Citation Nr: 1319872 Decision Date: 06/20/13 Archive Date: 07/02/13 DOCKET NO. 09-41 387 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Indianapolis, Indiana THE ISSUES 1. Entitlement to a compensable rating for scar, residuals of appendectomy. 2. Entitlement to service connection for right foot drop, to include as secondary to service-connected scar, residuals of appendectomy. 3. Entitlement to service connection for low back disability, to include as secondary to right foot drop. 4. Entitlement to service connection for torn right rotator cuff, to include as secondary to right foot drop. 5. Entitlement to service connection for Alzheimer's, to include as secondary to right foot drop. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Amanda Christensen, Associate Counsel INTRODUCTION The Veteran had active military service from May 1958 to August 1961. This appeal comes to the Board of Veterans' Appeals (Board) from a September 2008 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. The Veteran withdrew his Board hearing request in June 2010. The Board has not only reviewed the Veteran's physical claims file but also the Veteran's file on the "Virtual VA" system to insure a total review of the evidence. FINDINGS OF FACT 1. The Veteran's appendectomy scar is associated with some underlying soft tissue loss but is not of an area of at least 6 square inches, is not unstable or painful, does not involve symptomatic peritoneal adhesions, and is not productive of any disabling effects. 2. The Veteran does not have a current diagnosis of right foot drop, nor did his right foot drop have its onset in active service or as the result of a disease or injury incurred in active service. 3. The Veteran's arthritis of the spine did not have its onset in active service or manifest to a compensable degree within one year after discharge from active service and is not the result of a disease or injury incurred in active service. 4. The Veteran's right rotator cuff disability did not have its onset in active service and is not the result of a disease or injury incurred in active service. 5. The Veteran's senile dementia did not have its onset in active service and is not the result of a disease or injury incurred in active service. CONCLUSIONS OF LAW 1. The criteria for a compensable rating for scar, residuals of appendectomy are not met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.114, 4.118, Diagnostic Codes 7301, 7800-7805 (2008). 2. The criteria for service connection for right foot drop have not been met. U.S.C.A. §§ 1131, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310 (2012). 3. The criteria for service connection for a back disability have not been met. 38 U.S.C.A. §§ 1112, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310 (2012). 4. The criteria for service connection for a right rotator cuff disability have not been met. 38 U.S.C.A. §§ 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310 (2012). 5. The criteria for service connection for senile dementia have not been met. 38 U.S.C.A. §§ 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist 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, 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, 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); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from VA 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). Such notice should also address VA's practices in assigning disability evaluations and effective dates for those evaluations. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). While the required notice should be furnished prior to the issuance of the appealed rating decision, any initial errors of notice will not be prejudicial if: 1) corrective actions (e.g., issuance of a post-adjudication notice letter containing the required information) are taken, and 2) the appeal is readjudicated (e.g., in a Supplemental Statement of the Case). See Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007). Here, the VCAA duty to notify was satisfied by way of letters sent to the Veteran in February 2008, May 2008, and January 2009. In the May 2008 letter, the RO informed the Veteran of what evidence was required to substantiate his claims for service connection and of the Veteran's and VA's respective duties for obtaining evidence. In the February 2008 and January 2009 letters the RO provided notice with regard to how VA assigns disability ratings and effective dates. VA also has a duty to assist the Veteran with the development of facts pertinent to the appeal. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). This duty includes the obtaining of "relevant" records in the custody of a federal department or agency under 38 C.F.R. § 3.159(c)(2), as well as records not in federal custody (e.g., private medical records) under 38 C.F.R. § 3.159(c)(1). VA will also provide a medical examination if such examination is determined to be "necessary" to decide the claim. 38 C.F.R. § 3.159(c)(4). The Board finds that all necessary development has been accomplished. The RO has obtained the Veteran's Social Security records and private treatment records identified by the Veteran. Further, although the Veteran indicated in November 2009 that he had been told his medical records were destroyed in a fire and that he did not undergo a physical at discharge from service, the Veteran's service treatment records, including a July 1961 discharge examination, have been obtained and associated with his claims file. The Veteran stated in his February 2009 claim that he was treated and released for an in-service injury to his head in 1960 at St. John's Air Force Base in Newfoundland. In November 2009 he stated that St. John's Hospital in Newfoundland would have records of his treatment for his head injury. The RO obtained the Veteran's service treatment records, including a January 1960 Air Force hospital record that notes the Veteran's treatment for a head injury. In a February 2010 supplemental statement of the case, the RO requested that the Veteran notify the VA if he believed the service treatment record obtained did not refer to the same incident as the Veteran was citing or if he believed there was a clinical record of the in-service injury he was referring to and to provide information on the location of that hospitalization record. The Veteran did not reply directly, but in an April 2010 brief his representative stated that all records from Ernest Harmon Air Force Base Hospital should be requested. The Board finds that the VA has obtained the records related to the Veteran's treatment at the Ernest Harmon Air Force Base Hospital for his 1960 head injury. Neither the Veteran nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. The Veteran was afforded a VA scars examination in June 2008. The examiner, a medical professional, performed an examination and provided the Board with sufficient information to rate the Veteran's disability. Therefore, the Board finds that the examination is adequate and contains sufficient information to decide the issue of entitlement to an increased rating for scar, residuals of appendectomy. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The Veteran was not afforded an examination with respect to his claims for service connection for right foot drop, Alzheimer's, torn right rotator cuff, and back disability; however, none is required. In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d) and 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court of Appeals for Veterans Claims has stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and the veteran's service. The types of evidence that "indicate" that a current disability "may be associated" with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Federal Circuit has addressed the appropriate standard to be applied in determining whether an examination is warranted. In Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010) and Colantonio v. Shinseki, 606 F.3d 1378 (Fed. Cir. 2010), the Federal Circuit held that while there must be "medically competent" evidence of a current disability, "medically competent" evidence is not required to indicate that the current disability may be associated with service. Colantonio, 606 F.3d at 1382; Waters, 601 F.3d at 1277. On the other hand, a conclusory generalized lay statement suggesting a nexus between a current disability and service would not suffice to meet the standard of subsection (B), as this would, contrary to the intent of Congress, result in medical examinations being "routinely and virtually automatically" provided to all veterans claiming service connection. Waters, 601 F.3d at 1278-1279. Here, the only evidence that the Veteran's claimed disabilities of right foot drop, back disability, right rotator cuff disability, and senile dementia are related to his military service is his own conclusory generalized lay statements, which are unsupported by even speculative medical evidence. Accordingly, the Board finds that referral for a VA medical examination is not warranted. Hence, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio, 16 Vet. App. 183. Scar, Residuals of Appendectomy Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of disability will be resolved in the veteran's favor. 38 C.F.R. § 4.3. Where, as here, entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, staged ratings are appropriate for an increased rating claim if the factual findings show distinct time periods where the service-connected disability exhibited symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The following discussion addresses the Veteran's level of disability from the time the increased rating claim was filed in December 2007. Francisco, 7 Vet. App. 55; Hart, 21 Vet. App. 505. The claimant bears the burden of presenting and supporting his/her claim for benefits. 38 U.S.C.A. § 5107(a). See Fagan v. Shinseki, 573 F.3d 1282 (Fed. Cir. 2009). In its evaluation, the Board shall consider all information and lay and medical evidence of record. 38 U.S.C.A. § 5107(b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board shall give the benefit of the doubt to the claimant. Id. Another way stated, VA has an equipoise standard akin to the rule in baseball that "the tie goes to the runner." Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Notably, the benefit of the doubt doctrine is not applicable based on pure speculation or remote possibility. See 38 C.F.R. § 3.102. The Veteran's service-connected scar, residuals of appendectomy is currently rated as noncompensable. Scars are rated under Diagnostic Codes 7800-7805. 38 C.F.R. § 4.118. On October 23, 2008, during the course of this appeal, the rating criteria pertaining to scars were revised. The revisions to these diagnostic codes are applicable only to claims filed on or after October 23, 2008. See 73 Fed. Reg. 54,708 (Sept. 23, 2008). Because the Veteran's claim was filed before this date, the revised criteria are not applicable; therefore his scar will be rated under the rating criteria in effect prior to October 23, 2008. Diagnostic Code 7800 contemplates scars of the head, face or neck and therefore provides no basis for a higher rating for an abdominal scar. 38 C.F.R. § 4.118 (2008). Diagnostic Code 7801 contemplates scars that are deep or cause limited motion. A compensable rating is assigned for a deep scar that is an area of at least 6 square inches. A deep scar is one associated with underlying soft tissue damage. Id. Diagnostic Code 7802 contemplates superficial scars or those that do not cause limited motion. A compensable rating is assigned for a superficial scar that is in an area or areas of 144 square inches or greater. A superficial scar is one not associated with underlying soft tissue damage. Id. Diagnostic Code 7803 contemplates scars that are superficial and unstable. An unstable scar is one where for any reason there is frequent loss of covering of skin over the scar. Id. Diagnostic Code 7804 contemplates superficial scars that are painful upon examination. Id. Diagnostic Code 7805 provides that any other scars (including linear scars) and other disabling effects of scars should be evaluated even if not considered in a rating provided under diagnostic codes 7800-04 under an appropriate diagnostic code. 38 C.F.R. § 4.118. Id. Also for consideration are the provisions of 38 C.F.R. § 4.114, Diagnostic Code 7301, for peritoneal adhesions. A 10 percent rating is warranted for moderate adhesions; pulling pain on attempting work or aggravated by movements of the body, or occasional episodes of colic pain, nausea, constipation (perhaps alternating with diarrhea) or abdominal distension. A noncompensable rating is assigned for mild adhesions. The report of the Veteran's June 2008 VA examination reflects that the Veteran has a transverse scar in the right lower quadrant of his abdomen that the examiner noted to be an appendectomy scar. The examiner measured the scar as 9 centimeters long and 0.5 centimeters wide. It was described as depressed and attached to the underlying tissue. The examiner noted minimal loss of underlying soft tissue. On examination the scar was found to not be tender or hypersensitive. The examiner noted the surface of the scar is smooth and the color the same as the surrounding skin. Further, no area of breakdown, infection, edema, inflammation, or keloid formation was found. The examiner stated that the scar causes no impairment of function. Considering the pertinent evidence in light of the applicable criteria, the Board finds that a compensable rating for the Veteran's abdominal scar is not warranted at any time pertinent to this appeal. The evidence reflects that although the Veteran's abdominal scar is associated with some underlying soft tissue loss, it is not of an area of at least 6 square inches, nor is it unstable or painful. Thus, the scar does not meet the requirements for even the minimal compensable rating of 10 percent under any of the applicable diagnostic codes for scars. The Board has also considered whether there are any other potentially applicable diagnostic codes pursuant to which any higher rating for the Veteran's service-connected abdominal scar could be assigned, but has found none more applicable here. In this regard, the medical evidence does not show that the Veteran's abdominal scar is productive of disabling effects such as to warrant a higher rating under other diagnostic criteria. The Veteran's scar is essentially asymptomatic, and there are no signs that there was or is evidence of any symptomatic peritoneal adhesions. As such, there is no basis for assignment of a compensable rating. Therefore, the Board finds that a compensable rating for the abdominal scar must be denied. As the preponderance of the evidence is against assignment of a compensable rating, benefit-of-the-doubt doctrine is not for application. See 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert, 1 Vet. App. at 53- 56. Right Foot Drop The Veteran contends that the appendectomy with spinal tap that he underwent in service caused his right foot drop. Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Additionally, service connection may be granted, on a secondary basis, for a disability which is proximately due to or the result of an established service-connected disorder. 38 C.F.R. § 3.310 (2012). To establish service connection, there must be a competent diagnosis of a current disability; medical or, in certain cases, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. Hickson v. West, 12 Vet. App. 247, 252 (1999); see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. The Veteran's service treatment records reflect that he had an appendectomy in January 1959, although the records do not indicate whether he was administered a spinal tap at that time. His service treatment records do not show any complaints of, treatment for, or diagnosis of right foot drop in service. In his July 1961 report of medical history prior to discharge from service the Veteran denied foot trouble. His feet were found normal on examination. In October 1993, the doctor who performed the Veteran's Social Security examination noted that the Veteran had developed drop foot in his right foot after being hit by a van in 1970. He stated that the drop foot was due to a contusion of the perineal [sic] nerve in the Veteran's right leg and gradually disappeared over a number of months. No other medical records discuss the Veteran having right foot drop. In December 1994 when the Veteran was fitted for a prosthesis he denied weakness of his lower extremities. In February 2008 the Veteran stated that he did not have foot drop prior to his appendectomy. He stated that he did have foot drop in 1960, which caused him to stumble in an incident that injured his head. He stated that he continues to stumble and fall frequently, including a fall in January 2007 due to foot drop. The Veteran is competent to report that he experiences foot drop as it is a condition capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007). However, the lack of mention of foot drop in his service treatment records and recent medical treatment records raises questions as to the credibility of the Veteran's assertion that he has had the condition since service. Notably, the record contains no current diagnosis of foot drop by a medical professional. In fact, the only mention of foot drop in the records indicates that the condition arose and resolved over a number of months in the 1970s after a post-service incident in which the Veteran was injured. The Veteran's private treatment records from September and October 2005, September and November 2007, and March 2008 all note the Veteran had a normal gait. Further, the Veteran's lay statements are the only evidence of record as to a nexus between the Veteran's claimed foot drop and service. Specifically, he contends he had a spinal tap in service during an appendectomy and his foot drop is a result of that spinal tap. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case, the etiology of the Veteran's claimed foot drop, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Therefore, the Board finds the Veteran is not competent to render an etiology opinion. The fact that the Veteran denied foot troubles on discharge and that none were found on examination weighs against his claim, as does the lack of complaints of or treatment for foot drop after service with the exception of what is described as a temporary condition in the 1970s, at least a decade after the Veteran left service. Thus, the Board finds a preponderance of the evidence does not show that the Veteran has currently diagnosed right foot drop that is related to service. Back Disability Although the RO has categorized the Veteran's claim for service connection for low back disability as to include as secondary to right foot drop, the Veteran specifically contended in a November 2009 statement that his back pain was a result of a spinal tap given during an appendectomy done in service in 1959. Service treatment records note the Veteran reported lumbar back pain in May 1958. He told the doctor he had previously injured his back seven to eight months ago, prior to service, when a car fell on him. X-rays were negative. The Veteran's service treatment records contain no other complaints of back pain, and in his 1961 report of medical history prior to discharge the Veteran denied bone, joint, or other deformity and arthritis or rheumatism. The Veteran's spine was found to be normal at his July 1961 discharge examination. After service, the Veteran's back is first mentioned in his medical records in October 1993 when the doctor performing the Veteran's Social Security disability examination noted that the Veteran reported pain in the lumbosacral-sacroiliac areas bilaterally and his flexion and extension were limited. In December 1994 after ordering MRIs, the Veteran's private physician stated that the Veteran has mild degenerative arthritis of the spine. The Veteran's private treatment records reflect that in November 2007 he reported he had been experiencing lumbar back pain for several weeks aggravated by prolonged riding in a car over rough surfaces. He recalled no specific injury. His doctor found mild limitation of lumbar range of motion and a bilateral spasm from L2 to L4. He diagnosed the Veteran with acute paravertebral lumbar strain. Arthritis, as the Veteran has been diagnosed with, is one of the disabilities enumerated in the list of chronic diseases in 38 U.S.C.A. § 1101(3) or 38 C.F.R. § 3.309(a). Therefore, entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303(b) is applicable. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The continuity of symptomatology rules of 38 C.F.R. § 3.303(b) apply only where a chronic disease or its symptoms are noted in service or during the one year presumptive period but is not shown to be chronic or a diagnosis of chronicity may legitimately be questioned. Id. In this case, the Veteran has not contended and the evidence does not show that the Veteran's back disability has been continuous since service. Further, there are no notations of arthritis in the Veteran's service treatment records and only one complaint of back pain. Also, the Veteran denied arthritis at separation and his spine was found normal on examination. Where a veteran served continuously for ninety days or more during a period of war, or during peacetime service after December 31, 1946, and arthritis becomes manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2012). In this case the evidence does not show that the Veteran's degenerative arthritis of the spine was diagnosed within one year of his discharge from service. The Veteran may still show entitlement to service connection by establishing a nexus between his current disability and service under 38 C.F.R. § 3.303(a). The Veteran has contended the incident in service that precipitated his back disability is his 1959 appendectomy. However, his service treatment records contain no complaints of back pain after the surgery and the Veteran was not diagnosed with degenerative arthritis of the spine until more than three decades after leaving service, all of which weighs against a finding that his back condition is related to service. Although the Veteran has offered a nexus opinion in this case, the Board finds he is not competent to do so as the cause of degenerative arthritis is not capable of lay observation. No medical opinions regarding the etiology of the Veteran's degenerative arthritis of the spine are of record. Finally, to the extent that the Veteran has claimed that his back disability is secondary to his right foot drop, the Board notes its decision above that the Veteran is not service-connected for right foot drop. Based on the forgoing, the Board finds the preponderance of the evidence is against a finding of service connection for the Veteran's degenerative arthritis of the spine. As the preponderance of the evidence is against this claim, the benefit of the doubt doctrine does not apply. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. Torn Right Rotator Cuff The Veteran has contended that his right foot drop caused him to fall in January 2007, injuring his right rotator cuff. The Veteran's private treatment records from February 2007 do reflect he complained of a recent fall resulting in a right shoulder injury. An x-ray showed significant rotator cuff disease and an MRI showed full thickness tears supraspinatus and infraspinatus with retraction. The Veteran's doctor diagnosed a right shoulder soft tissue injury. However, the Board has found that the Veteran does not have service-connected right foot drop; therefore the Veteran is not entitled to service-connection on a secondary basis to that. The Veteran's post-service medical records also note that the Veteran injured his right shoulder in 1970 when he was hit by a vehicle, and a 1994 note from his private physician states that he diagnosed the Veteran with arthritis with subacromial bursitis after the Veteran complained of bilateral shoulder pain. However, there is no evidence of direct service connection as the Veteran's service treatment records contain no mention of a right shoulder injury; he denied bone, joint, or other deformity and painful or "trick" shoulder on his medical history report prior to discharge; and his upper extremities were found normal at his discharge examination. Based on the forgoing, the Board finds the preponderance of the evidence is against a finding of service connection for the Veteran's right rotator cuff disability. As the preponderance of the evidence is against this claim, the benefit of the doubt doctrine does not apply. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. Alzheimer's The Veteran contends he has Alzheimer's as a result of a 1960 head injury in service. Service treatment records reflect that in January 1960 the Veteran was treated for an abrasion and hematoma after an incident in which he reported he was loading metal into a truck and hit his head. He was told to use a cold pack for the hematoma and dressing on the abrasion. A follow-up the following day does not discuss any residual problems. Nor do subsequent service treatment records discuss any residual problems, including with the Veteran's memory. On his medical history report prior to discharge in 1961 the Veteran denied headaches, dizziness, nervous trouble, depression, excessive worry, loss of memory, and amnesia. His head, neurological system, and psychiatric state were found normal at his discharge examination. Records show the Veteran first complained of memory problems after service in September 2005, telling his private physician that he had experienced the problems for the past few months. After testing, he was diagnosed with mild cognitive impairment by his doctor. The doctor noted the Veteran reported a "vague history of concussion in the past but can not be specific," but that he reported no significant head injury with loss of consciousness. In 2007 the doctor diagnosed him with senile dementia. The Veteran has not been diagnosed with Alzheimer's. The fact that the Veteran's service treatment records contain no complaints of memory problems and the Veteran did not report difficulty with his memory until more than 40 years after leaving service, weigh against a finding that his senile dementia is related to service. Although the Veteran has offered a nexus opinion in this case, the Board finds he is not competent to do so as the cause of dementia is not capable of lay observation. No medical opinions regarding the etiology of the Veteran's dementia are of record. Finally, to the extent that the Veteran has claimed that his dementia is secondary to his right foot drop, the Board notes its decision above that the Veteran is not service-connected for right foot drop. Based on the forgoing, the Board finds the preponderance of the evidence is against a finding of service connection for the Veteran's dementia. As the preponderance of the evidence is against this claim, the benefit of the doubt doctrine does not apply. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. ORDER A compensable rating for evaluation of scar, residuals of appendectomy, is denied. Service connection for right foot drop is denied. Service connection for low back disability is denied. Service connection for torn right rotator cuff is denied. Service connection for Alzheimer's is denied. ______________________________________________ MICHELLE L. KANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs