Citation Nr: 1319509 Decision Date: 06/17/13 Archive Date: 06/27/13 DOCKET NO. 05-04 631 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for a lumbosacral strain (a back disability). 2. Entitlement to service connection for a cervical strain (a neck disability). 3. Entitlement to service connection for a stomach disability, to include as due to an undiagnosed illness. 4. Entitlement to service connection for a chronic disability manifested by whole body joint and muscle pain, to include as due to an undiagnosed illness. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD William Alan Nelson II, Associate Counsel INTRODUCTION The Veteran served on active duty from November 1979 to October 1994. He had active duty in the Southwest Asia Theater of Operations during the Persian Gulf War from October 1990 to April 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2004 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. In August 2011, the Veteran testified before the undersigned in a Travel Board hearing. A copy of the hearing transcript is associated with the claims file. The issues of service connection for neck and back disabilities and stomach and whole body muscle and joint pain, including due to an undiagnosed illness, were previously remanded by the Board in July 2012 for further evidentiary development consisting of providing the Veteran a medical opinion for those issues. This was accomplished, and the Board concludes that it may proceed with a decision at this time. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998), where the Board's remand instructions were substantially complied with), aff'd, Dyment v. Principi, 287 F.3d 1377 (Fed. Cir. 2002). In evaluating this case, the Board has not only reviewed the Veteran's physical claims file, but has also reviewed the Veteran's file on the "Virtual VA" system to ensure a complete assessment of the evidence. FINDINGS OF FACT 1. The Veteran served in the Southwest Asia Theater of Operations during the Persian Gulf War. 2. The Veteran sustained back and neck injuries in service. 3. Back and neck disability symptoms were not chronic in service. 4. Back and neck disability symptoms have not been continuous since service. 5. The Veteran's currently diagnosed back and neck disabilities are not related to active service. 6. The Veteran does not have a current stomach disability. 7. The Veteran does not have a current disability manifested by whole body muscle and joint pain. CONCLUSIONS OF LAW 1. A back disability was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1112, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2012). 2. A neck disability was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1112, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2012). 3. The criteria for service connection for a stomach disability have not been met. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309, 3.317 (2012). 4. The criteria for service connection for a chronic disability manifested by whole body muscle and joint pain have not been met. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309, 3.317 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) enhanced VA's duty to notify and assist claimants in substantiating a claim for VA benefits, as codified in pertinent part at 38 U.S.C.A. §§ 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.326(a) (2012). For the reasons to be discussed below, the Board finds that VA has satisfied its duties to the appellant under the VCAA. A VCAA notice consistent with 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) must (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. See Quartuccio v. Principi, 16 Vet. App. 183 (2002). VCAA notice requirements apply to all five elements of a service connection claim-(1) veteran status; (2) existence of disability; (3) connection between service and the disability; (4) degree of disability; and (5) effective date of benefits where a claim is granted. Dingess v. Nicholson, 19 Vet. App. 473, 484 (2006). VA has made all reasonable efforts to assist the Veteran in the development of his claims, has notified him of the information and evidence necessary to substantiate the claims, and has fully disclosed VA's duties to assist him. In March 2004, April 2004, and March 2006 letters, the Veteran was notified of the information and evidence needed to substantiate and complete the claims on appeal. Additionally, the March 2006 letter provided him with the general criteria for the assignment of an effective date and initial rating. Id. The Board notes that, in the present case, initial notice from March 2004 and April 2004 was issued prior to the August 2004 adverse determination on appeal; thus, no timing issue exists with regard to the notice provided the claimant. See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). The Board also notes that the March 2006 letter providing him with the general criteria for the assignment of an effective date and initial rating was issued after the August 2004 adverse rating decision on appeal. However, importantly, the Veteran is represented by a veterans service organization (VSO) and that organization is presumed to have knowledge of what is necessary to substantiate a claim for VA benefits, including the general criteria for the assignment of an effective date and initial rating. Neither the Veteran nor his representative has pled prejudicial error with respect to the content or timing of any VCAA notice. See Shinseki v. Sanders, 129 U.S. 1696 (2009). The Board further finds that VA has complied with the duty to assist by aiding the appellant in obtaining evidence. It appears that all known and available records relevant to the issues on appeal have been obtained and are associated with the Veteran's claims files. The RO has obtained the Veteran's service treatment records, as well as VA and non-VA medical records. Pertinent medical records have also been obtained from the Social Security Administration. See Baker v. West, 11 Vet. App. 163, 169 (1998); Murincsak v. Derwinski, 2 Vet. App. 363, 370-72 (1992). Indeed, upon questioning by the undersigned, the Veteran, through his representative, ensured that the relevant medical records were associated with the claims file. Hearing transcript at 4. During the hearing, the Veterans Law Judge clarified the issue and asked about the possibility of forgotten records - such actions supplement the VCAA and comply with 38 C.F.R. § 3.103. In short, the Board is not aware, and the Veteran has not suggested the existence of, any additional pertinent evidence not yet received. The Veteran was also provided with multiple VA examinations (the reports of which have been associated with the claims file) in July 2004 and November 2012. The Board finds the VA examinations were thorough and adequate and provide a sound basis upon which to base a decision with regard to the Veteran's claim. The VA examiners personally interviewed and examined the Veteran, including eliciting a history from him, and provided the information necessary to evaluate his disability. As described, VA has satisfied its duties to notify and assist, and additional development efforts would serve no useful purpose. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991). The Court held in Bryant v. Shinseki, 23 Vet. App. 488 (2010), that 38 C.F.R. 3.103(c)(2) requires that the RO official or Veterans Law Judge who conducts 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, during the 2011 Board hearing, the undersigned Veterans Law Judge specifically asked questions as to the Veteran's history concerning his symptoms and treatment he had received. Moreover, 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. As such, the Board finds that, consistent with Bryant, the Acting Veterans Law Judge complied with the duties set forth in 38 C.F.R. 3.103(c)(2), and that any error in notice provided during the hearing constitutes harmless error. Service Connection Laws and Regulations Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Back and neck disabilities (spinal spondylosis) are "chronic diseases" listed under 38 C.F.R. § 3.309(a), therefore, 38 C.F.R. § 3.309(b) applies to the claims for back and neck disabilities. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Stomach disability and whole body joint and muscle pain are not "chronic diseases" listed under 38 C.F.R. § 3.309(a), therefore, 38 C.F.R. § 3.309(b) does not apply to these issues. See id. In addition, service connection may also be granted on the basis of a post-service initial diagnosis of a disease, where the physician relates the current condition to the period of service. 38 C.F.R. § 3.303(d). Other specifically enumerated disorders will be presumed to have been incurred in service if they manifested to a compensable degree within the first year following separation from active duty. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Establishing service connection generally requires (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 present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Court has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). Service connection may also be established on a presumptive basis for a Persian Gulf Veteran who exhibits objective indications of qualifying chronic disability, including resulting from undiagnosed illness, that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than not later than December 31, 2016, and which by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C.A. § 1117; 38 C.F.R. § 3.317(a)(1). In claims based on undiagnosed illness, unlike those for "direct service connection," there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004). Notably, laypersons are competent to report objective signs of illness. Id. A "qualifying chronic disability" for purposes of 38 U.S.C.A. § 1117 is a chronic disability resulting from (A) an undiagnosed illness, (B) a medically unexplained chronic multisymptom illness (such as chronic fatigue syndrome (CFS), fibromyalgia, or irritable bowel syndrome) that is defined by a cluster of signs or symptoms, or (C), any diagnosed illness that the Secretary determines in regulation prescribed under 38 U.S.C.A. § 1117(d) warrants a presumption of service connection. 38 U.S.C.A. § 1117(a)(2); 38 C.F.R. § 3.317(a)(2)(i)(B). "Objective indications of chronic disability" include both "signs," in the medical sense of objective evidence perceptible to a physician, and other, non-medical indicators that are capable of independent verification. To fulfill the requirement of chronicity, the illness must have persisted for a period of six months. 38 C.F.R. § 3.317(a)(2), (3). Signs or symptoms that may be manifestations of undiagnosed illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders. 38 C.F.R. § 3.317(b). For purposes of § 3.317, disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a six-month period will be considered chronic. The six-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. 38 C.F.R. § 3.317(a)(4). The Board notes that, effective July 13, 2010, VA has amended its adjudication regulations governing presumptions for certain Persian Gulf War Veterans. Such revisions amend § 3.317(a)(2)(i)(B) to clarify that chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome are examples of medically unexplained chronic multisymptom illnesses and are not an exclusive list of such illnesses. Additionally, the amendment removes § 3.317(a)(2)(i)(B)(4) which reserves to the Secretary the authority to determine whether additional illnesses are "medically unexplained chronic multisymptom illnesses" as defined in paragraph (a)(2)(ii) so that VA adjudicators will have the authority to determine on a case-by-case basis whether additional diseases meet the criteria of paragraph (a)(2)(ii). These amendments are applicable to claims pending before VA on October 7, 2010, as well as claims filed with or remanded to VA after that date. See 75 Fed. Reg. 61,997 (Oct. 7, 2010). Compensation under 38 U.S.C.A. § 1117 shall not be paid if: (1) there is affirmative evidence that an undiagnosed illness was not incurred during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War; (2) if there is affirmative evidence that an undiagnosed illness was caused by a supervening condition or event that occurred between the veteran's most recent departure from active duty in the Southwest Asia theater of operations during the Persian Gulf War and the onset of the illness; or (3) if there is affirmative evidence that the illness is the result of the veteran's own willful misconduct or the abuse of alcohol or drugs. 38 C.F.R. § 3.317(c). The term "Persian Gulf Veteran" means a Veteran who served on active military, naval, or air service in the Southwest Asia Theater of operations during the Persian Gulf War. 38 C.F.R. § 3.317(d)(1). A Persian Gulf Veteran is one who served in Southwest Asia (including Iraq) at any time since August 1990. 38 C.F.R. §§ 3.2, 3.317. Based upon a review of service records, the Board finds that the Veteran is a Persian Gulf Veteran. The DD Form 214 reflects that the Veteran had service in the Southwest Asia theater of operations from October 1990 to April 1991. Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno. The Board is charged with the duty to assess the credibility and weight given to evidence. Wensch v. Principi, 15 Vet. App. 362, 367 (2001); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). 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. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board may weigh the absence of contemporaneous medical evidence against the lay evidence in determining credibility, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the veteran's claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). The Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). Medical evidence that is speculative, general or inconclusive in nature cannot support a claim. See Obert v. Brown, 5 Vet. App. 30, 33 (1993); see also Beausoleil v. Brown, 8 Vet. App. 459, 463 (1996); Libertine v. Brown, 9 Vet. App. 521, 523 (1996). A physician's statement framed in terms such as "may" or "could" is not probative. See Warren v. Brown, 6 Vet. App. 4, 6 (1993). A significant factor to be considered for any opinion is the accuracy of the factual predicate, regardless of whether the information supporting the opinion is obtained by review of medical records or lay reports of injury, symptoms and/or treatment. See Harris v. West, 203 F.3d 1347, 1350-51 (Fed. Cir. 2000) (examiner opinion based on accurate lay history deemed competent medical evidence in support of the claim); Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005) (holding that a medical opinion cannot be disregarded solely on the rationale that the medical opinion was based on history given by the veteran); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. The Board has reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by a veteran or obtained on a veteran's behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Service Connection for Back and Neck Disabilities The Veteran contends that his back and neck disabilities are a direct result of his military service. During the current claim, the Veteran asserted that he had back and neck symptoms in service and has had continuous back and neck disability symptoms since service separation. In a September 1981 service treatment record, the Veteran reported back pain after falling off a tank. The service examiner diagnosed left flank contusion and the Veteran was placed on light duty and prescribed painkillers and heating pad therapy. In a March 1984 service treatment record, the Veteran reported low back pain after falling off a truck. The service examiner diagnosed muscle spasm due to trauma; X-rays reflected a normal lumbosacral spine. In a January 1992 service treatment record, the Veteran reported suffering a neck injury during a basketball game. The service examiner diagnosed neck strain and prescribed pain killers and a soft neck collar. In a July 1992 service treatment record, the Veteran reported low back pain. The service examiner diagnosed lumbar strain and prescribed two days of bed rest. The Veteran's service treatment records indicate that the Veteran's back and neck injuries resolved with treatment. The Veteran was not placed on permanent profile or permanent restriction in service because of a back or neck injury. In a December 1987 service "Report of Medical Examination," the service examiner reported normal neck and spine. In a December 1987 service "Report of Medical History," the Veteran specifically denied any recurrent back pain, providing highly probative evidence against this claim. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (upholding Board's finding that a veteran was not credible because lay evidence about a wound in service was internally inconsistent with other earlier lay statements that he had not received any wounds in service); see also Curry v. Brown, 7 Vet. App. 59 (1994) (noting that contemporaneous evidence has greater probative value than history as reported by the veteran); see also Caluza, 7 Vet. App. at 512, aff'd per curiam, 78 F.3d. 604 (Fed. Cir. 1996) (credibility can be affected by consistency with other evidence of record). 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). The Board next finds that the weight of the evidence demonstrates that back and neck disability symptoms have not been continuous since service separation in October 1994. During the August 2011 Board personal hearing, the Veteran testified that he injured his neck and back in service and that his treatment for those injuries has been ongoing since that time. While the Veteran is competent to state that he had back and neck disability symptoms at any time, including in service, the Board finds that the Veteran's more recent assertions of chronic back and neck disability symptoms in service and continuous back and neck disability symptoms since service, made in the context of the claim for service connection (VA disability compensation) for back and neck disabilities, are outweighed by the other, more contemporaneous, lay and medical evidence of record, and are not credible. See Charles v. Principi, 16 Vet. App. 370 (2002). The recent statements of chronic back and neck disability symptoms in service and continuous post-service back and neck disability symptoms are inconsistent with the service treatment record evidence and the histories and symptoms credibly reported by the Veteran during post-service VA and private treatment. In an August 1995 private treatment record, the Veteran reported neck and back pain from a post-service motor vehicle accident (MVA). See Harvey v. Brown, 6 Vet. App. 390, 394 (1994) (Board decision properly assigned more probative value to a private hospital record that included lay history that was made for treatment purposes than to subsequent statements made for compensation purposes). In an August 1997 VA treatment record, the VA examiner reported no costovertebral angle (CVA) tenderness and reported the Veteran's neck as normal. A March 2001 private X-ray reflected a negative cervical spine. In a May 2001 private treatment record, the Veteran reported back and neck pain from a MVA approximately five weeks prior; the private examiner diagnosed myofascial syndrome, resolving. See Harvey, 6 Vet. App. at 394. In a September 2008 private treatment record, the Veteran reported low back pain. The private examiner reported that a March 2008 MRI revealed no significant findings and X-Rays revealed minimal spondylosis. The private examiner provided a diagnosis of lumbar radiculopathy and sacroilitis. In a March 2010 VA treatment record, the VA examiner reported full range of motion of the cervical spine and mild to moderate limitation of motion of the lumbar spine. There was no tenderness of the cervical or lumbosacral spinous processes or paraspinal musculature. The Board further finds that the weight of the competent evidence demonstrates that the Veteran's currently diagnosed back and neck disabilities are not related to active service, specifically including the back and neck injuries during service. In a March 2004 private spine opinion, the private examiner opined that the neck and back disabilities were at least as likely as not related to injuries incurred in service; however, the private examiner only opined that it "may be possible" and subsequently opined that he had no proof to support his assertion. In a July 2004 VA spine examination, the VA examiner diagnosed lumbar and cervical strain; the X-rays of the lumbar and cervical spine were within normal limits (WNL). The VA examiner opined that the cervical and lumbar strains were less likely than not related to active duty service. In the November 2012 VA spine examination, the VA examiner diagnosed contusion of the back, resolved, and neck strain, resolved. The VA examiner reported no documented arthritis and no intervertebral disc syndrome. The VA examiner opined that it was less likely than not that the Veteran's back and neck disabilities were related to active duty service. The VA examiner reasoned that the Veteran's service treatment records reflected that the Veteran's neck and back injuries in service had resolved and that he did not have any other back or neck injuries until private treatment records dated from March to May 2001 reflected back and neck pain due to a post-service MVA. The VA examiner further reasoned that the post-service imaging of the spine was normal until April 2011 that showed mild degenerative changes; however, the VA examiner opined that this was due to the Veteran's age. The Board finds that the March 2004 private spine opinion is of limited probative value. The March 2004 private examiner opined that it "may be possible" that the Veteran's neck and back disabilities were related to his active duty service. A physician's statement framed in terms such as "may" or "could" is not probative. See Warren, 6 Vet. App. at 6. The Board also finds that the March 2004 opinion is of limited probative value because the private examiner supplied a bare conclusion and did not support the opinion with a rationale. The Court has held that such a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller, 11 Vet. App. at 348; see also Bloom, 12 Vet. App. at 187 (an opinion that is unsupported and unexplained is purely speculative and does not provide the degree of certainty required for medical nexus evidence). The Board finds that the July 2004 VA spine opinion is of limited probative value because the VA examiner supplied a bare conclusion and did not support the opinion with a rationale. The Court has held that such a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller, 11 Vet. App. at 348; see also Bloom, 12 Vet. App. at 187. The November 2012 VA spine opinion is of high probative value because it is based on a factually accurate history, as it appears the VA examiner was informed of the relevant evidence in this case that included back and neck symptoms in service. The VA examiner relied on accurate facts, and gave a fully articulated opinion that is consistent with the accurate facts found in this case and is supported by sound reasoning. The only evidence of record supporting the Veteran's claim is his own lay opinion that his currently diagnosed back and neck disabilities are related to his period of service. In this regard, the Board acknowledges that the Veteran can provide competent evidence about what he experienced; for example, his statements are competent evidence as to continuous back and neck symptoms after service separation; however, as noted above, the Board has found his statements to not be credible. In addition, lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a lay person is competent to identify the medical condition (i.e., where the condition is simple, for example, a broken leg), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). However, while the Veteran may be sincere in his belief that his back and neck disabilities are related to his service, his expressions of such belief have little, if any, probative value. The determination of whether a current disability is related to service is a complex medical question not capable of resolution by mere lay observation; it requires medical expertise. In addition, the Board does not find that the Veteran's back and neck disabilities are subject to lay diagnosis, as medical tests are required to establish such an assessment. The Veteran is a layperson with no medical training; he does not cite to any medical texts or treatises to support his self-diagnoses and/or theory of causation; and he does not offer any explanation or rationale for his opinions. See Jandreau, 492 F.3d at 1377. Specialized education and/or training are required for a determination as to determine the etiology of back and neck disabilities. The Veteran is not competent to provide an opinion on the causation of his back and neck disabilities. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran's claim for service connection for back and neck disabilities, and the claims must be denied. Because the preponderance of the evidence is against the claims, the benefit of the doubt doctrine is not for application. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. Service Connection for Stomach Disability The Veteran contends that service connection is warranted for a stomach disability. For the reasons that follow, the Board finds that the Veteran does not have a current stomach disability. The Board finds that the weight of the evidence demonstrates that the Veteran did not have chronic symptoms of a stomach disability in service. In an October 1984 service treatment record, the Veteran reported stomach pain. The service examiner diagnosed a viral illness. The Veteran's service treatment records indicate that the Veteran's stomach pains resolved with treatment. The Veteran was not placed on permanent profile or permanent restriction in service because of stomach pain. In a December 1987 service "Report of Medical Examination," the service examiner reported a normal abdomen. In a December 1987 service "Report of Medical History," the Veteran specifically denied any stomach trouble, providing highly probative evidence against this claim. Madden, 125 F.3d at 1481 (upholding Board's finding that a veteran was not credible because lay evidence about a wound in service was internally inconsistent with other earlier lay statements that he had not received any wounds in service); see also Curry (noting that contemporaneous evidence has greater probative value than history as reported by the veteran); see also Caluza, 7 Vet. App. at 512, aff'd per curiam, 78 F.3d. 604 (credibility can be affected by consistency with other evidence of record). As noted above, because the Veteran's stomach condition is not defined as a chronic disease in § 3.309(a), the provisions of § 3.303(b) for chronic disabilities do not apply, and evidence of a continuity of symptomatology after service is not sufficient by itself to support the claim. See Walker. Service connection may still be established if all the evidence of record shows that the Veteran has current stomach disability that is related to active service. See 38 C.F.R. § 3.303(d). The post-discharge evidence of record does not contain any notation indicating a diagnosis of a stomach disability. In an August 1987 VA treatment record, the VA examiner reported the Veteran's gastrointestinal system as normal. In a February 1999 private treatment record, the private examiner reported the abdomen was benign, without masses, organomegaly, or tenderness. In a January 2000 VA examination, the VA examiner reported the Veteran's abdomen as normal. In a March 2008 VA treatment record, the VA examiner reported a negative abdomen examination. In a March 2008 VA genitourinary examination, the Veteran reported no nausea or vomiting. In a June 2008 VA genitourinary examination, the VA examiner reported a negative abdomen examination. In a March 2010 VA examination, the Veteran reported nausea and stomach pains since 1990; however, the VA examiner reported normal abdomen with no stomach symptoms present. In a March 2013 VA addendum, the VA examiner reported no current stomach symptoms were diagnosed in the November 2012 VA examination. The VA does not generally grant service connection for symptoms alone, without an identified basis for those symptoms. As noted above, the Veteran was provided multiple VA examinations to determine whether he had any stomach disability, but no such condition was shown. With any claim for service connection (under any theory of entitlement), it is necessary for a current disability to be present. See Brammer, 3 Vet. App. at 225. In this case, the record of evidence indicates that the Veteran's stomach was examined on several occasions by VA and private medical providers in different contexts, including for treatment purposes. The treatment reports and examination reports on these occasions show no continuous stomach symptoms since service, or show currently diagnosed stomach disability. The Board has also considered entitlement to service connection for a stomach disability as due to undiagnosed illness; however, a grant of service connection on such a basis also requires that objective indications of a "qualifying chronic disability" became manifest either during active service in Southwest Asia or to a compensable degree not later than December 31, 2016. See 38 C.F.R. § 3.317 (as revised by 76 Fed. Reg. 81834 (Dec. 29, 2011)). Here, there are simply no objective findings of a stomach disability, or disability manifested by stomach pain, either during or after service. As such, service connection is not warranted as no current disability, to include as due to an undiagnosed illness, is shown. In summary, for the reasons and bases expressed above, the Board concludes that the preponderance of the evidence is against the Veteran's claim for service connection for stomach disability, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. Service Connection for a Disability Manifested by Whole Body Joint and Muscle Pain The Veteran contends that service connection is warranted for whole body joint and muscle pain. For the reasons that follow, the Board finds that the Veteran does not have a current disability manifested by whole body muscle and joint pain. Service treatment records do not reflect that the Veteran was treated for whole body joint and muscle pain. In a December 1987 service "Report of Medical Examination," the service examiner reported normal upper and lower extremities. In a December 1987 service "Report of Medical History," the Veteran specifically denied any joint trouble, providing highly probative evidence against this claim. Madden, 125 F.3d at 1481 (upholding Board's finding that a veteran was not credible because lay evidence about a wound in service was internally inconsistent with other earlier lay statements that he had not received any wounds in service); see also Curry (noting that contemporaneous evidence has greater probative value than history as reported by the veteran); see also Caluza, 7 Vet. App. at 512, aff'd per curiam, 78 F.3d. 604 (credibility can be affected by consistency with other evidence of record). In a June 1993 service treatment record, the Veteran specifically denied any symptoms of joint pain. As noted above, because the Veteran's whole body joint and muscle pain is not defined as a chronic disease in § 3.309(a), the provisions of § 3.303(b) for chronic disabilities do not apply, and evidence of a continuity of symptomatology after service is not sufficient by itself to support the claim. See Walker. Service connection may still be established if all the evidence of record shows that the Veteran has whole body muscle pain that is related to active service. See 38 C.F.R. § 3.303(d). In private treatment records dated from March 1998 to January 2004 and VA treatment records dated from February 2000 to April 2009, the Veteran did not report or receive any treatment for symptoms of whole body muscle and joint pain. For treatment, the Veteran would be expected to give a full and accurate history to get good treatment. In none of these examinations for treatment does the Veteran mention chronic whole body muscle and joint pain symptoms in service, or continuous whole body muscle and joint pain since service. See Cartright, 2 Vet. App. at 25; Pond; Gardin, 613 F.3d at 1380. The VA does not generally grant service connection for symptoms alone, without an identified basis for those symptoms. As noted above, the Veteran was provided multiple VA examinations to determine whether he had any disability manifested by whole body muscle and joint pain, but no such condition was shown. With any claim for service connection (under any theory of entitlement), it is necessary for a current disability to be present. See Brammer, 3 Vet. App. at 225. In this case, the record of evidence indicates that the Veteran was examined on several occasions by private and VA medical providers in different contexts, including for treatment purposes. The treatment reports and examination reports on these occasions show no continuous whole body muscle and joint pain symptoms since service, or show a current disability manifested by whole body muscle and joint pain. The record indicates that the Veteran has reported generalized muscle and joint pain. At his October 2011 Board personal hearing, the Veteran testified that the muscle and joint pain occurred in his knees and hands. The Board has considered the Veteran's statements. The Federal Circuit has held that in certain situations, lay evidence can even be sufficient with respect to establishing medical matters such as a diagnosis. The Veteran is competent to report that he experienced joint and muscle pain; however, his statements are not sufficient and competent to establish a diagnosis of a disability manifested by whole body joint and muscle pain, because a layperson is not competent to identify the condition. See Jandreau. The Board has also considered entitlement to service connection for a disability manifested by whole body joint and muscle pain as due to undiagnosed illness; however, a grant of service connection on such a basis also requires that objective indications of a "qualifying chronic disability" became manifest either during active service in Southwest Asia or to a compensable degree not later than December 31, 2016. See 38 C.F.R. § 3.317 (as revised by 76 Fed. Reg. 81834 (Dec. 29, 2011)). During service, the Veteran reported joint pain in his knees; however, while joint pain is a sign or symptom of a chronic multisymptom illness, there were no reports or findings of other overlapping symptoms or signs or any inconsistent laboratory findings. Further, these intermittent symptoms are not described as chronic. These intermittent symptoms of localized joint and muscle pain - without any of the other signs and symptoms of a chronic nature as described in the laws and regulations related to Gulf War illness - is simply not enough to warrant an award of service connection. The medical records associated with the claims file also do not document any treatment or diagnosis for whole body joint and muscle pain after service. As such, service connection is not warranted as no current disability, to include as due to an undiagnosed illness, is shown. The Board also notes that the Veteran is currently service-connected for his right and left knee disabilities; therefore, a separate disability rating for such disabilities due to undiagnosed illness would be in violation of 38 C.F.R. § 4.14. The Board further notes that the Veteran has not been diagnosed with any joint or muscle disability separate from his right and left knee disabilities. In summary, for the reasons and bases expressed above, the Board concludes that the preponderance of the evidence is against the Veteran's claim for service connection for a disability manifested by whole body muscle and joint pain, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. ORDER Service connection for a back disability is denied. Service connection for a neck disability is denied. Service connection for a stomach disability, to include as due to an undiagnosed illness, is denied. Service connection for a chronic disability manifested by whole body muscle and joint pain, to include as due to an undiagnosed illness, is denied. ____________________________________________ T. D. Jones Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs