Citation Nr: 1319410 Decision Date: 06/14/13 Archive Date: 06/21/13 DOCKET NO. 07-14 471 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to service connection for a neck disorder. 2. Entitlement to service connection for a low back disorder. 3. Entitlement to service connection for left shoulder rotator cuff repair. 4. Entitlement to service connection for a right shoulder disorder. 5. Entitlement to service connection for loss of use of the right upper extremity with moderate paralysis. 6. Entitlement to service connection for loss of use of the right lower extremity with moderate paralysis. 7. Entitlement to service connection for glaucoma and right-sided homonymous hemianopsic visual field loss (claimed as right eye injury). 8. Entitlement to service connection for chronic obstructive pulmonary disease (COPD). REPRESENTATION Appellant (Veteran) represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Christopher McEntee, Counsel INTRODUCTION The Veteran had active military service from August 1963 to February 1964, and from March 1964 to February 1967. The appeal comes before the Board of Veterans' Appeals (Board) from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The Veteran has since moved and the claims file has been transferred to the VA RO in Houston, Texas. In August 2012, the Board remanded this matter for additional evidentiary development. In addition to the paper claims file, there is a Virtual VA electronic claims file associated with the Veteran's claims. The record indicates that no additional relevant evidence has been added to either claims file since the most-recent supplemental statement of the case (SSOC) issued to the Veteran in February 2013. 38 C.F.R. §§19.31, 20.1304 (2012). Based on statements of record from the Veteran, it appears that he is interested in claiming service connection for sleep apnea. The Board has no jurisdiction over this issue. As such, the issue is referred to the Agency of Original Jurisdiction for appropriate action. FINDINGS OF FACT 1. During active duty, the Veteran was treated for complaints of pain in his neck, shoulder, and lower back. 2. A chronic neck disorder was not shown in service; chronic problems with the neck were not shown until many years after service; and the Veteran's current neck disorder is not related to a disease or injury of service origin. 3. A chronic low back disorder was not shown in service; chronic problems with the low back were not shown until many years after service; and the Veteran's current low back disorder is not related to a disease or injury of service origin. 4. A chronic left shoulder disorder was not shown in service; chronic problems with the left shoulder were not shown until many years after service; and the Veteran's current left shoulder disorder is not related to a disease or injury of service origin. 5. A chronic right shoulder disorder was not shown in service; chronic problems with the right shoulder were not shown until many years after service; and the Veteran's current right shoulder disorder is not related to a disease or injury of service origin. 6. A chronic right arm disorder was not shown in service; chronic problems with the right arm were not shown until many years after service; and the Veteran's current right arm disorder is not related to a disease or injury of service origin. 7. A chronic right leg disorder was not shown in service; chronic problems with the right leg were not shown until many years after service; and the Veteran's current right leg disorder is not related to a disease or injury of service origin. 8. A chronic right eye disorder was not shown in service; chronic problems with the right eye were not shown until many years after service; and the Veteran's current right eye disorder is not related to a disease or injury of service origin. 9. A chronic pulmonary disorder was not shown in service; chronic problems with the Veteran's respiratory system were not shown until many years after service; and the Veteran's current COPD is not related to a disease or injury of service origin. CONCLUSIONS OF LAW 1. A neck disorder was not incurred in or aggravated by active service, and may not be presumed related to service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 2. A low back disorder was not incurred in or aggravated by active service, and may not be presumed related to service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 3. A left shoulder disorder was not incurred in or aggravated by active service, and may not be presumed related to service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 4. A right shoulder disorder was not incurred in or aggravated by active service, and may not be presumed related to service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 5. A right arm disorder was not incurred in or aggravated by active service, and may not be presumed related to service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 6. A right leg disorder was not incurred in or aggravated by active service, and may not be presumed related to service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 7. A right eye disorder was not incurred in or aggravated by active service, and may not be presumed related to service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 8. A pulmonary disorder was not incurred in or aggravated by active service, and may not be presumed related to service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), in part, describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). The VCAA applies to the claim to service connection decided here. Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). 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. 38 C.F.R. § 3.159(b)(1). VCAA 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/Hartman v. Nicholson, 19 Vet. App. 473, 484-86 (2006), aff'd, 483 F.3d 1311 (Fed. Cir. 2007). VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction decision on a claim. Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). The RO submitted several notice letters to the Veteran between February 2005 and August 2012 which provided full notification regarding what information and evidence is needed to substantiate the Veteran's claims of service connection. The letters addressed the information and evidence that must be submitted by the Veteran and the evidence that VA would obtain. The letters included provisions regarding disability ratings and effective dates. Moreover, though full notification was not provided prior to the rating decisions on appeal, full notification was provided to the Veteran prior to the readjudication of his claims in the February 2013 SSOC. See Overton v. Nicholson, 20 Vet. App. 427, 437 (2006) (a timing error may be cured by a new VCAA notification followed by a readjudication of the claim); Mayfield, supra. VA has therefore met its duty to provide VCAA notification to the Veteran regarding the claims addressed in this decision. With regard to the duty to assist, the RO obtained the Veteran's service treatment records (STRs), relevant private and VA treatment records and reports, and accepted into the record lay statements from the Veteran. Moreover, pursuant to the Board's August 2012 remand, VA attempted to obtain relevant evidence from the Social Security Administration (SSA). An August 2012 memorandum from SSA indicates, however, that SSA medical records pertaining to the Veteran had been destroyed. The Board notes further that the Veteran underwent VA compensation examination into his claims in August 2005, October 2008, June 2009, and April 2011. The reports indicate a review of the Veteran's medical history and complaints, reflect clinical observations, and render assessments regarding whether the Veteran has the several disorders at issue, and whether any such disorders relate to service. As will be detailed in the decision below, the examinations, and the reports and opinions regarding service connection, are adequate for decision purposes when considered together. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (finding that VA must provide an examination that is adequate for rating purposes). In sum, the record is sufficiently developed for a determination at this time. The Board will rely on the record to determine the Veteran's claims to service connection. Appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). II. The Merits of the Claims to Service Connection The Veteran claims that he incurred during service several orthopedic and neurological disorders as the result of a motor vehicle accident (MVA) he experienced in 1964. He also claims service connection for an eye injury he experienced in service in 1966. Service connection for VA compensation purposes will be granted for a disability resulting from disease or personal injury incurred in the line of duty or for aggravation of a preexisting injury in the active military, naval or air service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303(a) (2012). When a Veteran seeks service connection for a disability, due consideration shall be given to the supporting evidence in light of the places, types, and circumstances of service, as evidenced by service records, the official history of each organization in which the Veteran served, the Veteran's military records, and all pertinent medical and lay evidence. 38 U.S.C.A. § 1154; 38 C.F.R. § 3.303(a). Service connection may be awarded where the evidence shows that a Veteran had a chronic condition in service or during an applicable presumptive period and still has the condition. 38 C.F.R. §§ 3.303(b), 3.307, 3.309. Certain disorders such as arthritis are presumed to have been incurred in service if manifested to a compensable degree within one year after service. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. If there is no evidence of a chronic condition during service or during an applicable presumptive period, then a showing of continuity of symptomatology after service is required to support the claim. The U.S. Court of Appeals for the Federal Circuit recently clarified that the continuity of symptomatology language in § 3.303(b) is limited to the chronic diseases listed under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for disease that is diagnosed after discharge from active service, when the evidence establishes that such disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to establish service connection, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C.A. § 5107(b). When a reasonable doubt arises regarding service origin, such doubt will be resolved in the favor of the claimant. Reasonable doubt is doubt which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102. In Alemany v. Brown, 9 Vet. App. 518 (1996), the United States Court of Appeals for Veterans Claims (Court) found that in light of the benefit of the doubt provisions of 38 U.S.C.A. § 5107(b), an accurate determination of etiology is not a condition precedent to granting service connection; nor is "definite etiology" or "obvious etiology." The question is whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which event the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990). The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence submitted by the appellant or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). Rather, the Board's analysis below will focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that 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). In this matter, the record establishes that the Veteran currently has the disorders he claims. The June 2005 VA report and its August 2005 addendum report noted diagnoses of COPD, degenerative changes in the cervical and lumbar spines, cervical strain, left shoulder degenerative changes, right shoulder "calcifinic tendonitis," bilateral rotator cuff tears, radiculopathy related to the spinal degenerative changes, and right-sided numbness and right knee and ankle hyperflexivity due to a cerebral vascular accident (CVA) in 1995. The October 2008 VA report and its May 2009 addendum report noted a diagnosis of glaucoma in the right eye, as well as restricted vision and generalized constriction with homonymous hemianopsia. The June 2009 VA report notes a diagnosis of right shoulder degenerative joint disease. The April 2011 VA report notes diagnoses of left shoulder degenerative arthritis, right hip degenerative joint disease, lumbar spine degenerative joint and disc disease, spondylolystesis and spinal stenosis, cervical spine degenerative joint disease, right hemiparesis due to the 1995 CVA, and upper and lower extremity radiculopathy associated with the spinal degenerative changes. Furthermore, private and VA treatment records, dated between the mid 1990s and 2012, reflect treatment for the Veteran's several disorders. The record also demonstrates that the Veteran experienced injuries during service. Multiple STRs of record indicate back, neck, shoulder, and eye disorders. Certain STRs dated in November 1964 indicate that the Veteran was treated that month for orthopedic pain resulting from the in-service MVA. Several STRs, dated between April 1964 and December 1966, reflect the Veteran's complaints of neck, shoulder, and lumbar pain. The noted impressions in the STRs are muscle spasm and possible lumbar strain. Further, a December 1965 STR indicates right eye pain as a result of an injury from a "hot poker," while September 1963, June 1964, and January 1967 STRs indicate complaints of eye pain related to headaches and sinusitis. A June 1964 STR indicated that the Veteran used tinted glasses to alleviate pain. Further, the STRs indicate that the Veteran wore glasses to correct his vision to 20/20. In assessing whether the Veteran experienced injuries during service, the Board has considered the lay statements of record regarding his in-service injuries. Lay assertions may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). As the Veteran is competent to attest to symptoms such as pain and limitation he may have experienced as a result of injury, his lay assertions are of probative value. The Veteran's symptoms, which he felt, are observable in nature. Moreover, the Veteran's lay assertions of in-service injuries are credible, as they are consistent with the STRs, which support his claim to having experienced a traumatic MVA during service, and eye problems during service. See Caluza v. Brown, 7 Vet. App. 498 (1995) (in weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness). The Board finds the record sufficiently developed with medical and lay evidence to conclude that the Veteran did in fact injure his neck, back, shoulder, and an eye during service. See Smith v. Derwinski, 1 Vet. App. 235, 237-38 (1991) (credibility is determined by the fact finder). With reference to Hickson element (3), the ultimate question before the Board is whether the Veteran's current disabilities relate to service in general, and the injuries noted above in particular. For the Veteran to be successful in any of his claims, the evidence must show either that it is at least as likely as not that one of his current disorders is related to a disease or injury that occurred in service, or that a neurological or degenerative disorder was shown in the first post-service year. 38 C.F.R. §§ 3.303, 3.307, 3.309. If the preponderance of the evidence shows otherwise, the Veteran's claims must be denied. Though the Board finds the Veteran with the current disabilities he claims, and accepts as fact that he was injured during service by a hot poker, and by MVA, the preponderance of the evidence is against the assertion that any of the current disorders relates to the in-service injuries. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. Indeed, the record demonstrates that the Veteran did not incur during service a chronic orthopedic disorder, a chronic neurological disorder, a chronic pulmonary disorder, or a chronic eye disorder, did not develop any of these disorders within one year of his February 1967 discharge from active service, and did not experience a continuity of symptomatology of any of these disorders for many years following service. 38 C.F.R. §§ 3.303, 3.307, 3.309. As indicated, the Veteran complained of neck, shoulder, back and eye pain during service. However, the Veteran's November 1966 separation reports of medical examination and history indicate no chronic disorder as each is negative for complaints or findings of back, neck, shoulder, arm, leg, eye, or lung disorders. Moreover, the record is negative for complaints, treatment, or diagnoses of any of the relevant disorders for nearly three decades after separation from active service. The earliest post-service medical evidence addressing the Veteran's health is found in the mid 1990s, over 25 years following the February 1967 separation from active duty. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of many years between discharge from active service and the medical documentation of a claimed disability may be considered in evaluating a claim of service connection). The medical evidence in the mid 1990s primarily addresses the Veteran's CVA, which occurred in June 1995. This evidence indicates right-sided weakness. VA hospital treatment records in 1995, noting the Veteran's treatment for his CVA, do not mention the MVA or eye injuries in service. Further, on VA examination in March 1996, it was reported that he had no history of injury of any importance. It is not until over 30 years after service, in a VA orthopedic examination in October 1999, that the Veteran relates the history of the in-service MVA. It that report, he described a history of constant back and neck pain since the MVA. When compared with the other evidence of record, including the paucity of evidence of treatment for an orthopedic disorder, an eye disorder, or a lung disorder between service in 1967 and the mid 1990s, the Board is left with no other conclusion but that the Veteran's service did not cause a chronic disorder that continued in the years following service to the present day. With regard to the neck, shoulders, back, and right eye the record indicates treatment during service, but indicates that any injury to the neck, shoulders, back, and right eye had resolved by the time of the Veteran's separation from service. 38 C.F.R. §§ 3.303, 3.307, 3.309. With regard to the other claimed disorders - right upper extremity, right lower extremity, and lung disorders - the STRs are entirely silent as is the evidence of record until the mid 1990s. Indeed, a continuity of symptomatology linking the Veteran's disorders to the complaints and findings noted in service is not demonstrated in the record by the objective evidence. See 38 C.F.R. § 3.303(b); see also Savage v. Gober, 10 Vet. App. 488, 498 (1997). Rather, the objective evidence indicates that the Veteran had no chronic disorders in service, and no chronic disorders for many years following service. In assessing the issue of medical nexus between current disorders and service, the Board has reviewed several medical and lay opinions of record, from private and VA physicians, and from the Veteran. The Board first notes that none of the medical opinions of record is supportive of the Veteran's claims to service connection for right arm, right leg, right eye, or lung disorders. Rather, the only medical professionals to comment on any of these issues found service likely unrelated to the current disorders. With regard to the right eye, the October 2008 VA examiner initially provides conflicting information in the report of record on the issue of whether service related to the Veteran's glaucoma, homonymous hemianopsia, and impaired vision. The examiner clearly stated that the Veteran's "visual field loss is partly due to his stroke and partly due to glaucoma." The examiner then noted the greater density in homonymous hemianopsia in the right eye as the result of the 1995 CVA. But the examiner also noted the Veteran's complaints that he experienced an in-service injury to the right eye from a hot poker (documented by the December 1965 STR). The examiner stated that he could find no evidence of record of the claimed injury, but that it was "as likely as not" that a poker injury to the right eye "could contribute to the patient's visual field loss." The Board notes that the October 2008 VA report does not indicate a review of the claims file. In a May 2009 addendum report, which does indicate a review of the claims file, the October 2008 VA examiner addressed the evidence of the Veteran's in-service eye injury. The examiner indicated that the injury was mild, required only irrigation, involved no foreign bodies, and that eye ointment was given as treatment. The examiner noted that subsequent eye examination in service, in November 1966, indicated no eye disorder. The examiner then stated that the Veteran's right eye disorder during service was likely not related to his current disorders. In support, the examiner stated that the Veteran had glaucoma in his left as well as his right eye, which implies the disease process is unrelated to the injury. Further, the examiner stated that the "dense right-sided homonymous hemianopsia visual field loss is due to his stroke" in 1995. Thus, the only medical professional to address the Veteran's claim regarding an eye disorder ultimately finds the in-service injury unrelated to the current disorders. This opinion, along with the absence of evidence indicating a chronic in-service or post-service eye disorder, comprises a preponderance of the evidence against the Veteran's claim that he incurred a chronic eye disorder as the result of service. With regard to the Veteran's COPD, the June 2005 VA examiner, in his August 2005 addendum report, found the Veteran with mild obstructive pulmonary findings, but stated that the "lung diagnosis is not related to the auto accident." The Board recognizes that the opinion is not a model of clarity, or of detail. Further, the June 2005 examiner never indicates in his report that the claims file had been reviewed. Nevertheless, the examiner's negative opinion certainly cannot be construed as favorable evidence in support of the Veteran's claim. Rather, the negative albeit flawed opinion, combined with the absence of evidence of a chronic disorder during service or for three decades following service, comprises a preponderance of the evidence against the Veteran's claim that incurred a chronic pulmonary disorder as the result of service. With regard to the right arm and right leg, the only medical professional to comment on the Veteran's claim clearly finds the right upper and lower extremity disorders unrelated to service. In the April 2011 VA report, the examiner indicated a review of the claims file, summarized the evidence of record noted in STRs and in post-service evidence, and then attributed the Veteran's right-side problems, particularly his right-sided hemiparesis, to his CVA in the mid 1990s. No medical evidence challenges this finding. Again, the negative opinion, along with the absence of evidence indicating either chronic in-service or chronic post-service right leg or right arm problems comprises a preponderance of the evidence against the claims to service connection for right upper extremity and right lower extremity disorders. The medical evidence is divided, however, with regard to the service connection claims for neck, shoulder, and low back disabilities. Three medical statements of record favor the Veteran's claims, while three medical opinions counter his claims. A May 2003 private treatment record contains a note stating, "back pain subsequent to MVA service connected." The August 2005 VA addendum report includes an opinion stating that the Veteran's neck, shoulder, and back disorders as likely as not relate to his in-service MVA (the examiner did not specify which shoulder, but did note in his report disabilities in each shoulder). Further, an August 2010 VA treatment note completed by a treating VA physician stated that it was "as likely as not" that the Veteran's current back pain began in the service following the MVA. On the other hand, opinions of record dated in October 1999, June 2009, and April 2011 counter the Veteran's claims to service connection for neck, shoulder, and low back disorders. The October 1999 VA examiner reviewed the Veteran's claims to service connection for back and neck disorders (originally denied by the Board in March 2000). The examiner noted the Veteran's neck pain and back pain, and noted evidence of degenerative changes in the neck and back. The examiner stated that he had reviewed the claims file, and the examination report reflects this. The examiner indicated that the record did not support the history reported by the Veteran that he experienced a disabling continuity of symptomatology since service. The physician noted that the Veteran had been unemployed and in a wheelchair since his the 1995 CVA, which had left him with a dense right hemiparesis. The physician did not attribute any of the Veteran's current difficulties regarding his back or neck to service. In the opinion, the examiner opined that the Veteran had age-related degenerative changes of the neck and lower back. According to the examiner, the age-related arthritis, combined with his other post-service infirmities, accounted for the Veteran's current symptoms. The June 2009 VA examiner addressed solely the claim to service connection for a right shoulder disorder. The examiner discussed the Veteran's in-service MVA and subsequent complaints of right shoulder pain. The examiner noted a review of VA medical evidence since 1995, and found that the evidence did not indicate significant right shoulder disability. The report notes an examination of the Veteran's right shoulder and indicates pain and minor limitation of motion. Based on x-ray evidence, the examiner stated that the Veteran had right shoulder degenerative joint disease that was age related rather than service related. In an addendum opinion dated the following day in June 2009, the examiner indicated a review of the claims file, and noted the decades-long absence of complaints of right shoulder disability until the Veteran's CVA in 1995. The examiner indicated that there was no evidence of a chronic in-service or post-service right shoulder disorder until the CVA. The examiner attributed right shoulder limitations to "weakness and fatigue in the upper right extremity" associated with the CVA. The April 2011 VA examiner indicated a review of the claims file. The examiner reviewed the Veteran's history of in-service injuries. The examiner discussed the Veteran's in-service MVA. The examiner detailed a physical examination of the Veteran finding pain and limitation of motion in the neck, shoulders, and back. And the examiner diagnosed the Veteran with degenerative arthritis in the neck, shoulders, and back, and with neurological symptoms associated with the lumbar spine arthritis. The examiner also offered clear opinions that the neck, back, and left shoulder disorders were likely not related to the in-service MVA in 1964. The opinion was based on evidence of record showing that the Veteran did not seek medical treatment for his problems until the 1995 CVA, or for his back until the late 1990s. Further, the examiner indicated that the private and VA treatment records dated in the mid 1990s do not reflect complaints of back pain, or medication prescribed for such complaints. The opinions countering the Veteran's claims are of probative value because each is based on a review of the claims file, each involved a physical examination of the Veteran, each is supported by a rationale, and each addresses the three decade lapse of medical evidence between service that ended 1967 and the Veteran's treatment for the 1995 CVA. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the value of a physician's statement is dependent, in part, upon the extent to which it reflects clinical data or other rationale to support the opinion). By contrast, the supportive opinions are of limited probative value. None is accompanied by a statement that the Veteran's claims file had been reviewed. Rather, the opinions indicate a reliance on the Veteran's history regarding his injury, rather than on the medical evidence. An examiner's opinion based on accurate lay history may be considered competent medical evidence in support of a claim. Harris v. West, 203 F.3d 1347, 1350-51 (Fed. Cir. 2000). However, lay histories are not transformed into competent evidence merely because the transcriber happens to be a medical professional. LeShore v. Brown, 8 Vet App 406 (1995). For a medical statement to have probative value, it should be corroborated by clinical data or other rationale explaining how a disorder would relate to service. See Bloom, supra. In this matter, the Veteran's lay history of his in-service CVA, and of his claimed post-service continuity of symptomatology, forms the premise for the favorable medical statements - the statements do not appear to be based on the actual record of evidence. Indeed, none of the favorable opinions addresses the largest weakness with the Veteran's contentions - that, for nearly three decades, the record was silent for treatment of the disorders he claims were chronic. Simply put, the favorable opinions, though consistent with the Veteran's reported history, are not consistent with objective evidence of record showing that the Veteran for many years following service had no chronic neck, shoulder, or back disorders. On the issue of medical nexus, the Board has closely considered the Veteran's lay statements of record, in which he states that his current disorders relate to his in-service injuries. As indicated, the Veteran is competent and credible to offer evidence of his in-service injury and the symptoms he experienced in the mid 1960s, and following his service. However, on the question of whether the in-service injuries and post-service symptomatology relate medically to his current chronic orthopedic, neurological, visual, and pulmonary disabilities, his statements are of limited probative value. First, the Veteran's assertions that he experienced a continuity of symptomatology of his in-service injuries following service are not credible. He states that, in the three-decade interim between service and medical evidence dated in the mid 1990s, he received private medical treatment for his disorders but that the records have been destroyed. The Board cannot say that such records did or did not exist. However, the fact that the Veteran did not complain in the mid 1990s of long-term pain and limitation associated with neck, shoulder, back, and eye injuries significantly undermines his assertion to having experienced continuous symptoms from the in-service injuries until the present. Second, while the Veteran is competent to address issues of pain and limitation, he is not competent to render diagnoses or comment on the issue of etiology. The disabilities at issue in this matter involve internal pathologies that are beyond the capacity for lay observation. Their etiologies and their development cannot be determined through observation or by sensation such as feeling. The Veteran's comments are not persuasive regarding the way in which the disorders in his body - arthritic, neurological, pulmonary, visual - developed. He does not have the training and expertise to provide medical evidence connecting service to the symptoms, or connecting the symptoms to the disorders at issue. The Veteran cannot provide evidence that states that what he felt in his body during service, or has felt since service, resulted in degenerative, neurological, pulmonary, or visual changes. On these essentially medical questions, the medical evidence is of more probative value. And the medical evidence clearly indicates no relationship between the Veteran's service and the orthopedic, neurological, pulmonary, and visual disorders he now has. Though the Board finds the Veteran credible with regard to what he experienced during service, his statements - regarding how his arthritis developed, how his radiculopathy and hemeparesis developed, how his glaucoma developed, or how his COPD developed - are of limited probative value. In sum, the record demonstrates that the Veteran experienced a MVA during service that injured his neck, back, and shoulders, and that he experienced adverse right eye symptoms during service for reasons including an injury by a hot poker. The evidence also indicates that he has current neck, shoulder, and lower back disorders, that he has neurological disorders affecting his right side of his body, and that he has eye and pulmonary disorders. However, the preponderance of the evidence of record demonstrates that the current problems are unrelated to the injuries the Veteran experienced in service in the mid 1960s. Service connection is therefore unwarranted under 38 C.F.R. §§ 3.303, 3.307, 3.309 for the disabilities he claims. As the preponderance of the evidence is against the Veteran's claims, the benefit-of-the-doubt rule does not apply, and the claims must be denied. 38 U.S.C.A. § 5107(b); Gilbert, supra. (Continued on next page.) ORDER Entitlement to service connection for a neck disorder is denied. Entitlement to service connection for a low back disorder is denied. Entitlement to service connection for left shoulder disorder is denied. Entitlement to service connection for a right shoulder disorder is denied. Entitlement to service connection for loss of use of the right upper extremity with moderate paralysis is denied. Entitlement to service connection for loss of use of the right lower extremity with moderate paralysis is denied. Entitlement to service connection for glaucoma and right-sided homonymous hemianopic visual field loss (claimed as right eye injury) is denied. Entitlement to service connection for a pulmonary disorder is denied. ___________________________________________ MICHAEL A. PAPPAS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs