Citation Nr: 1319989 Decision Date: 06/20/13 Archive Date: 07/02/13 DOCKET NO. 10-32 684 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUES 1. Entitlement to service connection for a bilateral hand disability diagnosed as bilateral osteoarthritis of the hands. 2. Entitlement to service connection for a low back disability diagnosed as degenerative joint disease of the lumbar spine. REPRESENTATION The Veteran represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Russell P. Veldenz, Counsel INTRODUCTION The Veteran served on active duty from May 1947 to January 1951. This matter is before the Board of Veterans' Appeals (Board) on appeal of a rating decision in October 2010 of a Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky. In December 2012, the Board remanded the case to the RO to afford the Veteran a VA examination. The VA examination occurred in January 2013. As the requested development has been completed, no further action is necessary to comply with the Board's remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). The issue of service connection for chronic obstructive pulmonary disease has been raised by the record in a March 2004 statement, but has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT 1. Bilateral osteoarthritis of the hands was not present in service; was not manifest to a compensable degree within one year of separation from service; and is unrelated to an injury or disease or event in service. 2. Degenerative joint disease of the lumbar spine, was not present in service; was not manifest to a compensable degree within one year of separation from service; and is unrelated to an injury or disease or event in service. CONCLUSIONS OF LAW 1. Bilateral osteoarthritis of the hands was not incurred in or aggravated by service and service connection may not be presumed. 38 U.S.C.A. §§ 1110, 1112, 5107(b) (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 2. Degenerative joint disease of the lumbar spine was not incurred in or aggravated by service and service connection may not be presumed. 38 U.S.C.A. §§ 1110, 1112, 5107(b) (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA, codified in part at 38 U.S.C.A. §§ 5103, 5103A, and implemented in part at 38 C.F.R § 3.159, amended VA's duties to notify and to assist a claimant in developing information and evidence necessary to substantiate the claims. Duty to Notify Under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b), when VA receives a complete or substantially complete application for benefits, it will notify the claimant of the following: (1) any information and medical or lay evidence that is necessary to substantiate the claim, (2) what portion of the information and evidence VA will obtain, and (3) what portion of the information and evidence the claimant is to provide. Also, the VCAA notice requirements apply to all five elements of a service connection claim. The five elements are: 1) veteran status; 2) existence of a disability; 3) a connection between the Veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess v. Nicholson, 19 Vet. App. 473, 484-86 (2006). The VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable adjudication by the RO. Pelegrini v. Principi, 18 Vet. App. 112, 119 (2004). The RO provided pre- adjudication VCAA notice by letter, dated in September 2010. The notice included the type of evidence needed to substantiate the underlying claims of service connection, namely, evidence of an injury or disease or event, causing an injury or disease, during service; evidence of current disability; and evidence of a relationship between the current disability and the injury or disease or event, causing an injury or disease, during service. The Veteran was notified that VA would obtain service treatment records, VA records, and records from other Federal agencies, and that he could submit other records not in the custody of a Federal agency, such as private medical records or with his authorization VA would obtain any non-Federal records on his behalf. The notice included the provisions for the effective date of a claim and for the degree of disability assignable. As for content of the VCAA notice, the documents complied with the specificity requirements of Quartuccio v. Principi, 16 Vet. App. 183, 186-87 (2002) (identifying evidence to substantiate a claim and the relative duties of VA and the claimant to obtain evidence); of Charles v. Principi, 16 Vet. App. 370, 374 (2002) (identifying the document that satisfies VCAA notice); of Pelegrini v. Principi, 18 Vet. App. 112, 119-120 (2004) (38 C.F.R. § 3.159 notice); and of Dingess v. Nicholson, 19 Vet. App. 473, 484-86 (2006) (notice of the elements of the claim). Further VCAA notice is not required. Duty to Assist Under 38 U.S.C.A. § 5103A, VA must make reasonable efforts to assist the claimant in obtaining evidence necessary to substantiate the claim. The RO has obtained service treatment records, VA records, records from private medical caregivers, and afforded the Veteran a VA examination in January 2013. The report of the VA examination included a review of the Veteran's medical history, including his service treatment records, an interview and an examination of the Veteran, and sufficient findings to rate disability. The examiner also offered opinions on the relationship of the low back disability and the bilateral hand disability to service and explained the facts and reasons supporting the opinions. Therefore, the Board concludes that the VA examination is adequate. 38 C.F.R. § 4.2; see Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). As the Veteran has not identified any additional evidence pertinent to the claim and as there are no additional records to obtain, the Board concludes that no further assistance to the Veteran in developing the facts pertinent to the claims is required to comply with the duty to assist. Facts and Analysis Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. § 1110, 38 C.F.R. § 3.303. Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service, or if preexisting such service, was aggravated by service. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303(a). Service connection may be established by either continuity of symptomatology after service under 38 C.F.R. § 3.303(b) or by initial diagnosis of the medical condition after service under 38 C.F.R. § 3.303(d). The Federal Circuit recently held that continuity of symptomatology under 3.303(b) applies only to chronic diseases listed in § 3.309. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir 2013). Degenerative joint disease of the lumbar spine and osteoarthritis of the hands are a listed disease as arthritis in § 3.309. The showing of a chronic disease in service requires a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b). For a Veteran who served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for arthritis, if the disability is manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. § 1112; 38 C.F.R. §§ 3.307, 3.309. 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). Evidentiary Standards VA must give due consideration to all pertinent lay and medical evidence in a case where a Veteran is seeking service connection. 38 U.S.C.A. § 1154(a). Competency is a legal concept in determining whether lay or medical evidence may be considered, in other words, whether the evidence is admissible as distinguished from credibility and weight, factual determinations going to the probative value of the evidence, that is, does the evidence tend to prove a fact, once the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). Competency is a question of fact, which is to be addressed by the Board. Jandreau, v. Nicholson, 492 F.3d 1372, 1377 (2007). When the evidence is admissible, the Board must then determine whether the evidence is credible. "Credible evidence" is that which is plausible or capable of being believed. See Caluza v. Brown, 7 Vet. App. 478, 511 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (the determination of credibility is a finding of fact to be made by the Board in the first instance). If the evidence is credible, the Board, as fact finder, must determine the probative value or weight of the admissible evidence, that is, does the evidence tend to prove a material fact. Washington v. Nicholson, 19 Vet. App. 362, 369 (2005). If the evidence is not credible, the evidence has no probative value. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran. 38 U.S.C.A. § 5107(b). Service Connection for a Bilateral Hand Disability The Veteran seeks service connection for a bilateral hand disability. The Veteran states that while attempting to assemble a pontoon bridge, both hands were caught between two sections. Although it is not clear from the various statements, it appears that the Veteran recalls the injury to his hands in an incident separate and earlier than the incident where he injured his back, discussed below. The incident occurred in 1949 The Veteran's brother has submitted a statement that he recalled the incident to the hands as both he and the Veteran were assigned to the same fort and, although the two served in different units, the brother and the Veteran kept in contact. He recalled that after the injury to the hand, the Veteran was seen in the dispensary and placed on light duty. The service treatment records do not reveal any complaints, diagnosis, or treatment for the hands. After service, the first indication of a hand disability occurred at VAMC in January 2003 where a note indicated he had a history of arthritis in his hands. In April 2003, the Veteran complained of arthritic pain, mostly in his hands, low back, and neck. In an April 2004 statement, the Veteran stated he had arthritis and he cannot even make a fist. In August through November 2009, it was noted the Veteran had no joint, back, or other pain symptoms. In August 2009, his hand grips were described as strong and equal. In July 2010, the Veteran, in his claim for service connection, stated that while attempting to place a pontoon bridge, his hands where mashed between two sections of the bridge, It caused his hands to be deformed with a limited grip and movement accompanied with extremely powerful joints. In June 2011, the Veteran complained of bilateral hand and finger pain for the past several years, the right was worse than the left. It was noted in his history that he had osteoporosis. The medical provider noted that both the right and left hands had angled fingers. In January 2013, the Veteran was provided a VA examination for his bilateral hand disability. The Veteran advised that a few weeks before injuring his back he injured both hands working on a pontoon bridge. He was working on one side of the bridge taking in a section and another soldier jammed the section against another section catching Veteran's hands in between. The Veteran believed his right third digit was broken and recalls losing the fingernail on the left third digit. The Veteran's current symptoms include deformities of the digits, restriction in range of motion and ongoing pain, which is treated with pain medication. The Veteran is right handed. He did not have any flare-ups that impacted the function of the hand. On examination, the Veteran exhibited pain. There was no gap between the thumb pad and the fingers. In flexion, however, all four fingers of each hand had painful motion and a gap of 1 inch or more between the fingertips and the proximal crease of the palm. Extension of the right index and long finger was limited by no more than 30 degrees. Pain did not limit this motion and repetition did not change any result. The examiner, in describing the Veteran's functional loss, stated the Veteran had less movement than normal for all of the right fingers and the left fingers. All digits, including the thumbs, displayed weakened movement, excess fatigability, incoordination, and pain on movement. The right long finger and thumb, and the left long, index, and thumb were deformed. The right third digit and the left second, third, and thumb displayed angulations. The VA examiner stated the appearance of the right third digit was compatible with a mallet finger injury. There was no ankylosis. The muscle strength was 4/5. Imaging studies indicated degenerative or traumatic arthritis. The VA examiner made two diagnoses: advanced osteoarthritis of both hands and a mallet finger of the right third digit. The disabilities resulted in marked difficulty in grasping or handling objects. Addressing the osteoarthritis, while arthritis can arise as a post-traumatic phenomenon, such post-traumatic arthritis is expected to be highly focal in nature. Any given injury would expect to impact certain specific joints while sparing others. In the Veteran's case, the osteoarthritis identified on x-ray studies is highly symmetric and generalized, involving the distal and proximal interphalangeal joints of both hands. This process is very frequently associated with simple osteoarthritis, which is commonly associated with the aging process. Given the symmetrical findings, excluding the mallet finger of right third finger, the probabilities would suggest that a relationship to service of the Veteran's current bilateral osteoarthritis of the hands would be considered less likely as not related to service. As to the mallet finger of the right third digit, the examiner concluded that injury was at least as likely as not related to service. The Veteran's description suggests a "jamming" injury of the hand when his hand was caught against elements of a bridge. He does recall an injury to the right third digit, possibly a fracture. This mechanism of injury is commonly described with reference to mallet finger injuries. The Veteran did not report any other injury to the right hand. The examiner also noted that the Veteran's right finger deformity is asymmetric and the left hand is not similarly deformed. Thus, the VA examiner based his conclusion on the Veteran's recall of the mechanism of injury, the involved digit, the asymmetry of the findings, and the current exam findings. In April 2013, the RO obtained an opinion from another VA expert who, while expressing some disagreement regarding the mallet finger deformity and service, agreed with the January 2013 VA examiner that the osteoarthritis was at least as likely as not consistent with his aging process and not aggravated beyond its natural and normal aging process. She also agreed that it is less likely than not that the Veteran's bilateral osteoarthritis hand disability was incurred in, caused by, or aggravated by service. In a rating decision dated in February 2013, the RO granted service connection for the mallet finger of the right hand. The Board now turns to whether the Veteran is entitled to service connection for bilateral osteoarthritis of the hands. Initially, the Board recognizes that the Veteran has provided lay evidence of his symptoms, their onset, and the continuing presence of symptoms thereafter. The preliminary issue now addressed by the Board is the opinions expressed by the Veteran as to what disabilities he has and their relationship to service. Competency of evidence is a question of fact, which is to be addressed by the Board. Jandreau, v. Nicholson, 492 F.3d 1372, 1377 (2007). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159. Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer a medical diagnosis, statement, or opinion. 38 C.F.R. § 3.159. As a lay person, the Veteran is competent to describe symptoms, which he is able to perceive through the use of his senses. 38 C.F.R. § 3.159 (Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience; lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person.); see Layno v. Brown, 6 Vet. App. 465, 469-71 (1994) (lay testimony is competent as to symptoms of an injury or illness, which are within the realm of one's personal knowledge, personal knowledge is that which comes to the witness through the use of the senses). Further, the Veteran's statements and testimony are admissible and are to be considered as evidence of continuity. Rucker v. Brown, 10 Vet. App. 67, 74 (1997) (Competency is a legal concept in determining whether lay evidence may be considered, in other words, whether the evidence is admissible). The Board thus finds that the Veteran is competent to describe his symptoms in service, their onset, and the continuing presence and nature of symptoms. While the Veteran is competent to describe symptoms both during service, and since service, he is not a doctor competent to diagnosis his condition in service or in the years following separation. When the medical evidence weighs against the likelihood of a link between an inservice condition and a current condition, VA will not find that there is a relationship between a current diagnosis (for example, degenerative joint disease) and service, based upon the continuity of symptomatology as stated by the Veteran. Medical evidence is required to demonstrate such a diagnosis and a relationship to service unless such the diagnosis and the relationship to service is one to which a lay person's observation is competent. See Savage v. Gober, 10 Vet. App. 488, 497 (1997) (medical evidence is required to demonstrate continuity of symptomatology and any present disability unless such a relationship is one to which a lay person's observation is competent). Although the Veteran is competent to describe his symptoms of the hands, osteoarthritis is not a condition capable of lay observation. See Jandreau, 492 F.3d at 1377 (explaining in a footnote, sometimes a layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer). Osteoarthritis requires medical expertise and medical training including the use of X-rays, to diagnose. Furthermore, the diagnosis of osteoarthritis cannot be made by the Veteran as a lay person based on personal observation. That is, perceived symptoms of the hands may be experienced by any lay person, but the actual medical diagnosis of the cause for such symptoms is not competent unless provided by a doctor trained in the medical field. As demonstrated by this case, the diagnosis depends upon interpretation of history and symptoms, and clinical and diagnostic tests, such as X-rays and laboratory tests, which requires medical knowledge. No factual foundation has been established that the Veteran is otherwise qualified through specialized education, training, or experience to offer a medical diagnosis. Therefore, the Veteran's assertion or opinion that he has a hand disability, or more generally, that the current osteoarthritis in both hands is due to service is the opinion of a layman. It is not competent medical evidence of a diagnosis by a medical professional. The Veteran's discussion of his symptoms over the years certainly is important; however, the Veteran's opinion as to the cause of his symptoms cannot outweigh the opinion of a medical professional. Therefore, to this extent only, the Veteran's opinions are excluded. To sum up the foregoing, the Board will consider the Veteran's testimony as it relates to the onset and continued presence of symptoms of the hands such as pain. Such lay evidence is relevant and competent. To the extent that the Veteran is offering his own opinion as to what disability is causing the symptoms, or the relationship of the disability to service, the Board has disregarded the Veteran's opinions in its analysis. To the extent that the Veteran asserts continuity of symptoms since service, 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). Arthritis is a chronic disease listed in 38 C.F.R. § 3.309. Therefore, if there is competent an credible evidence of continuity of symptomatology since service, entitlement to service connection would be warranted. 38 C.F.R. § 3.303(b), see also Walker v. Shinseki, 708 F.3d. 1331 (Fed. Cir. 2013). In this instance, there are no in service treatment records of the Veteran for hand injuries even though he recalls fracturing one finger and losing the fingernail on the other hand. The Board also notes that shortly thereafter, the Veteran was hospitalized in service for tuberculosis findings and during the extensive treatment, no abnormalities of the back or hand were noted in the examination notes. The first time he sought treatment for his hands occurred in 2003 with complaints of arthritis. The Board is not stating that the Veteran's testimony must be corroborated by contemporaneous medical records, see Buchanan v. Nicholson, 451 F. 3d 1331, 1335 (Fed. Cir. 2006) (lack of records does not, in and of itself, render lay testimony not credible). Instead, the evidence of continuity fails not because of the lack of medical documentation; rather the assertions of continuity are not credible and less probative than the negative evidence, which interrupts continuity. Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006); see also 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); Kahana v. Shinseki, 24 Vet. App. 428, 440 (2011) (Lance, J., concurring) (the silence in a medical record can be weighed against lay testimony if the alleged injury, disease, or related symptoms would ordinarily have been recorded in the medical record being evaluated by the fact finder). Thus, the Board recognizes that documentation of an injury is not required, Buchanan, supra, but rather, the Board has weighed the negative evidence of the in service treating medical records and subsequent treating records against the Veteran's statements that an injury to the hands in service has caused him problems since separation to the present. The Veteran's post-service medical records are negative for complaints, symptoms, treatment, findings, or diagnoses for more than five decades following separation. Furthermore, as noted, the VA examiner determined that the picture of the Veteran's bilateral osteoarthritis of the hands is not consistent with arthritis of a traumatic origin. Thus, for the foregoing reasons, the Board has determined that while the Veteran is competent to provide lay evidence concerning the onset of his bilateral osteoarthritis of the hands disability, the Veteran is not as credible as the documented medical evidence that the onset of symptomatology occurred after service. The Board has therefore assigned little weight to the Veteran's assertions of continuity of symptoms since service. As the Veteran's lay evidence is not competent evidence on the questions of either a diagnosis or causation, or credible evidence of continuity of symptomatology, the Board looks to the medical evidence. Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer a medical diagnosis, statement, or opinion. 38 C.F.R. § 3.159. As for the Veteran describing a contemporaneous medical diagnosis and symptoms described by the Veteran that later support a diagnosis by a medical professional, the Veteran has not stated that a physician told him that his current disability is caused by or related to service or that he was told within a year after separation that he had osteoarthritis of the hands. The only competent medical evidence is the opinion of the VA examiner in January 2013 and the VA expert in April 2013. Both are qualified by education, training, or experience to diagnosis a medical condition and to offer an opinion on causation. With regard to medical opinions, the probative value or evidentiary weight to be attached to a medical opinion is within the Board's province as finder of fact. The guiding factors in evaluating the probative value of a medical opinion include whether the opinion applied valid medical analysis to the significant facts of the case in order to reach the conclusion submitted in the opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-03 (2008). The Board finds the unfavorable medical opinion of the January 2013 VA examiner is well reasoned, detailed, provide a rationale that is consistent with other evidence of record, and included reviews of the claims file and the Veteran's symptoms. The examiner noted, for instance, what treatment was provided in service and the lack of findings at separation regarding the back. He closely examined the extent and appearance of the osteoarthritis in the radiological studies noting the symmetrical appearance suggested aging as the cause of the arthritis. In contrast, a traumatic origin would lead to a more focal display in the studies. The examiner also took into account all of the medical evidence of record. He set forth an accurate historical history with medical details taken from the Veteran's claims file, which renders it especially probative. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (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). Being based on a complete review of the record, these opinions also take into account the Veteran's own assertions, but the examiner has determined the Veteran's assertions do not establish a relationship to service. The Board therefore finds that the opinion of the January 2013 VA examiner as persuasive evidence against the claim for service connection for a hand disability, to include osteoarthritis. As the VA examiner applied medical analysis to the significant facts of the case to reach the conclusion expressed in their opinions, the Board also finds the evidence competent and credible and highly probative on the material issues of fact, pertaining to the diagnosis and cause of a current disability of the hands or the relationship to service, which opposes, rather than supports, the claim. Accordingly, the weight of the medical evidence is against an association or link between any current bilateral osteoarthritis disability of the hands and service, including the incident with the pontoon bridge. The preponderance of the evidence is against the claim of service connection on the applicable theories of service connection, and the benefit of-the-doubt standard of proof does not apply. 38 U.S.C.A. § 5107(b). Service Connection for a Low Back Disability The Veteran seeks service connection for a low back disability. The Veteran has stated that while attempting to assemble a pontoon bridge, he slipped and fell. Although it is not clear from the various statements, it appears that this injury occurred after the incident where he injured his hands, discussed above. The service treatment records do not reveal any complaints, diagnosis, or treatment for the back. In January 2003, the Veteran had no complaints of numbness or tingling in his lower legs and had a normal straight leg test and his low back disability was considered stable. In April 2003, the Veteran complained of arthritic pain, mostly in his hands, low back, and neck. X-rays demonstrated marginal spurs at L4-L5 and facet arthritis at L5-S1. He did not have any numbness and tingling in the extremities but the low back pain will radiate into the left leg if he sits for prolonged periods. In August 2005, the Veteran reported to his medical providers at VA that he could walk two miles in his neighborhood without pain. In August through November 2009, it was noted the Veteran had no joint, back, or other pain symptoms. In August 2009, the Veteran had no specific lumbar or sacroiliac joint pain and his osteoarthritis of the lumbar spine was considered stable. In December 2009, there was a complaint of the upper to mid back, which appears to have been related to coughing, possibly due to pleurisy. By February 2010, it was noted the Veteran still had pain with deep inspiration, but he did not have any lumbar or sacroiliac joint pain. In July 2010, the Veteran, in his claim for service connection, stated that while attempting to assemble a pontoon bridge, he injured his back. In October 2010, the Veteran's back and extremities had fair to good range of motion. In January 2013, the Veteran was provided a VA examination for his low back disability. The Veteran stated he injured his back in service in 1949 while working on pontoons and he slipped and fell. He did go to the medical dispensary where he was treated with liniment and placed on light duty. The Veteran states he has had back pain ever since that time, located in low mid back to thigh levels. He also states he went to doctors after service at a number of locations for chiropractic care but has been unable to obtain the records. He currently cannot do much bending or lifting and is unable to work in the garden. He takes pain medication and uses a walker at home and a cane when he goes out. He did not report flare-ups. The Veteran also did not report radicular pain nor were any other signs or symptoms of radicular pain reported. He has not had any incapacitating episodes over the previous 12 months due to intervertebral disc syndrome. The Veteran had forward flexion to 15 degrees and extension to 5 degrees. He had 10 degrees lateral flexion bilaterally and 20 degrees rotational flexion bilaterally. The examiner described the functional loss as less movement than normal, weakened movement, disturbance of motion, pain, and interference with sitting, standing, or weight-bearing. There was not, however, any change or additional limitation with repetition. The Veteran had tenderness to the left L4-L5 area but no guarding or spasm. Muscle strength, reflexes, and sensory findings were normal except the left lower leg/ankle (L4/L5/S1) was decreased. The straight leg test was normal. The diagnosis was degenerative joint disease of the lumbosacral spine. The examiner concluded it was at least as likely as not the degenerative joint disease was incurred in or caused by an in-service injury, event, or disease, including the incident with the pontoon bridge. The examiner noted X-rays show facet joint arthritis at the level of L5-S1. There were no changes specifically identified on the X-ray reading as being potentially post-traumatic in nature. In general, degenerative facet disease of the lumbosacral spine is extremely common. It is often associated with spondylosis (arthritic changes of the spine) and degenerative disc disease. These changes often accompany the aging process independently of preceding trauma and have strong genetic component. Citing medical literature, the examiner noted that while trauma is often imputed as the cause of degenerative arthritis of the lumbosacral spine, most medical evidence suggests that its role is very minor as contrasted with other potential causes. Therefore, in the examiner's opinion, the evidence did not support an etiological relationship between the Veteran's current back condition and the injury he described occurring while in service. Initially, for the same reasons expressed above regarding the Veteran's opinion of the relationship between his hand disability and service, the Board finds that the Veteran is not competent to provide a medical opinion on the relationship between the back disability and the pontoon bridge incident. The Board will consider the Veteran's testimony as it relates to the onset and continued presence of symptoms of the back such as pain. Such lay evidence is relevant and competent. To the extent that the Veteran is offering his own opinion as to what disability is causing the symptoms, or the relationship of the disability to service, the Board finds that the Veteran is not competent to provide that opinion, because to do so requires medical expertise and training. See Jandreau v. Nicholson, 493 F.3d. 1372 (Fed. Cir. 2007). Arthritis (degenerative joint disease) is a chronic disease listed in 38 C.F.R. § 3.309. Therefore, if there is competent an credible evidence of continuity of symptomatology since service, entitlement to service connection would be warranted. 38 C.F.R. § 3.303(b), see also Walker v. Shinseki, 708 F.3d. 1331 (Fed. Cir. 2013). In this instance, there are no in service treatment records of the Veteran for a back injury even though he recalls going to the dispensary. The Board also notes that shortly thereafter, the Veteran was hospitalized in service for tuberculosis findings and during the extensive treatment, no abnormalities of the back or hand were noted. The first time he sought treatment was in 2003 with complaints of arthritis. The Board is not stating that the Veteran's testimony must be corroborated by contemporaneous medical records, see Buchanan v. Nicholson, 451 F. 3d 1331, 1335 (Fed. Cir. 2006) (lack of records does not, in and of itself, render lay testimony not credible). Instead, the evidence of continuity fails not because of the lack of medical documentation; rather the assertions of continuity are not credible and less probative than the negative evidence, which interrupts continuity. Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006); see also 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); Kahana v. Shinseki, 24 Vet. App. 428, 440 (2011) (Lance, J., concurring) (the silence in a medical record can be weighed against lay testimony if the alleged injury, disease, or related symptoms would ordinarily have been recorded in the medical record being evaluated by the fact finder). Thus, the Board recognizes that documentation of an injury is not required, Buchanan, supra, but rather, the Board has weighed the negative evidence of the treating medical records and subsequent treating records against the Veteran's statements that injury to the back in service has caused him problems since separation to the present. The Veteran's post-service medical records are negative for complaints, symptoms, treatment, findings, or diagnoses for more than five decades following separation. The Board has thus determined that while the Veteran is competent to provide lay evidence concerning the onset of his back disability, the Veteran is not as credible as the documented medical evidence that the onset of symptomatology occurred after service. The Board has therefore assigned little weight to the Veteran's assertions of continuity of symptoms since service. As the Veteran's lay evidence is not competent evidence on the questions of either a diagnosis or causation and his assertions of continuity of symptomatology are not credible, the Board looks to the medical evidence. Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer a medical diagnosis, statement, or opinion. 38 C.F.R. § 3.159. As for the Veteran describing a contemporaneous medical diagnosis and symptoms described by the Veteran that later support a diagnosis by a medical professional, the Veteran has not stated that a physician told him that his current disability is caused by or related to service or that he was diagnosed with degenerative joint disease of the lumbar spine with a year after separation. The only competent medical evidence is the opinion of the VA examiner in January 2013. The examiner is qualified by education, training, or experience to diagnosis a medical condition and to offer an opinion on causation. With regard to medical opinions, the probative value or evidentiary weight to be attached to a medical opinion is within the Board's province as finder of fact. The guiding factors in evaluating the probative value of a medical opinion include whether the opinion applied valid medical analysis to the significant facts of the case in order to reach the conclusion submitted in the opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-03 (2008). The Board finds the unfavorable medical opinion of the January 2013 VA examiner is well reasoned, detailed, provide a rationale that is consistent with other evidence of record, and included reviews of the claims file and the Veteran's symptoms. The examiner noted, for instance, what treatment was provided in service and the lack of findings at separation regarding the back. The examiner also took into account all of the medical evidence of record. He set forth an accurate historical history with medical details taken from the Veteran's claims file, which renders it especially probative. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (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). Finally, his analysis was based upon medical literature concluding that trauma plays a minor role in the development of degenerative joint disease. Being based on a complete review of the record, these opinions also take into account the Veteran's own assertions, but the examiner has determined the Veteran's assertions do not establish a relationship to service. The Board therefore finds that the opinion of the January 2013 VA examiner as persuasive evidence against the claim for service connection for a low back disability, to include degenerative joint disease of the lumbar spine. As the VA examiner applied medical analysis to the significant facts of the case to reach the conclusion expressed in the opinions, the Board also finds the evidence competent and credible and highly probative on the material issues of fact, pertaining to the diagnosis and cause of a current disability of the low back or the relationship to service, which opposes, rather than supports, the claim. Accordingly, the weight of the medical evidence is against an association or link between any current disabilities of the low back and service, including the incident with the pontoon bridge. The preponderance of the evidence is against the claim of service connection on the applicable theories of service connection, and the benefit of-the-doubt standard of proof does not apply. 38 U.S.C.A. § 5107(b). ORDER Entitlement to service connection for bilateral osteoarthritis of the hands is denied. Entitlement to service connection for degenerative joint disease of the lumbar spine is denied. ____________________________________________ ROBERT C. SCHARNBERGER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs