Citation Nr: 1320214 Decision Date: 06/21/13 Archive Date: 07/02/13 DOCKET NO. 11-08 729 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUE Entitlement to service connection for a right knee disability. REPRESENTATION Appellant represented by: South Carolina Office of Veterans Affairs WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD A. Barone, Counsel INTRODUCTION The appellant had active duty for training (ACDUTRA) with the Army National Guard (ANG) for periods from April 1953 to July 1992, with additional ANG service throughout that period. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2010 rating decision by a Regional Office (RO) of the Department of Veterans Affairs (VA). This case was previously before the Board in July 2012, when it was remanded for additional development. As discussed below, the Board also finds that the actions directed by the Board's July 2012 remand have been completed with substantial compliance. The appellant testified at a Travel Board hearing in April 2012. A transcript of the hearing is of record. Please note 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). The Board observes that the Veteran's contentions in this case regard a "right knee" disability during service that allegedly began with an injury requiring emergency medical treatment and later featured as a medical basis for his eventual retirement from service. The Board observes that the Veteran's contentions may suggest, in the context of the evidence of record, that some of the Veteran's statements may confuse a right knee disability with right lower extremity symptoms from sciatica related to a back disability. There is documentation of emergency medical treatment involving back pain during service, and right sided sciatica from a back disability is documented to have been addressed in evidence surrounding the Veteran's final medical evaluations. As the Veteran's contentions in this case have expressly focused upon a right knee injury and the evidence shows that he has a clear diagnosed current right knee disability, the scope of this issue on appeal is limited to consideration of a right knee disability. However, under the circumstances, the Board finds that it may be appropriate to obtain clarification from the Veteran as to whether he also intended to raise a separate claim of entitlement to service connection for a back disability with sciatica affecting the right lower extremity. The matter of obtaining clarification from the Veteran as to whether he wishes to claim entitlement to service connection for a back disability with sciatica of the right lower extremity is hereby referred to the RO for appropriate action. FINDINGS OF FACT 1. Any right knee injury suffered by the Veteran during military service, including that alleged to have occurred in 1982 or during any period of ACDUTRA or inactive duty training, was acute in nature and resolved without residual chronic disability. 2. The Veteran's current chronic right knee disability has not been caused or aggravated by any injury or disease incurred in line of duty during active military service, to include any right knee injury during ACDUTRA or inactive duty training. CONCLUSION OF LAW The Veteran's chronic right knee disability was neither incurred nor aggravated in line of duty during any active military service, to include any ACDUTRA or inactive duty training. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Veterans Claims Assistance Act of 2000 (VCAA) As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the United States Department of Veterans Affairs (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; 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a). Duty to Notify Upon receipt of a complete or substantially complete application, VA must notify the claimant of the information and evidence not of record that is necessary to substantiate a claim, which information and evidence VA will obtain, and which information and evidence the claimant is expected to provide. 38 U.S.C.A. § 5103(a). The notice requirements apply to all five elements of a service connection claim: 1) veteran status; 2) existence of a disability; 3) a connection between the veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess v. Nicholson, 19 Vet. App. 473 (2006). The notice must be provided to a claimant before the initial unfavorable adjudication by the RO. Pelegrini v. Principi, 18 Vet. App. 112 (2004). The notice requirements may be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). The RO provided the appellant notice by letter in October 2009; such notice was prior to the March 2010 RO rating decision on appeal. In aggregate, the notification complied with the specificity requirements of Dingess v. Nicholson, 19 Vet. App. 473 (2006) identifying the five elements of a service connection claim; and Quartuccio v. Principi, 16 Vet. App. 183 (2002), identifying the evidence necessary to substantiate a claim and the relative duties of VA and the claimant to obtain evidence. The Veteran has received all essential notice, has had a meaningful opportunity to participate in the development of his claim, and is not prejudiced by any technical notice deficiency along the way. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). In any event, the Veteran has not demonstrated any prejudice with regard to the content of the notice. See Shinseki v. Sanders, 129 S.Ct. 1696 (2009) (Reversing prior case law imposing a presumption of prejudice on any notice deficiency, and clarifying that the burden of showing that an error is harmful, or prejudicial, normally falls upon the party attacking the agency's determination). See also Mayfield v. Nicholson, 444 F.3d 1328, 1333-34 (Fed. Cir. 2006). Duty to Assist VA has obtained service treatment records; obtained private and VA post-service treatment records; assisted the Veteran in obtaining evidence; and afforded the Veteran a VA examination on the issue on appeal in December 2012. The Veteran did not report to the VA examination scheduled for December 2012. As he was advised in a November 2012 letter, when entitlement to a benefit cannot be established or confirmed without a current VA examination, and a claimant, without "good cause," fails to report for such examination scheduled in conjunction with an original claim, the claim will be decided based on the evidence of record. 38 C.F.R. § 3.655. In this case, the VA examiner addressed the pertinent medical questions (featuring questions of etiology based upon medical history) on the basis of review of the information available in the claims-file without examination of the Veteran. The Board finds that the December 2012 VA examination report presents a thorough and complete discussion of the significant history, medical principles, and pertinent evidence. The December 2012 VA examination report addresses the essential medical questions with expert determinations informed by review of the claims file such that the report presents adequate and probative evidence in this case. The Board also finds that the actions directed by the Board's July 2012 remand have been completed with substantial compliance. An April 2013 RO Formal Finding of Unavailability details the efforts taken leading to a determination that there are no 1982 hospitalization records pertinent to the Veteran's appeal available from the Charleston Naval Hospital. The RO has also now sought and obtained (and associated with the claims-file) additional service record documentation of the Veteran's National Guard service, including records associated with the Veteran's 1992 retirement medical evaluation and including records confirming details of the Veteran's service status over its span of several decades; there is no indication that additional pertinent records are available. A July 2012 letter to the Veteran sought authorization to obtain additional records from Dr. Holford, and the Veteran replied in July 2012 by submitting a medical statement from Dr. Holford together with a partially completed VA Form 21-4142 required for proper authorization for VA to obtain additional treatment records from that provider (although the Form accompanied a statement from Dr. Holford, the Form itself was not completed with regard to the identity and the address of the source of information to which the authorization would pertain, among other incomplete sections). In January 2013, the RO sent new copies of VA Form 21-4142 with a specific request: "Please complete and return the enclosed VA Form 21-4142, Authorization and Consent to Release Information, for [Dr.] Holford and [Dr.] Presnal...." The Veteran did not reply to this request and did not provide the requested authorization. While VA has a statutory duty to assist the appellant in developing evidence pertinent to a claim, the appellant also has a duty to assist and cooperate with the VA in developing evidence; the duty to assist is not a one-way street. See Wood v. Derwinski, 1 Vet. App. 190 (1991). The Board notes that further development for these records is not possible without the Veteran's cooperation. Insofar as the Veteran did not provide the information and/or authorization that was necessary in order for VA obtain any additional private treatment records, those records could not be obtained and the Board finds that no additional assistance in this regard is required. As discussed above, there has been substantial compliance with the July 2012 remand's directive to provide the Veteran with a VA examination to address the etiology of his right knee disability. The Veteran failed to report, but the etiological questions at issue were addressed by the VA examiner on the basis of the available documentation of the Veteran's pertinent medical history. The Board finds that the directives of the Board's July 2012 remand have been substantially complied with and all associated assistance of the Veteran has been provided. All known and available records relevant to the issue on appeal have been appropriately sought and, to the extent possible, obtained and associated with the Veteran's claims file; the Veteran has not further identified any other source or avenue for obtaining any outstanding pertinent evidence. VA has complied with the notice and assistance requirements and the Veteran is not prejudiced by a decision on the appellate issue at this time. Laws and Regulations The Veteran claims entitlement to service connection for a right knee disability. He primarily contends that he incurred a chronic knee disability as a result of a right knee injury suffered during training exercises in 1982; he has testified that the alleged right knee disability progressively worsened from that time onward until eventually providing a medical basis for his retirement from the military in 1992. Applicable law provides that service connection will be granted if it is shown that the veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury or disease in line of duty, in the active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. The term "active military, naval, or air service" includes active duty, any period of active duty for training during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty training during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty. 38 U.S.C.A. § 101(24). That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. 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). Additionally, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, such as arthritis, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. §§ 1101, 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). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Board determinations with respect to the weight and credibility of evidence are factual determinations going to the probative value of the evidence. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). A veteran is competent to describe symptoms that he experienced in service or at any time after service when the symptoms he perceived, that is, experienced, were directly through the 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.); Layno, 6 Vet. App. at 469-71 (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; lay testimony is competent only so long as it is within the knowledge and personal observations of the witness, but lay testimony is not competent to prove a particular injury or illness); see Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation). The absence of contemporaneous medical evidence is a factor in determining credibility of lay evidence, but lay evidence does not lack credibility merely because it is unaccompanied by contemporaneous medical evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim); Barr, 21 Vet. App. 303 ("Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms"). In determining whether statements submitted by a veteran are credible, the Board may consider internal consistency, facial plausibility, consistency with other evidence, and statements made during treatment. Caluza v. Brown, 7 Vet. App. 498 (1995). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Also, a veteran as a lay person is competent to offer an opinion on a simple medical condition. Davidson v. Shinseki, 581 F. 3d 1313, 1316 (Fed. Cir. 2009) (citing Jandreau). VA must consider the competency of the lay evidence and cannot outright reject such evidence on the basis that such evidence can never establish a medical diagnosis or nexus; however, this does not mean that lay evidence is necessarily always sufficient to identify a medical diagnosis, but rather only that it is sufficient in those cases where the lay person is competent and does not otherwise require specialized medical training and expertise to do so, i.e., the Board must determine whether the claimed disability is a type of disability for which a layperson is competent to provide etiology or nexus evidence. See Davidson, 581 F. 3d at 1316 (recognizing that, under 38 U.S.C.A. § 1154(a), lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition; he is reporting a contemporaneous medical diagnosis; or lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). The Board further notes that it has reviewed all of the evidence in the Veteran's claims file and in "Virtual VA" (VA's electronic data storage system), with an emphasis on the evidence relevant to the matter on appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence as appropriate and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as to the claim. Analysis The Veteran contends that his current chronic right knee disability is the result of an injury during his military service. Specifically, the Veteran contends that he suffered a right knee injury during National Guard service in 1982. The Veteran has indicated, including during his April 2012 Board hearing testimony, that he suffered a significant right knee injury during drill duty in 1982 in Charleston, South Carolina. The appellant testified that he was taken to "the Naval Hospital" and that he believed that there would be pertinent records of his injury at that location. As discussed above, even following the Board's July 2012 remand directing additional efforts of seek such records, there is no documentation of record that the Veteran was injured or hospitalized in connection with military service in 1982. More significantly, however, development of the evidence in this case has revealed no contemporaneous documentation of any symptoms or treatment of any right knee problem during the Veteran's military service at any time. The Board acknowledges that the Veteran is competent to testify that he recalls suffering an injury to his right knee and experiencing right knee symptomatology. However, even assuming for the sake of the Veteran's argument that he suffered a right knee injury during service, the contemporaneous service treatment records contain ample evidence documenting that the Veteran's right knee was free of any residual chronic disability through the time of the conclusion of his military service. An injury during service, without residual chronic disability resulting from that injury, does not provide a basis for a grant of service connection. To the extent that the Veteran's testimony suggests that he experienced a continuity of chronic symptoms of right knee symptoms following an in-service right knee injury, such testimony is competent but is not credible in the face of significant probative and contemporaneous evidence showing no complaints or signs of a chronic knee disability throughout the Veteran's military service. The Veteran's service treatment records include periodic medical examination reports showing that the Veteran was examined and found to have clinically normal lower extremities with no suggestion of any right knee disability in April 1956, February 1957, April 1960, November 1967, June 1971, January 1975, March 1979, April 1982, April 1984, May 1985, and October 1989. The Veteran completed medical history questionnaires denying any history of trick or locked knee in April 1956, February 1957, April 1960, October 1963, November 1967, June 1971, January 1975, April 1982, April 1984, May 1985, and October 1989. An April 1985 service treatment record shows that the Veteran received emergency treatment for back pain associated with a trauma; no information in this record suggests any manner of right knee symptoms or diagnosis. A May 1991 private medical record shows that the Veteran had gout with complaint for approximately the prior year involving the medial epicondyle (part of the arm), the feet, low back pain with intermittent sciatic pain down the right leg, and complaints of renal stones. This report, including notes from a physical examination, contains no suggestion of a disability of the right knee. A June 1991 report shows that the Veteran's symptoms improved with treatment, but still involved some elbow pain and shoulder pain. A November 1991 private medical record shows that the Veteran received a statement shows that the Veteran "has been seen and treated ... for a right sciatica and medial epicondylitis. He also has plantar fasciitis, bilaterally." This medical statement, which was prepared for the express purpose of explaining the Veteran's medical conditions limiting his ability to perform physical activities, presents no suggestion of a right knee disability. The Veteran has testified, including at his April 2012 Board hearing, that his retirement from service in 1992 was related to medical concerns that his right knee disability rendered him unfit for duty. However, the service records and medical reports from that time reflect that medical attention was paid to several disabilities (including right sciatica, medial epicondylitis, and plantar fasciitis noted in a November 1991 medical statement recommending some limitation of physical activities), but despite the attention paid to various disabilities limiting the Veteran's duty capacities the documentation shows no suggestion of any right knee disability or right knee symptoms. The Board finds it reasonable to assume that the records identifying the Veteran's physical limitations in connection with decreased duty capacity are precisely where notation of a right knee disability would be documented; thus, the service records strongly suggest that medical professionals believed that the Veteran did not have a right knee disability at the time of his retirement from service in 1992. The Board finds that the contemporaneous service records are probative evidence which contradict the Veteran's recent testimony that he had a right knee disability during service which was followed and medically evaluated in connection with his 1992 retirement. The Board finds that the Veteran's service treatment records and private medical records concurrent with service, in aggregate, show that any alleged in-service injury to the right knee (alleged to have occurred in 1982) resulted in no manner of chronic disability or persistent symptomatology during service. The medical reports strongly suggest that neither trained medical professionals, nor the Veteran himself, believed that the Veteran had any pertinent chronic disability or any symptomatology suggestive of a chronic right knee disability at any point through the conclusion of his military service. September and October 2001 private medical reports from an orthopedic care provider show that the Veteran was receiving treatment for right shoulder strain and surgical repair of the right Achilles tendon. None of the symptom complaints or medical impressions presented in these records refer to or otherwise suggest any right knee disability at the time. February 2002 private medical reports from the same orthopedic care provider show that the Veteran had developed symptoms characterized by a medical professional as "he may have torn his cartilage" or "[h]e may have just twisted his knee and irritated this." The Veteran was given an injection to the knee and issued a Neoprene knee sleeve to wear for support. The Board finds that this record, in the context of the preceding records from the same orthopedic care provider which make no suggestion of any knee problem, strongly suggests that the Veteran's knee complaints began proximately prior to the February 2002 consultation. Another February 2002 report from this provider describes "resolving right knee strain with possible meniscal pathology." Subsequent records from this provider regularly document continuing medical attention to persistent right knee symptom complaints whereas, prior to February 2002, the Veteran's consultations with the same provider included no symptom complaints or medical attention to the right knee. The Board finds that these private medical reports strongly suggest that the right knee symptoms documented from February 2002 onward had onset with an injury in or around February 2002, and that the Veteran presented no right knee complaints prior to that time. The private medical reports document that these symptom complaints led to a diagnosis of osteoarthritis and an eventual total right knee arthroplasty. None of the medical evidence from this period shows any medical indication that the right knee pathology was related to an in-service injury, and no medical evidence from this period otherwise indicates a symptom history dating back to an in-service right knee injury. An April 2012 statement from one of the Veteran's private medical doctors (but not the doctor who authored the earliest notes of record regarding right knee symptoms in 2002), opines that the Veteran's current right knee disability is likely related to an injury the Veteran has described as taking place during military service in 1982. This medical opinion makes it clear that the authoring doctor has no direct knowledge of the described in-service injury apart from the Veteran's own account of the matter: "He received medical treatment for his right knee numerous times over the years and states that he first injured his knee while in the Service at the Charleston Naval Weapons Station in Charleston, SC in 1982." The doctor goes on to cite the Veteran's account that he "received treatment at that time but has had problems since that injury resulting in several surgeries...." The Board does not find that this medical opinion is probative evidence supporting the Veteran's claim on appeal. The author relies upon facts that were merely drawn from the Veteran's own account and are strongly contradicted by probative contemporaneous evidence. There is no documentation of the claimed 1982 in-service injury or the alleged treatment for such injury and, significantly, the contemporaneous medical evidence during service and following service strongly contradicts the Veteran's account of having symptoms of a chronic right knee disability until 2002. The Board finds this April 2012 assessment is not probative as it is based on the self-reported, and unsubstantiated, history of the Veteran without a review of the claims file. Medical opinions premised upon an unsubstantiated account of a claimant are of no probative value. See, e.g., Swann v. Brown, 5 Vet. App. 229, 233 (1993) (generally observing that a medical opinion premised upon an unsubstantiated account is of no probative value, and does not serve to verify the occurrences described); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (the Board is not bound to accept a physician's opinion when it is based exclusively on the recitations of a claimant); see also LeShore v. Brown, 8 Vet. App. 406 (1996). The Veteran was scheduled for a VA examination in December 2012 but failed to report; the claims-file was nevertheless forwarded to the VA examiner for review of the available information and to provide a medical opinion. The December 2012 VA examiner's report discusses pertinent evidence from the Veteran's period of service and the years following the conclusion of his military service. The examiner found no medical documentation suggestive of any right knee disability prior to 2002, when osteoarthritis of the right knee was noted. The examiner was "unable to find any documented evidence that the Veteran had a knee injury while in service." The examiner commented that: it is not possible for me to opine that his knee osteoarthritis was related to military service, as I can find no evidence in review of the C-file that he had any knee problems while in service and the civilian medical records do not show any confirmation of that while he was in military service or within 1 year of his discharge. The examiner's opinion goes on to discuss the possibility that the Veteran's right knee disability could be related to gout which the Veteran may have had during military service, although the examiner said he was unable to find sufficient evidence to make such a determination. The Board notes that gout, as a disease process, has not featured in the Veteran's contentions of entitlement to service connection in this case. The Veteran's contentions have clearly focused upon his assertion that his right knee disability is the result of an injury to that knee during service training in 1982. The Veteran has not contended nor identified any evidence suggesting that the right knee disability on appeal is the result of incurrence of a disabling disease (such as gout) during any identified period of active military service; the Veteran's military service consisted of inactive service with the National Guard and he had periods of ACDUTRA. Even accepting that the Veteran may have had gout concurrent with some of his National Guard service, no contention or evidence suggests incurrence of gout in the line of duty during any qualifying service. The Board thus finds that the VA examiner's comment does not transform or broaden this issue into a claim of entitlement to service connection for gout, nor does it identify a basis for which service connection for right knee disability may be legally granted. The Board accordingly focuses its analysis at this time to the contentions presented by the Veteran, specifically that his right knee was permanently disabled by an injury to the knee during military service. The Board finds that the December 2012 VA examiner's report is probative evidence considering and discussing the available pertinent evidence and providing a clear and persuasive rationale for the conclusion that it is "not possible ... to opine that his knee osteoarthritis was related to military service." This medical opinion is adequate and competent to address the medical question, and clearly weighs against the Veteran's claim in this case. Conclusion The Board finds that the preponderance of the evidence is against the claim of entitlement to service connection for a right knee disability. In reaching this decision, the Board has reviewed the entirety of the evidence of record but finds that there is no other evidence of record which probatively contradicts the findings presented in the most probative evidence discussed above. The Board acknowledges that the claims file contains a quantity of other documents, but none of the information in these records substantially supports the Veteran's claim or otherwise contradicts the evidence deemed to be most probative in the discussion above. Here, the evidence weighs against finding that the Veteran's diagnosed right knee disability has been caused or aggravated by his military service. The Veteran has been afforded a VA examination and, following the development of the December 2012 VA examination report, the evidence presents adequate medical information and opinion in connection with this claim; the December 2012 VA examiner provided a clear opinion with persuasive discussion of rationale weighing against the claim. The examiner's discussion addresses, with persuasive rationale, the evidence of record and the Board finds that the December 2012 VA examination report is the most probative evidence of record. Significantly, the December 2012 VA examination report is not contradicted by any other competent medical opinion of record. The Board acknowledges that service connection may indeed be granted when a chronic disease or disability is not present in service, but there is evidence of continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). In this case, however, the evidence is against finding a continuity of symptoms associated a chronic right knee disability from any pertinent period of service to the time of this appeal. The evidence in this case does not show continuity of symptomatology associated with a chronic disability for the purposes of application of 38 C.F.R. § 3.303(b). In accordance with Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006), the Board concludes that the lay evidence presented by the Veteran concerning continuity of symptoms since service does not provide a persuasive basis to award service connection in this case because such testimony in this regard is not credible. Contemporaneous medical reports shows that neither the Veteran nor trained medical professionals believed that the Veteran had pertinent symptoms or disabilities during service or at the conclusion of his military service. The Veteran's testimony to the effect that a right knee disability was a feature medical consideration with regard to his retirement in 1992 is contradicted by the documentation of his medical evaluations in connection with the 1992 retirement. There is also no documentation of medical consultation for any right knee disability until 2002. As discussed above, the Veteran's orthopedic medical provider treated several joint disabilities and documented complaints prior to the documented 2002 emergence of right knee symptoms; the evidence indicates that the Veteran did not have right knee symptom complaints prior to a time on or around February 2002. The onset of medical attention for right knee symptoms in February 2002 included no documented report of medical history indicating a continuity of symptoms to any pertinent period or event during military service. Any contention of continuity of symptomatology in this case is viewed as a self-interested statement in pursuit of monetary benefits, contradicted by probative contemporaneous evidence, and not credible. The Board finds that there is no credible evidence in this case establishing continuity of pertinent symptomatology for any right knee disability from the time of any pertinent period or event during military service. Even were the Board to assume that the Veteran suffered an injury to his right knee in 1982 as he has testified, the credible competent evidence is nevertheless against finding that a continuity of chronic symptomatology followed or otherwise manifested prior to a time many years after service. As the evidence is against finding onset of any chronic right knee disability until many years after the Veteran's final period of service, as discussed above, the evidence is necessarily against finding onset of any chronic right knee disability within one year following any period of service. Thus, there is no basis for granting service connection on a presumptive basis. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. The Board acknowledges the Veteran's belief that his right knee disability is related to his military service. However, there is no evidence of record showing that the Veteran has the specialized medical education, training, and experience necessary to render a competent medical opinion as to the diagnosis and etiology of a disability. The Board finds that questions of identifying the specific etiology of his right knee disability is a medical question requiring specialized knowledge and expertise; such questions are not generally resolvable through information available to lay senses. Consequently, the Veteran's own assertions as to diagnosis and etiology of a disability have no probative value. Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C.A. § 1153(a); 38 C.F.R. §§ 3.303(a), 3.159(a); see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). See also Robinson v. Shinseki, 312 Fed. Appx. 336 (Fed. Cir. 2009) (non-precedential) (confirming that, in some cases, lay evidence will be competent and credible evidence of etiology). However, a determination concerning diagnosis of a specific disease or a determination concerning the possibility of a causal relationship requires specialized training, and may therefore not be established by lay opinions on etiology. As the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for a right knee disability, the benefit-of-the-doubt rule does not apply and this claim is denied. See 38 U.S.C.A § 5107. ORDER The appeal is denied. ____________________________________________ ALAN S. PEEVY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs