Citation Nr: 1319706 Decision Date: 06/18/13 Archive Date: 06/27/13 DOCKET NO. 10-12 742 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Salt Lake City, Utah THE ISSUE Entitlement to service connection for a low back disorder. REPRESENTATION Appellant represented by: Kenneth Carpenter, Attorney ATTORNEY FOR THE BOARD G. E. Wilkerson, Associate Counsel INTRODUCTION The Veteran served on active duty from March 1966 to January 1968. This case comes before the Board of Veteran's Appeals (Board) on appeal from a January 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. Jurisdiction was subsequently transferred to the RO in Salt Lake City, Utah. In August 2011, the Board remanded the case for additional development. That development was completed, and the case has since returned to the Board for further appellate review. A review of the Veteran's Virtual VA electronic claims file reveals no additional records. FINDING OF FACT The Veteran does not have a low back disorder that manifested in service or within one year thereafter and that is causally or etiologically related to his military service. CONCLUSION OF LAW A low back disorder was not incurred in active service, and arthritis may not be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1137, 5103(a), 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012). Proper notice from VA must inform the claimant of any information and medical or lay 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); Quartuccio v. Principi, 16 Vet. App. 183 (2002). In addition, the notice requirements of the VCAA apply to all elements of a service-connection claim, including the degree of disability and the effective date of the disability. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Further, this notice must include information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. at 486. VCAA notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). Where complete notice is not timely accomplished, such error may be cured by issuance of a fully compliant notice followed by readjudication of the claim. See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); see also Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). In this case, regarding the duty to notify, the Veteran was sent a letter in August 2008, prior to the initial adjudication of the claim. The letter provided information as to what evidence was required to substantiate the claim and of the division of responsibilities between VA and a claimant in developing an appeal. The letter also explained what type of information and evidence was needed to establish a disability rating and effective date. Accordingly, no further development is required with respect to the duty to notify. In addition, the duty to assist the Veteran has also been satisfied in this case. The Veteran's service treatment records as well as all identified and available post-service medical records pertinent to the years after service are in the claims file and were reviewed by both the RO and the Board in connection with the Veteran's claim. The Veteran's Social Security Administration (SSA) records have also been obtained and are associated with the claims file. The Veteran has not identified any other outstanding records that are available and relevant to the claim being decided herein. Moreover, the record includes various written statements provided by the Veteran and his representative. As previously noted, the Board remanded the case in August 2011. The remand directives specifically indicated that the Veteran's SSA records should be obtained, and that an attempt should be made to obtain additional treatment records. Such development was completed, and the claim was readjudicated in a supplemental statement of the case. Therefore, the Board finds that there was substantial compliance with the August 2011 remand directives. Accordingly, no further remand is necessary. See Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. at 104-05. The Veteran was also afforded VA examinations in November 2009 and March 2013 to determine the nature and etiology of his claimed low back disorder. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that the VA examinations obtained in this case are adequate, as it is predicated on a review of the claims file and the pertinent evidence of record as well as on an orthopedic examination. The Board concludes the Veteran was provided the opportunity to meaningfully participate in the adjudication of his claim and did in fact participate. Washington v. Nicolson, 21 Vet. App. 191 (2007). For these reasons, the Board concludes that VA has fulfilled the duty to assist the Veteran in this case. Hence, there is no error or issue that precludes the Board from addressing the merits of this appeal. Law and Analysis Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. 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). The Board notes that 38 C.F.R. § 3.303(b), applies to only those chronic diseases listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). With respect to the current appeal, this list includes arthritis. See 38 C.F.R. § 3.309(a). In addition to the requirements for establishing service connection on a direct basis, service connection for certain diseases, such as arthritis, may also be established on a presumptive basis by showing that the disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). In this case, the Veteran's service treatment records reflect that he was seen in September 1967 with a three month history of a persistent low back ache. It was noted that radiographs appeared within normal limits at that time. No further complaints with respect to the back were noted in service, and the Veteran's spine was normal during his December 1967 discharge examination. Post-service treatment records include September 1979 and February 1981 radiographs of the lumbar spine, which the Veteran contends are supportive of a finding that he had a herniated disc that was caused by an in-service injury. A March 2002 private treatment report reflects that the Veteran was fairly active and that swam and skied approximately three times per week each. He complained of left-sided leg pain, but he denied having back pain. A December 2007 MRI of the lumbar spine documents a clinical history of numbness in the buttocks and bilateral radiculopathy symptoms. The impression was multilevel degenerative changes throughout the lumbar spine and throughout the lower thoracic spine. A January 2008 report from a private physician, Dr. W. (initials used to protect privacy), shows that the Veteran reported for a neurosurgical opinion with regard to his low back. It was noted that he had had longstanding problems with his back with a history of a laminectomy in 1981. It was also noted that a December 2007 MRI revealed multilevel degenerative changes throughout the lumbar spine and severe degenerative disc disease at almost every level. Dr. W. further noted that there was spondylosis and foraminal facet disease as well as narrowing at the T11-T12 level. A March 2008 from another private physician, Dr. S., documents a chief complaint of posterior lower buttock pain and left pain and numbness in the perianal region with urine incontinence. He denied having any previous pain in the same area. After a physical examination, the impression was broad-based bulging disc at L5-S1 with annular tear and extension into the foramina, mild central canal stenosis at L1-L2, L2-L3, and L3-4, multiple level facet joint arthropathy and spondylosis in the lumbosacral spine, and lumbar radiculopathy. A March 2008 MRI of the lumbar spine revealed multilevel degenerative changes throughout the lumbar spine with disc osteophystic ridging with central and transverse canal stenosis. A May 2008 neurological follow-up from Dr. W. reflects that the Veteran presented describing a more gradual onset of cauda equina-like symptoms. Dr. W. noted that, while the Veteran's symptoms remained complex, they were consistent with what appeared to be progressive neurogenic claudication. A May 2008 report from a private physician, Dr. T., reflects that the Veteran presented with a history of lumbar spondylosis. It was noted that he had had a prior lumbar spine procedure. A May 2008 report from Dr. T. indicates that the Veteran had a complex history of lumbar spinous disease dating to 1981, when he underwent surgery. The Veteran presented with radicular symptoms provoked by coughing and most compatible with compromise of the thoracic and lumbar canal. A May 2008 report from Dr. W. reflects that the Veteran was seen for an orthopedic spine consultation with a chief complaint of low back, buttock, and posterior thigh pain of about 8 months duration. It was noted that the Veteran's history of spine problems dated to the early 1980s and that he underwent decompression surgery in 1981. He did well after the surgery and was able to return to regular activities, including somewhat extreme skiing without major difficulties. His difficulties reemerged in the fall of 2007 without a major precipitating event and with increased aching and sharp pains in the low back and buttock area with radiation to the posterior thighs. A May 2008 MRI of the lumbar spine reveals a history of spinal stenosis, and multilevel degenerative changes of the lumbar spine with spinal stenosis most severe at the L3-4 level were indicated. A June 2008 report indicates that the Veteran had a history of progressive back pain radiating to the buttocks. An evaluation revealed lumbar disc disease with moderate spinal, thoracic, and cervical spinal stenosis. It was noted that he planned to have decompressive surgery to help relieve and reduce his pain as well as improve his neurologic symptoms. The Veteran underwent a neurosurgical evaluation in June 2008 for consideration of issues related to cervical and lumbar canal narrowing. The Veteran reported an onset of symptoms in his buttock and waist region in September 2007 along with urinary and fecal incontinence. The examiner indicated that he believed that this was related to canal compromise in the lumbar area. He favored proceeding soon with lumbar decompressive surgery. A June 2008 surgical report reflects that the Veteran underwent previous L4-5 decompression surgery in 1981 and did well following this procedure. He was able to return to regular activities, including extreme skiing without major problems. The Veteran reported that he had difficulties again beginning around the fall of 2007 with no major precipitating evident. The Veteran underwent a microlaminectomy with partial facetectomy, foraminotomy and nerve root decompression of the right and left T11-12 and T12-L1 along with bilateral L1-2, L2-3, and L3-4, microdecompression via left laminotomy, right laminoplasty with partial facetectomy, foraminotomy, and nerve root decompression bilaterally. In an October 2008 statement, a private physician, Dr. P., noted that, over the previous year, the Veteran had progressive low back pain with radiation down the back of his legs, as well as progressive urinary incontinence. He had lumbar spinal stenosis with decompressive surgery. While his pain had improved, he still had saddle anesthesia and pain as well as rectal and urinary incontinence. A SSA disability determination report reflects that the Veteran was found to be disabled and eligible for benefits beginning in June 2008 due to his degenerative disc disease of the lumbar and cervical spine. In a February 2008 statement, Dr. P. indicated that he had been the Veteran's primary care physician since 2001. He noted that the Veteran suffered from lumbar degenerative disc disease and stenosis. He had a history of a lower back injury in service and had been treated for back pain up to the point he became his primary care physician. The Veteran had no other history of specific injury to his back. Dr. P. commented that, while the aging process had likely contributed, it was his opinion that more likely than not the degenerative disc disease originated with the injury sustained in service. The Veteran was afforded a VA examination in November 2009 during which the examiner indicated that he had reviewed the entire claims file. The Veteran related a history of a back strain in service in 1967 when he was unloading boxes of food down a set of stairs. He noted that he had no treatment on his back and that x-rays of his back were apparently negative when he returned to shore. He indicated that he was discharged from service a few months thereafter. Since then, the Veteran had many visits over the years for chiropractic manipulation and eventually underwent lumbar laminectomy in 1981. He underwent another surgery in June 2008 with postoperative diagnoses of lumbar and cervical stenosis, dysfunctional bladder, and erectile dysfunction. The Veteran reported that his sciatica was relieved by this surgery and that he had since had low back stiffness that "comes and goes." He still had cauda equina syndrome with loss of bowel and bladder function for the past two years. In addition, the Veteran told the November 2009 VA examiner that he had been retired for about 10 years. He indicated that he had previously worked for 29 years as a utilities manager at a ski resort, particularly dealing with the water and sewer systems, and then branched out on his own business in the same area. He reported that he never played sports much, but enjoyed occasional fishing and sailing. Following a physical examination, the examiner diagnosed the Veteran with multiple level lumbosacral spinal stenosis with prior lumbar nerve root irritation and sciatica, corrected through multiple level foraminotomies and laminectomies, with residuals. X-rays revealed severe multilevel hypertrophic spondylosis of the thoracolumbar spine. The November 2009 VA examiner opined that it is less likely as not that the Veteran's current back condition had any relationship to his history of a back sprain while in service 42 years earlier. He noted that he had reviewed Dr. P.'s opinion and indicated that this opinion was based on the Veteran's own comments and history. The examiner pointed out that the Veteran's separation physical examination was normal. He also noted that the Veteran spent 29 years working in the utility maintenance field, which could have easily attributed to his development of ongoing back problems on an intermittent basis. In addition, the Veteran had congenital stenosis, which the examiner indicated would be unrelated to service. In an April 2010 notarized affidavit, the Veteran's sister wrote that he did not have any injury to his back prior to service, but that upon his return from service, he occasionally complained of low back pain, sought treatment from a chiropractor, and took medication. She stated that the Veteran had experienced continual problems with his low back since 1968. In a November 2010 statement, Dr. P. noted that he had treated the Veteran since 2001. He indicated that the Veteran suffered from lumbar degenerative disc disease and stenosis and had a history of injury to his back in service. He noted that he reviewed the Veteran's service treatment records and the statement from the Veteran's sister. He also observed that, according to the Veteran, his job in the maintenance field was primarily sedentary at a desk. As such, he opined that the Veteran's resulting back condition was at least as likely as not related to the initial injury he sustained in service. In a September 2011 notarized affidavit, the Veteran reported that he injured his back while unloading provisions aboard the U.S.S. Guam. He indicated that he noticed back stiffness and aching after lifting boxes for several hours. He stated the pain continued after his return from ship duty and continued for several months until he went to sick bay. He did not recall receiving any particular treatment. After discharge, he continued to have back aches and stabbing pains and requested a less physical position than his post-work position as a telephone installer. He subsequently transferred to an office job as a complex line assigner. The Veteran noted that he saw many doctors and chiropractors throughout the 1970s. By the 1980s, the pain became constant and sharp, and he underwent a laminectomy in 1981. The Veteran reported having continued back pain after the surgery. In 2007, he indicated that he began to suffer from additional symptoms of cauda equina syndrome, and he underwent additional surgery in 2008. He noted that the surgery relieved the pain down his legs, but not the persistent low back pain. He also stated that he had not had any other incidents of a back injury since his discharge from service. In summary, the Veteran asserted that he first hurt his back in service and suffered from continuous back pain to varying degrees since service. He indicated that his back pain and related problems had escalated over the years and that he was now totally disabled due to his back disability. Continued private treatment records include a September 2011 report noting cauda equina syndrome and lumbar spondylosis. A February 2012 statement from a private physician, Dr. O., reflects that the Veteran was his patient from 1974 to 2000. He noted that he did not have any medical records from the Veteran, but he did recall that the Veteran had chronic low back pain and significant osteoarthritic changes on x-rays. He indicated that the Veteran needed narcotic medication for pain control, although he was able to remain fairly physically active. Dr. O. recalled that the Veteran's back problems during those years were significant and chronic. In a March 2012 statement, a private physician, Dr. F., noted that he had no records available pertaining to the Veteran's 1981 surgery, but he did know that he operated at L4-5 for a herniated nucleus pulposus. He opined that it is at least as likely as not that the Veteran's back problems in 1981 were directly related to the initial injury he sustained in service in 1967. During the March 2013 VA examination, the Veteran reported that he injured his back in 1967 while lifting heavy boxes. He indicated that, since this initial injury, his back problems had been an ongoing issue. He noted that his back pain, despite long-term, intensive conservative medical management, including injections, and chiropractic and physical therapy sessions, had not been resolved, even with surgeries in 1981 and 2008. The Veteran stated that he continued to have persistent back pain, almost resistant to any medications, as well as ongoing problems with bladder and bowel movements. Following a physical examination, the examiner diagnosed the Veteran with thoracolumbar degenerative arthritis with a strain and radiculopathy involving the bilateral sciatic nerve as well as status post thoracolumbar spine laminectomies with residual scars. The examiner indicated that she reviewed the Veterans' claims file and opined that the claimed low back disorder was less likely as not incurred in or caused by the claimed in-service injury or event. The examiner noted that she based her opinion on numerous medical records and claims consultation. She observed that there was only one medical note referring to a back ache in service and that there was no indication regarding a back problem at the time of his discharge from service. She also noted the post-service diagnosis of lumbar stenosis and cauda equina syndrome. The examiner indicated that existing narrowing of the spinal foramina could have contributed to the developing of stenosis as well as leg pain and weakness. She stated that cauda equine syndrome could be caused by multiple factors, such as degenerative changes of the spine. She further commented that other factors, such as Veteran's civilian job, which he described as "office work," advanced age, and lifestyle could have impacted the Veteran's back issues and led to the development of degenerative changes of the spine. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to service connection for a low back disorder. The above-cited evidence clearly reflects that the Veteran has a current low back disorder. Moreover, the record includes a report of an in-service back ache of a few months duration. Thus, the crux of this case turns on the question of whether the Veteran's current low back disorder resulted from the in-service injury. The Board acknowledges that there are conflicting opinions with respect to whether the Veteran's current low back disorder is related to his military service. While Dr. P. and Dr. F. indicated that such a relationship was likely, the November 2009 and March 2013 VA examiners found it less likely than not that the Veteran's current low back disorder is related to service. It is the responsibility of the Board to assess the credibility and weight to be given the evidence. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). The probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). When reviewing such medical opinions, the Board may appropriately favor the opinion of one competent medical authority over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). However, the Board may not reject medical opinions based on its own medical judgment. Obert v. Brown, 5 Vet. App. 30 (1993); see also Colvin v. Derwinski, 1 Vet. App. 171 (1991). In assessing medical opinions, the failure of the physician to provide a basis for his opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Other factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000). A medical opinion may not be discounted solely because the examiner did not review the claims file. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In this case, the Board finds the VA examiners opinion to be most probative. In so finding, the Board points out that the VA examiners based their opinions on a review of the entire claims file, to include the pertinent in-service findings with respect to the low back, and provided a rationale for the conclusions reached that is consistent with the evidence of record. Both examiners noted other relevant factors in consideration of the Veteran's development of low back problems, including age and lifestyle. In contrast, the private physicians did not provide any rationale for their opinions, did not discuss or account for the relevant findings in service, such as the normal radiographs and lack of diagnosis on discharge, or note or address other relevant factors, such as the Veteran's post-service activities. While Dr. P. indicated that he reviewed the Veteran's service treatment records, he did not have access to the entire claims file or provide any reasoning for his conclusion that the current disability was related to service. Indeed, he did not address the fact that the Veteran's spine was normal at discharge, or as will be discussed below, his inconsistent reports regarding the onset of his back problems. The Board notes that a medical opinion that contains only data and conclusions is also not entitled to any weight. It is the factually accurate, fully articulate, sound reasoning for the conclusion that contributes probative value to a medical opinion. The Board must be able to conclude that the medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). See also Bloom v. West, 12 Vet. App. 185, 187 (1999); Black v. Brown, 5 Vet. App. 177, 180 (1995); Knightly v. Brown, 6 Vet. App. 200 (1994); Miller v. West, 11 Vet. App. 345, 348 (1998). Thus, the most persuasive opinions on the question of whether there is a nexus between the Veteran's current low back disorder and service are that of the VA examiners, which weigh against the claim. The Board has also considered the lay statements of record indicating that he first injured his low back in service and that he has experienced chronic, continuous symptoms since that initial injury. The Board notes that lay persons are certainly competent to report observable symptoms of which they have first-hand knowledge. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, such statements must still be weighed against the other evidence of record. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). Although the Veteran has reported that he has had continuous symptoms since service, such a report is inconsistent with the normal separation examination, which is affirmative evidence showing that he did not have a back disorder at that time. It is also inconsistent with his denial of a pertinent history of such problems in service and when he was otherwise seeking medical attention for his back symptoms following service. Rather, post-service private treatment records mainly reflect the Veteran's reported onset of back problems beginning in the 1980s, which is around the time of the first surgical treatment. Upon seeking treatment for the reemergence of symptoms in 2007, the Veteran also did not report continuous back problems since an in-service injury. While the Veteran's private physician, Dr. O., noted that he treated the Veteran from 1974 to 2000 for his low back pain and arthritis, he did not provide any details as to exact onset, diagnosis, or nature of the back complaints, to include whether this treatment stemmed from an initial in-service injury. In this case, the Board is faced with more than a mere silent record. See Maxson v. West, 12 Vet. App. 453, 459 (1999), affirmed sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000), (it was proper to consider the veteran's entire medical history, including a lengthy period of absence of complaints). Savage v. Gober, 10 Vet. App. 488, 498 (1997)(in a merits context, the lack of evidence of treatment may bear on the credibility of the evidence of continuity). Instead, the post-service assertions are inconsistent with the contemporaneous history noted at the time of his service discharge, as well as the Veteran's own statements made while seeking treatment. In other words, there is actually affirmative evidence showing that he did not have continuity of symptomatology, including a discharge examination and the Veteran's own statements. The Board also notes that the Veteran's report of his post-service activity level and occupational tasks are at times contradictory and inconsistent with the report of continuous back pain since service. During the November 2009 VA examination, the Veteran reported that he never "played sports much," but the record otherwise reflects that he enjoyed frequent exercise and extreme skiing. While the Veteran indicated that he requested a less physically demanding job and that his occupation was mainly a desk job, he also reported that he ran utilities at a ski resort and then opened his own business in the same field. The SSA disability evaluation report reflects that the Veteran's job as a utility operator, which he reportedly held from 1974 to 2000 and from 2004 to 2008, was a highly skilled and physical occupation, though described as light. The position required frequent reaching and handling and occasional climbing, balancing, kneeling, and crouching to complete the duties. The Veteran indicated that his job included duties, such as taking care of laboratory work, inspecting water treatment and wastewater treatment and reservoirs, supervising employees, and filing reports. He noted that, with respect to a typical day on the job, he spent approximately 1 hour per day walking,1 hour standing, 2 hours sitting, 1 hour climbing, .5 hours stooping, .3 hours crouching, .15 hours handling, grabbing, or grasping big objects, .15 hours reaching, and 2 hours writing, typing, or handling small objects. He noted that he used tools, which he carried up to 100 feet twice per day, and while he mainly lifted objects that were less than 10 pounds, he did lift objects up to 40 pounds. Thus, these reports regarding his work duties are inconsistent with report of an office-type, sedentary job. Based on the foregoing, the Board finds that the Veteran's assertion of low back symptoms is inconsistent and contradicted by other affirmative evidence. Caluza v. Brown, 7 Vet. App. 498 (1995) (In assessing credibility, the Board may consider interest, bias, inconsistent statements, bad character, internal inconsistencies, factual plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness). Therefore, the Board finds that the Veteran's reported history regarding the onset and continuity of symptomatology since service to be not credible. The Board also notes that arthritis has not been shown within a year of the Veteran's discharge from service. To the extent that Veteran has been diagnosed with degenerative arthritis, section 3.303(b) is applicable. However, the Board has found the assertions of continuity to be not credible. Moreover, to the extent that the Veteran alleges that his current low back disability is related to service, the Board acknowledges that lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (Board's categorical statement that "a valid medical opinion" was required to establish nexus, and that a layperson was "not competent" to provide testimony as to nexus because she was a layperson, conflicts with Jandreau). In this case, however, the Board finds that the probative value of the Veteran's assertions is outweighed by the probative value of the specific, reasoned opinions of the VA examiners, particularly in light of their expertise and rationale. Based on the foregoing, the Veteran's low back disability did not manifest in service or for many years thereafter and is not causally or etiologically related to his military service. Accordingly, the claim for service connection for low back disability must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of- the-doubt doctrine. However, because the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). ORDER Entitlement to service connection for low back disorder is denied. ____________________________________________ JESSICA J. WILLS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs