family members do not relate any history of injuries to the back, knees, shoulders, right Achilles tendon or right foot either in 1951 or at anytime during the Veteran's service. There is also a statement from an individual who served with the Veteran confirming the 1951 parachute injury, as well as referencing another incident where the Veteran fell on his shoulder. Again, the 1951 injury is not in dispute. The question is whether any current disorders of the spine, knees, shoulder, right Achilles tendon and/or right foot are related to service, to include the Veteran's parachute activities. A VA examiner with full knowledge of the Veteran's history and review of the available records is against a nexus to service. This opinion is highly persuasive. In this decision, the Board has considered all lay and medical evidence as it pertains to the issue. 38 U.S.C.A. § 7104(a) ("decisions of the Board shall be based on the entire record in the proceeding and upon consideration of all evidence and material of record"); 38 U.S.C.A. § 5107(b) (VA "shall consider all information and lay and medical evidence of record in a case"); 38 C.F.R. § 3.303(a) (service connection claims "must be considered on the basis of the places, types and circumstances of his service as shown by service records, the official history of each organization in which he served, his medical records and all pertinent medical and lay evidence"). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Here, the Veteran did not have documented reported symptoms of the back, neck, shoulders, knees, right foot, or right Achilles tendon at the time of his separation from service. The pertinent body systems were evaluated by military medical personnel as clinically normal. This suggests that it was the opinion of the medical examiners that no abnormalities were detected. It is also significant that there is no persuasive evidence of the claimed disabilities for many years following service. In fact, the Veteran did not include these claims when he filed a claim based on heart disability in 1986. As late as 1987 the Veteran's musculoskeletal system was reported to be normal on medical examination. The Veteran has been afforded a VA examination in connection with his claims; the examiner provided negative nexus opinions. The June 2011 VA examiner provided persuasive rationale discussed above that addressed the Veteran's in-service injury history, his post-service injury history, and the significance of his specific symptom histories and clinical findings. To the extent that the Veteran's statements suggest a continuity of lay-perceivable symptoms after his alleged in-service injuries, assertions are inconsistent with the discharge examination report which shows the pertinent systems to be clinically normal. Such statements made many years after the fact are of diminished credibility when viewed against the discharge examination findings. The Veteran has clearly received treatment for the claimed disabilities on appeal since 1993, but this appears to have begun approximately 40 years after service; the Veteran's own reports consistently place the onset of his symptoms several years after his separation from service. The post-service medical records do not reflect any continuity of symptomatology, medical treatment, or other manner of perception of pain or pathology of the back, neck, shoulders, knees, right foot, or right Achilles tendon in the years proximately following service. The Court has indicated that normal medical findings at the time of separation from service, as well as the absence of any medical records of a diagnosis or treatment for many years after service is probative evidence against the claims. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991). Given the facts that (1) the STRs do not diagnose any chronic claimed disability, (2) no symptoms of the back, neck, shoulders, knees, right foot, or right Achilles tendon were reported at any time during service, (3) the first evidence of any chronic claimed disability is not shown until at least 40 years after service, and (4) the medical evidence of record fails to relate any currently existing claimed disability to active service, the Board finds that the Veteran's statements are afforded low probative value as to the onset and etiology of his current chronic disabilities. In sum, the Board finds that the preponderance of the evidence is against the Veteran's service connection claims. As such, the benefit-of-the-doubt rule does not apply, and the Veteran's claims of entitlement to service connection are denied. See 38 U.S.C.A § 5107. ORDER Service connection is not warranted for lumbar spine disability, for cervical spine disability, for right knee disability, for left knee disability, for bilateral shoulder disability, for right Achilles tendon disability, or for right foot disability. To this extent, the appeal is denied. REMAND In an April 2013 statement, the Veteran stated that he is unable to walk without dragging his feet. On the most recent VA examination in June 2011, his gait was antalgic but physical examination of the left foot was unremarkable. While a new examination is not required simply because of the time which has passed since the last examination, VA's General Counsel has indicated that a new examination is appropriate when there is an assertion of an increase in severity since the last examination. VAOPGCPREC 11-95 (1995). The Veteran has alleged that the current rating does not reflect his current state of impairment. The April 2013 statement and those of the Veteran's representative arguably advance an implicit claim that the left foot disability is more severe than shown on the 2011 VA examination. To fully assist the Veteran, a more current examination is appropriate. Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). Expedited handling is requested.) 1. The RO should secure for the record copies of the complete updated (since March 2013) clinical records of any VA treatment the Veteran has received for his left foot disability. 2. The RO should then schedule the Veteran for an appropriate VA examination to ascertain the current severity of his left foot disability. The Veteran's claims file must be furnished to the examiner for review in connection with the examination. Examination findings should be reported to allow for application of all potential VA rating criteria for left foot disability. 3. After completion of the above and any additional development the RO may deem necessary, the RO should review the expanded record and readjudicate the claim. The Veteran and his representative should be furnished an appropriate supplemental statement of the case and be afforded an opportunity to respond. The case should then be returned to the Board, if in order, for further review. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ ALAN S. PEEVY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs